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Inspection on 02/12/08 for The Gables (Cambridge) Limited

Also see our care home review for The Gables (Cambridge) Limited for more information

This inspection was carried out on 2nd December 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides general care and support to residents in the home. The environment is homely and comfortable and meets the needs of residents. Care staff were observed to be friendly, caring and sensitive to residents needs.

What has improved since the last inspection?

Refurbishments and decoration have been carried out including a new shower room, new upstairs bathroom, redecoration of the lounge and repairs to walls near the downstairs shower. Further refurbishments and decoration are being planned as part of an ongoing maintenance plan.

What the care home could do better:

Weight charts need to be accurately recorded to ensure residents assessed health care needs are being met. Wider ranges of activities need to be organised to fully meet the needs of residents so that their preferences and interests can be met both within the home and in the community. The recording of controlled medication must be accurately maintained to ensure the safety of residents.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Gables (Cambridge) Limited 93 Ely Road Littleport Ely Cambridgeshire CB6 1HJ One Star Adequate Service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Andy Green Date: 0 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: The Gables (Cambridge) Limited 93 Ely Road Littleport Ely Cambridgeshire CB6 1HJ 01353861935 01353862887 gables@caringhomes.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Gables (Cambridge) Limited Name of registered manager (if applicable) Mr Christopher Stannard Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 16 0 0 0 1 care home 16 dementia learning disability physical disability Additional conditions: 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 Date of last inspection A bit about the care home The Gables is a registered care home with nursing 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 near to the city of Ely. The current charges for placements in the home ranges from #673 - #1328 Copies of CSCI reports are made available to residents and their relatives. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: One Star Adequate Service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home We, the Commission for Social Care Inspection carried out an unannounced inspection of the home on 2nd December 2008. We met with the registered manager and members of the care team. A variety of records were inspected including care plans, staff files, fire safety records and medication records. A tour of the building was undertaken and we met a number of residents. The home completed an AQAA (Annual Quality Assurance Assessment) which is a self audit document completed annually by the home. Surveys were received from residents and staff. What the care home does well What has got better from the last inspection Refurbishments and decoration have been carried out including a new shower room, new upstairs bathroom, redecoration of the lounge and repairs to walls near the downstairs shower. Further refurbishments and decoration are being planned as part of an ongoing maintenance plan. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Andy Green CPC 1 Capital Park Fulbourn Cambridge CB21 5XE If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home carries out assessments to ensure that residents needs can be met. Evidence: Since the last inspection of the home there have not been any admissions to the home. Consequently there were no new assessments to evidence any changes to the assessment process. The home has updated the Statement of Purpose and the Service User Guide. A creative pictorial version of the Service User Guide has been developed to assist residents understanding of the facilities and services that are provided. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The care plans provide general guidance for staff regarding the care and support needs to meet the assessed needs of residents. Evidence: Three care plans were inspected. They provided guidelines regarding care and support needs including; personal hygiene, weight charts, continence, family contact, weekly activities, personal care , pressure sore care, mealtime preferences, finances, death and dying, communication and eating and drinking. It was noted, however, in one of the care plans that the weight charts were inconsistently recorded with only two entries made when the instructions clearly stated that weights should be recorded monthly. It was also noted that the persons weight had decreased from 80kg to 71kg during a twelve month period with no explanation recorded. The weekly activities records seen in individual care plans were very brief and listed watching television, reading magazines and playing board games. It was difficult to ascertain how residents lifestyle and interests are developed or being met. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Activities for service users are inadequate and need to be improved to meet the personal references and lifestyle needs. Evidence: There has not been any improvement in the ranges of activities provided for residents since the last key inspection of the home. There was little evidence of any organised activities in the home apart from from a small number of residents who were attending a local day service. The home has a quiet and uninspiring atmosphere which does not reflect the age group of the residents. Records of activities for one service user showed played with toys, played his piano and watched TV as the main activities over a seven day period. Records of activities over a ten day period for three other service users listed watched TV and read magazines. Surveys received from residents stated that they spent a lot of time sitting on their backside and were bored There was no evidence of any day trips or arranged holidays. Staff confirmed that there were inadequate amounts of activities apart from board games or aimlessly watching television. Staff also stated that there were not enough staff on duty so that groups of residents could go out into the community with any regularity especially at weekends. The lack of organised activities was highlighted during the last key inspection and this Evidence: is an area that must be improved to ensure that residents can lead more fulfilled lives rather than only just having their basic care and support needs being met. It was also recommended that the employment of an activities coordinator may be able to generate a programme of varied and meaningful activities. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents receive appropriate health and personal care but improvements are needed regarding the recording of controlled medication. Evidence: Residents receive personal care and support to meet their needs. Input from a range of health care professionals continues to be available and visits/appointments from health care professionals are recorded in care plans and daily notes. Examples included visits from GPs, occupational therapist, music therapist and an aromatherapist. Individual risk assessments are recorded and reviewed to ensure that residents are protected from potential harm. Three resident files were inspected and risk assessments were in place. Examples included moving and handling, fire safety, protection from abuse, bathing, eating, using transport and accessing the community. Medication records were generally accurate and up to date. However, there was a discrepancy in the controlled medication records for one of the residents. This was pointed out to the nurse in charge who could not account for the error. It was disappointing that there was an error especially as only the trained nurses administer medication in the home. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has a complaints process to ensure that residents are able to raise concerns. Evidence: The homes complaints procedure ensures that all concerns are fully investigated and actioned appropriately. There have been no formal complaints raised with the home since the last inspection. CSCI has also not received any complaints since the last inspection. The home continues to ensure that safeguarding adult issues are dealt with via the local authority policies, to ensure that residents are protected from potential abuse and harm. Staff receive appropriate safeguarding training to ensure safe practice. Care staff were observed to interact and speak with residents in a friendly and social manner appropriate to their individual needs. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The environment of the home provides residents with a safe, comfortable and clean place to live. Evidence: The home remains comfortable, homely and generally suitable for the needs of the residents. Decoration and refurbishments have been carried out in response to requirements made at the last inspection. These include the installation of a new shower room on the ground floor, a new bathroom on the first floor and the redecoration of the communal lounge. The walls near to the ground floor shower room have been replastered and decorated. The manager stated that there are further redecorations and refurbishment in hallways and bedrooms as part of the providers ongoing maintenance plan. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The homes recruitment and training processes ensure that residents are protected from harm. Evidence: Three staff files were seen and they contained relevant recruitment information, including references, application form and satisfactory Criminal Records Bureau checks. There have not been any changes to the recruitment procedure since the last inspection of the home. Staff training is in place to ensure that all mandatory and client specific training is delivered. Refreshers and updates are organised as part of an ongoing process throughout the year. The care staff spoken with stated that they had received a variety of mandatory training in the home including; induction, moving & handling, fire safety, first aid, food hygiene and moving and handling. One of the nurses stated that she had attended study days to update her knowledge and gave the example of a recent update regarding wound care. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Improvements need to be made regarding the managers communication with staff to ensure there is a closer working relationship and clarity regarding roles and responsibilities in the home. Evidence: As previously observed in the last key inspection report there still appears to be improvements needed regarding communication between the manager and care staff working in the home. Staff spoken with stated that they still found the manager to be remote and that he was often in the upstairs office away from the communal areas of the home. These issues were discussed with the manager who was surprised regarding the comments that were raised. Fire alarm and emergency light testing records were accurate . Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 6 15 Weight charts must be accurately recorded to meet the service users assessed needs. 31/01/2009 To ensure that service users needs are appropriately met. 2 12 16 The must provide a range of activities which are appropriate to meet the needs of service users. 28/02/2009 So that service users have access to a variety of social and cultural activities to meet their needs and interests. 3 20 13 Controlled medication must be accurately recorded and monitored to ensure service users safety. 31/01/2009 To ensure the safety of service users. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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