Inspection on 13/07/06 for The Gables, Burnham-on-Sea

This inspection was carried out on 13th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gables, Burnham-on-Sea 15/10/08

The Gables, Burnham-on-Sea 16/10/07

The Gables, Burnham-on-Sea 11/10/05

The Gables, Burnham-on-Sea 19/05/05

The Gables, Burnham-on-Sea 15/12/04

The Gables, Burnham-on-Sea 09/06/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Gables Grove Road Burnham-on-sea Somerset TA8 2HF Lead Inspector David Kidner Key Unannounced Inspection 13th July 2006 09:45 The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address Grove Road Burnham-on-sea Somerset TA8 2HF 01278 782943 01278 782943 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) R J Homes Ltd Care Home 10 Category(ies) of Learning disability (10) registration, with number of places The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named person over the age of 65, as stated in the letter from Craegmoor, dated 29th September 2004. 11th October 2005 Date of last inspection Brief Description of the Service: The Gables is registered with the Commission for Social Care Inspection (CSCI) to accommodate up to ten people under the age of 65 who have a learning disability. (There is a condition on the homes registration that allows them to accommodate one named person over the age of 65). The home is a large detached property within walking distance of the sea front and all the amenities of Burnham on Sea. Service user accommodation is arranged over two floors and all bedrooms are for single occupancy. One room has en suite facilities and other service users share communal washing and toilet facilities. The Registered Provider is R.J. Homes, which is owned by the Craegmoor Group Ltd. There is no Registered Manager at the home. However, a new Manager has now been appointed and has applied to become the Registered Manager. This application is being processed by the CSCI. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector conducted this key Unannounced Inspection over one day (8.75hrs). The Inspector viewed records in relation to care plans, risk assessments, health and safety, the management of medicines, staff recruitment and supervision and toured the premises. On the day of the inspection nine service users were living at the home. The Manager was available throughout the inspection. The Inspector met a number of service users at the time of the inspection and was able to speak to one service user in privacy of their bedroom. Other service users were occupying themselves in their bedroom and did not wish to be spoken to. The Inspector sat in the lounge area and dining room and observed staff interactions with service users. It was noted that staff were interacting well with service users and were using promoting and respecting the needs of the service users. The Inspector spoke to four staff in private. As part of the Inspection process the Inspector received six comment cards from Relatives/visitors. All comments received stated that they were happy with the overall care provided, they were made to feel welcome at the home and the vast majority of comments stated that they are kept informed of important matters. The Inspector sent comments card to the GP, a number of care managers and a variety of health care professions. There was a very good response to the comment cards and a pleasing amount was returned. All care managers stated that they were satisfied with the overall care provided. The Inspector would like to thanks service users, relatives, care staff and Care Managers for their contribution to the inspection process. It is the Inspectors opinion that The Gables is in need for stability in the post of Registered Manager and the care team. There are indications that the Manager has made a positive impact at the home. It is hoped that this continues so as to provide a high quality service at The Gables. As a result of this inspection the home has requirements and 13 requirements and 3 recommendations. What the service does well: The home has a detailed Statement of Purpose and Service User Guide. Service users that were able to give an opinion and the care staff that the Inspector spoke to confirmed that choices are given wherever possible. Care staff stated that service users are given choices in all aspects of daily living including food, drinks, clothing, bathing/shower and activities. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 6 One service user is currently accessing an Advocate. The home encourages contact with Relative/Visitors. It appears that communication with the home is good. All returned comment cards stated that relatives/visitors are satisfied with the overall care provided at The Gables. Service users who were able to express an opinion stated that the quality of the food was good. Service users have access to a range of healthcare professionals and are supported in the way they prefer. The home’s procedures for the management and administration of medication are good. What has improved since the last inspection? What they could do better: The home must ensure that care plans reflect the current needs of service users and includes detailed behavioural management plans were needed, including the use of physical intervention. The Manager must complete detailed individual service user and environmental risk assessments. The Manager must ensure that the home has adequate staff to ensure that service users have access to leisure and social activities. The Manager must advise the CSCI on the action plan to improve the environment. The Manager should review the training needs of the care team and conduct regular team meetings. The Manager must improve its quality assurance and quality monitoring systems. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 The home has not had any new admissions since June 2002. Therefore, not all Standards were assessed at this inspection. The outcome group is good The home provides a Statement of Purpose and Service User Guide to reflect the range and scope of services offered. The home does not admit service users unless a detailed Pre-Admission Assessment has been conducted. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide, which identify services offered by the home. Additional charges include those for toiletries, some activities, chiropody and contribution towards holidays. The Service User Guide is presented in symbols. Fees are arranged to reflect individual service user’s needs. The CSCI have not been advised of any changes to the Statement of Purpose or Service User guide. There have been no admissions to the home since June 2002. At present the home is not providing respite care. It was identified at the previous inspection that a service user receiving respite care had been previously assessed by a ‘sister’ home but The Gables had not conducted a Pre-Admission assessment prior to the person receiving a service at The Gables. Following discussions The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 10 with the Manager the Inspector was advised that the home would not admit a person to the home without conducting a detailed Pre-Admission Assessment. The Manager confirmed that the home has a vacancy and that an assessment had taken place by the manager of a prospective service user. It was identified that the home would not be able to meet their needs and therefore a place at the home was not offered. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 8 9 10 The outcome group is Adequate. The care plans viewed did not reflect the individual needs of the service users that would not ensure that all staff provided a consistent approach to care. Service users are supported to make choices about their day to day lives. The home conducts detailed risk assessments but some are in need of reviewing. EVIDENCE: The Inspector viewed the care plans of two service users. Both care plans had recently been reviewed but it appeared that they did not contain up to date information to inform staff how to provide and manage the care needed. For one service user it appeared that a full annual review was last conducted on 25/05/06. The other service user had an annual review arranged for later this month. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 12 One care plan did not contain Management Behaviour Guidelines and at the time of the inspection the Inspector was able to witness the types of behaviours exhibited. The Manager stated that appointments have been arranged to meet with a Senior Psychologist to address such needs and develop strategies to address episodes of challenging behaviour. The care plan for one service user did not include the agreed method of physical intervention that can be used. Also a care plan did not give detailed information in relation to the service user’s communication needs, specifically in what key words the person can use and understand. The home keeps daily running records of the care that is given and visits to health care professionals. The Inspector viewed documentation in relation to the reporting of incidents. The Inspector was able to speak with a number of staff on duty during the day and it appeared that staff were aware of the care plans and made reference to the care that is provided. However, the Manager must ensure that care plans are regularly reviewed and contain up to date information as to the care and support required to meet service users needs to ensure continuity and consistency. Service users that were able to give an opinion and the care staff that the Inspector spoke to confirmed that choices are given wherever possible. Care staff stated that service users are given choices in all aspects of daily living including food, drinks, clothing, bathing/shower and activities. It was noted that one service user uses Somerset Total Communication (STC) to communicate more effectively. The Inspector is able to use STC to gain their views; likewise the Inspector noted the Manager could use STC. Further discussion highlighted the need for staff at the home to undertake STC training. One service user is currently accessing an Advocate. The Inspector viewed documentation in relation to risk assessments. It was noted in care plans that a variety of risk assessments had been conducted but some were in need of reviewing and had not been signed or dated. This must be addressed. Service users and their families have access to the home’s policies and procedures and on the day of the inspection it was noted that service users records are kept secure. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 12 13 14 15 16 17 The outcome group is adequate. The home is not providing service users with adequate social and leisure activities. The home promotes and encourages contact with relatives and friends of service users. Any restrictions imposed on service users must be detailed in individual risk assessments. The home appears to provide a varied choice of meals based on individual needs and preferences. EVIDENCE: Some people living at the home attend college on a regular basis. Each service users have a weekly or daily activity plan. These are displayed either in personal rooms or communal areas. Signs, symbols and photographs The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 14 are used to enable people to understand their plans and make choices about activities. However, the inspector spoke to some service users and a number of staff as to the frequency of activities currently taking place. The home is experiencing a number of changes and staffing levels at the home do not appear to be adequate so as to provide service users with the planned choice of activity and ad hoc trips to local facilities and leisure and social opportunities. The Inspector was advised that this has had a detrimental effect on the service provided to service users in relation to providing activities. Staff commented that episodes of challenging behaviour have increased and that there are minimum staffing levels. This was discussed in detail with the Manager at the time of the inspection. There are currently a number of care staff vacancies at the home. The Manager agreed to ensure that staffing levels would be addressed without further delay so as to provide service users with appropriate activities and accessing local facilities. The home encourages contact with Relative/Visitors. All six comment cards received from relatives/carers stated that the staff welcomes them at the home and all but one stated that they could see their relative in private. It appears that communication with the home is good. All returned comment cards stated that relatives/visitors are satisfied with the overall care provided at The Gables. Service users are encouraged to take an active part in the day to day running of the home. There is a life skills rota that covers household tasks such as hovering, dusting and laundry. On the day of the inspection the Inspector noted that interaction between staff and service users was good and people were given opportunities to take part in some activities out of the home after a member of staff who was off duty was contacted. All bedrooms are lockable but the majority of service users do not lock their doors. Staff were observed knocking on doors of personal rooms before entering. The Inspector observed that people moved freely about the communal areas of the home and were able to access their private rooms at anytime. However, it was noted that the kitchen is locked to promote health and safety, as it is not possible for any service user to be unsupported in the kitchen. The Manager must ensure that individual risk assessments are completed to reflect this and located in care plans. To enable people to make choices about the food coming into the home the service users accompany staff to the local supermarket. Care staff are responsible for the preparation of meals, service users are encouraged to assist as much as possible. There is a four-week menu in the home and personal menus for people requiring a specialist diet. Service users who were able to give an opinion commented that they liked the food at the home. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 15 The main dining room in the home is poorly furnished and decorated. Some improvements have been made to the dining area since the last inspection but still needs further improvement. It is the Inspectors opinion that the dining area does not provide a pleasant environment in which to have meals. This is further highlighted in Standard 24. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 20 The outcome group is good. Service users have access to a range of healthcare professionals and are supported in the way they prefer. The home’s procedures for the management and administration of medication are good. EVIDENCE: The Inspector spoke to a number of staff at the time of the inspection. All staff were able to demonstrate how the home provides service users with choices in food, drink, times for going to bed and getting up of a morning, clothing and day to day living. Where needed advice from other health care professionals including psychology and physiotherapists is sought. The Inspector was able to view evidence of this in documentation seen. Bathroom locks have now been fitted to promote privacy and dignity. Service users access a variety of health care professionals. Care plans seen contained records of visits to GP, Clinical Psychiatrist, dentist, chiropodist and optician. Each service user had a health care file detailing all contacts made and outcomes of visits, including action to be taken if needed. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 17 The Inspector viewed the systems in place in the management of medicines. Currently no one living at the home administers his or her own medication. Only senior staff that have received relevant training, administer medication. The Inspector viewed the Medication Administration Records (MAR) and found them to be well maintained. Some advice was given in relation to the recording of medicines on the MAR sheets. Each service user has a PRN medication protocol. The GP has signed individual homely remedy agreements. The home maintains a medicines returns book. The Inspector viewed the Controlled Drugs registrar and completed a spot check. Records and balances were correct. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 The outcome group is Poor. The complaints procedure has now been made available in a format appropriate to service users. Complaints that have been made to the home have been addressed but the home is not recording complaints adequately. The home does not ensure that service users are fully protected from abuse, as there are no written behavioural management guidelines and the agreed physical intervention to be used, where needed. Other systems are in situ to promote protection in other areas. EVIDENCE: The home has policies on making a complaint, recognising and reporting abuse and whistle blowing. All staff spoke with at the time of the inspection confirmed that they were aware of the whistle blowing policy and demonstrated the action that they would take if needed. The complaints procedure is provided in an appropriate format for service users. The Manager stated that the home has received three complaints in approximately four months. One was substantiated and the other two were partially substantiated. The Manager was able to show some records relating to these complaints, however, the home has not kept a record of all complaints received and the action taken. This was discussed with the Manager and must be addressed. The Inspector has previously identified that one care plan did not include behaviour management guidelines and the agreed method of physical The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 19 intervention. Physical intervention has been used on very few occasions. However, detailed records of such interventions have not been formally recorded. All staff spoken to at the time of the inspection confirmed that they have received training in physical intervention. The Inspector discussed these matters with the Manager at the time of the Inspection and was advised that the home is seeking the support of other professionals in the management of this and visits by the professional had taken place. The home must ensure that where needed behavioural management guidelines are developed and written guidance provided on the agreed physical intervention that can be used. These must be regularly reviewed and incorporated into the care plans. At the previous inspection the Inspector spoke with a large number of staff. The previous Inspector was concerned that many staff spoke of inappropriate language being used by staff at the home. This was raised with the Manager of the home at the time of that inspection. At this inspection the Inspector was not made aware of this still being a concerning issue and was not given any cause of concern. The Inspector discussed the management of service users finances with the Manager and sampled two service users records. The Inspector was advised that Craigmore Group Ltd is the appointee for all service users with the exception of one service user where a relative is the appointee. Each service user has an individual bank account with statements produced. The Inspector did not view these as they are held at head office. The Inspector was advised that the home has recently completed an internal audit of service user finances. The Inspector viewed the individual records pertaining to two service users spending money. Records are kept of all transactions with receipts wherever possible. Two staff signatures support each transaction. Balances were checked and were correct. The Manager stated that she audits the records regularly. The Inspector advised the manager to sign the record sheets when this is completed. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 25 2728 30 The outcome group is Adequate. Parts of the home are homely but the overall opinion is that the home needs some refurbishment and redecoration to provide a more homely and comfortable place to live. On the day of the inspection the home appeared clean and hygienic. EVIDENCE: The Gables is a two storey building located within walking distance of Burnham town centre and the sea front. The home is fitted with a fire alarm system and all fire doors have electronic door closures fitted. The home has a passenger lift but this is no longer used. The home has grab rails fitted and bathing aids have been provided where needed. To the front of the house there is a pleasant garden, which is used by service users for relaxing in and growing flowers and vegetables. One service user thoroughly enjoys gardening and was gardening at the time of the inspection. Staff were sitting with service users in this garden and enjoying the pleasant weather. The Inspector was advised that no service users are able to sit in this garden area unsupported, as it is not safe and secure. The main entrance to The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 21 the home is accessed via this garden area. A fence is fitted as a busy main road runs alongside this garden area. To the rear of the home is a small courtyard area. The courtyard is presently not very inviting for service users but appears to be able to provide a pleasant area to sit and is more private and secure which may allow service users to be more independent when sitting outside. On the day of the previous inspection a contractor had been to the home to look at landscaping the area. There has been no further improvement in this. It is recommended that this be given further consideration. On the ground floor there is a communal dining room, kitchen, bathing and toilet facilities, laundry, some bedrooms and a comfortable lounge area. There is also a small room next to the office that is used by the care team. The Manager has a separate office. The dining room is poorly furnished and decorated. Some improvements have been made to the dining area since the last inspection but it still needs further improvement. Staff have attempted to make these improvements but this is not appropriate given current staffing levels and the support needs of the service users. It is the Inspectors opinion that the dining area does not provide a pleasant environment in which to have meals. The Manager advised that she has been given the authorisation to purchase new tables and chairs. This must be addressed. Other communal areas appear to be in need of redecoration and refurbishment. The home must compile an action plan, with time scales, to state how the environment will be up graded. The Inspector viewed the majority of the bedrooms. Service users spoken to stated that they like their bedroom. Bedrooms viewed appeared to meet the needs of the service users and were personalised. One bedroom has en suite facilities and, with the exception of one, all others have wash hand basins. The Inspector was advised that the taps to one washbasin had been removed due to the service users needs. This is not currently identified in the individual persons care plan. The Manager stated that this would be addressed without delay. It was noted in one ground floor toilet that a star lock was fitted. A privacy locks must be fitted. It was also noted in this toilet area that a small cupboard that houses the electricity meter had a padlock fitted to promote health and safety. This lock was damaged and did not provide adequate health and safety measures. The Manager took appropriate action to address this at the time of the Inspection. There are four communal bathrooms and these are now fitted with privacy locks. The Inspector noted and was advised that in one bathroom area the two The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 22 service users who primarily use this facility tend to damage the facility on a regular basis. It was noted at the previous inspection that some toiletries and items of clothing are not kept in the rooms of individual service users. The Inspector noted that in one service users bedroom there was not a wardrobe to house the service users clothes. The Inspector was advised that a large double wardrobe was on order and is waiting delivery. The wardrobe will then have a lockable facility to meet the needs of the service user. The kitchen appeared clean and well managed. The laundry facilities in the home appear appropriate to the needs of the service users. However, the Inspector noted that the laundry room was exceptionally hot. This maybe due to the fact that the laundry equipment was in operation and that the homes boiler and central heating system is located here. It is recommended that consideration be given to improving ventilation in the laundry room. The home used to employ a maintenance person. Presently there is a vacancy for this post. Appointing to this post may improve to the immediate repair and replacement of furnishing/equipment. All areas seen by the Inspector appeared clean and fresh. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 34 35 36 The quality outcome is adequate. The home provides good levels of training for care staff although further improvement is needed in relation to care staff obtaining NVQ qualifications and staff completing food hygiene training. The home does not have adequate staff on duty to meet the needs of the service users. Staff now receive regular supervision. EVIDENCE: The Inspector was advised that three of the sixteen care staff have NVQ2 qualification or above. It is unclear what the commitments of the home are in relation to ensuring that care staff are supported and obtain a formal qualification. The home must develop a programme to ensure that 50 of the care staff has a NVQ2 in care. However, it is clear that the home strives to ensure that care staff receive appropriate training to meet the needs of the service users. Staffs spoken to were extremely complimentary of the training that is provided by the home. The Manager has developed a training matrix that records all the training that staff have undertaken. Staff confirmed that they have received mandatory The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 24 training in fire, food hygiene, basic first aid, manual handling, challenging behaviour/ CPI training, protection of vulnerable adults (POVA) and some staff have received specific training in phenylketonuria awareness. The Inspector viewed the training matrix. It appears that only 4 of the care team have received training in food hygiene. This must be addressed as the staff prepare and cook meals for the service users. Eight staff have received training in POVA/Abuse. Following discussions with the Manager and staff it is recommended that staff receive training in alternative methods of communication. As previously mention under standards 13 and 14 it appears that the home is running on minimum staffing levels. This does not allow the care team to support service users in accessing social and leisure opportunities as much as they wish. This is having a detrimental effect on the service users. The home has undergone an episode of disruption and has a number of care staff vacancies at senior level and for night working. It appears that the care team are able to meet basic care needs and conduct other household duties such as cooking and cleaning. It appears that the staff team are committed in providing a quality service to the service users, but this is being compromised. The Inspector felt that morale amongst staff was low primarily caused by the shortage of staff. The Inspector had lengthy discussions with the Manager in relation to this. The Inspector was advised that adverts have been placed to fill existing vacant posts and other possibilities of increasing the staff compliment have been considered. It is required that the home ensures that staffing levels are maintained to meet the needs of the service users. The Manager stated that agency staff would be used to maintain and increase staffing levels. Staff meeting are not happening on a regular basis. This should be addressed. Following discussions with the Manager and staff it is recommended that all staff receive training in alternative methods of communication, specifically STC. The Inspector viewed the recruitment files of two of the most recently appointed staff. POVA first checks had been conducted and Enhanced CRB disclosures obtained. One file did not contain the required documents as listed in Schedule 2 of the Care Homes Regulations 2001, in particular two references, one from the previous employer. The Manager demonstrated her awareness of the need of the required documentation and was going to follow this up with Head Office. The CSCI is to be advised of this outcome. All staff spoken to confirmed that they now receive regular 1:1 supervision. One newly appointed staff member stated that they had a good induction. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 25 At the previous inspection the Inspector identified that there appeared to be a lack of clarity about the roles and responsibilities of staff. A requirement was made to address this. The newly appointed manager was unaware if this had been met and remains a requirement. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 38 39 42 Standard 37 could not be fully assessed as the Manager has applied to become the Registered Manager of the home. The outcome group is adequate. The home appears to be well run and the Inspector has received positive comments in relation to the new Manager. Quality assurance and monitoring systems have begun to take place. Further improvement is needed. The home strives to promote health and safety but further improvement is needed. EVIDENCE: Since the last inspection conducted on the 11/10/05 the Registered Manager has left and a Manager was appointed to the home in February 2006. Sharon Sowden is the current Manager and has applied to be the Registered Manager. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 27 The CSCI is processing this application. Sharon has approximately 20yrs experience in care and has been employed by Craigmore Group Ltd since 2002. Sharon has obtained an NVQ3 in care, AI Assessors Award and is currently undertaking the Registered Managers Award. There is a vacancy for the post of deputy and senior care workers. It is expected that once these positions are filled the Manager will be able to move the service forward and ensure that the service users receive a high quality service. The Inspector spoke to a number of staff in private and on the whole received positive feedback from staff. Staff commented that Sharon is approachable; she assists service users with daily living skills, friendly and understands the needs of the service users. The Inspector has received positive comments from health care professionals commenting that the home is improving in many aspects relating to service user care and support. The feedback from all care managers was very positive in relation to the management of home. The Manager advised that Craigmore audit a number of areas of its service. However, through discussions it appears that the home must further develop effective quality assurance and quality monitoring systems by seeking advice from service users and other interested stakeholders as to the views of the services provided. At the last inspection there was evidence of regular service user meetings but unfortunately minutes held show that the last meeting was in April of this year. This should be addressed as part of the homes quality assurance process. Staff meeting are being held on a regular basis with minutes kept. The home appears to provide a safe environment. The Manager confirmed that environmental risk assessments are yet to be completed. This must be addressed. The Inspector viewed records in relation to the following heath and safety matters: FIRE SAFETY – The fire risk assessment is dated 18/08/05. The fire alarm system and emergency lighting had an annual service on 24/05/06. Weekly emergency lighting and fire tests are conducted; the last test was dated 19/05/06. A fire drill was conducted on the 07/07/06 and the fire fighting equipment was serviced on 01/06/06. It appears that all staff have received fire training. ELECTRICAL SAFETY – On the day of the inspection an electrical contractor was testing the homes electrical hardwiring. The home must forward a copy of The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 28 this certificate to the CSCI. Portable Appliance Testing was completed on 17/06/06. HOT WATER- The home regularly monitors the hot water temperature with records kept. GAS SAFETY – The Gas Safety Certificate is dated 27/02/06. This is out of date and a new certificate must be obtained. ACCIDENTS – The Inspector viewed records in relation to accidents and part of the care tracking process. FIRST AID – The home has 11 staff trained in this area. FOOD SAFETY – The home must ensure that all staff that prepares food has received training in food hygiene. This has been previously highlighted in this report. First floor windows have been restricted and hot surfaces have been guarded. It was noted that one wardrobe had not been fixed to the wall. This must be addressed. Up to date certificates of registration and insurance are displayed. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 2 32 1 33 1 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 2 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X X 3 2 X X 1 X The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 30 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement The Manager must ensure that service users care plans are kept under review and reflect the needs in respect of the person’s health and welfare and how they will be met. The Manager must ensure that individual service user risk assessments are regularly reviewed. The Manager must ensure that it provides service users with social interests and make arrangements for then to engage in local, social and community activities. The Manager must complete detailed risk assessments in relation to any restrictions imposed on service users. The Manager must ensure that the home keeps records of all complaints received and the action taken to address them. Timescale for action 31/07/06 2. YA9 12 31/08/06 3 YA13 YA14 16 (2) (m) 31/07/06 4. YA16 12 (1) (a) 31/07/06 5 YA22 17 (2) Schedule 4 of the Care Homes Regulations 2001. 13 (7) (8) 15 31/08/06 6. YA23 The Manager must ensure that behavioural management guidelines are developed and DS0000015983.V298726.R01.S.doc 12/08/06 The Gables Version 5.2 Page 31 7 YA24 23 (2) b 8 YA25 12 (1) (a) 12 (4) (a) 9. YA31 18 (1) (a) 10. YA32 18 (1) (a) 11. YA33 18 (1) (a) 12. YA39 24 (1) 13 YA42 13 where physical intervention is used, agreed techniques are identified with records kept and regularly reviewed. The Manager must compile an action plan, with time scales, to state how the environment will be up graded. (This requirement was made at the last two inspections). The Manager must ensure that an appropriate privacy lock is fitted to the identified ground floor toilet and that this area is safe for service users to use. The Manager must ensure that all staff are aware of their roles and responsibilities. (This was a requirement at the last inspection). The Registered Manager must ensure that staff are suitably qualified to meet the needs of the service users. Particularly in relation to developing an action plan for staff to achieve NVQ qualification. The Manager must ensure that all staff receive training in food hygiene, as all staff are responsible for the preparation and cooking of meals. The Manager must seek the views of all interested stakeholders as part of the homes quality assurance and quality monitoring systems. (This was a requirement at the last inspection). The Manager must ensure that environmental risk assessments are conducted to promote health and safety in the home. 30/09/06 31/07/06 31/08/06 31/10/06 31/10/06 30/11/06 30/08/06 The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA24 YA33 YA33 Good Practice Recommendations The Manager should consider improving the patio area to the rear of the home. Staff meeting are not happening on a regular basis. The Manager should address this. It is recommended that all staff should receive training in alternative methods of communication, particularly in STC. The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Gables DS0000015983.V298726.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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