Inspection on 11/05/05 for The Gables Retirement Home

This inspection was carried out on 11th May 2005.

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 Retirement Home 22/08/06

The Gables Retirement Home 11/10/05

The Gables Retirement Home 30/11/04

The Gables Retirement Home 10/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE THE GABLES RETIREMENT HOME Heath Road Holmewood Chesterfield, Derbyshire S42 5SJ Lead Inspector Marie Bonynge Unannounced Inspection 11/05/05 at 9.30am 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 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 RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Gables Retirement Home Address Heath Road Chesterfield Derbyshire S42 5SJ 01246 855152 01246 857761 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr David OBrien Mr David OBrien Care Home 35 Category(ies) of OP registration, with number of places THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: NONE Date of last inspection 30th November 2004 Brief Description of the Service: The Gables Retirement Home is registered to provide personal care and accommodation for up to 35 older people. The Home is situated in the village of Holmewood that has a number of shops and a public house nearby. Access is provided to community services such as GP, District Nurse, Dentist and the Optician. Services within the Home include hairdressing and activities such as dominoes, bingo and cards, trips out are also organised. There are two lounges, one of which has a dining area. The large garden has undergone futher development and there is a patio area with seating. Car parking space is provided and the home is near a main bus route. THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in May 2005. The main focus of this inspection was to monitor progress made regarding requirements and recommendations made at the last inspection and upon outcomes for service users. A tour of the building took place and records and certificates of maintenance were examined. Care plans, medication records and staffing rotas were also examined. Service users and relatives / visitors to the home were spoken with and discussions held with the management and staff. What the service does well: What has improved since the last inspection? Residents’ individual accommodation continues to benefit from the programme of redecoration and upgrading of the fixtures and fittings. Some of the bedrooms have been redecorated and the garden has been partially landscaped. Some of the windows frames have been repainted. The care plans have been reviewed and contain more detailed information about how the care needs of service users are to be met. THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4 and 5 A thorough needs assessment and trial period of residence contribute to the home being able to provide a comfortable and homely environment that meets with the expectations of residents. EVIDENCE: Residents had a contract and a statement of terms and conditions that had been signed by the resident or their representative. These included the rights and obligations of the resident and registered provider, however the fee payable had not been completed and the room to be occupied was not specified. This did not serve to protect the service user. Needs assessment information had been obtained for the three residents whose care plans were examined. The home had also completed a detailed needs assessment that included the persons’ social interests and family and community contacts. A letter had been written to the resident to confirm that the home could meet the residents’ needs at the point of admission. This served to assure the person that their needs could be met. Discussions with residents and their relatives indicated that there was a high level of satisfaction with the level and quality of care provided. One relative said that ‘nothing was THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 9 too much trouble for staff’ and a service user commented that ‘they couldn’t look after you better’. Discussions with staff demonstrated a commitment to providing a caring and homely environment. Staff spoken with had a good understanding of the needs of residents. A referral to the Psychiatrist had been made for one resident whose mental health had deteriorated and there was involvement from the Community Psychiatric Nurse for specialist input. All of the service users spoken to reported that they had been able to visit the home before making a decision to stay on a permanent basis and some residents had been to the home for day care. The Registered Manager had made every effort to ensure that residents had been able to sample the life of the home. This was an area of good practice. THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Residents’ needs are clearly set out in a plan of care that serves to underpin the care received. Medication systems are in place but are not always robust and could place service users at potential risk if the systems are not adhered to. EVIDENCE: The care plans were detailed and included instructions for staff as to how carry out the daily routine of the persons’ care. This covered the things that were important to the person such as what they liked to wear and how they preferred to be moved. A risk assessment in relation to the prevention of falls had been carried out for each resident, although this did not include an assessment of the residents’ footwear. A number of residents who were at risk of falls were wearing slippers. Information regarding falls guidance from the National Institute for Clinical Excellence was given to the Manager. The daily records had improved since the last inspection and contained information about significant events during the day. Care plans were being reviewed in the main, although one care plan did not reflect the changes to one residents’ continence and mental health. Care staff spoken with were aware of the changes to this persons health and could describe the care that THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 11 was being given to the person. Relationships with the District Nurses and local GP’s were said to be good and observations of this were made during this visit. One resident said that they if they needed to see a Doctor an appointment was made straight away. Relatives reported that they were kept informed of any changes to the needs or care of the person they had come to see. A record of weight gain or loss and nutritional status was kept although this did not always reflect the nutritional risk assessment. Residents weight was recorded three monthly where a resident was noted to need assistance with feeding and did not always take adequate diet. This did not assist in making sure that any potential problems would be detected early on. Medication systems had been reviewed and 5 requirements had been complied with that were made at the last inspection in respect of medication. The thermometer used for recording the temperature of the medicines fridge was not suitable for recording the maximum and minimum temperature of the fridge. It could not be ensured that medicines requiring cold storage were being stored at the correct temperature. A controlled drugs register had not been introduced and their storage did not meet with the Misuse of Drugs (Safe Custody) Regulation 1973 as amended. The members of staff with responsibility for the administration of medicines had attended training and received certificates of attendance. Medication Administration Charts had not always been signed, some signatures had been crossed out and the reason for not administering a medication had not always been recorded. Service users could be at potential risk if these systems are not robust. Residents’ satisfaction with the level of privacy afforded them was high with residents reporting that staff treated them with respect. THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 Activities and meals are provided that suit the expressed preferences of residents and visitors are welcomed in the home. This contributes to the pleasant atmosphere and makes for high levels of satisfaction. EVIDENCE: Four residents who were interviewed said that they felt the home provided sufficient activities and catered for their interests. The garden has undergone some improvement and residents made positive comments about being able to go out in the gardens in the better weather. Residents talked about an Indian evening they had recently had where they had tasted different foods and enjoyed the music. An old time dancing evening had also been held that residents said they had enjoyed. Residents’ interests were recorded and acted upon. Visitors to the home spoke highly of the welcome they received when they visited and said that they were always offered a drink and sometimes stayed for a meal. Many of the residents were from the local area and had established networks in the local community that they reported had been maintained and had helped them to settle in the home. A sample of menus was seen on the wall outside the kitchen. This indicated that residents had three meals each day, the main cooked meal being at lunch time. A cooked breakfast was offered twice each week and it was confirmed that this was by residents choice. Positive comments were made about the THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 13 meals provided and it was said that the food was plentiful. During the lunch time meal a resident was being assisted to eat their meal in a manner that was not conducive to being relaxed and unhurried. This was raised with the Manager at the time. THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Staff were aware of what constituted abuse, however it could not be ensured that staff would respond appropriately in all instances to safeguard the interests of residents. EVIDENCE: A Protection of Vulnerable Adults Procedure was in place and the home had signed up to Derbyshire’s multi agency procedure. Discussions with staff indicated that although they would respond appropriately in ensuring the safety of a resident they were not familiar with the local procedures for responding to allegations of abuse. Staff had attended previous training from an external company regarding adult abuse. The Registered Manager had obtained details of training for staff regarding Derbyshire’s joint adult protection procedure. THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 22, 23, 24, 25 and 26 Residents enjoy a homely and comfortable environment that has benefited from some redecoration and upgrading, the continuation of this programme will service to enhance residents day to day experiences. EVIDENCE: The proprietor has continued to upgrade and improve the environment, particularly the bedrooms and toilets. There are further plans to improve the décor and furnishings of the lounges and communal living areas. The rear garden has undergone some landscaping work and residents are beginning to enjoy the benefits of this, being able to walk outside and sit in the garden in fine weather. Residents and relatives commented that if anything could be improved upon, then it was the decoration and furnishings of the communal living space. The windows to the front of the building were in some need of painting and redecoration. The proprietor has opened up some shared rooms to make large single rooms, these provide for the option of a sitting area with comfortable seating. Residents told the Inspector that they liked their bedrooms with one resident saying that they were able to relax in their room. THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 16 Residents had brought in personal possessions such as photographs and ornaments that they said had helped them to make their living space more like home. The building was warm and well ventilated, residents said that they found their rooms to be warm enough. THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The stable and committed staff group contribute to the home being satisfactorily staffed to meet with the assessed needs of service users. EVIDENCE: A sample of staff rotas was examined for the weeks commencing from the 3rd April 2005 to week commencing 1st May 2005. These indicated that the home was suitably staffed to meet with the assessed needs of residents. The Manager assessed the dependency levels of residents on a regular basis and balance this with the skill mix of staff. Staff spoken with demonstrated an awareness of the needs of individuals. THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 37 and 38 The manager provides clear leadership throughout the home and the staff group are well supported enabling good communication systems within the home. EVIDENCE: The Registered Manager is also the Proprietor of the home and maintains a strong ‘hands on’ presence in the home. He has many years experience of working in the care sector including the care of older people. Mr O’Brien has achieved NVQ level 4 in management and care. Staff spoken with were clear about the lines of accountability and were positive about the style of management. It was reported that they could approach the Manager with any concerns or suggestions. Records had been reviewed as required at the last inspection although there were some that remained to be updated more regularly as identified in standard 8. Records were generally well maintained and up to date and were THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 19 stored securely. Service users spoken with were aware that they could access their records if they wanted to. Certificates of maintenance were examined including the nurse call system, fire alarm system and gas safety. These were up to date and had been renewed thus contributing to the health and safety of service users and staff. THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 x 2 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 3 x x x x x 2 3 THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP2 OP7 Regulation 5 15 Requirement The statement of terms and conditions must specify the fee payable and by whom. Care plans must be reviewed at least once a month and updated to reflect changing needs and actioned. The monitoring of service users weights must be done in accordance with the nutritional risk assessment. (From inspection report 30th November 2004). The maximum and minimum temperatures of the medicines fridge must be recorded daily and lie between 2 degrees Celsius and 8 degrees Celsius. Receipt, administration and disposal of Controlled Drugs must be recoreded in a Controlled Drugs register. Controlled Drugs must be stored in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973. Medication Administration Charts must be signed where a medication has been Timescale for action 1st August 2005 1st August 2005. Previous timescale 1st February 2005. New timescale 1st June 2005. 1st July 2005 3. OP8 12 4. OP9 13, 17 Schedule 3 13, 17 Schedule 3 13 5. OP9 1st July 2005 1st August 2005. 1st July 2005 Page 22 6. OP9 7. OP9 13 17 Schedule 3 THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 administered. 8. 9. 10. 11. OP9 OP9 OP18 OP23 13, 17 Schedule 3 13, 17 Schedule 3 13 23 Where a medication has been omitted the reason for the omission must be recorded. Where a signature has been crossed out the reason for this must be recorded. Staff must attend Derbyshires multi agency training regarding protection of vulnerable adults. The communal living space must be redecorated and refurbished as part of a planned and recorded programme of renewal. The windows to the front of the building must be repainted as part of a planned and recorded programme. 1st July 2005 1st July 2005 1st September 2005 1st October 2005 1st October 2005 12. OP23 23 13. 14. 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 OP2 OP7 Good Practice Recommendations The terms and conditions should specify the room to be occupied. Up to date information regarding falls prevention should be obtained. (Reference Falls: the assessment and prevention of falls in older people, National Institute for Clinincal Excellence, November 2004. Where there is a change in the dose of medication to be administered these should be chedked and signed by a second person. Staff who assist residents to eat their meal should ensure that they are sitting down and allow sufficient time for this activity. 3. 4. 5. 6. OP9 OP15 THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI THE GABLES RETIREMENT HOME CO2 C52 S19990 The Gables V226994 110505 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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