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Inspection on 09/12/05 for The Gables Nursing Home

Also see our care home review for The Gables Nursing Home for more information

This inspection was carried out on 9th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents and staff continue to be well supported by Mrs Barrington and the Providers; there is a nice homely and friendly atmosphere in the home. A good standard of cleanliness is maintained throughout the home. Staff were seen to work hard to meet the needs of the residents in a caring and friendly manner and residents and relatives were positive about the home and the way the staff care for residents. The chef provides well-balanced and nutritious meals which residents were complimentary about. The Registered manager and the Providers are committed to improving services and staff support, training and development and training records are kept up to date. The communal areas of the home and some of the resident`s rooms were nicely decorated for Christmas.

What has improved since the last inspection?

The home underwent an audit for Investors in People and has only one minor amendment to make to achieve this. The home will be re assessed towards the end of December. The home has also been awarded a contract as being a suitable placement for training overseas nursing staff on adaptation training.

What the care home could do better:

A nurse does not always visit residents from the home before being admitted. This practice should be reviewed and where practical new residents should be pre assessed before being admitted. This will ensure that residents and their relatives will know that the home will be able to meet their needs. Social care plans and individual activities should be expanded to identify social and cultural needs so that all residents have activities related to their dependency needs.The routines at mealtimes should be reviewed, or a hot trolley be provided to ensure all meals are served hot. (Since the inspection CSCI have been informed that another trolley for keeping meals hot has been ordered).

CARE HOMES FOR OLDER PEOPLE The Gables Nursing Home 56 Ifield Green Crawley West Sussex RH11 0NU Lead Inspector Mrs A Peace Unannounced Inspection 9th December 2005 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Gables Nursing Home Address 56 Ifield Green Crawley West Sussex RH11 0NU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01293 552022 01293 528001 Excel Care Homes Limited Ms Sara-Jane Barrington Care Home 56 Category(ies) of Old age, not falling within any other category registration, with number (56) of places The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th July 2005 Brief Description of the Service: The Gables Care Home is registered to provide personal and nursing care for fifty-six residents in the category of older people. Excel Care Homes Limited privately owns the service and the Responsible Individual on behalf of the company is Mr K Indra. The Registered Manager is Mrs Sara Jane Barrington. The home is located in Ifield Green which is on the outskirts of Crawley. There is a car park to the front of the home. A local shop, post office and pub are close by. Bus services are available close to the home and Crawley town centre and other amenities are approximately 10 minutes drive away. The home consists of a two-storey building, the majority of the residents rooms are situated on the ground floor, those on the first floor are accessible by a passenger lift. Fifty-two of the resident’s rooms are single, twenty-five have en-suite facilities. Two double rooms are available, one of which has an en-suite facility. An enclosed garden is in the centre of the premises; resident’s rooms surround this. A pleasant garden with a lawn, shrubs and flowers is to the front of the premises. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Mrs Ann Peace Regulatory Inspector carried out this unannounced inspection on Friday December 2005. Prior to the inspection all records held on file since the last inspection were reviewed. Mr Indra the Responsible Individual was at the home during the inspection. During the inspection a tour of the home was carried out and the majority of the rooms visited. The home was warm, homely, had a nice atmosphere and Christmas decorations had been put up. Staff were friendly and helpful during the inspection. Records relating to the care of residents and the administration of the home, including a number of staff records were examined. A case tracking exercise for a number of residents with pressure sores or wounds was carried out. New residents records were also seen. Information was seen from their records since pre-admission and tracked to care being given, the continuity of that care and any equipment used. This Inspector concluded that care was being given appropriately and that aids and equipment was being supplied when necessary. The inspector was satisfied that once residents are admitted then the information in the records is adequate to identify the majority of their needs, although information collated pre admission is lacking. One relative was spoken to during the inspection and was complimentary about the home and the staff. Sixteen residents were spoken with and all were complimentary about the home and the staff, there was only one complaint from them regarding the temperature of the meals served and this was discussed with the providers at the conclusion of the inspection, who said action would be taken to address. The conclusion of the Inspector was that a good standard of care continues to be provided at The Gables from a caring and committed team. No immediate requirements were made so a feedback form was not left at the home following the inspection. Any matters arising from the inspection were discussed with The Providers following the inspection. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 6 Where the situation in the home is unchanged from previously the report will remain the same. What the service does well: What has improved since the last inspection? What they could do better: A nurse does not always visit residents from the home before being admitted. This practice should be reviewed and where practical new residents should be pre assessed before being admitted. This will ensure that residents and their relatives will know that the home will be able to meet their needs. Social care plans and individual activities should be expanded to identify social and cultural needs so that all residents have activities related to their dependency needs. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 7 The routines at mealtimes should be reviewed, or a hot trolley be provided to ensure all meals are served hot. (Since the inspection CSCI have been informed that another trolley for keeping meals hot has been ordered). 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 Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 The home does not have a thorough pre assessment procedure for residents admitted from hospital. However once admitted the homes assessment procedure is mainly satisfactory, residents are told they can visit on a trial basis to ensure the home will meet their needs. Not all prospective residents or their relatives were given written information about the home. EVIDENCE: The Statement of Purpose and Service User Guide for the home is available, however relatives and residents told the inspector that they had been invited to visit the home but not been given any written information about what the home offers. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 10 Residents admitted from hospital are still not always assessed before admission to the home. Those pre assessments that were in the files were not comprehensive. Mrs Barrington does ask for all relevant information before deciding if the home would be able to meet the resident’s needs and at the last inspection said she was confident that this arrangement was satisfactory. Evidence from the case tracking exercise indicated that an assessment is undertaken when residents are admitted and any risk assessments carried out. However there is still not enough attention paid to completing a social assessment and recording previous life styles/habits. A number of residents still did not have a contract in their file. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10, Residents are cared for at The Gables to a good standard and are respected and treated kindly by the staff. Social care needs are not set out in a plan. EVIDENCE: Mrs Barrington has the overall responsibility for the care of residents. Since being employed at the home she has built up a good team who support her and she is now able to delegate certain responsibilities to other qualified nurses. Care plans and risk assessments are clear and contain the personal and health care information staff need to care for the residents. Daily records of care are kept to ensure all needs are met on a daily basis and plans are regularly updated and show the changing needs of residents. A number of care record forms have been introduced to ensure staff are accountable for their care they give and that residents are monitored on a regular basis. One resident said that night staff do rounds three times during the night to make residents comfortable which was appreciated. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 12 Staff were noted to care for residents in a respectful, caring and sensitive manner. Since the last inspection Mrs Barrington has been on leave from the home so the recommendations from the last inspection relating to social care plans have not been addressed. Social care plans should now be expanded to identify social and leisure needs for all residents and how the staff will meet those needs on a collective or individual basis. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 The home provides a lifestyle that respects the privacy and dignity of residents. The home operates an open door policy for family and friends if residents choose. Meals served are varied, nutritious and well balanced. Social care plans are not comprehensive. EVIDENCE: A number of residents do choose to stay in their rooms for the majority of the time; others use the large open plan lounge or a smaller conservatory. One member of staff who does have another role at the home does a very good job in undertaking activities with residents on a regular basis and is due to attend a course relating to provision of activities. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 14 However individual activities for those residents who do not like collective activities or who cannot take part are lacking. The Registered Providers should review the allocation of time and staff for activities. Locks are not routinely provided on bedroom doors but residents have been told they can have one fitted if they wish and at the last inspection Mrs Barrington had a list of residents to show they had all been asked. Residents who could offer an opinion were complimentary about the food served, however a number of them in one part of the home said that food is often left standing while staff are busy feeding residents and so the meals are cold when they are served. Meals are delivered to the other part of the home in a hot trolley and those residents had no complaints. This was discussed with the providers who have now informed the Commission that they have ordered another trolley. Staff were noted to help residents who needed feeding in a sensitive and appropriate manner. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 The clear complaint procedure enables those using the service or their representatives to have confidence that their complaint will be responded to within 28 days. The home operates the West Sussex Adult Protection Guidelines and staff have been trained to recognise abuse. EVIDENCE: There is a clear complaint procedure available. The Commission has received one complaint since the last inspection; this has been passed to the home to investigate in the first instance. Records indicated that 17 of the staff had recently attended training in adult protection. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,23,24,25,26 Residents live in a safe, clean, well-maintained and comfortable environment with aids and equipment to meet identified needs. EVIDENCE: The home was clean and fresh with no unpleasant odours detected during the inspection. All areas are decorated and furnished in a homely fashion and since the last inspection the nurse’s station has been moved out of the lounge into the dining room and a comfortable sitting area near bookcases has been arranged. Although the nurses area is now in a better position than previously there is still the risk that confidential information is not secure. The registered providers are reminded that security must be addressed. Resident’s rooms are comfortable and meet the needs of the residents. Residents and their relatives have been encouraged to personalise their rooms The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 17 to make them more homely and a great number of them has Christmas decorations in them. Call bells were available for residents to summon staff if needed and bells were noted to be answered promptly by staff. There is a pleasant garden to the front of the home and an enclosed garden laid to lawn in the central area of the home. The rooms on the upper floor can be accessed by a passenger lift. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 There is sufficient staff to meet the needs of the residents and the majority of staff have received training related to residents needs and health and safety requirements. EVIDENCE: Duty rotas were available and indicated that staff are employed with the appropriate skill mix to meet the needs of residents over the 24-hour period. Trained nurses and care staff work in two teams one at each end of the home to ensure all areas of the home are covered by staff at all times. Residents were complimentary about all of the staff in the home. The Gables is committed to training and development and numerous training sessions were recorded in the nursing office. The Gables has recently been recognised as a suitable training establishment for overseas nurses undertaking adaptation courses through Buckingham and Chilterns University College. The home will meet the practical aspect of the course and oversee the theoretical learning. Students are due to start in December 2005; this does mean that the home will audited at regular intervals by the college. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 19 The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,36,37,38 The home is well managed and run in the best interests of the residents. Residents are protected by the environmental, health and safety practices of the home. EVIDENCE: Mrs Sara-Jane Barrington is the Registered Manager and under her leadership the home runs well and the staff are supported to carry out their work. The staff at The Gables said they feel well supported by the manager and providers who are always available and approachable. Staff training in health and safety issues is provided and records are available. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 21 Staff recorded accidents and any follow up action recorded. Improvements have been made to protect residents in the event of a fire and fire safety checks on equipment and training for staff has been provided. Monthly Regulation 26 reports on the conduct of the care home have not been received by the Commission and this has been made a requirement. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 22 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 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 x 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 x x x 3 3 3 The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? No 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 2 Standard OP3 OP32 Regulation 14 26 Requirement The registered providers should ensure Regulation 26 reports are sent to CSCI on a regular basis. New residents are admitted on the basis of a full assessment undertaken by people trained to do so. Timescale for action 31/12/05 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard 12 37 Good Practice Recommendations It is recommended social care plans are completed and consider increasing the allocation of time and staff to meet the identified individual social care needs. Confidential records should be kept secure. The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Gables Nursing Home DS0000024225.V270277.R01.S.doc Version 5.0 Page 25 - 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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