Inspection on 11/10/06 for The Gables Nursing Home

This inspection was carried out on 11th October 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 11/07/06

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 11th October 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables Nursing Home DS0000001338.V314221.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.V314221.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.V314221.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 11th July 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 October 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. Copies of previous inspection reports are available in the entrance area of the home. The Gables Nursing Home DS0000001338.V314221.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 Following the last inspection enforcement notices were served on the registered providers to address serious shortfalls in the management of continence, nutrition, privacy and dignity, infection control and skills and experience of staff. The home has made significant progress in all of these areas and the date for meeting the requirements of the enforcement notices has been extended by four weeks until the 17th November 2006. After this date a further monitoring visit will take place. This unannounced key inspection, carried out over two days by two inspectors, was the second 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, the requirements of the enforcement notices 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, the manager and visitors to the home. A pre-inspection questionnaire was sent to the home before the last inspection in July 2006, and this provided some information for this inspection. Feedback at the end of the inspection was given to the manager and one of the registered providers (owners). Social Services and the Primary Care Trust have recently been in contact with some relatives and comment cards/questionnaires were left for residents and relatives at the last inspection. So as not to place an additional burden on relatives and residents additional survey cards were not sent out before this inspection. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home has worked hard at trying to meet the requirements of the enforcement notices. In recognition of this hard work, the date for meeting the requirements in full has been extended. The home is working in partnership with a community dietician in trying to improve nutrition for residents, and people are being assisted to the toilet more regularly. The hairdresser no longer uses one person’s bedroom for communal hairdressing services, and during the inspection residents who were sitting in an undignified position were covered with a blanket to protect their dignity. A number of improvements have been made to the environment. Air condition units have been fitted in lounge areas, three new lounge chairs have been purchased, some clinical waste bins have been repaired, a bath seat and hoist have been repaired, some sinks have been replaced and stains removed from others, and corridors are being decorated. To comply with the requirements of the health and safety inspector a viewing panel has been fitted on a corridor door and new window restrictors have been fitted, although the replacements are not sturdy and one broke during this inspection. The kitchen storeroom is now tidy and is no longer used as a changing room for the chef. A recent environmental health visit showed that the home had met the requirements of the last inspection. The laundry room is clean and tidy and is no longer used as a changing room for cleaning staff. Although further work is needed, infection control in the home has improved. Care records are secure and care plans now contain some good information about the resident and his/her life before he/she was admitted to the home. Residents are been offered more snacks in-between meals and the dietician is giving staff training on how to increase calorie intake and encourage residents to take more fluids. Storage sheds are being erected in the garden area to help ease the home’s lack of storage space. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 7 Changes have been made to the duty roster so that it is easier to see who is on duty and the hours that they have worked. The deputy manager has completed a moving and handling co-ordinator’s course so that she can now train other staff in the home. What they could do better: The quality rating for all outcome groups remain poor, but if the home continues to improve this will be reflected in the quality rating at the next key inspection. The home must meet the requirements of the enforcement notices relating to nutrition, infection control, privacy and dignity, promotion of continence and skills and experience of staff. To do this infection control must be managed by providing staff with protective aprons and disposable gloves in all areas where there is contact with bodily fluid and/or clinical waste is handled. To maintain residents’ dignity their clothing must be returned to them in a good condition after laundering and clothing and underwear must be returned to the right person. An individual continence programme must be developed for a minimum of two residents, and this must be reviewed and amended where necessary with a view to promoting continence. In order to improve nutrition the recommendations from the dietician’s training session must be put into practice. Wherever possible residents’ must be provided with a daily fluid intake of no less than 1500 mls. Qualified staff must complete accurate nutritional assessments, so that risks are identified and care plans are put into place. Staff must transfer learning from a dementia course into practice when working with residents and they must show that they are skilled in meeting the needs of all residents. The home must only admit residents whose care needs can be met at the home. The home’s pre-admission assessment information should be more detailed so that staff know the precise care needs of people before they are admitted. All residents have a right to know the terms and conditions of their stay and they must have a statement of terms and conditions by no later than the day of admission. Care plans must give staff clear instructions so that they know the level of care required for each person. Staff must use equipment, needed by residents who are at risk of developing pressure sores, properly. Staff must follow proper procedures when recording and giving out medication, so that residents get the right medication at the right time. Care must be given in a way that respects the individual choices of residents. Residents must be consulted about all aspects of their daily life and their choices, wherever possible, must be respected. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 8 Suitable activities must be made available to all residents so that their daily life is as stimulating as possible. The home’s policy on adult abuse must be amended to give staff clear instructions on the action that they must take if they suspect any resident is being abused. In order to prevent the risk of financial abuse, residents’ money must not be held in the home’s bank account. Two communal lounges are very cramped. The home must look at ways of creating more spacious seating areas for residents. For safety reasons window restrictors must be sturdy, corridor areas from carpet to vinyl must be made safe, the garden area must be suitable for the needs of residents and bed rails must not be fitted until a proper assessment has taken place and alternative safety measures considered. Staff must use safe procedures when moving and handling residents. For the comfort of residents stained pillows must be replaced, bedside lighting must be provided in all bedrooms, and this must be within easy reach when the person is in bed. Lockable space must be provided in all rooms. The home must look at staff working routines and practices to make sure that residents are not left unattended and proper recruitment checks must take place to make sure that staff are suitable to work with older people. The home’s induction programme for new staff must be up to date, and give staff correct information on the best way to deliver care. The induction programme must be cross-referenced to the Skills for Care induction standards. To manage all of the above changes the manager needs to be supernumerary to the duty roster. A list of the requirements and recommendations made to address these issues 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 summary of this inspection report can be made available in other formats on request. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 9 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.V314221.R01.S.doc Version 5.2 Page 10 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, 2, 3 & 4. 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 Residents’ needs are not always met because the home has continued to admit people outside of its registration category. Through their working practices staff do not demonstrate that they have the skills to meet the needs of people with dementia. EVIDENCE: The statement of purpose is on the wall in the entrance of the home, but is also within the service user guide, which is placed on a small table in the front entrance. The print is small making it difficult for some people to read. The care records of two residents, both of whom were admitted since the last key inspection visit, were seen. It was clear that the home has continued to admit outside of its registration category, despite this being raised at previous inspections. Both residents had an assessment completed before admission The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 11 and from the details recorded it was clear that confusion and dementia were one of the main areas of need in both cases. The home carried out a pre admission assessment, but this was basic, and it was not clear when and where the assessment was carried out, who completed the assessment or who was involved in the process. Only one person had a signed contract of terms and conditions of the home. This document is out of date as it refers to the home being registered with Social Services and the Health Authority and states that it is registered to provide ‘mental aftercare’. The manager said that four staff have completed a distance-learning workbook on ‘understanding dementia’, but there was little evidence of good practice in dementia care seen throughout the inspection. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 12 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 poor. This judgement has been made using available evidence including a visit to this service. Some improvements have been made in this outcome group, but information in care plans does not give staff clear and detailed instructions on how to deliver care that meets individual needs. This means that some aspects of the resident’s health and social care needs could be overlooked. Issues around privacy and dignity for residents have improved, but laundry is not always returned to the right person, which means that residents may wear other people’s underwear. Medication Administration Records were not accurate therefore there is no guarantee that residents are receiving the correct medication at the correct time. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 13 EVIDENCE: Three care plans were looked at in detail and others were sampled. All of the care plans had a good personal profile of the resident, which gave a good historical account of their life up to the point of admission. The plans however, were not specific and did not reflect the actual care given. For example, one person’s moving and handling plan said that he was able to walk a few steps with two members of staff assisting. His prevention of falls care plan said that he must be assisted when mobilising. During the inspection this person was walking around constantly, without the help or support of staff, and at one point was stood unsupervised behind a lounge door, which if had been opened from the other side would have knocked him to the floor. His continence care plan said that he should be escorted to the toilet 2 hourly. A care worker spoke about monitoring his body language and said that if he fidgets with his trousers it means he wants to go to the toilet. This important information was not in the care plan. His communication care plan said that staff should, ‘monitor verbal signs of communication and interpret correctly’ but gave no instructions on how to do this. His personal cleansing and dressing plan said that he is ‘assisted with washing and brushing teeth’, but gave no instructions about the specific amount of assistance required, what toiletries he liked and what time he preferred to be washed, bathed and dressed. There was no record of what tasks he was able to do without assistance. Another person’s personal cleansing care plan said that she must have a shower weekly, staff must maintain her privacy and dignity, give her nail care and ensure her hair was washed, but there was no information about her daily personal care needs or how the care should be delivered. Some care plans were repetitive for example information in one person’s plan on mobility, safety and use of the lift all had duplicate information. In all of the care records there were care plans that were not necessary, for example there were care plans for breathing despite the residents having no problems or needs in this area. Throughout the inspection care records were secured in a locked filing cupboard in a lounge area. From observation, looking at records and speaking to staff it was clear that residents are being assisted to the toilet more frequently than before. It was difficult however, to get a clear picture because toileting is being recorded on 2 charts, fluid charts and continence charts, and the information does not correspond. Staff said that most residents are assisted to the toilet at the same time, rather than having an individualised programme, and there is no system of monitoring or review of the effectiveness of the toileting plan. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 14 One person had a pressure cushion and mattress in place but there was no pressure area care plan for this. Two pressure mattresses in use by residents were set at the wrong pressure setting for the resident’s weight. Wound care plans had the size and depth of the wound recorded. The home uses a blister pack system for medication, which is based on a 4week cycle. However, several of the Medication Administration Records (MAR) had different start dates, which made it difficult to audit. There were some gaps on these records and abbreviations were used such as ‘prn’. One person’s allergy to Erythromycin was not recorded on her MAR. There was a discrepancy with one person’s Digoxin tablets. Seven were signed for but ten had been dispensed from the blister pack. On this resident’s discharge from hospital her Digoxin had been changed from tablets to liquid form, but during this inspection a nurse administered the medication in tablet form. There was also a discrepancy with one person’s Warfarin. The home had received a stock of twenty eight tablets, ten were signed as being administered, but nineteen remained in stock. This is unacceptable. Staff said that the hairdresser no longer uses one person’s bedroom for communal hairdressing services, residents looked clean and tidy and one person who was sitting with her knees against her chest was covered with a blanket. Wardrobes were tidy, but a number of residents had items of underwear in their drawers that did not belong to them; some items were torn and in a poor condition and some white underwear looked grey. Minutes of a relatives’ meeting dated 7th September 2006 showed that a relative had complained about clothing that had been mixed in with other colours and had ended up ‘pink’. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 15 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 poor. This judgement has been made using available evidence including a visit to this service. Staff remain focussed on tasks, which means that residents have little choice and control over their lives. There has been some improvement in nutrition, but further work is needed to make sure that residents have an adequate food and fluid intake. EVIDENCE: One person’s care plan said ‘offer choice of clothing’; but in view of this person’s level of understanding there were no instructions for staff on how to do this. A care worker, when asked about this, had no idea, and said that night staff leave out clothes that people with dementia will wear the next day. This was confirmed by another care worker who then went on to say that sometimes she wakes people up in the morning if she thinks that they have had enough sleep. One care worker said that residents have a choice of meals, and that if someone has dementia, relatives are asked about the person’s likes and dislikes. The relatives of one person, unable to express her personal choice, The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 16 said that she had been a semi-vegetarian since the age of 5. A care worker was seen assisting this person with her evening meal, but when asked she was unable to say what the meal was, despite the person being a vegetarian. The cook had a list in the kitchen of people’s food preferences, but there was little evidence in care plans of people’s likes and dislikes in other aspects of their care. Some residents and visitors spoke about outings, and some good practice was seen such as staff spending time chatting, playing cards and organising a Karoke session with residents. There were however, a number of people who were left without any stimulation. One person shouted out constantly, and rather than spending time with her, staff gave her biscuits and buns to pacify her. Records of activities showed that some people have access to activities more than others. The only activities recorded for one person was chats when he was bathed or showered. The manager has converted one lounge into a separate dining room, which means that existing lounge areas are crowded and facilities for private visiting are restricted. Each time a resident wanted to move about or staff wanted to move someone in a wheelchair they had to interrupt conversations and ask visitors to stand up to allow people to pass by. Other residents who constantly shouted also interrupted conversations between visitors and residents and made visiting difficult and stressful. Some residents were assisted to the dining room table at 12.30pm but were not served with their meal until 1.20pm; pudding was not served until 1.50pm. One resident said that she/he was fed up with waiting for meals to be served. One person was confused and constantly shouted out for her meal, much to the annoyance of other people. The dining room was unattended other than at times when people were assisted to the table. There was no menu displayed to tell residents what was being served and one person, who had dementia, was given a meal without any explanation of what was being offered. The lunchtime meal was liver and onions, new potatoes, cauliflower and carrots. The meal looked appetising and one resident said the cook knew he didn’t like liver so he had an individual meat pie. Fluid charts showed that Fortisip and milk are now being given and snacks such as buns, biscuits and fruit are offered mid-morning and mid-afternoon. One person who was at risk of poor nutrition had a bowl of fresh fruit and cheese chunks in front of her. These were removed after a reasonable amount of time. There was no evidence on fluid charts of milky supper drinks such as Horlicks, Ovaltine or Cocoa, although the manager said that these were offered. One person had a history of poor dietary intake but her nutritional assessment on admission showed her as being at ‘minimal risk’. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 17 The dietician was visiting the home during the inspection and said that she was delivering a training session to all staff later in the week. This training was to include the importance of an adequate fluid intake, how jellies, mousses, and fruit smoothies can be used to increase fluid intake, and how to enrich food to provide additional calories. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to this service. Despite the fact that staff have received training on issues relating to abuse and adult protection there is a lack of awareness of residents’ rights and the way the home operates day to day does nothing to promote the rights of residents as individuals. EVIDENCE: Qualified and care staff have attended training on adult protection and adult abuse and were aware of the different types of abuse and the action they should take if they suspected abuse was happening. The manager was not able to produce the adult abuse policy during the inspection, but sent it by fax soon after this visit. The policy consists of a flow chart with eleven bullet points, most of which are unclear and do not give staff precise instructions on the action they should take if abuse is suspected or reported. Tables were still being used but only when service users had drinks, food or other items on them. Staff are task orientated and their routines such as sitting someone at a dining table for almost an hour before their meal is served could be construed as institutional abuse. Residents and relatives said that they would complain if necessary and that they felt listened to. Information about how to complain is in the service user guide in the entrance of the home. The manager has started to record complaints but was given further advice on the best way to do this. The The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 19 registered provider has recently carried out a complaint investigation, a copy of which was sent to the CSCI. The report of this investigation was unsatisfactory and advice was given on the way that any future investigation should be carried out and recorded. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 20 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 & 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some improvements have been made to the environment but communal lounge areas are cramped and noisy and do not meet the needs of the people who live there. Infection control has improved, reducing the risk of the spread of infection in the home. EVIDENCE: The laundry room was clean and tidy and several improvements were noted. Domestic staff have been provided with changing and locker facilities in an area other than the laundry room and surplus items and cleaning materials were no longer stored there. Disposable towels were provided and protective clothing such as gloves and aprons were readily available. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 21 Not all clinical waste bins were in good working order, but the registered provider replaced these during the inspection. Waste in clinical waste bins was double wrapped. Disposable aprons and waste bags were available for staff in bathrooms and toilets, but latex gloves were not always available. The manager said that he encourages staff to wear disposable mittens that are intended for use with cleansing foam because this reduces the amount of latex gloves used. He was given a copy of the Department of Health publication on infection control, which states that gloves should be worn when coming into contact with bodily fluids or clinical waste, and that these should be ‘snug fitting’. The mittens are acceptable for washing and cleansing people but are not a snug fit when handling soiled and used continence products or coming into contact with bodily fluids. During the inspection the manager contacted the infection control nurse for advice and was arranging for an in-house training session to take place. The front lounge near to the front door has been converted into a dining room since the last inspection. This means that the majority of residents spend most of their day in one of two lounges, which are extremely cramped and noisy. Three people occupy the remaining lounge, which is spacious and is used as a smoking lounge. During the inspection contract gardeners were cutting the grass and hedges, and outdoor storage units are being provided to help with the lack of indoor storage. A decorator was painting doors and walls on the ground floor corridor. The manager said that since the last inspection the home has purchased three new lounge chairs and some bedroom sinks have been replaced. The bath seat and hoist have both been repaired since the last inspection. Recordings of water temperatures showed temperatures in excess of 47o and 48oc. The manager and registered provider said that they were aware of this and a plumber was visiting to rectify the problem. To comply with an improvement notice issued by the Health & Safety inspector a viewing pane has been fitted in one corridor door. New window restrictors have been fitted on all windows but there is little difference between these and those that were removed. One restrictor broke during the course of this inspection. Pillows in some rooms were badly stained and need replacing. The floorboards were loose in one room and were uneven in another. The slope from carpet to vinyl near to the lift is uneven and could cause slips, trips or falls. The manager said the handyman is looking at ways to rectify this. Not all rooms have lockable space and where bedside lighting was provided, in some rooms the lamps were unplugged and not within reach of the bed. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 22 The handyman explained how he checks bed rails. He said that he has had guidance on how to check these, and knew about ill-fitting bedrails, and entrapment due to gaps and spaces between the bars. Those bed rails seen were fitted correctly. The handyman carries out a fire alarm test at a different actuation point each week. However, the manager could not provide evidence that external professionals check the emergency lighting and fire safety system. Similarly, the manager could not produce the 5-year electrical wiring certificate. This has been addressed in a separate letter to the registered provider. The kitchen storeroom was clean, tidy, and no longer used as a changing room. Opened packets of food in the freezer were secured and there was a record of when they were first opened. There was a large sign on the lounge door, but little signage elsewhere and nothing to distinguish one part of the home from another. The corridor carpet was badly stained. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 23 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 poor. This judgement has been made using available evidence including a visit to this service. Deployment of staff throughout the home does not make sure that resident’s needs are always met. Recruitment checks are not completed and returned before new staff commence employment, which means that there is no guarantee that staff are safe and suitable to work with older people. Induction takes place but this is not based on current professional standards, and records of completion do not show how the person has demonstrated their competency. Therefore there is no guarantee that new staff understand good practice in care of older people. EVIDENCE: Some changes have been made to the way that the duty roster is recorded, and staffing levels appear acceptable. However, deployment remains an issue. The manager said that he converted the front lounge into a dining room at the request of relatives, who said that residents were isolated when it was being used as a lounge. During this inspection visitors said that the previous day their relative, who shouts out frequently, and another resident who makes choking noises were sat in the dining room. They visited for 1½ hours and during that time only one member of staff ‘popped in’. On the second day of this inspection these two people were sitting in the dining area and left without any staff presence. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 24 The recruitment records of two people were seen. One person started work one month before there was any recorded evidence of a POVA first (Protection of Vulnerable Adults) check being completed. There were two written references, but there was no recorded evidence that the manager had followed up issues that were raised within the references, and that could have made the person unsuitable to work with vulnerable people. Although the manager said that this person had completed an induction programme there was no evidence of this in the recruitment file, and there was no terms and conditions of employment. The recruitment records of another person showed that she started work 7 days before her CRB/POVA (Criminal Record Bureau/Protection of Vulnerable Adults) disclosure was received. This person said that she was completing an induction programme, however the home does not keep any record of how the outcomes of the induction standards have been achieved. The home’s induction programme is not based or cross-referenced to the Skills for Care induction standards. Although four staff have completed training in dementia care, there was little evidence seen during this visit of staff transferring theory into working practices. Ten staff attended adult protection training during this inspection, and the deputy manager was attending a moving and handling co-ordinator’s course so that she is able to train other staff in the home. Certificates from training sessions in staff files did not show the learning outcomes or the course content. The manager was asked to request this level of detail in future. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 25 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 poor. This judgement has been made using available evidence including a visit to this service. Due to the lack of management time staff are not supervised and managed for most of the time. Proper financial arrangements are not in place to protect residents from risk of financial abuse. The health and safety of residents is compromised by some practices in the home. EVIDENCE: The manager works as a member of the qualified staff team and has approximately 6-10 hours per week dedicated to management. The deputy manager who works as a member of the qualified staff team only works between 12 – 18 hours per week, and has no dedicated management time. Staff therefore are not managed and supervised for most of the time. This is unacceptable. The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 26 The manager said that his deputy is completing a course on health and safety, which should give her more knowledge on how to complete the home’s health & safety audit properly. The manager said he is trying to cross reference the home’s quality assurance audit to the National Minimum Standards for Older People, in a hope of making it more effective. Minutes of a relative’s meeting were seen, and the registered provider has carried a regulation 26 visit. There are still some concerns about the way that some residents’ finances are managed. The administrator said that she is still waiting for Social Services to arrange for Power of Attorney for two residents, one who has money held in the home’s bank account. Another resident’s family pay a lump sum for fees and the remaining pocket money is paid into the home’s bank account. This is unacceptable and is open to financial abuse. The administrator keeps small amount of cash for some residents. This is secure and records of spending and receipts were seen. The handyman was fitting bed rails to one resident’s bed at the request of the night staff. Records showed that this person had a fall the previous night and the night nurse had requested that bed rails be fitted, without any consultation with other members of staff, or completing a bed rail risk assessment. Records showed that another resident who had bed rails fitted was restless in bed, fidgety and crawling to the bottom of the bed, but this had not triggered a review of the use of bed rails. Throughout the inspection residents who were unable to weight bear were moved in the lounge areas without the use of a hoist. One care worker said that she had never seen the hoist being used in the lounges. The manager had started to keep an audit of accidents but this was not analysed properly to identify any trends or patterns. For example it was clear from looking at one person’s records that he had sustained a number of falls after an increase in his medication. His medication was eventually reduced, but this had not been identified or recorded in the falls analysis. The Gables Nursing Home DS0000001338.V314221.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 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X X 2 X 2 X 2 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 2 X 1 X X 1 The Gables Nursing Home DS0000001338.V314221.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. This is outstanding from 11.7.06. 2. RQN 14 The registered persons must not admit residents outside of their registration category. This is outstanding from 6.1.06 and 11.7.06. 3. OP4 18 The registered person must ensure that staff individually and collectively have the skills and experience to deliver specialist dementia and other care to residents. Staff must demonstrate good practice in the in the care of people with dementia and must demonstrate that they have the skills to meet the needs of the The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 29 Timescale for action 31/12/06 13/10/06 17/11/06 service users. This is outstanding from 6.1.06 and 11.7.06 and is subject to an enforcement notice. 4 OP7 15 Care plans must provide staff 31/12/06 with detailed information on how to provide all aspects of health, personal and social care needs to residents. To make sure that resident’s needs are met, staff must follow instructions within care plans. Care plans must be reviewed and updated. This is outstanding from 11.7.06. The promotion of continence must be managed on an individual basis according to need. 5. OP8 12 17/11/06 6. OP8 12,15. This is subject to an enforcement notice. Pressure area care plans must be 31/12/06 in place for all residents who are risk at developing pressure sores. Staff must understand how to use pressure-relieving equipment correctly. This is outstanding from 31.8.05 and 6.1.06 & 11.7.06. 7. OP9 13 Staff must follow correct procedures when administering and recording medication. If it known that s resident has an allergy this must be recorded on the Medication Administration 13/10/06 The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 30 8. OP10 12 Record. The dignity of residents must be respected and protected at all times. This is outstanding from 6.1.06 and 11.7.06. Clothing laundered on the premises must be returned in good condition to the right person. Residents must not wear clothing belonging to another resident. This is subject to an enforcement notice. 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 & 11.7.06. 17/11/06 9. OP12 16 31/12/06 10. OP12 12 The registered person must conduct the home to maximise residents’ capacity to exercise personal autonomy and choice. This is outstanding from 6.1.06 & 11.7.06. 31/12/06 14. OP15 12, 16. To make sure residents receive adequate nutrition, nutritional risk assessments must be completed properly. Specific training in the completion of the nutritional risk assessments must be provided. A snack meal must be offered in the evening and the interval between this and breakfast must be no more than 12 hours. 17/11/06 The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 31 Wherever possible residents must maintain a fluid intake of no less than 1500mls each day. This is outstanding from 11.7.06. This is subject to an enforcement notice. The homes policy and procure on adult abuse must be revised to give staff clear and specific instructions on the action they must take if abuse is suspected or reported. The home must review all practices in the home to make sure that residents are not at risk of institutional abuse. Window restrictors must be robust. The home must explore ways of creating more spacious seating areas for residents. Lounges and bedrooms must be decorated. Corridor carpets must be cleaned and stains must be removed. The first and second floor 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. 20. OP22 23 Signs must be provided throughout the home to assist those residents with dementia or visual impairment. A review of all bedding in the home must take place. Stained DS0000001338.V314221.R01.S.doc 15. OP18 13 31/12/06 16. OP18 13 31/12/06 17 18. OP19 OP38 OP19 13 23 31/12/06 31/12/06 19. OP19 23 31/12/06 31/10/06 21. OP24 16 31/12/06 The Gables Nursing Home Version 5.2 Page 32 pillows must be replaced. Bedside lighting must be provided in all bedrooms, unless the reason for not doing so is specified in the care plan. Where lighting is provided it must be accessible to the person when in bed. Lockable space must be provided in all rooms. 22 OP26 13 Infection control must be managed properly. Staff must wear protective gloves and aprons at all times when coming into contact with clinical or bodily waste. This is outstanding from 11.7.06. This is subject to an enforcement notice. 23 OP27 18 The home must review the 30/11/06 deployment of staff to make sure that residents are not left unattended. 13/10/06 The registered person must operate a thorough recruitment process that protects residents. Issues raised in references that indicate that the person may not be suitable to work with vulnerable people must be followed up. Criminal Record Bureau/Protection of Vulnerable Adults disclosure checks must be returned before the person is allowed to work in the home. Staff files must include the terms and conditions of employment. 17/11/06 24. OP29 19 & Sch 2 The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 33 25. OP30 18 The home’s induction programme must be crossreferenced to the Skills for Care induction standards. Evidence of how the person has achieved the standards must be retained in the home. 31/12/06 26. OP31 18 27. 28 OP35 OP38 13 13 29. OP38 12,13. In order to provide leadership and appropriate management support the manager must be supernumerary to the duty roster. Residents’ monies must not be held in the home’s bank account. Bed rails must not be fitted unless a bed rail risk assessments has been completed, and all other alternatives have been explored. Staff must follow safe moving and handling procedures at all times. 31/12/06 01/12/06 13/10/06 13/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP1 OP2 OP3 Good Practice Recommendations The statement of purpose and service user guide should be in a format suitable to the needs of residents. The home’s contract of terms and conditions should be updated. 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 The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 34 needs. 4. 5. 6 OP8 OP9 OP15 This is outstanding from 11.7.06. Toileting records should only be recorded on continence charts. Abbreviations and Latin terms such as ‘prn’ should be avoided. Residents should not be left sitting the dining room table for long periods before their meal is served. Menus in a format suitable to the needs of residents should be provided. When staff are assisting residents to eat, they should give a full explanation of the meal they are offering. Food and fluid charts should be accurate. Milky drinks such as Horlicks, Ovaltine or Cocoa should be offered at suppertime. Training certificates should include the course content and/or the learning outcomes of the course. The manager should analyse all accidents on a monthly basis so that any trends or patterns can be identified. 7 8. OP30 OP38 The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Gables Nursing Home DS0000001338.V314221.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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