Inspection on 23/04/08 for The Gables Residential Care Home

This inspection was carried out on 23rd April 2008.

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

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 06/11/07

The Gables Residential Care Home 01/05/07

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 Lucy Burgess Unannounced Inspection 23rd April 2008 09:45 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.V361569.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.V361569.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 0161 764 6593 Mr Ghennessen Pumbien Mrs Radha Rajcoomaree Pumbien ** Post Vacant *** 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.V361569.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. 6th November 2007 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 conservatory, which is the designated smoking lounge. 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. The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a key inspection carried out by 2 inspectors, which included a site visit and took place over one day, for a period of 9 hours. The service did not know that the inspectors were going to visit. During the inspection care and medication records were looked at as well as information about the staff and health and safety including how the home and the equipment were kept safe. The inspectors also looked around the building to check if it was clean and well decorated. A random inspection was also carried out in January 2008 due to the number of issues previously identified. Time was spent during that visit looking at progress made and areas still requiring action. Information has been added to this report. As part of the inspection process the provider’s are asked to complete a selfassessment survey information document (Annual Quality Assurance Assessment). This was sent to the home before the inspection and had been completed by one of the providers and the deputy manager and returned to us prior to the site visit. Other information was gathered from the feedback surveys we sent out. We received completed surveys from 7 people living at the home and 6 staff. We also spent time speaking with residents, members of staff, a relative and a training assessor who was visiting the home. Comments have been added to the report. As of May 2007 the weekly charge for accommodation and services is £339.00 with an additional charge being made for hairdressing. During the visit the provider was asked for the up to date scale of charges however was unable to provide the information. This has been requested. Since our last key inspection another manager has left, therefore the home does not have a Registered Manager. Due to the on-going concerns about the service we have held six management reviews to look at what action needs to be taken. Discussion and feedback was held with Mrs Pumbien, one of the owners of the home. The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The atmosphere within the home appeared more settled and relaxed with a reduction in some of the behaviours displayed by people. Whilst the general environment still requires attention it was clear that improvements had been made to the standards of hygiene. Rooms appeared cleaner and fresher providing more comfortable living accommodation for people. The way in which food stocks are managed appeared better with items being rotated and used within date ensuring people are not given meals of a poor quality. Care plans had improved providing up to information about people and any changes that had taken place. This provided staff will clear details about how they are to support people in meeting their needs. The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 7 Records in relation to the administration of medication had improved showing what people were being given. What they could do better: Mr and Mrs Pumbien are reminded that only those people the home is registered to care for should be admitted to the home. This will ensure that their needs can be met and people are not placed at risk. The home has been without a registered manager for some time. This must be addressed and application should now be made. An immediate requirement was made with regards to water temperatures as these were again too high and potentially place people at risk of harm or scalding. A second immediate requirement was made in relation to the safe storage of medication as the medication was being stored in the office, which could not be locked. This could potentially leave people at risk of harm. All areas identified in the risk assessments need to be completed so that an accurate scoring is recorded and the appropriate level of support is provided ensuring risk is minimised. The providers have started to make some improvements to the general environment. They are asked to provide us with a programme of redecoration and refurbishment along with timescales for completion so that people living at the home live in comfortable pleasant surroundings. An up to date training matrix is to be provided showing the specific training needs of staff so that they have the skills to meet the needs of people living at the home. This should also include a detailed induction programme in line with the competences set out by Skills for Care. The Providers must provide confirmation that arrangements have now been made for individual bank accounts for each person they hold money for. Mr and Mrs Pumbien must ensure that concerns around fire safety are addressed so that people living and working at the home are safe. Job descriptions should be developed so that staff are clear about what responsibilities are held by the registered manager, deputy manager and senior carer. An up to date copy of the homes statement of purpose and service user guide is requested. This should provide clear information about what the home is registered to provide and what people can expect should they move into the home. The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 8 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.V361569.R01.S.doc Version 5.2 Page 9 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.V361569.R01.S.doc Version 5.2 Page 10 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, 3, 4 and 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People continue to be admitted to the home whose assessed needs are different to what the home is registered to provide and supported by a staff team who do not have the skills or experience to meet such needs therefore potentially leaving people at risk. EVIDENCE: Concerns were noted during our last key inspection in November 2007 that people were being placed at the home that did not fall into the category of older people requiring personal care support. Due to this enforcement action has been taken. During this visit a further person was admitted to the home. We were concerned to note that there had again been a referral from the Older Persons Community Mental Health Team (CMHT). We looked at the persons assessment information to establish their care needs and if these could be met The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 11 by the home. It was evident from the information provided that the person has a formal mental health diagnosis as their primary care need. Information showed that they required support in managing their mental health and had a history of hospital admission under the Mental Health Act. Time was spent talking with Mrs Pumbien about the homes current registration and plans to vary the categories to include mental disorder. We asked Mrs Pumbien to considered the mix of frail elderly with people with mental health needs, the potential risks and how these were to be managed. We did however observe the staff supporting and assisting the new resident to settle into the home. Staff were reassuring and spent considerable time talking with the person sharing information about the home as well as establishing what preferences, routines the person had. We spoke with the new resident who expressed that ‘the staff had made her very welcome’ and that she was ‘quite comfortable’. In relation to meeting peoples needs staff still require training specific to the support required particularly in relation to mental health. The deputy manager explained that she too had identified this for the team and had requested this from Mr Pumbien. Without such training there is no assurance that the specific needs of people can be met. Whilst looking around the building we saw brochures about the home in each of the bedrooms. These appeared to have been updated. We asked for a copy to be provided. The Providers are reminded this will need to be kept under review and amendments made if there are changes to their registration. Standard 6 does not apply to The Gables as they do not provide an intermediate care service. The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 12 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. This judgement has been made using available evidence including a visit to this service. Care plans show what support each person needs however the risk assessments need to be expanded upon to ensure they accurately reflect concerns and action required. Medication storage also needs to be improved so that this is safe and people are not placed at risk. EVIDENCE: The deputy manager, senior carer and care staff take responsibility in developing, monitoring and reviewing the care plans and risk assessments. Improvements have been made to the records. Care plans were looked at for those people where previous areas of concern had been found and for those individuals where there had been changes since our last visit. Information had been updated to reflect the changing needs of people or progress being made. Generally plans were being reviewed on a monthly base and formal review meeting with the local authority had also taken place. The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 13 It was also evident that the health care needs of people were also being addressed with additional support from relevant health professionals such as the dietician, district nurse and optician. In relation to risk assessments, these still required some improvements. Areas of special risk such mental states, health etc, moving and handling and pressure care assessments had not been scored and therefore did not provide an accurate outcome score. The Providers need to ensure that staff completing the assessments have received the necessary training and support and fully understand the risk assessment process so that information is accurate and areas of potential risk are addressed. Concerns were identified within the review notes of one person. Whilst it was felt within the review meeting the home was meeting the persons needs and there had been no concerns around past behaviours. Issues were raised as the person expressed discontentment and boredom. It also appeared from reading their daily records that they were missing meals and spending more and more time in their room isolating themselves from others. Appropriate action should be taken to support this person so previous areas of concerns do not reoccur as this would potentially leave people at risk of harm. We also looked at daily records for those people with diagnosed mental health problems to see if their needs were being met. Records generally showed that people were settled, there had been no incidents in relation to behaviours. Other records are maintained with regards to daily reports, nutritional charts and monthly weights. These are done more frequently if concerns have been identified. The medication system was looked at. All medication is supplied by BOOTS pharmacy and further training has been planned with them for the staff team. On examination of records we found information on all items brought into the home and those returned to the supplying pharmacist. A signature list is also on file for those staff responsible for administering medication. Observations of practice have also been undertaken with some members of the team to ensure that practice is safe. This remains outstanding for 3 people. Stocks appeared well managed. The deputy manager and senior carer take responsibility for the management and reordering of medication. In the records for one person we noted that they were in receipt of PRN mediation to aid sleep and reduce certain behaviours. However looking at the administration of this medication over the last month we found that this had been refused on 10 occasions, that the MAR sheet had not been signed on 3 occasions and on 1 occasion no medication at all had been given, as the person was asleep. This medication was also only being offered at night although the prescription stated it could be given in the morning and night. The deputy manager explained that this had been discussed with the social work team and The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 14 that medication had been changed. This needs to be clearly shown on the records. Another person was identified as having changes in medication due to behaviours. A letter had been provided by the GP stating what the changes were. During our visit a further visit was made by the consultant to review the medication again. In relation to the storage of medication the trolley is now stored in the office on the 1st floor. The trolley was not secure and the door is not fitted with a lock therefore unsafe. An immediate requirement was made requesting a lock be fitted. We discussed with Mrs Pumbien the practicality of having the trolley stored upstairs. She advised us that this made administration easier as they could easily access bedrooms and had been made at the staff’s request. On speaking with the staff they said that whilst in the morning it was easier, throughout the day it was more difficult and felt that it was better stored downstairs. We asked that Mrs Pumbien explore this with the staff team. A separate fridge is available and sited in the dining room. This was locked and record of temperatures had been recorded. The Gables Residential Care Home DS0000065390.V361569.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. This judgement has been made using available evidence including a visit to this service. Activities are provided both in and away from the home, which people are encouraged to participate in should they choose. Improvements have been made with regards to food stocks and meals served looked appealing and were enjoyed by people living at the home. EVIDENCE: People living at the home are supported in various ways depending on their needs and abilities. Each follow routines of their own choosing including activities both in and away from the home. Several individuals access the community independently, visiting local shops, the community centre and pubs. One person who attends the community centre is learning computer skills. Other people visit the centre for social gatherings. They have recently taken part in a jumble sale, which was supported by both staff and residents. There are plans to take part in another sale with the proceeds being used for a day trip. At the home occasional activities are offered these include karaoke, arts and crafts, nail care and chatting and reading the papers. There is also on outside The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 16 exercise group that visits the home to do armchair exercise as well as a hairdresser. On person likes to spend time doing puzzles and drawing. One person living at the home had recently had a placement review. Minutes showed that the person had expressed some ‘discontentment and boredom’ at the home. This should be explored so that areas of potential risk do not arise due to the frustration felt by this person. People have opportunity to spend time with family and friends both in and away from the home. People are able to meet in private if they wish or in one of the communal areas within the home. A residents meeting was held on the 25th March. People discussed the activities available. Some people were interested in having a pool table as well as starting a vegetable garden. People were also asked if they would like to change the menu, everyone agreed they were happy with things at the moment. Some time was also spent talking about key workers and the fire drill. Completed feedback surveys were also received from 7 people living at the home. Some people had been supported by staff to complete the form. Overall people answered ‘always’ and ‘usually’ to receiving the support they need, liking the meals, the home being clean and tidy and knowing how to make a complaint. One person stated ‘I am happy here’. In relation to peoples appearance this had improved. Some people had recently had their hair done by the hairdresser, were wearing clean clothing, their hair had been brushed and they were wearing their glasses and hearing aids. Staff interacted well and spent time with people talking, enjoying an open friendly rapport. During our random visit in January action had been taken to address some of the concerns we had previously found in relation to stocks of food. During this visit we again examined food stocks and menus. Food items stored within the basement and freezers were better managed. Only one item had exceeded the use by date. Shopping is done by Mrs Pumbien who then leaves food items out each day for the cook. Menus have recently changed with more processed items being purchased such as pies etc. Since our last key inspection the food hygiene inspector has again visited the home to follow up on action identified. This has been addressed. The main meal is served at lunchtime and prepared by the cook. Breakfast and a lighter tea are prepared by the care staff. We observed the meal served for lunch, which appeared to be nicely cooked. This was beef burgers, potatoes, cabbage, carrots and gravy followed by bread and butter pudding for desert. The person who had just moved into the home is vegetarian. Time The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 17 was spent talking with them exploring what types of food and meals they liked to eat so that suitable arrangements could be made. Advise and support is accessed from the dietician should this be required. Supplements are provided where necessary. Assessments and food/liquid intake charts are completed as well as monthly weight records ensuring the nutritional needs of people are monitored. The Gables Residential Care Home DS0000065390.V361569.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. This judgement has been made using available evidence including a visit to this service. Suitable arrangements are in place with regards to responding to concerns however the team would still benefit from further training to ensure that people living at the home are protected. EVIDENCE: The home has an up to date complaints procedure, which is displayed within the home and easily accessible to the people living there and visitors. During our previous visit a file had been put in place to record any concerns or complaints raised within the home. Information provided on the AQAA stated that there had been 1 complaint. We asked Mrs Pumbien to clarify what the issue was however she was unable to provide any information. All 7 people who returned the feedback surveys confirmed they knew how to make a complaint and said they would speak with ‘the deputy manager and carer worker’ if they were not happy. The home has a copy of the Local Authority Safeguarding Procedure in relation to protecting vulnerable adults. Whilst some staff have previously undertaken training in relation to adult protection, further training is required in relation to the new policy and procedure. This will ensure staff are fully aware of the procedure to follow should an issue arise. Discussion was held with the deputy manager in relation to sourcing relevant training for staff. The Gables Residential Care Home DS0000065390.V361569.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, 20, 24, 25 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Further improvements are required to the property so that people live in a pleasant, safe and well maintained home. EVIDENCE: We spent some time looking around the home following up on previous issues, which had been identified. Some improvements were found. Hand-washing provision were now available within toilets, bathrooms and the laundry. Chemical items had been stored safely within the kitchen. Bedding was clean, several bedrooms had been painted and generally the environment appeared cleaner and fresher. However there were still a few areas, which had still not been addressed. These included; • Rubbish building up again in the cellars • Boiler door unlocked and the front of the boiler was off The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 20 • • • • • Sink within the laundry required cleaning Fryer in the kitchen was in need of cleaning In the downstairs bathroom the clinical bin had no lid. Water temperatures were still reading up to 55°C Outside the home some rubbish had been removed however the out houses were still full, flags are uneven and the gate would not open. This is a means of escape from the rear of the property. The providers are asked to provide a rolling programme of outstanding work in relation to redecoration and refurbishment of the home along with timescales for completion. It was also previously noted that the cancelling system for the call bells does not work in the dining room and staff therefore have to access the upstairs indicator unit that is situated in the manager’s office. This should be repaired or replaced so that staff are able to easily access and manage the system. Fire safety remains a cause of concern. Arrangements were made by the Providers for an external assessment to be carried out. This has been done and an action plan has been provided in relation to work required. Whilst the Providers have started to address some of the issues, other areas remain outstanding. This information was also provided to the local fire officer following his visit to the home January 2008. All action must be taken by the Providers to ensure all these areas of concern are addressed and people are not placed at risk of harm. At present the majority of domestic tasks are undertaken by the domestic who works from 9am and 11.30 am each weekday, with no cover at weekend. Some of the additional tasks are undertaken by care staff. It was clear from looking round the home that the domestic staff has worked hard to improve the standards of hygiene and cleanliness throughout the home. Mr and Mrs Pumbien are asked to keep this under review depending on the support needs of people living at the home. The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. Whilst recruitment practice had improved, staff still require the relevant training and support required for their role so that they are able to meet the needs of people safely. EVIDENCE: In relation to staff we were advised that the deputy manager has been delegated much of the responsibility for supervising and supporting staff, recruiting new staff as well as planning and monitoring training. Whilst some areas still require further development it was apparent that the deputy manager has worked hard in trying to make improvements in these areas. Staffing levels were looked at. Two new night staff have recently been employed and at present there are no vacancies. Staff on duty during our visit included a cook, domestic, carer, senior carer, deputy manager and Provider. Rotas showed that there is only 2½ hours allocated each morning for the cook. Breakfast is usually prepared by care staff, as is the evening meal. In relation to domestic hours these too are 2½ hours each week day morning with no cover at weekend. Other tasks are undertaken by care staff. Night cover remains the same with a wake in staff member as well as either Mr or Mrs Pumbien sleeping in the flat on the second floor. The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 22 As previously identified Mr and Mrs Pumbien need to ensure that sufficient care and ancillary staff are provided at all times so that the areas of concern identified are properly addressed. In relation to training, the deputy manager has started to develop a training matrix, which identifies the training needs of staff. We requested that this was brought up to date and a copy sent to us. Some courses have already been planned these include incontinence care, fire safety and medication. As already stated a request has been made to Mr Pumbien for a course in mental health. We discussed with the deputy manager the support and training offered through the local authority training partnership group who provide quality training in line with the competences set out by skills for care. The deputy manager was aware of the group due to the previous manager making initial contact. This was to be followed up. NVQ training has also been offered. Some of the staff have already achieved Level 2 whilst others are working towards achieving the award. Up to date figures for this have been requested within the training matrix. An NVQ assessor visited the home, whilst we were there, to meet with one of the members of staff. This member of staff was said to be progressing well through the course and appeared pleased with the progress she was making. Further support was provided by the deputy manager who offered very positive feedback and encouragement to the carer. The deputy manager has also commenced Level 4 in management and Mrs Pumbien is currently undertaking the Level 4/Registered Manager’s Award. We also clarified with the deputy manager what induction training is undertaken by new staff. At present this is a general checklist covering day to day work practices within the home. The deputy manager was advised of the requirement in this area and advised of how to access the relevant information. Recruitment files were looked at for the 2 newest members of the team. Information included an application form, references, copies of identification, health declaration, POVA 1st checks and Criminal Record Check (CRB). The CRB had not been received for 1 member of staff and therefore Mrs Pumbien was undertaking a wake in shift with the person ensuring they were not left working unsupervised. Information held on file had improved. The deputy manager was asked to ensure that the start dates were clearly recorded and that a detailed employment history had been gathered ensuring any gaps were explored. Time was spent talking with the staff on duty. Each of them felt that improvements were being made within the home and that communication between the team and the owners was improving. Our observations of staff on duty during the visit were that they worked effectively and efficiently as a The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 23 team and were clear about their own responsibilities. Good practice was seen as well as positive interactions with people living at the home. Feedback surveys were received from 6 staff. They expressed that whilst they felt able to carry out their roles, ‘communication could be improved upon’, and that the ‘deputy manager does supervisions and is always around for support and advice.’ Other comments included, ‘we meet the individual needs of service users’, ‘the service provides a warm and friendly place for elderly people and tend to their everyday need’, ‘it tries to encourage them with activities and social events’ and ‘I would like to see more outings for people’. The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 24 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 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A clear management structure needs to be in place to ensure that staff are supported in carrying out their duties and that people living at the home receive a quality service, which meets their needs. EVIDENCE: As identified at the previous key inspection there have been a number of changes within the management of the home over the last 12 months. Since our last visit in November a further manager has left. This has meant that the home has been without a registered manager since December 2006, which is cause for concern. This was discussed with Mrs Pumbien, one of the providers. We were advised that she is going to make application as the manager. At present she is The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 25 waiting for information from her GP. On receipt of this she can then submit the application form to us. As stated earlier we received a completed AQAA prior to our visit. This had been completed by the deputy manager and Mr Pumbien. One of the senior carers has also been appointed deputy manager. Her role will be to work along side Mrs Pumbien in the office. At present it appears that management duties are being undertaken by the deputy manager and not Mrs Pumbien. The Providers are asked to draw up a clear job description for the registered manager role, deputy manager role and senior carer. This will ensure that the team are clear about the individual responsibilities of senior staff as well as ensuring there are clear lines of responsibility and accountability between the deputy manager and owners. We also have serious concerns about the people being admitted to the home in relation to their primary care needs. The local authority commissioners had been written to following the last inspection about the quality rating however a further placement has been made via the mental health team. This is a category that the home is not registered for. Following our visit in November we held a management review and enforcement action was taken. Mr and Mrs Pumbien were interviewed under caution in line with the Police and Criminal Evidence Act (PACE) and accepted a ‘simple caution’ in relation to a breach in registration. We were informed by the deputy manager that Mr Pumbien had completed a variation form requesting to add the category of mental disorder (MD) to the homes registration and that this had been forwarded to us. However this has yet to be approved and a further admission has been made out of category. The area of quality assurance was not explored during this visit due to the number of outstanding requirements and issues at the home. This will be looked during our next inspection. Only a few people are supported by the Providers in managing their finances. Mrs Pumbien previously advised us that arrangements were being made for individual bank accounts for some of these people. We asked if this had been completed. Again Mrs Pumbien was unable to provided this information and stated that Mr Pumbien was managing this. The owners are asked to provided written information to confirm that this has been carried out. We discussed staff supervision with the deputy manager. A plan has been put in place but has yet to be undertaken with each member of the team. Sessions are to be conducted by the deputy manager and the senior carer. With the deputy and senior then supporting each other. The deputy manager is aware of the requirement in this area. The Providers must esure that the The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 26 deputy is also supported in her role by someone suitably qualified and experienced to do so. Issues in relation to health and safety were also explored to see what progress has been made. Action previously identified in relation to the oil boiler, electric circuits and small appliances have now been addressed. The Providers have also had a fire risk assessment completed. This has identified a number of areas, which require attention. A copy of this has been provided to the fire officer. Previous action identified in relation to the servicing of the oil boiler, small appliance and main electric circuit had been addressed when we visited at the random inspection. Further clarity was needed with regards to the electric check. This was provided during this visit and found to be in order. A further area of concern remains in relation to water temperature. Records of checks carried out by staff showed that temperature ranged from 22°C to 55°C. Water temperature must be maintained at 43°C so that people are not placed at risk of harm or scalding. An immediate requirement was left with Mrs Pumbien requesting that appropriate action is taken within 24 hours. We were contacted the day after our visit by Mr Pumbien and advised us that action had been taken to reduce temperature and that arrangements were to be made for some of the thermostatic valves to be replaced. It was agreed that these would be completed by the 2nd May 2008. We were not aware of any accidents or incident occurring within the home. The deputy manager is aware that information in line with Regulation 37 is provided with regards to any incidents, which potentially affect the well-being of residents. The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 1 X X X 2 1 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 1 1 X 1 The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 28 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)(d) Requirement People should not be admitted to the home unless there assessed needs are that for which the home is registered to provide. This potential leave people at risk. (previous timescale of 30/04/08 not met) Staff need to receive comprehensive training and support to evidence that they have the knowledge and skills needed to meet the assessed needs of people who are admitted to the home, so that people are supported appropriately and safely. (Previous timescale of 30/4/08 not met) Risk assessments need to be completed by staff that have been trained to do so ensuring all relevant information is recorded and reflects an accurate outcome so that people living at the home are not placed at risk of harm or injury. (Previous timescale of 30/6/07 and 30/4/08 not met) DS0000065390.V361569.R01.S.doc Timescale for action 03/06/08 2. OP4 18(1)(a) 30/06/08 3. OP8 13(4)(a) (b)(c) 30/06/08 The Gables Residential Care Home Version 5.2 Page 29 4. OP9 13(2) Changes to prescribed medication should be clearly recorded on the MAR sheet to help ensure medicines are administered as prescribed. (Previous timescale of 3/12/07 and 30/4/08 not met) Immediate action was identified to ensure that medication was being stored safely and securely so that people were not placed at risk of harm. That all areas of concern noted within the report in relation to the condition and safety of the environment are acted upon so that people living at the home are safe from harm. (Previous timescale of 30/01/08 and 30/4/08 not met) That a programme to improve the physical environment including refurbishment and redecoration is development along with timescales for completion. A copy of the programme should be forwarded to the CSCI. The providers must keep under review the hours provided by domestic and catering staff so that this does not impact on care staff and compromise the support required by people living at the home. (Previous timescale of 30/6/07 and 30/4/08 not met) A detailed employment history should be provided for all new staff and any gaps explored. A start date should also be recorded so that information can be easily audited ensuring DS0000065390.V361569.R01.S.doc 30/06/08 5. OP9 13(2) 24/04/08 6. OP19 13(3) 23(2)(b) 23(2)(o) 30/06/08 7. OP19 23 30/06/08 8. OP27 18(1)(a) 30/06/08 9. OP29 19(1)(b)S chedule 2 30/06/08 The Gables Residential Care Home Version 5.2 Page 30 workers who are suitable and fit to care for the people who use the service. (Previous timescales of 07/08/06, 31/01/07, 30/6/07, 30/01/08 and 30/4/08 not met) 10. OP30 13(3) 18(1) Mr and Mrs Pumbien are asked to provide a programme of training for staff. This should include topics such as infection control, health and safety, safeguarding, diabetes etc so that the people who use this service are supported by staff who are skilled and competent in carrying out their duties. (Previous timescale of 16/02/07, 30/6/07 and 30/4/08 not met) Newly employed staff must be provided with structured induction training that meets the specification of Skills for Care, therefore making sure that new and inexperienced workers receive the correct training. (Previous timescale of 30/6/07, 30/01/08 and 30/4/08 not met) The Responsible Individual should make an application to have the presently employed manager approved and registered with us 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. (previous timescale of 30/01/08 and 30/04/08 not met) The Providers must develop job descriptions for the position of registered manager, deputy manager and senior carer clearly DS0000065390.V361569.R01.S.doc 30/06/08 11. OP30 18(1)(c) (i) 30/06/08 12. OP31 Section 11Care standards Act 2000 30/06/08 13. OP31 17(2) schedule 4 30/06/08 The Gables Residential Care Home Version 5.2 Page 31 evidencing the responsibilities held by them and the delegation of roles. 14. OP35 20(1)(a) (b) Evidence that residents’ monies 30/06/08 have been placed in their own individual bank accounts must be provided. This is to ensure that the resident’s best interests are protected. (Previous timescale of 31/01/07, 30/6/07 and 30/4/08 not met) All staff must be offered formal supervision and support in line with the standard and records made of such meetings. Serious concerns need to be addressed in relation to regulating water temperatures. These should be maintained at 43°C so that people are not placed at risk of harm or injury. (Previous timescale of 30/01/08 not met) Action must be taken to address issues in relation to fire safety within the home so that people living and working there are not placed at serious risk or harm or injury. (Previous timescale of 30/12/07 and 30/4/08 not met) 30/06/08 15. OP36 18(1)(2) 16. OP38 13(4) 02/05/08 17. OP38 23(4)(a) (b)(c) 30/06/08 The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP12 Good Practice Recommendations That up to date copies of the home statement of purpose and service user guide are forwarded to the CSCI. The range of planned social and recreational activities needs to be monitored and reviewed so that the all people using the service are able to join in activities, which are stimulating and of their choosing. The accessibility of the home’s alarm call indicator/cancelling equipment should be reviewed so reducing any unnecessary inconvenience for the staff. Arrangements should be made for those staff yet to complete NVQ do so. 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 that these people have access to information about how well the home is performing in meeting their needs. 3. OP22 4. 5. OP28 OP33 The Gables Residential Care Home DS0000065390.V361569.R01.S.doc Version 5.2 Page 33 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.V361569.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!