Inspection on 30/10/07 for The Gables Care Home

This inspection was carried out on 30th October 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Gables Care Home 15/10/08

The Gables Care Home 02/05/07

The Gables Care Home 02/05/06

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 The Gables Care Home 37 Manchester Road Buxton Derbyshire SK17 6TD Lead Inspector Rose Veale Unannounced Inspection 30th October 2007 09:30 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 The Gables Care Home DS0000019989.V351747.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 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. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Care Home 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 Vacancy Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 The maximum number of persons to be accommodated at The Gables is 23 2nd May 2007 Date of last inspection 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 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 CSCI inspection reports, is available in the entrance area of the home and on request from the provider or acting manager. The fees at the home range from £333 to £380 per week. This information was given by the provider on 30/10/07. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and took place over 4½ hours. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 20 residents accommodated in the home on the day of the inspection visit. Residents, visitors and staff were spoken with during the visit. The provider and the acting manager were available and helpful throughout the inspection visit. 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 records, staff records, maintenance, and health and safety records. A tour of the building was carried out. At the last key inspection in May 2007 the overall rating for the home was poor and so the home was included in the CSCI improvement strategy. A management review was held with the inspector and regulation manager, and then a meeting with the providers of the service. The providers were required to produce an improvement plan detailing how they were going to make the necessary changes to comply with the regulations and improve outcomes for residents at the home. The improvement plan was produced in the required timescale and all of the requirements made were met. What the service does well: What has improved since the last inspection? Since the last inspection in May 2007, the acting manager, the providers, and other staff had worked together to meet the requirements made, and to make other improvements at the home. All of the requirements made at the last inspection had been met. Care records and staff records had been reviewed and reorganised to include more detail and to make them easier to read. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 6 New staff had been recruited so that it was easier to cover for staff sickness and holidays. The recruitment process had been developed and improved to ensure residents were protected by a more robust system. Of 8 care staff, 6 had already achieved NVQ (National Vocational Qualification) at Level 2 or 3 in care. 2 staff were about to start working towards NVQ Level 2. This exceeds the National Minimum Standard of 50 of care staff with NVQ. There was a continuing programme of redecoration and refurbishment at the home. Since the last inspection, the interior and exterior of the home had been redecorated, new carpets and curtains had been provided in some of the rooms. Residents had been involved in choosing décor. There were plans for further refurbishment, including new dining room furniture. 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 Care Home DS0000019989.V351747.R01.S.doc Version 5.2 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 The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 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. 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 this service. There was a comprehensive needs assessment process so that residents were confident the home was able to meet their needs. EVIDENCE: The care records were seen of 4 residents admitted to the home since the last inspection. Each included a range of assessment information. There was a detailed assessment completed before admission by the provider or the home’s acting manager. There was information about the resident’s needs from social services and / or hospital staff. The home confirmed in writing to the resident that their needs could be met at the home. People spoken with confirmed that the provider or acting manager had visited the resident before admission, and said that residents’ needs were met at the home. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 9 Since the last inspection, the provider had produced the terms and conditions for residents in large print. Standard 6 did not apply to this service. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 10 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. 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 this service. The care plans did not have enough detail to ensure residents’ individual needs and preferences were fully met. EVIDENCE: The care records had been reviewed and reorganised since the last inspection and were more detailed and easier to read. Each of the care records seen had a care plan and the care plans had all been reviewed at least monthly. 1 care plan had been signed by the resident to indicate their involvement and agreement. The care plans were brief and did not include enough detail of residents’ personal preferences, or of the action required by staff to meet residents’ needs. There were assessments of continence and nutritional needs, with appropriate referral to health care professionals. There were records of the input of health care professionals, such as GPs, District Nurses, and chiropodist. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 11 People spoken with said that residents personal and health care needs were met at the home. Staff spoken with were knowledgeable about the care needs of residents. It was observed that staff were aware of residents needs and preferences. People spoken with said that staff treated residents with respect and ensured their privacy and dignity. It was commented that staff were “friendly”, “kind”, and had “a good attitude to the residents”. Medication was administered by staff who had received appropriate training. The medication policy had been reviewed and amended since the last inspection to include all the required information. Medication administration records seen were generally correctly completed. It was seen that handwritten entries were not signed by the person making them, or countersigned by another person who had checked they were correct. This was recommended at the previous two key inspections. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 12 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. 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 this service. There was a flexible approach to activities and routines so that residents’ choices were respected and the lifestyle in the home met their expectations. EVIDENCE: The care records included details of the life history of the resident, including their family, their past interests and jobs. People spoken with said the routines at the home were flexible. For example, a resident was pleased they could enjoy a late breakfast, and other residents enjoyed helping with washing dishes after meals. The care records and policies in the home referred to respecting residents’ choices and staff showed a good awareness of this. The activities provided for residents included a weekly session of music and gentle exercise, walks in the garden and into the town, manicures, and games. The home was planning a bonfire night party for residents and relatives. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 13 Visitors said they were made welcome at the home and were able to visit at any reasonable time. They were pleased that they could make hot drinks for themselves in an area next to the kitchen. Residents said they enjoyed the meals at the home. The dining room was pleasant and spacious with a view of the gardens. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements had been made to the complaints system to ensure that all complaints and concerns were effectively managed. Residents were protected by staff awareness and the policies and procedures in place. EVIDENCE: Since the last inspection, the home had developed the complaints system so that all complaints and concerns raised were recorded. The records included details of the action taken and the outcome. The records showed that complaints were dealt with promptly. No complaints had been received by CSCI about the home since the last inspection. People spoken with were aware of the complaints procedure and said they would be able to raise any concerns with the acting manager or provider. All staff had received training about safeguarding vulnerable adults. Staff spoken with were aware of the correct procedures to follow if abuse was suspected. There were appropriate policies and procedures in place. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 15 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. 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 this service. The home was clean and well maintained so that residents were provided with a pleasant and comfortable environment. EVIDENCE: There was a continuing programme of redecoration and refurbishment at the home. Since the last inspection, the interior and exterior of the home had been redecorated, new carpets had been provided in 5 of the bedrooms, new bedding had been provided, and new curtains in some bedrooms, bathrooms and in the large lounge. There was evidence that residents had been involved in choosing décor. There were plans for further refurbishment, including new dining room furniture. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 16 The gardens were well kept and paths had been re-laid to ensure residents’ safety. Tall trees had been trimmed at the request of residents to allow a better view and more light. Residents clearly enjoyed using the gardens and also the view of the gardens from the communal rooms and bedrooms. The bedrooms seen were personalised with residents’ own furniture and belongings. A resident was pleased they could have their own furniture in their bedroom, commenting, “it’s just like home”. It was commented that there were residents at the home who would benefit from the provision of a ‘stand-aid’ type hoist to ensure safe manual handling. There was a lifting hoist available for residents who needed this. There was a room in the home where smoking was allowed for residents but the room did not comply with smoke-free regulations. Also, as the staff toilet was situated off this room, staff had to walk through the smoke room to use the toilet. The sink for staff to wash their hands was in the smoke room. There were no disposable paper towels provided at this sink, only an ordinary towel. Paper towels would improve the control of infection. The home was clean throughout and free from any offensive odours. Most staff had received training about the control of infection. Staff were observed to use disposable gloves and aprons appropriately. It was commented that disposable wipes should be provided to reduce the risk of cross infection when helping residents with personal care. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were improved recruitment practices, a good staff training programme and adequate staffing levels so that residents were protected and supported by competent staff. EVIDENCE: The staff rotas seen showed that there were usually 3 care assistants on duty for the morning and afternoon shifts, and 1 waking with 1 sleeping-in care assistant at night. In addition, the provider worked at the home for 3 days each week. New staff had been recruited since the last inspection so that it was easier to cover for staff sickness and holidays. People spoken with said there were usually enough staff on duty to meet residents’ needs. There were individual records of staff training that showed staff had received training as required, such as manual handling, medication, and first aid. Staff had also had training about dementia. New staff had received induction training, although it was not clear that this met Skills For Care standards. Of 8 care staff, 6 had already achieved NVQ (National Vocational Qualification) at Level 2 or 3 in care. 2 staff were about to start working towards NVQ Level 2. This exceeds the National Minimum Standard of 50 of care staff with The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 18 NVQ. The acting manager had recently completed the Registered Manager’s Award. Staff spoken with were pleased with the training provided and said they found it helpful. The records of 3 members of staff were seen. The recruitment process had been developed and improved since the last inspection. The records included all the required information and documents. There was evidence of good practice in recruitment, such as a checklist to ensure all required documents were in place, keeping interview notes, and notes where gaps in employment history had been explored with the applicant. The records were well organised, although dates of employment were not easy to find. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was effectively managed and improvements had been made so that the health and safety of residents and staff was generally well promoted. EVIDENCE: The acting manager had recently completed the Registered Manager’s Award. The provider, Mrs Rzepa, said that she intended to be the registered manager for the home and had recently started the application process with CSCI. It was planned that the acting manager would continue in a role with responsibility for care management. Since the last inspection, care staff had each been given an area of responsibility within the home to assist and support management. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 20 The acting manager, the provider, and other staff had worked together to meet the requirements made at the last inspection, and to make other improvements at the home. All of the requirements made at the last inspection had been complied with. The quality assurance system had been further developed to include audits of records kept, and of the environment of the home. There was an analysis of the responses received to surveys and a report of this was displayed in the entrance area of the home. A newsletter for residents and their relatives had been produced and this was also displayed in the entrance area. There was a plan for the continuing refurbishment of the home. Since the last inspection, action had been taken to meet health and safety requirements. The bath hoist, lifting hoist and wheelchairs had all been serviced as required. There were electrical and gas safety certificates in place. There had been recent inspections of the home by the environmental health department and the fire service. Both inspections were satisfactory. As noted previously in this report, it was commented that there were residents in the home who may benefit from a ‘stand-aid’ type hoist to ensure safe manual handling. Also, as noted in the Environment section of this report, the room where smoking was allowed did not comply with smoke free regulations. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 21 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 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 2 The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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 Standard OP7 Regulation 15(1) Requirement Care plans must include details of the action required by staff to meet the resident’s individual needs and preferences. This will ensure residents’ needs are fully met and give clear guidance for staff. Regarding the smoke room, the providers must make sure that residents and staff are protected from avoidable risks to their health safety. Timescale for action 14/12/07 2 OP38 13(4) 30/11/07 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 OP9 Good Practice Recommendations 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. This will ensure medication is given as prescribed. The provision of a ‘stand-aid’ type hoist should be DS0000019989.V351747.R01.S.doc Version 5.2 Page 23 2 OP19 The Gables Care Home 3 4 5 OP26 OP26 OP30 considered to ensure safe manual handling for all residents. Disposable paper towels should be provided for hand washing facilities in communal and staff areas to improve the control of infection in the home. Disposable wipes should be provided for use when assisting residents with personal care to improve the control of infection in the home. The induction training for new staff should meet Skills For Care standards to ensure a structured and robust programme. The Gables Care Home DS0000019989.V351747.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Care Home DS0000019989.V351747.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!