Inspection on 06/11/07 for The Gables Residential Care Home

This inspection was carried out on 6th November 2007.

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

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

Other inspections for this house

The Gables Residential Care Home 08/12/08

The Gables Residential Care Home 23/04/08

The Gables Residential Care Home 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 6th November 2007 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables Residential Care Home DS0000065390.V340761.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.V340761.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.V340761.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 May 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 recently built conservatory that has not yet been brought in to use. There is a garden and limited car parking at the front of the home. A Service User Guide (Residents Information Guide) and a Statement of Purpose describing the home’s services is available on request and the provider gives other information about the home to new and prospective residents and their families verbally. A copy of the latest inspection report is also available on request. As of May 2007 the weekly charge for accommodation and services is £339.00 with an additional charge being made for hairdressing. The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second unannounced key inspection to the home. A visit took place by 2 two inspectors on the 6th and 12th November 2007 and lasted 17 hours. The pharmacy inspector also visited the home on the first day to check the management of medication. Time was split between talking to one of the owners and the manager, checking records, looking around the home, watching what was happening and talking with people. Since the last key inspection one manager has left and a new one has recently been appointed however the service has been without a registered manager for over 12 months. 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 had been completed by the manager and returned to us prior to the site visit. Surveys were also sent to residents and their relatives asking for their comments. We received 8 completed surveys from residents and 1 from a relative. Due to the on-going concerns about the service we have held two management reviews to look at what action now needs to be taken. What the service does well: What has improved since the last inspection? One of the staff members has been identified as the activity worker providing daily activities for people to join. One person said, ‘there’s always something going on’. The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 6 What they could do better: A number of the requirements made at the last inspection are still outstanding. 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. Care files need to be consistent and show that the physical, social and emotional needs of each person have been appropriately assessed. Risk assessments should be reviewed regularly and clearly show what staff need to do so that people are not placed at risk. More attention needs to be given when monitoring people’s weight and nutritional needs ensuring their health and well-being is not affected. Where necessary additional support and advice should be sought so that needs are clearly met. People were potentially being left at risk as their medication was not being safely administered and managed. A number of concerns were found during the visit with regards to food and fire safety. Due to this we asked the food hygiene inspector and fire officer to visit and look at their particular areas. Separate reports have been completed identifying what action they need to take to ensure peoples safety. A lot of concerns were found within the environment relating to hygiene, infection control, comfort and safety as it had not been maintained or cleaned to a standard that ensures the health and well being of people living there. More robust management needs to be made with regards to food stocks so that people are not offered food, which is unsafe to eat. Staffing levels were poor, with care staff having responsibility for cleaning and cooking. This is not acceptable, as it does not allow the staff time to provide people with the care and attention needed ensuring their health, personal care and appearance are appropriately met. Some minor shortfalls were found with regards to staff recruitment files. Without clear robust processes there is no assurance that people are not being placed at risk. Improvements are needed with regards to staff being provided with quality training and induction so that they are clear about the role and responsibilities in meeting peoples needs safely. The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 7 Not all health and safety checks had been carried out or where action had been identified this had not been addressed. This potentially leaves people living and working at the home at serious risk of harm. Call bell leads should be provided throughout the home so that people can alert the staff in the event of an emergency or when they need assistance so they do not come to any harm or distress. The owners need to provide confirmation that arrangements have now been made for individual bank accounts for each person they were hold money for. The owners must ensure that concerns around fire safety are addressed and that people living and working at the home are placed at serious risk. The home has been without a manager being registered with us for some time. This must be addressed and application should now be made. 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.V340761.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.V340761.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): 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 are being admitted to the home whose assessed needs are different to what the home is registered to provide and by a staff team who do not have the skills or experience to meet such needs therefore potentially leaving people at risk. EVIDENCE: During the visit we looked at the admissions information that had been used when admitting the newest residents. We were concerned to note that a number of residents had been admitted to the home following a referral from the Older Persons Community Mental Health Team (CMHT), having a formal mental health diagnosis as their primary care need. Information showed that some individuals have a history of violent and aggressive behaviour towards others. The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 10 As the home is registered to care for Older People we were concerned about the safety and vulnerability of other residents due to them being very elderly and frail. We also looked at staff training files and found that no formal training had been undertaken in relation their mental health needs and areas of potential risks. Staff had completed some training in risk assessments however this was provided through an in-house video session and therefore not felt to be adequate in addressing the identified risks. This potentially left some residents, particularly the older frail residents at risk. The registered provider must ensure that only those people for whom the home is registered to care for are admitted to the home. Since staring at the home the new manager has looked at the homes admission document as she felt that it did not allow for all relevant information to be gathered. The new documents are to be used when assessing any future prospective residents. Standard 6 does not apply as the home does not provide Intermediate Care. The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans need to clearly demonstrate that the health and personal care needs of people are being monitored and reviewed, without this people are potentially being placed at risk of harm. EVIDENCE: Individual files were in place for each of the residents. Files contained assessments, care plans, risk assessment, professional appointments/visits and diary notes. Four files were looked at. Some of the documentation belonged to another organisation. Information was not consistent throughout each file. Whilst some plans reflected the physical and emotional support needs of older people others looked mainly at person’s mental health and behaviours. In relation to risk assessments, these varied depending on the person and covered areas such as nutrition, pressure care, falls, diabetes, mental health and aggression. In one of the files information had been recorded by staff in The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 12 the diary notes about the person having verbal outbursts towards staff and others, refusing medication from a staff member and making accusation of sexual harassment however this had not been clearly detailed within the plan identifying what staff needed to do to reduce such risks. The monitoring of peoples nutritional needs were not being managed properly. One assessment stated ‘cause for concern’ in July and then ‘at risk and obese’ in August however the person had last been weighed in July. Another nutritional assessment showed the person was at ‘very high risk’ however no review had been carried out since August. It was also unclear how some people were being weighed when they were unable to weight bear. Another plan identified that this person had ongoing behaviours in relation to an eating disorder. This person had previously lived at the home, moved out, but then returned. Whilst the concerns were noted on the plan outlining that staff needed to monitor this area there was no up to date record of the persons weight or what action had been taken when behaviours had been noted on the diary sheets. To ensure that the health and well-being of all residents is maintained a clear system needs to be in place showing what the areas or concern/need are, what support is needed and evidence of regular monitoring and reviewing so that if needs change action can is taken promptly. There was evidence within the files that people were having access to other health and social care professionals. The district nurses, chiropodist, social workers and community psychiatric nurses (CPN) had made visits to the home. Reviews and risk screening had been carried out as part of the Care Programme Approach (CPA) for those people who had been placed at the home by the Community Mental Health Team and minutes were held on file. One of the newest residents was assessed has had on-going issues with regards to alcohol, which linked to violence and aggression. This was discussed with the manager with regards to how they felt they were able to manage this within the home. The manager explained that a ‘contract’ would be drawn up with the person and their CPN/social worker stating that he must abstained from drinking or would risk losing his placement at the home. This is not adequate and does not ensure that risk has been minimised or that others living at the home are protected. Information about the residents is held within the dining room in a filing cabinet and therefore easily accessible for staff however the manager said that the lock on the cabinet is currently broken and in need of repair. This should be done to ensure information about the people living at the home is kept confidential and held securely. From observations made interactions between residents and staff were relaxed and friendly. Staff were seen to support people properly, knocked on doors before entering, used individuals preferred names and spoke with them The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 13 appropriately. One resident expressed that ‘I get on with all of them and they are very helpful’. Our visiting pharmacy inspector looked at the medication system and found the medication policy was available for reference in the home but did not provide clear guidance in the safe handling of homely remedies (medicines that can be bought from a chemist). Paracetamol tablets were kept but were not safely stored and some staff didn’t know they were available. Worryingly, a box of strong prescription painkillers were also kept with the paracetamol. These can only be given to the person they were prescribed for and if no longer needed then should have been sent for safe disposal. The manager was aware that medication was not well managed because staff audits (checks) of medication handling showed medicines could not always be accounted for. We found similar examples where records showed that more medicine had been given than actually received into the home. The manager explained that following a recent audit changes had been made to the group of staff authorised to handle medication. These audits were not recorded, this is recommended to enable the manager to quickly identify whether improvements are being made. We were additionally concerned that one person’s eye drops were not administered properly for the previous two months. They were given too often for one month, then completely missed the following month. The wrong dose of a newly prescribed tablet was given to another resident for 12 days. These mistakes put residents’ health and well being at risk. Another person was prescribed a nutritional drink. There was no information in their care plan about when or how often this should be given. Records showed the person had missed meals but none showed that the supplement had been given. Senor staff said supplements were given when the person was not eating well. The safe self-administration of medication was not well supported. Risk assessments were not always completed to help ensure people receive any support they need to safely administer their own medicines. One person dropped a family-filled ‘dosette box’ so care staff now administer his/her tablets. The resident continues to manage his/her own inhalers and eye drops. When the risk assessment is completed consideration should also be given to the safest way to support self-administration of tablets should the resident wish to continue to do so. Care staff can only normally administer medicines from the original pharmacylabelled containers. These need to be promptly obtained should carers need to continue to administer the resident’s tablets. The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 14 It was not possible to tell whether all staff handling medication had completed suitable training. Strangely, one of the certificates seen listed the wrong topics under the course title. The acting manager said she would look into what training was actually provided and how it was assessed. The medication storage was mainly adequate but some medicines were kept in the draw of a filing cabinet. These would be more safely stored in one of the medicines trolleys. There was no medicines fridge for the storage of prescribed insulin. If kept in the catering fridge it needs to be in a locked box. The home did not currently handle controlled drugs but due to a recent change in the law would need a controlled drug cabinet if any were prescribed. The Gables Residential Care Home DS0000065390.V340761.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 adequate. This judgement has been made using available evidence including a visit to this service. Whilst activities are provided these do not provide opportunities for everyone to participate in stimulating and meaningful activities of their choosing. Arrangement in relation to the management of food items is poor and potentially means people are being offered found which is unsafe to eat. EVIDENCE: Routines within the home are flexible with people rising and retiring when they chose. Due to people being frail and vulnerable activities tend to take place within the home. The manager said that there is one member of staff who has been identified as an activity worker. Recent activities have included sing-alongs, arts and crafts, make up and manicure, games and sherry evenings. During the second visit to the home people were taking part in an arts and crafts session. Three residents had recently been supported on a shopping trip to Bury and there had been a Halloween party and birthday party. There is also on outside exercise group that visits the home to do armchair exercise as well as a hairdresser and weekly communion. One resident said, ‘there’s always something going on’. The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 16 Family and friends are also welcome and visits take place to the home. People are able to meet in private if they wish or in one of the communal areas within the home. A completed survey was provided by one relative who expressed, ‘excellent care’, ‘would be difficult to improve’, ‘keep up the good work’ and ‘I have total faith in their commitment and abilities’. Completed feedback surveys were also received from 8 people living at the home. Some people had been supported by staff to complete the form. All answered ‘Yes’ or ‘usually’ to receiving the care and support they need, receiving medical support, staff listen to what they say and are available when I need them, like the meals, activities are provided and now how to make a complaint. It was noted however that some of the resident were wearing soiled clothing, their hair had not been brushed and glasses worn by one lady were filthy and had not been cleaned for sometime. More care and attention should be given when supporting people to wash and dress. It is assumed that time had been impacted on due to the current staffing levels and daily tasks expected of the carers. With regards to food the majority of food items are stored within the basement for which only the owner and manager have a key. Shopping is done by one of the owners who then leaves food items out each day for staff to cook. We looked at the stocks provided. We found a lot of items stored within the 3 freezers, which were items that should not been frozen, there were also a lot of reduced priced items and meat product which had been frozen longer than the specified time. The owner explained that a lot of the items identified were for her and that she had placed them there whilst she was defrosting her freezer in the second floor flat. It was apparent however that there was no stock control or monitoring and therefore difficult to judge if sufficient food for residents was provided. The owner was asked to make sure that any items belonging to her that are stored with residents food are wrapped together so that it can be clearly identified who they belong to. In relation to dry and canned items, further items were found to be out of date, for example custard powder dated April 2007, stock cubes dated January 2007, yogurt drink dated April 2006 and tomato sauce dated February 2007. In the kitchen cupboards, tablets were found. This has previously been found at the home. It was unclear whom these belonged to. A book, which is filled in when giving first aid, was also held in the kitchen. This showed that several residents had been administered pain relief however it was unclear whether this was from this stock. Other food items found in the kitchen cupboards included items, which should have been refrigerated when opened but had not. The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 17 Due to these issues we asked the food hygiene inspector to visit. This took place when we returned on the second visit. Action was identified. A copy of the report is to be forwarded to us and the officer is to make a further visit to the home to discuss safe practice. The home has developed menus, which were displayed in the office but not in the dining room. Breakfast menus however had been placed on the tables. At present the menus are for a 2 week period, the manager said that these would be increased to a 4 week menu offering further choice. Residents were overheard saying that their lunchtime meal of meat pie, potatoes and vegetables was ‘lovely, very nice’. People were also offered extra helping. The Gables Residential Care Home DS0000065390.V340761.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. Satisfactory arrangements are in place with regards to responding to concerns however the team would benefit in further training to ensure that people living at the home are protected. EVIDENCE: The home was asked to amend their complaints procedure, this has been done and is clearly displayed within the home showing the process as well as contact details for us. The new manager has set up a file for recording any concerns or complaints brought to her attention, this too was identified at the previous inspection. One complaint has been made since the last inspection. All correspondence was held on file to evidence what action had been taken. The home has recently received a copy of the Local Authority Safeguarding Procedure in relation to protecting vulnerable adults. Training is available for both staff and management through the partnership. It is strongly advised that this is undertaken ensuring those working in the home are aware of their responsibilities in ensuring residents are protected. Other policies and procedures are held within the home. The manager explained that she is currently reviewing and amending these. The Gables Residential Care Home DS0000065390.V340761.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, 21, 25 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst the Gables provides adequate living space it is not maintained or cleaned to a standard which ensures the health and well being of people living there. EVIDENCE: The Gables is a large detached house in a residential area of Bury. There is a large lounge, dining room and conservatory, 3 bath/shower rooms and 6 single and 4 double bedrooms. At present two of the double rooms are occupied as single rooms. Time was spent looking around the home as a number of requirements had been made at the last inspection, some of which had still not been addressed. Several areas of concern were found with regards to cleanliness and quality of bedding and how often these were changed, malodour within some bedrooms, soiled carpets, areas of damp, dirty and worn furniture, overloading electric The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 20 sockets, cobwebs and staining to walls. Examples of this include, marks down a wall in the lounge where one of the residents sits. This was discussed with the Owner who said, ‘yes she spits at the wall’ and although aware nothing had been done to clean it up. Also in the lounge the television, video, fish tank, lamps and all been plugged into the double electric sockets behind the television, with a lamp being placed on top of fish tank, which was partially open at the top. Again when raised with the owner, she was aware that other sockets within the room where not being used. It was suggested that consideration was given to the lay out of equipment within the room so that sockets are not overloaded. We also found ‘poison’, which had been place in a container behind the television. The owner explained that a staff member had report hearing something. During the second visit it was that this had been removed. At the previous inspection issues were raised about the home’s alarm call system as there were no extension push button leads available, which would provide better access to the system in an emergency situation. During this visit again no leads were available however during the second visit to the home the manager stated that they had found a few leads, which were in a drawer however additional ones were required. It was also previously noted that the cancelling system after a call is difficult due to the fact that the indicator/cancelling unit is placed high on the dining room wall, which makes it inaccessible to the staff. The staff therefore have to access the upstairs indicator unit that is situated in the manager’s office. Although not explored this appears to be unchanged. Fire safety was a cause of concern as rubbish had been put in the basement instead of being disposed with, the storage of bedding and towels were kept next to the oil boiler, which had last been serviced in April 2005. Action was identified but had not been addressed. Fire doors to some bedrooms did not close properly and the new conservatory, which was the smoking room, had not been fitted with a smoke detector, the door adjoining the dining room was not a fire door and had a gap at the bottom and residents were using a plastic bin with a plastic bag as a liner as an ashtray. Furniture and other items were also placed along the stairs. The owner said that some of these were her items and the top stair case was not accessed by residents. The owner was advised that this was not separate from the main building and therefore in the event of a fire would affect those people living at the home. Action must be taken by the owners to ensure all these areas of concern are addressed and people are not place at risk of harm. Due to these concerns the local fire officer has also been contacted and a requested has been made for them to carry out a further inspection in relation to this area. We also found unwanted items being stored within the outside areas of the home and the side gate missing offering little or no security to the back of the The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 21 home. At the side of the house there is an area, which drops several feet from the path, this is not blocked off and could potentially be a hazard if someone was to fall. It was discussed with the owner and manager about the management of domestic tasks. At present due to staffing issues there was an expectation by the owner that the care staff on duty, generally 2 throughout the day, were responsible for doing the domestic tasks, care and cooking. This is not acceptable and has inevitably resulted in the standard of hygiene deteriorating. We were advised that steps were being taken to recruit for the positions of domestic and cook, however the hours allocated were only 8 hours each per week. This too was not felt to be adequate. During the second visit to the home, a domestic worker had commenced employment. The manager explained that the hours for the role had not been increased. In the laundry area and bathrooms inadequate hand washing provisions were available. One bathroom had no toilet roll, other had paper towels but no liquid soap and the toilet seat was broken. Two of the bathrooms had faeces on the handrail, toilet seat and wall. The water supply was also poor, with some bedrooms having no water to the sinks. Water temperatures were also low with readings between 28°c and 38°c. Cleaning products used by the staff were being stored in the kitchen however the cupboard had not been fitted with a lock and a bottle of bleach did not have a safety top. Suitable arrangements need to be made to ensure that items are held securely. The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. To ensure the safety and protection of people living at the home the providers must ensure that staff are robustly recruited, trained and in sufficient numbers so that needs can be met. EVIDENCE: Rotas were looked at. These had been completed in pencil and did not have the staff member’s full name. Staffing levels showed that between the hours of 9am and 9pm there were 2 carers on duty. Over recent weeks there has not been a cook or domestic. The manager and one of the owners were also at the home however it was unclear about roles and responsibilities as it appeared that catering, domestic and caring duties were to be carried out by the 2 carers on duty. It was discussed at the previous inspection about night cover and the home providing 2 wake in staff. This is not provided. Cover consists of 1 wake-in staff member with one of the owners sleeping in the flat on the second floor. As identified earlier in the report the owners need to ensure that sufficient care and ancillary staff are provided at all times so that the areas of concern identified are properly addressed. The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 23 In relation to training, records were looked at. This included information on 10 of the 12 current staff. Training had been offered by the previous manager in topics such as moving and handling, medication, first aid, health and safety, infection control and risk assessments however this had all been video training with questionnaires then completed and marked by the manager. It was felt that this was not sufficient as there was no evidence to support that the training was being provided by a competed trainer or that practice had been assessed in relation to the staff member’s level of competence in carrying out such tasks. This potentially left people at risk. NVQ training had been done with 4 staff having achieved level 2 and one person level 3. The manager was currently doing the NVQ level 4 training. Further training will also be provided for those staff yet to complete the course. The manager has also arranged a training course at the home by an external provider covering person centred planning. The manager was advised of the Bury Adult Care Training Partnership where training is available to local providers in line with competences set out by Skills for Care. During our second visit to the home the manager had been in contact with the Partnership and had arranged to attend the December meeting. The manager also explained that she would be looking at the homes induction programme as she felt this too needed further development. The manager must ensure that this is line with the skills for care induction ensuring all new staff are clear about their roles and responsibilities. Recruitment files were also looked at for the newest members of the team. Criminal records checks and/or POVA 1st checks had been carried out. A recent POVA 1st check was seen for the new domestic worker. Files had an application form, written references, and copies of identification, health declaration and contract however a short fall was found with regards to employment histories. Information should also be recorded clearly with regard to start dates so that records can be more easily audited. In relation to the manager, information was provided by the owners in a letter dated 3 August 2007 stating that they had a criminal record check dated March 2007 however had not carried out their own. In light of the fact no application has been made to register with us a further check should now be undertaken by the owners. The Gables Residential Care Home DS0000065390.V340761.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, 25 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Without clear a management structure and lines of responsibilities and accountability there is no assurance that people living at the home are receiving a quality service. EVIDENCE: The home has not had a Registered Manger in post since December 2006. With two managers having left since the last key inspection. As identified at the last inspection the homeowners had not informed us about the first managers’ absence in line with Regulation 39 of the Care Homes Regulations. In relation to the second manager, she contacted our office to advise us that she was leaving, we then had to write to the providers again requesting information about what steps they had taken to address the matter. The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 25 A further manager has now been recruited having taken up the position in August 2007, however has yet to make application to register. Through discussions with the manager she was aware that there were a lot of areas of improvement required but expressed that she was committed and wanted to make it work. As identified at the last inspection the need for clear robust management of the home had caused many of the problems identified. In recruiting a manager the home must address the concerns ensuring that there are clear lines of responsibility and accountability between the 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 outcomes however further placements have made via the mental health team. This is a category that the home is not registered for. Through discussion with the new manager we were told that she had been looking at the outstanding requirements and at what documentation was needed, such as care plans, risk assessments, policies and procedures. She also talked about developing the homes business plan identifying other areas of improvement needed and who would be responsible. In relation to quality assurance, monthly visits by the providers are not completed as they work at the home throughout the week. The new manager has reintroduced resident meeting and staff meeting. Minutes were looked at. From the resident meetings it was clear that individuals had an opportunity to express themselves and share ideas, satisfaction surveys had also been completed as part of the last meeting. This is an area of development so that feedback is sought from other people who are involved with the home, such as GP’s, social workers, relatives, district nurses etc. The results of such surveys should be summarised into a brief report outlining the responses including any dissatisfaction and of any action taken in response. A copy of the report should be made available to all those concerned. We discussed with the manager the National Minimum Data Set information to be completed for Skills for Care as no information had been provided on the AQAA. The manager was unaware of the documentation so was advised about how to access it. The home continues to hold money on the behalf of a number of residents for safekeeping. A random check was carried out on the money currently held. This was found to correspond with the records held. The owner also stated that they were in the process of arranging individual bank accounts for some residents so that money went directly into their own accounts and was not being held by them in the business account. It was stated that this was no The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 26 longer being done. The owners are asked to provided written information to confirm that this has been carried out. One of the owners takes responsibility in addressing health and safety and maintanance within the home. As identified throughout the report there were a number of concerns around health and safety resulting in the fire officer and food hygiene inspector being contacted. We also looked at safety certificates for the heating, electric and appliances within the home. The heating system is run off an oil boiler. This had last been service in April 2005, action was identified in relation to the air supply not being suitable. No action had been taken to address this. The electric circuits had been examined in 2006, this was found to be unsatisfactory and immediate action identifed. It appeared that no action had been taken to address this, other than an invoice dated April 2007. Stating that ‘remedial work’ had been carried out in March 2007. The owners were again asked to provide evidence that the areas of work identified have been addressed and that the system is safe. Records were looked at with regards to the testing of small appliances. This had been carried out by one of the owners as well as the fitting of thermostatic valves to sinks. We requested information to evidence that the owner was trained to carry out such tasks and that the machine used for testing appliance had been serviced. This was not provided. On the second visit to the home we were advised by the manager that a trained electician had now been called to carry out such test, however work to the thermostatic values was still to be addressed by the owner. The manager was advised that the owners must ensure that this undertaken by someone qualified to do so ensuring that the system is safe for residents use. Other checks had been carried out to the passenger lift, fire alarm and fire equipment. In house fire checks, drills and water temperature. The home does not have a fire risk assessment. As stated earlier in the report it was noted that the water temperature when people where bathing ranged between 28°c and 38°c. Water temperature must be maintained at 43°c. The manager said that a new thermometer was to be purchased to ensure accurate readings. The home’s accident book was looked at and showed that accidents were being recorded appropriately. Other information, which should be sent to us under Regulation 37 had not always been provided. The manager must ensure that any incidents, which potentially affect the well-being of residents, are brought to our attention. The Gables Residential Care Home DS0000065390.V340761.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 X X 1 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 1 1 X X X 1 1 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 X X 1 The Gables Residential Care Home DS0000065390.V340761.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. 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. Care plans need to reflect the current and changing needs of people having been reviewed at the required monthly intervals and where necessary updated. This is to ensure that the staff will both know what the needs of people are and they are met properly and safely. (Previous timescale of 30/6/07 not met) DS0000065390.V340761.R01.S.doc Timescale for action 03/12/07 2 OP4 18(1)(a) 28/02/08 3 OP7 15(1)(2) (b) 30/01/08 The Gables Residential Care Home Version 5.2 Page 29 4 OP8 13(4)(a) (b)(c) Risk assessments need to be developed in all areas where concerns have been identified and reviewed on a regular basis so that people living at the home are not placed at risk of harm or injury. (Previous timescale of 30/6/07 not met) The monitoring and reviewing of individual nutritional needs has to be improved so that people receive that appropriate level of support and intervention to ensure that their health and well being is not affected. Medicines must be offered as prescribed with the date and time of administration recorded, to ensure that people receive the correct levels of medication. (Previous timescale of 31/01/07 and 30/06/07 not met) 30/01/08 5 OP8 12(1)(a) (b) 30/01/08 6 OP9 13(2) 06/11/07 7 OP9 13(2) Arrangements for the handling of 03/12/07 homely remedies need to be reviewed to ensure they are stored and used safely. Complete, clear and accurate records of medication handing (receipt, administration and return) must be maintained to help ensure medicines are administered as prescribed. 03/12/07 8 OP9 13(2) 9 OP9 12(1)(b) All medication self-administration 03/12/07 must be assessed to ensure residents receive any support they need to do so safely. Sufficient staffing needs to be provided so that they are able to afford people with the level of support needed to fully address their personal care and appearance. DS0000065390.V340761.R01.S.doc 10 OP10 12(4)(a) 18(1)(a) 30/01/08 The Gables Residential Care Home Version 5.2 Page 30 11 OP15 17(2) A full record of the food provided to individual residents must be kept, to ensure that in future and if necessary adequate food provision can be verified. (Previous timescale of 31/01/07 not met) 30/01/08 12 OP15 16(2)(i) A robust system should be 30/01/08 developed to ensure that food stocks are monitored and rotated ensuring people are not given food, which is unsafe to eat. 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. 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. Adequate hand washing provisions must be provided in each of the bathrooms and laundry to ensure there is no cross infection. (Previous timescale of 30/6/07 not met. The condition of bed linen, pillows and towels must be assessed to make sure that these items are fit for use. So making sure that the people living at the home are so provided with such articles that are in suitable condition. Alarm call extension push button leads must be provided, so giving the residents better access to the system in an DS0000065390.V340761.R01.S.doc 13 OP19 OP20 23(2)(b) 23(2)(o) 30/01/08 14 OP19 23(4)(a) (b)(c) 30/12/07 15 OP21 16(2)(j) 30/12/07 16 OP24 16(2)(c) 30/12/07 17 OP24 23(2)(c) 30/12/07 The Gables Residential Care Home Version 5.2 Page 31 emergency. (Previous timescale of 30/6/07 not met) 18 OP26 23(2)(d) Standards of hygiene must be improved (i.e. faeces, cobwebs, malodours etc) must be addressed making sure that clean, pleasant and hygienic surroundings are provided and that the health and safety of the people living and working at the home is ensured. (Previous timescale of 30/6/07 not met) All staff must be provided with quality training in the topics of infection control and health and safety so that the people who use this service are not at risk from cross infection or any other form of risk. (Previous timescale of 16/02/07 & 30/6/07 not met) Prompt action must be taken to ensure that sufficient domestic and catering staff are working at the home so that care is not compromised and people live in an environment, which is clean and have food provided by someone who suitably trained to do so. (Previous timescale of 30/6/07 not met) 30/12/07 19 OP26 13(3) 18(1) 28/02/08 20 OP27 18(1)(a) 30/12/07 21 OP29 19(1)(b) Schedule 2 Staff must be safely and properly 30/01/08 recruited with all of the required checks being completed before they are employed, to ensure that workers who are suitable and fit to do this work care for the people who use the service. (Previous timescales of 07/08/06, 31/01/07 and 30/6/07 not met) Newly employed staff must be provided with structured induction training that meets the DS0000065390.V340761.R01.S.doc 22 OP30 18(1)(c) (i) 30/01/08 The Gables Residential Care Home Version 5.2 Page 32 specification of Skills for Care, therefore making sure that new and inexperienced workers receive the correct training. (Previous timescale of 30/6/07 not met) 23 OP30 18(1)(a) A programme of training needs 30/01/08 to be provided for all staff ensuring they have the knowledge, skills and competences to safely meet the range of needs for those people living at the home. This may include topics such as medication, adult protection, first aid, dementia, diabetes etc. 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. 30/01/08 24 OP31 8 25 OP35 20(1)(a) (b) Evidence that residents’ monies 30/01/08 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 not met) All significant and serious events must be notified to the CSCI so that this information can then be assessed, monitored and action taken if required. (Previous timescale of 30/6/07 not met) Action identified on the home’s DS0000065390.V340761.R01.S.doc 26 OP38 37 30/12/07 27 OP38 13(4)(c) 30/12/07 Page 33 The Gables Residential Care Home Version 5.2 23(2)(a) (b) electrical wiring circuits must be confirmed as being appropriately and fully addressed ensuring the health and safety of the residents and the staff is not put at risk. Action identified during the 30/12/07 servicing of the home’s oil boiler must also be confirmed as being appropriately and fully addressed ensuring the health and safety of residents and staff is not put at risk. The certificate verifying the safety of the home’s portable electrical appliances must be provided ensuring the safety of the people living and working at the home. (Previous timescale of 31/01/07 & 15/6/07 not met) 30/12/07 28 OP38 13(4) 23(2)(a) (b) 29 OP38 13(4) 23(2)(a) (b) 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 OP7 Good Practice Recommendations The lock to the filing cabinet where resident’s records are held should be repaired so that information is held securely and confidentially. A lockable medicines fridge should be used to store medicines requiring refrigeration. Checks (audits) of medication handling and assessment of staff competency should be recorded to help ensure improvements in the handling of medication are made and The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 34 2 OP9 maintained. 3 OP12 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. Four weekly menus should be developed and made available within the dining area so that residents are able to see what choice is available to them. 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. 4 OP15 5 OP22 6 7 OP28 OP33 The Gables Residential Care Home DS0000065390.V340761.R01.S.doc Version 5.2 Page 35 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. 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