Inspection on 30/04/07 for The Gables Nursing Home

This inspection was carried out on 30th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Gables Nursing Home 07/11/08

The Gables Nursing Home 23/04/08

The Gables Nursing Home 11/10/06

The Gables Nursing Home 11/07/06

The Gables Nursing Home 06/01/06

The Gables Nursing Home 13/07/05

The Gables Nursing Home 21/12/04

The Gables Nursing Home 19/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Gables Nursing Home 231 Swinnow Road Pudsey Leeds Yorkshire LS28 9AP Lead Inspector Ann Stoner Unannounced Inspection 10:00 30th April & 1st May 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Nursing Home Address 231 Swinnow Road Pudsey Leeds Yorkshire LS28 9AP 0113 2570123 0113 2551336 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dr Hussan Ara Minhas Dr Emad-Ul-Mulk Minhas Mr Kevin Joseph Brennan Care Home 23 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (3), Old age, not falling within any other of places category (23), Physical disability (1) The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The place for Physical Disability is specifically for the service user named in the variation application dated 20 February 2004. Not to exceed 3 service users in total for the categories DE and DE(E) Date of last inspection 11th October 2006 Brief Description of the Service: The Gables Nursing Home is an extended converted building that provides personal care with nursing for both men and women over 65 years. It is a three-storey building, but people living at the home have access to only two of these, the third storey is used for storage and office space. The home is situated on a busy main road with good access to public transport for Leeds and Bradford. Facilities nearby include a public house, shops, a post office, a cricket ground and a GP surgery in the grounds of the home. The majority of bedrooms are single but there are some shared rooms. Some rooms have ensuite facilities, the majority of which have limited access. Lounges and the dining room are on the ground floor; the garden can be accessed from one lounge by a portable ramp. On the 23rd March 2007 the manager said that the weekly fees ranged from £400 - £577 per week. Additional charges are made for newspapers, hairdressing, chiropody and personal toiletries. Copies of previous inspection reports are available in the entrance area of the home. The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) inspects homes at a frequency determined by how the home has been quality rated. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. The focus of inspection is on the outcomes for the people using the service. All of the core National Minimum Standards are assessed at a key site visit and this forms the evidence of the outcomes experienced by the people who live at the home. More information about the inspection process can be found on our website www.csci.org.uk On occasions it may be necessary to carry out additional site visits, some visits may focus on a specific area and are known as random inspections. The last key site visit was carried out on the 11th October 2006; following this two random inspections took place on 20th November 2006 and 2nd February 2007. As a result of these inspections the registered providers (owners) were asked to produce an improvement plan with information about how they intend to address the identified shortfalls. This was received in February 2007. This key site visit was carried out between 10.00am and 5.00pm on the 30th April and 9.40am and 5.30pm on the 1st May 2007. The purpose of the visit was to assess progress in the implementation of the improvement plan and to make sure the home was operating and being managed for the benefit and well being of the people who live there and in accordance with requirements. Before the visit accumulated evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the visit. Two hours on the 30th April were spent observing the care being given to a small group of people. The care of four people was looked at in depth when comparisons with the observations were made with the homes records and the knowledge of care staff. A number of documents were looked at during the visit and some areas of the home used by the people living there were visited. A proportion of time was spent speaking to the manager, the registered providers, staff and visitors. Before the visit the manager completed a pre-inspection questionnaire (PIQ) to provide additional information about the home and survey forms were sent out to relatives of people living at the home, general practitioners and other healthcare professionals. A telephone conversation also took place with The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 6 relatives of two people living at the home. Information provided in this way will be reflected in the report. Feedback at the end of the two days was given to the manager and the registered providers. I would like to thank everyone who contributed to this report, and for the hospitality on the day. What the service does well: What has improved since the last inspection? Although the home must continue to improve and develop, significant improvements were seen during this visit. Plans are in progress to landscape the garden at the rear of the home, and the registered providers spoke about incorporating some features that are good practice in dementia care, such as providing sensory plants such as fragrant lavender and rosemary, a safe pathway with benches so that people can sit and relax and bird tables to add interest and provide stimulation for people. The smoking lounge has been divided, which has made the smoking area smaller and created additional lounge space for other people. The registered providers described their plans to extend the conservatory lounge to provide a separate hairdressing room and a nurses’ station. This will make additional space for people sitting in the area where the nurses’ station is currently based. The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 7 Care staffing hours have improved, which has made a difference to the amount of time staff spend with people living at the home. This was particularly noticeable during the observation on the first day of the visit, and was reflected in comments made by people visiting the home. The care manager has completed a moving and handling course and as a result has trained all staff on how to move and handle people safely. In addition, a range of equipment has been purchased, including a new hoist. Throughout the visit staff followed good practice when moving and handling people. Some rooms have been decorated, three new armchairs and new bedding has been purchased and new carpets have been ordered for some areas. A new cook has been recruited who has a particular interest in providing food suitable to the people that live at the home. On the second day of this visit she supervised a baking session for three people. She said that this would be a regular event on the first Tuesday of each month. The people taking part enjoyed the session and were extremely proud of the end result, a Victoria sponge, carrot cake and buns. The manager has some time dedicated to management, which has allowed time for staff supervision and meetings to take place. What they could do better: The requirements and recommendations made as a result of this visit have been prioritised and overall relate specifically to good practice in dementia care. Other improvements identified in the different outcome groups in the main body of this report will be addressed at a later date. This allows the registered providers to focus on the most important outcomes for people living at the home. Written information about the home and the service it provides must be available to people thinking about moving in, and those people already living at the home. Because the home has a large proportion of people who have some degree of dementia this information must be in a format suitable to their needs, such as large print, sequenced by colour and by using pictures or photographs. Pre-assessment information should give staff information about what the person can and cannot do for themselves in all aspects of their care. Everybody living at the home must have a care plan that gives staff clear instructions about their needs, their likes and dislikes and what tasks they can do for themselves. This will make sure that staff give the care that people need. To make soft diets more appetising, wherever possible, the home should use moulds that look like the food that is being served. To make sure people know The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 8 what food is on offer before it is served menus should be developed that meet the needs of everyone living at the home. People should not be left for long periods sitting at the dining table before their meal is served. To make sure that food is served at the correct temperature the home should consider buying a ‘hot trolley’. Staff must follow proper procedures when giving out medication to make sure that people living at the home receive their medication as prescribed. The home must make sure that everyone living at the home has the opportunity to join in recreation and leisure activities. This makes sure that people needing a high level of care and people with advanced dementia have the same opportunities as other people living at the home. The owners must continue to repair and replace furniture and fittings so that the home is suited to the needs of the people that live there. People living in the home should be able to distinguish one part of the home from another and there should be signs throughout to direct them and help them familiarise themselves with different rooms and different areas. Checks must take place on the home’s fire safety equipment to make sure people living at the home are safe in the event of a fire. The manager must make proper checks on nurses before they are appointed to make sure they are safe and qualified to work with vulnerable people. A full list of requirements and recommendations made as a result of this visit can be found at the end of this report. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Gables Nursing Home DS0000001338.V335945.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 DS0000001338.V335945.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): Standards 1, 2, 3 & 5. Standard 6 does not apply to this home. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Information about the home is not suited to the needs of the people that live there. This could leave people feeling excluded from the admission process. Inaccuracies and lack of detail on pre-admission assessments creates a risk that specialist care needs will not be met. EVIDENCE: The home has written information in the form of a statement of purpose and service user guide that tells people about the home and the service that it offers. These documents are not in large print, there is no use of colour to distinguish one section from another and there are no pictures or photographs to help make them more accessible to people thinking about moving in to the home, or the people living there. The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 11 The home’s contract and terms and conditions of residency have been updated but a minor amendment is needed because information about regulatory bodies is incorrect. The manager agreed to rectify this. The manager carries out pre-admission assessments to make sure that the home can meet the person’s needs. This assessment now includes information about who was involved in the process, the person’s needs and the services that need to be available if the person is admitted. Because this information is held in different parts of the person’s care plan important information could be missed. It is recommended that all the pre-admission information be held together. During a telephone conversation before this visit, one relative said that the manager had been very supportive and informative throughout the admission process. One pre-admission assessment failed to give accurate and specific detail. For example other information said that the person had seven falls in his previous care home but The Gable’s pre-admission assessment information said he had not had any falls and there was limited information about the person’s dietary needs and aggression. If assessment information is not accurate and precise staff do not have a clear picture of the person’s background and previous and current health issues, which could result in needs not being fully met. Another person’s pre-admission assessment was more detailed and included good information about the person’s likes, such as prefers to wear trousers rather than skirts and enjoys showers. The Gables Nursing Home DS0000001338.V335945.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): Standards 7, 8, 9, & 10. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s health care needs are met but because care plans are not always detailed and specific there is the potential for needs to be overlooked. Medication records are not always accurate which means that there is no guarantee that people are given their medication as prescribed. EVIDENCE: From discussions with care staff it was clear that they know about the individual needs of each person, but this is not always recorded in care plans. From those care plans seen some were more detailed than others. One person’s personal hygiene and dressing plan had good information about what the person could do for herself and what assistance she needed. For example, ‘can brush her own teeth but staff need to put toothpaste on her toothbrush’. However another person who was reluctant at times to wash had no personal hygiene care plan. There were good reviews and updates in some care plans but in others information recorded in reviews had not triggered an update of The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 13 the care plan. Further work should take place to make sure that care plans give staff clear instructions on how to meet the person’s needs in all aspects of their life. Records showed that people living at the home have access to health care services, such as chiropody, dental and optical services. During a telephone conversation before this visit, one relative said that she and a social worker could see an improvement in her father’s condition since living at the home. She went on to say that both she and her mother felt involved and included in her father’s care. Manual handling and falls risk assessments were in place, but those nutritional assessments seen did not identify risk accurately. One person was taking a nutritional supplement, had previously seen a dietician and had a mobility plan in place that said ‘poor intake’, but the nutritional assessment was scored as minimal risk. The manager should address this to make sure that those people at risk are properly identified so that preventative action can be taken. The care manager explained how ordering and disposal of medication follows good practice but some discrepancies on the medication administration records (MAR) were noted with administration of short courses of antibiotics. On three occasions people living at the home had been prescribed antibiotics for a short period of time, but the amount received did not correspond with the records of administration. This indicates that people are not receiving medication as prescribed and this is unacceptable. The manager must address this with qualified staff. Handwritten entries on the MAR are not checked and countersigned by a second person. This increases the risk of mistakes. Care staff described the different ways that they protect the privacy and dignity of people living at the home. Visitors said that people living at the home were nicely dressed, but some visitors said they thought it was undignified for the home to give toilet roll rather than paper tissues to people who needed them. This is something the home should address. The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who live at the home have an improved quality of life because of improved staffing levels and the way that the registered providers are trying to address shortfalls. EVIDENCE: During the inspection people living at the home were observed for two hours. A marked improvement was seen in the amount of time staff spent with people. Wherever possible staff sat alongside people chatting, reading books or encouraging people to drink or eat. During this time people were offered several drinks and ice lollies to increase their fluid intake. This observation identified however, that people with a high dependency level had less staff contact time than those people who were able to interact. This was a view echoed by visitors at different times during the visit, who said that activities and stimulation were geared more towards those people who could join in or interact rather than those people with advanced dementia. Some staff said that they found it difficult trying to provide activities for people with advanced dementia. The home would benefit from regular external entertainers who have a background and/or experience in providing entertainment for people The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 15 with dementia. During the feedback session the manager said that he was aware of this and was trying to address it. Overall staff were kind, patient and worked at the pace and level of the person, but there were a few occasions when staff carried out a task without fully explaining the reason to the person. There were several visitors to the home over this two day visit, some were offered a drink, but others were not. All said that they could visit at any time throughout the day, but one person said that there was little space for visitors in the lounge areas. This is something the registered providers are trying to address. Staff said that improved staffing levels meant that they had time to take one person to church. On hearing this, another person said that he would like to go out to church on Sunday. Staff said that they would try to arrange it. A new cook has recently been appointed. This person is clearly enthusiastic about her work and likes making dishes suited to the age group of people living at the home. Discussions with the cook and the registered provider showed that they are aware of, and considering good practice in dementia care. They are trying to obtain moulds for blended food and are considering introducing picture menus and menu boards so that people are aware of what food is being offered before it is served. Meals are brought from the kitchen to the dining room and lounge areas on an open trolley. This does not guarantee that correct temperatures are maintained. The home should consider purchasing a ‘hot trolley’ that is thermostatically controlled. Staff started taking people to the dining room for lunch 30 minutes before their meal was served. One person said, “I am getting bored because everything is taking so long.” The home should look at ways of reducing the amount of time people have to sit at the dining table to wait for their meals. The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 16 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): Standards 16 & 18. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Because the home does not have a copy of the Local Authority Adult Protection Procedures there is no guarantee that senior staff will follow correct reporting procedures if abuse is suspected or reported. EVIDENCE: There have been no complaints since the last key visit and the home now has a system for recording and monitoring complaints. Relatives of people using the home said that they would have no hesitation in making a complaint. Care staff described the different types of abuse and knew what to do if they suspected that a person living at the home was at risk of being abused. The home now has a policy on whistle blowing and adult abuse but has still to obtain a copy of the Local Authorities Multi-Agency Adult Protection Procedures. The home must have a copy of these procedures so staff can follow the proper reporting procedures. The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 17 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): Standards 19 & 26. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Improvements are taking place but some people with dementia or memory loss may be confused or disorientated because of poor signage. EVIDENCE: The original smoking lounge has been divided into two lounges by a glass partition. This has created an additional lounge for people who do not smoke, and created more space in another lounge. The registered providers spoke about their plans to extend the conservatory lounge to provide a hairdressing room and a new nurses’ station. This will increase the amount of space in the lounge where the nurses’ station is currently situated. The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 18 The garden at the back of the home is being landscaped, when finished this should provide some sensory areas where people can see, smell and touch plants and seating areas where people can sit and enjoy their surroundings. Carpets in the lounge areas have been cleaned but because this has not been successful the registered providers said that new carpets are being ordered. Other improvements include the purchase of new bedding and three new armchairs. The registered provider is aware that further new chairs are required, and these are included in the home’s long-term refurbishment plan. Two visitors said that they could see some areas of improvement to the environment. Lighting is inadequate in the lounge where the nurses’ station is currently positioned. There is no access to natural light and the central ceiling lighting does not provide enough light for the area. The registered providers should look at ways to address this. There is little signage throughout the home to help those people with dementia or memory loss. A lengthy discussion took place during the feedback session following this visit about good environmental practice in dementia care. Written information was given to the manager and registered providers. The manager said that an external profession had started to check the fire safety equipment and emergency lighting but this was not yet complete. This must be completed as a matter of urgency and the home must provide evidence of completion to the CSCI. The laundry room was clean and tidy. Infection control was well managed and there were no offensive smells throughout the home. The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 19 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): Standards 27, 28, 29 & 30. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Improved staffing levels, training and recruitment practices makes sure that the needs of people living at the home are met by sufficient numbers of staff who are trained and are safe and suitable to work with vulnerable people. EVIDENCE: Staffing levels have improved and as noted during the 2 hour observation staff have more time to spend with people living in the home. Two visitors said that they could see a difference in the home because of improved staffing. It is difficult to establish what training each person had done because there are no individual training records in staff files and no formal annual training plan. It is recommended that an annual training plan be developed, which includes when mandatory and fire training updates are needed. It would also be good practice to hold individual training records in each person’s staff file. The care manager has responsibility for bed safety rail awareness and all staff have been made aware of the dangers of entrapment and measures taken to prevent this from happening. The care manager is also the home’s moving and handling co-ordinator and has trained all staff in correct moving and handling procedures. During the feedback session a lengthy discussion took place about the benefit of this person having responsibility for training and The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 20 development. She would then have the opportunity to develop an annual training plan and individual training records, identify training needs and access training to meet these needs, and make sure that theory is transferred into practice on a day-to-day basis, particularly theory related to dementia care. In order to do this she would need time supernumerary to the rota. The registered providers agreed to look into this. The manager said that 60 of staff have achieved a NVQ (National Vocational Qualification) and a further 4 staff were starting assessment. He said that training for staff in this financial year will focus on dementia care, adult protection, mental capacity and making sure that there is someone on duty at all times with a current first aid certificate. The manager said that he was considering enrolling on a dementia care course run by Bradford University. The home has reviewed and amended its induction programme for new staff so that it is in line with the Skills for Care induction standards. The recruitment files of two new members of staff were looked at. There were completed application forms, 2 written references, interview records, offer of employment and statement of terms and conditions. The manager was reminded that this would need amending when the new smoking at work regulations are implemented later this year. There was no job description in either of the files. The manager said that he received written confirmation of a successful POVA First (Protection of Vulnerable Adults) disclosure check for both people from the Leeds Care Homes Association, but there was no evidence of this in the home. It was recommended that he request written notification of these checks. When recruiting qualified staff the manager does not check their PIN (Personal Identification Number) with the NMC (Nursing and Midwifery Council). Instead he accepts written documentation from the person stating that their registration has been renewed. He was advised that he must carry out these checks as part of the recruitment process and that the person must not be employed as a nurse until confirmation of their PIN and eligibility to work has been received. The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 21 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): Standards 31, 33, 35 36 & 38. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Improvements in management practices means that staff receive direction and supervision on a day-to-day basis, which in turn improves the quality of care for people living at the home. EVIDENCE: The manager said that he now has time supernumerary to the rota. This has given him the opportunity to have structured supervision time with staff. He gave examples of how he has been able to challenge some practices and offer reassurance about current practices. Throughout this visit the care manager constantly supervised and monitored staff and reminded them about tasks that needed doing. The manager and care manager should now have The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 22 supernumerary time together so that they can consolidate practices and make sure that a consistent management approach is achieved. Minutes sent to the CSCI before this visit showed that meetings take place for staff, senior staff and relatives of people in the home. The manager said that quality assurance questionnaires had recently been sent out. Comments in those surveys already returned related to people not being involved in reviews and issues around personal laundry of people living at the home. The manager was reminded that an action plan should be developed on how the home is to address these issues. This should then be made available to all interested parties. The manager now analyses all accidents and falls in the home. Fire points are tested weekly and a different actuation point is tested each week. As identified earlier in this report checks on the home’s fire alarm systems have not yet been completed by an external professional. The home’s administrator has responsibility for finances and was not available during this visit for discussion. The manager explained how the finances of people who have money held for safekeeping at the home are managed. Evidence has been seen of the home contacting the local social services team for advice on several occasions regarding the finances of people who have money held in the home’s bank account. To date there has been no change in this situation. The manager was advised to contact the new Independent Mental Capacity Advocates, once they are in post, to deal with this issue. The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 23 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 2 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 3 X 2 The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 24 No 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 OP1 Regulation 4 (1) (2) 5 (2) Requirement The home’s Statement of Purpose and Service User Guide must be in a format that is suitable to the needs of the people living at the home. This will make sure that people are aware of the services that the home provides. All people using the service must have an up to date and detailed care plan. This will make sure that staff have clear instructions on how to meet the person’s needs in all aspects of their care. Staff must follow proper procedures when administering medication. This will make sure that people receive their medication as prescribed. The home must provide facilities for recreation and leisure for all people living at the home. This will make sure that people The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 25 Timescale for action 31/08/07 2. OP7 15 (1) 31/08/07 3. OP9 13 (2) 02/05/07 4. OP12 16 (2) (n) 31/08/07 5. OP19 23 with high dependency needs and advanced dementia are included in activities suited to their abilities. The home must continue with the refurbishment programme. Signage must be provided throughout the home and the environment must take into account good practice in dementia care. This will make sure that the home is suited to the needs of the people living in the home. An external professional must check the home’s fire safety equipment and emergency lighting. This will ensure the safety of the people living at the home. This is outstanding from the inspection on the 11th October 2006. 31/08/07 6. OP19 23 (c) (iv) 30/06/07 7. OP29 17 (2) The home must notify the CSCI on completion of this work. Recruitment checks for nurses 30/06/07 must include a NMC check on the person’s PIN and eligibility to work. 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 OP3 Good Practice Recommendations The home’s pre-admission assessment should identify the strengths and limitations of the person in all aspects of DS0000001338.V335945.R01.S.doc Version 5.2 Page 26 The Gables Nursing Home their care. This will make sure that staff have accurate information on the amount and level of care and supervision each person needs. Wherever possible when serving soft food the home should use moulds representing the food that is being served. The home should look at ways of implementing menus in a format suited to the needs of the people that live at the home. This will make sure that people are aware of the meal before it is served. Practices should be reviewed to make sure that people are not left sitting at the dining table for long periods before their meal is served. The home should consider purchasing a ‘hot trolley’ so that food transferred from the kitchen is kept at the correct temperature. Consideration should be given to the care manager having supernumerary time so that she can take responsibility for training and development in the home. The manager and care manager should have supernumerary time together so that they can consolidate practices and make sure a consistent management approach is achieved. 2. OP15 3. 4 OP28 OP31 The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Gables Nursing Home DS0000001338.V335945.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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