Inspection on 01/06/06 for The Gables Residential Care Home

This inspection was carried out on 1st June 2006.

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

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

Other inspections for this house

The Gables Residential Care Home 08/12/08

The Gables Residential Care Home 23/04/08

The Gables Residential Care Home 06/11/07

The Gables Residential Care Home 01/05/07

The Gables Residential Care Home 19/12/06

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

CARE HOMES FOR OLDER PEOPLE The Gables Residential Care Home Thrush Drive, Huntley Mount Road Bury Lancs BL9 6JO Lead Inspector Stuart Horrocks Key Unannounced Inspection 1st June 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Residential Care Home Address Thrush Drive, Huntley Mount Road Bury Lancs BL9 6JO 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) 0161 764 6593 Mr Ghennessen Pumbien Mrs Radha Rajcoomaree Pumbien Mrs Roma Bennett Care Home 14 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (13) of places The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 14 service users, to include: Up to 13 service users in the category of (OP) Older People; Up to 1 service user in the category DE (Dementia) under 65 years of age. The service should employ a suitably experienced and qualified manager who is registered with the Commission for Social Care Inspection. 2. Date of last inspection Brief Description of the Service: The Gables is a privately owned care home providing care and accommodation for up to 14 older people. The home is situated in a residential area of Bury approximately 1 mile from the town centre. There are bus routes, shops, and other community facilities close by. The home is on two floors and it has 6 single and 4-shared bedrooms. None of the bedrooms have en-suite facilities There is one large comfortable lounge and a separate dining room. There is a garden and limited car parking at the front of the home. A brochure describing the home’s services is available and the provider gives other information about the home to new and prospective residents and their families verbally. As of June 2006 the weekly charge for accommodation and services is £339.00 with an additional charge being made for hairdressing. The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was started at 9.30am on the 1st June 2006.It took place over two days and it lasted for about twelve hours. The time was split between talking to the Registered Manager and both of the owners and checking records, looking around the home, watching what was happening and talking to residents, a relative and other staff. Four residents, one relative and four staff were spoken with. The home was registered to new owners (Mr & Mrs Pumbien) in December 2005 with the previous owner (Mrs Bennett) now running the home on a dayto-day basis as the Registered Manager. This was therefore the first full inspection of the home since the change of ownership. The care services (case tracking) provided to three specific residents were used a basis for the process of the inspection. What the service does well: What has improved since the last inspection? What they could do better: The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 6 The home’s Statement of purpose and the Service User Guide need to be improved so that prospective residents and their families are provided with sufficient information to enable them to decide whether the home can meet their care needs. The initial assessment process needs to be made more reliable so that all parties, including potential residents and their relatives, can be sure that their needs will be assessed and therefore met. The home must improve the residents care planning and risk assessment paperwork so making sure that the staff have the up to date information they need to meet the residents needs. The residents must be told about the home’s complaints procedure so making sure that concerns are speedily dealt with. Evening and night-time staffing levels need to be checked to make sure that enough staff are on duty at this time to see to the residents needs. Recruitment needs to be made better to make sure that all of the required checks are done before new staff start work, therefore making sure of the safety and protection of the residents. The training for staff, including that for new staff, which shows them how to do the work, should be made better. Management processes need to be made better so that the home will be both better run and the staff will know whom they are responsible to. The way that the residents are asked about their opinions as to how well the home looks after them needs to be brought in to use. This should also be used with the resident’s families and with other people such as their doctor or social worker. The accounting system needs to be improved therefore ensuring that both the residents and staff interests are protected. A small number of health and safety issues are in need of attention. 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 Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 7 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 Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 8 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 and 3. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. People who use this service do not have sufficient information about the home in order to make an informed decision about whether the service is right for them. The lack of a personalised needs assessment is some instances means that people’s diverse needs are not always identified and planned for before they move in to the home. The home does not provide intermediate (rehabilitative) care so this Standard (6) does not apply. EVIDENCE: The home has a Statement of Purpose but this document does not contain all of the information required by the Standards or the Regulations and therefore needs to be rewritten. Advice and written information regarding this was given to the manager at the time of the inspection. The home also has a satisfactory Service User Guide (Residents Information Guide) although details of the new owners need to be added and a full copy of the home’s complaints procedure needs to be included with this document. The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 9 None of the residents spoken with was aware of the above informative documents and none were found to have been provided in the resident’s bedrooms although one set was seen to be present in a residents care file. A leaflet style brochure is available that provides useful information for prospective residents and their relatives. The care files of the three case tracked residents plus four others were checked for the required pre-admission needs assessment information. Five of these were found to contain community care assessments although one of these was not up to date having been transferred from a previous care home. The other two files did not contain any pre-admission assessment information and there was only limited evidence of in-house needs assessment having been undertaken. The manager must make sure that before a resident is admitted that sufficient information is available to enable the home to make a decision as to whether the home can meet the resident’s care needs. The manager said that new residents and their families are welcome to visit the home where they can spend some time, meet the residents and the staff, and have a meal before deciding to live there. This was confirmed in discussion with two of the three residents that were case tracked. All of the above residents had a contract of residence that includes the facility of a trial period of stay at the home. The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 10 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): 7,8,9 and 10. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. Poor practice regarding the planning and delivery of care means that all residents cannot be sure that their health and personal care needs will be fully met. EVIDENCE: The care plans/files of the three case tracked residents and one other were looked at. All of these files contained a care plan although one of these had been transferred from another care home with no Gables care plan having been put together. These care plans were inadequate and poorly written, they did not properly describe what the residents care needs were, how these needs will be dealt with and what the preferred outcome (goal) was. None of these care plans had been reviewed or updated at the required monthly intervals with none having been reviewed during 2006. Two of the above files showed regular proffessional health care input whilst the others had no entries. Four of the residents living at the home have identified mental health needs with the inspector being told that these needs are The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 11 regularly monitored by a consultant psychiatrist and community psychiatic nurses, these interventions must be regularly recorded. Only one of the above files contained any risk assessment information but this was out of date. The inspector therefore checked three other files for the quality of the risk assessment information provided. These were found to contain nutritional and safe manual handling assessment but all were out of date. Following the change of ownership of the home the residents care files had been moved from the ground floor of the home to a first floor office with the result that the care plans were less readily accesible to the care staff. The care staff commented upon this feeling that this may in part have led to the failure to review care plans regularly. The home now intends to make these care plans more avilable to the staff and to introduce a supportive key worker system. In essence the care delivery/recording documentation is something of a mixed bag. “In-House” care plans must be in place for all residents and these must be regularly reviewed at the required monthly intervals, proffesional health care interventions must always be recorded and risk assessments must be put in place for pressure sores, nutrition and safe manual handling; these risk assessments must be regularly reviewed and updated. Written information and advice regarding the above risk assessments and a suggested care planning system was provided by the inspector at the time of this visit. The medications are provided in weekly pre-packed cassettes with pre-printed administration records also provided that were found to be up to date. The medications supplied are not checked in to the home and those medicines retuned to the pharmacy were also not recorded. Medicines are stored in a locked trolley but this is not tethered to a secure point. The home does not have the required storage for the safe keeping of Controlled Drugs although none appeared to be in use at the time of this inspection. A Contrlolled Drug register is available. The medicine trolley was found to contain a number of out of use medicines and some strips of unidentified drugs; these must be returned to the pharmacy. Those staff that give out medicines have been given the necessary training for this task. There is an adequate medication administration policy and procedure but this does not include a self-administration or a homely remedies policy and procedure. No resident was dealing with their own medicines at the time of the inspection. The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 12 Records looked at emphasised the need for the residents privacy and dignity to be respected at all times, and the staff gave examples of how the residents privacy and dignity were promoted in the home, such as when giving personal care. Residents said that the staff treat them with respect and that their dignity is valued, for example they said that the staff knocked on their bedroom doors before entering. Those residents spoken with said that the staff were “respectful”, “considerate”, “pleasant” and that “they (the staff) talk to us properly”. The staff were seen to have a good relationship with the residents, speaking to them in a natural, caring and friendly manner. The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 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): 12,13,14 and 15. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The activities offered within the home mean that residents do have some opportunities to participate in stimulating and motivating activities. Residents have choice about their daily routines, and mealtimes are generally satisfactory. EVIDENCE: The home has a seven-day “entertainment” programme with events such as exercises, quizzes, bingo, board games and sing-a-long being described. This programme was not displayed in the home, but this was rectified during the period of the inspection. Those residents that the inspector spoke with were not aware of this programme, but some said that they joined in with recreational activities when they were offered. The staff carry out these activities during the afternoons with current and up to date collective and individual records kept of when residents took part in an activity. The residents social and recreational interest are recorded to a limited extent in their care records and a requirement was made at the time of the last inspection that the “residents must be consulted with about the types of social interests they enjoy or that they might wish to be involved in”. One of the proprietors (Mr Pumbien) said that he had done this but no details appear to have been recorded. This requirement is therefore repeated. Members of the clergy visit the home regularly. The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 14 From talking with residents, a relative and staff the inspector confirmed that the visiting arrangements are flexible with these being described in the home’s brochure. Those residents spoken with said that they “were free to see their visitors wherever they wanted to”. They described taking visitors to their bedrooms for privacy or seeing them in the main lounge. The residents said that visitors are made welcome and the visitor spoken with said that they were regularly offered refreshments. Issues regarding residents choice are described in some detail in the home’s Statement of Purpose and brochure. Discussion with the residents showed that they made choices about when to rise and retire, about the food they ate, where they spent the dayand spent their time and the clothing they wore etc. The staff described how they assisted residents with choices such as choosing clothing and food etc. The staff were seen to treat residents in a dignified,respectful and curteous manner and to deal with them in a friendly and natural way. The home uses a weekly menu that offers a variety of homely and traditional food. This menu provides a single choice but alternatives are readily available and are regularly provided. Warm food is always offered at midday and a warm choice is also usually available at teatime. This is a relatively small home where individual choices are easily catered for. This was confirmed by the residents who said that the food was “good”, “OK”, “enough” and that “there is a choice”. Everyone spoken to praised the food and no complaint was made. A choice of hot and cold drinks and snacks are available throughout the day. The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 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 and 18. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Residents feel safe and listened to. However formal processes need to be further developed so that the home’s procedures are available and understood by all interested parties. EVIDENCE: The home has a satisfactory complaints procedure that states how a complaint is to be made, who to and that an initial response will be provided within two days with a final outcome forwarded within four weeks. The facility of complaining directly to the CSCI is also included in this paperwork. The complaints procedure described above is displayed in the entrance hall of the home although none of the residents or the relative that the inspector spoke was aware of this procedure. All of these people did however say that they would feel comfortable about raising concerns and that if necessary that they would “speak to the staff or Roma” (the manager) if they had any worries. In the nine residents survey questionnaires that were returned two people indicated that they would not know how to complain and one person in the four relatives surveys that were returned also stated that they were not aware of the home’s complaints procedure. It was clear in discussion with staff that they also knew what steps to take should a resident make a complaint. A number of staff said that if “they couldn’t sort things out at the time” then they would inform the manager about the problem. The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 16 The home has a proper record for noting complaints No complaints have been made directly to the home since the last inspection in January 2006 and no complaints have been made to the CSCI during the above period of time. However a complaint that was made and dealt with in November 2005 needs to be entered in the home’s complaint record. There are written procedures and policies covering adult protection, whistle blowing, the none acceptance of gifts, borrowing money and legacies. The inspector and the manager talked about the home obtaining a copy of the local inter-agency adult protection policy, which it was agreed would further support the homes existing policies. Looking at records showed that many staff had been given training in adult protection procedures. In discussion the staff confirmed that they had received such training and they were aware of the different sorts of abuse and they also understood what they should do if they suspected that someone was being abused. The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The Gables care home provides clean, comfortable, homely and friendly surroundings for the people living there. EVIDENCE: The Gables is generally well maintained to both the inside and the outside. Redecoration and replacement of furniture and equipment etc is done on an as required basis. New easy chairs have recently been provided in the lounge and three bedrooms have been re-carpeted Decoration, furnishings and most of the lighting (two ground floor bedrooms have fluorescent lights) are domestic in standard and they are properly presented. The three case tracked resident’s bedrooms and all others were checked. These were found to be generally properly decorated, furnished and equipped The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 18 and those residents spoken with were satisfied with the standard of the accommodation provided. Some residents have brought personal items into the home such as photographs, pictures and ornaments whilst some have brought items of their own furniture. Not all bedroom doors are provided with locks (the inspector was told that a lock would be fitted if so requested by a resident) and most bedrooms are provided with a lockable piece of furniture where residents can keep items safely. There is good accessibility around the building with handrails, an assisted bath and a passenger lift. Aids and adaptation are provided in bedrooms, bathroom and toiltets. There is a well-kept garden area to the front of the home and the inspector understands that the proprietors are considering adding a conservatory to the rear of the property. The home has dealt with the recommendations made by the local fire service and by the environmental health department thus ensuring everyone’s safety. The home was clean and tidy on the day of this inspection with a good standard of hygiene and cleanliness achieved. No malodours were detected. Appropriate laundry equipment is sited in the home’s basement that also contains freezers for the storage of food. Care must be taken in ensuring that cross-infection does not occur. Information regarding the control of infection is available and some staff have had training in this subject Residents clothing is marked to enable easy identification and the residents had no complaints about the laundry service provided by the home. The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. The staff in the home are not always properly recruited and staffing levels needs to be reviewed so ensuring that residents are protected and their care needs met. EVIDENCE: Looking at staff rotas showed that as well as employing care staff, the home also employs domestic (cleaning) and catering but not laundry staff. Some of the staff have worked at the home for a fair amount time, which ensures that residents are cared for by people they know and are familiar with. Staff moral did not appear to be particularly good; this seemed to be due to difficulties within the home’s management structure-see Standard 30. The residents said that the staff are “kind”, “happy to help” and that they were “patient and considerate”. The inspector checked the care staffing rotas for the period 19th May to 15th June 2006. These showed that two care assistants were available throughout the daytime period, with one waking and one “sleep-in” person available overnight. The manager is present from 8am to 5pm Monday to Friday and one of the proprietors is in the home 24hours per day (living in the staff flat on the second floor of the home). The proprietors, the manager and the staff felt that two care staff during the day was sufficient to be the residents’ needs. However taking in to account The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 20 that the care staff have to undertake laundry and some cleaning duties the inspector requires that daytime ancillary staffing levels be reviewed and if necessary increased to ensure that the care staff are able to dedicate their time to providing care to the residents’ rather than to domestic tasks. As mentioned above night-time staff cover is provided by one waking care assistant with one other person (currently often one of the proprietors) providing “sleep-in” support. The inspector questions the suitability of this arrangement particularly in regard to health and safety for both the residents and the staff where lone workers do not have access to immediate support and are they and the residents’ are therefore susceptible to risk. The inspector therefore requires that the adequacy of the home’s night-time care staffing levels be reviewed with consideration given to increasing provision to two waking staff. The home presently accommodates 12 white British residents, eight of these are female and four are male. There is a wholly female staff group,plus the two proprietors who are from Mauritius. The makeup of this staff group does not appear to cause any difficulties. There is a good age and experience mix of staff. Of the 12 care staff employed at the home six have got a National Vocational Qualification in Care at Level 2. This meets the requirement for the home to have 50 of the care staff with NVQ level 2 qualifications or above by the end of 2005. Four staff files, including a recently employed worker were checked for safe and proper recruitment. These did not fully evidence a safe and proper recruitment system. One person was employed without a CRB or POVA First clearance and no references; the other three staff had only one reference instead of the required two. Job application forms had been completed and criminal convictions and health declarations were signed, but in three instances no evidence of identification had been recorded. With regard to staff recruitment the following requirements are made: • CRB checks must be obtained before staff are employed. • Two written references must also be obtained before staff are employed. • The manager is reminded that POVA First clearance should not routinely be used as a substitute for a CRB check. The inspector was told that at times the proprietors’ son is employed as a care worker within the home. This person must not work at the home until they have been fully and properly recruited and they must meet all of the requirements demanded of all care workers. The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 21 Staff training was also checked. No formal training records are kept other than the actual certificates received at the time that given training was provided. Analysis of these certificates showed that a range of training had been provided including the mandatory topics (e.g. health & safety, fire safety, moving & handling and first aid) but that some of this training will need updating soon. Discussion with staff confirmed that they had been provided with the above listed training. The inspector and the home’s manager discussed the way that staff training is presently recorded. The inspector suggested that the development of individual staff training records and a training matrix would assist the manager in seeing what training had been completed, the date it had been done and what other training the staff needed to undertake. The inspector provided examples of such training records. A requirement of Standard 30 is that new staff must be given approved (e.g. the “Skills for Care” organisation) induction and foundation training. The home does have an induction checklist but this is mainly procedural and does not provide inexperienced staff with the required social care induction to the job. Information was provided by the inspector regarding the “Skills for Care” induction process and also of a commercially produced induction programme. The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 22 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): 31,33,35 and 38. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. Unclear management arrangements are negatively impacting upon the needs of the service and quality-monitoring systems need to be introduced. EVIDENCE: The registered manager (Mrs Bennett) was previously the owner/manager of The Gables who has continued to manage the home following the home’s change of ownership late in 2005. Mrs Bennett is therefore well experienced in the care of older people and she is currently in the process of undertaking the required NVQ 4 Registered Mangers Award. As mentioned previously in this report the home’s new owners do spend time regularly in the home when they become involved in some of the decisionmaking and day-to-day work. This may have blurred the lines of management accountability with the staff having become somewhat confused and resentful about this with what appears to be drop in staff moral. The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 23 The inspector therefore strongly recommends that these issues be sorted out, that clear lines of management be established so that the home will be both better run and the staff will know who they are responsible to. A requirement of Standard 33 is that care homes must use quality assurance systems that are largely based on seeking the views of residents to measure their success in meeting the home’s aims and objectives. The home has previously operated such a system but this has now lapsed. A requirement is therefore made that such a quality assurance system must now be reintroduced. The home is reminded that when these questionnaires are returned the answers must be brought together in the form of a report so that both good and not so good comments are highlighted and steps can then be taken to deal with any issues. A requirement of the previous inspection was that the proprietor(s) must undertake “monthly, unannounced audits of the quality of care provided by the home with records kept”. The inspector understands that one such audit has been done; the inspector reminds the proprietors that these audit/visits must be undertaken regularly, monthly. A number of survey questionnaires were sent out to the residents, relatives and health workers (GP’s, district nurses etc) before the inspection. These questionnaires give these people the opportunity to comment upon various aspects of the services provided by a care home. At the time of writing this report 14 questionnaires had been returned; the bulk of these were generally complimentary about the accommodation, the services and the care provided at The Gables. The home safe keeps amounts of money on the behalf of three residents for safekeeping Records of transactions are recorded, but these records need to be improved so that they comprise a full credit and debit account with spending described. a running balance kept and signatures applied. These monies should not be pooled but must be kept as individual amounts. The cash amounts kept all balanced with the existing record. The home has a gift, wills and legacies policy and procedure. The home is generally safely maintained with fire precautions tests done weekly and the details of accidents are properly recorded. Looking at records and maintenance certificates showed that these were up to date apart from that for the home’s electrical wiring circuits which has expired. In order to ensure the safety of the residents the inspector requires that hot water temperatures at baths, showers and in random bedroom are checked and recorded at weekly intervals. The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 24 The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 25 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 1 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 2 X X 2 The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4&5 Timescale for action The registered person must 31/08/06 ensure that a Statement of Purpose and a Service User Guide is produced that comply in content with the Standards and the Regulations and that a copy of these documents are forwarded to the CSCI. The registered person must 31/08/06 ensure that copy of the Service User Guide is made available to prospective and existing residents. The registered person must 07/08/06 ensure that residents care needs are fully assessed before they are admitted to the home. The Registered Person must 07/08/06 ensure that all residents have a care plan formulated. The registered person must 31/08/06 ensure that the residents care plans are written in such a way as to clearly show how identified care needs are to be met The registered person must 07/08/06 ensure that the residents care plans are reviewed and updated at the required monthly DS0000065390.V290575.R01.S.doc Version 5.2 Page 27 Requirement 2 OP1 5 3 OP3 14 5 6 OP7 OP7 15 15 7 OP7 15 The Gables Residential Care Home 8 OP8 15 9 OP8 15 10 OP9 13 11 OP9 13 12 OP9 13 13 OP9 13 14 OP12 16 intervals. 07/08/06 The registered person must ensure that residents risk asessments are in place, which reviewed and updated regularly. The registered person must ensure that professional health care interventions are always recorded in the residents care files. The Registered Person must ensure that when medicines are received and disposed of that this is properly recorded therefore ensuring the safe handling of medicines. The Registered Person must ensure that the required storage for the safe keeping of Controlled Drugs is provided. The Registered Person must ensure that out of use and unidentified medicines are promptly returned to the pharmacy. The Registered Person must ensure that a policy and procedure for self-administration of medicines and homely remedies is developed. The Registered Person must ensure that the residents are consulted with about the types of social interests they enjoy or that they might wish to be involved in. (Previous timescale of 31/03/06 not met) 07/08/06 07/08/06 07/08/06 31/08/06 07/08/06 31/08/06 31/08/06 15 OP16 22 The Registered Person must 31/08/06 ensure that residents and visitors are made aware of the home’s complaints procedure and that a copy of this procedure is included in the Service User Guide (Residents Information Guide) The registered person must 31/08/06 Version 5.2 Page 28 16 OP18 13 The Gables Residential Care Home DS0000065390.V290575.R01.S.doc 17 OP27 18 18 OP27 18 19 OP29 19 20 OP30 18 21 OP33 24 obtain a full copy of the Bury Social Services Adult Protection Policy so that local guidance is followed should an abuse situation arise. The Registered Person must ensure that daytime ancillary staffing levels be reviewed and if necessary increased to ensure that the care staff are able to dedicate their time to providing care to the residents’ rather than to domestic tasks. The Registered Person must ensure that the adequacy of the home’s night-time care staffing levels be reviewed with consideration given to increasing provision to two waking staff. The Registered Person must ensure that all workers are safely and properly recruited with all of the required checks being completed before they are employed. See the body of this report under Standard 29 The Registered Person must ensure that the home puts together a staff training plan, that staff training is properly recorded and that inexperienced staff are provided with social care induction training to the Skills for Care specification The Registered Person must ensure that quality-monitoring systems are reintroduced including the regular use of residents quality assurance surveys with a report of the findings and of any action taken produced and made available. 07/08/06 07/08/06 07/08/06 31/08/06 31/08/06 22 OP35 17 The Registered Person must 31/08/06 ensure that records of residents’ financial transactions are improved so that they comprise a full credit and debit account DS0000065390.V290575.R01.S.doc Version 5.2 Page 29 The Gables Residential Care Home 23 OP38 13 24 OP38 13 with spending described. a running balance kept and signatures applied. The registered person must 07/08/06 arrange for weekly records to be kept to show that water temperatures have been checked at hot outlets. (At baths, showers and in random bedroom) The Registered Person must 31/08/06 ensure that the homes electrical circuits are certified as being safe with a copy of this certification sent to the CSCI. 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 OP30 Good Practice Recommendations The Registered Person should give consideration to the development of a training matrix that can be used to show any gaps in staff training and also to show when training needs to be updated. The inspector strongly recommends that the home’s management issues be clarified, that clear lines of management be established so that the home will be both better run and the staff will know who they are responsible to. 2 OP31 The Gables Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Residential Care Home DS0000065390.V290575.R01.S.doc Version 5.2 Page 31 - 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!