Inspection on 23/04/08 for The Gables Nursing Home

This inspection was carried out on 23rd April 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

The Gables Nursing Home 07/11/08

The Gables Nursing Home 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 13/07/05

The Gables Nursing Home 21/12/04

The Gables Nursing Home 19/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Gables Nursing Home 231 Swinnow Road Pudsey Leeds Yorkshire LS28 9AP Lead Inspector Sean Cassidy Key Unannounced Inspection 09:00 23rd April 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Nursing Home Address 231 Swinnow Road Pudsey Leeds Yorkshire LS28 9AP 0113 2570123 0113 2551336 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dr Hussan Ara Minhas Dr Emad-Ul-Mulk Minhas Mr Kevin Joseph Brennan Care Home 23 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (3), Old age, not falling within any other of places category (23), Physical disability (1) The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The place for Physical Disability is specifically for the service user named in the variation application dated 20 February 2004. Not to exceed 3 service users in total for the categories DE and DE(E) Date of last inspection 30th April 2007 Brief Description of the Service: The Gables Nursing Home is an extended converted building that provides personal care with nursing for both men and women over 65 years. It is a three-storey building, but people living at the home have access to only two of these, the third storey is used for storage and office space. The home is situated on a busy main road with good access to public transport for Leeds and Bradford. Facilities nearby include a public house, shops, a post office, a cricket ground and a GP surgery in the grounds of the home. The majority of bedrooms are single but there are some shared rooms. Some rooms have ensuite facilities, the majority of which have limited access. Lounges and the dining room are on the ground floor; the garden can be accessed from one lounge by a portable ramp. On the 22nd April 2008 the manager said that the weekly fees ranged from £440 - £545 per week. Additional charges are made for newspapers, hairdressing, chiropody and personal toiletries. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence in this report has included: • • A review of the information held on the home’s file since the last inspection. Information obtained from residents, relatives, staff and other health care professionals. Two inspectors and one pharmacy inspector conducted an unannounced visit to the home that lasted one day. The majority of this time was spent speaking to residents, management, staff and relatives. A number of documents were looked at during the visit and some areas of the home used by the people living there were visited. A proportion of time was spent speaking to the manager, the registered providers, staff and visitors. The information required from the provider in the form of the Annual Quality Assurance Assessment was not obtained before this report was written. Feedback was provided at the end of the inspection to the manager. I would like to thank everyone who contributed to this report, and for the hospitality on the day. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes What the service does well: Residents spoken to during the inspection spoke highly about the dedication of the staff team. They felt they tried their best to give good care. Care staff interact and communicate well with the people living in the home. Two residents said there was a nice ‘friendliness’ about the home, which gave it a ‘cosy’ atmosphere. Staff respond well with the nutritional needs of people who are identified as at risk. A visiting dietician commended them for helping a resident to gain a significant amount of weight. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home’s Statement of Purpose and Service User Guide must be in a format that is suitable to the needs of the people living at the home. This will make sure that people are aware of the services that the home provides. All people using the service must have an up to date and detailed care plan that is reviewed monthly and shows evidence that people or their representative have been involved. This will make sure that staff have clear instructions on how to meet the person’s needs in all aspects of their care. There must be improvement with the administration, storage and record keeping in relation to medications in the home. This will make sure that people receive their medication as prescribed. The toilet and shower/bath facilities must have locks on the inside of the doors. This will help promote peoples’ privacy in the home. A more structured programme of activities and outings must be developed and provided to all people living in the home. These must be focused on the specialist dementia needs of those people living there. This will promote the well being of all people living in the home. Any incident that places staff or residents at risk of harm must be properly referred to the safeguarding team. This will help protect people from harm. The home must develop an annual refurbishment programme that identifies areas that need improvement. This will make sure that the home is suited to the needs of the people living in the home. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 7 The staff working in the home must receive training that is centred around the care needs they are providing care in. This will ensure people are receiving the correct care. The manager must establish a robust quality assurance system within the home. The providers must ensure that regulation 26 visits take place and that they monitor all the key areas within the care service. This will help to improve the quality of care experienced by people living there. The manager must ensure all areas and equipment used in the home are thoroughly risk assessed. This will help minimise the risk of harm to people living in, working in or visiting the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables Nursing Home DS0000001338.V363701.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 5 People who use the service experience adequate quality outcomes in this area. People are assessed by a professional and have the opportunity to look around the home prior to moving in. They are not provided with the required information, which means they are not fully informed about the service when making their decision to take a room. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has developed a brochure, which the manager said was given to people when they made an enquiry about the home. Two people spoken with said that they were given some information when they looked around for the first time. The brochure does not contain al the required information set out in Schedule 1 of the Care Homes Regulations 2001. A Service User Guide has not been developed. The absence of this information means people are not The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 10 provided with sufficient information to enable them to make an informed choice about moving into the home. All care files showed evidence that people were assessed prior to moving into the home. These documents included sufficient information for the assessor to identify whether they could meet that person’s needs within the home. People spoken to during the inspection said they had the opportunity to visit the home before agreeing to take a place. Relatives said they met with the manager who showed them around and answered any questions they had. One also said she met with the provider when she visited. The Gables Nursing Home DS0000001338.V363701.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 adequate quality outcomes in this area. People are provided with care plans and risk assessments that help ensure their identified care needs are met. There are poor systems for the accurate administration, recording and storage of medicines. This puts people at risk of not receiving their medication safely and as prescribed. This may have an affect on their health and wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection, the care files of four people were closely inspected. The evidence seen shows improvements in the standard of care planning and risk assessment provided to people. Evidence was in place to show each person had care plans that assisted staff with meeting the care needs of the individuals they were caring for. Risk assessments for pressure area care, The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 12 nutrition, continence and falls were also in place. When a risk was identified, a plan of care was developed to minimise the risk in these areas. However, Care plans and risk assessments are not reviewed monthly. Gaps of at least two months were identified in all those inspected. This means peoples’ care is not reviewed regularly so that any changes in their condition can be acted upon quickly. All care documentation seen showed there was little emphasis placed on a person centred care approach. This meant it was very difficult to get a picture of who each individual person was, what they could do for themselves and what their likes and dislikes were in relation to living a fulfilled life in the home. An example of this was, a person identified as having severe mental health issues and also dementia, has lead to social isolation. The care plans developed for this individual provided very little evidence to show this person was being helped in any way with these problems. Examples of staff entries in the daily records for this person were, “Spent the day in his room.” “Cares given in room.” No evidence was seen to show how they were involving other professional with his health needs in order to improve his current condition. There was evidence in the care records to show people who need to see another health professional are referred. Two files seen showed a dietician had been involved with their care. One dietician had developed a plan of care for one individual. Two months later they had reviewed that person and found that he had gained a significant amount of weight. He congratulated the home for their efforts. The majority of the care staff were observed caring for people during the course of the inspection. This care was delivered in a very caring and attentive way. Staff used a lot of touching and holding hands which appeared to be well responded to by those involved. The communication between staff and the people who live there was seen as good. People were given time to ask and answer questions. Privacy and dignity appeared to be well respected. One person was moved from her chair to a hoist in a way that was respectful. She was spoken to and reassured throughout the whole process. This was good practice. We found that a significant amount of the shower/bathrooms and toilets did not have locks on the inside. This is poor practice as it removes the right to privacy for those people living in the home. There were some concerns raised about getting people up early and putting them to bed early. Staff spoke of their routines and confirmed that that people are up before they come on duty and they start getting people to bed at around 6.15pm. Breakfast was being served upon our arrival. Some people in the dining room had their head on their arms, resting on the tables sleeping. Staff said that there was a practice of getting people up before the day staff came on duty. The manager said these times were reflected in the care plans. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 13 When a random person’s care plan was case tracked this evidence was not seen. Care files should reflect peoples’ preference times for going to bed and getting up. This information should be obtained at assessment and during the early stages of a person’s stay. Relatives spoken to gave some positive feedback about the standard of care delivered in the home. “The personal touch is good here. The carers are very welcoming and helpful.” “ The staff give you an air of confidence.” Evidence was found of poor record keeping with regards to medication. Many signature gaps were identified on medication charts. Antibiotic courses that had signatures of administration did not match the quantity supplied. Medication was signed for as given but still in the supply. Medication identified as being out of stock meant people were going without their medication. Medication with limited use once opened without dates of opening on. One box of out of date medication found in the cupboard. The fridge was not locked on day of visit, stored in a separate room to other medicines, which was not locked and accessed by all staff. Care staff are being asked to give medications by a senior member of staff when this is not allowed. This is poor practice. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. People benefit from individualised interaction from staff when they have time to provide it. A more structured programme of events should be developed which takes into consideration the specialist dementia needs of the people that live there. This will help to improve the wellbeing of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an activities co-ordinator 10 hours per week to set up trips etc. Care staff undertake afternoon activities for people they are key workers for, although, staff said they were frustrated at times due to pressures of work meaning these activities can slide. Documented evidence was seen under each person’s name to show what activity the key worker was involved with that person. The records were tailored to individual needs as much as possible i.e. hand massages for people with dementia and communication difficulties. Care staff stated that they were The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 15 about to attend a dementia course that would help them understand the activity needs of people with dementia. There is a significant proportion of people living in the home with dementia needs. There was little evidence available to show the activity needs of this group are met using specialist methods. Evidence was available to show some activities had been taking place recently. Pictures were on the wall of a recent Clothes party and Pancake Day event where the chef was involved with residents tossing pancakes. Residents spoken to said people do have the ability to go out and get involved with trips that the home plans. These are focussed mainly on those people who are more able to mobilise. Staff confirmed this during conversations. Two staff said “ Those people that are more able get to go on the trips. Those that aren’t don’t have the choice.” This must be reviewed to ensure all those living in the home are equally enabled to access trips out and evidence must be available to ensure this happens. One relative said that she called four times per week and hasn’t seen much activity being provided in the home. One resident said that he didn’t leave his room at all. His notes showed that this was the case. His daily records showed no evidence of any activity involvement at all. One resident has been confined to her bedroom for three weeks as the home was replacing her chair. The manager said that this had been ordered. There was evidence available to show some people had attended trips to Tong garden centre, the Christmas lights in Leeds, fish and chip supper in Leeds and to the local pub. The chef gets actively involved in developing theme food days, which people said they enjoyed. Examples of these are on Halloween and Valentines Day. One person living in the home said “The girls are good to us all I get on well with them. It’s a bit boring sat looking at each other; I would prefer to go out if someone would take us. I like to read, I get enough books from another residents daughter, there is a library available”. One person living in the home expressed wishes to receive Holy Communion every month and the home has arranged this. At Lunch, music was playing in the dining room, which was laid with cloths and napkins with artificial flowers on the tables. People were observed talking with each other. Key workers record the food likes and dislikes for people and these are kept in the kitchen. Chef said there are other choices of food available if people don’t like what’s on offer. She sees them herself and asks people what they want instead. Regular cold drinks were available in the lounge areas and drinks provided for residents and visitors on request. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 16 Lunch looked appetizing and reflected what was highlighted on the menu. The chef and kitchen staff were able to identify people who had special diets. These were observed being given at lunchtime. Portion sizes could be specified. Foods were fortified with cream etc for people who were nutritionally challenged. People could choose where to have their meals. Those requiring some assistance and monitoring with food were served lunch in a dining room assisted by patient staff in an unhurried manner. However, one ladies meal arrived late. Although it was hot, it was a few minutes before a carer came to assist with the meal. Once she sat down she described the food to the resident and gave her full attention and support to feeding the lady. The chef said that there was one lady who was assessed as not having much of an appetite so they asked her each day what she would like and make that for her. The use of equipment such as non-slip mats under plates, feeder cups and plate guards were seen to help people feed themselves. Food hygiene was being maintained in the kitchen. Fridge freezer and hot meat temperatures were recorded. The home has recently been assessed by the environmental health and it was awarded a status of three stars, which is good. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience adequate quality outcomes in this area. People spoken to felt comfortable about making a complaint if they needed to. The policies and procedures for complaints and safeguarding need improved to ensure people are properly protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy needs updated so that people are informed that they can contact the Commission for Social Care Inspection if they needed to. No recorded complaints have been made since the last inspection. The Commission has assisted a complainant with their complaint regarding the standard of care in the home. This has recently been concluded as part of a safeguarding adults investigation. The safeguarding policy needs to be reviewed so that it is correct. It states, “ Care Commission will investigate.” This is not the case, as the CSCI does not have the power to do this. The manager said the home did not have local safeguarding guidelines information from Leeds Safeguarding team to say how allegations of abuse should be handled. A safeguarding issue was identified with the manager that was not referred to the safeguarding team when it clearly should have been. This raises concern about the managers understanding of when to make a referral in order to protect all involved. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 18 Staff questioned about safeguarding answered with knowledge and understanding of what action they should take. They had also received safeguarding training. Relatives spoken to during the inspection said they felt comfortable approaching the manager or the person in charge to make a complaint if they needed to. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. People who use the service experience adequate quality outcomes in this area. The environment of the home has been improved in some areas. People living in the home would benefit more if there was a annual refurbishment plan that identified areas for improvement in the coming year. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People spoken to said that the home is “Cosy” and “homely”. One relative said she wasn’t happy about the posters that are stuck on the glass of the front door as it restricted the view of the person waiting there. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 20 Pictures have been put up around the home that remind people of film stars and singers from the past. Some bedrooms have pictures of the occupant of the door which helps remind them that that is their room. Good practice recommends using pictures of people when they were younger. They are more likely to recognise themselves from an older picture. There are a large proportion of bedrooms that have furnishings that are in a poor condition and in need of replacing. Peoples’ drawers and wardrobes were in a poor state of repair and in need of replacement. Some work has been carried out to improve the environment in the past year. The manager has not developed an annual plan for refurbishment of the home so we were unable to identify what improvements were planned and budgeted for the coming year. Lighting remains inadequate in the lounge where the nurses’ station is currently positioned. There is no access to natural light and the central ceiling lighting does not provide enough light for the area. The registered providers should look at ways to address this. The laundry room was clean and tidy. Infection control was well managed and there were no offensive smells throughout the home. Evidence was available to show staff received infection control training. This was confirmed through conversations with staff during the inspection. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 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 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 adequate quality outcomes in this area. Peoples’ needs are being met. Improvement with the levels of staff and the training they are provided would improve the standard of care delivered in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing levels on duty at the time seemed suitable for the work they were expected to do. Staff spoken said they do feel rushed and could benefit from having more staff on duty as this would mean they could spend more time providing individualised and group activities with the people who live in the home. The following are comments made by staff re the staffing levels, “We don’t have enough staff to do the activities we would like to do with the residents.” “When we do get involved with activities we get asked to do other things around the home.” “Last year we went out with residents to a local park for a walk. The manager told us we were not allowed to do it again because we didn’t have the staff.” This evidence suggests there are still issues with staffing levels in the home, which have a negative affect on the wellbeing of people living there. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 22 Evidence was seen to show training is available to staff in the home. The manager has developed a staff training matrix that covers areas for mandatory training. This should be further developed so that there is clear evidence that training is provided in all areas of care need within the home to ensure people benefit from a well trained workforce. Staff said they received training in: Manual Handling, fire training, infection control, equality and diversity, handling medicines and visual training, the understanding of people with visual impairment. Three members of staff felt the training should be more robust and more refresher training is needed. Staff said they were not familiar with care needs of residents in areas such as diabetes, continence care, pressure area care and nutrition. The manager stated he has given this training in the past and will plan more for the future. Not all said they were provided with supervision. The manager does hold staff meetings on a regular basis. Three members of staff who have been working at the home for longer than a year have said they did not have an induction when they started but they are now receiving one. The recruitment files for three new starters were seen and contained all the necessary information needed to ensure the appropriate checks were completed prior to commencing employment. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience adequate quality outcomes in this area. People living in the home do not benefit from management systems and processes that maintain and improve the quality of care they receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) was sent out to the manager of the home. The manager said that this never arrived in the post. Another was sent out to complete prior to this inspection. The manager said that he does not have full supernumery status, which causes difficulty with fulfilling his management responsibilities. There are some tools used for assuring quality but these are not robust. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 24 The provider does visit the home but does not complete Regulation 26 reports to provide evidence that the quality of care is being monitored and improved. Although some improvement in areas has been noted, there are still a significant percentage of outstanding requirements from the last inspection carried out in April 2007 that have not been complied with. This provides evidence to show the manager is finding the management of the home difficult and also means that the standard of care experienced by people is not at the level it should be. The manager tries to quality assure the care provided by surveying residents in the home and auditing falls, but there is no evidence that action was taken as a result of this. The falls audits identify residents who have had regular falls but no action taken to show how the manager intervened to reduce this risk. There is no annual plan developed for the home that highlights a clear system for evaluating the quality of the services provided at the home. This means there is no clear budgeting system that clearly allocates funds for areas such as refurbishment of the environment, staffing and training. The most recent inspection report is not available for residents and visitors to read. The availability of this document would promote openness and transparency. The finances of three people were inspected and these were found to be in order. The manager has developed an environmental risk assessment for the home that covers most of the areas that staff and residents have access to. This is reviewed monthly. There were several health and safety risk identified on this inspection. These were: • The bed rails in several peoples’ rooms were not securely fastened and posed an acute health and safety risk to residents. The manager said these are checked regularly and agreed that they would be reviewed immediately. This is an area that has been identified as a high risk to people in the home on a previous occasion. It is recommended that the training of the person identified as checking the bed rails be reviewed. A broken sluice in the sluice room was not locked and posed a possible risk to people. The fire escape door on the top landing was not alarmed and was very easily opened. The opening lead to two flights of steep metal steps. This is a risk to residents’ health and safety. The hoist in the bathroom was identified as being last checked on 12/1/06. A sticker was placed on it stating, “This has passed this time but will not pass the next one.” This is a risk to residents’ health and safety. DS0000001338.V363701.R01.S.doc Version 5.2 Page 25 • • • The Gables Nursing Home • Staff are carrying used commodes down stairs and into the sluice on the ground floor. This practice raises concerns in both infection control and health and safety. The above issues were given to the manager during feedback at the end of the inspection. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x 3 x 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 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x 2 x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 2 The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 (1) (2)5 (2) Requirement The home’s Statement of Purpose and Service User Guide must be in a format that is suitable to the needs of the people living at the home. This will make sure that people are aware of the services that the home provides. (Previous date of 31/8/07 was not met.) 2. OP7 15 (1) All people using the service must have an up to date and detailed care plan. This will make sure that staff have clear instructions on how to meet the person’s needs in all aspects of their care. (Previous date of 31/8/07 was not met.) 31/07/08 Timescale for action 31/07/08 3. OP9 13 (2) Staff must follow proper procedures when administering medication. This will make sure that people receive their medication as 31/07/08 The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 28 prescribed. (The previous timescale of 16/8/07 was not met) 4 OP10 12(4)(a) The toilet and shower/bath facilities must have locks on the inside of the doors. This will help promote peoples’ privacy in the home. A more structured programme of activities and outings must be developed and provided to all people living in the home. These must be focused on the specialist dementia needs of those people living there. This will promote the well being of all people living in the home. Any incident that places staff or residents at risk of harm must be properly referred to the safeguarding team. This will help protect people from harm. The home must continue with the refurbishment programme. This will make sure that the home is suited to the needs of the people living in the home. 8 OP30 18(1)(c) (i) The staff working in the home must receive training that is relevant to the care needs they are providing care in. This will ensure people are receiving appropriate care. The manager must establish a robust quality assurance system within the home. This will help to improve the quality of care experienced by people living there. The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 29 31/07/08 5 OP12 16(2)(m) 31/07/08 6 OP18 13(6) 31/05/08 7 OP19 23 31/08/08 31/08/08 9 OP33 24 31/08/08 10 OP38 13(4)(a) The manager must ensure all areas and equipment used in the home are thoroughly risk assessed. This will help minimise the risk of harm to people living in, working in or visiting the home 31/07/08 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. Refer to Standard OP12 OP15 The home should consider purchasing a ‘hot trolley’ so that food transferred from the kitchen is kept at the correct temperature. 3. OP28 Consideration should be given to the care manager having more supernumerary time so that she can take responsibility for training and development in the home. The manager and care manager should have supernumerary time together so that they can consolidate practices and make sure a consistent management approach is achieved. Good Practice Recommendations Evidence must be made available to show all residents living in the home have the equal opportunity to go on day trips. 4. OP31 The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Gables Nursing Home DS0000001338.V363701.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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