Inspection on 11/07/06 for The Gables Nursing Home

This inspection was carried out on 11th July 2006.

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

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

Other inspections for this house

The Gables Nursing Home 07/11/08

The Gables Nursing Home 23/04/08

The Gables Nursing Home 30/04/07

The Gables Nursing Home 11/10/06

The Gables Nursing Home 06/01/06

The Gables Nursing Home 13/07/05

The Gables Nursing Home 21/12/04

The Gables Nursing Home 19/04/04

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

CARE HOMES FOR OLDER PEOPLE The Gables Nursing Home 231 Swinnow Road Pudsey Leeds Yorkshire LS28 9AP Lead Inspector Ann Stoner Key Unannounced Inspection 10:00 11th & 12th July 2006 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 Home DS0000001338.V301497.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 Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Nursing Home Address 231 Swinnow Road Pudsey Leeds Yorkshire LS28 9AP 0113 2570123 0113 2558644 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) Dr Hussan Ara Minhas Dr Emad-Ul-Mulk Minhas Mr Kevin Joseph Brennan Care Home 23 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (3), Old age, not falling within any other of places category (23), Physical disability (1) The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The place for Physical Disability is specifically for the service user named in the variation application dated 20 February 2004. Not to exceed 3 service users in total for the categories DE and DE(E) Date of last inspection 6th January 2006 Brief Description of the Service: The Gables Nursing Home is an extended converted building that provides personal care with nursing for both men and women over 65 years. It is a three-storey building, but residents have access to only two of these, the third storey is used for storage and office space. The home is situated on a busy main road with good access to public transport for Leeds and Bradford. There are good facilities nearby which include a public house, shops, a post office, a cricket ground and a GP surgery in the grounds of the home. The majority of bedrooms are single but there are some shared rooms. Some rooms have ensuite facilities, the majority of which have limited access. Lounges and the dining room are on the ground floor; the garden can be accessed from one lounge by a portable ramp. On the 12th July 2006 the manager said that the weekly fees ranged from £400 - £500 per week. Additional charges are made for newspapers, hairdressing, chiropody and personal toiletries. Information about the home is available in the front entrance, although some of this is not accessible to people in wheelchairs and people with some visual impairment. Some of the information is out of date. Copies of previous inspection reports are also available in the entrance area. The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group for example Choice of Home. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers outcomes to the people using the service. The judgements categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded within the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk Since the last inspection two unannounced random visits were carried out on the 20th and 21st June 2006 following an incident in the home. The purpose of these visits was to assess the health and safety of residents using bed safety rails. As a result of the visit on the 21st June an immediate requirement notice was issued. This unannounced key inspection, carried out over two days by two inspectors, was the first key inspection during the inspection year 2006/2007. The purpose of this inspection was to monitor the home’s progress in meeting the requirements and recommendations made at the last inspection and random visits and to look at the standard of care for people living in the home. The people who live in the home prefer the term resident therefore this will be used throughout this report. During the inspection, we looked at records, made a tour of the building, saw staff carrying out their work and spoke with residents, staff, and the manager. A pre-inspection questionnaire was sent to the home; this provided some information for this inspection. Feedback at the end of the inspection was given to the manager and the provider (owner). Comment cards/questionnaires are left for residents and visitors at each inspection and are sent out to other professionals before the inspection. These provide an opportunity for people to share their views of the home with the CSCI. Comments received in this way are shared with the provider. One GP returned a comment card; no adverse comments were noted. What the service does well: Good information in the entrance of the home gives people advice on how to contact and use advocacy services. Medication storage and administration is good. Staff are kind when working with residents. The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The outcome for residents in each outcome group was judged to be “poor”. For the home to achieve an “adequate” outcome a significant improvement will be needed in each outcome group. The home continues to admit outside of its registration category, which means that there is no guarantee that it can meet people’s needs. This was discussed with the manager at the last inspection, but there has been no improvement. Information about fees and what the home provides must be given to people on admission, so that they have up to date information about their stay. All residents have a care plan, but because information in these plans is poor and because staff do not always follow instructions in care plans, there is a risk that people’s needs will not always be met. Because of strict routines, particularly around bedtime and getting up in the morning, some people’s choices are overlooked. Visitors to the home said residents’ clothing is not ironed, and they do not always wear their own clothes. This is undignified and must be rectified. The home has an activity organiser, but because activities are not based around people’s previous interests, some residents are left with little stimulation other than the television. The religious and cultural needs of some people are overlooked. Some residents, particularly those who are assisted to bed at 6pm are at risk of dehydration because according to records they do not have anything to eat, and have little to drink, for periods of more 16 hours. To make sure the home is safe and comfortable for people to live in some parts of the home must be decorated, some furniture and bedding must be replaced, and faulty equipment must be repaired quickly. The heating in all parts of the home must be monitored to make sure the temperature is suitable for people living there. The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 7 Controls to stop the spread of infection must be managed properly to make sure residents are not put at risk. The home must have a recruitment system, which makes sure that people working in the home are safe and suitable to work with older people. The manager must take an active role in supervising staff and making sure that practices in the home are safe and meet the needs of people who live there. A number of health and safety concerns must be addressed to make sure residents are safe. These include making sure all bed safety rails are fitted properly and do not create any risk of residents being trapped or falling out of bed over the top of the bed rails. Proper window restrictors must be fitted and food must be stored safely. Some policies and procedures must be reviewed and others must be developed so that staff have clear instructions on how to work with residents. Care records must be kept secure to prevent unauthorised access to confidential information about residents. The home must improve the way that it records complaints and financial transactions made on behalf of residents. A number of requirements and recommendations have been made to address the above. A full list of these can be found at the end of this report. 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 Gables Nursing Home DS0000001338.V301497.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 Home DS0000001338.V301497.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, & 3. Standard 6 does not apply to this home. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home continues to admit people outside of its registration category, which means that staff do not have the necessary skills and experience to meet the diverse needs of the resident group. EVIDENCE: A statement of purpose is displayed page by page on the wall in the front entrance of the home. The position of this document means it cannot be read by people in wheelchairs, or those with any visual impairment. The service user guide is out of date and does not give any information about daily life in the home. The home is using an old brochure but the manager said that a new one is being developed. The home had no way of providing information about the home to a resident, recently admitted, who is registered blind. The manager said verbal details about the home were given. A contract of terms and conditions has not been given to this resident because details about fees have not been finalised. The contract of terms and conditions for another person was out of date. It referred to the home being registered with Social Services and the Health Authority and did not give any information about the rights and responsibilities of all concerned. The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 10 The home continues to admit people outside of its registration category despite this being an issue raised at the last inspection. The home is not registered to admit people with a mental disorder, but a person with mental health needs has recently been admitted. The pre admission assessment for this person had no information about who carried out the assessment, when it was carried out, where it was carried out or who was involved in the process. The assessment stated that the person had ‘behavioural problems’. There was no exploration of how this would affect existing residents in the home, the precise nature of the behaviour, or if staff had the necessary skills and experience to manage the behaviour. A recent incident showed that staff do not have the skills and knowledge to meet this person’s mental health needs. The home has a condition of registration that it does not exceed three residents with dementia. Despite caring for a large number of people with dementia, the home admitted another person with vascular dementia in May 2006. Although some staff have started a distance learning package on dementia care, they did not demonstrate any good practice in caring for people with dementia. Requirements and recommendations have been made to address these issues. The Gables Nursing Home DS0000001338.V301497.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some records and care practices are poor which means that residents are placed at risk of not having all of their health & social care needs met. EVIDENCE: Care plans do not provide staff with clear and detailed instructions on how to deliver care in a way that meets the needs and likes of residents. One person’s communication plan said that staff should discourage paranoid talk, but gave no details about how to do this. There was no care plan on how to communicate with a resident who is registered blind and very deaf, nor was there information for staff about how to communicate with a resident whose first language is not English. One person’s care records made reference to him having hallucinations at night, but there was no information about this, or how to deal with it, in his night care plan. There was an optical prescription in one person’s care records, but no information in his care plan about wearing glasses or of having any sight problems. Staff said he had some glasses in his room but didn’t wear them. One person admitted in May 2006 with a diagnosis of vascular dementia had no care plan for personal care, dementia care, social care or nutrition. The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 12 Instructions in care plans are not always followed. One person had a care plan for controlling body temperature, which said that he should wear suitable clothing. In a lounge where the room temperature was in excess of 90o F he was wearing a jumper and had a blanket over his knees. Another care plan stated that a resident should only smoke when being supervised and observed by staff. Although he had to ask staff to light his cigarette he was left unsupervised to smoke. Another person’s care plan stated that she preferred to go to bed at 9pm, but other records showed that she was assisted to bed at 6pm. Some risk assessments particularly those for smoking, are generic and do not reflect the individual risks to residents. One person’s moving and handling assessment said that he could weight bear, whilst his care plan said that he could not weight bear. Another person’s moving and handling care plan said that a hoist was needed for all transfers. Staff were not seen using a hoist and when asked they said that the hoist is only used in one bedroom for a resident who is nursed in bed. The skin integrity risk assessment for one resident noted that his skin was intact; it was not updated to reflect the pressure damage referred to in a wound care plan. Wound care plans are not sufficiently detailed. One plan had a sketch of the wound but there was no grading of the wound, and although the wound was not healed records ceased on the 7th June 2006. Pressure area care and health care is not managed properly. One resident was identified as being at risk of developing pressure sores on admission. There was a record stating that a pressure relieving mattress was required. His records showed that the mattress was not in place until 2 weeks later, this was after 3 small sores had developed. A review of this person’s nutritional risk assessment stated that his pressure areas were still intact, despite the fact that three sores had developed. Another person’s care plan stated that a pressure relief cushion should be used, but on both days of this visit this resident was sat in recliner chair without any pressure relieving equipment. Another person’s care records said that he should be assisted to the toilet 2/3 hourly to relieve pressure from sitting. During our inspection we did not see this happening. Most air mattresses in use were set at the wrong pressure, indicating that staff do not know how to use them properly. The tissue viability nurse had adjusted one setting, but this had not prompted staff to check the other mattresses. Pressure area care plans do not specify the type of pressure relieving equipment to be used. One resident is deaf but had no hearing aid and no dentures. There was no evidence that the home has tried to do anything about either of these issues since admission. Continence is not managed effectively and according to need. From discussions with staff it emerged that residents are assisted to the toilet only The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 13 twice during the day. This was confirmed by written instructions for staff. If residents wear continence products the exact type of product is not specified within the care plan. The home uses a blister pack system for medication. Medicines are properly stored, drug fridge temperatures are recorded and there is a contract for disposal of medicines. Medication administration records include a photograph of the resident and these records were up to date. There are no residents who self medicate and a self-medication risk assessment is held in care plans. It was clear from talking to a nurse that this is a standard form and there is no proper assessment of the individuals’ ability to self medicate. The nurse was clear on how to deal with drug errors, she said there is no policy on covert medication but said they do not do this; residents have the right to refuse medication. There were no controlled drugs or insulin in use. Staff described how they protect the privacy and dignity of residents by knocking on bedroom doors before entering. However, one resident’s privacy is compromised because her bedroom is used as a communal hairdressing room. As can be seen later in this report residents do not always wear their own clothes, some female residents were wearing men’s socks or knee length pop socks and staff made no attempt to cover up one resident who had her skirt around her thighs. A visitor said that her relative is not always dressed properly and her clothes are not ironed. A number of requirements have been made to address these issues. The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Routines are centred around staff rather than residents, therefore individual choices are restricted. Staff have little understanding about the individual needs of people so that some needs, particularly the religious, cultural, recreational and leisure and diverse needs of people are unmet. EVIDENCE: The routines of the home restrict the individual choices of residents. Staff said that night staff begin their morning routine at 5.30am with assisting residents to get up. They said that the people who are assisted first are usually the people who cannot communicate. Written instructions for night staff confirmed this. These residents are usually the first to be assisted to bed at 6pm. Staff said that these people are given supper in bed, but a visitor said that she wasn’t confident that residents have anything to eat after 6pm. Fluid charts confirmed this. The home has several people with dementia but there is very little recorded about their likes, dislikes and choices in all aspects of their daily life. The diverse, religious and cultural needs of residents are not recognised and acknowledged. Staff failed to realise that one male resident, who was sitting in the sun, was upset at having to wear a female sunhat for protection. A The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 15 resident who is a practising Roman Catholic said that he had not seen a priest since his admission, and he was unable to pray because his rosary beads were stolen whilst he was in hospital; staff were unaware of this. There was no information for staff on how to communicate with a resident whose first language is not English. When asked, staff had no understanding of the specialist needs of people with dementia and failed to recognise how the behaviour of some residents upset other people. The home has an activity organiser who works 7 hours a week; she was sat outside with the same 2 residents for most of the time during the first day of this visit. She explained how she has set up an individual activities file for residents and described activities such as bathing, showering, nail care, hairdressing, bingo and karaoke. She also said she is planning a trip to the seaside and trying to get relatives involved. One visitor said that although she was generally happy with the home, there was no stimulation for residents. This was a view echoed by another relative in a satisfaction questionnaire, which stated, “There could be more activities other than television.” During this visit the TV was switched on in most areas during the day but few people were watching it, and when one person was watching a programme during the afternoon a care worker came along and changed the channel. Staff said that they felt they were making progress in providing activities and spending time with people, but one person’s records over a two week period showed the only activities that had taken place were a shower, hair wash, nail care and listening to music on Sunday. Information about advocacy and contact telephone numbers were displayed in the entrance of the home. One visitor to the home was offered a drink, but said that she is not always kept informed of her relative’s condition. She went on to say that whilst she thought residents had a good breakfast, the menu could be more varied, and she thought one meal the previous week, which was sausage and a mushroom, both in batter, was unsuitable. This was a view reflected in a satisfaction questionnaire where a relative stated that she thought chicken nuggets unsuitable for older people. The home has a 4-week menu cycle, which shows alternatives such as salads, omelettes, and jacket potatoes. The chef said that alternatives are provided. On the first day of this visit one resident had finger food of waffles and fishcakes. Her plate at lunchtime, which remained untouched, was left in front of her until 3.30pm. The following day she was given chicken and salad. At least 3 people walked past the table and asked her if she was going to eat it, one care assistant made an attempt, whilst standing, to help her to eat but gave up very quickly. On both days this person was not offered any alternative. The evening meal on the first day of this visit was spaghetti hoops for people needing assistance, and ½ a small pizza, ¼ bread with toasted cheese, a mini sausage roll and ½ mini pork pie. There was no fruit, The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 16 vegetables or salad. Drinks were offered throughout the day, but staff did not always encourage people to drink. One resident knocked over and spilt a drink without staff being aware; other people had drinks lined up in front of them. One resident, with a weight of 34 kg, had a fluid chart in place. This showed that on the 10th July 2006 she had tea at 4pm and breakfast at 10am on the 11th July. In between she had nothing to eat and approx 300mls of fluid. This person is prescribed Fortisip twice a day, her fluid charts show this is not being given. Another person’s fluid chart showed that she is up at 6am each day and goes to bed at 6pm. On the 10th July she had breakfast at 8am, there was nothing recording the previous evening after 5pm. Previous fluid charts showed a similar pattern. An evaluation of this person’s care plan said that snacks are given, but none were recorded on the fluid chart and none were seen being offered during this inspection. Another resident’s fluid chart showed that he only had 870mls of fluid in a 24 hour period and again nothing to eat after 4pm. A number of requirements have been made to address these issues. The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Complaints are not recorded so there is no way of knowing if they are dealt with properly. Staff have received training on adult abuse but fail to recognise that some practices in the home constitute institutional abuse. EVIDENCE: The home’s system for recording complaints is unacceptable because although details of the complaint are filed away along with any investigation, there is no log or record kept of all complaints received. There was no information available about a recent complaint received by the Commission for Social Care Inspection, which was passed to the home to investigate. The manager said this was because the registered provider was dealing with the matter. There was no record of this complaint anywhere in the home. Two visitors gave examples of complaints they had made, and although dealt with appropriately, again there was no record of this. Care and qualified staff knew about the different types of abuse and were clear about reporting any suspicions of abuse. Senior staff said that they had not considered that reclining chairs and tables that are placed in front of residents throughout the day could be a form of restraint. Most staff have attended training on adult abuse and the manager has attended a ‘train the trainer’ course so that he can cascade abuse training in the home. He was however, unaware of the Multi Agency Adult Protection Procedures. He was advised on how to obtain a copy and how to bring the home’s procedure on adult protection in line with the multi agency procedures. Senior staff must review some practices in the home because they constitute institutional abuse. These The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 18 include, restricting resident choice, institutional routines such as bed times, times for getting up in the morning, toileting arrangements, and failure to meet nutritional and pressure area care needs. A number of requirements have been made to address these issues. The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 25 & 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment is not suited to the needs of the residents and infection control is not managed properly, which puts residents at risk. EVIDENCE: The kitchen food store was dirty and appeared to be used as a changing room for the chef. There was a pair of jeans behind the door and a pair of trainers on the floor alongside a box of carrots, some of which were black, a box of rotting broccoli, a box containing 5 rotting baking apples and a bag of potatoes. One fridge was dirty and had a cardboard container stuck inside a 6” layer of ice on the inside of the fridge wall. Packets of fishcakes, sausages, burgers and other frozen foods in the freezer had been opened, none were tied and there was no record of when the packets were originally opened. One packet of cooked meat was too frozen to distinguish what it was, or how old it was. Several areas of the home need decorating, some chairs in lounges are worn and scuffed, corridor carpets are badly stained and walls and woodwork are The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 20 badly scuffed from wheelchairs. Not all radiators are guarded and the wire mesh radiator guards on first floor make the narrow corridor even harder to negotiate with wheelchairs. The corridor floor from carpet to vinyl is uneven and poses a trip hazard. Storage space is limited and items such as hoists, chair scales and other pieces of equipment are stored in corridors. On the first day of this visit the temperature in the dining room was in excess of 90o F. The manager was asked to deal with this, and the temperature was eventually reduced when an air conditioning unit was moved into the dining room from another communal area. Several bedrooms had dripping hot water taps and many sinks were badly stained. Bed linen was not ironed, some was worn and thin, some white sheets looked grey and the beds were poorly made. Bedside lighting is not provided in all rooms. Not all areas have signs, which places those residents with dementia or a visual impairment at a disadvantage. There is a ramp from one lounge area to the garden. The door to the ramp is kept closed even when it is very hot as it was on the days of the inspection. Staff said this was because one resident might wander out, she was not allowed out alone but it was not clear why not. The garden was not well kept; the activity organiser said that a rockery and a barbecue had been started but had not been completed. The manager described the system of recording and dealing with repairs, but this is not monitored effectively. One bath seat and one mobile hoist have been out of action for over 6 months. The laundry room is used as a domestic staff changing room and was cluttered with numerous items including a birdcage, a baby seat, and a bag of soft toys. On the first day of this visit a care worker was carrying out laundry tasks. She was not wearing protective gloves and apron, and failed to wash her hands after handling dirty linen. The towel dispenser on the wall was empty. One domestic worker transferred a cleaning product from a 5-litre container into an unmarked dispenser, and then diluted this with water. She was not wearing any protective clothing and when asked she was unsure about the dilution ratio of product to water. Another person used a laundry product from an unmarked container without any instructions for use. Domestic staff said that they had received training on infection control, but then described how they clean toilets without wearing gloves or an apron. Staff said that they used the sluice disinfector, which is in the laundry room. There were clinical waste bins throughout the home, but the pedal operation on one bin was not working although the bin was still being used. Used and soiled incontinent pads in all clinical waste bins were not double wrapped. All personal laundry is done in the home and staff said that all clothing is marked with either the resident’s name or initial. Several people had The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 21 underwear and socks in their wardrobe that was not marked, so there is no guarantee that underwear is returned to the right person. A visitor said that her mother was wearing another person’s cardigan; staff confirmed that although it had been taken from her mother’s wardrobe, it did in fact belong to someone else. Another visitor said that her relative did not always wear her own clothes. A number of requirements have been made to address these issues. The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recruitment processes are not robust and do not guarantee that people are suitable to work with residents. Training is on offer, but from observing care practices in the home, the quality of this training is in doubt. EVIDENCE: Staff rotas do not specify the specific hours worked each day, and there is no rota for domestic and catering staff. Although in principle there seems to be sufficient staff on duty, in some communal areas residents are left unattended. During the two days several incidents happened which staff were unaware of and generally there appeared to be a lack of management presence. 50 of the care team have completed a National Vocational Qualification (NVQ) in care and staff seemed to feel that there was a good deal of training on offer. Qualified nurses provide health care training sessions on subjects such as diabetes, eating and drinking, communication and health & safety. From evidence throughout this report the quality of this training and subsequent supervision of care practices is questionable. Some training on dementia care has started to take place. New staff complete an induction package that the home says meets the TOPSS (Training Organisation for Personal Social Services) Induction Standards. There was a written record signed by the inductee and inductor saying that the standards were met, but there was no other evidence available in the home to support this. The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 23 The recruitment records of two people were sampled. In both cases the information supplied on the application form was insufficient; one had no previous work history listed, whilst the other person had only listed her last employer. The manager had made no attempt to rectify this or to explore any gaps in employment. There was only one written reference for each person. The manager had made a written record saying that he had obtained a second reference verbally. Although the manager had a written record of the date on which the CRB/POVA (Criminal Record Bureau/Protection of Vulnerable Adults) disclosure was received by the home, these had been destroyed and therefore were not available for inspection. All interviews are conducted solely by the manager. The record of the interview is more of a prompt for the manager to discuss the job description, sick pay, holidays etc rather than a record of questions, responses, evaluation and outcome of the interview. Requirements and recommendations have been made to address these issues. The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management in the home is poor and institutional and abusive care practices go unnoticed. Poor record keeping means that residents are at risk of financial abuse and poor knowledge of health and safety places residents at risk. EVIDENCE: Management in the home is poor. Many issues that should have been identified through good management practices and supervision have gone unnoticed. This includes the safety risks to residents by poor fitting bed safety rails, poor infection control measures, institutional routines and some maintenance issues. The manager said he likes to be ‘visible and supervise staff’, but this was not seen during this inspection. He said that there is a formal system of staff supervision, but there is no matrix or plan showing when supervisions sessions are to be held. One care worker had not had a formal supervision session since February 2006. The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 25 The manager and his deputy carry out a 6 monthly health & safety audit and a general audit of the home. The deputy manager completed the health & safety audit on the 8th May 2006 and scored the home as maintaining a good standard at 86 . The manager carried out the general audit on 1st July 2006 and scored the home as maintaining an exceptional standard at 89.6 . The effectiveness of these audits is questioned, considering the findings of this inspection visit. Although the provider visits the home on a regular basis, visits determined by Regulation 26 of the Care Home’s Regulations are not carried out. Conflicting information was given about residents’ who have their money managed by the home. The manager and administrator said the home does not act as appointee for anyone, however money for 3 residents is paid directly into the home’s bank account. The records for these three people were confusing. They showed items being purchased for residents by the home, such as cigarettes, hairdressing and chiropody. The administrator said that a running total of all expenditure is kept by the home but is not deducted from the resident’s money until such time as they leave the home. This system means that residents and/or their representatives do not have up to date information, at all times, about their current balance. On admission one resident handed money to the home for safekeeping. The records of this transaction were not clear and entries were made in the wrong place. The home does not give receipts to residents or relatives for money handed over for safekeeping, so it was not possible to establish exactly how much money this person had handed over and what had happened to it. One lounge is like a corridor with people passing through to access other parts of the home. There is a nurses’ station in this area and confidential care records are accessible enabling unauthorised access to personal information about residents. As a result of a recent visit by health & safety inspectors an improvement notice was served on the home requiring proper window restrictors be fitted to ensure the health & safety of residents. Also included in this notice was the requirement to fit a viewing pane to a door at the top of one staircase and a handrail on stairs leading to the top floor. Following an immediate requirement notice, which was served on the 21st June 2006 requiring the home to make safe four bed rails that were in use, a number of divan type beds have been replaced. One remaining divan type bed still has bed rails fitted; and these were capable of moving up and down the bed. Another hospital type bed had bed rails fitted, but the overlay mattress underneath an air mattress made the combined mattress height a hazard as this could lead to the resident falling over the top of the bed rails. The maintenance man has responsibility for checking bed safety rails, but the manager said that he intends to start his own monthly checks. The The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 26 maintenance man finished before we had the opportunity to speak to him. His file showed the only health & safety training he had was from watching videos. The home does not have a trained moving & handling co-ordinator; the manager said there are plans for the deputy to take on this role. From discussions with staff it appears they have only had theory of moving and handling from distance learning packs, therefore have had no opportunity to practise the correct moving and handling techniques. The manager said that he analysed accidents on a monthly basis. However, this appeared to be a record of the number of accidents each month, rather than a detailed analysis of who was involved and where and when the accident happened so that any trends or patterns are identified. The Commission for Social Care Inspection had not been notified about an accident resulting in a resident sustaining a black eye and a cut to her forehead. The manager said that he thought notifications were only necessary in the case of fractures. Requirements and recommendations have been made to address these issues. The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 27 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 2 1 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 1 X 1 X 1 1 1 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 2 1 1 The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 28 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 OP2 Regulation 5A Requirement Each resident must have a statement, by no later than the day of admission, specifying the fees payable by, or in respect of, the resident for the provision of accommodation, including food, nursing and personal care. The registered persons must not admit residents outside of their registration category. This is outstanding from 6.1.06. The registered person must ensure that staff individually and collectively have the skills and experience to deliver specialist dementia and other care to residents. Timescale for action 30/08/06 2 *RQN 14 13/07/06 3 OP4 18 30/08/06 4 OP7 15 This is outstanding from 6.1.06. Care plans must provide staff 30/09/06 with detailed information on how to provide all aspects of health, personal and social care needs to residents. To ensure that resident’s health, The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 29 personal and social care needs are met staff must follow instructions within care plans. Care plans must be reviewed and updated. 5 OP7 12, 13 Risk assessments must be in place for all areas of risks to residents. These must specify the precise risks to the individual and the actions required by staff to minimise the risk. Risk assessments must be reviewed and updated as and when necessary. 6 OP8 12,15, 23 Wound care plans must include grading of the wound. Equipment necessary for the treatment of tissue viability must be provided by the home when needed and staff must understand how to use it correctly. This is outstanding from 31.8.05 and 6.1.06. 7 OP8 12 The promotion of continence must be managed on an individual basis according to need. The privacy and dignity of residents must be respected and protected at all times. This is outstanding from 6.1.06. The practice of using a resident’s room for communal hairdressing services must cease. Residents’ clothing must be ironed. The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 30 30/09/06 30/09/06 30/08/06 8 OP10 12 30/08/06 Clothing laundered on the premises must be returned to the right person. Residents must not wear clothing belonging to another resident. 9 OP12 16 Suitable activities must be provided to residents both inside and outside the home. These must be flexible and varied to meet resident’s expectations, preferences and capacity. This is outstanding from 30.9.05 & 6.1.06. Staff must make sure that the diverse, religious and cultural needs of residents are met. The registered person must conduct the home to maximise residents’ capacity to exercise personal autonomy and choice. This is outstanding from 6.1.06. 12 OP15 12, 16. To make sure residents receive adequate nutrition, nutritional risk assessments must be revised for all residents. Specific training in nutrition and the completion of the nutritional risk assessments must be provided for all staff. A snack meal must be offered in the evening and the interval between this and breakfast must be no more than 12 hours. Nutritious snacks and supplemented food must be provided to all residents who are considered at risk of poor nutrition. The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 31 30/09/06 10 11 OP12 OP12 OP14 12 12 30/08/06 30/09/06 30/08/06 13 OP16 22 14 OP18 13 15 OP18 13 16 OP19 13 Wherever possible residents must maintain a fluid intake of no less than 1500mls each day. The home must keep a log of all complaints that includes information about the nature of the complaint, any investigation, outcome and subsequent action. The home must review all practices in the home to make sure that residents are not at risk of institutional abuse. The home’s policy on adult abuse must be revised in line with the multi-agency adult protection procedures. Hygiene procedures in the food store must be reviewed. The food store must not be used as a changing room. Food must not be stored on the floor. Fruit and vegetables past their sell by date must be destroyed. Fridge and freezers must be cleaned and defrosted on a regular basis. Food that has been opened must be sealed with a record kept of when the product was opened. A programme of refurbishment must be developed. Lounges, corridors and bedrooms must be decorated. Corridor carpets must be cleaned and stains must be removed. Some chairs in communal areas must be replaced. The first and second floor 30/08/06 30/08/06 30/09/06 15/09/06 17 OP19 23 31/10/06 The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 32 corridor areas from carpet to vinyl must be made safe to prevent trips, slips and falls. The garden must be made suitable for the needs of the residents. 18 OP22 23 The registered persons must 15/09/06 ensure that equipment needed for the safe system of moving and handling is in a good state of repair. This also refers to ensuring assisted baths are in good working order. This is outstanding from 6.1.06. 19 OP22 23 The registered person must provide suitable storage space wherever possible. This is outstanding from 6.1.06. Signs must be provided throughout the home to assist those residents with dementia or visual impairment. All radiators must be guarded or have low temperature surfaces. A review of all bedding in the home must take place. Worn and thin bedding must be replaced. Bedside lighting must be provided in all bedrooms, unless the reason for not doing so is specified in the care plan. Stains from wash hand basins in bedrooms must be removed or the basin replaced. 23 OP25 23 Heating in all communal areas must be monitored to ensure that temperatures do not place DS0000001338.V301497.R01.S.doc 31/10/06 20 OP22 23 31/10/06 21 22 OP22 OP24 13 16 31/10/06 31/10/06 13/07/06 The Gables Nursing Home Version 5.2 Page 33 24 OP26 13 residents at risk. Cleaning products must not be decanted into unmarked containers. Staff must not dilute cleaning products unless they are following the manufacturer’s instructions. Cleaning staff must wear appropriate protective clothing when handling cleaning products. Infection control must be managed properly. The laundry room must not be used as a changing room for staff. The laundry should not be used as a storage area. Disposable towels must be provided at all times in all areas where clinical waste is handled. Staff must wear protective gloves and aprons at all times when coming into contact with clinical or bodily waste. All clinical waste bins must be controlled by a pedal control that is in working order. All used and soiled continence pads must be double wrapped. Staff rotas must include all staff working in the home and must specify the precise hours worked each day. 13/07/06 25 OP26 13 30/08/06 26 OP27 Schedule 4 30/08/06 27 OP27 18 The home must review the 15/09/06 deployment of staff to make sure that residents are not left unattended. DS0000001338.V301497.R01.S.doc Version 5.2 Page 34 The Gables Nursing Home 28 OP29 19 & Sch 2 This is outstanding from 6.1.06. The registered person must operate a thorough recruitment process that protects residents. Two written references must be received before any offer of employment is made. Completed application forms must include details of previous employment. All gaps in employment must be explored. This is unmet from 30.8.05 & 6.1.06. Criminal Record Bureau/Protection of Vulnerable Adults disclosure checks must be retained in the home to enable CSCI inspectors to see a sample at inspections. Staff must receive training from suitable qualified people appropriate to the work they perform. This is outstanding from 6.1.06. Staff must be appropriately supervised. The registered provider must carry out unannounced visits to the home as determined by Regulation 26 of The Care Homes Regulations 2001. The registered person must ensure that persons working at the care home do not act as the agent for the resident. This is outstanding from 6.1.06. 30/08/06 29 OP30 18 30/09/06 30 31 OP36 OP31 OP33 18 26 30/08/06 13/07/06 32 OP35 20 30/08/06 The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 35 33 OP37 13 Where money is handled on behalf of residents proper records must be kept of all transactions. The registered person must develop a policy and procedure for staff to follow on the safe use of bed rails. The registered person must ensure care plans are securely stored. This is outstanding from 6.1.06. The home must notify the Commission for Social Care Inspection about all significant events in the home. All bedrails in the home must be checked to make sure that they are safe and free from risks to the resident. The registered person must ensure that the health & safety of residents and staff is protected at all times. This is outstanding from 30.8.05 and 6.1.05. The requirements of the Health & Safety Inspector must be met. 15/09/06 34 OP37 17 30/08/06 35 *RQN 37 13/07/06 36 OP38 13 13/07/06 37 OP38 12 30/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The statement of purpose should be accessible in the DS0000001338.V301497.R01.S.doc Version 5.2 Page 36 The Gables Nursing Home 2 OP1 home. The service user guide should be updated to include information about daily life in the home. The service user guide should be in a format suitable for the needs of the residents. The home’s contract of terms and conditions should be updated to include the rights and responsibilities of all concerned. The home’s pre-admission assessment should show who carried out the assessment, where it was carried out and who was involved in the process. This assessment should form the basis of a care plan, and should demonstrate how the home can meet the person’s needs. A format for assessing the ability of residents to self medicate should be developed. Beds should be made properly and bed linen should be ironed. Recruitment interviews should be carried out by a minimum of two people. The interview schedule should be reviewed so that it reflects how the interview was carried out, along with justification for the outcome of the interview. The interview schedule should be signed and dated by both people conducting the interview. Where money is received on behalf of a resident, a record should be kept of the transaction, with signatures of the person handing over the money and the person receiving the money. Receipts should be issued. The home should have a named moving and handling coordinator. Moving and handling training for staff should include some practise of some moving and handling techniques. All staff should have access to, and be aware of, hazard warning notices relating to the use of bed rails. The manager should analyse all accidents on a monthly basis so that any trends or patterns can be identified. 3 4 OP2 OP3 5 6 7 OP9 OP24 OP29 8 OP35 9 OP38 10 11 OP38 OP38 The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Gables Nursing Home DS0000001338.V301497.R01.S.doc Version 5.2 Page 38 - 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. 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