Inspection on 02/05/06 for The Gables Care Home

This inspection was carried out on 2nd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Gables Care Home 15/10/08

The Gables Care Home 30/10/07

The Gables Care Home 02/05/07

The Gables Care Home 05/12/05

The Gables Care Home 20/07/05

The Gables Care Home 02/11/04

The Gables Care Home 08/04/04

The Gables Care Home 17/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Gables (The) 37 Manchester Road Buxton Derbyshire SK17 6TD Lead Inspector Rose Veale Unannounced Inspection 2nd May 2006 10:00 X10015.doc Version 1.40 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 Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Gables (The) Address 37 Manchester Road Buxton Derbyshire SK17 6TD 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) (01298) 70567 Mrs Teresa Alice Rzepa Mr Jaroslaw Antoni Rzepa Ms Elizabeth Greenfield Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 2005 Brief Description of the Service: 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 Peak District. Local amenities include an opera house, leisure complex and park. Shops are located in the town centre. 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. A spacious garden is provided to the rear of the building. Car parking space is available at the bottom of the steep drive. The fees at the home are from £295 to £345 per week, (this information was provided on 03/05/2006). Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 6 hours. There were 15 residents accommodated in the home on the day of the inspection. Residents and staff were spoken with during the inspection. Some residents 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. Records were examined including care plans, staff records, policies, maintenance records, and health and safety records. The acting manager was available and helpful throughout the inspection. The owners of the home were present for most of the inspection. The acting manager was appointed in February 2006 as the previous manager, Elizabeth Greenfield, had left. What the service does well: What has improved since the last inspection? What they could do better: The care plans needed more detail to ensure that residents needs were properly met. There were areas of the home where the décor and furnishings appeared ‘tired’ and outdated and in need of general upgrading. The quality assurance procedures needed fully implementing to ensure the home was run in the best interests of residents. There were health and safety issues identified which needed action to ensure residents were safeguarded. Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The assessment information was detailed to ensure residents’ needs could be met by the home. EVIDENCE: The care records of four residents were examined. All the records included detailed assessment information, including the community care assessment and the home’s own assessment prior to the admission of the resident. The home confirmed in writing to residents that their needs could be met. Standard 6 does not apply to this home. Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents’ personal and health care needs appeared generally well met. The care plans did not include enough detail to ensure that residents’ needs were properly met. EVIDENCE: Each of the care records seen included care plans which had been regularly reviewed. One care plan had been signed by the resident. The care plans seen did not include all the assessed needs of residents. For example, one resident had recently had a change of medication which required monitoring by staff. Although the change of medication was documented, there was no care plan detailing the action to be taken by staff to meet the residents needs. Records were seen of the input of GPs, community nurses, chiropodist, optician and dentist. It was clear from the daily reports that health issues were followed up promptly. For example, a resident returning from hospital with a pressure sore was referred to the district nurse. Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 10 The care records included details of the resident’s preferred daily routines, and likes and dislikes regarding food and activities. Details of the resident’s family and social history were included. Residents spoken with were satisfied with the care at the home, making comments such as “I’ve always liked it here” and “They do a good job”. Observations of the care provided and discussions with staff showed that staff were knowledgeable about the care needs of residents and familiar with residents’ preferences. It was observed that there were good relationships between residents and staff and that the approach to residents was appropriate and respectful. Staff spoken with were aware of protecting residents’ dignity and privacy. The medication policy / procedure and systems were seen. Medication was stored securely. Medication administration records were generally correctly completed. There were some records completed in pencil and there were handwritten entries which were not signed by the person writing them or signed by another member of staff checking them. All staff who administered medication had received appropriate training. There were no residents in the home who were able to be responsible for administering their own medication. Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The lifestyle in the home generally appeared to meet the expectations and preferences of residents. EVIDENCE: The care records seen included details of residents’ past and present interests and lifestyle, and of their religious and social needs. The care plans seen did not all include the action required by staff to meet residents’ social needs. There were records of activities offered to residents, including playing dominoes, quizzes, and singalongs. On the day of the inspection, residents were observed playing draughts with staff, having a manicure, reading newspapers, watching television and walking in the grounds of the home. Residents were able to exercise control over their lives, within the confines of risk assessment. For example, one resident wanted to go out of the home but was at risk of falling and so was accompanied by staff to walk in the grounds. Details of family contacts were included in the care records. There were no visitors in the home during the inspection. The home had an open visiting policy. Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 12 The dining room was pleasant, spacious and bright. The menu for the week was displayed in the dining room and appeared varied and balanced. Residents spoken with enjoyed the food provided, commenting that “There’s plenty of it” and “I like the puddings”. Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents were not fully protected from abuse due to the lack of staff training in this area. EVIDENCE: The complaints procedure for the home was included in the care records and had been signed by residents where possible. The complaints book was seen and included details of action taken and the outcome of complaints, although there were no recent entries. Staff spoken with were aware of the procedures to follow to protect residents from abuse. Most of the staff had not had training in the protection of vulnerable adults. Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents were provided with generally comfortable, clean and well maintained accommodation. There were matters which potentially compromised the health and safety of residents. EVIDENCE: A tour of the home was carried out. The home was clean, comfortably furnished and homely. There were areas where the décor and furnishings appeared ‘tired’ and outdated and in need of general upgrading. For example, the wallpaper was peeling away from the wall in one bedroom, and some bedroom furniture provided looked old and worn. Requirements made at previous inspections to cover exposed pipework in the hallway and to provide a suitable lock for the laundry door had been met. There was a cracked window pane in a vacant bedroom. Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 15 The laundry facilities included two washing machines and two dryers. Neither of the washing machines had a sluicing/disinfection cycle for soiled laundry. It was stated by staff that commode pans were emptied and cleaned in the toilets. There was a sluicing sink provided on the ground floor, but it appeared that this was not being used. Disposable aprons and gloves were provided for staff to use when assisting with personal care. Some staff training had taken place in the control of infection. There were several wash basins in communal areas which did not have liquid soap and paper towels provided. Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Staffing levels appeared adequate to meet the needs of residents. Although progress had been made, residents were not fully protected as there were gaps in staff training and staff records. EVIDENCE: The staff rota was seen and was found not to be a correct record of staff on duty. The staffing levels were appropriate for the number of residents accommodated. Staff spoken with said that staffing levels were adequate for the needs of residents. Additional domestic, laundry and catering staff were provided. Observation of care practices indicated that there was an adequate level of staffing in the home. The acting manager had some supernumerary time allowed for management responsibilities and said it was planned that this would be increased when more staff were recruited. There were vacancies for two senior care assistants. Two staff files were examined. One included most of the required information, including two written references and a Criminal Records Bureau disclosure. One did not include written references. The provider stated that references had been obtained verbally and written references had been requested, although there was no evidence of this. Neither of the files included a recent form of identification or a photograph. Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 17 Staff training records were seen. Each member of staff had an individual record and these were well kept. The records showed that staff had received most of the training required, including fire safety, first aid, and health and safety. Most staff had not had a recent update in moving and handling and had not had training in the protection of vulnerable adults. Of eight care staff, six had either achieved or were working towards NVQ Level 2 or 3 in care. The acting manager said that she and deputy manager were to commence NVQ Level 4 at the end of May 2006. Most staff had completed an ‘Induction into Care’ training programme. The file of a new staff member included the home’s own induction programme and the staff member confirmed that they were booked onto the ‘Induction into Care’ training at the local college. Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The overall management of the home was satisfactory. However, the health, safety and welfare of residents was compromised by the lack of a robust quality assurance system, and by potentially unsafe practices identified. EVIDENCE: An acting manager had been appointed in February 2006. The acting manager was experienced in the care of older people and had previously worked at the home as a senior care assistant. Staff spoken with were pleased about the appointment of the acting manager and said that she was well organised, helpful, supportive and ‘hands on’. The acting manager has applied to be registered with CSCI. Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 19 There was a quality assurance policy/procedure for the home. The provider said that questionnaires had been completed by residents / their representatives in previous years and a report compiled of the findings. The provider said that this had not happened for this year because the home had been without a manager for some time prior to the appointment of the present acting manager. The provider carried out Regulation 26 visits to the home and a report had been seen of the visit in January 2006. No reports since then were available at the home. Records were seen of residents personal money held in the home. The records were satisfactory and the money was stored securely in a safe. Records relating to health and safety were examined. The accident book was seen and was generally satisfactory. One entry had been completed in Polish as this was the care assistant’s first language. The entry had not been translated. The fire log book was up to date. Maintenance records were sampled and were up to date. It was observed that wheelchairs were being used without the footplates in place when transferring residents. The acting manager said this was to prevent possible injury to residents’ legs. There were no risk assessments or assessment by physiotherapist seen in residents’ records regarding this practice. There were items stored under the cellar staircase which potentially presented a fire hazard. Staff had not had recent updates in manual handling training related to moving residents. It was noted that some manual handling training had been included in the Induction into Care course which most staff had attended. This training was related to the general principles of manual handling, rather than specific to the manual handling needs of residents. Observation of care practice indicated that staff were aware of correct manual handling techniques when transferring residents or changing the position of residents in bed. Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 2 Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES 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. 5. 6. 7. Standard OP7 OP19 OP26 OP26 OP27 OP29 OP29 Regulation 15(1) 23(2)(d) 23(2)(k) 13(3) 23(2)(k) 13(3) 17(2) 19(1)(b) 19(1)(a) (b) Requirement Every resident must have a written care plan detailing how their needs are to be met. All areas of the home must be kept reasonably decorated. Adequate sluicing facilities must be provided for soiled laundry. Adequate arrangements must be put into place for the cleaning and disinfection of commodes. The staff duty rota must be a correct record of the hours of staff working at the home. A photograph and recent form of identification must be held for all staff working at the home. Two written references must be received prior to the commencement of the employment of staff. Previous timescale 05/01/06 The registered person must implement formal quality assurance systems. Original timescale 01/03/06 All staff must have appropriate training in the protection of vulnerable adults. DS0000019989.V292792.R01.S.doc Timescale for action 30/06/06 31/07/06 31/12/06 31/05/06 31/05/06 30/06/06 31/05/06 8. OP33 24(1)(a) 31/10/06 9. OP38 13(6) 31/10/06 Gables (The) Version 5.1 Page 22 10. 11. 12. OP38 OP38 OP38 13(4)(b) (c) 13(4)(b) 37 Arrangements must be in place to ensure the safe use of wheelchairs. All staff must have appropriate training in manual handling. Notifications must be made to CSCI of any occurrences under Regulation 37 of the Care Standards Act. 30/06/06 31/10/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP9 Good Practice Recommendations Entries on medication records should be written in black ink. Handwritten entries on medication records should be signed by the member of staff writing them and countersigned by another member of staff who has checked the entry is correct. Disposable towels and liquid soap should be provided in all communal and staff toilets. 3. OP26 Gables (The) DS0000019989.V292792.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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