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

This inspection was carried out on 15th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

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

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 20/12/2008.

CARE HOME ADULTS 18-65 The Gables, Burnham-on-Sea Grove Road Burnham-on-sea Somerset TA8 2HF Lead Inspector Gail Richardson Unannounced Inspection 15th October 2008 10:00 The Gables, Burnham-on-Sea DS0000015983.V372658.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, Burnham-on-Sea DS0000015983.V372658.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, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables, Burnham-on-Sea Address Grove Road Burnham-on-sea Somerset TA8 2HF 01278 782943 01278 782943 the.gables@craegmoor.co.uk 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 Julie Hoskins Care Home 10 Category(ies) of Learning disability (10) registration, with number of places The Gables, Burnham-on-Sea DS0000015983.V372658.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. 16th October 2007 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 homes has access to two vehicles for transport for people who use the service. The Registered Provider is R.J. Homes, which is owned by the Craegmoor Group Ltd. The registered Manager is Julie Hoskins. Fees at the home currently range from £768.00 to £1712.83 per week. Fees are dependant on the needs of the individual and consequent level of staff support required. Costs not included in the fees include, hairdressing, chiropody, personal items such as clothes and toiletries and peoples own birthday presents. The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection, which took place over 1 day (7 hours) on the 15th October 2008 by Regulation Inspector Gail Richardson. A tour of the home took place and a selection of the bedrooms and all communal areas were seen. There were 10 people currently residing at the home. The inspector spoke to 3 people using the service, and 5 members of staff, the Registered Manager was available throughout the inspection. The home has provided CSCI with a completed AQAA (Annual Quality Assurance Audit) which was completed by the Manager and gives details of all aspects of the home. As part of this inspection the inspector surveyed the opinions of a random selection of people using the service and staff and the responses are included in the body of this report. Records relating to care including 3 care plans, 4 staff files, finances and health and safety records were examined. Since the last key inspection a further random inspection took place on the 18th June 2008. The reason for this inspection was to follow up on the progress being made to meet the requirements of the last inspection and to look into concerns raised with the Commission for Social Care Inspection. The areas of concern have been addressed. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: The home provides a statement of purpose and service user guide, which provides information for prospective people using the service. Before any new The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 6 person resides at the home the manager ensures that a full assessment of needs is in place and ensures that the person can visit the home and ‘test run’ the service on several occasions before deciding if it is right for them. Each person at the home has a detailed care plan. This plan outlines the preferences of the person and an agreed plan of care is in place to support both preferences and any specific care needs. Risks identified are assessed and plans put in place to promote choice and independence. All records are maintained confidentially. People are supported with their healthcare needs by having access to the appropriate healthcare professionals. Medication systems are mostly clear and most staff have received the appropriate training to ensure safe practice is maintained. Medication update training is underway. There is a range of activities provided and people using the service are supported to access facilities both in house and outside of the home. Daily routines at the home appeared flexible to promote access to community facilities. There is suitable communal space with a comfortable lounge and dining area. Staffing levels at the home are adequate to meet the people’s needs. Staff training is ongoing to support the needs of people using the service. Recruitment is mostly robust to ensure the protection of people living at the home. The management of the home appears to support both the people using the service and staff. Health and Safety measures are in place to promote protection and policies and procedures are in place to ensure good practice. What has improved since the last inspection? At the previous key inspection four requirements and two good practice recommendations were made. The management of the home have been proactive in addressing all except one of those areas. The Manager Designate has recently been registered with The Commission for Social Care Inspection. All restrictions to people using the service are assessed, documented in detail and reviewed regularly. The rational for restraint is documented within the persons care plan. The clear glass identified in one person’s bedroom has had an opaque covering applied to ensure the privacy and dignity of that person. The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 7 The lift has been commissioned to service and is now used by people to access the activity room on the first floor. The ground floor lounge is being reorganised to provide a quiet sitting area. What they could do better: 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 summary of this inspection report can be made available in other formats on request. The Gables, Burnham-on-Sea DS0000015983.V372658.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, Burnham-on-Sea DS0000015983.V372658.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An updated Statement of Purpose and Service User Guide is available to provide details for any prospective person using the service. People are enabled to ‘test run’ the home on several occasions prior to admission to support the success of any admission. Contract are not available at the home and are stored at the companies head office. EVIDENCE: The home has up dated the homes Statement of Purpose to ensure that it reflects the changes that have occurred in the home. The service user guide gives clear information to people about the admissions process and what people can expect at the home this is also available in easier read format. Since the last inspection one new person has moved to the home. There was clear information received about the person moving in and there was evidence that they visited the home several times over a period of weeks prior to admission. One survey received from a person using the service confirmed that they had received enough information about the home prior to moving in. The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 10 The homes Annual Quality Assurance Audit (AQAA) says that, The residents on the whole get on well together and have built up trust and confidence in the staff, they are encouraged to be involved in all aspects of the home, they are encouraged to discuss any concerns and know they will be dealt with properly and efficiently. No contracts were available as they are currently stored at head office. The Gables, Burnham-on-Sea DS0000015983.V372658.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are supported by staff in making decisions, activities and developing independent life skills. Appropriate risk taking is promoted, and risk assessments are regularly reviewed and updated. Care plans are created and updated with the involvement of people using the service where appropriate. All records are stored securely. EVIDENCE: Since the last inspection the staff have reviewed and improved care plans to reflect a more person centred approach to care. We looked at three care records of people using the service. Each person using the service has a detailed plan of care, this plan outlines any specific care needs, risk assessments and any care plan resulting from that risk. Risk The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 12 assessments are completed to ensure that people using the service have access to care and activities in the safest way possible. Care records also included health and social care input, proof of access to NHS services, the persons preferences with regards to their care and activities, contact with relatives and friends, daily records and monthly summaries. Daily progress sheets detailed activities undertaken, nutrition and behaviour. Staff assist people using the service to make decisions about their day-to-day lives. Some people continue to create their own menus, people decide how they spend their time and are supported to make decisions about activities and holidays. Staff assist people to carry out personal shopping and make decisions about the clothes and other personal items that they buy. The homes AQAA states We always encourage residents to make choices, we recognise that all residents have a right to refuse, disagree or question the motives of others they may live and work with we avoid responding with disapproval or rejection No service users currently living at the home manage their own finances, the systems in place to provide access to money are based on the home providing the money from a petty cash system and then invoicing each persons account at the end of each month. It was evident that in some cases the home used people’s money as well as company money to purchase some people using the service birthday presents. There are some instances where restrictions are placed on people, for example when clothes are not kept in personal rooms, this was identified at the previous inspection and there is now a clear rationale available in the persons care plan when this action is in place. Staff surveys asked if the ways information was passed about people using the service between staff worked well ? 1 said always, 1 said usually and 1 said sometimes. One comment received was that “ We could do with more input from Social Workers “. People’s records were stored with other important records in one of the home’s offices in line with the Data Protection Act. The Gables, Burnham-on-Sea DS0000015983.V372658.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 16 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to access in age, peer and culturally appropriate activities, and use the local community. Routines in the home are flexible to enable people to make choices about their day to day lives. Appropriate personal and family relationships are supported. Residents are treated with dignity and respect. A healthy diet is promoted. EVIDENCE: Discussion with the manager confirmed that over the last few months staffing levels have had an effect on the amount of activities people using the service have accessed. Recruitment has been undertaken and the manager feels that this situation will now change. One staff surveys commented, “ More staff are needed for more residents to go out “ The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 14 One person using the service survey noted when asked, Do you make decisions about what you do each day stated sometimes and commented “Very rarely” and “ I cant when I want to because there are not enough staff”. Each persons care plan identified their preferences and choices of activities and there were records of each daily activities and the level of participation and enjoyment. The home does not employ a designated activity coordinator and activities are organised by staff members. The home accesses the local college and day centres and also provides activities within the home. On the day of inspection, one person attended college, people were seen to go out for walks and other people were helping staff reorganise an activity room. The activity room will not be freely accessible but people will have supported and supervised access. The hairdresser was also visiting the home. The homes lift is now in operation to ensure access for all people using the service to the upstairs activity room. The home also has two vehicles to enable people to access local facilities and have trips out. The home organises a holiday or day trips for each resident. Two people using the service told the inspector about their forthcoming trip away. The homes AQAA says that the home has improved by, Enabling residents to maximize their physical and intellectual capacities whilst respecting the wishes of those who prefer to not be as active or sociable. All people using the service are supported to maintain contact with families and friends. Families are welcome to call into the home and people are supported to maintain telephone and written contact. The home can arrange an advocate where there is an identified need. There is some flexibility around meals and mealtimes to fit in with activities. On the day of inspection breakfast was a selection of cereals, toast with hot and cold drinks. Breakfast was ongoing with people using the dining room. Lunch was a cooked meal of jacket potato with various fillings, there was a planned cooked meal in the evening. A healthy diet is promoted and monitoring of weight is maintained, all meals are served with appropriate staff support. As previously stated 2 people have created their own menu and although there is a set menu for others in the home people are able to have alternatives to the planned meal if they wish. The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Records confirm that each person receives personal support as they require, clear and detailed records are maintained. All areas of physical and emotional need are assessed and a care plan is in place to ensure staff can meet those needs. Medication systems are mostly satisfactory, some areas require further review to ensure that management of medication is safe. EVIDENCE: Each care plan provides clear information and guidelines about personal care routines including risk assessments were identified. Staff observed were clearly aware of the preferences of the person with their care needs and staff spoken with demonstrated a good understanding of peoples needs. 3 staff surveys were asked if they received up to date information about the needs of the people they care for, 2 said always and 1 said usually. The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 16 One person using the service survey asked if staff treat you well said – usually. And that they usually listen and act on what you say People using the service access local GP’s and district nurse teams. Care plans seen contained records of visits to GP, Clinical Psychiatrist, dentist, chiropodist and optician. Care plans give details of the level of support that individuals require with personal care and it was apparent that staff respected the privacy and dignity of people using the service. The home employs both male and female staff meaning that people are able to express a preference about the gender of the person who assists them with intimate care. Some people living at the home are not able to record their involvement within the care planning reviews and this is recorded by staff. Currently no one living at the home looks after their own medication. The medication systems were assessed to be mostly satisfactory however some areas require further review. The home has written protocols in place on the Medication Administration Records for the administration of most medications. There were no gaps evident in the Medication Administration Records, one persons record stated they had no allergies and this needs to be updated to reflect recent information received. There was evidence of variable doses being recorded however it was noted that on 2 occasions hand transcribed entries were not signed by two staff. This is required to enable a clear audit trail and prevent the risk of incorrect transcribing. All prescribed creams and dietary supplements are signed for on the Medication Administration Records. One person has a daily monitoring of their urine ph. Records indicated that some days this was not done as the necessary equipment was not available. The organisation of ordering this equipment must be improved to support the person using the service. All medications were stored safely and securely with systems in place for monthly ordering and disposal. Most staff have received some training in medication administration, however some staff training in this area is out of date and the manager is addressing this. The manager must also review that she has no current medication training and address this issue. Furthermore one person had been prescribed rectal diazepam but only two members of staff have had the correct training to administer this. This must be reviewed to support the needs of the person using the service. The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 17 The Gables, Burnham-on-Sea DS0000015983.V372658.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are policies and procedures in place to minimise the risks of abuse to people using the service. However, all complaints must be recorded and the action taken to address them. Further staff training is required in abuse awareness to support the protection of people using the service. Staff confirmed that they were aware of whistle blowing procedures and of their role in protecting people using the service from abuse. EVIDENCE: All 3 staff surveys knew what do if a concern was raised and two further staff described to the inspector what they would do if an allegation of abuse was made. Their understanding of the policy was in line with the Safeguarding Vulnerable adults Policy for Somerset (May 2007). No complaints have been recorded at the home since the last inspection, however some concerns were raised which were investigated and a random inspection took place. The registered manager is required to record all accidents and the action taken to address them. Many of the people living at the home may be unable to use the formal complaints policy but care plans gave triggers for staff to look for to identify if people were not happy. The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 19 Staff receive training in the Protection Of Vulnerable adults during their induction and this is up dated every two years. Staff also receive training in equal opportunities awareness every three years. The homes AQAA states that, Staff are trained in all areas e.g. POVA, Complaints Procedure, Equality and Diversity and are aware of the company’s policies and are compliant with these. However, not all staff has received updated training in abuse awareness and it is recommended that this be reviewed. The registered manager stated that further training is planned for November 2008. The inspector viewed the recruitment files of four newly appointed members of staff. All gave evidence that staff are checked against the Protection Of Vulnerable Adults (POVA) register and undergo an enhanced Criminal Records Bureau (CRB) check before they begin work in the home. The Gables, Burnham-on-Sea DS0000015983.V372658.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 25 26 27 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Grange shows wear and tear associated with its usage. Refurbishment is required in several areas to ensure that the environment is comfortable and does not pose a risk of cross infection. The communal areas are well furbished and most rooms reflect the personality of the people using the service. There are sufficient bathing facilities but all are in need of refurbishment. The standard of hygiene is adequate. EVIDENCE: As stated at the previous inspection, 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 grab rails fitted and bathing aids have been provided where needed. The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 21 The passenger lift has been returned to operation and enables people using the service to access the upper floor activity room. There is a lounge and dining room on the ground floor which are accessible to all people using the service. The lounge is a pleasant room with appropriate furnishings. It is planned that one area of the lounge is allocated as a quite area, though the lounge can be noisy and this may not be adequate to ensure privacy and peace. The homes AQAA says that the company aims to, To complete the re decoration of the home and move the office upstairs to enable a second lounge. The fabric of the home appears to need attention with doors and doorframes requiring repair or replacement. Some walls need attention where damage has been sustained. The hallway banisters require repair. Two wardrobes were seen to not be secured to the wall and may pose a risk of injury to people using the service. These were requested to be fixed and CSCI have received confirmation that this has been done. The home has purchased a new flat screen TV for the lounge, this must also be secured to the wall to prevent the risk of injury to people using the service. All bathrooms were seen. Some baths need repair and flooring in all bathrooms require repair/replacement to prevent the risk of cross infection. At the front of the house is a garden area where people are able to spend time. The garden is not secure and is close to a busy road so many people are unable access it without support. There is also a large secure courtyard area that is not used by people at the home. On the day of inspection there were bins stored underneath the fire exit stairs. This must be reviewed as may pose a fire risk. There has been no development of this area for use by people using the service since the previous inspection. The inspector was able to see most of the people’s rooms and these had been personalised to reflect the choices and needs of the individual. The homes cleaner is off sick and care staff have been cleaning as part of their care role. The standard of hygiene was adequate but review of this arrangement is recommended to ensure that sufficient people are available to maintain a good standard of hygiene. The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32 33 34 35 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. At the time of the inspection there were adequate numbers of staff on duty to meet the needs of the people using the service. The recruitment practices in the home minimise the risk of abuse to people using the service but are required for further review to ensure that all areas of recruitment are robustly checked. EVIDENCE: As previously noted, the home has experience a period of low staffing when low numbers of staff has had an effect on many aspects of the home including activity provision. Recruitment has taken place and new staff are about to commence employment. Staff surveys asked staff if there are enough staff to meet the individual needs of people? 3 said sometimes. Comments included “We are very under staffed, one client should get 70 hours a week one to one time but doesn’t” Another said, “ We always seem to be short staffed, people leave all the time and people are always phoning in sick “ The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 23 At the time the inspection there were 5 care staff on duty and one maintenance man. The manager and deputy manager were also on duty. The home operates a senior carer system to support less experienced staff. The manager identified that there had been a difficult staffing time but that staffing levels were now hopefully improving. Staff interacted well with people using the service and it was apparent that they had a good knowledge of the individual’s choices and preference for their care needs. Staff records showed that all new staff undertake an induction programme based on the Common Induction Standards. One staff member confirmed that they had undertaken the induction program and had received a variety of training including abuse awareness. Staff were asked if the induction covered everything they needed to know to do the job? 1 said very well, 1 said mostly and 1 said partly. Staff told the inspector that the home is a good place to work and that staff morale is improving. One staff said that the arrival of new staff was “A breath of fresh air”, another staff member commented, “Most of the staff are nice”. Staff training records identified that whilst staff training took place there were some gaps where staff needed updates in areas of mandatory training. The manager confirmed that this was all underway All staff stated that they had regular supervision and that this was an opportunity to discuss any issues they may have and to look at their personal training and development needs. The home maintains a supervision matrix, which showed that all staff receives supervision up to six times each year. One staff member told us that “We have regular supervision, about every six weeks. The senior staff supervise the care staff and the manager supervises the seniors”. Staff surveys asked if staff were being given enough training? 2 said yes and one said no. The home employs 21 care staff, 7 have a National Vocational Qualification in care and a further 3 people are working towards the award. This is below the 50 identified in Standard 32 of the National Minimum Standards. The inspector viewed the recruitment files of 4 recently appointed members of staff and found them to be mostly robust however, three people had gaps in their employment history which had not been explored at interview and documented. One person had provided a reference, which showed that they had only employed that person for 19 days. This is insufficient time to provide evidence of sustained employment, also one reference was not dated and one person had not signed their contract. The manager does not currently have a system to record how staff are supervised when working on induction having received the POVA check but not yet received the CRB check. It was discussed that this is required to evidence that staff were not left unsupervised. A recordable system is recommended to be put in place. The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37 38 39 41 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager shows a commitment to continual improvement. There are systems in place to monitor the quality of care. Record keeping is in line with the Data Protection Act 1988. EVIDENCE: The manager has now been registered with The Commission for Social Care Inspection. The manager continues to have an ongoing commitment to improving the quality of the service. The staff confirmed that the manager is approachable and during the inspection staff and people using the service accessed the office to ask questions and chat in a relaxed manner. The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 25 Staff surveys asked if the manager met with staff to give support and discuss how they were working / 1 said regularly, 1 said often and 1 said sometimes. Regulation 26 visits are completed each month and the company undertakes a regular audit to review the quality of the service provided. No current quality audit surveys have been sent out to people using the service or their representatives. The homes AQAA states that as a result of listening to people using the service We hold 8 weekly “Your Voice meetings “ Annual Health and medication checks are in the process of being held. More Activity based holiday’s/days out i.e. camping, horse riding, biking, and walking. Health and safety records inspected included the fire servicing and checking of fire equipment and systems, of gas and electricity, of portable electrical equipment, of mobile equipment and of water safety checks. All records seen were well organised and up-to-date. The hard wiring certificate is to be forwarded to CSCI offices. There is an annual training plan for staff that covers H&S updates including fire training and moving and handling training. Working practices in the home are safe and accidents are monitored to promote prevention. Records are kept securely and staff are aware of the requirements of the Data Protection Act The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 26 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 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 3 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 3 3 3 X 3 3 x The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 27 No 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. 2. Standard YA20 YA20 Regulation 13(2) Requirement Timescale for action 30/12/08 30/12/08 3. YA20 4. YA24 The registered manager must ensure that two staff sign all hand transcribed medications. 13(2) The registered manager must ensure that sufficient equipment is available in the form of urine testing sticks to support the needs of the person using the service. 13(2) The registered manager must ensure that staff receive the appropriate medication training and updates. 13(4)(a)(c) The registered manager is 16(2)(c) required to ensure that all areas of the home are well maintained and do not pose a risk of cross infection 30/12/08 30/01/09 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. Refer to Standard YA24 Good Practice Recommendations The registered person should consider improving the patio DS0000015983.V372658.R01.S.doc Version 5.2 Page 28 The Gables, Burnham-on-Sea 2. 3. 4. YA23 YA22 YA34 area to the rear of the home. The registered manager is recommended to ensure that all staff receive abuse awareness training and updates. The registered manager is recommended to keep a record of all complaints, concerns and allegation made and the action taken in response. The registered manager is recommended to ensure that all recruitment checks are completed. Any gaps in employment history should be explored and documented at interview. The registered manager is recommended to implement a recordable system to ensure that there is a record of which staff have supervised new staff who have not yet received a CRB check. 5. YA34 The Gables, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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, Burnham-on-Sea DS0000015983.V372658.R01.S.doc Version 5.2 Page 30 - 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. 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