Inspection on 18/04/06 for The Gables (Cambridge) Limited

This inspection was carried out on 18th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gables (Cambridge) Limited 02/12/08

The Gables (Cambridge) Limited 04/12/07

The Gables (Cambridge) Limited 21/12/06

The Gables (Cambridge) Limited 21/06/06

The Gables (Cambridge) Limited 20/10/05

The Gables (Cambridge) Limited 08/07/05

The Gables (Cambridge) Limited 29/11/04

The Gables (Cambridge) Limited 02/07/04

The Gables (Cambridge) Limited 05/05/04

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

CARE HOME ADULTS 18-65 The Gables (Cambridge) Limited 93 Ely Road Littleport Ely Cambridgeshire CB6 1HJ Lead Inspector Andy Green Key Unannounced Inspection 18th April 2006 10:00 The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 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 (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 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 (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Gables (Cambridge) Limited Address 93 Ely Road Littleport Ely Cambridgeshire CB6 1HJ 01353 861935 01353 862887 gables@caringhomes.org 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) Gables (Cambridge) Limited Care Home 16 Category(ies) of Dementia (5), Learning disability (16), Physical registration, with number disability (16), Physical disability over 65 years of places of age (1) The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The 5 places in category DE (under 65 years with dementia) are for 5 individuals, each with a primary vulnerability of learning disability The 1 place in category PD(E) (over 65 years with a physical disability) is for 1 named individual whose primary vulnerability is physical disability 20th October 2005 Date of last inspection Brief Description of the Service: The Gables is a residential service providing support and accommodation for up to sixteen adults with a physical and/or learning disability. The home has a respite care facility and has a number of residents using this throughout the year. The home itself is situated on the outskirts of Littleport in Cambridgeshire six miles away from the city of Ely. The current charges for placements in the home range between £650 - £1400. The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Andy Green, Regulation Inspector and Sue Pinner, Regulation Manager conducted an unannounced inspection on 18th April 2006. They met with the Manager, Operations Manager, care staff and service users to gather views regarding the services offered in the home. A number of records were inspected including care plans, training records and staff files. A tour of the building and grounds was also undertaken. Some requirements from the previous inspection were not met. What the service does well: What has improved since the last inspection? What they could do better: The carpet in the small lounge remains in need of replacement along with the carpet in one of the service users bedroom. This issue was raised in the last report. An audit regarding the state of carpets in the home needs to be undertaken to ascertain how many need to be replaced. A further audit of moving & handling equipment needs to be undertaken to ensure there are sufficient supplies. A greater choice and frequency of leisure activities need to be offered to reflect the age group and individual preferences of service users. The décor and furnishings in the communal areas of the home would benefit from an upgrade to give a more modern aspect to reflect the age group of service users. The doors and paintwork in the corridors also need attention as they are deteriorating due to being scuffed and damaged by wheelchairs. The reliance on videos to present training sessions should be reviewed and that other training methods should be researched. The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 6 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 (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 7 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 (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 8 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): 1,2,3,4, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Service users have access to good information, and can make an informed choice regarding the home’s services. EVIDENCE: There have been no additions or updates to either the Statement of Purpose or Service Users Guide. The Manager stated that both of these documents would be updated in the forthcoming months to ensure that accurate information is documented to reflect the home’s services. A copy of the care management assessment was contained in the care plans seen during the inspection. There were 14 service users in residence on the day of inspection; consequently there are currently two vacancies in the home. The manager and a member of the care staff carry out an assessment and pre admission visits to the home can be arranged. The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 9 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, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Care provided at the home is of a reasonable standard. Care plans are in place and updated to ensure that the home can meet each individual service user’s assessed needs. EVIDENCE: Four service user care plans were seen. Care plans provide guidance for staff in how they are to meet the assessed needs of the service users. The manager said that care plans are reviewed regularly to show any changes. Care plans tracked showed that residents are being weighed regularly and where required food and fluid intake is monitored. There was also evidence of reviews, risk assessments, and healthcare audits. Daily notes are also recorded in detail. It was recommended that the social profiles contained in care plans could be presented in a more creative way to give staff a deeper understanding of the person’s life history, photographs, key life events, preferences and dislikes. The service user files seen showed that health care services are available to ensure that service users receive adequate health care from a variety of professionals. The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 10 As the majority of service users met during the inspection were unable to communicate verbally it was not always possible to gauge their views of the home. One of the service users did however express her general satisfaction with the care and support she received in the home. It was also noted that service users were being spoken to in a friendly and sociable manner. However the atmosphere in the home does not reflect the fact the service users are younger adults and should be treated accordingly. The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 11 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): 12,13,14,15,16,17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. Service users have limited access to activities in the home and wider community. Consequently a wider range of age appropriate activities need to be provide EVIDENCE: The manager stated that available activities include dominoes, visiting the library, day trips, TV, shopping, gardening aromatherapy and massage. The manager also stated that there is a small gardening project in development and service users would be encouraged to take part. Some of the service users also attend a local day service. However, it was observed during the inspection that there was little in the way of organised activity with most of the service users sitting passively in the lounge. Three service users were playing a board game with a member of staff and a number of service users were watching television. One of the service users confirmed that there was little in the way of meaningful activity in the home. The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 12 It was also noted that no religious services had been organised for Easter. One service user used to attend church services but there was no longer anyone to take her were watching television. It was also noted that there are no religious services are provided. The manager stated that this would be developed to meet individual needs and preferences. Consequently a requirement has been made regarding the provision of suitable and age appropriate activities for service users. The manager stated that an activities co-ordinator has been appointed and will commence employment when recruitment checks have been completed. The co-ordinator will receive training to ensure knowledge regarding the individual needs of service users and be able to devise specific activities depending upon each individual’s capacity and preferences. A variety of meals are provided to meet the assessed needs of service and drinks and snacks are available throughout the day. However it is not clear how much the service users participate in menu planning and meal choices. The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 13 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Service users receive appropriate health and personal care to meet their assessed needs together with support in taking prescribed medication. EVIDENCE: All service users are registered with a GP and the senior staff member stated that any health problems are dealt with appropriately and recorded in care plans. Care plans showed evidence of healthcare visits. Staff accompany service users to hospital and GP appointments when necessary. A variety of healthcare professionals are in regular contact with service users including a speech therapist, OT, and a chiropodist. The administration records for individual service users medication were inspected and found to be accurate. It was recommended that a blind or curtain is put on the window in the medication room to aid security. The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The home has a satisfactory complaints process to make sure that service users have their complaints or concerns listened to and acted upon properly. EVIDENCE: The home has a complaints procedure including agreed timescales to make sure that all complaints are fully investigated and actioned appropriately. The home has not received any complaints since the last inspection. The home has a satisfactory policy in place, in line with the Local Authority policies, to make sure that service users are protected from abuse. The manager has undertaken Key Practitioner training in POVA and he will be cascading training throughout the forthcoming months. It was observed that care staff spoke to service users in a friendly, appropriate and respectful manner. The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 15 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): 24,25,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. The environment is not suitable for the needs of those living in the home. There is a need to improve the décor and furnishings and fittings and equipment provided in the home. EVIDENCE: The environment remains clean and generally, in a reasonable state of repair. However the lounges would benefit from a brighter and more modern approach to decor to reflect the age group of service users in the home. The individual service user bedrooms remain in reasonable decorative order. The carpet in the front lounge is stained and although it is been cleaned on a regular basis it is not possible to remove the stains. The operations manager stated that a new carpet had been ordered before Christmas 2005. She was reminded that a replacement carpet was raised at the last inspection and the organisation must action this urgently This must be actioned by 30th June 2006 and CSCI must be notified when this has been completed. The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 16 It was also noted that a number of carpets in service users bedrooms are showing signs of wear and the operations manager stated that an audit regarding carpets that need to be replaced will be undertaken. A number of doors and areas of paintwork in the corridors are scuffed and damaged caused by wheelchairs. Attention needs to be given to these areas as it gives an unkempt appearance to the home. The kitchen was clean and hygienic. All staff spoken to on the day of the inspection raised a concern about the lack of moving and handling equipment and the need to replace armchairs in communal areas, which are becoming worn. One service user stated that there were still not sufficient slings available and that she had raised this with the manager as she only has only one sling that she had been assessed for. The service user’s concern was raised with the operations manager who stated that moving and handling aids have been ordered and an audit of other equipment is being carried out and that necessary equipment would be provided. Appropriate fire escape signage needs to be added to the front door as a sign in the corridor suggests that it is a fire exit. The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The home’s recruitment policy and processes makes sure that service users are protected from harm. Training is provided to make sure that care staff are competent to deliver care to the service users they support. However it is recommended that training methods are reviewed as reliance on training videos is not adequate.. EVIDENCE: All staff are issued with contracts of employment, detailed job descriptions and clear details of their areas of responsibility. Three members of staff’s files were seen and they contained appropriate recruitment information including references and evidence of a satisfactory CRB/POVA checks. Regular recorded supervision meetings with individual staff members are in place. The manager stated that training in the home is regularly updated to ensure that both mandatory and client specific training. Staff files confirmed that training in food hygiene, dementia care, health and safety, COSHH, infection control, POVA, epilepsy and NVQ training have been undertaken. The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 18 However it should be noted that the majority of training is delivered through video presentations and reliance on such training is inacequate. It is recommended that staff should receive more courses given by presenters, which is a more interactive process rather than a reliance on video. The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 19 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): 37,38,39,41,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The home is well managed and the manager provides support and guidance to staff to ensure that service users receive good quality care. EVIDENCE: Since the last inspection the deputy manager has been appointed to the post of manager in the home. An application to register him as manager with the Commission for Social Care Inspection is being processed. The manager creates a supportive approach and communicates a clear sense of direction to ensure that the home is well managed. He is keen to develop the service in consultation with staff members and service users. Staff spoken to during the inspection confirmed that they received supportive and inclusive style of management and were positive about the manager. Records of weekly fire alarm and emergency lights testing were seen and found to be accurate. Service contracts are also in place to ensure that equipment and services in the home are maintained regularly. The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 20 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 3 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 3 ENVIRONMENT Standard No Score 24 1 25 2 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 3 X 3 3 X The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 21 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 2 Standard YA14 YA24 Regulation 16(2) (n) 23 (2) (b) Requirement Suitable activities must be provided to meet the individual needs of service users The provider must ensure that the home is well maintained and areas of furniture and paintwork are renewed or replaced Carpets in the lounge and a number of service user bedrooms need to be replaced The provider must ensure that there is adequate equipment provided in the home for service users with mobility needs. The registered person must ensure that there is a training and development programme to meet the changing needs of the service users. Timescale for action 30/06/06 31/07/06 3 4 YA24 YA29 23 (2) (b) 23 (2) (n) 30/06/06 30/06/06 5 YA35 18 (1) (c) 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 22 1 YA35 It is also recommended that the reliance on videos to present a number of training sessions should be reviewed and other training methods implemented. The Gables (Cambridge) Limited DS0000037198.V288420.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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. 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