CARE HOMES FOR OLDER PEOPLE
The Gables Nursing Home 1595 Wolverhampton Road Oldbury West Midlands B69 2BJ Lead Inspector
Mrs Jean Edwards Unannounced Inspection 23rd October 2006 08:20 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 DS0000004832.V316636.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 DS0000004832.V316636.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Gables Nursing Home Address 1595 Wolverhampton Road Oldbury West Midlands B69 2BJ 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) 0121 544 3988 0121 544 3989 Ashbourne Healthcare Limited Ms Kim Jeffery Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51) of places The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 01/02/2006 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 in reception 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 details, arrival and departure times. There is a staff team of 43 people including the Registered Manager, registered nurses, and care staff, domestic and catering staff. The level of fees for this home is currently between £426 and £593.60 (including free nursing care fees) per week. This home does not charge top up fees. The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first unannounced key inspection visit for 2006-7, undertaken by a Regulatory Inspector accompanied by a Pharmacy Inspector from the Commission for Social Care Inspection (CSCI). It has taken place over one weekday from 08:30 - 19:40. All Key National Minimum Standards have been assessed at this visit. The range of inspection methods to obtain evidence and make judgements includes: discussions with the registered manager, care manager, nurses and other staff on duty during the visit, examination of records and documents and discussions with residents, and relatives. Other information was gathered before this inspection visit from the pre inspection questionnaire, reports of visits undertaken by the organisations nominated representative, notification of incidents, accidents and events, and an action plan submitted by the home following the unannounced inspection in February 2006. Twenty service user surveys were sent to the home by the CSCI and an analysis of the seven survey forms returned is contained throughout this report. It is noted that this is a small response. There are currently 48 residents at the home, including one person in hospital. During the visit the inspectors have spoken to a number of residents. Longer discussions have taken place with the residents whose care was looked at in depth. Relatives and other visitors have been asked for their views. Comments indicate that the manager and staff are friendly, helpful and welcoming. There has been a tour of the premises, including the communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and a sample of residents’ bedrooms, with their permission. The CSCI Pharmacy Inspector has assessed the homes medication system. What the service does well:
The registered manager has responded to the previous inspection report with a comprehensive action plan and the majority of improvements required at the last inspection visit are now in place. Examples are three new adjustable nursing beds, with a further five on order and a renovated shower room on the first floor, giving residents a choice of pleasant, accessible bathing facilities. Southern Cross has provided revised information about the home, and issued comprehensive contracts / terms and conditions to residents and relatives, which are clear and easy to understand. In response to the CSCI service user survey question: Did you receive enough information about this home before you moved in so you could decide if it was the right place for you? All The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 6 responses state, yes, with a comment, was more than pleased when I saw my lovely little room, I never want to leave it The manager and staff continue to make sure that each resident, and as appropriate, their relatives are involved in the plan of how their care is to be provided. Residents’ care plans are up to date, medication storage is secure, and medicine records are clear and accurate. This means that residents’ medicine requirements are very well managed in a safe environment. All of the improvements required at the last inspection visit relating to medication are now in place. The home has very good relationships with the local GPs and other health care services, such as the community dietician and skin care specialists, providing support for the residents at The Gables. During the inspection nursing staff noted that a resident had become unwell, contacted the GP, who agreed to visit the home without delay. This demonstrates the excellent level of trust and professional respect between the home and primary care services. The residents are encouraged to treat The Gables as their own home and to be as independent as possible. Residents are able to choose the decor of their own bedroom and personalise it with their possessions, furniture and bedding if they wish. Residents are able to make choices about their daily routines, activities and meals. They are encouraged and supported to take an active part in meetings and surveys at the home. The residents meetings are now well established and generally well attended, with notes of topics discussed and action taken as a result. Relatives meeting are also scheduled, though these are currently not so well attended. It is very positive that the registered manager also holds an open surgery on Tuesday evenings for relatives to talk to her on an individual basis. However there has been very little take up of this initiative to date. The home has good links a local church and small groups of people escorted by the activities co-ordinator visit twice weekly events for activity classes and bingo, each Monday and Friday. There is also a monthly church service at the home. Arrangements are in place for ministers from other faiths to visit individual residents at the home, at their request. For example the local Catholic priest regularly visits one person who is nursed in bed. The menus offer a range of options for each meal, which are well prepared and appear appetising and well presented. Members of staff ask residents what they prefer at each mealtime, with each persons preferences recorded each day. The food is of a high standard and the majority of food is prepared using fresh ingredients. During this visit it has been noted that the trained nurse monitors mealtimes and makes sure each resident is supported to eat with a sensitive approach. The kitchen is very well organised. Southern Cross now directly employs the catering staff and there is an improved food budget. The
The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 7 cook takes time and trouble to obtain and prepare additional foods to meet residents preferences. Comments from residents during the visit have been positive such as, meals are always lovely, another resident says, I always have what I want, There are kitchenettes for visitors to make drinks and snacks for themselves and their relative if they wish. The home is generally warm, well lit, homely and comfortable. The Gables has a relatively stable group of staff, many have worked at the home for some time and know the residents well. Nursing and care staff are caring, committed and flexible, often willing to work extra shifts for the benefit of residents. The following comments have been made, all the staff seem pleasant and helpful and have a good rapport with mom, my mom on the whole has been happy at the Gables, staff are mostly very caring. There is a warm and friendly rapport between staff and residents. Staff are aware of residents’ likes and dislikes and how to meet their needs. They are keen to share views and have answered any questions in an open and honest manner. Comments are that the home is well run and staff are professional and approachable. In response to the CSCI service user survey question: Do the staff always listen and act on what you say? All 7 answered yes, with this range of comments, a qualified yes when hair needs cutting its sometimes needs repeated asking before it gets done., Well they can forget sometimes but they are usually very good, friendly hard-working staff , find it hard to hear. Some are better, more patient, you can always call them if you are in need and they do listen. Good standards of health and safety are maintained and the registered manager undertakes a regular analysis of all accidents occurring in the home, any areas for improvement are identified and dealt with. 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. What has improved since the last inspection?
The registered manager and care manager have introduced the new care planning and care records used in the Southern Cross organisation. These provide improved care planning information and allow clear guidance to be entered so that all staff are clear about each residents needs, preferences and wishes. A small number of omissions to care plans, such as a plan for the mouth care for a resident who is tube fed have been rectified during this visit. The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 8 Improvements have been made to the homes medication system, which the CSCI Pharmacist commends and two state of the art drugs fridges have been purchased to resolve the previously fluctuating fridge temperatures. New menus have been introduced as a result of improved spending power with the dedicated food budget. There are more homemade meals, pastries and cakes. The recently promoted cook has also completed additional training provided by Sandwell MBC. There are a number of areas in the home which have been redecorated and a new carpet has been fitted in the ground floor lounge. During the visit a small number of areas have been identifies as needing improvement. On the day following the visit the registered manager emailed the inspector with a very proactive response to confirm the follow actions: that grouting around edge of bath and seal around toilet in bathroom has been repaired and replaced, the skirting board in downstairs shower room has been painted, 50 new laundry boxes with lids have been purchased and approval has been given to purchase a profiling bed from pressure care solutions, and an elite replacement mattress and cushion set from Sunchoice Europe for the use of (resident). The introduction of Southern Cross staff policies and procedures mean that the improvements required at the previous inspection visit have now been actioned. Examples are that there is satisfactory evidence that checks against the Protection of Vulnerable Adults (POVA) registers and Criminal Records Bureau (CRB) have been made for all newly recruited staff; and that all staff policies reflect the actions needed to protect vulnerable adults. The introduction of Southern Cross policies and procedures relating to residents finances mean that the required improvements have been made to the management of residents finances held for temporary safekeeping. The registered manager has introduced a training matrix, which is used to track attendance at fire drills and fire training and to make sure that every member of staff attends for 2 fire drills and 2 fire training sessions every year. What they could do better:
The nursing staff must make sure that care plans show any changes to residents conditions, for example when they return from hospital or whenever there is a deterioration. In such circumstances the residents health care assessments and any areas of increased risk such as skin condition, dietary intake, and dependency must also be reassessed, with action taken where necessary. It is recommended that advice be sought to increase the calorific content of meals, and consider providing small frequent nourishing meals
The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 9 outside of normal meal times for residents who have poor appetites or are unwell. The registered manager must make sure that care staff take care of residents spectacles and hearing aids so that they can use them effectively. For example residents need to be in possession of their own, clean glasses; and hearing aid batteries need to be regularly checked to make sure they work. The registered manager must review and where necessary increase the range of activities and social stimulation to meet residents needs and wishes. The issue of lack of activities has been raised through the responses to the CSCI service user survey forms and during the inspection visit. A range of comments from the survey forms to the question: Are there activities arranged by the home that you can take part in? we need to have more entertainment there isnt any -only an occasional singer, very occasional, church Monday, Friday. No activities havent got the staff my parent gets so bored as .... is active in .... mind, and so are a few more. So therefore they get depressed, sleep and vegetate. They need activities, stimulation. Supposed to have a film afternoon - never happened, nothing and not so much now as when I came in activities coordinator now does care work so does not have the time, and yes they do have little get togethers. Id rather stay in my room, where Im happy The registered manager must explore the comments received on the CSCI service user survey forms about food, in response to the question: Do you like the meals at the home? 4 state - always, 1 states usually, 1 states sometimes, with a range of comments: the lunchtime meals are good breakfast also good, tea not so good - few warm tomato and a bit of bread and butter, ham, cheese and biscuits. Never hot like toast or spaghetti, or little warm jam sandwiches. not too bad on whole , lunch good also breakfast. Tea sandwiches always the same. Jam, tuna, Ham, cheese. An egg sometimes would be nice , and if there is anything we dont care for they will soon alter things The home has a programme of maintenance, repair and renewal, however a small number of items need timely attention, such as the replacement of any worn armchairs, one with exposed foam has been disposed of during this visit and the compromised double glazed window units in the bay window in the first floor lounge must be rectified. The home and residents must be supported and standards must be maintained at all times with adequate numbers of cleaning, laundry and maintenance staff, even though there may be very valid reasons for the absence or temporary shortage of permanent staff. Comments in response to the CSCI service user survey question about cleanliness are: the general cleanliness is good but areas such as dusty window sills and sink in room sometimes leaves a lot to be desired also the floor in room doesnt seem to be vacuumed regularly., always smells fresh, but room hardly vacuumed, it never dusted so I do it. Could do with a good vacuuming. But if theres any wee etc it is shampooed,
The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 10 but no dusting or vacuuming much. I know I go everyday. Under chair still talcum from the week before , upstairs is not as fresh as down. Have seen stale food on covers also on arms and seats of chairs and I cannot find any fault with the home, its always spick and span, I like my friends to come and visit 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 DS0000004832.V316636.R01.S.doc Version 5.2 Page 11 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 DS0000004832.V316636.R01.S.doc Version 5.2 Page 12 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): 2, 3, 4, 5, Standard 6 is not applicable Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an up-to-date statement of purpose and service user guide and residents have contracts / terms and conditions of occupancy. This has the effect that residents and their advocates have information regarding their rights and entitlements, any agreed restrictions and how care will be provided. The home generally uses comprehensive assessment tools, which means that residents’ needs are thoroughly assessed to ensure that care needs will be met. The home actively encourages introductory visits and there is evidence to demonstrate that people have been given the opportunity and time to make decisions, which are right for them. EVIDENCE: The home has a new statement of purpose, which clearly sets out the aims and objectives of Southern Cross and this is supported with a service user guide,
The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 13 providing good clear information about the home. Discussions with the registered manager indicate that residents and relatives are not currently given a personal copy of the service user guide and the previous practice of copies in each bedroom has lapsed. It would be good practice to resume the system. Copies of recent CSCI inspection Reports and information about advocacy services are located in the reception area. The home has people from different faiths and efforts are made to ensure that staff understand the cultural expectations of those residents and there is training and guidance for staff to enable them to be responsive to the residents individual needs. The home has an awareness of the traditions of two Asian residents, even though there are non-practicing. Similarly arrangements are in place for the local Catholic priest to visit an Irish resident who is nursed in bed. There is documentary evidence in the sample of case files examined that residents are provided with a contract or statement of terms and conditions. This is a Southern Cross document, which is easy to read and understand and sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the resident. Evidence from examination of residents records and discussions confirm that pre admission assessments are conducted professionally and sensitively and have usually involved the family or representative of the resident. The registered manager and care manager now use the Southern Cross comprehensive pre-admission assessment documentation, which is well completed. Individual preferences are recorded such as rising, retiring, preferred activities, likes and dislikes. The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 14 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service by the Pharmacy Inspector. The care planning and monitoring provides staff with the information they need to adequately meet residents needs. There is good multi disciplinary working taking place on a regular basis, which results in the health needs of residents being generally well met. The service has a comprehensive medicine policy that reflects good practice and staff can identify through records exactly what has been given to residents. This means that residents medicines are stored safely and that the majority of records show that the right medicine has been given to the right resident at the right time. The nursing staff team have a good relationship and excellent support from the General Practitioner (GP) practices. For example, residents have a regular medication review by their GP. The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 15 EVIDENCE: Each resident has a new care plan, using the Southern Cross format, which is comprehensive and flexible, and there is evidence showing good practice of involving residents and / or their relatives or representatives in the development and review of the plan. The plan in most cases includes essential basic information necessary to plan the residents care and includes a risk assessment element. The proforma is used to record each persons preferred daily routines for staff guidance to make sure that care is delivered with a person centred approach. For example one person likes to rise at approximately at 8 a.m., has a poor appetite and is only to be offered small portions, has a hearing aid, likes to go to bed around 9 p.m., likes to rest in the afternoon and needs a wheelchair, hoist and two carers for assistance. From examination of a sample of residents case files, some care plans have small omissions. Examples are missing areas from care plans are where a resident with has a peg feed and needs regular oral care and though it is stated this happens in practice there is no oral care plan. However it is commendable that this omission has been rectified during the inspection visit. Another resident who has recently returned from hospital has significant weight loss, 16.5kg from July 2006, (from 65.6 kg now 48.9 kg). This has been recognised by the home and a referral made to the GP has resulted in prescribed fortified drinks. This is not currently included in the residents care plan. The home also needs to make a referral to the community dietician for support and advice to introduce additional calorific content to meals. There is evidence from records and discussions that generally each resident’s health is monitored with appropriate action taken. There is evidence in the care plans examined of health care assessments, screening, treatment and intervention. However the significant changes in one residents condition, such as weight loss, increased number of falls and loss of mobility etc. has not been reflected in a review of the Waterlow tissue viability score, nutritional assessment and dependency level. The resident does not currently have appropriate bed, mattress or pressure relieving equipment for the wheelchair or reclining chair. The registered managers immediate response to rectify the omissions, by the day following this inspection visit is very positive and has been noted. The home is advised to contact the Sandwell Falls Service for advice for any residents who have repeated falls. All residents have good access to health care services to meet their assessed needs both within the home and in the local community. Some residents are able to choose their own GP within the limits of geographical borders and there is documentary evidence that all have access to dentists, opticians, and other community services. The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 16 The supplying pharmacy supports the home with regular visits and provides advice on medication issues. Two dedicated and lockable medication refrigerators had been obtained since the previous inspection. Regular checks (twice daily) on the temperature are documented and recorded. The correct temperature range of 2-8°C is being maintained. This means that residents medication requiring refrigeration is stored at the correct temperature. Medication storage is locked and secure. This ensures that all residents medicines are kept in a safe environment. The medicine charts document the residents current medicine requirements. This means that there is a record to show that medicine prescribed by a General Practitioner (GP) for a resident is recorded. In addition there were good procedures and double checks in place to make sure that all residents receive the correct medicine at the right time. The receipt, administration and disposal of medicine are recorded. The date of opening of medicine containers is not always documented, which meant a full audit could not be completed to ensure that medicine had been given to residents as prescribed by the GP. Two random audits were undertaken for two residents on a short prescribed course of medication and these were found to be accurate. Two residents care plans have been looked at. All of the care plans are up to date with current medication details. From discussions it is evident that staff are aware of the need to treat residents with respect and to consider dignity when delivering personal care. However during the tour of the premises it has been noted that a small number of residents have dirty fingernails and a number of pairs of smeared, un-named spectacles have been found in communal areas, on shelves in lounges. This confirms a comment made on the returned CSCI service user survey form, nails still dirty most of the time, also no-one cleans my glasses. During discussions with one resident it became evident that although both hearing aids were in place, neither are in working order, making communication for this resident very problematic. The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is not sufficient documentary evidence of planned and spontaneous activities available on a regular basis to give residents improved opportunities to take advantage of and develop socially stimulating activities. The majority of residents are able to maintain good contact with family and friends. Dietary needs of residents are well catered for with a balanced and varied selection of food that meets residents tastes and choices. EVIDENCE: Residents at The Gables Nursing Home have the confidence to discuss what makes them happy and comment where improvements can be made. The registered manager takes residents feedback seriously and makes changes where possible. Evidence from the service user survey forms indicate that staff listen to residents and make considerable effort to provide a flexible service, which enables them to enjoy a better quality of life. All seven responses indicate that staff always listen to residents and act on what they say. The registered manager and staff have growing confidence in the Southern Cross
The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 18 Healthcare quality assurance system to confirm that practice reflects the policies, procedures and guidance. The home has a key worker system, which enables closer resident staff relationships where likes, dislikes and needs are shared. Key workers can use the information to plan activities, which residents will enjoy. There is a good understanding for the need to increase the level of activities and access to socialisation. There is evidence that some people prefer to spend their time on their own in their own bedrooms, with individual interests. These decisions are well understood, respected and supported by staff at the home. The home needs to continue to develop a system for displaying information and bringing attention to community events and activities. The registered manager needs to explore results and comments contained in the responses to the CSCI service user surveys, which indicate a lack of satisfaction with provision of activities. Answers to the question: Are there activities arranged by the home that you can take part in? Always 1, Usually 2, Sometimes 3, Never 1, and comments include, not so much now as when I came in activities coordinator now does care work so does not have the time. During discussions a relative states, mom is happy to spend time in her room, she gets sick if she moves because of her condition. I know there are plenty of activities for those able to join in. It is noted that a resident nursed in bed has TV, radio and CD player, with CDs of Irish music in her bedroom. Observations over the inspection visit show that members of staff continually pop in to residents who are in their own room, which is good practice. However the level of stimulating contact with people in communal areas needs to be monitored and residents individual activities records must be fully completed, with refusals recorded and activities offered evaluated. There is evidence that family and friends of the residents feel welcome and know they can visit the home at any time. It has been indicated that staff always make time to talk to visitors and share information with the agreement of the resident. Relatives are aware of key workers names and state, there is always someone who will listen and respond. During the tour of the home there is good evidence that residents are able to have personal possessions in their room, though they may be not always be able to bring larger items of furniture due to for example, space restrictions or health and safety considerations relating to the residents bedroom. There are inventories of residents personal possessions on the sample of files examined, however these are not always signed and dated by the resident or their representative and witnessed by the member of staff. Residents inventories must be fully completed with all valuables, including hearing aids and thereafter kept up to date. The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 19 Residents enjoy the flexibility of meal arrangements and are able to eat in their own room if they wish. Regular drinks are available and staff are always willing make drinks at any time. It has been observed that there are plentiful supplies of cool drinks, with easy access for residents, around the communal areas of the home. The food in the home is of good quality, well presented and generally meets the dietary needs of residents. The cook is experienced, consults with residents, attends residents meetings and tries to meet the preferences and suggested dishes when preparing the menu. The home has introduced new menus, which include tea and suppertime choices as well as soup and other alternatives. The main meal of the day: tomato soup, homemade meat and potato pie, or beef burgers with fresh vegetables, followed by cherry sponge and custard or fruit and cream or ice cream has been enjoyed by all residents consulted. A comment from a relative suggests menus could be further improved, as there appear to be a lot of pies and beef burgers, which are not always to residents liking. The results of the CSCI service user surveys also indicate some variance in opinion about meals provided. Care staff have received training and are coached by nurses to help those residents who need help when eating and are sensitive in their approach. Visitors are able to make drinks in small kitchenettes on each floor for themselves and the residents they are visiting. These facilities continue to be well used and are much appreciated. The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 20 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, 17, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are listened to and action is taken to look into them, and there are systems to record investigations and outcomes. Arrangements for protecting residents are generally satisfactory. Policies, procedures, guidance and staff training have implemented in order to provide residents with safeguards from abuse. EVIDENCE: The Gables has a revised Southern Cross Healthcare complaints procedure, which is displayed in the reception area and contained in the service user guide. Information supplied as part of the pre-inspection questionnaire indicates that the home has received five complaints, over 12 months, which have been investigated by the provider within 28 days, with satisfactory outcomes. Three complaints were upheld and resolutions implemented. There is evidence that the homes administrator makes sure each persons right to vote is registered as they wish. Residents are enrolled on the electoral register and have a proxy or postal vote to allow them to vote in elections. From the results of the service users survey, there are some people indicating that they are unaware of how to raise concerns or use the homes complaints
The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 21 procedure. The results need to be discussed with residents and relatives to make sure they have sufficient awareness and knowledge of procedures. The home has not received any allegations relating to abuse of vulnerable residents. There is a copy of Sandwell MBC multi-agency procedures for the protection of vulnerable adults at the home. The organisations policies and procedures regarding protection of residents are satisfactory and they have been reviewed and updated to be generally in line with regulations and other external guidance. There is documentary evidence that all staff have been made aware and have been given time to read and understand procedures for the protection of vulnerable adults. Progress is being made to provide all staff with residents welfare training, which provides appropriate adult protection awareness. The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 22 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, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the décor within this home is good with evidence of improvement through proactive planning and continuous maintenance. This is an attractive and comfortable environment for residents. The systems for maintaining infection control are generally satisfactory. EVIDENCE: The Gables Nursing Home has a bright and cheerful interior and the exterior of the premises is enhanced with containers of winter flowering plants. The tour of the building identified that a number of improvements have been made and the program of redecoration and refurbishment is continuing, with the majority of requirements for repairs and redecoration issued at the last inspection acted upon. Examples are that the second of two bathrooms previously has been renovated to provide a shower room, which is now accessible to residents, and
The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 23 three adjustable nursing profile beds have been provided, with a further five on order. The registered manager has undertaken a full audit of the home from which a prioritised programme of repairs, redecoration and replacement of equipment has been devised and is in the process of implementation. There is evidence that the home continues to be refurbished, redecorated and repaired on an ongoing basis and is generally completed to high standards. The process has slowed recently due to the long-term absence of the homes handyperson. It is strongly recommended that contingency arrangements be made for the work this person usually undertakes. A number of minor repairs have been undertaken as soon as they were noted during this visit. During discussion residents indicate that they are comfortable, the home is clean, warm, well ventilated, and well lit. There are spacious communal rooms; including quiet rooms and residents are able to generally sit where they wish, though some people are protective about their own personal space. There are a small number of additional improvements required at this visit, examples are: 1) To replace any worn armchairs (one disposed of during visit) 2) To rectify the compromised double-glazed window units in the bay window in the first floor lounge 3) To identify a timescale for the replacement of the carpet, showing signs of wear, in the quiet lounge on the ground floor 4) To record regular monitoring of cleaning schedules in the home, noting any remedial action 5) To ensure that regular monitoring of bathing / toilet facilities cleaning schedules take place to maintain good infection control measures The homes main kitchen demonstrates that it continues to be maintained in good order, and it is clean and tidy and well organised, with improved lighting. 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 homes laundry is generally well organised and manages to maintain good standards of infection control. However staff shortages have caused some shortfalls and ironing has been undertaken away from the premises. It is stated that these are now resolved. The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 24 Discussions have taken place about the responses from the CSCI service user survey to the question: Is the home fresh and clean? Always 2, Usually 4, Sometimes 1, with comments, the general cleanliness is good but areas such as dusty window sills and sink in ....... room sometimes leaves a lot to be desired also the floor in room doesnt seem to be vacuumed regularly, and upstairs is not as fresh as down. Have seen stale food on covers also on arms and seats of chairs. The registered manager acknowledges that there have been some problems through long term sickness absences, though a new domestic assistant has been recruited and is due to commence employment, which should improve the situation, which will be monitored. The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 25 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home continues to maintain stable substantive staffing levels and residents receive good and consistent care. The staff recruitment processes are robust, which results in residents receiving a consistent and generally satisfactory service. The registered manager demonstrates a strong commitment to staff training and development. EVIDENCE: There are currently 48 residents accommodated, with a variety of dependency levels and diverse needs. The registered manager reviews staffing levels on a regular basis, taking account of the occupancy and dependency levels of residents accommodated, this is good practice. Assessment of staffing rotas and pre inspection information demonstrates that the home is generally maintaining satisfactory staffing levels. However as indicated at the previous section of this report the registered manager must ensure that there are adequate domestic, laundry maintenance hours to maintain standards in the home at all times. The Home now has a stable staff team of 44 people including 26 care staff, 2 domestic staff, 2 laundry staff, 1 housekeeper, 1 activities co-ordinator, 1 gardener / maintenance staff, 1 administration staff, 8 first level nurses, the
The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 26 Registered Manager and 4 catering staff now direct employees of Southern Cross Healthcare. Four staff have left the homes employ since February 2006 for valid reasons, and there are currently no staff vacancies. Random samples of staff files examined are satisfactory. Interview questions and answers are retained on staff personnel files as a matter of good practice. Southern Cross Healthcare policies and procedures take account of guidance from the DoH POVA/CRB and evidence is now available for inspection at the home. It has been noted that a new member of care staff has commenced employment at the home on a POVA first basis, however there is no documentary evidence of a written risk assessment in place identifying a named supervisor, or records on staffing rotas until CRB clearance received; neither was this information is forwarded to the CSCI office, Halesowen. There is evidence that 8 of the 26 care staff have achieved an NVQ level 2 care award, with 7 new candidates registered. This means that the home is not yet able to demonstrate that it meets the ratio of 50 of care staff with an NVQ 2 (or equivalent) award. There is evidence that the registered nurses are supported to keep up to date with their professional development. The registered manager demonstrates a strong commitment to staff training and development, together with support measures such as structured supervision. The home has training plan and individual staff training profiles and in discussions it is evident that staff feel supported. Although it is evident that staff are knowledgeable about what residents needs are and how to meet them and there is a warm rapport with both residents and visitors, there are some areas of residents care needing additional attention, such as clean spectacles and hearing aids, which work. Staff spoken to generally feel that morale is good and that they are aware of their responsibilities, what is expected of them. The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 27 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): 31,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager, trained nurses and senior staff are effective in providing leadership and good clear communication systems throughout the home and staff demonstrate a good 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. The standard of record keeping and health and safety compliance at this home is generally good, providing protection for residents from risks of harm. The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 28 EVIDENCE: Kim Jeffrey is the Registered Manager in day-to-day control of the home. She is a Registered General Nurse (RGN), with the Registered Managers Award (RMA) and she has considerable nursing and managerial experience. There is a Regional Manager, the nominated representative of the Responsible Individual from Southern Cross Healthcare, who provides supervision, support for the registered manager and monitoring through monthly unannounced Regulation 26 visits and reports. The regional manager has visited the home to conduct the monthly visit for October 2006, during this inspection visit. There are clear lines of accountability within the home, through the management structure. The registered manager has devised and implemented the homes annual development plan in February 2006. The NMC has approved this home as a placement, in association with Paisley University (Scotland) for adaptation for overseas nurses working for Southern Cross Healthcare. The home uses a number of self-auditing systems some introduced by Southern Cross Healthcare. The registered manager conducts monthly audits, which include assessment of 4 resident case files and 4 staff files in addition to other monitoring reports, such as accidents, incidents, staffing levels. The manager is required to score the homes performance and compliance in each area; this has been consistently above the required level. It is recommended that the responses from the CSCI service user survey and discussions during the inspection visit, such as meals, drinks, activities and cleaning are used as topics in residents, relatives and staff meetings, with outcomes monitored. The registered manager and team continue to make efforts to involve residents, relatives, representatives and other community stakeholders in the running of the home. There are regular residents meetings every three months, with minutes available. Survey questionnaires have recently been distributed to residents and families and completed forms have been returned. The regional manager is collating the results. There are plans to feed back the results and take action in any area where there are concerns or where performance needs improvement. Residents have the opportunity to manage their own money if they wish, and some facilities are provided to help keep it safe. Where the home manages money on residents’ behalf a system is in place to record transactions and accounts for spending. A sample of balances and financial records examined are satisfactory. Staff meetings take place regularly, with minutes posted on notice boards. There is good evidence that four staff meetings have taken place so far this year. There is a structured formal supervision system for all staff. Supervision
The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 29 sessions are used to identify training needs, personal development. Staff feel that the process is useful and value the time to consider their work with residents. Record keeping at the home continues to improve, achieving good standards, with only minor improvements required at this visit. All personal information continues to be held, stored and disposed of in accordance with the Data Protection Act 1998. A sample of fire safety and maintenance documentation has been examined and is satisfactory. The registered manager has agreed that when the planned service has been completed a copy of the 5-year fixed wiring the certificate will be forwarded to the CSCI Office, Halesowen. There is evidence 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 registered manager has introduced a matrix be used to track attendance at fire drills and fire training to audit that every member of staff attends for 2 fire drills and 2 fire training sessions in each 12 month period. There have been 39 recorded accidents involving residents since July 2006. The registered manager has an effective system for auditing, analysing and evaluating accidents involving residents, with effective measures implemented. The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 30 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 X 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 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 3 18 3 2 X 3 3 X 3 X 2 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 2 The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 31 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 OP7 Regulation 15(1) Requirement To ensure care plans are updated with changes to residents conditions or circumstances as they occur, such as return from hospital 1) To ensure health screening assessments are updated with changes to residents conditions they occur, such as return from hospital, infections etc. 2) To ensure the resident, discussed at the inspection visit and any other residents with significant weight loss are referred to the community dietician for support and advice to increase the calorific content of meals, such as small frequent nourishing meals outside of normal meal times 3) To ensure residents spectacles are appropriately labelled and not left in heaps in communal areas. 4) To ensure all equipment and aids such as residents
The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 32 Timescale for action 01/11/06 2 OP8 12(1)(b) 13(1)(b) 01/12/06 spectacles, hearing aids etc. are regularly cleaned and checked so that they can be used effectively 5) To contact the Sandwell Falls Service for advice for any residents who has repeated falls 3 OP12 16(2)(n) To ensure that residents individual activities records are fully completed, with refusals recorded and activities offered evaluated To ensure that residents inventories are fully completed with all valuables, including hearing aids and are signed, witnessed and dated, and thereafter kept up to date 1) To replace any worn armchairs (one disposed of during visit) 2) To rectify the compromised double glazed window units in the bay window in the first floor lounge 3) To identify a timescale for the replacement of the carpet, showing signs of wear, in the quiet lounge on the ground floor 6 OP26 23(2) 1) To ensure that there are adequate domestic, laundry maintenance hours to maintain standards in the home at all times 2) To record regular monitoring of cleaning schedules in the home, noting any remedial action 3) To ensure that regular monitoring of bathing / toilet
The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 33 01/12/06 4 OP14 17(2) 01/12/06 5 OP19 23(2) 01/12/06 01/11/06 facilities cleaning schedules take place to maintain good infection control measures 7 OP29 19(1) To ensure that any staff employed on a POVA first basis have written risk assessment in place identifying a named supervisor, also to be recorded on staffing rotas until CRB clearance is received; and this information is forwarded to the CSCI office, Halesowen 01/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations It is strongly recommended that the date of opening of all medication containers is recorded and any balances of medicines carried over onto a new medicine chart in order to undertake a complete medicine audit. That the responses from the CSCI service user survey and discussions during the inspection visit, such as meals, drinks, activities and cleaning are used as topics in residents, relatives and staff meetings, with outcomes monitored That when the planned service has been completed a copy of the 5 year fixed wiring certificate be forwarded to the CSCI Office, Halesowen 2 OP33 3 OP38 The Gables Nursing Home DS0000004832.V316636.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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
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