Inspection on 24/11/08 for The Gables Nursing Home

This inspection was carried out on 24th November 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 08/09/09

The Gables Nursing Home 23/10/07

The Gables Nursing Home 03/10/06

The Gables Nursing Home 09/12/05

The Gables Nursing Home 05/07/05

The Gables Nursing Home 13/10/04

The Gables Nursing Home 20/04/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOMES FOR OLDER PEOPLE The Gables Nursing Home 56 Ifield Green Crawley West Sussex RH11 0NU Lead Inspector Elizabeth Dudley Unannounced Inspection 24th November 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables Nursing Home DS0000024225.V373207.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 DS0000024225.V373207.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Nursing Home Address 56 Ifield Green Crawley West Sussex RH11 0NU 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) 01293 552022 01293 528001 Excel Care Homes Ltd Manager post vacant Care Home 56 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with Nursing - (N) to service uers of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) Dementia (DE) 2. Learning Disability (LD) 1 The maximum number of service users to be accommodated is 56. Date of last inspection 1st April 2008 Brief Description of the Service: The Gables Care Home is registered to provide personal and nursing care for fifty-six residents. Excel Care Homes Limited privately owns the service and the Responsible Individual on behalf of the company is Mr K Indra. The home is located in Ifield Green, which is on the outskirts of Crawley. There is a car park to the front of the home. A local shop, post office and pub are close by. Bus services are available close to the home and Crawley town centre and other amenities are approximately 10 minutes drive away. The home consists of a two-storey building, the majority of the residents rooms are situated on the ground floor, and those rooms on the first floor are accessible by a passenger lift. An enclosed garden is in the centre of the premises; resident’s rooms surround this. A pleasant garden with a lawn, shrubs and flowers is to the front of the premises. The fees currently being charged by the home are £558.30 to £968.30 per The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 5 week. This does not include extra services such as chiropody and hairdressing and details of the charges for these can be obtained from the home. The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection took place on the 24th November 2008 over a period of eight hours and was facilitated by the manager Mr C McMillan. Methodology used to inform the judgements made in this report included a tour of the home, examination of records which included care plans, medication records, staff training and personnel files and health and safety and catering documentation. During the course of the inspection all residents were seen and five residents, four visitors and six staff were spoken with in depth. Prior to the inspection the Annual Quality Assurance Assessment (a document required by regulation and supplied by the provider or manager of the home which shows what the home has achieved in the past twelve months and plans for the next twelve months) was received. This document was requested in May 2008 and received by the date we asked for it. However due to the home not having a manager at that time, it was completed by the previous home manager, who manages the sister home. Comments received by residents and relatives showed that whilst they were generally pleased with the care given by the home, there were some aspects that they felt needed improvement: The care is good and most of the staff are kind, but the food is variable. We don’t always get a choice of food I am happy with the care we receive but we don’t get so many activities now. What the service does well: The standard of care planning is good and provides clear guidance for staff on the care that the residents require. The Gables is clean, comfortable and well decorated and provides a pleasant home for residents. The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 7 Many of the residents spoken with commented on the cheerfulness of the staff and how they could have a laugh and a joke with them, and how this has makes a difference if you have to live in a care home. What has improved since the last inspection? What they could do better: The home has not complied with the three previous requirements made at the last inspection, these related to medication and staff supervision. A referral will be made to the CSCI pharmacist to undertake a pharmacy inspection and should this fail to result in compliance, the CSCI may commence enforcement action. Several areas around medication, staffing levels, staff training and supervision and resident choice, require attention and requirements have been made relating to these. The home is currently only allowing half the hours previously allocated to activities, which has resulted in residents not being provided with sufficient stimulation and leisure interests. Residents would benefit from a second choice of cooked meal at lunchtime. The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 8 Provider visits have not been taking place and if at the current time the provider is unable to do this, a representative should undertaken these. 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 DS0000024225.V373207.R01.S.doc Version 5.2 Page 9 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 DS0000024225.V373207.R01.S.doc Version 5.2 Page 10 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): 1,2,3,4,5,6. People who use the service experience adequate quality outcomes in this area The Statement of Purpose and Service User Guide do not present up to date information about the management structure within the home and are not produced in a format, which would enable them to be easily read and assimilated by existing or prospective residents. All prospective residents are fully assessed prior to admission to the home but do not receive written confirmation that the home is able to meet their needs and expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current Service User Guide and Statement of Purpose are not produced in a format suitable for the use of the residents in the home; the manager says The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 11 that this is in the process of being reviewed. Neither of these documents reflects the current management of the home and do not include any information regarding the homes recent registration which enables it to include accommodation and nursing care for older people with a dementia type illness. Discussions with the manager showed that reference to the meals served in the Statement of Purpose may require amending. All residents, both privately and local authority funded, receive a copy of the homes Terms and Conditions of Residence on admission to the home. Either the manager or the deputy manager visit and undertake a written assessment on prospective residents in order to ensure that the home can meet their needs. Prospective residents are admitted on a four-week trial period, this allows the resident to be sure that the home is meeting their needs and expectations. Residents or their representatives are encouraged to visit the home before they make decisions over whether it is the right home for them. The home is not currently informing residents in writing following assessment about whether the home can meet their needs. This should be commenced. Two preadmission assessments were examined; these were sufficiently comprehensive to give information to staff about the individuals health, psychological and social needs and to provide a basis for the care planning process. The home admits residents for respite and permanent care, but not for intermediate care. The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 12 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. People who use the service experience adequate quality outcomes in this area. Care plans address all the assessed needs of the residents and are regularly reviewed to reflect residents current and changing needs. Relatives and residents were complimentary about the care received. Lack of suitably trained staff for the dementia care unit and the absence of the use of recognised dementia care tools may result in residents needs not being met. The standard of medication administration, storage and recording does not safeguard the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 13 A total of six care plans from both the EMI and the general nursing units were examined. Care planning was generally of a good standard and showed evidence that where possible, care plans had been completed in consultation with the resident or their representative and all parts of the care plan had been reviewed on a monthly basis. Care planning had been undertaken for both the mental and general health needs of the residents and showed evidence that residents were weighed monthly, had continence care plans and nutritional care plans. Outside health care professionals including Community Psychiatric nurses and General Practitioners had been contacted as required. Whilst risk assessments were in place, these were basic and both the bedrail and bucket chair risk assessments must be expanded. Reasons for residents using a bucket chair must be clearly identified and these chairs should only be used if other methods of protecting the residents from harming themselves, have been tried. Moving and handling care plans were reviewed but should include the size of hoist sling to be used. Continence care plans should detail the size and type of continence aid required. Residents and staff would benefit from the home commencing the use of Malnutrition Universal Screening Tools, as these would allow greater checks on the residents nutritional status. Wound care plans are in place but no body plans are being used. Nursing records were kept in the nurses station, which is in the dining rooms; these included fluid charts, turning charts and daily care charts. Concerns were raised regarding confidentiality especially at handover times. Whilst fluid charts had been kept up to date, it was seen that some residents in the EMI units were receiving insufficient fluid, there was no notification in care plans to show that General Practitioners had been consulted regarding this although it was written in the care plans that residents were refusing fluids. Residents appeared well cared for and relatives spoken with said We are very happy with the care given. I very pleased with the care here, they keep her pretty free from pain. The residents are always clean and tidy and the staff are helpful. It was noted that some residents are being woken and being washed and dressed early morning by the night staff, and a senior member of staff said Unless the night staff get some residents ready, we would not have them up and dressed before lunch, we have 50 residents here and the staff numbers do not allow us to do this. There is insufficient time for night staff to undertake personal care for residents in a manner which is unhurried and for care to be given as residents would choose, also getting residents early unless the resident has requested this, is not allowing residents choice in the activities of daily living. The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 14 There are no registered mental health nurses employed by the home apart from the manager who is dual qualified, and there was no evidence of any staff having dementia care training. Care staff spoken with said that they move between units and the majority spoken with said that they had no previous experience of people with mental health conditions. Neither dementia care mapping nor specific person centred care for people with dementia is used in the home. The home has received a complaint concerning the number of toilet facilities available in the EMI unit, few of the rooms in this unit have ensuite facilities and the manager verified that only one toilet is available, there are three toilets on the general side of the locked doors to the unit. The manager stated that all the rooms have commodes. This could impact on residents dignity. It had already been noticed that all the bathrooms in the ground floor general unit were bolted, following the inspectors concerns that residents dignity could be compromised; the manager removed the bolts from these doors. The pharmacy inspector undertook a random inspection in April 2008, due to concerns raised about the standard of medication administration and records relating to medicines kept by the home. Requirements were made at this inspection, which have not been complied with. There was no evidence of medication policies and procedures having been updated and no evidence of a policy regarding up to date disposal of medication. The manager stated that they have a contract with an outside company for disposal of medication, but neither he, nor the staff spoken with, were aware of having specific boxes including denaturing boxes for controlled drugs, in the home for disposal of drugs. Many of the medications and none of the prescribed creams had been signed in the MAR charts on administration; some of the medications given as PRN (as required) were not identified on the prescription as being on an as required basis. There were no General Practitioners consent for any resident for some medications, such as paracetemol, to be administered as a homely remedy although staff said that they do administer this and aperients as a homely remedy at times. Prescriptions, which were handwritten on the MAR charts, were not signed, and in some cases it was difficult to decipher the name of the medication. It is good practice to ensure that all handwritten prescriptions are signed, preferably by two members of staff. At the random pharmacy inspection it was stated that drugs, which should be treated as controlled drugs in care homes, such as Oramorph 10mg in 5ml and Temazepam tablets and liquid, were not been kept in the controlled drug cupboard and had been moved to this cupboard during the inspection. The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 15 These were now in the ordinary medicine trolley. Whilst it was evident that the controlled drug cupboard is too small to contain all the controlled drugs used in the home, staff said that the previous manager had instructed them to move them back into the ordinary medication trolley following that inspection. Neither Temazepam liquid or tablets or Oromorph 10mg in 5ml was being recorded in the controlled drug register. The current home manager must familiarise himself with the medication guidance for care homes and ensure that the home complies with this. A chequebook, bankcards and money belonging to a previous resident were being kept in the controlled drug cupboard. Only drugs should be kept in this. The home must ensure it has suitable storage for controlled drugs. The clinic room temperatures have been as high as 28°C at times and a fan is used to cool the room when staff are working in there, however this has resulted in both drugs and supplementary feeds being stored at above optimum temperatures, the recommended storage temperature being not above 25°C. The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People who use the service experience adequate quality outcomes in this area. There is scope for increasing activities to ensure that residents have sufficient leisure interests and stimulation. This is an important part of holistic care. No second main menu is offered at lunchtime and some residents were unaware of the limited choices available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides an activities organiser for eighteen hours a week, previously the amount of activities for The Gables was over a 36 hour period but the activities organiser is now dividing this time between sister home and this home. The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 17 However the Gables has now increased to fifty six residents, thirteen of whom are in the EMI units and others are accommodated in some rooms just outside the unit. There are insufficient activities now provided in the home. On the day of the inspection there were no activities taking place in the home. There is an activities programme, which includes crafts, entertainers and the activities co-ordinator arranges fetes and Christmas parties. The provider should be aware that the provision of sufficient leisure activities is an important part of the holistic care, not an optional extra, particularly in the care of people with mental health illness. Staff said that many of the residents in the home are not getting sufficient stimulation or leisure activities. Residents in the EMI units were walking around or sitting in their rooms with no mental or physical stimulation and residents from the general care units were watching television, although there were many visitors in the home throughout the day. Residents preferred times of rising and retiring were not included in many of the care plans and the manager and staff say that some residents rise early and have their personal care attended to by the night staff. It was unclear about whether residents receive full choices in other activities of daily living, particularly in the EMI units. Staff said that most residents go to bed between 6 and 7 pm and that they like to have as many in their rooms as possible to help the night staff. Other staff said that some residents stay up until 10 or 11 at night. The Church of England minister visits weekly and the Roman Catholic minister visits when required. There is one resident of Hindu faith and his relatives attend to his religious requirements. There are staff in the home of the Hindu faith, and they are also able to converse with this resident. Lunchtime menus are nutritious and well balanced, however it was noted that some supper menus rely heavily on pre prepared food such as sausage rolls, tinned foods and sandwiches. This was particularly noticeable during one week of the rolling four-week menu. There are no choices of alternative main meal on the lunchtime menu other than baked potatoes, salad, omelette or sandwiches, few residents were aware of these alternative choices and it would be expected that a home of this size would prepare a second choice of main meal at lunchtime. One resident said we have sausages and more sausages. I dont like sausages, have never liked sausages and wont eat them. This resident had left the whole of the lunch and was not offered an alternative. Staff said that they go around with menus but it was clear that this person had not been The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 18 asked about a choice. Another resident who dislikes fish said that she has sausages offered when fish is on the menu. No menus are displayed in the lounges or dining rooms. Other residents said that they usually get offered a choice of menu, but staff know what they like. The food is fairly good. Food is usually not bad. One relative said that The food is fairly good on the whole The manager said that the night staff prepare breakfast whilst the cook on duty that day, who normally works at the sister home said that the catering staff prepare them. Care staff do not cook, but the Statement of Purpose says that residents may have a cooked breakfast. Staff said that sometimes some residents have a bacon sandwich. More clarity is required around the catering arrangements for breakfast and the Statement of Purpose amended accordingly. A resident on the general unit said we have breakfast in our rooms before we are dressed. Staff spoken with said that at least eight residents are up and dressed before the day staff come on duty. Residents can have snacks or beverages as they wish. The presentation of food including pureed food was good and some residents in the general unit sit at the table for their meals. Others, in both units have their meals on trays. The majority of the residents did not have condiments on their trays. The kitchen was clean and records as required by Environmental Health Authority have been completed. All catering staff have the food hygiene course. The home puts fresh fruit in the lounges for residents use and the cook said that other residents could have fruit on request. The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 19 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): 16,18. People who use the service experience adequate quality outcomes in this area. Residents receive a copy of the complaints policy in the service user guide but some were unaware of how to make a complaint. Not all staff have received adult safeguarding training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure displayed in the hall and this is also included in the Service User Guide. This does not show the correct contact details for the CSCI and requires amending. Some residents were unaware of how to make a complaint. Complaints and concerns received are recorded and are kept in a confidential manner. The Annual Quality Assurance Assessment shows that two complaints had been received since the last inspection and a further two received by the home since the Annual Quality Assurance Assessment was completed, one complaint was sent to the CSCI but although the home said that they had received this it was not included in the complaints file. All of the complaints were around the standard of care, food and toilet arrangements. . The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 20 There have been two adult safeguarding issues since the last inspection; one of these was followed up by a random pharmacy inspection. The manager was unsure about how one of these was finalised but the Annual Quality Assurance Assessment states that there were two referrals to Protection of Vulnerable Adults. The manager also informed the inspector of a further adult safeguarding alert, which is currently under investigation. It is unclear whether CSCI has been made aware of this. The manager has not undertaken adult safeguarding training but some of the staff have attended an in house course by means of a DVD and staff say they have also had training by an outside trainer. The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 21 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): 19,20,21,22,24,25,26. People who use the service experience adequate quality outcomes in this area. Residents live in a clean and well-maintained home, but there are difficulties due to lack of storage space. Restricted toilet facilities in the EMI unit could impact on residents dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 22 All areas of the home are well maintained and pleasantly decorated, communal in the form of lounges; dining rooms and a garden are accessible to all residents. There is insufficient space in the dining rooms for all residents to sit at tables for their meals and the nursing stations are situated in the dining rooms. Nursing records were kept on the dining tables in the EMI units when the tables are not in use, and this raises concerns about confidentiality especially at handover times. The EMI area is separated by a door, which is locked by keypad, although there are some residents with mental health conditions in the rooms adjacent to the unit. There are 52 single rooms and two double rooms, not all rooms have ensuite facilities and rooms within the dementia unit do not have these facilities. Residents rooms have been personalised with their own possessions and all rooms have a lockable drawer for residents private possessions. Call bells are provided in all rooms. Due to lack of storage space linen trolleys were being kept in the dining rooms, continence aids were seen out in residents rooms, which could impact on residents dignity. Maintenance records showed that the temperatures of the hot water to residents outlets have been checked and recorded at regular intervals and that these were within recommended parameters. Some window restrictors in upper floor rooms were broken, these were repaired on the day of the inspection but the manager must ensure that these are checked on a regular basis. The home has assisted bathing facilities. One assisted shower room has not had the tiling on the floor completed which could lead to residents being injured, the manager said this will be addressed. There were concerns raised about the limited toilet facilities in the EMI unit and the availability of toilets in the general unit and this has been pursued in the health and personal care section of this report. The home provides a range of equipment, including nursing beds and hoists, to enable residents to maintain their independence and although the top floor corridor is very narrow, staff said that they could manage to propel both wheelchairs and hoists along this. It was noticed that there is recurrent damage to the walls and radiators due to the width of the corridors. The home was very clean and staff were wearing disposable aprons and gloves for care tasks and separate protective aprons when entering the kitchen. However sponges and towels, a razor and communal toiletries had been left in some bathrooms, this could lead to spread of infection and also injury to residents in the home. The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 23 Alcohol hand cleansing gel is used throughout the home and staff said they had infection control training and were aware of the need to use this gel. Infection control policies were in place but require renewing to address current infection control risks and procedures. The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 24 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. People who use the service experience adequate quality outcomes in this area. There are not always sufficient staff on duty to meet the needs of the residents in a timely and unhurried manner. Not all staff have received up to date mandatory or care training and this could put residents and staff at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing rotas show that there are eight care staff and two registered nurses and the deputy manager employed during the morning. Six carers and two registered nurses employed in the afternoons and five care staff and one registered nurse employed during the night. Staff said that on occasions when staff are absent, agency nurses are not used and therefore unless another member of staff comes in they have to work short staffed. Both the manager and the deputy manager said that It is a push for staff to look after all the residents As some staff are working up to sixty hours per The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 25 week, the manager is in the process of recruiting more staff, however this will not result in more staff on the units during the twenty four hour period at the current time. Staff said that they were very busy during the day and that it was sometimes difficult to meet the needs of all residents, especially given the dependency of some of the residents. The manager should ensure that staff numbers are in relation to both the dependency and the numbers of the residents currently in the home. Residents and relatives spoken with said that at times the home was short staffed, with one relative saying, I try to make sure I am here at lunchtimes to assist with the meals as they really do have hard time to help everybody. The deputy manager does not work hands on during a morning shift but deals with tasks such as calling doctors and other care related administrative tasks. The duty rota showed that staff had worked short on some days. There are twenty-six care staff employed, five of whom have attained the National Vocational Qualification level 2 or 3 in care. No registered mental health nurses, other than the manager, are currently employed and there was no evidence that staff have attended any form of dementia care training. There was insufficient evidence to show that all staff currently working have had fire training, moving and handling or Protection of Vulnerable Adults training. Six members of staff have first aid training. Registered nurses have received updating in medications, first aid and mental capacity act training. The manager has introduced a care training package, which includes mandatory training and some aspects of care training; this includes the skills for care induction training. Whilst there was evidence that some previously employed staff have undertaken the homes local induction training, there was insufficient evidence to show that all staff have attended this and the manager said that he did not think they had all had this. He intends to commence the Skills for care training. Records showed that several night staff had not completed induction training. One member of staff who has been working in the home for four months said that they had attended induction training. The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 26 The manager said that not all care staff that prepare breakfast have the food hygiene training. There are plans to address training issues. Four staff personnel files were examined. These generally contained all documentation and checks as required by regulation. One member of staff employed under a previous management had been employed prior to a Protection of Vulnerable Adults first check having been obtained. One of the directors and the manager both stated that this had been overlooked and the home was generally very vigilant in ensuring that staff had the Protection of Vulnerable Adults First check in place prior to commencing work. They gave assurances that this would not reoccur therefore a requirement has not been made. Care staff receive the General Social Care Code of Conduct handbook on commencement of employment. The Gables Nursing Home DS0000024225.V373207.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): 31,32,33,35,36,37,38. People who use the service experience adequate quality outcomes in this area Staff are not receiving formal supervision, which may result in residents not receiving services of a quality which meet their expectations. Policies and procedures do not reflect current researched practice. Lack of staff health and safety training may put residents and staff at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 28 The current manager has been in post since July 2008, he is both a registered mental health nurse and registered general nurse and previous posts include senior positions within large mental health care establishments (previously at the Priory for over eight years) He is in the process of registering with the CSCI. The ethos within the home was generally good, staff and residents said that they enjoyed living and working at the home, found both the managers and owners approachable and felt able to go to the manager with any concerns they may have. The Annual Quality Assurance Assessment (an annual assessment required by regulation which tells us what has occurred in the home in the past year and the plans for the next twelve months) was received when we asked for it. Requirements made at the last key and random inspections have not been complied with. The current manager stated that he was unaware these requirements had been made. These will be repeated and must be complied with. The previous manager commenced a quality monitoring of the home and the current manager is in the process of completing this. He has also put an action plan in place to address shortfalls that he has found in documentation. Two staff meetings and three night staff meetings have taken place in the last five months, no resident or relative meetings have been held since the current manager came into post. The home does not act as appointee for residents and manages the personal allowances of one resident. This is done through a specific residents bank account and records were found to be in order. Policies and procedures have not been reviewed since 2006. There was no evidence of regulation 26 visits (Monthly visits to the home by the provider required by regulation) since March 2008. Formal staff supervision has not been taking place since the previous manager resigned, although a few staff appraisals have been commenced. Records and certificates relating to equipment and utilities were examined. A fire risk assessment was undertaken in May 2008. Portable Appliance testing has not taken place since 2006 and the manager says that this is being arranged. One of the emergency lights was broken on the day of the inspection. The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 29 The Public Liability Insurance certificate was out of date, but one of the directors of the home gave assurances that a new one has been received. Not all staff have received mandatory health and safety training. Risk assessment regarding bed rails, hoists and bucket chairs require expanding. The manager must ensure that regular checks are undertaken on window restrictors to ensure their integrity and the staff room, which contains a microwave and a kettle should be either locked or have a robust risk assessment to ensure that residents are not put at risk. Whilst the manager was aware of the need to provide the CSCI with reports of accident or incident affecting residents (Regulation 37 reports) it is unclear as to whether a report was received about a recent adult safeguarding issue. The Gables Nursing Home DS0000024225.V373207.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 2 3 3 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 3 2 3 x 3 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 x 3 1 2 2 The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 31 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 Reg 4(1) Requirement Timescale for action 01/01/09 2 OP3 Reg 14((d) 3 OP9 Reg 13(2) That the statement of purpose accurately reflect the management structure in the home and are accurate and up to date in regard to the life offered to service users. That the manager confirms in 01/01/09 writing to the prospective service user or their representative that the home is able to meet the assessed needs of the individual Medication policy and procedures 20/01/09 must be updated and reflect the practices of the home, for the guidance of staff and to ensure people receive medicines safely. This was a previous requirement with a compliance date of the 31/05/08 Medication audits must be carried out and records kept, to ensure good practice and that people receive medicines as prescribed. This was a previous requirement with a compliance date of the 30/04/08 All medications must be signed DS0000024225.V373207.R01.S.doc 4. OP9 Reg 13(2) 01/01/09 The Gables Nursing Home Version 5.2 Page 32 on administration to the service user. 5 OP12 Reg 16 (m) (n) That leisure activities are of a frequency and content to enable all service users to be adequately stimulated and occupied. That the routines of the home are sufficiently flexible to enable service users to have choices around all activities of daily living. That the manager ensures that bathrooms are kept free from personal toiletries, washcloths, block soap and razors to ensure service users safety and minimise the risk of cross infection. That the numbers and skill mix of the staff ensures that service users needs are met. That staff receive the relevant training, including induction training, for the work that they are to perform. That the registered provider or his representative undertake monthly visits to the home in accordance with this regulation and make the reports of these visits available to the manager. All staff must have formal supervision. This was a requirement on two previous inspections with compliance dates of 01/12/07 and 01/04/08 That risk assessments for equipment used in the home are comprehensive and contain sufficient information to enable staff to minimise any risk to the service user. That the manager liaises with the health and safety executive DS0000024225.V373207.R01.S.doc 20/01/09 6 OP14 Reg 12 (2) (3)(4)(a) Reg 13(3) (4) 20/01/09 7 OP26 01/01/09 8 9 OP27 OP30 Reg18(1) (a) Reg 18(1)(c) Reg 26 (1)(2)(3) (4) 20/01/09 20/01/09 10 OP36 20/01/09 11 OP36 Reg 18.2 20/01/09 12 OP38 Reg 13 (4) 01/01/09 The Gables Nursing Home Version 5.2 Page 33 regarding the testing of portable electrical appliances or ensures that these are tested. That all staff receive mandatory health and safety training and that this is updated. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP9 OP15 OP18 OP21 Good Practice Recommendations That handwritten prescriptions on MAR charts are checked and signed by two members of staff That service users receive a choice of main meal at lunchtime. That the manager attends adult safeguarding training as provided by the local authority That the manager and provider review the necessity or siting of lockable doors relating to the availability of the toilet facilities. The Gables Nursing Home DS0000024225.V373207.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 DS0000024225.V373207.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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