Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: The Gables Nursing Home 1595 Wolverhampton Road Oldbury West Midlands B69 2BJ The quality rating for this care home is:
three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jean Edwards
Date: 0 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home
Name of care home: Address: The Gables Nursing Home 1595 Wolverhampton Road Oldbury West Midlands B69 2BJ 01215443988 01215443989 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Exceler Healthcare Services Limited care home 51 Number of places (if applicable): Under 65 Over 65 51 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 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. The 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. Care Homes for Older People Page 4 of 35 Care Homes for Older People Page 5 of 35 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last Key Inspection on 23/10/06 and the CSCI undertook an Annual Service Review 17/07/08. We, the Commission for Social Care Inspection (CSCI), undertook an unannounced key inspection visit. This meant that the home had not been given prior notice of the inspection visit. The inspector visited the home between 07:00 am and 18:00 pm. We monitored the compliance with all Key National Minimum Standards at this visit. The range of inspection methods to obtain evidence and make judgements included, discussions with the registered manager, deputy care manager, and staff on duty during the visit. We also talked to people living at the home, and made observations of people without verbal communication skills. Other information was gathered before this Care Homes for Older People
Page 6 of 35 inspection visit including notification of incidents, accidents and events submitted to the CSCI. A number of records and documents were examined. The registered persons submitted the homes Annual Quality Assurance Assessment (AQAA) as requested prior to the inspection visit. We toured the premises, looking at communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and peoples bedrooms, with their permission, where possible. The home had not published the range of fees for the service and people are advised to contact the home for up to date information about the fees charged. What the care home does well: The registered manager had responded to the previous inspection report with comprehensive improvements. All requirements and good practice recommendations required at the last inspection visit had been actioned. Examples were, attractively redecorated dinning rooms, with new easy to clean flooring, a number of additional new adjustable nursing beds, renovated and very attractive and inviting bathing and showering rooms, giving people a choice of very pleasant, accessible bathing facilities. There was up to date, easy to understand information about the home, with audio versions for people who may not be able to read or understand written information. Everyone living at the home had been given a comprehensive contracts and terms and conditions, which were clear and easy to understand. In response to the CSCI surveys, comments were positive and included, the home invited us to view the home, and as a family we are very satisfied with The Gables and often feel that we are lucky that we chose this home. The manager and staff make sure that each person, and as appropriate, their relatives are involved in the plan of how their care is to be provided. The sample of peoples care plans looked at, were up to date. Medication storage was secure, and medicine records were clear and accurate. This meant that each persons medicine requirements were very well managed in a safe environment. All of the improvements required at the last inspection visit relating to medication were now in place. The home had very good relationships with the local GPs and other health care services, such as the community dietician and other specialist therapists, providing support for people living at The Gables. We saw that nursing staff noted that a person had become unwell and lost weight, and the advice of the GP and dietician was sought and acted upon. This demonstrated the excellent level of trust and professional respect between the home and primary care services. The people living at the home were encouraged to treat The Gables as their own home and to be as independent as possible. People were encouraged to choose the decor of their own bedroom and personalise it with their possessions, furniture and bedding if they wished. We saw lots of examples of people being able to make choices about their daily routines, activities and meals. They were encouraged and supported to take an active part in meetings and surveys at the home. The residents meetings were well established and generally well attended, with notes of topics discussed and action taken as a result. There were also relatives meetings and 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. We noted that there was good involvement in the running of the home and a pantomime including staff and relatives had been rehearsed and planned but unfortunately postponed due to inclement weather. The home had good links a local church and small groups of people escorted by the Care Homes for Older People Page 8 of 35 activities co-ordinator visited twice weekly events for activity classes and bingo, each Monday and Friday. There was also a monthly church service at the home. Arrangements were in place for ministers from other faiths to visit individual residents at the home, at their request. For example the local Catholic priest regularly visited one person who was nursed in bed. We received excellent responses to the CSCI surveys relating to the activities and social stimulation provided. They included, something is going on daily, bingo, a film, singers, Gentle exercises, and bingo. Mary is always around if we need to chat or shopping., daily activities take place, monthly entertainment, and I enjoy entertainment with singers, bingo, church service. The menus offered a range of options for each meal, which were well prepared and appeared appetising and well presented. We saw members of staff ask each person what they preferred at each mealtime, with each persons preferences recorded each day. The meals were a high standard and the majority of food was prepared using fresh ingredients. The home was inspected by Sandwell Environment Services and achieved Gold Standard for food safety and level 3 award for healthy eating. The trained nurses monitored mealtimes and made sure each person was supported to eat with a sensitive approach. The kitchen was very well organised. Southern Cross Health Care directly employ the catering staff and there was a good budget for food. The cook took time and effort to obtain and prepare additional foods to meet individual food preferences. Comments from people during the visit and responses to CSCI surveys were positive and included, meals are lovely, and the food is good and plenty of it. The small kitchenettes for visitors to make drinks and snacks for themselves and their relative if they wished were well used and appreciated. The home had been made more homely and it was warm, very clean and comfortable. We received comments such as, the home always smells nice, the cleaners do it every day, I treat the home like my home, and everyone tries hard to make us comfortable. The Gables had a stable staff group, with many people who had worked at the home for a long time and knew the people living there very well. Nursing and care staff were caring, committed and flexible, often willing to work extra shifts for the benefit of people living at the home. The following comments have been made, someone is always there for me and very helpful, everyone is caring. There was a warm and friendly rapport between staff and people living at the home. Staff were aware of individual peoples likes and dislikes and how to meet their needs. Comments from CSCI staff surveys were, Everything works well at the Gables we work as a team and I call good friends. We help each other including our manager, I am very confident in what I do. I have gained knowledge and experience over the years. Always willing to listen if something new is offered and patient care, the residents are looked after very well. The staff are friendly and kind. Very active social events organised by the coordinator with the full support by the staff. A response from a CSCI professional healthcare survey, commented, the staff are all Care Homes for Older People Page 9 of 35 friendly and very professional. They truly care for their clients. They know their clients extremely well and are quick to detect any problem and get them sorted out quickly. Good standards of health and safety continued to be maintained and the registered manager conducted regular quality audits and analysis of all accidents occurring in the home, any areas for improvement were identified and rectified. This inspection was conducted with full co-operation of the registered manager staff team and people living at the home. The atmosphere throughout the inspection was relaxed and friendly. What has improved since the last inspection? What they could do better: There were very few areas requiring improvement at this inspection. There were minor good practices, for example relating to medication records, which could clarify special instructions and life story plans and personal preference plans could be completed for each person. The introduction of Southern Cross Heath Care policies and procedures relating to residents finances meant that the organisation needed to make sure the management of peoples finances held for temporary safekeeping demonstrated individual choice, consent and compliance with the National Minimum Standards and Care Homes Regulations. Care Homes for Older People Page 10 of 35 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 11 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 35 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a comprehensive and easy to read of purpose and service user guide and people living at the home have contracts terms and conditions of occupancy. This has the effect that people and their advocates have good information regarding their rights and entitlements, and how care will be provided. The home uses comprehensive assessment tools, which means that each persons needs are thoroughly assessed to ensure that their needs and preferences 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 information contained in the homes AQAA about what it did well stated, We provide a comprehensive service users guide available in both written and Compact
Care Homes for Older People Page 13 of 35 Evidence: disk format. In addition to this we have a pack of information, which is given to prospective residents and their families. This information includes a copy of the latest newsletter The Gables Gazette which gives details of events that are going on through out the home. Each service user is provided with a current contract relating to all terms and conditions of the service provided as per company policy. This contract is discussed with the service user (where possible) and their relatives, prior to the document being signed. No one is admitted to the Gables without a pre admission assessment being carried out by either the home or deputy manager. Service users are provided with a letter informing them that the home can meet their needs following the pre admission assessment. A pre admission draft care plan is drawn up with the service user at the time of assessment. Relatives are encouraged to attend the pre admission assessment. We have found that this reassures the service user and in cases where there is little or no communication from the service users gives us valuable information. We insist that the care plan drawn up by the social work team is sent to us prior to admission. Pre admission visits are always offered to prospective service users. Relatives are always asked to come into the home to view the services provided prior to pre admission assessment taking place. The Gables does not offer intermediate care. The homes AQQA cited the following supporting evidence to demonstrate what it did well, Service users guides in service users bedrooms and on display in reception. Compact disc version of service users guide in reception. Copy of the Gables newsletter on display in reception. Contracts in service users files. Copies of letters informing service users the Gables can meet their individual needs kept in service users files. Pre admission assessment documents kept in residents files. Pre admission draft care plans kept in residents files. Notes that a pre admission visit has been offered are recorded on the draft care plan. Copies of care plan drawn up by the service users social worker. We looked at copy of the homes statement of purpose and service user guide, which had been updated and was also provided in an audio format. The documents clearly set out the aims and objectives of Southern Cross and provided good clear information about the home. The organisation had not included information about the range of fees in the service user guide. We discussed this omission with the registered manager who told us that generally fees charged were based on the fees paid by the Local Authorities. We recommended that information about fees should be included in the service user guide to give people comprehensive information about the service to help them make decisions about the choice of home. We looked at a sample of case files of people recently admitted to the home, which provided evidence that each person was provided with a contract and statement of
Care Homes for Older People Page 14 of 35 Evidence: terms and conditions. This were a Southern Cross documents, which were easy to read and understand and set out in detail what was included in the fee, the role and responsibility of the provider, and the rights and obligations of the person living at the home. From the information provided at the home we noted that five people were funding the costs of their own care the majority of other people were funded through the Local Authorities or PCT. We noted that the Registered Nurse Care Contribution, for free nursing care was added to the total fee and we recommended that this should be made clear and transparent. We saw evidence from examination of a sample of care records at the home, from CSCI surveys responses and during discussions, which confirmed the good practices in the homes AQAA. Such as pre admission assessments, which were conducted professionally and sensitively and had usually involved the family or representative of the person. The Southern Cross comprehensive pre-admission assessment documentation was well completed and individual preferences were recorded such as rising, retiring, preferred activities, likes and dislikes. This meant that staff had good and accurate information about each persons needs and how they wished to be cared for. Care Homes for Older People Page 15 of 35 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is comprehensive care planning, risk management and monitoring, which provides staff with the information and guidance to meet peoples needs and preferences well. Excellent multi disciplinary working takes place on a regular basis, giving people assurances that their health needs care needs are identified and 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 people living at the home. This means that each persons medicines are stored safely and that records show that the right medicine has been given to the right person at the right time. People living at this home can be assured that they will receive dignity and respect at all times. Evidence: We looked at a sample of care records for new people admitted to the home and
Care Homes for Older People Page 16 of 35 Evidence: people who had lived at the home for longer periods of time. We saw that each person had a comprehensive, flexible new care plan, using the Southern Cross formats. There was evidence demonstrating the good practice of involving the person and their relatives or representatives in the development and review of their planned care. We noted that the care plans were based on very comprehensive assessment information and included all essential basic information and identification of any associated risks. The additional personal preference plans and life histories used to record each persons preferred daily routines for staff guidance making sure that care was delivered with a person centred approach was an excellent initiative, which was implemented well. There was evidence from records and discussions that each persons health was carefully monitored with appropriate action taken. We saw evidence of well documented health care assessments, screening, treatment and intervention. An example was where there were significant changes in one persons condition, with weight loss, some loss of mobility and general deterioration this reflected in a review of the Waterlow tissue viability score, nutritional assessment and a referral to the GP and community dietician for advice and support and appropriate weight monitoring and increased calorific dietary intake. We saw that all persons living at the home had good access to health care services to meet their assessed needs both within the home and in the local community. Some people were still able to choose their own GP within the limits of geographical borders and there was documentary evidence to demonstrate that all persons had good access to dentists, opticians, and other community services, such as the Speech and Language service. We looked at the homes system to manage the medication for people accommodated. We noted that the supplying pharmacy, BOOTS, supported the home and provided advice related to medication issues at regular audit visits. In addition the home also conducted regular medication audits, which demonstrated good practice. We noted that all medication was appropriately stored in accordance with manufacturers guidance. There were two dedicated and lockable medication refrigerators, which were checked daily, with the minimum and maximum temperatures documented and recorded. The correct temperature range of between 2 C and 8 C was being maintained. This meant that peoples medication requiring refrigeration was stored at the correct temperature to maintain its integrity and effectiveness. Care Homes for Older People Page 17 of 35 Evidence: All medicines were stored securely. This ensured that each persons medication was kept in a safe environment. We looked at a sample of MAR (Medication Administration Records) sheets, which document each persons current medicine requirements and regime. These were very well maintained, which meant that there was an accurate record to show medicine prescribed by a General Practitioner was recorded, checked, monitored and administered in accordance with instructions. There were good procedures and checks in place to make sure that all persons received their correct medicine at the right time. The receipt, administration and disposal of medicine were recorded. The date of opening of medicine containers was documented, which meant we could carry out full audits on a random sample of medication to ensure that medicine had been given to each person as prescribed by the GP. The random audits undertaken for four peoples prescribed medication were found to be accurate. We noted that generally medication such as Allendronic Acid had the special instructions needed for its administration printed on the persons MAR sheet. However there were two MAR sheets where Risedronate Sodium 35 mgs to be given once weekly did not contain special instructions for administration. We recommended that the pharmacy provider should be contacted and requested to print the full instructions for the administration of any medication, which has to be given in accordance with special instructions, such as Risedronate Sodium 35 mg as a weekly administration. During our examination of the sample of individual care plans we noted that they contained up to date and current medication details and medication regimes, which demonstrated very positive practice. From our observations and in discussions it was evident that all staff were aware of how to treat each person with respect and to consider their dignity when delivering personal care. Care Homes for Older People Page 18 of 35 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is ample evidence of planned and spontaneous activities available on a regular basis offering people opportunities to take part in socially stimulating activities. People are enabled and encouraged to maintain good contact with family and friends. The dietary needs of each person are well catered for with a balanced and varied selection of foods that meets their preferences and nutritional needs. Evidence: The homes AQAA cited the following evidence of what was done well, Social needs and interests are identified and recorded in the residents care files. There is a regular church service. The visiting library service calls to the home on a monthly basis. We have a full time activities organiser who works with small groups of service users and individuals on a one to one basis. She has developed a plan of activities taken from the social history of the residents. Small groups of residents attend a local gentle exercise class at a local church weekly. There are no set visiting times at the Gables allowing relatives and friends to visit the service user when its convenient for them. Service users are given a choice in when they get up and go to bed. Some service users chose to manage their own finances and are supported to go to the local bank to make
Care Homes for Older People Page 19 of 35 Evidence: withdrawals. Service users are given a choice at every mealtime and are consulted about the items offered on the menu. There was evidence from the CSCI survey responses, which indicated that staff listened to people living at the home and made considerable efforts to provide flexible daily living routines, which enabled people to enjoy a good quality of life according to their personal preferences. We noted that there was a key worker system, which operated well and enabled closer relationships between people accommodated and staff, where likes, dislikes and needs were known about and met. Key workers and the Activities Coordinator used the information and their knowledge of people to plan activities, which each person enjoyed. It was positive that people were aware of key workers names knew there always someone who would listen and respond. There was a good understanding for activities and access to socialisation. The home had developed an excellent system of activities and socialisation, lead by the Activities Coordinator, who was also the homes Dignity Champion. We saw information for displaying and bringing peoples attention to community events and activities. It was very positive that it was understood and respected that some people preferred to spend their time in their own bedrooms, and they were supported with individual interests. We noted that there were a small number of people who were being nursed in bed or in their rooms. We saw that real efforts were made to maintain personal contact and socialisation according to their abilities and needs. We observed lots of staff popping in to a person near to where we sat to look at the homes records. We also noted that a person who had been nursed in bed for a long time had their TV, radio and CD player, and cultural and spiritual music in their bedroom. We looked at a sample of peoples individual activities records, which were well completed, with refusals recorded and activities offered evaluated. We saw evidence that family and friends were welcomed and people spoken to told us they knew they could visit the home at any time. We were told that staff always made time to talk to visitors and share information with the consent of the person concerned. During the tour of the home there was good evidence that people were encouraged to bring in their personal possessions to personalise their room. We saw inventories of personal possessions on the sample of files examined, which were signed and dated by the person or their representative and witnessed by the member of staff.
Care Homes for Older People Page 20 of 35 Evidence: We discussed nutrition with care staff and catering staff, who were knowledgeable about each persons nutritional needs. We were told that a vegetarian choice always offered, there were also diabetic and soft diets, and a thick and easy supplement, required to assist with swallowing was kept in the persons bedroom. We noted that flavoured Complan drinks were offered at 11 am and 3 pm each day. There was also added calorific value at mealtimes for people with poor appetite or at risk of weight loss, using cream, butter, cheese and pulses. We discretely observed mealtimes and saw that staff were aware of the needs of people who found it difficult to eat and we noted that they offered sensitive assistance with feeding. They were aware of the importance of offering food at the persons pace, so that they were not hurried. A small number of residents chose to have their meals, particularly breakfast at a different time, or in their bedrooms, to allow them time and space to eat at their own pace. There were trays with attractive dollies for this purpose. Also the dining rooms had been redecorated and looked inviting with attractive tablecloths, crockery and condiments. We looked at the menu for the day, breakfast options were porridge, cereals, toast, conserves, tomatoes, prunes, fruit juice and this was varied daily. Lunch options were homemade vegetable soup, mixed grill, sausage, eggs, hash browns, and black pudding, with an alternative corned beef hash. The pudding was bananas and custard, or fruit. The evening meal was assorted sandwiches, tuna pasta, jacket potato with fillings or omlettes and supper was a list of options including malt loaf, cheese and biscuits, fairy cakes, and shortbread. The meals looked and smelled appetising, and meal times were protected to provide a sociable, enjoyable experience. We asked a sample of people about the food at meal times, and received very favourable comments, food wonderful and plentiful, lots of choice. We saw that visitors were invited to make drinks for themselves and the people they are visiting in facilities in the small kitchenettes on each floor. These continue to be well used and much appreciated. Care Homes for Older People Page 21 of 35 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be sure that any concerns and complaints are listened to and action is taken to look into them, with systems in place to record investigations and outcomes. There are good arrangements in place to safeguard people living at the home from risks of harm. Evidence: We saw that The Gables had an up to date Southern Cross Healthcare complaints procedure, which was displayed in the reception area and contained in the service user guide. Information supplied as part of the Homes AQAA indicated that the home had received nine complaints, over 12 months, which have been investigated by the provider within 28 days, with satisfactory outcomes. One complaint was upheld and resolutions implemented. The organisation had new complaint forms to record formal complaints, which were improved and much better for providing detailed information. There was evidence that the homes administrator makes sure each persons right to vote is registered as they wish. People were enrolled on the electoral register and had a proxy or postal vote to allow them to vote in elections, according to their citizens rights and wishes. The responses to the CSCI surveys, people indicated that they were aware of how to
Care Homes for Older People Page 22 of 35 Evidence: raise concerns or use the homes complaints procedure. This demonstrated positive practice and the homes proactive response to peoples experiences and perceptions of the service. We were told that the home had not received any allegations of abuse of vulnerable persons. There was a copy of Sandwell MBC multi-agency procedures relating to safeguarding vulnerable persons living at the home. The organisations policies and procedures to safeguard vulnerable people were satisfactory and had been reviewed and updated to be in line with regulations and other external guidance. We were given 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. 46 staff had been provided with training, which provided appropriate awareness of safeguarding vulnerable adults and staff spoke to were aware of what they needed to do should an incident occur. Care Homes for Older People Page 23 of 35 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the decor within this home is good with evidence of improvement through proactive planning and continuous maintenance. The home presents as a safe, homely and comfortable environment for people living there. There are effective systems in place for maintaining infection control. Evidence: The Gables Nursing Home was purpose built on three floors. It provided a bright and cheerful interior and the exterior of the premises was enhanced with containers, which would have a display of winter flowering plants, when the winter weather improved. The tour of the building identified that a number of improvements have been made and the program of redecoration and refurbishment was continuing, with the majority of requirements for repairs and redecoration issued at the last inspection completed. The homes AQAA cited the following evidence as improvements made in the last 12 months, Both dinning rooms have been redecorated and have new flooring. Downstairs small lounge has been refurbished. Residents bedrooms have been redecorated. New flooring in visitors toilet, kitchenette, and bathroom 2. Additional door guards linked to fire alarm system fitted to more bedrooms at the request of individual service users. Quotes obtained for bathroom flooring through out the home. We saw that the first floor bathroom had been redecorated in antique cream, with
Care Homes for Older People Page 24 of 35 Evidence: attractive splash back tiles and floral pictures, which made the bathing facilities look much more inviting. There were similar improvements in bathroom 5, where a walk in shower had been created. We saw evidence of a full audit of the home from which a prioritised programme of repairs, redecoration and replacement of equipment had been devised and was in the process of implementation. There was good visible evidence that the home continued to be refurbished, redecorated and repaired on an ongoing basis with work completed to high standards. During discussion with people they told us they approved of the new decorations, especially the dining rooms and bathrooms. We were told that the home was always clean, warm, and comfortable. There were very minor additional improvements required at this visit, such as the lower area of the hoist frame needed a thorough cleaning, which was actioned immediately during the visit. The large laundry, located in lower ground floor of the building was well equipped with commercial washers and tumble dryers. The laundry service was generally well organised and the designated laundry staff demonstrated good standards of infection control. There was a laundry procedure and measures in place for supplies of disposable gloves and aprons to be readily available in the laundry at all times. The homes main kitchen was maintained in exceptionally good order, and it was clean and tidy and well organised. We noted that appropriate food hygiene and safety measures were in place, with well-kept records, monitored by the registered manager, the organisation and Environmental Services. The home had achieved the Local Authority Environmental Health and NHS Trust Gold food award for healthy eating and food hygiene. Throughout the home good standards of cleanliness continued to be maintained and there were no discernable malodours during this visit. We received a number of comments in response to the CSCI surveys, which all gave a similar view, the home always smells nice, cleaners come around every day. Care Homes for Older People Page 25 of 35 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home continues to maintain stable substantive staffing levels and people receive consistent and excellent standards of care. The staff recruitment processes are robust, which means that there are effective safeguards for people living at the home. The organisation and registered manager demonstrate a strong commitment to staff training and development. Evidence: The homes AQAA cited the following as evidence of what they do well, We have a stable staff group with a low staff turn over. We ensure there is the correct skill mix of staff on duty at all times. The staffing levels within the home are reviewed on a regular basis by the home manager, taking into account the occupancy and dependency of the service users. There are regular supervision sessions bi monthly for all care and nursing staff. The companys recruitment policy is adhered to at all times and no one is employed without two written references and a satisfactory CRB check being received. There are regular in house and outside provider training sessions for all staff. Registered nurses are supported to keep up to date with their professional development and have all attended relevant study days over the past year. A further 4 members of staff have registered this year for NVQ 2 in care. We hold regular staff meetings for all staff. Care Homes for Older People Page 26 of 35 Evidence: We were able to verify the good practices claimed from observations, discussions and examination of samples of records during this visit. We noted that there were 49 people accommodated, with a variety of dependency levels and diverse needs. The registered manager told us that she reviewed staffing levels on a regular basis, taking account of the occupancy and dependency levels of the people accommodated, which demonstrated good practice. Assessment of staffing rotas and information from the AQAA and staff personnel records demonstrated that the home was generally maintaining satisfactory staffing levels. The Home had 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 Registered Manager and 4 catering staff. Four staff had left the homes employ since in the past 12 months for valid reasons, and there were no staff vacancies at the time of this inspection. We looked at a random sample of staff personnel files, which were satisfactory. Interview questions and answers were retained on staff personnel files as a matter of good practice. The registered manager had continued to demonstrate robust recruitment practice, with very well ordered staff files and comprehensive documentation. We raised one query about the absence the copy of a UK work permit for an overseas care worker, with a passport showing student status. We have recommended that the registered manager sought clarification and additional documentation as necessary. We noted that the organisation continued to demonstrate a strong commitment to staff training and development and had continued to provide all staff with appropriate training to raise awareness and skills to respond to peoples changing needs. We saw evidence that 15 of 26 care staff had achieved an NVQ level 2 care award with new candidates registered for training. We were told that all staff had an annual appraisal and saw evidence of a formal structured supervision system, with matrix displayed to show dates that all care staff received a minimum of 6 one-to-one supervision meetings. During discussions it was evident that staff felt supported. The comments received on CSCI surveys from staff included, good teamwork residents are always well looked after by all staff, good team in home and good manager, and my manager is always there for me and very supportive, I know I can rely on her even if she is busy, and manager and care manager always give their support to us, we also have appraisal every two months. Care Homes for Older People Page 27 of 35 Care Homes for Older People Page 28 of 35 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager, trained nurses and senior staff provide effective leadership and good clear communication systems. All staff demonstrate good awareness of their roles and responsibilities, which means that people can be assured of excellent standards of care and attention. The systems for consultation at The Gables Nursing Home are good with ample evidence demonstrating that peoples views about the service are both sought and acted upon. The standard of record keeping and health and safety compliance at this home is very good, providing people with safeguards from risks of harm. Evidence: Kim Jeffrey was in position as the Registered Manager in day to day control of the home. She was a Registered General Nurse (RGN), with the Registered Managers
Care Homes for Older People Page 29 of 35 Evidence: Award (RMA) and she had considerable nursing and managerial experience. We noted that a Regional Manager, the nominated representative of the Responsible Individual from Southern Cross Healthcare, provided supervision, support for the registered manager. This person had also undertaken regular quality monitoring audits and monitored the conduct of the home through monthly unannounced Regulation 26 visits and reports. We saw evidence of very positive quality audits, which meant positive outcomes for people receiving the service, during this inspection visit. There were clear lines of accountability within the home, and through the management structure. We noted that the registered manager had devised and implemented the homes annual development plan for the current year. The NMC had approved this home as a placement, in association with Paisley University (Scotland) for adaptation for overseas nurses working for Southern Cross Healthcare, which was a positive accolade. We saw excellent evidence that the registered manager had used comprehensive self auditing systems, some introduced by Southern Cross Healthcare. These included monthly audits of areas such as peoples case files, tissue and pressure, staff personnel files, staffing levels and accidents, incidents and falls, with remedial actions to minimise risks identified. The manager was required to score the homes performance and compliance in each area. Evidence showed that had been consistently above the required level. The registered manager and team have continued commendable efforts to involve people living at the home, their relatives, representatives and other community stakeholders in the running of the home. We noted that there were regular residents meetings and relatives, with minutes available. The homes survey questionnaires had been distributed to residents and families and completed forms have been returned, with the results collated and published. We saw evidence that the results had been acted upon in any area where there were concerns or where performance needed improvement. An example was the introduction of comments books in each dining room used to record peoples views of the quality and choice after each mealtime. We noted that staff meetings were taking place regularly, with minutes posted on notice boards. The structured formal supervision system appeared to be working well for all staff. Supervision sessions identified training needs, personal development and support and as highlighted at the Staffing section of this report staff commented that the process was useful. This had evident benefits for their work with people living at the home. We noted that people were offered the opportunity to manage their own money if they wished, and the home provided facilities to help keep it safe. It was very positive to
Care Homes for Older People Page 30 of 35 Evidence: note that one person had their own bank account and travelled by taxi to bank to access their money, as it was required. Where the home managed money on each persons behalf a system is in place to record transactions and accounts for spending. However we noted that residents monies in temporary safekeeping were held in a pooled account. We were told that the homes administrator drew up list of people with money and gave names, though no details of balances, to hairdresser, so that she could offer to do their hair. This raised the issue, that people without money may not receive the services of the hairdresser and may not able to spend their person allowance as they wished. We also noted that the hairdresser provided a list of names and amounts on a communal receipt to be reimbursed. A similar process was in place for the private chiropody service. It was positive to note that there were individual receipts provided by key workers who purchased items on residents behalf. We discussed these issues with the registered manager and agreed to seek advice from the CSCI PRM allocated to Southern Cross Services in the Midlands. We received a written response confirming National discussions had taken place between the organisation and CSCI. The following information was shared, Southern Cross are introducing an IT banking system called integrated funds solution. It brings together the system used to manage fees etc., with a system that can offer one bank account for service users to choose to use. This account is separate from any business accounts of the company and allows for individual named sub accounts for services users. Each service user accrues interest on their individual amount at the given rate for the account. The CSCI head of finance, and PRM attended presentations on this system sometime ago and have offered advice with regards to regulation and NMS only. CSCI would not endorse a commercial product. The system is accessible from the care service with security measures built in; we were told that there is a comprehensive auditing and reconciliation system operated from the system operator and the company. The system does not replace the need for records, receipts and signatures to be held in the care service to justify account activity and service user spending. We would also expect to see that residents using this have chosen to do so with full information and have agreed to its terms and conditions (on file) and that that decision is reviewed regularly. We have included this information in the report for guidance. We discussed an issue raised by the Sandwell MBC contracts officer relating to the shop operated for residents benefit within the home with the registered manager during this inspection visit. We had indicated at the previous inspection that this had positive benefits in that it allowed people who would not normally be able to choose from a selection of goods to make their own preferred purchases. We have reiterated that as long as the stocking, management and accounts were transparent and there was independent auditing and scrutiny we did not believe this presented conflicts and
Care Homes for Older People Page 31 of 35 Evidence: provided a valuable service. We looked at a sample of heath and safety, fire safety and maintenance documentation, which was satisfactory and very well organised. There was ample 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 had 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 had been 187 recorded accidents, including incidents involving people living at the home in the past 12 months. The registered manager had an effective system for auditing, analysing and evaluating accidents involving residents, with effective measures implemented. Care Homes for Older People Page 32 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 35 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 1 It is recommended that information about the range of fees should be included in the service user guide to give people comprehensive information about the service to help them make decisions about the choice of home. It was recommended that the pharmacy provider be contacted and requested to print the full instructions for the administration of any medication, which has to be given in accordance with special instructions, such as Risedronate Sodium 35 mg as a weekly administration. 2 9 Care Homes for Older People Page 34 of 35 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 35 of 35 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
