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Inspection on 20/11/07 for The Gables Nursing Home

Also see our care home review for The Gables Nursing Home for more information

This inspection was carried out on 20th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is information available to potential residents and their care needs are identified with them, prior to their move to the home, to ensure that they can be met. The assessment takes into account the diverse needs of residents and their spiritual and cultural wishes. Residents` personal, healthcare and medication needs are met, promoting their wellbeing. Residents privacy and dignity is respected although this could be further enhanced by ensuring that residents can be cared for by a carer of the same sex, if that is their wish, and by providing greater privacy in the rooms which do not have ensuite facilities. The home offers a flexible lifestyle, in line with resident`s expectations and abilities and supports their autonomy. There is an activities coordinator who works part time and arranges a number of activities although some residents felt that they would like more to do. The meals are of a high standard and meet resident`s nutritional and social expectations. Residents said that that they enjoyed their meals, which were freshly cooked using fresh ingredients. Resident`s cultural needs are respected and menus to meet these are provided. The complaints and protection policies and procedures work well, giving residents and their families confidence that their concerns will be addressed and any safeguarding issues will be addressed, in conjunction with the Local Authority. Residents and their families knew who to talk to if they have any concerns and one said that ` any concerns I have are dealt with straight away`. The Commission for Social Care Inspection has not received any complaints about the home and has not been notified of any allegations made to the Local Authority under the multi-agency safeguarding policy. The home is a comfortable place for residents to live. Residents are encouraged to personalise their rooms and many had chosen to do so. The staffing levels are good, recruitment procedures are thorough and staff have access to training programmes to ensure that they have the correct attitude, knowledge and skills to care for frail older people. Residents and families spoke very highly of the staff, making comments such as `I find the staff are excellent, always cheerful and patient`, `the staff interact well with clients, they appear respectful and sensitive` and `they look after me well`. The home is well managed and the safety of service users and staff is protected. There is a quality assurance programme in place and resident`s views are sought both formally and on an everyday basis. There are health and safety procedures in place and service and maintenance records are up to date.

What has improved since the last inspection?

The care plans have improved and there is evidence that residents and their families have input into their care plan on a regular basis. A quality-monitoring programme has been introduced.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE The Gables Nursing Home The Gables Nursing Home 123 Wendover Road Aylesbury Buckinghamshire HP21 9LW Lead Inspector Christine Sidwell Unannounced Inspection 20th November 2007 10:30 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 DS0000019226.V348216.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 DS0000019226.V348216.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Nursing Home Address The Gables Nursing Home 123 Wendover Road Aylesbury Buckinghamshire HP21 9LW 01296 423077 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) mg_gbls@hotmail.co.uk Mandeville Care Services Limited Mrs Minerva Patti Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. General Nursing Care Date of last inspection 27th July 2006 Brief Description of the Service: The Gables Nursing Home is an older building with character and retains some of its original features. The home is situated on a main road close to local amenities. The home provides nursing care for twenty-two service users. The staff team consists of qualified nurses, carers and ancillary staff with a manager, who is a suitably qualified nurse. The home has access to a large well-kept garden, which is situated approximately five minutes away at Mandeville Grange, which is also owned by the proprietors. There is an outside patio sitting area at the home. Due to the close proximity of these two homes the manager is registered to manage both homes. Information about the home, in the form of a statement of purpose, which describes the services available and the terms and conditions, a service users guide and brochure can be obtained can be obtained from the home. The fees at the time of this inspection range from £482 to £550. Additional costs are incurred for newspapers, hairdressing, chiropody and personal items. The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted over the course of three days and included an unannounced visit to the home. The key standards for older people’s services were covered. Information received about the home since the last inspection was taken into account in the planning of the visit. Prior to the visit, an annual quality assurance self-assessment was sent to the manager and surveys were distributed to service users, relatives and visiting professionals. Twelve residents or their families and three health or social care professionals returned the questionnaires. Residents and families were also spoken to on the day of the unannounced visit. Discussions took place with the manager, nursing, care and ancillary staff. Care practice was observed. A tour of the premises and examination of some of the required records was also undertaken. The homes approach to equality and diversity was considered throughout. What the service does well: There is information available to potential residents and their care needs are identified with them, prior to their move to the home, to ensure that they can be met. The assessment takes into account the diverse needs of residents and their spiritual and cultural wishes. Residents’ personal, healthcare and medication needs are met, promoting their wellbeing. Residents privacy and dignity is respected although this could be further enhanced by ensuring that residents can be cared for by a carer of the same sex, if that is their wish, and by providing greater privacy in the rooms which do not have ensuite facilities. The home offers a flexible lifestyle, in line with resident’s expectations and abilities and supports their autonomy. There is an activities coordinator who works part time and arranges a number of activities although some residents felt that they would like more to do. The meals are of a high standard and meet resident’s nutritional and social expectations. Residents said that that they enjoyed their meals, which were freshly cooked using fresh ingredients. Resident’s cultural needs are respected and menus to meet these are provided. The complaints and protection policies and procedures work well, giving residents and their families confidence that their concerns will be addressed and any safeguarding issues will be addressed, in conjunction with the Local Authority. Residents and their families knew who to talk to if they have any concerns and one said that ‘ any concerns I have are dealt with straight away’. The Commission for Social Care Inspection has not received any complaints about the home and has not been notified of any allegations made to the Local Authority under the multi-agency safeguarding policy. The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 6 The home is a comfortable place for residents to live. Residents are encouraged to personalise their rooms and many had chosen to do so. The staffing levels are good, recruitment procedures are thorough and staff have access to training programmes to ensure that they have the correct attitude, knowledge and skills to care for frail older people. Residents and families spoke very highly of the staff, making comments such as ‘I find the staff are excellent, always cheerful and patient’, ‘the staff interact well with clients, they appear respectful and sensitive’ and ‘they look after me well’. The home is well managed and the safety of service users and staff is protected. There is a quality assurance programme in place and resident’s views are sought both formally and on an everyday basis. There are health and safety procedures in place and service and maintenance records are up to date. What has improved since the last inspection? What they could do better: All residents, irrespective of their funding source, must have a statement of their individual fee arrangements and the terms and conditions of their stay, to ensure clarity and transparency for them and their families. The home should endeavour to ensure that residents can be cared for by a carer of the same sex, if that is their wish, and better privacy should be provided for residents who do not have an ensuite toilet in their rooms and use a commode. The décor and some furnishings and beds are in need of upgrading to provide a pleasant and safer environment for residents and staff. The programme to replace divan beds with height adjustable beds for residents who require nursing care should be maintained. The infection control measures should be improved if residents are to be fully protected from acquired infection. Residents must not share hoist slings and sliding sheets and all bins, which hold clinical waste, must have foot-operated lids. The home should aim for the standard that 50 of care staff hold the National Vocational Qualification in Care at level 2 or above, to ensure that carers have the knowledge and skills that they need to meet the needs of older people. The issues identified in the home’s fire risk assessment should be addressed. The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 7 The proprietors or someone nominated on their behalf must undertake regular quality assurance visits to the home and the outcome of their visit should be recorded and kept at the home in line with Regulation 26 of the Care Homes Regulations 2001. A training matrix should be developed to ensure that all staff have had mandatory training in safe working practices, with annual updates where appropriate. 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 DS0000019226.V348216.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There is information available to potential residents and their care needs are identified with them, prior to their move to the home, to ensure that they can be met. There is a need to ensure that all residents, irrespective of their funding source, have a statement of their individual fee arrangements and the terms and conditions of their stay, to ensure clarity and transparency for all residents. EVIDENCE: The home has an up to date statement of purpose and service users’ guide, entitled ‘Your Guide to The Gables Nursing Home’. All but two of the residents, or families, who returned the questionnaires, said that they had received information about the home. A copy of the welcome pack was seen in residents’ rooms. The manager stated that the service user’s guide could be made available other formats if necessary. All residents who fund their own care have a contract with terms and conditions. There was evidence in the files that notice is given of fee The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 10 increases. Three of the service users or their families who returned the questionnaires said that they did not have a contract. The manager said that some residents whose care was funded in full or in part by a Primary Care Trust or Social Services Department might not have a statement of their terms and conditions with a full explanation of their fees and who was responsible for paying them. She said that the home is in currently reviewing all residents’ files to ensure that they have up to date contracts or statements of terms of conditions, which clearly detail the fees and who is responsible for paying them. She expected this to be completed within six months and a requirement is made in this report that be achieved. There was evidence in residents’ files that a comprehensive assessment of their needs is undertaken prior to their move to the home. The assessment documentation prompts staff to consider the diverse needs of residents and their cultural and spiritual wishes, which were recorded. The residents and families who returned the questionnaires and those spoken to on the day said that they had met someone from the home and had had the opportunity to visit the home before deciding to move. The home does not offer intermediate care. The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Residents’ personal, healthcare and medication needs are met, promoting their wellbeing. Resident’s privacy and dignity is respected although this could be further enhanced by ensuring that residents can be cared for by a carer of the same sex, if that is their wish, and by providing greater privacy in the rooms which do not have ensuite facilities. EVIDENCE: The care of three residents was looked at in detail. All had written care plans, which had been updated regularly. There was evidence that residents or their families had been involved in agreeing care plans. Care managers assessments were also available in the care plans and these had been incorporated into the residents care plan. Only one of the care plans seen had a photograph of the resident. This should be addressed. Residents’ personal care needs had been addressed and those who returned the questionnaires and those spoken to on the day said that the staff helped them and were kind and caring. Relatives made comments such as ‘I think the The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 12 staff give good care and support to my mother’ and ‘my father is always well cared for, clean and well nursed’. One family said that because of their mother’s illness, she could not speak but that ‘she knows what’s what and the staff know exactly what she wants, she loves them all’. The residents whose care was followed through had had their risk of developing pressure damage assessed and one who had been identified as at high risk had the appropriate support mattress and chair cushion. The manager said that no residents who had been admitted to the home in the last year had developed pressure damage. Nutritional assessments are undertaken and resident’s weight is monitored. There was evidence that additional food supplements are given if necessary although the standard of the food is good and this is not always necessary. There were moving and handling and falls assessments on file. Risk assessments are undertaken if it is felt that a residents may fall out of bed and would benefit from bedrails. Local general practitioners visit regularly. Two general practitioners returned the questionnaires and both said that the staff demonstrated a clear understanding of the care needs of residents and both were satisfied with the overall level of care provided to residents in the home. Other healthcare practitioners also visit the home, including an optician, chiropodist and specialist nurses. There are medication management policies and procedures in place and the staff spoken to were aware of these. Storage facilities are satisfactory. Records are kept of medication entering and leaving the home. The medication administration records were accurately completed. Controlled drugs were stored satisfactorily and all entries to the controlled drug register were signed. A contract is held for the disposal of unused medication. The registered nurses spoken to said that medication was not administered covertly. If a resident refused medication this would be recorded. If medication was essential the advice of the general practitioner would be sought and a way forward agreed with the resident or their family. The staff were observed to be respectful towards residents with and to protect their dignity. All care is given in residents’ rooms. The general practitioners said that they saw residents in their rooms. Both care managers who returned the questionnaires said that they felt that the service respected individual’s privacy and dignity. One resident however was upset that sometimes her care was given by a man and she only wanted a female carer. Her room did not have an ensuite facilities and she was afraid that someone might come in when she was using the commode. The manager should review this and ensure that residents can be cared for by someone of the same sex, if that is their wish, and that privacy is provided in rooms where a resident may be using a commode. The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The home offers a flexible lifestyle, in line with resident’s expectations and abilities and supports their autonomy. Some activities are provided to bring interest and diversion to the day. The meals are of a high standard and meet resident’s nutritional and social expectations. EVIDENCE: The home employs an activities coordinator who visits the home three days a week, including one day at the weekend. A range of activities is provided, including quizzes, manicures and gentle ball games. She does not have training in the provision of therapeutic activity for older people. A music afternoon and a carol concert are planned for December. Of the six residents who returned the questionnaires three said that activities were available, one said ‘usually’ and two said ‘sometimes’. One resident commented that she would like more to do. The residents spoken to said that they had a choice as to how they spend their day and some said that they preferred to stay in their rooms and enjoyed the television. The families who returned the questionnaires said that were always made welcome and the service user’s guide and statement of purpose states that the The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 14 home actively encourages families and friends and states that the policy of the home is ‘open house, enabling residents to have visitors of their choosing as a when they wish and in privacy’. One family member said that ‘ the staff know us all and it is like visiting family when we go to visit’. The residents spoken to said that they had a choice as to how they spent their day. The standard of food is good. There are three meals a day. Residents are offered a cooked breakfast if they wish and a choice of main meal. All the residents who returned the questionnaires said that they enjoyed the food. The chef was spoken to and it was clear that he knew everyone and was aware of resident’s likes and dislikes and was also aware of any special cultural or medical requirements. There was evidence that all food is home cooked and that fresh vegetables and fruit are available. The last meal is between 5.30 and 6.00pm. Hot drinks and sandwiches and biscuits are available in the evening. Residents were seen to have a drink within reach throughout the day. The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The complaints and protection policies and procedures work well, giving residents, and their families, confidence that their concerns will be addressed and any safeguarding issues will be addressed, in conjunction with the local authority. EVIDENCE: There are complaints policies and procedures in place. A complaints log is kept. Four complaints had been logged since the last inspection and all had been responded to promptly and action had been taken to address the concerns. All the residents who returned the questionnaires said that they knew who to speak to if they were unhappy. The residents spoken to said that they had never had to make a formal complaint and that if they were unhappy with any aspect of the service it would usually be dealt with immediately. The home is aware of the local multi-agency strategy for the protection of vulnerable adults. Most staff have now had safeguarding training and those spoken to said that they would have no hesitation in reporting any concerns about residents welfare. The Commission for Social Care Inspection has not received any complaints about the home and has not been notified of any allegations made to the Local Authority under the multi-agency safeguarding policy. The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 16 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 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The home is a comfortable place for residents to live. The décor and some furnishings and beds are in need of upgrading to provide a pleasant and safe environment for residents. The infection control measures should be improved if residents are to be fully protected from acquired infection. EVIDENCE: The home is an older building and has been adapted for its present use. The rooms vary in size. There is a programme of maintenance and the outside of the home and the communal areas have been redecorated in the last year. Some bedrooms have been redecorated and seven new height-adjustable, profiling beds have been bought. There is a need to continue the programme of replacing the beds with height adjustable beds for those residents who require care in bed. There is a stair lift to the upper floors, which has been maintained regularly. This does mean that care has to be exercised as to who can have a room on the upper floors as they need to be able to sit safely to The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 17 come to the lounge and dining room. In the annual quality assurance selfassessment the proprietor has stated that subject to funding constraints they hope to continue with the refurbishment of residents rooms and to buy additional height adjustable, profiling beds. There are control of infection policies and procedures, which have been updated in the last year. All rooms and clinical areas have liquid soap and hand towels available to staff. Alcohol hand gel is also used to help prevent cross infection. There are systems in place to separate soiled laundry and additional precautions are taken if it is known that a resident has an infection. Residents share hoist slings and sliding boards, which is contrary to the current Department of Health guidance and should be addressed. Not all clinical waste bins seen had foot operated lids. There were no offensive odours in the home on the day of the unannounced visit. The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 18 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 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The staffing levels are good, recruitment procedures are thorough and staff have access to training programmes to ensure that they have the correct attitude, knowledge and skills to care for frail older people. Care staff should be encouraged and supported to undertake National Vocational Qualifications in Care to give them the knowledge and skills that they need to meet the needs of older people. EVIDENCE: The home has good staffing levels and a low turnover of staff. There are four carers on duty in the morning, three in the afternoons and evening and one at night. In addition there is a qualified nurse on duty at all times. The care team is supported by housekeepers and a chef and kitchen assistant. The residents spoken to said that the care staff were able to answer their bells promptly and that they did not appear rushed. They spoke very highly of the all staff, making comments such as ‘I find the staff are excellent, always cheerful and patients’, ‘the staff interact well with clients, they appear respectful and sensitive’ and ‘they look after me well’. There are nine permanent care staff of whom three hold the National Vocational Qualifications in Care at level 2 or above and a fourth has commenced the course. The home does not yet meet the standard that 50 of care staff hold these qualifications. The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 19 The recruitment files of three members of staff were selected at random and examined. All had the required documentation. Staff had completed an application form, references had been sought from previous employers and Criminal Records Bureau disclosures had been sought before the staff member commenced work. An induction programme is in place and there was evidence in the files that staff undergo a training programme. The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 20 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, 15, and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The home is well managed and the safety of service users and staff is protected. EVIDENCE: The proprietors are experienced in the management of care homes for older people. The home’s manager is registered to manage two homes, which are in close proximity. There is an experienced deputy manager. The manager and deputy manager are qualified nurses. In addition the manager holds the National Vocational Qualifications in Management at level 4. The staff and residents said that managers was approachable and said that they felt that the home was managed smoothly. There is a quality assurance system in place. Regular surveys of resident’s and family’s views are undertaken and the manager has begun a programme of regular audit to ensure that the homes The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 21 procedures and processes have good outcomes for residents. The manager said that the proprietors visit the home regularly although they do not formally record the outcome of their visits as required by Regulation 26 of the Care Homes Regulations 2001. This should done. The home does not manage service users money on their behalf. A personal allowance may be stored for safekeeping on behalf of resident, if they wish. Receipts are given for any money left with the home and for expenditure undertaken on resident’s behalf. Most residents pay for additional items such as newspapers or toiletries through an invoicing system, to reduce the need for the home to hold money on behalf of residents. There are health and safety policies and procedures in place. Potentially dangerous substances are locked safely. The fire procedures have been maintained. A fire risk assessment has been undertaken although there was no evidence available in the home to show that all the issues that had been raised had been addressed. This should be addressed. Other fire records were up to date and there was evidence that regular fire drills are undertaken. The service and equipment maintenance records were up to date. There was evidence in staff files that training is given in safe working practices, including moving and handling and food hygiene. It would be easier for the manager to ensure that all staff had the required annual updates if a training matrix was developed which showed the dates when staff last had had the mandatory training or an annual update. The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 and 5B Requirement Timescale for action 31/03/08 2 OP26 13(3) 3 OP33 26 The proprietors must ensure that all service users have a statement of terms and conditions, which include details of the fees payable and by whom to ensure clarity for service users and their families. The proprietors must ensure that 30/06/08 residents do not share hoist slings or sliding sheets, to minimise the risk to residents of cross infection. All bins, which contain clinical waste, must have foot-operated lids to prevent the spread of infection. The proprietors must undertake 31/12/07 regular quality assurance visits to the home. The outcome of these visits must be recorded and a copy kept at the home. The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 24 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 6 7 Refer to Standard OP10 OP10 OP7 OP24 OP28 OP38 OP38 Good Practice Recommendations Residents should be cared for by a carer of the same sex if that is their wish. Better privacy should be provided in their rooms for residents who do not have ensuite facililities and have to use a commode. Resident’s care plans should have a photograph. The programme to replace older beds with height adjustable beds for those residents who require nursing care should be maintained. The home should aim for the standard that 50 of care staff hold the National Vocational Qualification in Care at level 2 or above. The issues identified in the homes fire risk assessment should be addressed. A training matrix should be developed to ensure that all staff have had mandatory training in safe working practices with annual updates where appropriate. The Gables Nursing Home DS0000019226.V348216.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 DS0000019226.V348216.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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