Inspection on 14/10/08 for The Gables Nursing and Residential Home

This inspection was carried out on 14th October 2008.

CSCI found this care home to be providing an Good service.

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 Nursing and... 06/11/07

The Gables Nursing and... 08/12/06

The Gables Nursing and... 03/11/05

The Gables Nursing and... 04/05/05

The Gables Nursing and... 05/10/04

The Gables Nursing and... 29/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Gables Nursing and Residential Home The Gables Nursing and Residential Home Eastrea Whittlesey Cambridgeshire PE7 2BD     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: Elaine Boismier     Date: 1 4 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 27 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 27 Information about the care home Name of care home: Address: The Gables Nursing and Residential Home The Gables Nursing and Residential Home Eastrea Whittlesey Cambridgeshire PE7 2BD 01733351252 01733204610 corbyan@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Dawn Anne Harbour Type of registration: Number of places registered: BUPA Care Homes (CFC Homes) Ltd care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: One named service user under the age of 65 years for the duration of their residency in the category of DE Up to 3 places in category DE for service users aged between 60 and 65 years of age Up to 45 places to provide nursing care Date of last inspection Brief description of the care home The Gables is a purpose built building providing accommodation, support and care, including nursing, for up to 55 people over the age of 65 years with mental health needs or dementia. The home is situated on the outskirts of the village of Eastrea, which lies east of Peterborough and two miles from the neighbouring market town of Care Homes for Older People Page 4 of 27 Over 65 54 54 4 0 Brief description of the care home Whittlesey. Public transport is available from Whittlesey to Peterborough and other nearby market towns. Accommodation in the home consists of 55 single rooms, all of which have en-suite facilities, and the home has other bathing and toilet facilities, which are provided with aids to enable the needs of the residents to be met. The gardens, which surround the home, include a sensory garden and there are views over surrounding arable land. Current fees range from £425 to £880 and additional costs include those for hairdressing and toiletries. Additional information about the fees can be obtained from the home. A copy of our inspection report is available on request from the home or via our webiste at www.csci.org.uk Care Homes for Older People Page 5 of 27 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 last key inspection took place on the 15th October 2007 and it was completed on the 6th November 2007. We, The Commission for Social Care Inspection, carried out this key unannounced inspection, by two Inspectors, between 9:40 and 14:00 and it took us 4 hours and 20 minutes to complete. Before the inspection we looked at the results of surveys we received from some of the staff, some relatives and one from a resident. An Annual Quality Assurance Assessment (AQAA) was also received from the home. During this inspection we spoke with the residents and the staff, including the Manager. We watched how staff were working and we observed activities in the home. Care Homes for Older People Page 6 of 27 We examined documentation and we had a look around the premises. For the purpose of this inspection report people who live at the home are referred to as people, person or resident/s. What the care home does well: What has improved since the last inspection? What they could do better: The assessments of people who have been identified as having challenging behaviours could be developed further to find out if there are any triggers (antecedents) that cause such behaviours. We expect the home to manage this rather than we make a requirement on this occasion. The records of when people have their position changed, when they are in bed, could be better. We expect the home to manage this rather than we make a requirement on this occasion. The standard of keeping peoples (hand) nails clean could be better. We expect the home to manage this rather than we make a requirement on this occasion. The peoples experiences at mealtimes was less than positive and could be much improved. We expect the home to manage this rather than we make a requirement on this occasion. The air temperature of the home needs to be at a level suitable for all of the people living there. We expect the home to manage this rather than we make a requirement on this occasion. Staff should have the opportunities to attend training in how to care for people with dementia and also for those people with challenging behaviours. We expect the home to manage this rather than we make a requirement on this occasion. Care Homes for Older People Page 8 of 27 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 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 27 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. People have a good standard of information to assist them in their decision where to live and there are good systems in place to make sure that the home can meet the needs of any person before they move in. Evidence: We received one survey from a resident that told us the persons family had information about the home before the person moved in. We received 3 surveys from relatives and these said that the person received enough information about the home before their relative moved in to live there. The Annual Quality Assurance Assessment (AQAA) told us The QUEST programme has been developed to ensure that we provide continously (sic) high levels of person centred care. All prospective residents undergo a pre-admission assessment to ensure the home can meet any identified need and the placement will be appropriate. All of Care Homes for Older People Page 11 of 27 Evidence: the 3 residents files that we examined had the QUEST document and this told us that the person had a full assessment of their health and social care needs, carried out by a senior member of nursing staff, of the home, before the person moved in. Care Homes for Older People Page 12 of 27 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. People receive a good standard of health care and mainly a good standard of personal care from kind and caring staff. Peoples dignity is sometimes, but not always, respected. Evidence: Three residents files were examined and we compared the detail of these with our observations of these people. The information in the care records was detailed and provided information about the life history and the needs of the person, including communication and mental health needs. It was not always clear, however, from the assessments, what triggers (antecedents) evoked any of the residents challenging behaviours. We expect the home to improve this area of assessment. Where the assessment provided such detail, we observed that the staff did not follow this guidance, for one of the people (See Standard 15 of this report). The resident survey said that the person usually had the care and support, including medical support, that they needed. One of the relatives surveys said that I have Care Homes for Older People Page 13 of 27 Evidence: always been more than satisfied with the care and attention my (relative) has been given. From an examination of one persons repositioning chart (to reduce the risk of pressure sore development) we could not tell if their care plan was followed, due to indecipherable writing and incomplete records. This is an area that needs to be improved by the home, rather than we make a requirement on this occasion. We noted that, from information provided by the Manager, that no current person had a pressure sore. The care files that we saw, and from our observations, that people have access to weekly visits, or more, from a general practitioner. The AQAA told us that an area that the home would like to improve is access to dentistry services. A requirement was made following the last inspection, about records for fluid intake. Although we did not see any such records we saw that the people were offered drinks during the mid morning and again at lunch time. We consider that this requirement has been met, based on our observations. We noted that people were well presented with clean clothes and hair although the standard of cleanliness of some of the peoples nails could be better. We expect the home to improve this area of personal care. A requirement was made with regards to medication administration records (MARs). We examined a number of MARs and considered that the requirement had been met. Medication was stored in a safe manner with the exception of the drug fridge that had temperatures ranging between minus 8 degrees to 14 degrees centigrade. According to the Manager arrangements have been made for a replacement fridge. Eye drops were dated when opened and the amount of controlled drugs reconciled with the records. The controlled drug register had the name of the dispensing pharmacy. We saw the staff knock on peoples doors before they went in and the interaction of the staff with the residents was kind and caring. During our inspection of the 15th October we noted there was an over usage of endearments such as love. During this inspection, of 2008, we noted that the staff were calling people love, darling and good girl. Another member of the staff referred to people, who needed help with their food, as feeds. (See also Standard 15 of this report). We expect the home to manage this issue, rather than we make a requirement. Care Homes for Older People Page 14 of 27 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. People have opportunities to live an adequate quality of life that could be better. Evidence: Since the last inspection the home has successfully recruited two activities cocoordinators, both of whom were on duty at the time we were at the home. We watched some of the people taking part in activities such as writing and art work and we saw photographs of some of the people weaving baskets. One of the residents care files told us that the person had contributed in the arrangements of the homes summer fete. We were informed that arrangements have been made for a person to go swimming. Taxi services are used to help people go out into the community. The residents surveys said that sometimes the home provided suitable activities that the person could take part in and we were told the same in one of the surveys from a relative who completed the survey on behalf of the resident that they were linked with. Although we observed how people are offered choice, with regards to choice at meal times (Standard 15) we have insufficient evidence to say whether or not people are offered choice, and as such we have considered this standard as generally met. Care Homes for Older People Page 15 of 27 Evidence: We saw people coming into the home to visit and evidence from the relatives surveys suggest that people receive visits from their families. The residents survey said that they always liked their meals and we were told the same in one of the surveys from a relative who completed the survey on behalf of the resident. One of the people we spoke with said that they liked the food and that they had a choice if they wanted. The AQAA noted that menus are available on individual dining tables and we saw that this was the case (albeit the main course served was different to that on the menu). Nevertheless there were alternatives, to the main menu, and we saw that an alternative choice of a salad, sandwich or omellete was offered to a person who chose not to have the main course of fish pie. We observed lunch time activities in one of the communal areas and we noted that this was a less than positive experience for the people. We saw some of the staff standing over some of the residents when helping them with their food and drink; one member of staff started helping a resident but this activity was taken over by another member of staff. For one person, who had a care plan that said they needed prompting to feed themselves, their spoon was left out of their reach and no encouragement or prompting, from the staff, was offered. When assisted, a member of staff, contrary to the persons care plan, sat close to the person (such close proximity was assessed to cause the person to become distressed and agitated-See Standard 7 of this inspection report) and placed a spoon of food directly into the persons mouth, rather than encouraging the person to be independent with this. We noted there was no choice offered for the type of drink people had (orange juice was the only drink given). We saw that a member of staff asked a person if they wanted a drink and gave the person their drink, without waiting for a reply. It was during our lunchtime observations that we noted the staff calling residents love darling etc (See Standard 10 of this report). We discussed our findings, about the lunch time experience, with the Manager, who told us that action has been taken to improve this area of poor practice. Care Homes for Older People Page 16 of 27 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. People are listened to and there are generally good systems in place in responding to any incidents of abuse against any of the residents. Evidence: The residents survey said that the person knew how to make a complaint and knew who to speak to if they were unhappy about something and we were told the same in one of the surveys from a relative who completed the survey on behalf of the resident. All of the 4 staff surveys said that the staff knew what to do should any resident or visitor have a concern about the home. The residents survey said that the staff always listened to what the person said to them and acted on this information and this was also reflected in the relatives surveys. The AQAA told us that the home has received 2 complaints within the last 12 months, both had been resolved within 28 days and both had been upheld. An examination of the record of complaints indicated that the home took seriously what the complainant had to say and the response to the complaint was that of a listening manner. Not all of the staff have attended training in safeguarding awareness although we were informed that the home has a member of staff who has been trained to train staff in this area. The staff we spoke with were able to tell us what they would do if they witnessed, or suspected, any abuse against a resident. Risk assessments were seen on Care Homes for Older People Page 17 of 27 Evidence: 3 of the peoples files that we examined and these assessments were how to reduce the risk of abuse from any other resident. The AQAA told us that there have been 35 safeguarding referrals within the last 12 months although, due to the mental health needs of the people, such a high number is not extraordinary. Since our last inspection we have been made aware of some of these safeguarding alerts and we are satisfied that the home has generally taken action to safeguard the vulnerable people in the home. Discussion with the Manager indicated that, recently, there was a delay in reporting safeguarding incidents, with particular regard to out of hours safeguarding services, action is now being taken to address this issue. (Safeguarding was previously referred to as protection of vulnerable adults or POVA). Care Homes for Older People Page 18 of 27 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. People live in a clean and generally comfortable home. Evidence: During the tour of the premises we saw that the home was well-maintained and had a good standard of decoration, including pictures on the walls of the corridors. There were well presented small courtyard gardens with garden furniture. Although when we visited the weather was cool and damp the Manager told us that the people can freely visit these gardens. A recommendation was made to consider the residents designated smoking area of the home. According to the Manager no resident smokes everyday, with the exception of the occasional cigarette. Although we saw no record of the fire safety officer (FSO) visit, the Manager informed us that the FSO had inspected this designated area of the home and considered that it met with the smoking regulations. We noted that the air temperature of the home was cool and within an enclosed bathroom the air temperature was recorded at 21 degrees centigrade. One person said that they felt cold and some of the people we touched had cool hands and arms. We expect the home to take action to ensure that the air temperature is suitable to the needs of all the residents. Care Homes for Older People Page 19 of 27 Evidence: A requirement was made about to ensure that any unpleasant smells are eradicated. This requirement has been met as we found the home to be clean and we found no offensive smells. The AQAA told us that We use a specialist microfibre cleaning system that combined with effective cleaning regimes keeps the home clean and odour free. We saw the staff placing soiled linen in appropriate red bags and information provided by the staff indicated that infection control procedures are followed by them. Care Homes for Older People Page 20 of 27 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. People can be confident that they are cared for by kind and caring staff who are wellrecruited and, on the whole, well-trained. Evidence: The staff we spoke with told us that they liked working at the home and we saw that the staff were kind and caring toward the residents. We saw, for example, a member of the staff touch a residents shoulder as they walked by. The staff said that there was enough staff on duty to meet the individual needs of the residents and the residents survey, and all of the staff surveys, said that there was usually enough staff on duty to meet their needs. Currently there are no vacancies for staff. A recommendation was made about increasing the number of staff with National Vocational Qualification (NVQ level 2 or equivalent, in care. Currently the home has 40 of staff with this NVQ and, according to the Manager, arrangements are in place to increase this percentage and thereby would meet Standard 28. Two staff files were examined, including a registered nurse and all the required information was available, including evidence that, whilst a criminal record bureau check is awaited there are arrangements in place to make sure the person does not work alone. Care Homes for Older People Page 21 of 27 Evidence: Three requirements were made with regards to staff training, including induction training, supervision of the staff during this induction period and availability of information about staff training. All of these requirements have been met. Examination of two files of staff most recently recruited, and discussion with the Manager, indicated that the induction training, is in line with the Skills for Care Common Foundation Standards, and this includes safeguarding awareness. Copies of certificates of such training was available in the files that we saw. There was evidence that a mentoring scheme is in place, during the induction training. We received 4 surveys from staff who said that they were satisfied with their induction training and that they received ongoing training to make sure that they were able to meet the needs of the residents and that this training was in line with up to date practice. Information about the staff training was available for our inspection purposes. The staff we spoke with said that they had attended training, with particular regard to mandatory training (see Standard 38 of this report) although training in caring for people with dementia and challenging behaviours had been attended some time past, or not at all. The Manager said that she would consider taking action to improve the training of staff in dementia care and how to care for people with challenging behaviours. Care Homes for Older People Page 22 of 27 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. People benefit from living in a well-managed and safe place. Evidence: The Registered Manager, a Registered Mental Nurse, has the Registered Managers Award. She has demonstrated an understanding of the requirements of the responsibilities of a registered manager, to include reporting to the CSCI of any untoward incident. There has also been compliance with all of the requirements made since our 2007 inspection. The AQAA was completed in a timely and satisfactory manner that provided information about what the home does well in, what has improved within the last 12 months and, as part of the homes quality assurance, what areas could be better, and plans to improve these identified areas. Two of the most recent copies of the regulation 26 reports, made by a representative of the registered owner, were seen and these demonstrated that audits were carried out on areas such as care plan Care Homes for Older People Page 23 of 27 Evidence: documentation, complaints, health and safety and medication. We do not know the views of any of the people, including the residents and the staff, about the home, as none were recorded. The home does not keep residents personal monies, in cash, as these are deposited in an interest bank account. Balances are recorded in peoples individual names and receipts are kept. We saw that there is a clear audit trail of any transactions made. The AQAA told us that 100 of catering staff and 85 of care staff have attended training in safe food handling. Records for temperatures for hot water, in bathrooms were satisfactory as were records for daily and monthly fire alarm and emergency lighting tests. Records for fire drills were seen and these recorded the names of all of the staff who attended this fire safety training, the last of which took place on the 18th September 2008. The staff we spoke with said that they had attended training in fire safety, moving and handling and infection control. The AQAA noted that checks have been carried out, in 2008, for portable electrical equipment and fire detection and fire fighting equipment. A report of a visit by the environmental health officer, in January 2008, said that the kitchen was Extremely clean and well run. Care Homes for Older People Page 24 of 27 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 25 of 27 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 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 Care Homes for Older People Page 26 of 27 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. 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