CARE HOMES FOR OLDER PEOPLE
The Gables Nursing Home 1595 Wolverhampton Road Oldbury West Midlands. B69 2BJ Lead Inspector
Jean Edwards Announced 19 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 Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Gables Nursing Home Address 1595 Wolverhampton Road Oldbury WEst Midlands. B69 2BJ 0121 544 3988 0121 544 3989 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) Ashbourne Healthcare Ms Kim Horton Care Home 51 Category(ies) of OP Old Age (51) registration, with number of places The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: NONE Date of last inspection 28/02/05 Brief Description of the Service: The Gables Nursing Home is situated on the A4123 Wolverhampton Road, Oldbury. It is easily accessible by public transport and ample off-road parking is available. The Home is registered to provide care for a maximum of 51 elderly persons. It is a purpose-built property with three floors. Lounges and dining rooms are available on the ground and first floors. Residents bedrooms are also located on both floors. The kitchen, laundry and staff facilities are situated on the lower ground floor. All floors can be accessed via lifts or stairways. Access into and around the Home is suitable for wheelchair users. The reception area is comfortably furnished with a couch and occasional chairs and the piped music provides a relaxing atmosphere for visitors entering the Home. Residents and visitors may access the information kept here about the Home and the service it provides. Visitors are welcome at any time and for health and safety reasons are requested to sign the Visitors Book with their arrival and departure. There is a staff team of 43 people including the Registered Manager, registered nurses, and care staff, domestic and catering staff. The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection visit was undertaken by the Inspector from the Commission for Social Care Inspection using the following information: the action plan submitted by the home to the unannounced inspection in March 2005, reports from the organisation relating to the conduct of the home, the pre-inspection questionnaire and records held at the home. The visit commenced at 09.10am and lasted until 6:00pm. During the visit the inspector spoke to the majority of the 48 residents who are currently living at the home, with longer discussions taking place with the residents or their relatives, whose care was looked at in depth. The Regional Manager, Registered Manager and Care Manager took an active part in the inspection process. Comments on survey cards returned to the CSCI are generally very positive, for example making favourable comparisons with other homes, stating that information is good and staff are caring. The inspector toured the building, looking in particular at the kitchen, laundry, bathing facilities, communal areas of the home and a sample of residents’ bedrooms, with their permission. What the service does well:
The registered manager, supported by the organisation, has responded to the previous inspection report with a comprehensive action plan, which gave dates for the required improvements to be put into place. The majority of improvements required at the last inspection visit are now in place. Information about the home and the service it provides is readily available on the premises. Relatives commented, information about the home is very good and very helpful”. Residents commented that the manager, is a nice lady and takes an interest in you; she is very thorough”. Other comments are, staff are very welcoming”, and they keep me informed”. The manager and staff make sure that each resident and as appropriate their relatives are involved in the plan of how their care is to be provided. The home
The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 6 also has good relationships with the local GP and other health care services, which provide support for the residents at The Gables. Residents are encouraged by staff to treat The Gables as their own home and to be as independent as their disabilities allow. Residents are able to make their own choices and can take an active part in meetings and surveys if they wish. Views can be freely aired about the running of the home. Comments are, its very good here, and I want to stay here. The meals are thoughtfully and well prepared, and the menus are pre-planned and each persons preferences are recorded each day. In addition members of staff were seen to ask residents what they preferred at each mealtime. Special diets are prepared and served in a way, which tempts people to eat. The majority of food is prepared using fresh ingredients and the cook visits the residents to find out if there are any special foods that would tempt them to eat. She takes time and trouble to prepare additional items such as Smoothies. Staff are available at mealtimes and are able to sensitively offer people help and assistance, as they need it. The Gables now has a stable group of staff, many have worked at the home for some time and know the residents well. They are caring, committed and flexible, often willing to work extra shifts. Residents and visitors spoken to described the home as ‘friendly’, ‘welcoming’ and ‘well run’. The staff are described as professional, and genuinely caring. There was a lot of friendly banter between staff and residents throughout the day. During the visit staff demonstrated a dedicated approach to their work; they clearly know residents’ likes and dislikes and how to meet their needs. They are keen to share views and answered any questions in an open and honest manner. The Gables Nursing Home maintains high standards of cleanliness. The home is tidy, homely and comfortable. There are comments that people are impressed with the standards of hygiene. The home benefits from support provided by the organisation and there are full and useful monthly monitoring reports of the regional managers visits, relating to the conduct of the home. This inspection was conducted with full co-operation of the Registered Manager, staff and residents. The atmosphere through out the inspection was relaxed and friendly. The Inspector would like to thank staff, and residents for their hospitality during this inspection visit. The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 7 What has improved since the last inspection?
There are detailed care plans in place for each resident; further information has been included to cover all areas of care needed. For example there is improved guidance to staff as to how to help with pain relief and how to improve monitoring arrangements for people with diabetes. Each persons plan now contains details about their social interests, alternative communication methods where needed, and preferred daily routines. The information staff write in daily records is now more detailed and gives a picture of how each person’s care needs are being met and how they are. Action has been taken to improve the way medication is stored, administered and recorded and the home now has a rigorous medication system, which safeguards residents well being, with only a few minor improvements still to be made. People who are able are encouraged to spend some of their time with a range of stimulating activities supported by the activities co-ordinator and staff. In addition each person is visited on a daily basis by the activities co-ordinator for a short chat. There are organised activities in the home every day and there are outings using community transport. Links have been made with the local church and small groups of people attend for weekly events such as activity classes and bingo. Comments from relatives are, impressed with sensitive support and stimulation and being able to have links with the church is very important. Some people may choose not to be involved in organised activities, decisions that are fully supported. The Manager has created a small private garden for the residents in a sheltered area to the side of the home. There is a patio, lawn, raised flowerbed and garden furniture. A summer fayre was held in June, raising £290 for the residents fund. The home has been provided with new carpets in the first floor dining room and lounge since the last inspection visit, which improves standards for the benefit of the residents. There is also a redecoration programme of the residents bedrooms. People are able to choose the decor for their own room from the bedroom board, displaying the colour schemes available. A new standing hoist has been purchased to assist with moving people with mobility difficulties, and improved checking procedures have been introduced. The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 8 The home follows a rigorous system to select and recruit new staff, a small number of improvements have been made so that all stages of the recruitment process are fully completed. Staff personnel files have been reorganised resulting in improved monitoring and auditing. The staff are being given awareness training relating to terminal care from the palliative care service, the course is being provided by Compton Hospice. The home demonstrates a strong commitment to training for all staff, for example there is 100 achievement for the following training: Health & Safety, Moving and Handling, Food Hygiene, Infection Control, First Aid and Fire training. Record keeping at the home has improved and there is an improved level of notification of events to the CSCI satellite office. The home has implemented its own surveys to obtain the views of residents, relatives, and visitors as to how they think the home is performing. Results are published and available. The Registered Manager has completed a risk management training course, she now uses the knowledge to minimise risks to residents, especially on outings. Potential hazards in unfamiliar environments are taken into account and sufficient numbers of trained and experienced staff are provided to escort residents on each outing. The Registered Manager undertakes a regular analysis of all accidents occurring in the home, from which areas for improvement are identified. What they could do better: The Organisation needs to review the contract / terms and conditions using the publication from the Office of Fair Trading: Guidance on Unfair Terms in Contracts in Care Homes; this is an outstanding requirement from previous visits. The Registered Manager must make sure that each persons susceptibility to develop pressure sores is accurately assessed and regularly reviewed to be consistent with any special pressure relieving equipment, especially if this is already in place. Records of the care provided to treat any pressure sores must be more detailed. The Registered Manager must ensure that the all healthcare screening processes and records are regularly reviewed and accurately show the current situation for each person, especially where weight loss is noted. Any resident with significant weight loss over a period of time must be referred to the GP and dietician in good time for advice and support The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 9 Although the home has made very good progress to improve the systems relating to medication in the home, there are a few required improvements from previous visits, not fully in place. For example any unclear directions for dosages must be discussed with the doctor and/or the pharmacist. The home has not yet fully resolved the excessive temperatures recorded at times, in the treatment rooms. The home must ensure that medication is stored at temperatures below 25 C at all times. In addition further investigation is needed to resolve the fluctuating temperatures recorded for the drugs fridges. Minor improvements are also required for the completion of medication records. The home has a programme of redecoration, maintenance and repair, however there is an outstanding issue relating to be renovation or replacement of the floor covering in the first floor treatment room, though it is acknowledged there may be a possible change of use for this room. As part of the maintenance program, planners have visited the home, however progress must be taken to ensure the two bathrooms currently not usable for residents are made accessible. The Organisation must take account of revised guidance from the Department of Health relating to the protection of vulnerable adults and Criminal Records Bureau clearances, and certificates are to be available to for inspection at the home, unless an alternative agreement is made. The Organisation must review and update its staff procedures in view of the introduction of the protection of vulnerable adult abuse (POVA) register. In addition the hairdresser and any other self-employed therapists must provide the home with evidence of satisfactory Protection of Vulnerable Adults (POVA) /Criminal Records Bureau (CRB) clearance. 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 E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 10 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 Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 11 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) 1,2,3,4,5 Information about the running and performance of the home is made proactively available and residents are encouraged to make their views known. The home has not yet updated contracts/terms and conditions of occupancy, this has the effect that residents and their advocates may not have the best information regarding their rights and entitlements and any agreed restrictions. The home uses comprehensive assessment tools, which means that residents’ needs are thoroughly assessed to ensure that care needs will be met. Introductory visits and trial stays are encouraged by the home, ensuring that people have time to make decisions, which are right for them. This home does not provide intermediate care. EVIDENCE: The home has an updated statement of purpose and service user guide, which are produced in an attractive format and are available in the reception area and each persons bedroom. There is evidence from discussions with residents and families that information about the home is given to them.
The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 12 There is an outstanding requirement for the homes contract / terms and conditions to be revised and updated taking account of the Office of Fair Trading publication Unfair Terms in Care Homes Contracts. At present there is insufficient evidence that each person has an appropriate contract / terms and conditions, which is appropriately signed and dated. Examination of a sample of residents’ case files demonstrates that the home has obtained the referral agency’s assessment of needs and in most cases a care plan. There are copies of Sandwell Authority’s single assessment information for people admitted from the Sandwell area. In addition the home has the Ashbourne comprehensive assessment tool, which is generally well completed with all relevant information. Evidence from informal discussions with residents and families is that the home does offer an opportunity to visit before an admission takes place. Most prospective residents are too frail to take the opportunity to visit; they are reliant on their relatives to make the choice. There is documentation relating to introductory visits on each persons case file. The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 13 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) 7,8,9,10 There is a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet residents needs. The health needs of residents are generally well met with evidence of good multi disciplinary working taking place on a regular basis. The home has made good progress to improve the arrangements for administration of medication, which safeguards the well being of people living at the home. EVIDENCE: The Gables uses standardised Ashbourne documentation and there is a very detailed and comprehensive care plan in place for each person, based on his or her assessed needs. There is good evidence that care plans are developed in conjunction with the resident and their relatives, with signatures in place to indicate agreement. The manager has made great improvements to care plans for people with Diabetes and other complex needs, such as peg feeds and indwelling catheters. These expanded care plans give staff explicit guidance about the monitoring arrangements, these are particularly good for diet, skin, eye and foot care for people with diabetes. On the sample of residents’ care plans there are records of the persons preferences for their daily routine, for example rising, retiring, and bathing. The staff record the life story for each
The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 14 resident, which is important in understanding the person prior to their admission to the home. There are generally good risk assessments in place and appropriately recorded health care screening assessment tools completed for each person. However on two of the sample of case files examined the tissue viability assessments and scores do not appear to correspond to the current condition of the residents or reflect susceptibility to pressure sores, especially as a Quatro pressure relieving mattress is already in place for one person. Currently there are two residents at the home with pressure sores; these are hospital acquired. Although Ashbourne provides a comprehensive pro forma for the care of pressure sores, there is insufficient detail documented regarding the size, grade and treatment of pressure sores of the two people affected. One person ES was admitted to the home with grade 4 pressure sores on heels, a grade 2 pressure sore to the right calf and grade 2 pressure sore to the sacrum. There was no documentation or care plan relating to the sacrum area. However it would appear that all pressure sores are now in the process of healing. There is generally satisfactory evidence that residents are weighed on admission and regularly weighed each month. From the sample of residents case files assessed, one person has lost an excessive amount of weight, weighing 63.6 kg on admission in April 2005, decreasing to 38.5 kg in July 2005, a loss of 21.1 kg. This person has spent approximately 12 weeks in hospital and since his return to the Gables has been seen by the GP and referred to the dietician. A female resident initially lost weight following admission to the home, she has now regained some of the weight loss and the diet is being supplemented with smoothies specially prepared by the cook. Another resident (SR) admitted in April 2005 weighing 60.8 kg, currently weighing 56.2 kg, has a weight loss of 3.6 kg over four months. Although there may be genuine underlying reasons for the weight loss relating to medical conditions such as Parkinsons disease and a recent fractured shoulder, a referral for medical and dietary advice has not yet been made. A referral for advice from the GP and dietician needs to be made for this person and any other resident with a weight loss over time. Documentation relating to the health care checks provided for older people are satisfactory to demonstrate that all regular checks have been offered, whether or not they had attended or what the outcome has been. Record sheets for health review, dentist visits, optician visits, chiropodist visits, medication reviews are available on the sample of residents case files assessed. The content of the daily notes has improved; these provide a comprehensive record of care provided on a daily basis. The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 15 It is positive that jugs of cold drinks are available in communal areas and bedrooms, staff ensure that all residents have a good intake of fluids, with a range of drinks proactively offered throughout the day and night if required. In addition visitors are able to make drinks in small kitchenettes on each floor for themselves and the residents they are visiting. These facilities are well used and much appreciated. There is a comprehensive medication policy and procedure, with staff signatures to demonstrate their awareness and compliance. Medication administered by the registered nurses during the visit was given in a sensitive manner, taking time to encourage each person to take their medicines. Completion of medication records (MAR sheets) has generally improved, though there are five gaps on MAR sheets on the first floor. Though the home is monitoring the temperature in the treatment rooms there is still some fluctuation and on occasions temperatures are rising to 27° C. efforts must continue to ensure that medication is stored below 25 C at all times. The home has recently purchased new thermometers for the drugs fridges and records show that fridge temperatures are more stable. However both fridges are registering temperatures below 2°C. on occasions, further investigation and resolution needs to be sought to ensure that the drugs fridges are maintained between 2°C. and 8°C. at all times. This is particularly important for the storage of insulin. There is good evidence that support is given to residents to be appropriately groomed and dressed. There are records of each person’s preferred name, and staff address residents in a respectful manner. Each person is supported in ways, which maintains their personal dignity. The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 16 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 This home makes planned and spontaneous activities available on a regular basis, even though not all residents are able to take advantage of socially stimulating opportunities. There is good contact maintained with family and friends for the majority of residents. The meals at The Gables are good, offering both choice and variety and catering well for special dietary needs. EVIDENCE: Residents and relatives spoken to confirm that they feel that there are generally sufficient staff on duty and that they have time to spend talking to them and to enable them to enjoy regular activities and outings. The home employs an activities co-ordinator for five hours, five days each week and there is a structured weekly activities programme, which is displayed. There is a range of social and spiritual stimulation available, such as a monthly church service at the home and weekly visits to a local church and a small group of residents who enjoy the activities and bingo provided. The home has a weekly pampering and relaxation session every Wednesday. In addition to the structured activities the activities co-ordinator spends a short time talking to each resident individually, each day that she is on duty. The outcome of these chats is recorded in the daily notes.
The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 17 There is evidence available to demonstrate that all residents have been consulted as to their preferred activities, hobbies, and outings, with documented preferences in assessment and care planning documentation, which informs the comprehensive activities programme. There is a visiting policy, which welcomes visitors. A considerable number of people visited during this visit. One person expressed her appreciation of the way her father, who is very poorly, is being cared for. The home has a rotating weekly menu, which offers a wide and varied choice of meals. There is a range of options for each meal, the three courses offered at lunchtime. In addition to the set menus people may request alternatives such as jacket potatoes, salad, soups, or omelettes with a choice of fillings. The menus are displayed in each dining room and care is taken to record each persons daily preferences. Catering staff take pride in preparing and cooking as much fresh food as possible and presenting the food to look appetising. Members of care staff offer sensitive assistance to people needing help or feeding. The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home has a satisfactory complaints system with good evidence that residents and relatives feel that their views are listened to and acted upon. Arrangements for protecting residents are satisfactory safeguarding them from possible risk of harm or abuse. EVIDENCE: The Home has a complaints procedure, which is displayed in the reception area and contained in the service user guide. The home has received three complaints in the past twelve months, these have not been substantiated and responses have been made within the 28 day timescale. The Home has a copy of the Local Authority multi-agency Adult Protection policy and procedure. The Home has developed its own policies and procedures relating to the protection of vulnerable adults, dealing with aggression, use of physical / non-physical intervention; whistle blowing, dealing with residents finances and there is a copy of the Public Disclosure Act available. The manager must continue to regularly raise staff awareness of non-physical intervention strategies through supervision sessions and training. There are records to demonstrate that all staff have attended a training course relating to abuse, residents welfare, provided by the Ashbourne organisation. The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 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 standard(s) 19,21,24,26 The manager has a good understanding of the areas in which the home needs to improve with considerable planning in place indicating how this improvement is going to be resourced and managed. The standard of the décor within this home is generally good with evidence of improvement through continuous maintenance. Although large, this is a homely and comfortable environment for residents. The Gables has effective systems in place to ensure sources of potential infection are controlled. EVIDENCE: The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 20 The Gables Nursing Home is a purpose-built property, currently providing accommodation for up to for 51 older people requiring nursing care. The home continues to be refurbished, redecorated and repaired on an ongoing basis. The décor, fixtures and furniture are generally completed to high standards. The property stands in its own grounds, with car parking at the front, and welltended grounds to the sides and rear. The manager and the maintenance person have created a small private garden side of the home in a wellsheltered spot. The residents are able to enjoy the attractive raised flowerbed, whilst sitting comfortably on the shaded patio. The Home has 6 communal bathing / showering facilities located on the ground and first floors in addition to the en suite facilities in 33 bedrooms. There are assisted baths suitable to meet the current needs of the residents, however to bathrooms identified a previous visits to be in need of adaptation have yet to be completed. In addition to the en suite facilities there are a number of communal toilets situated throughout the home, close to communal areas. The bathing facilities are free from communal items and extraneous items, though two soiled anti slip bath mats were removed during the tour the home. During the tour of the premises a sample of residents’ bedrooms were viewed, with their permission. These are furnished appropriately according to the needs of each person. The bedrooms are tastefully decorated and it is evident that people are encouraged to personalise their rooms with their own possessions, pictures, mementos and furniture. There is an inventory in place documenting personal possessions, furniture etc., brought into the Home, held on each person’s case file; these are signed and dated. It is evident that good standards of cleanliness continue to be maintained and there were no discernable malodours. The laundry is separately staffed; the person spoken to takes pride in being well organised. There are two industrial washing machines and two tumble driers and an ironing press. Good infection control measures are in place. The homes main kitchen is in good order, clean and tidy and well organised. Appropriate food hygiene/safety measures are in place, with well-kept records, which are monitored by the registered manager, the organisation and Environmental Services. The home has achieved the Local Authority (Environmental Health) and NHS Trust gold food award. The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 21 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) 27,28,29,30 Good progress has been made over recent years in creating stable substantive staffing levels and residents now receive consistent care. The standard of vetting and recruitment practices is good, with all appropriate checks being carried out. Staff morale is high resulting in an enthusiastic workforce working positively with residents to improve their whole quality of life. Good progress is being made to provide all staff with training, which safeguards the health and well being of residents. EVIDENCE: Assessment of staffing rotas demonstrates that the home continues to maintain satisfactory staffing levels. The registered manager reviews staffing levels on a regular basis, using Department of Health Residential Forum Staffing Tool, taking account of the occupancy and dependency levels of residents accommodated, as is good practice. The Home has a staff team of 43 people including 26 care staff, 3 domestic staff, 2 laundry staff, 2 kitchen assistants, 1 activities co-ordinator, 1 gardener / maintenance staff, 1 administration staff, 8 first level nurses, the Registered Manager and 4 catering staff employed by a separate company. The staff team is now relatively stable. Four staff have left the home’s employ in the past 12 months, for valid reasons. There are currently no staff vacancies. The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 22 The Home continues to demonstrate a strong commitment to staff training and development and has achieved a ratio of more than 50 of care staff trained by the end of 2005. Currently 62.96 of care staff have achieved the NVQ 2 award in care, with a further tranche of care staff registered as candidates to complete the training. The Home operates robust recruitment practices. Random samples of staff files examined are satisfactory. The registered manager has made very good progress to reorganise staff files, which are now much easier to monitor and audit. Interview questions and answers are retained on staff personnel files as a matter of good practice. The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 23 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) 31,37,38 The registered manager is supported well by her nurses and senior staff in providing clear leadership throughout the home, with staff demonstrating an awareness of their roles and responsibilities. The systems for resident consultation at The Gables Nursing Home are good with a variety of evidence that indicates that residents’ views are both sought and acted upon. EVIDENCE: Ms Kim Horton, appointed as general manager in September 2004, has been the Registered Manager at The Gables since December 2004. She is a RGN (Registered General Nurse), with significant management experience. She has commenced training to achieve the Registered Managers Award (RMA). She has many years of nursing experience, including the management of nursing homes. It is evident that she continues to update her training and personal development.
The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 24 There is an annual development plan for the Home, with continuous self monitoring, evidencing the involvement of residents, representatives and other community stakeholders. The regional manager conducts unannounced visits to the home on a monthly basis, providing comprehensive audit reports to the home and the CSCI office, Halesowen in compliance with regulation 26. Record keeping at the home continues to improve, achieving good standards, with only very minor improvements required at this visit. All personal information is held, stored and disposed of in accordance with the Data Protection Act 1998. A sample of mandatory training records, fire safety and maintenance documentation examined is satisfactory. The Manager ensures that all staff receive mandatory training commensurate with their roles; fire training, drills twice each year, moving and handling, first aid, food hygiene, health and safety and infection control training, commensurate with duties undertaken. The accident records examined are satisfactory. There have been 76 accidents involving residents since March 2005. The Manager undertakes a regular documented accident analysis each month, which is used to identify trends and instigate reviews / reassessments and corrective action as required. The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 25 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 3 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 4
COMPLAINTS AND PROTECTION 3 x 2 x x 3 x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x 2 3 The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 26 YES 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 2 Regulation 5(1) Requirement To review the contract / terms and conditions using the publication from the Office of Fair Trading: Guidance on Unfair Terms in Contracts in Care Homes (Timescale of 31/03/05 Not Fully Met) 1) The Registered Manager must ensure that the tissue viability score for WT is reviewed to reflect the susceptibility to pressure sores and the pressure relieving equipment already in place 2) The Registered Manager must ensure that the tissue viability and nutritional assessments for SR are reviewed and accurately reflect the current situation, especially in view of weight loss 3) To ensure that SR and any other resident with significant weight loss over a period of time are referred to the GP and dietician for advice and support 4) The Registered Manager must ensure that records relating to the care of pressure sores are
The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 27 Timescale for action 30/10/05 2. 8 12(1)(b) 13(1)(b) 15/08/05 3. 9 13(2) improved; to provide detail of all sores, the description, treatment, and progress. This especially relates to ES 1) To clarify as directed dosages with the prescriber and/or the pharmacist (Timescale of 31/10/04 Not Fully Met) 2) To record the actual dosage given where variable dosages are prescribed, for example 1or 2 tablets (Timescale of 31/10/04 Not Fully Met) 3) To resolve the excessive temperatures recorded in the treatment rooms, ensuring that medication is stored at temperatures below 25 C at all times (Timescale of the 31/10/04 Not Fully Met) 4) To investigate and resolve the fluctuating temperatures recorded for the drugs fridges on the ground and first floor, ensuring temperatures are maintained between 2 C - 8 C at all times (Timescale of 31/03/05 Not Fully Met) 5) To ensure that MAR sheets are completed without gaps, with signatures to indicate administration or an appropriate code to indicate nonadministration 31/08/05 4. 19 23(2) 5. 21 23(2)(j) To renovate or replace the floor 31/10/05 covering in the first floor treatment room (possible change of use) (Timescale of 31/03/05 Not Fully Met) Action must be taken to ensure 31/10/05 the two bathrooms currently not in use are made accessible to
Version 1.40 Page 28 The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc 6. 29 17 (2) Schedules 2 and 4 19(1) service users (Timescale of 31/10/04 Not Fully Met) 1) To take account of guidance from the DoH POVA/CRB certificates are to be available to for inspection at the home (Timescale of 31/10/04 Not Fully Met) 30/09/05 7. 29 17 (2) Schedules 2 and 4 19(1) 17(2) 20(1) 8. 35 2) To review and update the grievance procedure in view of the introduction of the protection of vulnerable adult abuse (POVA) register. (Timescale of 31/10/04 Not Fully Met) To ensure that the hairdresser 30/09/05 and any other self-employed therapists provide the home with evidence of satisfactory POVA/CRB clearance The organisation must review 31/10/05 and revise the policy and procedures relating to the management of service users finances to demonstrate compliance with Regulation 20(1) and the protection of vulnerable adults (Timescale of 31/10/04 Not Fully Met) 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 Good Practice Recommendations The Gables Nursing Home E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 29 Commission for Social Care Inspection West Point Mucklow Office Park Mucklow Hill Halesowen. B62 8DA 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 E55 S4832 The Gables Nursing Home V233869 190705 Stage 4.doc Version 1.40 Page 30 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
