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Inspection on 21/12/06 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 21st December 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 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.

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 Gables provides service users with well co-ordinated care and support to ensure independence and lifestyle is maximised as much as possible. Staff members are committed and enthusiastic in providing proactive support to assist service users in making choices about their lives. Care plans are presented in a person centred format. Clear guidance and documentation is in place to ensure that individual service user`s support needs and lifestyle preferences are being met. It is not always possible to gain comments from all of the service users due to their verbal communication skills. However observations on the day confirmed that service users were supported in a friendly and respectful manner.

What has improved since the last inspection?

The acting manager and staff team have worked positively to review and improve the services provided in the home. The atmosphere and morale is much improved and there is now a greater emphasis placed on teamwork rather than completing tasks. The care planning processes are well co-ordinated and have been reviewed to ensure consistency. The home provides all care plans in a person centred approach format to ensure that service users are involved as much as possible in making choices about their lives. There have been improvements made to the environment including a completely refurbished shower room. Decoration and refurbishments have been carried out in a number of areas of the home including corridors, lounge and service user bedrooms.

What the care home could do better:

Improvements need to be made to the environment including one of the corridors, which needs repair and redecoration. It is also recommended that the downstairs bathroom facilities should be reviewed to improve bathing facilities for service users. The storage of medication held in service user`s bedrooms must be improved. Arrangements for the supervision of staff needs to be developed and improved to ensure that performance and development needs are regularly monitored. Suitable locks need to be installed on service users bedroom doors to aid security and privacy.

CARE HOME ADULTS 18-65 The Gables (Cambridge) Limited 93 Ely Road Littleport Ely Cambridgeshire CB6 1HJ Lead Inspector Andy Green Key Unannounced Inspection 21st December 2006 10:00 The Gables (Cambridge) Limited DS0000037198.V322534.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 (Cambridge) Limited DS0000037198.V322534.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 (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 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 ***Post Vacant*** 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.V322534.R01.S.doc Version 5.2 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 21st June 2006 Date of last inspection Brief Description of the Service: 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 six miles away from the city of Ely. The current charges for placements in the home ranges from £650 - £1400. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Andy Green, Regulation Inspector and Cathryn Bramham, Regulation Manager undertook this key unannounced inspection 21st December 2006. They met with the acting manager, senior staff, support workers and service users to gather views regarding the services that are provided in the home. A number of records were inspected including care plans, training records, staff files, medication records and fire testing and health & safety records. A tour of the building and grounds was also undertaken. What the service does well: What has improved since the last inspection? The acting manager and staff team have worked positively to review and improve the services provided in the home. The atmosphere and morale is much improved and there is now a greater emphasis placed on teamwork rather than completing tasks. The care planning processes are well co-ordinated and have been reviewed to ensure consistency. The home provides all care plans in a person centred approach format to ensure that service users are involved as much as possible in making choices about their lives. There have been improvements made to the environment including a completely refurbished shower room. Decoration and refurbishments have been carried out in a number of areas of the home including corridors, lounge and service user bedrooms. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 6 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 (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 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.V322534.R01.S.doc Version 5.2 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. 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. Prospective service users have access to good information, and can make an informed choice regarding the home’s services. EVIDENCE: The Statement of Purpose has recently been reviewed to ensure that all required information remains up to date. There have been no admissions to the home since the last inspection and the acting manager stated The home obtains information via the care management process prior to admission to ensure that they can meet the individual’s assessed needs. Reports are received from Psychiatrists, Psychologists and Speech and Language therapists. Relatives are encouraged to be involved in the referral process where appropriate. A number of visits to the home can be arranged for prospective service users before they make a decision to move in. There have been no admissions to the home since the last inspection. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are treated with dignity and respect and receive personal care to meet their assessed needs. Detailed care plans are kept to make sure each service user receives appropriate care and support. EVIDENCE: The care plans of three service users were inspected and they contained detailed and appropriate information. The care plans are now presented in a far more professional and accessible manner with clear guidelines to ensure that the care and support needs of each service user can be appropriately provided. Information included a pen picture, likes and dislikes, review of activities, support and personal care needs including guidelines for the delivery of care and records of visits made by healthcare professionals. All of the service user plans are now in a “Person Centred Plan” format, which gives a more holistic approach to care and incorporates the service users views, choices and preferences as much as possible. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 10 . It was noted that the acting manager and staff have worked hard in making a number of improvements to the care planning process and there is a clear commitment to ensure that these improvements are maintained. There is a risk assessment procedure in place to ensure that service users are protected from harm both within the home and when accessing the community. The acting manager conducts care-planning meetings with trained staff and key workers to ensure that there is a consistent approach. Regular reviews of care plans take place and include any updates or changes in care. This was evidenced in the care plans seen during the inspection. Each service user has a key worker and link worker to ensure that care is consistently delivered to meet individual needs. Staff members spoken to during the inspection confirmed that they continued to be regularly involved in the care planning process. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,1315,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The staff provide appropriate support to ensure that service users can access the community to engage in activities appropriate to their needs. Service users have a choice of meals, which are prepared and served in a homely manner. EVIDENCE: Wider ranges of activities are being developed both in the home as well as access to the community for service users. During the inspection there was clear evidence of service users and staff engaging socially in the home. Each service user’s preferences/activities are recorded in their care plan with any changes monitored and reviewed. Examples include cookery sessions, art and crafts and attendance at a local day centre. Service users make regular trips to the local community, with staff assistance. This includes personal and house shopping, meals in restaurants, pub trips and cinema. Trips to local events including theatres are also organised throughout the year. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 12 Service users are encouraged to furnish/equip their bedrooms to meet their style so that they are they able to enjoy spending time in their own rooms as well as using communal facilities. Service users benefit from a varied menu in the home and service users receive a choice of meals to meet their dietary needs and preferences. Service users continue to be involved in the shopping and preparation of food where possible. The acting manager stated that a number of service users are now encouraged to access the additional kitchen space to make their own snacks and drinks with the assistance of staff where necessary. A dietician is available to give advice regarding service users dietary requirements as necessary. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. Care is provided appropriately in the home. There are clear guidelines regarding the safe administration of medication. However improvements regarding the storage of some medication need to be improved. A risk assessment procedure is in place to protect service users. EVIDENCE: Service users continue to receive care from a wide range of healthcare professionals including GPs district nurses, occupational therapists, chiropodist and speech & language therapy. Outpatient appointments are also arranged as required. The acting manager stated that there had not been any new contacts with healthcare professional since the last inspection. Staff assist service users with personal care where appropriate and clear guidelines were recorded in the care plans seen during the inspection. Healthcare is documented in individual care plans and visits from healthcare professionals are recorded as appropriate. Assistance is also given so that service users can access outpatient appointments at local hospitals or surgeries. Risk assessments are recorded on individual files and are regularly reviewed to ensure that service users are protected from potential harm. Three service user files were inspected and risk assessments were in place. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 14 Medication records were accurate and up to date. However it was noted that a prescribed cream was not safely stored in one of the service uses rooms and an immediate requirement was left with the acting manager regarding this issue. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints process to make sure that service users and their representatives are able to raise concerns and have them dealt with appropriately. There are suitable arrangements for ensuring the protection of service users from neglect or harm. EVIDENCE: The home’s complaints procedure ensures that all concerns are fully investigated and actioned appropriately. There have been no complaints raised with the home since the last inspection. CSCI has also not received any complaints since the last inspection. The home ensures that adult protection issues are dealt with in line with local authority policies, to ensure that service users are protected from potential abuse. Care staff confirmed that they receive appropriate training to ensure they are aware of adult protection procedures and was also evidenced in the home’s training programme. It was observed that care staff interacted and spoke with service users in a friendly and social manner, which was appropriate to service user’s individual need. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 16 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): 24,25,26,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment of the home provides service users with a safe, comfortable, clean place to live. However, there are areas in the home, which need refurbishment and redecoration. EVIDENCE: The home is generally suitable for the needs of the service users. The handyman continues to deal with day-to-day repairs and refurbishments in the home and the maintenance of the gardens. Service users bedrooms were seen and they are personalised, furnished and decorated to meet the individual service user’s needs and preferences. The home was generally clean and free from odours. The upstairs shower room has been completely refurbished to a high standard giving service users a more appropriate and accessible area. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 17 The front lounge has also been redecorated and a new carpet has been laid. Redecoration has been carried out to some of the corridors and three bedrooms have been re-carpeted. The walls in the corridor near to the service users kitchen are in need of repair and redecoration Consequently a requirement will be made regarding this issue. It was noted that bedroom doors are not fitted with locks. This was discussed with the acting manager who stated that she would ensure that this work would be carried out with appropriate locks being fitted to aid security and preserve the privacy of service users. Consequently a requirement will be made regarding this issue. It is also recommended that the downstairs bathroom needs to be reviewed to improve health and safety regarding bathing. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. The agency’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 personal care to the service users they support EVIDENCE: Three staff files were seen and they contained appropriate information including two references and evidence of satisfactory POVA/CRB checks. Staff training in the home continues to be well co-ordinated and a programme is in place to ensure that mandatory and client specific training is delivered. Refreshers and regular updates continue to be organised throughout the year. NVQ training is also in place for care staff and managers to meet expected nationally agreed standards. 3 members of care staff spoken stated that they had received a variety of training in the home including induction, moving & handling, fire safety, first aid, food hygiene, moving and handling, medication administration, COSSH, POVA, challenging behaviour, person centred planning, epilepsy and NVQ training. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 19 Care staff confirmed that they felt well supported by the management team and that they were actively encouraged to be involved in the development of the service. They also confirmed that morale in the home had improved and that there was a good teamwork approach which is more outcome based rather than being task driven. There are vacancies for two support workers and one registered nurse at present. Any shortfalls in care hours are being met by the use of agency staff. Staff supervision has been infrequent and needs to be improved. The acting manager is aware that this is an area that needs to be improved and she stated that this would be developed to ensure that staff are adequately monitored on at least 6 occasions during the year. The acting manager stated that senior staff would be taking a more active role in supervision and that it is anticipated that they would have delegated groups of care staff that they supervise. Consequently a requirement will be made regarding supervision. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 20 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): 37,38,39,42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well managed and the acting manager provides supportive leadership to ensure high quality care is delivered and monitored through quality assurance processes. EVIDENCE: The acting manager has provided, with her senior staff team an inclusive and supportive management style in the home. Since the last inspection a detailed ‘Improvement Plan’ has been actioned regarding the service and the acting manager and her staff are to be commended for the positive and active improvements that have and continue to be made. CSCI has received a copy of the ‘Improvement Plan’. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 21 There was a positive atmosphere in the home and staff confirmed that they now feel more actively involved in the service in a proactive manner especially in the care planning processesand the improved teamwork approach. The acting manager stated that a new manager had been successfully recruited and should commence employment in the home by the end of January 2007. Weekly alarm and monthly emergency light testing records were inspected and were recorded accurately. Water temperatures are also accurately recorded. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 22 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 3 ENVIRONMENT Standard No Score 24 3 25 3 26 2 27 3 28 2 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X 3 3 X The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 23 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 3 4 Standard YA20 YA26 YA28 YA36 Regulation 13(2) 12(4)(a) 23(2)(b) 18(2) Requirement Medication held in service user’s bedrooms must be stored securely. All service user’s bedroom doors must have locks fitted. The premises need to be well maintained and kept in good decorative order. Arrangements must be in p0lace to ensure that staff are regularly supervised. Timescale for action 21/12/06 28/02/07 28/02/07 28/02/07 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 YA29 Good Practice Recommendations It is recommended that the layout of the downstairs bathroom is reviewed to aid service users when bathing. The Gables (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 (Cambridge) Limited DS0000037198.V322534.R01.S.doc Version 5.2 Page 25 - 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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