CARE HOMES FOR OLDER PEOPLE
The Gables Nursing and Residential Home Eastrea Whittlesey Cambridgeshire PE7 2BD Lead Inspector
Don Traylen Unannounced Inspection 11:00 15 October & 6 November 2007
th th 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 Nursing and Residential Home DS0000024303.V354395.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 Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Gables Nursing and Residential Home Address Eastrea Whittlesey Cambridgeshire PE7 2BD 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) 01733 351252 01733 204610 corbyan@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Miss Dawn Anne Feeke Care Home 55 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (54), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (54) The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Up to 45 places to provide nursing care 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 8th December 2006 Date of last inspection Brief Description of the Service: 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 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 ensuite 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. Fees at the home range between £729.00 and £828.00 per week. Copies of CSCI inspection reports are kept in the administrator’s office and in a staff area. These are available for relatives and visitors to the home should they wish to read them. The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection consisted of two site visits conducted on the 15th October and the 6th November 2007. The visit on the 15th October was carried out by two inspectors and was a brief visit of 2 hours using a short observational method to determine the wellbeing of people living at the home and the quality of the interaction with care staff. One inspector carried out the visit on the 6th November when all key National Minimum Standards were assessed. The inspection on 6th November commenced at 11 am and lasted 6.5 hours. It included speaking to residents, staff members, relatives, the deputy manager and the manager. However, it has been possible to include conversations with only one person in this report, due to the level of verbal impairment affecting most of the people who live at the home. The inspection included case tracking three people, observations, reading documents, a tour of the building, views of visiting relatives and information provided in the Annual Quality Assurance Assessment (AQAA) requested from the home by the Commission and referred to throughout this report as, ‘AQAA’. What the service does well:
The home provides care, including nursing and accommodation to older people with dementia and mental health needs, in a safe and pleasant environment. Comments from relatives of people living at the home at the time of the inspection and through surveys conducted prior to the inspection were all positive. The home completes an assessment of need for people who want to live there before they are accepted or move into the home. These are in addition to the assessments from hospital discharge planning teams or PCT social care managers. Written information is available to show people what the home is like, and people who are considering moving into the home and their relatives can visit before moving in. This also ensures the home has enough information to decide whether they can care for a person. All people living at the home have access to healthcare professionals, as they need them. A local GP has made a very significant initiative to ensure the home is able to care for a person should they require dementia related palliative care. The home has developed guidance for staff on how to properly care for a person with such needs and the GP has provided vital systems of support for the home in these circumstances. In addition, the GP holds a ‘significant events’ meeting at the home every month to discuss the important The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 6 and ongoing needs of people. The same GP also visits the home each week to hold a ‘surgery’ to ensure the wellbeing and essential access to health services. The home is active in including the family and relatives in the care planning and this was endorsed as a valuable and appreciated aspect of the home’s approach. Families are encouraged to visit and are consulted about their relative’s care. They are able to stay at the home for as long as they wish when visiting. Meals are varied over a four-week rota and alternatives are available if something is not liked. Relatives of people living at the home are often invited to take meals if visiting during meal times. Information about how to deal with or make complaints or concerns about protection from abuse is available. The home has a well-qualified and experienced manager, who has been in this role since October 2004 and although she was on extended leave at the time of inspection and the interim arrangements for the deputy manager to act as manager were working well. Care staff and the nursing staff all work well as an effective team and this was demonstrated by the knowledge and eagerness shown during the inspection. What has improved since the last inspection?
Two of the three requirements made at the last inspection report have been met. Care plans have been extensively represented in a different format and were current, included the amended risks assessments and the actions to reduce risks and had been represented in a format that was easy to read and well signposted. Care plans are now reviewed each month and were clearly recorded as having been done and showed the changes and alterations to care plans and risk assessments. Full employment details had been obtained prior to the appointment of two new care staff. The home has enhanced their provision of palliative care and has adopted the Gold Standards Framework to work towards. This means the home are committed to giving an effective and planned approach to anticipated care needs. The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 7 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 Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 8 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 Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 9 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): 1,3,6, Quality in this outcome area is good. Pre-admission assessments of prospective users of the service ensure the home is aware of the needs of people considering moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information is available for prospective service users and their relatives or representative. This includes a service users guide and statement of purpose. A contract is provided by the home to service users who are privately funded. The contract for those whose placement at the home has been made through the local authority or PCT is made with the placing authority. Three visiting relatives said the home was the right place for their family member. The manager completes pre-admission assessments to ensure people’s needs are properly assessed and planned for. Assessments of need are also obtained from healthcare professionals and PCT care managers. This gathers as much
The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 10 information as possible about each person before they enter the home and ensures their needs can be met. The home does not provide accommodation for intermediate care. The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 11 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): 7,8,9,10, Quality in this outcome area is adequate. People’s care planning is well recorded although the attention to recording certain aspects of care and medication is less than good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three people’s care was tracked. Their care plans were good. They had been improved since the last inspection. All care plans had been rewritten. These were current and included the amended risks assessments and the actions to reduce risks. One person’s care plan included ways to manage her known risks and associated behaviour. The format was easy to read and well signposted. The plans included details about meeting needs that were action directed and include topics for swallowing advice; use of bedside rails; stimulation; communication with “an aim to understand (name) feelings and eye recognition and non-verbal communication”. Another care plan include a plan to “observe (name) for body language or facial expressions”. Care plans had
The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 12 been reviewed each month and were each recorded as having been done and showed the changes and alterations to care plans and risk assessments expected by the last report. Pressure monitoring and reviews of this are recorded. Significant effort and achievement has been made to the care plans and they are practical and informative tools for care staff. The chart maintained for recording the fluid intake of one person had not been completed for the day of the 05/11/2007, although other information about nutrition intake and turning to relieve pressure had been maintained for that day. This person was bed-bound and dependent upon all his care needs being given to him. The acting manager was informed of this omission during the inspection and was agreed to be addressed immediately by her. As this response was made, an Immediate Requirement was not made on this occasion, although it has been shown as a requirement in this report. The home have enhanced their provision of palliative care and have adopted the Gold Standards Framework to work towards. This means the home are committed to giving an effective and planned approach to anticipated palliative care needs. Medication administration record (MAR) charts were found to be less than good and this was after the previous inspection report indicated similar findings. There was an omission for a daily-prescribed antidepressant drug that was unexplained. Another person’s medication prescribed as “when required” had been marked with a letter when not administered. This was confusing because the new MAR charts did not include any codes for entries, although this has been pointed out to the pharmacist by the home, who were awaiting new MAR charts to be provided. This was discussed with the nurse administering medication and that suitable codes for administering medication must be used and appropriate explanations written for any missed medication and these must be acted upon and recorded. The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 13 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): 12,13,14,15, Quality in this outcome area is good. People enjoy a safe lifestyle and do exercise their choices within a risk-assessed approach. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home no longer employs the two activities co-ordinators referred to in the last report. Staff are intending to taken on these roles but this had not yet been finalised at the 6th November 2007. Meals are served in two of the three dining rooms, in the lounge rooms or service users own room if that is preferred. People are helped to sit in the dining room, and those that need help to eat are given it. Staff members stay with people until they have eaten as much as they want. Lunch was served during the inspection and appeared relaxed and unhurried. A full and varied menu is available in the home. On the 15th October the inspectors observed four people and this observation included the state of being of the person, what they were doing and what and
The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 14 how staff interacted with these people. We observed that the majority of the time people were in a positive state of being and that they did not experience any negative emotion or behaviour. During our observation of four people and how staff interacted with people we noted that activities were provided to two of the four people and this activities were presented in a meaningful and comprehensive way such as painting with two colours a wooden object. On the 6th November 2007 it was noticeable that people were living in a home in a relaxed ambience and where they could safely and individually express themselves through their dementia. Their safety was known and risk assessed. For instance, when one person placed himself the floor to sleep and then to crawl, there was one care assistant present who was there to assist and to ensure his safety. There was an allowance for his behaviour that included anticipation, observation and a degree of risk taking, but all within the range of the person’s physical ability to express himself. There were other instances where individual behaviour was respectfully assessed by care staff. This close attention to individual needs and the freedoms enable people to express themselves through their dementia and indicated that their best interests were upheld. People were actively asked what type of music they would like to hear. Staff were on the whole respectful and attentive to the four people that we were observing. We would suggest that the use of names such as “love” and “dear” does not compromise the dignity of people. We noted that people were given drink and biscuits in a way that was respectful with a couple of occasions when this was not the case. A person was given a biscuit but this was directly into the person’s mouth rather than in their hand. We observed that this person was able to feed themselves with the biscuit with encouragement and prompts. The AQAA told us that, “We have a structured activities programme tailored to the individual needs and preferences of our residents. The home has an open visiting policy taking account of residents wishes. Residents may handle their own finances should they wish to do so”. The AQAA also told us that the area that the home could improve upon is for photographs to be taken of events, which they have done. On the 6th November three visitors to the home spoke to the inspector and stated they were frequent visitors and considered their relatives well cared for and that staff were respectful and attentive. The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 15 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): 16,18, Quality in this outcome area is good. People are assured they will be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Not all staff have received training in protecting vulnerable adults from abuse although this was intended to be provided for two care staff known not to have received this training. Staff stated they would report abuse when asked and felt confident about raining any issue they felt might be abusive. It is recommended that the home also use the local authority provided training in safeguarding/protecting vulnerable adults, in addition to their ‘in-house’ training. This was discussed with the acting manager that the more and the more specialist training offered by Cambridgeshire and Peterborough Local Authorities might be a valuable for the home in safeguarding vulnerable people living at the home. Policies and procedures are available in the home to guide staff in dealing with complaints and safeguarding adults. Information received since the inspection shows the home has responded appropriately to these instances. Not all the records of the instances were available to inspect on the 7th November 2007 and there appeared to be a different arrangement for storing Strategy Meeting minutes held under adult protection Local Authority protocols. It was therefore
The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 16 difficult to ensure what actions had been implemented under adult protection protocols although the home had kept a clear record of their actions in these instances and had informed CSCI when any abusive incident had occurred. The AQAA informed us that 37 safeguarding referrals have been made by the home in line with local reporting procedures and we have evidence (regulation 37 notifications) of these reporting. This high number of referrals is generally due to the nature of the client group that the home provides care for. In April 2007 the Commission was notified of what action the home had taken with regards to allegations of abuse by a member of staff. The home carried out an investigation and found that the allegations not to be proven. In June/July 2007 the Commission was notified of allegations of verbal and physical abuse by two staff members. The home took appropriated action to safeguard people from the risk of abuse by suspending the two staff members pending an investigation. The home had followed correct safeguarding reporting procedures also, including referring one of these staff members to be considered for inclusion on the POVA list. The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 17 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): 19,21,26, Quality in this outcome area is adequate. People enjoy a safe, comfortable and relaxing environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Generally the environment is pleasant and safe. There were no unnecessary hazards or obstacles noticed, an important aspect of the environment where there is a lot of activity and walking around by people living in the building. There was an unpleasant odour of stale urine noticed in some areas of the home near to the main lounge and close to the entrance and corridor off the main lounge. This odour was noticed in the morning at 11 am on the 6th November 2007 and at various times throughout the day in other some other parts of the home. This was discussed during feedback with the acting
The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 18 manager and the associated continence management needs of different people were acknowledged. One person’s bedroom smelled unpleasant and there were at flies in her room when a care assistant accompanied the inspector to the person’s bedroom. The person stated she chose to keep her windows and curtains closed. During feedback to the acting manager it was agreed that opening windows for improved ventilation was a task that care staff should be more aware of. There were small and scattered pieces of litter on carpets in different communal areas and passageways in the home. The carpeting on the stairs leading to the manager’s office was grubby. These floor areas were in contrast to the bathrooms and toilets that were immaculately clean, as were each of the five en-suite facilities that were seen. The home employs two domestic cleaners between Mondays and Fridays and usually one or two cleaners at weekends. The cleaners were observed to be working continuously all day. The continuous task of maintaining the environment is acknowledged by the home that has made these suitable arrangements. In addition, there were two dedicated workers attending to the laundry. The laundry room was very clean, tidy and well organised. The smoking area should be reconsidered. The current procedure is to block of a passageway by closing the doors and ventilating the area by external doors to the inner courtyards. As this is not a dedicated room but a corridor with fire alarm smoke detectors fitted, it is not a satisfactory area to provide as a smoking area. This practice is restrictive use of the corridor and it was observed that at least five people needed to pass through this area at the time when one person wanted to use it as a smoking area. The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 19 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): 27,28,29,30, Quality in this outcome area is adequate. People are assured they are safeguarded by satisfactory recruitment processes but can be better assured their needs will be met by improved training arrangements for care staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a good ratio of staff members to people living at the home on the 6th November 2007. There were three nurses and eight care staff working in the morning of the 6th November and two nurses and seven care staff in the afternoon. 3 nurses staffed the night time shift between 8pm and 8am and two care assistants. The home employs registered nurses trained in mental health nursing and adult nursing, and has at least one registered nurse on duty at all times. During the observational inspection on 15th October 2007 we saw that there was a sufficient number of staff to provide 1:1 attention to residents that included walking, talking, activities and help with drinking and feeding. The AQAA stated, “There is a training matrix specific to the home that identifies the training requirements of all staff.” However,this matrxc was not available on inspection. The acting manager stated that the care staff individual files contained their training undertaken, although these were not accessible by the acting manager on the day of inspection. A subsequent email
The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 20 message revealed that the training spreadsheet, or matrix, was not completed but would be made available to the Commission. On this occasion, the full training arrangements for all staff were unable to be assessed. The records that were assessed in the recruitment folders for two care staff employed within the previous two months showed training was given and a brief induction but there was not structured induction or a recorded plan for training although there was a list of training topics to be dated when provided. The surveys returned by care staff contained a range of comments about the induction programme provided. Two of the 5 staff surveys said that the induction programme covered everything very well in preparation when they started their job; 2 of the 5 surveys said that the induction programme mostly covered everything in preparation when they stared their job. The remaining survey said that the induction programme did not prepare the person at all to do their job. A staff survey said, “I received an extensive induction and training is on-going all the time and is available to all staff.” Three of the staff surveys said that the training provided was relevant to the member of staff’s role; that it helped the member of staff understand and meet the individual and diverse needs of the residents and that the training kept the member of staff up to date with new ways of working. The two remaining surveys stated that the training provided did not meet any of these staff training needs. Two files for two recently recruited care staff were read. The initial first 2-3 days of Induction for new care staff were brief and contained detail of policies shown. However, there was no structured plan to the induction either for the first 2-3 days or for the ongoing induction that was staid by the acting manager to last between 12 weeks and 6 months. The ongoing induction based on the Skills for Care six standards were well presented in an Induction manual that was a usable tool that was expected to be completed during the induction. There was no record of this being started, or monitored by a supervisor for the two people whose files were assessed. The whole induction process was not clearly mapped out. One person was unable to inform me about their induction and what it consisted of. There was no record of how that person was assessed or monitored throughout their induction period. Two care staff could not inform me of their training plan or knew what their future training expectation was. Training opportunities are made known to care staff on the wallboard near to the staffroom and care staff are expected to declare their interest in training topics. Any supervisory arrangements made during the induction process were not recorded. It was evident in the files of two recently recruited care staff that not all staff has received training in protecting vulnerable adults from abuse. As this is a vital topic that overarches all aspects of care, it was discussed with the acting manager for possible inclusion in the first days of induction. The acting The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 21 manager spoke of her eagerness and was positive to promote adult protection training. The AQAA informed us that in the last 12 months 22 full time care/nursing staff and 6 part time care/nursing staff have left. A recommendation was made following the last inspection for the home to have 50 of their care staff with an NVQ level 2 award (or equivalent) in care. According to the AQAA, 22 of care staff have the NVQ level 2 or equivalent in care. This recommendation has not been achieved and should be acted upon and especially as the inspector was informed, the organisation employ people who are NVQ award assessors. The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 22 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): 31,33,35,38, Quality in this outcome area is good. The home is managed in the best interests of people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is registered with the Nursing and Midwifery Council as a registered nurse – mental health. She has worked as manager of the home since October 2004, and previously as a Community Psychiatric Nurse, and is undertaking a Registered Manager’s Award. The manager is currently on maternity leave and an acting manager has been nominated and has been appropriately managing the service in the registered manager’s absence.
The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 23 The relaxed ambience and the close attention to individual needs and the freedoms allowed to enable people to express themselves as already stated in this report, indicate that people’s best interests are upheld. It has previously been reported that people moving into the home are given written information about how the home takes care of their money and the procedures for debiting an account. Statements are sent on a monthly basis, detailing incoming and outgoing transactions, and any interest earned. Although all service users funds are placed into the same account, each service user using the system has a separate written account and record on the computer. The AQAA states that BUPA Care Homes, “hold regular Health & Safety meetings with a standardised agenda givivng staff the opportunity to communicate on Health and Safety issues. The minutes from these meetings go to the Regional Manager. There are dedicated Health & Safety staff within the Quality and Compliance directorate. BUPA Care Homes has a comprehensive suite of policy and procedure manuals that are regularly reviewed by experts and updated when required. BUPA Care Homes has a annual customer satisfaction survey and has appointed a Director of Quality and Compliance and has developed a national Quality and Compliance team of experts.” Quality assurance questionnaires have been sent to people using the service and their relatives, representatives and to stakeholders in the community. Replies are sent to the provider’s head office, information collated and reports sent to the home from there. Regulation 37 reports have been sent to the Commission when appropriate, as have Regulation 26 reports. During a tour of the building it was noted that fire equipment had been checked and records inspected showed fire certificates fire logs books had been maintained and fire drills and weekly and monthly testing carried out. Emergency lighting was recorded as being regularly tested each month. Monitoring the administering of medication, the methods used to help people manoeuvre and checking fluid intake charts were discussed with the acting manager during feedback as recommended ways to ensure quality of care and heath and safety. According to the AQAA 100 of catering staff and 100 of care staff have received training in safe food handling. The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 24 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 3 X 3 X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 25 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 Standard OP8 Regulation 12(3) Requirement Timescale for action 10/11/07 2 OP9 13(2) The home must ensure that the fluid intake amounts are provided to people and are satisfactorily recorded as such for people who are dependent for their fluid consumption to be monitored, so that they are safely cared for. The reason for medication not 01/12/07 being given must be clearly stated on medication administration records so that people are not at risk of under dosing or overdosing. The timescale of 31/01/07 made at the last inspection has not been met. Unpleasant odours must be eradicated. The home must ensure that staff are appropriately trained, including their induction training period and must ensure that this training meets the Skills for Care standards, so that people are assured of well trained staff to meet their needs. 3 4 OP26 OP30 16(2)(k) 18(1)(c) 01/01/08 01/01/08 The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 26 5 OP30 18(2) 6 OP30 Care Standards Act 2000 section 31(1) Newly recruited care staff must be appropriately supervised during their induction period so that people living at the home are assured they are safe. The home must ensure it can make available to the Commission the training arrangements details for all staff when and if requested, so there is evidence that people are provided with appropriately trained care staff. 01/01/08 01/01/08 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 3 Refer to Standard OP25 OP28 OP38 Good Practice Recommendations The area of the home intended for use as a smoking area should be reconsidered. Care staff should be enabled and encouraged to achieve a National Vocational Qualification level 2 award in care. Aspects of care giving such a fluid intake and administering medication should be monitored to prevent the re-occurrence of the incidents referred to in this report. The Gables Nursing and Residential Home DS0000024303.V354395.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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