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Inspection on 15/10/08 for The Gables Care Home

Also see our care home review for The Gables Care Home for more information

This inspection was carried out on 15th October 2008.

CSCI found this care home to be providing an Good 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.

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

People told us they were "very well satisfied with the care and support", and that a relative was "safe and well cared for" at the home. One person said, "it`s lovely here". A visitor said they had seen "an amazing difference" in their relative since admission to the home. People told us they, or their relatives, were treated with respect by staff. They said the staff were "kind and helpful", "always friendly", and, "they talk properly to people". The expert by experience said, "The care staff I observed all worked well together, carefully moving and handling those residents who needed assistance, vigilantly watching others and were sensitive to those who liked to take an afternoon siesta. It was obvious from the chatter, talk and exchanges between them and residents that there was a good rapport, a happy and relaxed atmosphere and ambiance at the home". Eleven of the fifteen care assistants had achieved National Vocational Qualification (NVQ) Level 2 in care - this exceeded the national minimum standard of 50% of care staff with NVQ at level 2 or above.

What has improved since the last inspection?

The owner, Mrs Rzepa, had become the registered manager for the home. She was supported by the deputy manager. People told us the manager and deputy manager were "easy to get on with" and "approachable". They said there was a good atmosphere in the home and "everything runs smoothly". The main entrance door to the home had been fitted with a code pad lock to improve security. The door leading to the stairs to the laundry had also been fitted with a code pad lock to protect people from possibly falling on the stairs. New bedding had been provided in some of the bedrooms. New tables and chairs had been provided in the dining room. A new bath hoist had been installed in a first floor bathroom.

What the care home could do better:

There could be more active involvement, where possible, of people and / or their relatives in care planning. There were some gaps in care plans that should be addressed to ensure that people`s needs were fully met. There could be a more structured approach to providing activities for people in the home, particularly for people with dementia. The employment of a suitably experienced activities coordinator would help to ensure better use of local resources and the provision of more meaningful activities for people in the home.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Gables Care Home 37 Manchester Road Buxton Derbyshire SK17 6TD     The quality rating for this care home is:   two star good service 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: Rose Moffatt     Date: 1 5 1 0 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. the things that people have said are important to them: They reflect 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 Older People 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. Care Homes for Older People Page 2 of 31 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. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Gables Care Home 37 Manchester Road Buxton Derbyshire SK17 6TD (01298)70567 01614423783 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Theresa Rzepa Type of registration: Number of places registered: Mrs Theresa Alice Rzepa,Mr Jaroslaw Antoni Rzepa care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of persons to be accommodated at The Gables is 23 To admit into The Gables 1 LD place under 65 years for a service user named in the Notice of Proposal letter dated 30th June 2006 Date of last inspection Brief description of the care home The Gables is a care home registered to provide personal care and accommodation for up to 23 older people. The home is located on the outskirts of Buxton in the Derbyshire Peak District. Local amenities include an opera house, leisure complex, park and shops. Accommodation is provided on 2 floors with a passenger lift and stair lift accessing the upper floor. There is a large communal lounge and separate dining room. 15 of the bedrooms are single accommodation and 4 are double. There are no bedrooms with en-suite facilities. There is a garden accessible to residents. Car parking is available at the bottom of the steep drive. Information about the service, including Care Homes for Older People Page 4 of 31 Over 65 23 0 Brief description of the care home CSCI inspection reports, is available in the entrance area of the home and on request from the manager. Care Homes for Older People Page 5 of 31 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. The fees range from 345.52 pounds to 374.31 pounds per week. This information was provided by the deputy manager on 21st October 2008. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. Care Homes for Older People Page 6 of 31 We looked at all the information we have received, or asked for, since the last key inspection or annual service review. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. We carried out an unannounced inspection visit that took place over six and a half hours on one day. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. There were 20 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. The manager, (who is also the owner), was available and helpful throughout the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. Three people were selected and the quality of the care they received was assessed by speaking to them and / or their relatives, observation, reading their records, and talking to staff. The inspector was accompanied by an expert by experience, Mrs Iris Wagstaffe, for part of the inspection visit. An expert by experience is a person who, because of their shared experience of using services, and / or ways of communicating, visits a service with an inspector to help get a picture of what it is like to live in or use the service. The expert by experience spoke to people living in the home and their relatives about the lifestyle in the home and their views of the service. Information from the findings of the expert by experience has been included in the body of this report. What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Older People Page 8 of 31 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. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 thorough assessment process ensured that people were confident their needs could be met at the home. Evidence: We looked at the records for three people living in the home. Each person had an assessment by the home manager and also by social services prior to admission. Each person had a letter confirming that the home would be able to meet their needs. The home also re-assessed people already living in the home if they had been admitted to hospital to ensure their needs could still be met at the home. People told us they had enough information about the home before they moved in and they confirmed that an assessment of needs had been carried out by the home and social services. People said their needs, or those of their relative, were met at the home. They said they were very well satisfied with the care and support, and that a Care Homes for Older People Page 11 of 31 Evidence: relative was safe and well cared for at the home. Staff told us they had training to help them meet the needs of people living in the home, such as training about manual handling and the care of people with dementia. The AQAA said that there was a trial period to ensure the persons needs could be met at the home. Standard 6 did not apply as there were no people in the home receiving intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a focus on individual needs so that people received the care they needed in the way they preferred, and their dignity was promoted. Evidence: People told us they, or their relative, received the care and support they needed. They said, its lovely here. A visitor said they had seen an amazing difference in their relative since admission to the home. The expert by experience said, The care staff I observed all worked well together, carefully moving and handling those residents who needed assistance, vigilantly watching others and were sensitive to those who liked to take an afternoon siesta. It was obvious from the chatter, talk and exchanges between them and residents that there was a good rapport, a happy and relaxed atmosphere and ambiance at the home. We looked at the care records for three people living in the home. Each person had details of their preferred daily routine. The care plans had sufficient detail of the action required by staff to meet the persons needs, including maintaining their privacy and Care Homes for Older People Page 13 of 31 Evidence: dignity. The care plans covered most of the assessed needs of each person, although there were some gaps. One person did not have a care plan that specifically addressed pressure area care and the action to be taken by staff to reduce the risk of developing pressure sores - this person had been assessed as at high risk of developing pressure sores. Two people did not have a care plan about the help they needed with washing and dressing - although this information was included in the daily routine, assessment information, and daily records, and staff were able to describe the care needed. The care plans had been reviewed approximately every 3 months, or when there were changes in the persons needs. None of the care plans seen were signed by the person or their relative to indicate involvement and agreement. Relatives told us they had been involved in the assessment of the person, but they were not all aware of the care plan. There were informative daily records for each person. The records showed that the persons health needs and general condition were monitored and appropriate action taken. For example, one person was noted to be chesty, was seen by their GP the same day and antibiotics started. Their subsequent progress was commented on in the daily records. There were records of visits by the GP, District Nurse, chiropodist, optician and dentist. Visitors told us that they were kept informed of any concerns about the persons health, and confirmed that the GP was called promptly when necessary. There were assessments for each person of the risk of developing pressure sores, risk of falls, their continence needs, and their nutritional needs. The assessments had been reviewed and updated approximately every three months. The nutritional assessment included relevant information, but did not have any scoring or rating system to determine if the person was at risk and to indicate what action should be taken to reduce the risk. There were records of each persons weight, usually checked every month. One person could not be weighed as they could not stand on the scales and there were no sit-on scales at the home. We observed that some wheelchairs were used without the foot-plates. There were no risk assessments in place to ensure the safety of people who chose not to use the footplates on their wheelchairs. People told us they, or their relatives, were treated with respect by staff. They said the staff were kind and helpful, always friendly, and, they talk properly to people. We observed staff speaking to people in a respectful and appropriate way. We observed spontaneous affection between people living in the home and staff. Staff spoken with gave examples of how they would ensure privacy and dignity, such as knocking on Care Homes for Older People Page 14 of 31 Evidence: doors before entering, and keeping people covered up as far as possible when helping with personal care. Medication in the home was stored securely. Since the last inspection, a new trolley and a suitable cupboard for storing controlled drugs had been provided. The senior care assistants at the home gave out medication and all had received appropriate training. Each person had a medication administration record (MAR) with a photograph and brief, relevant details. We looked at the MARs for three people in the home. All had handwritten instructions for some medication, (rather than printed instructions from the pharmacist). The handwritten instructions were not signed by the person who had written them, or counter-signed by another person who had checked the instructions. The instructions for a topical cream for one person were not specific about where the cream should be applied. It appeared for one person that they had not been given eye drops as prescribed for over a week as there were no signatures to indicate administration of the medication or code letters to indicate why it had not been given. There were suitable records of the receipt and disposal of medication. Care Homes for Older People Page 15 of 31 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. 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. Although people were generally satisfied with the lifestyle in the home, there was a lack of structured, appropriate and meaningful activities to meet the needs of people with dementia. Evidence: There were photographs displayed in the home of activities people had taken part in. The manager said that a party was planned for bonfire night and also a Christmas pantomime by visiting entertainers. There was a weekly programme of activities displayed in the dining room, although there was no evidence of any organised activities on the day of the inspection visit. The home did not employ an activities coordinator, the manager organised activities and outings. The manager said that she took some people out regularly in her car. The home did not use the local community transport scheme to take people out. Some people went out regularly with relatives. Two people went out most days, one to a day centre, and the other to their previous family home. There were games and jigsaws in the dining room for people to use. However, these were not all appropriate for people living in the home as they were designed for children. Care Homes for Older People Page 16 of 31 Evidence: There was a large television in the central communal area of the home where most people were sitting. The expert by experience observed that Due to the constraints of this area some of the armchairs and the sofa were not conveniently placed to enable comfortable television viewing. In the large lounge, there was a small television that did not have a clear picture. Both televisions remained on throughout the day, even when people did not appear to be watching them. There was a music CD player in the dining room with an appropriate selection of music. There were times during the day when the volume of the music seemed loud, although we observed some people enjoying the music at times. The expert by experience said the home should consider setting up a residents and relatives group and a residents amenity fund. She said the homes owner / manager agreed it might be useful to consider these ideas but felt that many relatives would not wish to make regular commitments to supporting such a group. People told us they made good use of the gardens, when the weather allowed. One visitor said their relative in the home enjoyed walking around the garden and also liked the view of the garden from their bedroom. There were bird tables in the garden that people could see from inside the home. Staff said that they took people for walks in the grounds when they could. We found that routines in the home were flexible. People could get up and go to bed when they chose. If people chose to get up later in the morning, breakfast was still available to them. A visitor told the expert by experience, the staff are always willing to do a bacon and egg breakfast even at 11.30 am or even in the middle of the night if requested. People could spend time in their room when they wanted to. Visitors told us they were always made welcome and were offered a drink, or could make their own if they wanted to. They said they could have a meal with their relative in the home if they wanted to. The home encouraged visitors to take people out if possible and to join in with activities and events. Most people ate in the dining room. Since the last inspection, new dining tables and chairs had been provided. The dining room was spacious and had a view onto the garden. People told us they usually enjoyed meals at the home. One person told the expert by experience that they preferred the way the cook at the home prepared cabbage as its much tastier than how I did it. The expert by experience sat with people during lunchtime and said, Care staff appeared to comprehend and react to known preferences and certainly knew how and what residents liked e.g. preferred drinks. I witnessed two care staff patiently assisting three residents with their lunch in Care Homes for Older People Page 17 of 31 Evidence: a gentle and unhurried manner. The expert by experience made the following suggestions to improve meals and mealtimes at the home: - menus for the day on each table (on the day of my visit the menu on the dining room notice board was almost a week out of date. - cruets on all tables - all tables to have covers - all tables to be laid with full sets of cutlery (at my visit the only cutlery supplied to residents were spoons although one lady was eventually offered and given a fork - paper napkins to be provided in addition to the protective aprons provided for frailer residents - consideration to be given to more aesthetically attractive receptacles than plastic beakers in which to serve cold drinks... - centrepieces for each table of seasonal flowers or foliage or good quality artificial flowers... - portions on most plates appeared to be of similar amounts and I noticed that a number of residents left substantial amounts uneaten - perhaps some extra attention and monitoring of the sizes of portions could be undertaken. Also, that the home could consider providing a platter of prepared assorted fruit to residents at some point each day. Care Homes for Older People Page 18 of 31 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. There were satisfactory policies in place and good staff awareness so that people were protected and they were confident their complaints would be taken seriously. Evidence: People told us they knew how to make a complaint and said they were confident the manager or deputy manager would take appropriate action to address any concerns. The complaints procedure was displayed in the main entrance area of the home. We looked at records of complaints. There were records of minor and more formal complaints with details of the action taken and the outcome. There were also records of compliments made about the home. There had been no complaints made directly to CSCI since the last inspection. Most staff had received training about safeguarding vulnerable adults. Staff we spoke with knew what to do if abuse was alleged or suspected. There were appropriate policies and procedures in place. Staff were not aware of the Mental Capacity Act 2005. One person at the home was using a local advocacy service with the support and encouragement of the manager and staff at the home. The manager said the person had benefited from using the advocacy service as their voice can now be heard. Care Homes for Older People Page 19 of 31 Care Homes for Older People Page 20 of 31 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, 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. 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 was clean, well maintained and suitably equipped so that people enjoyed a safe, pleasant environment that met their needs. Evidence: Since the last inspection, the main entrance door had been fitted with a code pad lock to improve security. The door leading to the stairs to the laundry had also been fitted with a code pad lock to protect people. New bedding had been provided in some of the bedrooms. New tables and chairs had been provided in the dining room. A new bath hoist had been installed in a first floor bathroom - the flooring in this room needed replacing and the manager said this was to be done as soon as possible. The large lounge was bright and comfortably furnished. Chairs were arranged in two groups, rather than all around the edges of the room, to give a more homely appearance. The central communal area was clearly favoured by most people as they were at the centre of everything going on in the home and could have access directly to the garden in good weather. This area was furnished with comfortable chairs and a sofa arranged on either side of the room. As noted by the expert by experience, this arrangement was not ideal for viewing the television. The bedrooms seen were personalised with peoples own belongings, photographs and, sometimes, furniture. Care Homes for Older People Page 21 of 31 Evidence: The ground floor of the home was spacious and allowed easy access for people using walking frames and wheelchairs. We observed that people were able to move around freely on the ground floor as any areas of risk had been secured, such as by keeping the kitchen door closed, and using a code pad lock for the main door. The home was equipped with a lifting hoist, bath hoist, handrails, and a passenger lift to the first floor. A visitor told the expert by experience that the home offered a safe and secure environment. There were large, mature gardens with level paths and garden furniture. One person said it would be useful to have a bench in the lawned area of the garden. People clearly enjoyed the gardens and commented on the trees and the autumn colours. At the last inspection, we found that the room off the kitchen was being used as a smoking room for people living in the home. As this did not meet the smoke-free regulations, the use of the room for smoking was stopped and people who want to smoke now go outside. People told us the home was always clean and fresh. The home appeared clean throughout and was free from offensive odours on the day of the inspection visit. Most staff had received training about the control of infection. We observed staff using disposable gloves and aprons appropriately. Since the last inspection, to improve the control of infection, disposable paper towels were available in communal and staff handwashing areas, and disposable wipes were provided for use when assisting people with personal care. Care Homes for Older People Page 22 of 31 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. There were good recruitment practices, satisfactory staff training and staffing levels so that people were protected and supported by a well motivated staff team. Evidence: From discussion with people, observation, and looking at staff rotas, we found there were sufficient staff available when needed. There were three care staff on duty all day and staff said this was enough to meet the needs of the people currently living in the home. In addition to the care staff, the manager worked in the home on three or four days each week. There was also a cook each day, plus domestic staff and a maintenance man. We looked at the records of three members of staff. All the records included the required documents and information, although two did not have a full employment history. There was an induction programme for new staff, though this did not meet the Skills for Care standards. Training records showed that most staff had received the required training, such as manual handling, first aid, and safeguarding vulnerable adults. Most staff had received training about the care of people with dementia. Senior care assistants had received appropriate training about the safe-handling and administration of medication. Care Homes for Older People Page 23 of 31 Evidence: Eleven of the fifteen care assistants had achieved National Vocational Qualification (NVQ) Level 2 in care - this exceeded the national minimum standard of 50 of care staff with NVQ at level 2 or above. Staff told us they enjoyed working at the home. One member of staff told the expert by experience that they love coming to work and thoroughly enjoy caring for and supporting residents. Another member of staff said they liked working at the home as we always have time to spend with the residents. People told us the staff were kind and helpful, and, always friendly - we have a laugh. Care Homes for Older People Page 24 of 31 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 was well managed so that people received a service that generally met their needs and was run with their best interests in mind. Evidence: Since the last inspection, the homes owner, Mrs Rzepa, had become the registered manager. Mrs Rzepa was suitably experienced and qualified to manage the home. She was supported by a deputy manager and they shared management responsibilities. People told us they had confidence in the manager and deputy manager to take appropriate action to sort out any problems. People said the manager and deputy manager were easy to get on with and approachable. They said there was a good atmosphere in the home and everything runs smoothly. The AQAA was completed by the manager and deputy manager and was returned to us by the due date. The AQAA contained clear, relevant information that was supported by a wide range of evidence. The AQAA gave details of changes made in the home and Care Homes for Older People Page 25 of 31 Evidence: where they still need to make improvements. The data section of the AQAA was accurately and fully completed. The quality assurance system included annual surveys of people living in the home and / or their relatives. The results of the surveys were available to people. The manager carried out audits of the environment of the home and of the records kept. We looked at the records of peoples personal money kept in the home. The money was kept securely with access limited to the manager and deputy manager. There were records of all transactions with receipts. From information in the AQAA and records seen during the inspection visit, we found that all necessary servicing and maintenance of equipment and systems was up to date. Action had been taken to meet the smoke-free regulations. Staff had received training as required, such as manual handling and fire safety training. As noted in this report, we observed the use of wheelchairs without foot-plates and found there were no risk assessments in place regarding this practice. We looked at accident records and found that these were mostly satisfactory, although some did not have sufficient information about the circumstances of the accident. The manager and deputy manager were not fully aware of the notifications to be sent to CSCI about events in the home. A notification had not been sent about a person admitted to hospital. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 27 of 31 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 Requirement 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 Requirement Timescale for action 1 7 15 The care plan must cover all 30/11/2008 of the assessed needs of the person. This will ensure that the persons needs are fully met. 2 7 13 There must be a risk 30/11/2008 assessment in place for each person who chooses not to use the footplates of their wheelchair. This will identify and reduce the risk of injury to people. 3 9 13 The medication 30/11/2008 administration record must be accurately completed for all prescribed medication, using the initials of the person giving the medication or a code letter where medication has not been given. This will ensure that people are protected and receive medication as prescribed. Care Homes for Older People Page 28 of 31 4 38 37 The home must notify CSCI of all events as specified in the regulations. This will help to protect people. 30/11/2008 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 1 7 Wherever possible, people living in the home and / or their relatives should be actively involved in the planning and review of care. Care plans should be signed by the person or their relative to indicate their involvement and agreement. Care plans should be reviewed and updated at least every month to ensure that the persons changing needs are accurately recorded and appropriate action taken to ensure needs are met. The home should have sit-on weighing scales to ensure that the weight of all people living in the home can be accurately monitored. The nutritional assessment should include the conclusions of the assessment and the action to be taken by staff to ensure the persons needs are met. Where there are handwritten entries on medication administration records, these should be signed by the person writing them and counter signed by another person who has checked the entry is correct. This will protect people and ensure medication is given as prescribed. There should be a more structured approach to providing activities at the home, particularly with the needs of people with dementia in mind. This would help to ensure that people living in the home were involved in meaningful and enjoyable activities each day. The suggestions of the expert by experience ( see Daily Life and Social Activities section of this report) should be considered to enhance the quality of care for people living in the home. There should be information available in the home, and training for staff, about the Mental Capacity Act 2005. This will help to protect people and ensure their rights and 2 7 3 8 4 8 5 9 6 12 7 15 8 18 Care Homes for Older People Page 29 of 31 choices are recognised and promoted. 9 29 There should be a full employment history for all staff employed at the home. Any gaps should be noted and a satisfactory explanation provided. This will ensure a more robust recruitment procedure that protects people living in the home. The induction programme for new staff should be in line with Skills for Care standards. This will ensure a thorough induction to nationally recognised standards. Accident records should contain sufficient information so that the circumstances of the accident can be determined. This will help to protect people and to guide action taken to reduce the risks of further accidents. 10 30 11 38 Care Homes for Older People Page 30 of 31 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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