Inspection on 30/01/08 for The Gables Residential Care Centre

This inspection was carried out on 30th January 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Honeybourne House

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

CARE HOME ADULTS 18-65 The Gables Residential Care Centre Oak Lodge Close Bristol Road Chippenham Wiltshire SN15 1NG Lead Inspector Sally Walker Unannounced Inspection 30 January 2008 10:10 th The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 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 Residential Care Centre DS0000070439.V355125.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 Adults 18-65. 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 Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Residential Care Centre Address Oak Lodge Close Bristol Road Chippenham Wiltshire SN15 1NG 01249 658498 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) Ashgables House Ltd Mrs Rosie Pretorius Care Home 26 Category(ies) of Learning disability (26), Mental disorder, registration, with number excluding learning disability or dementia (26) of places The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Mental disorder (Code MD) The maximum number of service users who may be accommodated is 26. New Service Provider 2. Date of last inspection Brief Description of the Service: The Gables was registered to Ashgables House Limited in August 2007. Mrs Rosie Pretorius is the registered manager. This is the first inspection under the new owners and manager. The service comprises of two houses each with its own separate facilities. The home is registered to provide care to 26 people who may have a mental health problem or learning difficulty. All the bedrooms are single accommodation. Minimum staffing levels are three care staff in each house during the day, with 2 staff in the evenings. At night there are two waking night staff in each house. Details of the weekly fees can be obtained directly from the home. The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place on 30th January 2008 between 10.10am and 7.25pm. Mrs Pretorius was present during the inspection. We spoke with 4 residents and 3 staff. We examined the care plans and daily reports, the arrangements for medication administration, risk assessments, menus and staff personnel files. As part of the inspection process we sent survey forms to the home for residents, relatives, staff and healthcare professionals to tell us about the service. Comments can be found in the relevant section of this report. We also asked Mrs Pretorius to complete an Annual Quality Assurance Assessment. This was received on time and filled out in full. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Thorough pre-admission assessments are carried out with people considering The Gables as their home. People have the opportunity to stay at the home to see if it is suitable for their needs. Care plans direct the care with good detail on all aspects of individual’s care and support needs and how they are to be met and monitored. Regular reviews are carried out with residents and others involved in their care programme. People are encouraged to make decisions and choices about their lives. Risk assessment does not restrict residents from experiencing new and different opportunities. Care managers and healthcare professionals are invited to contribute to care planning and review. Residents have their own money to spend as they wish. They are encouraged to save. College courses encourage residents to familiarise themselves with money management. Residents are very pleased with this development. Residents have access to local advocacy services. Residents are encouraged to maintain links with family. The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 6 Residents have good and improving access to the facilities in the locality. An activities co-ordinator provides a range of relevant leisure and educational activities. Residents have the choice of a range of varied meals produced from fresh ingredients. Residents have good access to healthcare professionals. Systems are in place for safe administration of medication. Systems are in place so that people can raise concerns about the service and have them considered. Staff have been trained in the local safeguarding vulnerable adults referral procedure. Plans to improve and modernise the environment are underway. Residents are not restricted by their environment. Staff have access to relevant training. Further training needs have been identified and courses arranged. Staff are well supported by Mrs Pretorius. All staff are supervised and regular staff meetings are held. What has improved since the last inspection? What they could do better: 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 Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Thorough pre-admission assessments are carried out with prospective residents. Information is gained from all those involved in the person’s care programme. People can spend time at the home so that they can see whether it meets their needs and expectations. EVIDENCE: Mrs Pretorius had carried out thorough pre-admission assessments with recently admitted people. Information is gained from the resident, any previous placements, healthcare professionals and care managers. People are encouraged to visit the home to meet with the residents and staff and ask questions as part of the admission process. The process includes an over night stay. The home does not take emergency admissions. Comments in residents survey forms included: “I visited The Gables in 2001 & decided I would be happy here. I have lived here since then. I was shown the UNIT garden activity room made up my mind I’d like to live here.” “The home is further away from my family and friends so did not really wish to live here. I would have liked to stay where I was.” The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New care plans show all aspects of residents care and support needs and how they are to be met. Significant efforts have been made to include residents and staff in the care planning process. Residents have been given more choice and are being encouraged to make more decisions about their lives. Risk assessment does not restrict residents from experiencing new and different opportunities in the locality. EVIDENCE: Mrs Pretorius had reviewed all of the residents and developed new care plans setting out their current person centred care needs. Staff were now more involved in reviewing and revising care plans as needs changed. Residents’ files showed good information on their social and medical history. There was evidence of how residents were supported to make decisions about their lives. The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 10 Care plans set out guidance on supporting residents with all aspects of their lives including, preferred routines for personal care, communication, healthcare, benefits and finance, going out alone and personal safety, behaviour management, self harm, mental well being, choice and decision making and activities of daily living. It was clear from the records that male residents had responded well to their intimate personal care being given by male staff. Daily reports showed good detail in relation to the guidance in care plans. The care plans direct the care. Mrs Pretorius had written to care managers who had not reviewed their clients for some time, inviting them to consider the new care plans she had developed. We noted that some files were being kept under the kitchen table in one of the houses. We advised that they must be kept securely. We also noted that some personal details about residents were being recorded in the staff handover and communication book. We advised that this information must only be recorded in residents’ individual files. Mrs Pretorius was supporting people to be more independent. She told us that residents had not had access to their own money in the past. Residents were encouraged to open their own named bank accounts and to save. Residents have access to a local advocacy service. The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Considerable efforts have been made to support residents with experiencing new opportunities for personal development and leisure. People have benefited from going out into the locality and using local facilities. People are encouraged to maintain links with family. Efforts have been made to promote people’s independence. More choice and fresh ingredients are offered in the menus. EVIDENCE: Mrs Pretorius had reviewed each resident’s activity programme with them. Activities are now more relevant to individual preferences. Residents have significantly improved access to the locality. One resident is attending college on a computer course. Other residents were doing numeracy, literacy and cookery at the local college. Another resident went to a day service. The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 12 Residents either went out alone or with staff support depending on need. Mrs Pretorius told us of her plans to empower residents and support them with this different lifestyle. A full time activities co-ordinator had been appointed from one of the other services in the company. All of those residents spoken with told us how pleased they were to go out and about. One resident talked about going out for a meal. Another said they went out to a café. Some of the residents told us about their enjoyment of going out and spending their own money. One resident showed us the new clothes and shoes they had bought. Other activities included: arts and crafts, swimming, a Halloween party and trips to the theatre in Bath, bowling and to a butterfly park. The activities coordinator told us that they arranged “girls nights out” and “boys nights out”. These were regularly arranged according to what residents wanted to do. The female residents had recently been to bingo and the male residents had been to the pub. There were also more structured educational activities; for example, numeracy and literacy. There is separate accommodation for activities. The co-ordinator has developed care plans and carried out risk assessments for each resident’s activity programme. There are also plans to access the local Gateway Club, MIND services and an aromatherapist. The coordinator showed us some of the many resources used for activities. Staff were playing dominoes with some residents and supporting a resident with knitting in one of the houses. The home has its own minibus. Some of the residents are now involved in light domestic duties. Residents are encouraged to have more regular contact with families. Arrangements can be made to take residents to visit their families. We spoke to the chef in one of the houses and the member of staff cooking in the other house. The cook told us about the improvements in the menus. Each house had a different 3 weekly menu. The lunch in one of the houses was cottage pie or sausages and the other was liver and onions or lasagne. Residents have contributed to the menus. Residents have a choice at breakfast and evening meal. The chef said that as well as cereals and toast, porridge and a boiled egg were available. On a Tuesday and Friday bacon and egg were available. Meals are prepared from fresh ingredients and all meals are ‘home cooked’. One of the residents told us that they preferred to stay in their bedroom and had all their meals brought to them. They explained how their special diet was catered for. Seven of the residents had their lunch in their bedrooms. Those residents following a special diet had their own menus, which they discussed with the chef. The chef was undertaking a catering course at college and had NVQ Level 2. Residents were able to make a drink, help themselves to fruit and prepare a sandwich in the kitchens at any time during the day. The chef showed us the food stores. The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 13 There was plenty of fresh fruit, ingredients for making a snack and chocolates and sweets. Staff now eat with the residents. Comments from residents survey forms included: “I go to the activity room every day.” “There is not enough to do each day.” “It is a very good place to live. We have lots of outings with the staff.” “The food could be better.” Comments from relatives survey forms included: “[Kept up to date with important issues?] This has not arisen so far. My [relative] receives the support [they] need. [Does well?] Most things as far as I am aware.” “They look after them well. My [relative] seem quite happy there. I can’t think of anything to improve it at the moment.” The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are consulted about personal care support preferences. Resident’s health and personal care needs are being met. Residents are protected by the home’s procedures for the safe handling of medicines. However guidelines for medicines which are not used regularly must be improved. EVIDENCE: Care plans set out individual healthcare programmes. Any concerns were promptly referred to relevant healthcare professionals. Mrs Pretorius had reestablished links with health and social care managers involved in residents care programmes. The community psychiatric nurse had reviewed residents and behaviour management guidelines were now in place. The consultant psychiatrist had visited residents to review their care and support needs. One of the residents told us how staff were aware of their visual impairment. They had different equipment including a hand bell to call staff. They said they would walk to the door if staff did not hear them ring. The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 15 Mrs Pretorius told us that she had contacted a local association for people with visual impairment so that more opportunities could be made available for residents with visual impairment. The resident’s care plan gave details of supporting the resident with daily living. One of the residents told us that staff monitored their blood glucose levels. Mrs Pretorius had referred people with diabetes to the diabetic nurse and dietician for a review of their care. Only staff trained by the district nurse test blood glucose levels. Care plans showed details of parameters of blood glucose levels for the well being of residents with diabetes. Food supplement drinks were prescribed where necessary. Our Pharmacist Inspector looked at arrangements for the handling of medicines. We looked at the records and medicines kept in the home and had discussions with the manager and staff. We also saw medicines being given out at lunchtime in one of the units. Medicines were stored in two secure areas, however the controlled drug cupboards do not comply with recent legislation. Printed medication administration records were used. Written additions to these charts were signed, checked and cross-referenced with information from the prescriber. Records are kept of all medicines received into the home and returned for disposal. Staff giving medicines have had training and a policy and procedure is available for them to follow. They were seen to follow this correctly and deal sensitively with residents. All blood tests and treatments from other healthcare professionals are recorded. Some medication prescribed ‘as required’ do not have clear guidelines for care staff to follow in the event that they are needed. The recording of the use of creams and lotions was not always clear. Some people are prescribed emergency treatment which can only be given after staff have received training. This had not been used for some time, but the manager was not aware if staff were able to administer it. Comments from healthcare professional survey forms included: “[Act on and seek advice?] This is not consistent. However to be fair we don’t have many service users with LD from North Wilts. [Are health care needs met?] New providers are making good progress in this area. New providers are providing a more concerted effort through training and improvements in professional approach to service users. [Support to live the life they choose?] From what I’ve seen, yes. [Staff have right skills and experience?] Very energetic in this area. I have provided 4 episodes of training to this organisation. [Respond appropriately when concerns raised?] New owners will do this. [Does well?] Not enough information an interface at this time to judge. [Can improve?] The property needs to be modernised.” “Very recent change of management. Rather early to assess new team yet but, so far been very good.” The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place so that people can complain about the service. Residents have benefited from staff’s better awareness of procedures for reporting allegations of abuse. EVIDENCE: The home follows the company’s complaints procedure. We asked people about making complaints. One resident said they would talk to their keyworker or Mrs Pretorius. Another resident told us about a form for complaints that they would give to Mrs Pretorius. There was a complaints and suggestions book for recording outcomes of investigations and response to complainants. Mrs Pretorius was familiar with the local Safeguarding Adults procedure. She had identified that staff needed to train in the local procedure. A programme of training was already in place. Details of contact numbers had been posted on all the notice boards so that staff could make referrals at any time. Staff had been trained in recognising all forms of abuse. Residents are being supported to manage their own benefits and to save. Comments from residents survey forms included: “Since the Gables have been taken over there’s not been a time when I could talk to those in charge. If I make a complaint I am afraid I will be asked to leave.” The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Significant efforts are being made to improve the quality of the environment for people. Plans are in place for further modernisation and improvements. Residents are no longer restricted in their environment. The home is cleaned to a good standard and staff are trained in infection control. The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 18 EVIDENCE: There are large gates to the front of the building so we had to ring and wait to gain entrance. Some of the residents who go out have the number to unlock the gates. Mrs Pretorius told us she was gradually integrating the two houses which had operated as separate units in the past. Mrs Pretorius plans to upgrade the physical environment for people. Estimates had been sought to carry out works to modernise the environment and make it more comfortable for people. Bedrooms were becoming more personalised as residents chose new bedding, towels and curtains. New seating was being purchased together with more modern pictures to hang on the walls. Floor coverings were to be replaced. Commodes were gradually being discarded as the toilets are now unlocked when not in use. A maintenance person has been employed. The hot water supply to the baths had been fitted with thermostatic control valves. We advised that an audit of the bathrooms and toilets is carried out so ensure that locks are provided for privacy. Radiators in residents’ bedrooms were gradually having guards fitted to ensure low surface temperatures. The laundry was a separate building. Arrangements were in place for disposal of clinical waste and laundering soiled items. Comments from residents survey forms included: “Lovely and clean.” “The cleaning is of a very high standard is cleaned top to bottom everyday.” “I clean my own room but with help. Some times laundry goes missing and some times the ironing is not done.” “The home is kept immaculate.” The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels enable residents to be supported in the way that they wish. Staff roles have been changed giving them more responsibility in care planning. Staff have access to relevant training. Teambuilding is ensuring that staff work better as a team. A robust recruitment process is in place. All staff are regularly supervised. EVIDENCE: The staffing rotas showed a minimum of at least three care staff in each house during the day, with 2 staff in the evenings. At night there are two waking night staff in each house. Mrs Pretorius had introduced a keyworker for each resident. She had also introduced team leaders to lead the shifts. She told us about the staff development programme she had introduced. Mrs Pretorius is a qualified mental health nurse and has a teaching degree. She is carrying out some of the staff training. The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 20 One of the courses was on health education; sexual health and emotions. Other recent training has included colostomy care, diabetes, health and safety, epilepsy, mental health, complaints and safeguarding vulnerable people. Regular staff supervision has been set up for all staff. Mrs Pretorius had carried out some team building training with staff. Male staff have been employed so that male residents are better supported. They have one to one time and go out to lunch. We advised that a gender working policy should be implemented. This should set out how residents make decisions about any intimate personal care being provided by staff of a different gender. Any decisions must be recorded in residents care plans. Mrs Pretorius told us that she had discussed the issues with male staff and would produce an interim policy for the home. One of the residents told us that staff were “lovely, they are kind to me”. One of the staff told us they were very happy and felt more relaxed. They said they were learning more and were very well supported by Mrs Pretorius. They told us they had undertaken training in care planning and risk assessment. Another staff member told us they preferred the extra responsibilities they had as keyworkers in writing care plans and risk assessments. They told us about the staff meetings that were currently held twice a month. They said they had regular supervision and could bring their own agenda. Mrs Pretorius had produced a training matrix to identify individual staff’s training needs. Staff had individual files showing training certificates. Recent training included: infection control, moving and handling, first aid, skin care and pressure damage prevention, safeguarding adults and mental health. Mrs Pretorius and her line manager had audited staff personnel files to ensure that all the relevant documents and information were held. No recent photos of staff were on file. There was a robust recruitment process in place with all new staff employed since the company took over. New staff are inducted into their role. We advised to check with the Home Office where staff had transferred from another home in the company and their leave to stay related to that establishment. Comments in residents survey forms included: “[Staff treat you well?] They are always willing to help. We live in a happy environment and would like to keep it that way.” “There is not staff there at all times.” “There is always support from my keyworker.” “The staff treat us with lots of love and [illegible]. The staff and residents are all supportive.” The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mrs Pretorius is clear about how she intends to the home to develop. She has already implemented many changes for the benefit of residents. The home is run in the best interests of residents. Residents’ health and safety and welfare is promoted. The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 22 EVIDENCE: Mrs Pretorius was registered as manager in August 2007. She is a registered nurse, mental health. She has many years experience of working with younger people in different care settings. Mrs Pretorius told us she was undertaking the Registered Managers Award. Mrs Pretorius meets with managers from the company every Monday. An administrator has been employed. Mrs Pretorius told us that residents can come to the office at any time to discuss issues. When Mrs Pretorius first took over the running of the home, she invited parents and relatives to a social event as an introduction to the new company and herself as the new manager. As part of the home’s quality monitoring system, a relatives and parents forum has now been set up. It has been agreed that these meetings will take place every four months. Mrs Pretorius sent out questionnaires to relatives and parents in December 2007 to seek their views on the service. She was in the process of collating the responses in order to produce an action plan. Residents can keep small amounts of cash in the home’s safe. Records and receipts are kept of all transactions. The arrangements are regularly audited. The rota provided for a fire marshall to be on duty every day. The home’s fire risk assessments have been made available to staff. The environmental risk assessments were carried out in December 2007. Generic risk assessments were in place regarding tasks completed by staff. Risk assessments had also been carried out with regard to residents accessing different venues in the activities programme. The Gables Residential Care Centre DS0000070439.V355125.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 Adults 18-65 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 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X The Gables Residential Care Centre DS0000070439.V355125.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 YA20 Regulation 13(2) Requirement The person registered must ensure that all controlled drugs must be stored in a cupboard that meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. The person registered must ensure that all medicines prescribed ‘as required’ must have clear guidelines for their use which are accessible to all care staff. The person registered must ensure that the use of all creams and lotions must be recorded The person registered must ensure that medicines which require special techniques for administration must not be used until staff have received the correct training. The person registered must ensure that all documents relating to residents are securely kept. Staff must not write DS0000070439.V355125.R01.S.doc Timescale for action 30/04/08 2 YA20 13(2) 28/03/08 3 YA20 13(2) 28/03/08 4 YA20 13(2) 14/03/08 5 YA41 17(1)(b) 30/01/08 The Gables Residential Care Centre Version 5.2 Page 25 6 YA18 12(2) personal details about residents in the communication or handover books. The person registered must ensure that a gender working policy is implemented to ensure that residents are consulted and make decisions about intimate care provision by staff of a different gender. Decisions should be recorded in care plans 01/03/08 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 YA34 Good Practice Recommendations Home office guidance should be followed with regard to employing staff who are given leave to work specifically at the home. The Gables Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Residential Care Centre DS0000070439.V355125.R01.S.doc Version 5.2 Page 27 - 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!