Inspection on 01/05/07 for The Gables Residential Care Home

This inspection was carried out on 1st May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 19/12/06

The Gables Residential Care Home 01/06/06

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 Unannounced Inspection 1st May 2007 09:00 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.V334510.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.V334510.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 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.V334510.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. 19th December 2006 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, a separate dining room and a recently built conservatory that has not yet been brought in to use. There is a garden and limited car parking at the front of the home. A Service User Guide (Residents Information Guide) and a Statement of Purpose describing the home’s services is available on request and the provider gives other information about the home to new and prospective residents and their families verbally. A copy of the latest inspection report is also available on request. As of May 2007 the weekly charge for accommodation and services is £339.00 with an additional charge being made for hairdressing. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which included a site visit that was started at 9.00am on the 1st May 2007. It took place over two days and it lasted for about 15 hours. The time was split between talking to one of the Owners and the acting manager and checking records, looking around the home, watching what was happening and talking to residents, a relative and other staff. Four residents and three staff were spoken with. The Registered Manager’s post was vacant at the time of this visit so the inspection was conducted with the assistance of the acting manager who had come into post on the day before the inspection. Two inspectors were present on the morning of the first day of the inspection with the remainder of the inspection being conducted by one inspector. A provider’s self-assessment survey information document (Annual Quality Assurance Assessment) was sent to the home before the inspection but this had not been returned at the time of writing this report. However satisfaction surveys had been returned by six residents and one relative. The care services (case tracking) provided to two specific residents were used as a basis for the process of the inspection. Concerns about the home were made directly to the CSCI in April 2007. Individual issues arising from these concerns have been examined under the National Minimum Standards outcome groups “Health & Personal Care”, “Daily Life & Social Activities”, “Staffing” and “Management” and they are commented upon in these sections of this report. What the service does well: What has improved since the last inspection? The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 6 Some progress has been made to make sure that the things, which needed improving from the last inspection, have been done. Of the requirements made at the last inspection in December 2006 only a relatively small number have been dealt with. All medicines kept by the home have now been identified as belonging to individual residents, most of the staff have now been provided with training in adult protection topics and the residents’ monies held for safekeeping by the home were now found to balance with the corresponding paperwork. What they could do better: The inspector considers that the apparent failure to address some of the requirements made previously is due to a lack of suitable management of the home as a manager has not been in post since December 2006. The recent recruitment of an acting manager has now provided the opportunity for the home to improve the service and to ensure good standards of care delivery. The home now needs a period of settled and consistent management with the acting manager being supported and encouraged in their role. The initial assessment process must 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 home must make sure that the residents are given their medicines as prescribed and that this is properly written down so ensuring that no mistakes are made. The home must offer sufficient social, cultural and recreational activities to keep the residents interested and stimulated and a menu must be made available to the residents so that they can choose what they wish to eat at all mealtimes. Night time staffing levels must be increased to make sure that the care needs of the residents are met and that the health and safety requirements of the staff are also met. Dedicated catering and domestic cleaning staff must be employed to make sure that the kitchen is properly and hygienically managed and the home is suitably presented. Maintenance and repair work is required to various parts of the home’s equipment and services to make sure that the people living at the home have the usual facilities available for day-to-day living. Recruitment must 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 The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 7 protection of the residents and the training for new staff, which shows them how to do the work, must be made better. The accounting system for residents’ money still needs some improvement to ensure that both the residents and staff interests are protected and a 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 summary of this inspection report can be made available in other formats on request. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 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 Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 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. 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 available evidence including a visit to this service. The lack of a personalised pre-admission needs assessment means that people’s diverse needs are not always identified and planned for before they move in to the home and that therefore the home cannot be sure that it can meet their needs. The home does not provide intermediate (rehabilitative) care so Key Standard 6 does not apply. EVIDENCE: The home has both a Service User Guide (Residents Information Guide) and a Statement of Purpose that provide new and existing residents and their families with information about the services that the home provides. Although both of these documents are generally satisfactory some of the information about the home’s senior staff and the contact details of the CSCI need to be updated. However the acting manager said that she intends to review and fully revise both of these documents shortly. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 10 There is an expectation that new residents will have had their care needs assessed before they move in to the home so that they can be assured that the home can meet their needs. Such assessments are usually provided by the referring agency (e.g. a Social Services Department) or in the case where residents are paying for their care by the home’s assessment procedure. At the time of previous inspections this initial assessment process was found to be unreliable with the home then being reminded that in future that before a resident was admitted that sufficient information must available to enable the home to make a decision as to whether the home can meet the resident’s care needs. One new resident has been admitted to the home in the period since the last inspection (December 2006) so this person’s file was checked to see if the required pre-admission needs assessment information had been obtained. This person had been admitted to The Gables from another care home with some information regarding risk supplied but the required needs assessment as described above had not been done. The inspector was told that some information was provided verbally from the previous care home and also from a social worker who was involved in the transfer but none of this appeared to have been recorded. This resident also did not have a care plan and none of the required risk assessments had been undertaken since their admission to the home in March 2007. A requirement is therefore made that in future the home must obtain the required pre-admission needs assessment information as described under Standard 3 of the National Minimum Standards. The inspector was told 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 the above recently admitted resident who said that both they and their relative had visited the home before they made the decision to live there. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 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. 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 available evidence including a visit to this service. Poor practice regarding care planning, risk assessment and the giving of medicines means that all residents cannot be sure that their health and personal care needs will be fully met and their wellbeing ensured. EVIDENCE: The care files of the two case tracked residents (including the newly admitted person) and one other were looked at to see if their health, personal and social care needs were being properly dealt with. As mentioned in the above section of this report the recently admitted resident did not have a care plan. Examination of the other two care files showed that generally satisfactory care plans were in place but neither had been reviewed monthly as required. The failure to both provide and review care plans means that residents care needs may not be being fully dealt with and this puts the residents well being at risk. (The acting manager said that she intends to review, revise and improve the existing care plan format). The above care files were also checked for the required resident risk assessment information for safe moving and handling, pressure sores and The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 12 nutrition. The newly admitted resident’s file contained brief risk assessment information for all of the above topics that had been provided by the previous care home but none had been done at The Gables. Another file did not have any information regarding the above topics whilst the remaining file did have out of date information about nutritional and pressure sore risk. Two of the above files also contained general health and safety risk assessments for resident activities both inside and outside of the home, but neither of these had been updated recently. It was noted that one of the above residents had had a number of falls recently but no falls risk assessment was in place. The failure to both provide and review the above described risk assessments puts both residents and staff welfare at risk. Talking to residents, the acting manager and the staff and looking at records showed that the resident’s medical care needs are taken care of and that when necessary health workers such as doctors, nurses and opticians are called. Examination of records showed that the residents weight is regularly checked, day and night progress reports are consistently recorded and the acting manager has recently introduced a communication book that ensures that information is passed between shifts of staff. All medicines are safely and securely stored. The residents’ medicines are provided in pre-filled blister packs with pre-printed prescription/recording sheets also provided The medications supplied are checked in to the home , and medicines returned to the pharmacy are also recorded. Identification photographs of each resident are kept with the medication administration records. The home has the required storage for the safe keeping of Controlled Drugs although none were in use at the time of this inspection. A Contrlolled Drug register is available. Those staff that give out medicines have been given the necessary training for this task. The home has a satisfactory medicines policy and procedure that includes guidance for the self-administration of medicines and the use of homely remedies. It was noted in the residents’ care files that were checked that two of these people were administrating their own medicines (respiratory inhalers) with the required risk assessments for this having been previously done. However neither of these risk assessments had been reviewed recently. The failure to regularly check these arrangements means that the home cannot be sure that these people are taking these medicines properly or that it is safe and appropriate that they continue to do so. Information received before the inspection alleged that one worker was filling in the medicine administration records when the medicine had not actually The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 13 been given. In discussion this particular worker strenuously denied this allegation, which the inspector was unable to substantiate. Examination of the medicine administration records showed that these were not entirely up to date and that they had not always been properly completed. These showed gaps in the records for a number of residents. However checking revealed that the medicines had been removed from the blister packs with it being likely that the medicines had been given but not recorded as so. The home must therefore make sure that all medicines are offered as prescribed and that the date and time of administration is always recorded. Records looked at emphasised the need for the residents privacy and dignity to be respected at all times and those residents spoken with were all complimentary about how staff assisted them with personal care tasks and felt their privacy and dignity was respected at all times. This was also observed during the inspection. The care assistants interviewed were able to give good examples of how they promoted privacy and dignity in their daily care routines, for example knocking on bedroom doors before entering. Those residents spoken with said that the staff were “courteous”, “caring”, “lovely” and that “they (the staff) talk to us properly”. However the inspector understands that at times some residents are not always given their personal mail promptly. All residents must be given their mail unopened (sub-standard 10.2). If residents have difficulty in dealing with their letters then these should, and with their permission, be opened in the their presence and if necessary the contents read out to them. Those staff observed during the inspection 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.V334510.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 ands 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service There is a lack of provision of social activities that means residents’ do not have opportunities to participate in stimulating and meaningful activities of their choice. Whilst there is adequate food served consideration needs to be given to ensuring that residents receive a balanced, wholesome and nutritious and appetising diet of their choice. EVIDENCE: During the inspection, those residents spoken with said that there was little to do apart from watch TV, although two residents followed their own pastimes such as visiting a local day centre or going to the pub or bookies. Whilst it was acknowledged that this was the case the opportunities for the more dependent residents was limited. Staff said that they tried to spend time with residents on the social aspect of care but it was difficult because they were often busy attending to other care duties and it was often the residents’ personal choice not to engage in activities. They did occasionally provide impromptu activities such as board games, which was confirmed by the residents, but this was on adhoc basis and was decided by the staff rather than the residents. There was no planned programme of activities available for inspection in the home and there was no information in care plans recording that any activities had taken place. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 15 Discussion took place with the manager about the need to organise staffing to enable the home to provide a stimulating variety of individual and group activities (including things outside the home) that residents will enjoy doing. Residents need to be consulted as to their preferences and staff must continue to discuss and offer opportunities for the residents. Staff members said that people could choose what time they got up or went to bed; this was confirmed by the residents spoken with, and also observed during the inspection. Residents could spend their time in their rooms, or in one of the lounges. Some liked to sit outside, weather permitting. Residents and staff confirmed that visitors were welcomed in the home and that there were no restrictions with an open visiting policy. Entries in the visitor’s book showed residents friends and relatives visiting at different times during the day and the evening. Some residents had the preference of seeing visitors in the privacy of their own rooms or in the main lounge. Residents spoken with said representatives from local Churches visited the home every couple of weeks to offer a traditional service or Communion to residents. This was confirmed by staff. Although residents were able to make some day to day choices as stated above, they had limited control over other areas of their lives, especially in relation to food. There was a three weekly menu that was seen on the wall both in the kitchen and the manager’s office. There were no other menus available for residents to view and this was confirmed in discussion with them. They were informed what was available for lunch that was prepared by the cook on duty and asked what they would like for tea, which was prepared by care staff. On the day of the inspection lunch consisted of meat and potato pie, vegetables and gravy and rice pudding. The meal was served in the dining room with condiments on the table. Portion sizes were adequate. Three residents spoken with stated that the food was ‘acceptable’ but said they ‘would like more choices’. They also confirmed that choices at breakfast were cereals, toast and preserves and boiled eggs. Hot and cold drinks were observed to be available throughout and this was confirmed with residents and staff. As required at the last inspection a basic record was kept of what food had been provided at lunch time but this did not relate to individuals, or record what they had eaten or if they had been offered alternatives if they did not like what was being offered. The record of food prepared did not always correspond to the planned three weekly menu that was being followed. It was clear from discussion with the staff on duty in the kitchen that they were aware of individual residents preferences but this was not recorded in resident’s records. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 16 There were adequate stocks of both fresh and frozen foods in the fridge and freezer as well as an adequate supply of dry stores. Whilst there was an adequate supply of food consideration needs to be given to offering a nutritional and well balanced diet. There was no cook specifically employed at the home and these duties were covered by three care staff on a rotational basis, when they were not undertaking caring duties. There were also concerns over practices undertaken within the kitchen. Care staff were observed entering and leaving the kitchen several times throughout the inspection to make drinks. They did not wash their hands or change aprons, which a health hazard and could lead to infection. Some of the fresh food such as potatoes were inappropriately stored on the floor in a small outbuilding. The kitchen was in need of remedial work to bring it up to standard, especially over the food preparation and cooking area where there were bare walls with loose flaking plaster. This again is a serious health hazard that requires urgent attention. The dining room was also in the middle of works and this needs to completed as soon as possible causing the least disruption to residents whilst at the same time as ensuring their safety. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 19. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s present written complaints procedure is not sufficient to make sure that resident’s concerns are properly dealt with, however good protection of vulnerable adults guidance and staff training in this topic makes sure that residents are protected from harm. EVIDENCE: The home has two differently worded complaints procedures, with the “ninestage” version being more informative and appropriate than the other. This copy describes how a complaint is to be made, who to and that an initial response will be provided within two days with an outcome forwarded within four weeks. This version should replace the currently displayed copy and it must be included the home’s Service User Guide. The facility of contacting the CSCI is also included in this paperwork, although this needs to be updated to include the CSCI’s recent change of address and telephone number. The home has previously had a record book for recording complaints, however this could not be found at the time of this inspection. The home now therefore needs to put together such a record with the layout of this being explained to the acting manager by the inspector No complaints have been made to the home in the period since the last inspection, but as mentioned earlier in this report a number of concerns have been expressed directly to the CSCI in April 2007. Issues raised included allegations about the home’s medication procedures, the quality of the food provided, staffing levels and recruitment and about the management of the The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 18 home. Individual issues arising from these concerns have been examined under the National Minimum Standards outcome groups as described under the Summary section of this report. Discussion with residents showed that these people would have no hesitation in making their concerns known to the staff or manager, and they believed that their anxieties would be listened to and acted upon. The staff interviewed were clear that any complaints made by residents or relatives would be reported immediately to the manager or to senior staff on duty. Written procedures and policies are in place covering adult protection, whistle blowing, the none acceptance of gifts, borrowing money and legacies and the home has now obtained as previously recommended a full copy of the Bury inter-agency adult protection policy and procedure. Looking at records showed that the majority of the staff have now been given training in adult protection procedures. Those staff that the inspector spoke with confirmed that they had been provided with such training and they had a reasonable understanding 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.V334510.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although The Gables provides comfortable and friendly surroundings for the people living there, maintenance and the replacement work is needed to ensure that a suitable environment is provided for the people living and working at the home. EVIDENCE: Although The Gables is generally adequately maintained to both the inside and outside a number of areas were identified as requiring attention during the course of the inspection. Since the last inspection a rainwater damaged bedroom has been refurbished and redecorated and some of the fitted kitchen units have been replaced. The inspector was told that new flooring has been ordered for the kitchen and a bathroom. The main lounge is pleasantly decorated and furnished which provides restful and homely surroundings for the people living at the home. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 20 There is good accessibility around the building with handrails, an assisted bath, a mobile lifting hoist and a passenger lift provided. 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 but no staff have had training in this subject. Residents clothing is marked to enable easy identification and the residents have no complaints about the laundry service provided by the home. Cobwebs were present in the high areas of many rooms and kitchen hygiene was not entirely satisfactory where bare plaster was exposed above cooking and food preparation areas. The latter would be improved if dedicated kitchen staff were employed who would then have the responsibility for all aspects of kitchen management and cleanliness. Issues about the home’s alarm call system were seen in that there are no extension push button leads available, which if provided would give better access to the system in an emergency situation. Cancelling this system after a call is difficult due to the fact that the indicator/cancelling unit is placed high on the dining room wall, which makes it inaccessible to the staff. The staff therefore have to access the upstairs indicator unit that is situated in the manager’s office, which is inconvenient for the staff and at times disrupts the manager’s duties. Each call unit has the facility of cancelling calls but the “keys” for this appear to have been misplaced. A number of bedrooms were seen to be using trailing sockets and in one instance an extension reel to power electrical items. This is unsafe both in terms of possible electrical overload risk and of presenting a tripping hazard to the residents and staff. The use of these must be avoided; this may mean that additional sockets have to be provided. Radiator guards in some bedrooms were found to be damaged and not fully secured and some hot water outlets had a poor flow and they were discharging cold water with all of these issues needing to be dealt with. The furniture and equipment (e. g. commodes) in some bedrooms was rather old and looking well used as was the standard of decoration. However 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. The dining room needs redecorating, but the inspector suggests that this is delayed until the work on the recently constructed conservatory is completed. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 21 Paper hand towels need to be provided in the communal toilets, the door locks to these rooms need to be repaired and the flushing mechanism in the toilet near to bedroom number six is difficult to operate and is thus in need of attention. The assisted bath in the ground floor bathroom was found to be damaged. There is hole about half way up the side of the bath that had rough edges that both presented a risk to the people being bathed and also prevented the bath from being properly filled. Temporary repairs were done during the inspection that made the bath safe, but the bath must be replaced with a requirement made in this report to this effect. 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. Some bed linen and towels are well used and almost threadbare, and many pillows were found to be stained and out of shape with many of these items therefore needing to be replaced. At the time of this visit there was a strong smell of fuel oil in the building. This had apparently been caused by the overfilling of the home’s central heating fuel storage tank. Care must be taken to ensure that this does not happen again. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff in the home continue to be not always properly recruited, overnight staffing levels need to be increased and new staff induction training must be improved so ensuring that residents are protected and their care needs met. EVIDENCE: Examination of duty rotas demonstrated that two staff are available from 9.00am until 9.00pm. The acting manager is also on duty from 8.00am until 3.00pm Monday to Friday. One of the two owners is also usually available during the day and they also sleep-in overnight. In discussion the above people said that in their opinion this level of staffing is sufficient to properly meet the needs and dependency levels of the people currently living in the home. 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. At previous inspections the inspector had questioned 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 they and the residents’ were therefore susceptible to risk. At the time of the last inspection a requirement was therefore made that the sleep-in person would assist the waking night worker from 6.00am and that the suitability and safety of this arrangement must be kept under review. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 23 Information received before this inspection alleged that no assistance was being provided from 6.00am and that because of this residents were falling, as they could not be properly supervised. Examination of staff rota’s and enquiries made evidenced that no support was being provided in the early morning and that three entries had been made in the accident book for this early morning period. Taking account of this information, the above-described unsatisfactory situation and the residents’ dependency and care needs the inspector now requires that overnight staffing levels be increased to two full time waking workers. The home no longer employs a cook and a dedicated domestic cleaner is available for only eight hours per week .In the main the care staff therefore undertake these duties and although these tasks are separated from their caring duties such an arrangement carries the risk of possible cross infection. These arrangements are also generally unsatisfactory in that as mentioned previously the employment of a dedicated catering staff would improve kitchen management and hygiene; and the provision of dedicated domestic staff would also improve the overall hygiene of the home. Of the 12 care staff employed at the home nine have got a National Vocational Qualification in Care at either Level 2 or 3. These figures exceed the requirement for the home to have had 50 of the care staff with a completed NVQ level 2 qualification or above by the end of 2005. A requirement made at the time of the previous inspection was that “Staff must be safely and properly recruited with all of the required checks being completed before they are employed, to ensure that workers who are suitable and fit to do this work care for the people who use the service”. Information received before this inspection alleged that staff may not be being correctly and safely recruited. The staff files of four recently employed workers were therefore checked for safe and proper recruitment. These did not fully evidence a safe and proper employment system. Although job application forms had been completed some of the forms do not contain sections for health and criminal declarations nor is there space for the recording of the applicants full work history. In some instances the applicant’s identity had not been confirmed and the two required references had not always been obtained. The acting manager has now introduced paperwork to deal with these issues and she is currently in the process of addressing any earlier shortfalls in staff recruitment. All of the above files contained satisfactory CRB (police) checks. Although the issue of unsafe staff recruitment has been brought up at the last three inspections, the home continues to fail to employ staff safely. These omissions must not occur again, a requirement is therefore made yet again in this report regarding the safe employment of staff. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 24 Discussion with staff and examination of records showed that the staff have been provided with a range of training including first aid, safe moving and handling, fire safety and training in the giving out of medicines. Some of this training however appears to need updating and most of the staff still need training in the subjects of infection control and health and safety (previously required). A recommendation previously made was that the home should provide induction training for new staff that complies with the nationally recognised Scils for Care Common Induction Standards. Little progress appears to have been made with this, but the acting manager has recently obtained information regarding this topic and she intends to use this form of induction training shortly. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home needs to be properly managed so that standards are improved and the staff receive clear guidance. The handling of the residents’ money still requires improvement and a number of health and safety issues need to be dealt with. EVIDENCE: Standard 31 could not be assessed, as presently the home does not have a Registered Manager. The home has not had a Registered Manger in post since December 2006. Although Regulation 39 of the Care Homes Regulations 2001 requires that care homes must inform the CSCI of such absences the home’s owners had not informed the CSCI of this situation. The owners must now inform the CSCI in writing of this situation and the home’s Registration Certificate will need to be amended. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 26 An acting manager came into post on the 30th April 2007; this person now needs to apply for approval and registration with the CSCI. Information received before this inspection alleged that in the absence of a Registered Manager the home was being run by the home two owners with this resulting in a lack of clear managerial guidance causing low staff moral. The inspector considers that the want of robust management of the home to be the root cause of many of the problems identified throughout this report. In recruiting an acting manager the home now has the opportunity to deal with these issues and the above person must be supported and encouraged in their role. 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. In October 2006 the home used a 14-point satisfaction survey with most of the residents. This allows the residents to comment upon the care and services provided by the home. Although the results were mostly positive the home now needs to analyse the results of these surveys so that a brief report can be put together that describes the responses including any dissatisfaction and of any action taken in response to the survey. A copy of this report should be made available to the residents and should be included in the home’s Service User Guide. The inspector reminds the manager that in future these surveys should not only include the views of the residents, but also their relatives and other interested parties (GP’s, social workers etc). A number of survey questionnaires were also sent out to the residents and their relatives by the CSCI 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 seven questionnaires had been returned; the bulk of these were generally complimentary about the accommodation, the services and the care provided at The Gables although one person appeared to be unaware of the home’s complaints procedure. The home keeps amounts of money on the behalf of a number of residents for safekeeping. A requirement made at the time of the previous inspection regarding this was that “Residents’ monies held for safekeeping by the home must balance at all times with the corresponding paperwork, to ensure that both theirs and the staff’s interests are protected”. This system was therefore again checked with the details found to be properly written down and with the correct amounts of money now being kept. One of the owners of the home acts as a pension appointee for a number of residents with their state pension funds being paid directly in to the home’s business account. Although the owner is keeping detailed individual records of this money and can fully account for each persons funds the inspector The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 27 considers this practice to be unsafe both in terms of his own and the residents best interests. A requirement was therefore previously made that “Residents’ monies must either be kept in individual bank accounts or in a collective account that is used exclusively only for this purpose and which is clearly identified with the bank as a residents’ fund account”. The owner explained that as these residents’ do not have the capacity to open bank accounts he has continued to keep their money in the home’s business account. The inspector still considers this practice inadvisable with the above requirement being therefore repeated. The records regarding the safe keeping of the residents’ monies were not available during the main period of the inspection with the inspector having to twice return to the home afterwards to complete this check. Regulation 17 of the Care Homes Regulations 2001 requires that such records are at all times available for inspection by the CSCI, a requirement to this effect is therefore mad in this report. Standard 36 requires that the care staff should receive formal recorded supervision at least six times a year. These supervision sessions give staff the opportunity to meet with their manager at regular intervals to discuss their work, development and possible training needs. Examination of records showed that this had not happened for some time; however the newly appointed manager has now revised this supervision format ands she has also recently had such meetings with four of the staff. Progress with this work will be checked at the next inspection. Looking at the fire precautions record revealed that the home’s fire safety systems had not been checked since December 2006. Such checking and testing is routinely done at weekly intervals. The inspector therefore requested that the that the system was tested immediately, which was done. In view of the above lapse the inspector requires that that the home’s fire precautions system and equipment is tested and recorded regularly so ensuring the safety of both the residents and the staff. A requirement made at the time of the last inspection was that “The certificate verifying the safety of the home’s portable electrical appliances must be renewed, therefore ensuring the safety of the people living and working at the home”. This work has not been done; the requirement is therefore repeated in this report. Further checking of the home’s servicing and safety certificates showed that these were all up to date. However although the home’s electrical circuits had been examined in August 2006 the engineer had noted that six items required urgent remedial attention. The inspector was unable to verify as to whether this work had been done, a requirement is therefore made seeking clarification regarding these items. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 28 A check must be done on the home’s upper floor windows to make sure that they do not open too widely so ensuring that they do not present an unnecessary risk to the people living at the home. Regulation 37 of The Care Homes Regulations 2001 require that care homes must notify the CSCI of deaths, illnesses and certain other events so that this information can then be assessed, monitored and action taken if required. During the course of this inspection the inspector was told that in the period since the last inspection that a resident had died. There does not appear to be any record of this person’s death having being notified to the CSCI. The registered person is therefore reminded that such events must be notified with a requirement made in this report to this effect. Examination of the home’s accident book showed that although accidents are being regularly recorded the entries lacked sufficient information about the nature of the incident and also as to whether the resident required any treatment as result of the accident. The recording of such information is necessary; so that sufficient detail is available should future enquiries need to be made in to an incident. A requirement made at the last inspection was that “The staff must be provided with training in the topics of infection control and health and safety, therefore ensuring that the people who use this service are properly cared for”. There was no evidence to show that this training had been provided so the requirement is repeated. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 29 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 X X 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 1 2 X 1 1 2 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 2 3 X 1 The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes. 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 OP3 Regulation 14 (1) (a) (b) (c) (d) Timescale for action A personalised pre-admission 30/06/07 needs assessment must be completed before people are admitted to the home. This will ensure that these people’s diverse needs always identified and planned for before they move in to the home and therefore the home can be sure that it can meet their needs. All residents must have a care 30/06/07 plan formulated that is reviewed at the required monthly intervals and if necessary updated. This is to ensure that the staff will both know what these people’s needs are and that their changing needs are fully dealt with. All of the people living at the 30/06/07 home must have the described risk assessments in place that are regularly reviewed and if necessary updated. So that unnecessary risks to their health and safety are identified and so far as possible eliminated. Medicines must be offered as 30/06/07 prescribed with the date and time of administration recorded, DS0000065390.V334510.R01.S.doc Version 5.2 Page 31 Requirement 2 OP7 15 (1) (2) (b) 3 OP8 13 (4) (c) 4 OP9 13 (2) The Gables Residential Care Home 5 OP12 6 OP15 7 OP15 8 OP16 9 OP21 10 OP21 to ensure that people receive the correct levels of medication. (Previous timescale of 31/01/07 not met) 16 (2) The residents must be provided (m) (n) with regular planned social and recreational activities, so that the people using the service are kept stimulated and motivated. 16 (2) (i) A menu that describes a nourishing and well balanced diet must be made available to the residents, so that the people using the service can easily choose what they want to eat at mealtimes. 17 (2) A full record of the food provided to individual residents must be kept, to ensure that in future and if necessary adequate food provision can be verified. (Previous timescale of 31/01/07 not met) 20 (1) (2) The home must put together a (3) (4) suitable complaints procedure (5) (7) and make this available to the (8) people living and visiting the home, so that these people will both know how to make a complaint and how their concerns will be dealt with. A record of any complaints made must also be kept at the home, so that the level and nature of any complaints made can be monitored and if necessary any issues addressed. 23 (2) (c) The damaged bath in the ground floor bathroom must be replaced, so that the people living at the home can be bathed safely and properly. 23 (2) (c). Paper hand towels must to be provided in the communal toilets, the door locks to these rooms must to be repaired and the flushing mechanism in the toilet near to bedroom number DS0000065390.V334510.R01.S.doc 30/06/07 15/06/07 15/06/07 30/06/07 15/06/07 30/06/07 The Gables Residential Care Home Version 5.2 Page 32 11 OP24 16 (2) (c) 12 OP22 OP24 23 (2) (c) six is in need of attention. The undertaking of this work will ensure the resident’s personal hygiene and privacy and dignity needs can be met. The condition of bed linen, 30/06/07 pillows and towels must be assessed to make sure that these items are fit for use. So making sure that the people living at the home are so provided with such articles that are in suitable condition. Alarm call extension push button 30/06/07 leads must be provided, so giving the residents better access to the system in an emergency. The use of electrical trailing sockets and extension reels must be avoided so reducing the risk of electrical overload and possible tripping. Damaged and loose radiator 30/06/07 heating guards must be made safe therefore ensuring the protection of the people living at the home. Cold and poor flow from hot water outlets must be dealt with so making sure that the people living at the home have adequate personal washing facilities. Standards of hygiene must be 30/06/07 improved (i.e. cobwebs) and the exposed wall plaster in the kitchen must be appropriately covered. This will make sure that clean, pleasant and hygienic surroundings are provided and that the health and safety of the people living and working at the home is ensured. To ensure that people using the 15/06/07 service are properly cared for, DS0000065390.V334510.R01.S.doc Version 5.2 Page 33 13 OP24 OP25 23 (2) (c) (j) 14 OP26 23 (2) (d) 15 OP27 18 (1) (a) The Gables Residential Care Home two waking night staff must provided. This will also make sure that the residents’ and the staff’s health and safety needs are met. 16 OP27 18 (1) (a) To ensure that people who use 30/06/07 the service have a clean environment to live in and receive food from a clean kitchen, a cook must be employed to prepare meals and keep the kitchen clean and sufficient numbers of cleaning staff must be employed. Staff must be safely and properly 30/06/07 recruited with all of the required checks being completed before they are employed, to ensure that workers who are suitable and fit to do this work care for the people who use the service. (Previous timescales of 07/08/06 and 31/01/07 not met) Newly employed staff must be 30/06/07 provided with structured induction training that meets the specification of the nationally approved Scils for Care Common Induction Standards. Therefore making sure that new and inexperienced workers receive the correct training. The absence of a Registered 15/06/07 Manager should be notified to the CSCI so that both the arrangements for the interim and the proposals for appointing another person can be assessed as being satisfactory. Residents’ monies must either be 30/06/07 kept in individual bank accounts or in a collective account that is used exclusively only for this purpose and which is clearly identified with the bank as a residents’ fund account. This is DS0000065390.V334510.R01.S.doc Version 5.2 Page 34 17 OP29 19 (1) (b) 18 OP30 18 (1) (c) (i) 19 OP31 38 (e) 20 OP35 20 (1) (a) (b) The Gables Residential Care Home to ensure that the residents and the staff’s best interests are protected. (Previous timescale of 31/01/07 not met) 21 OP37 17 (3) (b) All of the records required by 30/06/07 regulation to be kept by a care home must be available for inspection at all times so that such information can be readily and efficiently checked. The home’s fire precautions 15/06/07 system and equipment must be tested regularly so ensuring the safety of both the residents and the staff. The staff must be provided with 30/06/07 training in the topics of infection control and health and safety, therefore ensuring that the people who use this service are not at risk from cross infection or any other form of risk. (Previous timescale of 16/02/07 not met) It must also be ensured that staff wash their hands and change their aprons when alternating between caring, domestic and cooking duties. The certificate verifying the 15/06/07 safety of the home’s portable electrical appliances must be renewed, therefore ensuring the safety of the people living and working at the home. (Previous timescale of 31/01/07 not met) The safety of the home’s 30/06/07 electrical wiring circuits must be verified therefore ensuring the health and safety of the residents and the staff. A check must be done on the 15/06/07 home’s upper floor windows to DS0000065390.V334510.R01.S.doc Version 5.2 Page 35 22 OP38 23 (4) (ii) 23 OP38 OP26 13 (3) 24 OP38 13 (4) (c) 25 OP38 13 (4) (c) 26 OP38 13 (4) (c) The Gables Residential Care Home 27 OP38 37 (1) 28 OP38 17 (10 (a) make sure that they do not open too widely so ensuring that they do not present an unnecessary risk to the people living at the home. All significant and serious events 30/06/07 must be notified to the CSCI so that this information can then be assessed, monitored and action taken if required. Accident records must contain 30/06/07 sufficient detail to enable if necessary, the making of future enquiries into the nature of an incident. 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 OP10 Good Practice Recommendations Where residents may have difficulty in dealing with their personal letters then these should, and with their permission, be opened in the their presence and if necessary the contents read out to them. The inspector recommends that a record be kept of when residents take part in social activities so that the level of the residents’ involvement is monitored and also such information often shows which activities are the most successful. The accessibility of the home’s alarm call indicator/cancelling equipment should be reviewed so reducing any unnecessary inconvenience for the staff. The Responsible Individual should make an application to have the presently employed acting manager approved and registered by the CSCI to ensure that the residents’ 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. A copy of the home’s quality assurance satisfaction survey report should be made available to the residents and should be included in the home’s Service User Guide; so DS0000065390.V334510.R01.S.doc Version 5.2 Page 36 2 OP12 3 4 OP22 OP31 5 OP33 The Gables Residential Care Home that these people have access to information about how well the home is performing in meeting their needs. The Gables Residential Care Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Home DS0000065390.V334510.R01.S.doc Version 5.2 Page 38 - 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. 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