Inspection on 19/12/06 for The Gables Residential Care Home

This inspection was carried out on 19th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 01/05/07

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 19th December 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.V312895.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.V312895.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.V312895.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. 1st June 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 and a separate dining room. 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 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 available on request. As of December 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.V312895.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 8.45am on the 19th December 2006. It took place over two days and it lasted for about ten hours. The time was split between talking to the Owners and checking records, looking around the home, watching what was happening and talking to residents and other staff. Five residents and four staff were spoken with. The home manager was not available due to illness at the time of this visit so the home’s two owners and an agency employed senior care worker assisted with the inspection. A completed pre-inspection questionnaire was received along with a feedback survey from one resident. 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 December 2006. Individual issues arising from these concerns have been examined under the National Minimum Standards outcome groups “Health & Personal Care”, “Daily Life & Social Activities”, “Environment” and “Staffing” and they are commented upon in these sections of this report. A Random Inspection was carried out at the home on the 30th August 2006. The reason for this visit was to assess the progress made by the home in meeting the requirements and recommendations made at the Key Inspection of the 1st June and at the Pharmacy Inspection of the 17th July 2006. The home was then found to have made some progress in meeting these requirements and recommendations; reference to this inspection is made in various parts of this inspection report. What the service does well: The residents said that they were well looked after by the staff who they described as being “helpful”, “caring”, “friendly” and “easy to get along with”. The residents looked well cared for and the paperwork kept for each person showed that their health, personal and social care needs were being met. During the inspection the staff were seen to deal with the residents in a comfortable, caring and natural manner. The residents are treated with respect and their privacy and dignity is upheld and they are helped to make choices and decisions. The home’s visiting arrangements are flexible thus enabling the residents to have good contact with their family and friends as they please. The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 6 The atmosphere within the home was relaxed and the home had a friendly, homely feel about it with staff spending time talking to the residents. The Gables provides clean, comfortable and agreeable surroundings for the people living there. What has improved since the last inspection? What they could do better: 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. A record of the food given to the residents must be kept, to that in future and if necessary adequate food provision can be confirmed. The staff must be provided with training in adult protection subjects, to ensure that the people who use the service are protected from harm. 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. The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 7 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 new staff, which shows them how to do the work, should be made better. The accounting system for residents money needs to be improved therefore ensuring that both the residents and staff interests are protected. The home’s management arrangements now need to become more settled so ensuring that the residents’ will continue to receive a satisfactory standard of care. 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.V312895.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.V312895.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 could not be fully assessed. The initial assessment process was previously found to be unreliable, but as there have not been any new resident admissions to the home recently this Standard (3) could not be assessed, as only old existing information was available. The home’s Statement of purpose and the Service User Guide provide prospective residents and their families with sufficient information to enable them to decide whether the home can meet their care 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 with useful and clear information about the services that the home provides. A requirement of the previous inspection (August 2006) was that prospective and existing residents must be provided with a copy of the Residents The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 10 Information Guide so that they are aware of what to expect from the home and they will also have information about the home’s complaints procedure. Copies of both of the above documents were seen to be in place in all of the residents’ bedroom although in discussion few of the residents had read them. 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 the last key inspection (June 2006) such information was not present in two of the five care files that were then checked. The manager was then 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. There have not been any new admissions to the home since the key inspection. Therefore this requirement could not be properly assessed, as only old existing information was available. However whilst checking four existing residents care files for other information the inspector noted that such information was present in three of these files. 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. The Gables Residential Care Home DS0000065390.V312895.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 adequate. Individual care plans are in place, which were up to date, regularly reviewed and provided the staff with the information they needed to give a satisfactory standard of care. Although the home’s medication arrangements have improved mistakes in some instances mean that the residents cannot always rely on getting their medicines as prescribed. Care practices in the home ensure that the residents are treated with respect and their privacy and dignity is upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A number of requirements were made at the time of the key inspection regarding the way that the care needs of the residents were recorded and the way that care was delivered. The home has now put in place a key worker system with individually named staff being allocated to the care of groups of residents. This is good practice that should improve the standard of care provided to these people. The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 12 The home has also discontinued the use of collective progress reports with individual record sheets now being used for each resident. Such a method of recording gives a better picture of the care given to the residents. The home has also developed a recorded staff handover system that is used to pass information between shifts of staff therefore improving communication about residents needs. The residents care files have now been revised and the information contained is now well laid out in a logical and easy to follow format. All of the residents now have a care plan in place. The care planning documents have been fully revised with a needs index and individual sheets for each need that describes how identified care needs are to be met Examination of the two case tracked residents care files confirmed that the their health, personal and social care needs are dealt with in their care plans that had been reviewed at the required monthly intervals. The staff said that they knew each residents needs by reading the care plans, which are readily available to them. The home has developed a risk assessment format with copies of these found to be in place in those files that were checked. These risk assessments are used when a need is identified and they include those for safe moving and handling, pressure sore risk and general health and safety risks for activities both inside and outside of the home. As previously required the home has now put in place a nutritional risk assessment that is used regularly. The home has also put in place documentation to record when residents receive visits from health care workers such as doctors, nurses and opticians. Talking to residents and the staff and looking at the above record confirmed that the resident’s health care needs are taken care of and that when necessary the above described health workers are called. The CSCI Pharmacist Inspector who assessed the adequacy of the homes medication arrangements has made a number of visits to the home during the summer of this year. The last visit took place on the 20th October 2006 when although it was noted that there had been improvements it was also recorded that care needed to be taken to ensure that complete records for the administration of medication were made. Also that prescribed medicines should only be given as prescribed and that mistakes in the administration records can lead to mistakes when administering medication. It was also required that risk assessments for residents’ that manage their own medicines needed to be completed. Examination of the home medication systems at the time of this inspection found that the above-described shortfalls had been largely dealt with. The home’s medication arrangements have now been changed to that of a Monitored Dosage System where the medicines are provided in 28 day “blister The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 13 packs” with corresponding pre-printed administration records also being provided by the supplying pharmacy. The introduction of this system has improved the way that the home deals with the residents’ medicines. The medications were found to be safely and securely stored and those staff that give out medicines have been trained in this task. A record of all medicines received into and leaving the home is made to enable the handling of residents’ medicines to be tracked. The medication policies and procedures have been re-written and provide clear guidance for carers handling medication and assessments for those residents dealing with their own medicines were seen to be in place. Photographs are not included with the medication administration records to assist with the positive identification of residents. But, the provider said plans were in place for these to be introduced. Some loose unidentified strips of medicines were found to be present in the medication trolley. The home must ensure that all medicines that are currently in use are identified to a resident and unidentified medicines should be returned to the pharmacy. Information received before the inspection alleged that some medicines were being “potted up” rather than being given directly to the residents from the original container. It was also alleged that some residents were not being given their medicines regularly and that one particular resident’s health condition was being made worse because they were not getting their medicines on a regular basis. No evidence was seen during this inspection that the medicines were being “potted up” and when questioned the senior care worker denied this allegation. Examination of the medicine administration records showed that these were up to date and had been properly completed apart from in two instances. These showed no entries on one day for a morning dose of medicines for one resident and they also showed no entries for the particular resident described above for a four day period at various times of the day. 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. The home’s philosophy statement, Service User Guide and Statement of Purpose all reinforced the importance of staff treating residents with respect and dignity. 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. The residents said that the staff had a “kind The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 14 and considerate” manner and that the staff spoke to them in a “civil and courteous” way. The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 15 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 and 15. Quality in this outcome area is good. The activities offered within the home mean that residents have opportunities to participate in stimulating and motivating activities. Residents can spend their time as they please, and mealtimes are satisfactory. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement made at the time of the key inspection was that the “residents must be consulted with about the types of social interests they enjoy or that they might wish to be involved in”. Looking at records showed that this consultation has now taken place and that some residents did show some interest in certain social activities whilst others expressed little interest. The home displays a seven-day “entertainment” programme with events such as exercises, quizzes, bingo, board games and sing-a-long being described. Those residents that the inspector spoke with were in the main aware of such a programme although some residents chose not to join these activities. The staff carry out these activities during the afternoons and evenings with a record previously being kept of when residents take part in such activities but the completion of these appears to have lapsed recently. The inspector considers that it is good practice to keep such records so that the level of the residents’ involvement is monitored and such information often shows which activities are the most successful. The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 16 At the time of this inspection preparations were being made for the Christmas celebrations with a party having been arranged for the 22nd December when two singers were visiting the home to entertain the residents. In discussion the residents and staff confimed unrestricted visiting arrangements and the residents said that visitors are made welcome and that they (the visitor) can have a warm drink if they so wish. 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. Issues regarding residents choice are described in a variety of documentation including the home’s Service User Guide and Statement of Purpose. Residents said that they had choice about such things as going to bed and getting up times, which clothes to wear, which lounge they sat in, how they spent their day and whether or not to participate in activities. For those residents who may have a limited ability to make decisions and choices about their day-today living arrangements the staff said that they try to assist the them with this by offering choices about such things as what clothing to wear, when to rise and retire and helping to choose from the menu. The residents are able to, and do bring personal items in to the home such as televisions, radios, photographs, pictures and ornaments. The home has previously used a menu that offered a variety of homely and traditional food. A copy of this menu was not available at the time of this inspection with the inspector being told that the menu was being revised and had been taken home by the manager (not present at this visit due to illness) to work on. The inspector was informed that in the meantime the residents were being offered a choice food on each day but those residents that the inspector spoke with appeared to have little knowledge of the food that was available. Following discussion with one of the home’s owners it was agreed that an interim menu would be prepared and displayed in the home. The cook does however keep a record of the food provided but this is not always filled for all of the meals provided on each day. The inspector therefore requires that the home must make sure that a record of the food provided to the residents is kept so that in future and if necessary adequate food provision can be verified. Information received before the inspection alleged that poor low quality food was being given to the residents. The inspector therefore checked the sort and quantity of food that the home had in stock. The home was found to be mainly buying supermarket own brands and value lines. Some well known branded goods were also purchased and some products were also bought from Bury open market. Tinned, packet and frozen The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 17 products were in store with more than adequate amounts of food found to be in stock. The home also buys fresh vegetables daily. The inspector is of the opinion that the food purchased meets recognised nourishment values but that matters of taste and flavour are subject to individual interpretation. The inspector therefore largely relied upon the comments made by the residents regarding the quality of the food offered. The residents that the inspector spoke with praised the food served saying that the food was “good and warm” and they told the inspector that they had “enjoyed the meal” and they also said that drinks and snacks were available at most times if the day. The inspector sampled the potato pie at lunchtime that was found to be properly prepared, warm and satisfactory. In discussion the cook and the staff were of the opinion that the quality of the food recently purchased by the home had improved. The meals were seen to be presented in an appealing manner with good portions offered. The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 18 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 18. Quality in this outcome area is adequate. The residents have now been given the required information about how to make a complaint and the complaints procedure is sufficient to make sure that their concerns are properly dealt with. Although adult protection information is in place, the obtaining of a full copy of the local inter-agency policy and additional staff training in this topic will further ensure that residents are protected from harm. This judgement has been made using available evidence including a visit to this service. 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. Although this complaints procedure is displayed in the entrance area of the home few of the residents or a relative that the inspector spoke with at the time of the last inspection were aware of this procedure. A requirement was then therefore made that residents and visitors were to be made more aware of the home’s complaints procedure and that a copy of this procedure was to be included in the Service User Guide so ensuring that people have the necessary complaints information. As mentioned previously copies of the Service User Guide have now been given to all of the residents and in discussion they did 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. The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 19 The staff interviewed were clear that any complaints made by residents or relatives would be reported immediately to the manager or senior staff on duty. The home has a proper record for writing down complaints. No entries have been made in this record although one complaint has been listed on the preinspection questionnaire as having been made directly to the home in period since the key inspection in June 2006. Unfortunately due to the manager’s absence due to illness the details of this complaint could not be checked; the inspector will follow this up when the manager returns to work. As mentioned earlier in this report a number of concerns have been expressed directly to the CSCI in December 2006. Issues raised included allegations about the home’s medication procedures, the quality of the food provided, the adequacy of the heating provided in the home and the safety of the home’s staff recruitment practices. 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. There are written procedures and policies covering adult protection, whistle blowing, the none acceptance of gifts, borrowing money and legacies and the home has now obtained as previously recommended a part copy of the Bury inter-agency adult protection policy and procedure. It would appear that the final section of the latter described document has been omitted. The inspector therefore again recommends that a full copy of the above document be obtained so that local guidance can be followed should an abuse situation arise. Looking at records showed that some staff had been given training in adult protection procedures. However those staff that the inspector spoke with said that they had not been provided with such training although they did have some understanding of the different sorts of abuse and they also understood what they should do if they suspected that someone was being abused. Staff training about adult protection had been arranged by the home that was due to take place in mid December 2006 but unfortunately this did not go ahead as the worker who was to provide this training was unavoidably unable to keep the appointment. The inspector was told that the home now intends to rearrange this training for January 2007. The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 20 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 and 26. Quality in this outcome area is good The Gables care home provides clean, comfortable, homely and friendly surroundings for the people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home 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. Since the last inspection a new carpet has been fitted in a resident’s bedroom, some redecoration has been done in the ground floor bathroom, and the basement area has been tidied and repainted. Fitted bed sheets have been purchased and some mattresses have been replaced. A small conservatory has been constructed at the rear of the building. Work on this is not yet completed, but when finished this will enhance the home’s presentation and will provide more lounge space for the residents. The inspector and the owner discussed the health and safety precautions that will need to be taken when the entrance to the building from the new conservatory The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 21 is “broken through” to the main building. It is expected that this work will be able to be completed in one day. There has been a rainwater leak through the roof of the property that has damaged the ceiling, decoration and some of the furnishings in the bedroom below. Work was ongoing to dry this room out with various repairs to then follow. In the meantime the resident that was living in this room has been temporarily moved to a vacant bedroom until the repair work has been completed. A requirement made at the time of the random inspection in August 2006 was that a number of loose radiator guards be made safe. This work has been done with these guards now being securely fixed. Decoration, furnishings and most of the lighting (two ground floor bedrooms have fluorescent lights) are domestic in standard and they are properly presented. The two case tracked resident’s bedrooms and all others were checked. These were found to be generally properly decorated, furnished and equipped 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, a mobile lifting hoist and a passenger lift provided. Aids and adaptation are provided in bedrooms, bathroom and toilets. 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 inspector saw that the cover appeared to missing to a smoke/heat detector in the basement, this piece of equipment must be checked to ensure that it is still working properly 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 The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 22 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. Information received before the inspection alleged that for a period of time (about three days) the central heating system was not working due to the fact that the home did not have any heating oil to fuel the system. It was also stated that during this time that electric fan heaters were brought in to the home and that the use of these may not have been safe. A further allegation was made that at times the home’s owners are either turning the heating down or off in order to save on heating costs. Enquiries showed that due to an error the home did run out of heating oil for the central heating system on Friday the 8th December 2006 with the system having to be shut down on the Friday, Saturday and Sunday of that week. Supplies of heating fuel were delivered to the home on the following Monday and the system was restarted. Approximately 2000 litres of heating oil were found to be in stock at the time of this inspection. The inspector was told that electrical fan heaters were brought in to the home and he was assured that these were used safely. These heaters have since been removed from the home. In discussion the owners vigorously denied turning off the heating in order to save on heating costs and those resident that the inspector spoke with said that the home was usually warm and comfortable. At the time of this inspection all parts of the home were found to be warm and properly heated. The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 23 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. The staff in the home are 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Looking at staff rotas showed that as well as employing care staff, the home also employs domestic (cleaning) and catering 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. The inspector checked the care staffing rotas for the period 1st to the 28th December 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 24 hours 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. 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 the time of the key inspection in June 2006 the The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 24 inspector 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. The inspector then required that the adequacy of the home’s night-time care staffing levels be reviewed with consideration to be given to increasing provision to two waking staff. At the time of the random inspection in August 2006 the night time staffing arrangements had been altered so that the sleep-in person then started work at 6.00am therefore providing assistance from this time to the waking member of staff. The inspector then considered this to be a satisfactory arrangement. However at the time of this inspection the inspector was told that this arrangement had been changed and the 6:00am worker had been withdrawn. The inspector spoke to one of the night staff on the first day of this inspection who said that they felt that they were able to provide adequate care to the residents whilst working single handed and that they could call on the sleep in worker if necessary. Whilst taking in to account the above night time workers comments the inspector considers that following the withdrawal of the 6:00am worker that the night time staffing arrangements are inadequate and therefore the inspector requires that this worker must be reinstated. The inspector also requires that the adequacy of the above-described arrangements must be regularly risk assessed and reviewed thereby taking in to account the changing needs of the residents and also ensuring the health, safety and well being of the residents and the staff. Furthermore two waking night staff must be provided should resident numbers increase above the number (11) currently living at the home. Of the 10 care staff employed at the home seven have got a National Vocational Qualification in Care at either Level 2 or 3. These figures meet the requirement for the home to have 50 of the care staff with completed NVQ level 2 qualifications or above by the end of 2005. Information received before this inspection alleged that some staff were being employed without the required CRB (police) check being done. Five staff files, including some recently employed workers were therefore checked for safe and proper recruitment. These did not fully evidence a safe and proper recruitment system. Although job application forms had been completed the form in current use does not contain sections for health and criminal declarations nor is there space for the recording of the applicants full work history. In some instances job references obtained were not fully safe in that they were of the open, undated to “whom it may concern” format rather than being dated and addressed directly to the person requesting the reference. Also in some instances only one reference had been obtained and not the required two. The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 25 All of the above files contained the required CRB (police) checks but in two instances these had been obtained after the staff member had started work at the home. There was also little evidence that the applicant’s identity had been confirmed. With regard to staff recruitment the following requirements are made: • CRB checks must be obtained before staff are employed. • Two proper written references must also be obtained before staff are employed. • Proof of identity must be checked and recorded. • Staff job application forms must include a section for health and criminal declaration and for the recording of a full work history. The home is also reminded that CRB checks cannot be transferred from job to job, a new check must be obtained a the time of the workers recruitment. It is necessary to obtain all of the above-described information so that residents and their families can be confident that the staff employed at the home are fit and suitable to provide care to vulnerable people. Staff training was also checked. Training recently provided included first aid, safe moving and handling, fire safety and training in the giving out of medicines. The provision of this training was confirmed in discussion with staff and by looking at training certificates and this also showed that other training had been provided in safe food hygiene. Staff however appeared to need training in the subjects of infection control and health and safety. The inspector and the home’s manager had previously discussed the way that staff training is presently recorded. The inspector then suggesting 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 provision of induction to the job training for new and inexperienced staff using the Scils for Care Common Induction Standards was also discussed at the above time. The home has now developed such a staff-training matrix from which the inspector was able to confirm that some of the above described had been provided. Sections for food hygiene and infection control training need to be included in this matrix so that all of the training required under Standard 38.2 is recorded. Apart from the recently developed matrix the home largely relies on training certificates as a means of recording staff training, consideration should again be given to the development of separate staff training sheets so making sure that each workers training is individually and fully recorded. Since the key inspection the home has further developed the induction programme for newly employed inexperienced staff. Although this is an The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 26 improvement the inspector doubts that the content of this programme meets the specification of the Common Induction Standards (as produced by the nationally recognised “Scils for Care” Organisation) for workers providing social care. The inspector therefore recommends that the content of the home’s current induction programme should be checked against the above Standards therefore making sure that these workers receive the correct training. The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 27 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): Quality in this outcome area is adequate. The home’s management arrangements now need to become more settled so ensuring that the residents’ will continue to receive a satisfactory standard of care and the handling of the residents’ money needs to be improved. This judgement has been made using available evidence including a visit to this service. 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. Although Mrs Bennett is therefore well experienced in the care of older people she needs to give consideration to undertaking the required NVQ 4 Registered Mangers Award. Information received before this inspection alleged that the relationship between the owners and the staff was poor. This allegation was also made shortly before the random inspection in August of this year. Discussion with the staff and the home’s owners in August showed that the home was then The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 28 being better run with clearer lines of accountability being in place. The staff appeared to be happier and more content and they then seemed to know whom they were responsible to and staff moral appeared to have improved. The owners have recently taken on an agency employed senior care worker to assist in the running of the home. This worker has replaced another senior carer who was formerly employed at the home. This person now needs time to become established in the job and to become familiar with the home’s routines and to get to know the residents and the staff. Those staff interviewed at this inspection said that they felt that their relationship with the owners was comfortable and that all parties were able to voice their opinions without resentment and that staff moral was good. The inspector felt that the atmosphere in the home was comfortable and that the staff and the owners were interacting with each other in a civil manner. 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. A requirement made previously was that the home must reintroduce a previously used but lapsed quality assurance system. Since the key inspection the home has twice 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. 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). The one survey questionnaire returned to the CSCI by a resident showed that this person was very pleased with the care provided and they expressed a high level of satisfaction with the services offered by the home. The home keeps amounts of money on the behalf of a number of residents for safekeeping. A requirement made previously was that the paperwork recording the transactions of this money needed to be improved so that it comprised a full credit and debit account with spending described a running balance kept and signatures applied. Errors were found at that time between the cash amounts held and the amount recorded. Examination showed that the home has since revised the system used for the recording of residents’ personal monies and that this system now complies with the above-described requirement. However upon checking of cash amounts held it was again shown that two of these did not correspond with the amount recorded. These errors were corrected at the time of the inspection. The home must ensure that at all times the amount of money kept must always balance The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 29 with the amount recorded. This is important not only for the protection of the residents’ interests but also of the staffs’. 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 considers this practice to be unsafe both in terms of his own and the residents best interests. In order to afford protection to all parties the owner should first explore the possibility of opening individual saving accounts for these residents or a separate bank account should be opened that is only used for the holding and transactions of residents’ funds and that it is clearly identified with the bank as a residents’ fund account. At the time of the last Key Inspection it was found that the certificate verifying the safety of the home’s electrical circuits had expired with a requirement then being made that new up to date certification be obtained. Work regarding this was ongoing at the time of this visit that was expected to be completed shortly. Looking at other records and maintenance certificates at this visit showed that these were up to date apart from that for the home’s portable electrical appliances which had expired on the 7th November 2006; this cerificate must therefore be renewed. Otherwise the home is safely maintained with fire precautions tests done weekly, details of accidents are properly recorded and safe hot water temperatures being regularly checked. The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 30 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 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 3 17 X 18 2 3 X X X X X X 3 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 3 X 1 X 3 X X 3 The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 31 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 OP9 Regulation 13 (2) Timescale for action All medicines kept by the home 31/01/07 must be identified as belonging to individual residents, to ensure that people receive the correct levels of medication. Medicines must be offered as 31/01/07 prescribed with the date and time of administration recorded, to ensure that people receive the correct levels of medication. (Previous timescale of 20/10/06 not met) A record of the food provided to 31/01/07 the residents must be kept, to ensure that in future and if necessary adequate food provision can be verified. The staff must be provided with 16/02/07 training in adult protection subjects, to ensure that people who use the service are protected from abuse. Night time staffing levels must 19/01/07 be increased to those previously in place (see Standard 27), to ensure that people are properly cared for. The adequacy of the current 31/01/07 night time staffing arrangements DS0000065390.V312895.R01.S.doc Version 5.2 Page 32 Requirement 2 OP9 13(2) 3 OP15 17 (2) 4 OP18 13 (6) 5 OP27 18 (1) (a) 6 OP27 18 (1) (a) The Gables Residential Care Home 7 OP27 18 (1) (a) 8 OP29 19 (1) (b) 9 OP35 17 (2) 10 OP35 20 (1) (a) (b) 11 OP38 17 (3) 18 (1) (c) (i) 12 OP38 13 (4) (c) must be regularly risk assessed and reviewed, therefore ensuring that people using the service are properly cared for. A copy of the completed risk assessment must be sent to the CSCI by the timescale indicated opposite. To ensure that people using the service are properly cared for, two waking night staff must provided should resident numbers increase above the number (11) currently living at the home. 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. 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. (Previous timescale of 20/10/06 not met) 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. This is to ensure that the residents and the staff’s interests are protected. 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. The certificate verifying the safety of the home’s portable electrical appliances must be DS0000065390.V312895.R01.S.doc 31/01/07 31/01/07 19/01/07 31/01/07 16/02/07 31/01/07 The Gables Residential Care Home Version 5.2 Page 33 renewed, therefore ensuring the safety of the people living and working at the home. 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 OP12 Good Practice Recommendations 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 inspector recommends that a full copy of the local inter-agency adult protection procedure should be obtained so that local guidance can be followed if an abuse situation arises. Consideration should be given to the development of separate staff training sheets so making sure that each workers training is individually and fully recorded. The inspector recommends that the content of the home’s current induction programme should be checked against the nationally recognised Common Induction Standards therefore making sure that new and inexperienced workers receive the correct training. 2 OP18 3 4 OP30 OP30 The Gables Residential Care Home DS0000065390.V312895.R01.S.doc Version 5.2 Page 34 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: 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. 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