Inspection on 13/07/05 for The Gables Nursing Home

This inspection was carried out on 13th July 2005.

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

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

Other inspections for this house

The Gables 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 11/07/06

The Gables Nursing Home 06/01/06

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 231 Swinnow Road Pudsey Leeds LS28 9AP Lead Inspector Sean Cassidy Announced 13 July 2005 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 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 J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Gables Address 231 Swinnow Road Pudsey Leeds LS28 9AP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0113 2570123 0113 2558644 Dr Minhas Mr Brennan Care home with nursing 23 Category(ies) of Old age (23) Physical disability (1) Dementia registration, with number (3) Dementia - over 65 (3) of places The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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 21/12/04 Brief Description of the Service: The Gables Nursing Home is a converted building, which has been extended over the years. The home is situated on a busy main road equidistant from Leeds and Bradford with good access to public transport. The home is next to a public house and close to other amenities, including shops and a post office. Pudsey cricket ground is to the rear of the home and some of the bedrooms enjoy views over the ground. The Gables Surgery is situated within the grounds.The home provides personal care with nursing for both men and women, over the age of 65. The majority of rooms are for single occupancy with some shared rooms available. There are some en-suite facilities, the majority of which have limited access. The lounges and dining rooms are situated on the ground floor. There is limited access to the grounds by means of a re-moveable ramp from one of the lounges. The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by one inspector and lasted a full day. The purpose of this inspection was to ensure the home was operating and being managed to a satisfactory standard for the benefit of the residents. The methods used in this inspection included discussions with service users, visitors and staff, examination of records including service users care plans and staff files, a tour of the home and indirect observation of care practices. The inspector spoke to several residents, relatives and members of staff. A number of documents were examined which included care plans, staff files and training files. What the service does well: What has improved since the last inspection? What they could do better: The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 6 • • • • • • • • • The service user guide is not given to residents at the point of moving into the home. They are not being fully informed of the home’s aims and objectives or services and facilities. Many residents living in the home have dementia needs that are not yet being met due to lack of specialist training provided to the staff group. Care plans must be developed to ensure all the care needs of the residents are met. These documents must also show evidence that the resident or their representatives have been involved with drawing them up. All care staff should read care plans so that they are fully informed of the resident care needs. When the home has identified that specialist equipment is needed to prevent tissue breakdown then it must be provided. Also, when a referral needs to be made to another healthcare professional then this should be done. A structured activities programme must be developed which includes providing opportunities outside the home environment where possible. Improvement must be made in recruiting staff so that service users are properly protected. The registered manager must ensure that notifications of any serious incidents in the home are given to the Commission. Equipment used in the home such as hoists, wheelchairs and bedrails should be checked regularly to protect residents’ health and safety. The provision of locks on residents’ doors would further increase privacy. 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 J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,5. The home provides prospective service users with information that helps them make their choice whether to move in or not. The Service User Guide is not freely available to residents and should be reviewed so that it contains the correct information. Assessments are made prior to admission so that care can be appropriately planned. EVIDENCE: The home has developed a Statement of Purpose and a Service User guide. These documents are provided to prospective residents and their families prior to making a decision to move into the home. The Service User Guide is not given to residents at the point of entry and does not contain the necessary information. A relative and resident spoken to said that they were provided with all the necessary information needed to make their decision to move in and they had an opportunity to come and visit prior to making this decision. A statement of Terms and Conditions is provided by the home but these are not given at the point of admission. The files of recent admissions showed that the residents are assessed prior to admission. The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7,8,10. The home attempts to provide care plans that ensure residents’ needs are met. But more work is needed to ensure all the care needs, such as dementia, are provided for and that they are drawn up with the involvement of the resident or a representative. The home is not fully meeting the care needs of the residents. Residents and relatives felt their privacy and dignity is well respected by the home. EVIDENCE: Four care plans of residents were case tracked during the inspection. The care files showed that care plans were written for each resident and they are regularly reviewed. Each resident is risk assessed for the prevention of falls and also a nutritional risk assessment. Many residents were identified as having obvious dementia needs but this need was not planned for in the documentation. Although the care plans gave good details of the care that was to be provided, carers were not familiar with these documents and could not identify what the actual needs of the residents were. There was little evidence to show that the home actively seeks to gain The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 10 residents or their representatives consent to the care plans. Relatives and residents spoken to confirmed this. The home keeps a record of when each resident is reviewed by other health professionals, such as, Chiropodists, GPs, and Opticians. Files showed that residents do not always get referred to a specialist health care worker when needed. Pressure area risk assessments are carried out on each resident but the equipment needed to help prevent skin breakdown was not always provided, even when the care plans stated it should be. Evidence was not found to show that residents nursed in bed were being turned at the stated time and the manager is not notifying the Commission when a resident has developed a Grade 2 Pressure sore or above. One resident was identified as being at a high nutritional risk and no referral was made to a GP or dietician. Residents and relatives said that they thought the staff always respected their privacy and dignity. They could meet relatives and friends in private and they always knocked on bedroom doors before entering. Residents and staff also praised the laundry service. Locks on resident bedroom doors have still not been installed and therefore compromises residents privacy and dignity. The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12,13,15 The home does provide activities to service users. Activities should reflect the dementia needs of the resident group and should be more structured with more access to external environments. The service users receive a wholesome and appetising diet. EVIDENCE: An activities coordinator comes to the home three days per week and provides a number of activities for residents. The care files examined contained records of the residents’ interests and what activities they had been involved in. Those residents that were able to express their views on the activities provided said that they enjoyed them. The home has an open policy with regards to visiting and relatives and friends are encouraged to visit as often as they wish. Two residents and their families confirmed this. Two residents felt they would benefit from opportunities to get out of the home but these aren’t provided unless your relatives take you out. The owners stated that there is a lack of funds to provide these types of excursions. The menus are displayed in the dining room and are based on a four weekly rota. The cook keeps a record the residents likes and dislikes with regards to food and these have been incorporated into the menu. The menu was varied and appealing and some residents spoke highly about the quality of the food. The kitchen appeared clean and tidy with daily cleaning rotas appropriately completed. Hot food is always probed to monitor the serving temperature. It The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 12 was recommended the cook keep a record of the food served to service users in case it might be needed by environmental health. Food was served to residents in a number of settings. The majority of residents sat in the lounge with side tables and others used the dining facilities or were not able to come downstairs. Residents were seen to receive assistance from carers with eating and this was an unrushed task. Only four residents used the dining room during the lunchtime meal. It was recommended that the home encourage and assist residents to use this room for all meals. This would help promote meals as a more social occasion. The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16,18 The home actively promotes residents and relatives to make complaints and those using the services are confident that their complaints will be properly dealt with. The staff group are trained in the area of adult protection but not familiar with how to report an incident. EVIDENCE: The complaints procedure was well displayed in the entrance hall of the home. Some residents knew where the complaint procedure could be found and how to use it. Relatives also said that they were confident that their complaint would be listened to if made. Nearly all staff had attended adult protection training. Some staff had a good understanding as to what this involved and some were unsure who they would contact regarding an Adult protection issue. The home does not have a procedure for referral and did not possess a copy of the local Adult Protection Guidelines. The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 14 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 standard(s) None These Standards were not inspected on this visit. EVIDENCE: The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29. Staff training does not yet provide for all the specialist needs of the residents. The recruitment procedure adopted by the home does not properly protect residents and places them at risk. EVIDENCE: Residents, who were able to comment, felt that the staff tried their best and were trained to do their job well. The staff training records showed that the manager has implemented recent relevant training that will assist carers to meet residents’ needs. Staff spoken to felt that the training provided by the home was adequate for their needs. This will benefit the resident group. The home is currently attempting to provide staff with dementia training. I was able to give some ways in which they could access dementia training. It was clear from all the evidence examined that the home has difficulties in this area of training. Progress is being made by the home to ensure all care staff attains NVQ level 2 in care before the end of this year. Staff confirmed that all new starters receive an induction and that supervision is provided. Supervision records were seen. The recruitment files show that the home does not obtain all the necessary information on each member of staff prior to starting work. Appropriate police checks were not obtained for some staff. The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,38. The manager has obtained the experience and management qualifications necessary to manage the home properly. The home provides appropriate health and safety training to protect residents but must ensure health and safety risks are dealt with appropriately and equipment is regularly checked. EVIDENCE: The manager has worked in the home for a number of years, having had one short sabbatical. He has attained management qualifications that have assisted him with the day-to-day management. There are clear lines of accountability within the home and a senior nurse assists with the management duties. The accident book was examined and this identified that the home records accidents well and what actions were taken following these. There have been a couple of serious accidents that involved residents being admitted to Accident The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 17 and Emergency departments. The manager did not notify the Commission of these. Moving and Handling, Fire Training and COSHH training is given to staff regularly. It was recommended that staff sign for this training to evidence that they have received it. Not all equipment is checked regularly to ensure it is in good working order. Two areas of risk were pointed out to the manager that needed attention. • The landing in front of the gate on the first floor is in need of attention as it is a potential health and safety risk to residents and staff. • The door adjacent to the kitchen must be closed to prevent residents accessing areas to the home that are a potential risk. The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 2 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x x x x x x 2 The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 Page 19 Are there any outstanding requirements from the last inspection? 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 1 Regulation 5 Requirement Each resident must be provided with the Service User Guide at the point of entering the home. This must contain the Terms and Conditions of their stay. Each residents care plan must set out in detail the action which needs to be taken by care staff to meet all their needs. These must be drawn up with the involvemnent of the resident or their representative. Equipment necessary for the treatment of tissue viability must be provided by the home when needed. The registered person must enable residents to access other members of the multidisciplinary team when there is a need. The registered person must ensure suitable activities are provided to residents both inside and outside the home. The registered person must operate a thorough recruitment process that protects residents. The registered person must give notice without delay any serious injury to a resident. The registered person must Timescale for action 30 September 2005 30 September 2005 2. 7 15 3. 8 16 31 August 2005 31 August 2005 30 September 2005 30 August 2005. 30 August 2005 30 August Page 20 4. 8 12 5. 12 16 6. 7. 8. 29 38 38 19 & Schedule 2 37 12 The Gables J52 S1338 The Gables V210904 130705 Stage 4.doc Version 1.30 9. 24 12 10. 4 12,18 ensure that the health and safety 2005 of residents and staff is protected whenever possible. This refers to the absence of some equipment checks and also the risks identified in this standard.checks Doors to service users 31 October accommodation must be fitted 2005 wit suitable locks and accessible to staff in an emergency. The registered person must demontrate the homes capacity to meet the specialist dementia needs of the residentds. 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. 4. 5. Refer to Standard 2 15 18 28 Good Practice Recommendations It is recommended that all care staff are encouraged to read the resident care plans so that they are aware each persons individual care needs. it is recommended that the registered person encourages residents to use the dining facilities provided. The home should develop an Adult Protection procedure that is accessible to all staff. 50 of care staff should be trained at NVQ Level 2 or above by April 2005. 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