Inspection on 19/01/06 for The Gables, Truro

This inspection was carried out on 19th January 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gables, Truro 04/06/09

The Gables, Truro 05/06/08

The Gables, Truro 28/06/07

The Gables, Truro 08/06/06

The Gables, Truro 07/06/05

The Gables, Truro 05/01/05

The Gables, Truro 19/07/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Gables Newquay Road Goonhavern Truro Cornwall TR4 9QD Lead Inspector Ian Wright Announced Inspection 19th January 2006 13:00 The Gables DS0000008970.V276962.R02.S.doc Version 5.1 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 DS0000008970.V276962.R02.S.doc Version 5.1 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 Adults 18-65. 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 DS0000008970.V276962.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Gables Address Newquay Road Goonhavern Truro Cornwall TR4 9QD 01872 571030 01872 571030 choicecareservices@yahoo.com 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) Mr John Aubrey Nicholls Mrs Rebecca Jane Warren Mr John Aubrey Nicholls Care Home 9 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (1), Physical disability (4) of places The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 9 adults with a learning disability (LD) Service users to include up to 4 adults with a physical disability (PD) Total number of service users not to exceed a maximum of 9 Date of last inspection 7th June 2005 Brief Description of the Service: The Gables is registered to provide care for nine service users with learning disabilities (of which four may have a physical disability). In addition to this the home offers Day care (for which there are two workshops situated at the rear of the home); Respite care; holidays for service users who have a learning disability. The home is situated in the village of Goonhavern, which is between Perranporth and Truro. The registered providers Mr Nicholls and Ms Warren live on the premises. The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over nine and a quarter hours. The inspection was carried out on an announced basis. The primary focus was regarding requirements from the previous inspection. Core standards, and other standards not inspected on the last inspection, were also inspected. The inspector was able to speak to some of the service users, and several of the staff on duty. The inspector examined the medication system, staff and care records, and inspected the building. What the service does well: What has improved since the last inspection? What they could do better: Despite satisfaction expressed by service users, inspections are still resulting in an above average number of statutory requirements. In this report there are ten. Of these, three have been renotified at least three times. There are renotifications of firstly, the need to improve training required by regulation, and secondly for at least one of the registered providers’ to complete National Vocational Qualifications in care and management. Training is essential so management and staff are competent to carry out their roles. The registered providers have been served with a statutory requirement (enforcement) notice regarding the need to improve staff training. This has led to improvement but some aspects of the notice are still not complied with. This The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 6 issue will be reinspected in March 2006. If there is a failure by this date to comply, prosecution could follow. The third requirement is for the registered providers to take precautions against the risk of Legionella. This is vital so service users can be assured appropriate health and safety standards are maintained. Enforcement action could follow if the registered providers fail to comply with the above three requirements. Other issues, which require improvement, include for the registered providers to develop: • An effective policy and procedure regarding pre admission assessment. New service users and funders need to feel assured service users’ needs can be met by the providers. • Care planning for all service users. This must include appropriate day-today record keeping and review. Effective care planning, record keeping and review will ensure service users needs are satisfactorily recorded. For example this will improve consistency of care. • Risk assessment procedures regarding the restriction of service users’ looking after their own money. This will ensure any restrictions are regularly reassessed, and if possible, independence developed. • A system for issuing service users with terms and conditions of residency / contracts when they move into the home. This will ensure service users and their representatives are aware of users’ rights and responsibilities. • The death and dying policy to also include issues of ageing and illness. This will ensure issues of ageing and illness (as appropriate) are considered for example as part of the care planning process. • Rigorous procedures for reporting any suspected cases of abuse. This will ensure service users’ are appropriately protected. 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 DS0000008970.V276962.R02.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 Information provided to service users on admission, needs to be improved. Although a service user guide is issued, service users must have a statement of terms and conditions /contract (as applicable). The registered provider must develop a pre admission assessment procedure, so the providers can assure service users they can meet users needs. Service users can visit before admission is arranged so they can assess whether they would like to live at the home. Suitable links have been developed with external professionals. EVIDENCE: The registered providers have developed a suitable statement of purpose and service user guide. The service user guide has been issued to service users, and a copy is kept in bedrooms used for respite or holidays. However due to many of the users poor literacy skills, it is suggested a copy of the service user guide is also issued to next of kin / service user representatives. Although the provider gains a copy of a social services assessment for new service users, there is still no evidence the registered provider completes pre admission assessments. There is no pre admission assessment policy or assessment form as outlined within the national minimum standard. An appropriate policy and procedure must be developed. The registered provider is developing a training programme so staff can develop appropriate skills to work with service users. Three staff are enrolling to complete a National Vocational Qualification in care. One staff member is currently undertaking this training. There is contact between staff and external The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 9 professionals. Links with GP’s, psychiatrist’s chiropodists and district nurses are satisfactory. Two service users from outside Cornwall have placements monitored by social workers at least annually. There has been some input in the past from a community nurse specialist in learning disabilities. However support for Cornwall Social Services is limited-for example no Social Worker monitors placements arranged by the county. The Inspector has written to social services to express concern. Currently no advocacy services are involved in service users’ care. There are no service users from ethnic minorities are accommodated. Service users are able to visit The Gables before formal admission is arranged. A number of service users have stayed for a period of respite before formal admission is arranged. A suitable statement of terms and conditions of residency /contact has been drawn up by the registered provider. However the Inspector could only find one completed copy of a statement of terms and conditions of residency issued to a service user on file. However copies of contracts issued by social services were on some service user files. The registered provider must issue a completed statement of terms and conditions of residency or contact (as applicable), as part of the service user guide, to all service users accommodated. A copy must be maintained on service user files. The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 The care plan system in operation enables staff to know what care individual service users need. However each service user must have a care plan, and the system of review must be improved. Daily records also need improvement. Although there is some evidence of service users being involved in decisionmaking and participation, in the home and community, it is recommended further opportunities are explored. Risk assessment processes are satisfactory although the management of service user moneys must be covered through risk assessment. All information is stored confidentially. EVIDENCE: Care records were inspected. Service users who live permanently at The Gables all have a care plan. This contains satisfactory information to enable staff to deliver care. However three service users who are admitted for respite do not have a care plan. Review of care plans is variable. It is recommended formal reviews are held with external professionals to assess the effectiveness of placements, and to assist the development of service users. Daily notes are kept regarding any occurrences regarding individual service users. Some entries could be regarded as very subjective, and extra care needs to be taken with terminology and descriptions of behaviour used. Some The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 11 service users staying for respite only have very basic daily records kept. It is advised daily notes for these service users are kept in a similar manner to other service users. There is only limited evidence of service users being involved in decisionmaking. The registered providers said discussion regarding life in the home is carried out on an informal basis. For example no formal reviews or residents meetings take place. Staff manage the bulk of service users’ monies. The receipt of personal allowances and expenditure is documented. Service users however look after small amounts of their money. Two of the staff act as appointees for two service users’ benefits. There is some evidence of service user consultation and participation in home life. The registered providers said they try to involve service users in decisionmaking through informal discussion. Service users have some involvement in domestic tasks around the home for example laying tables, doing their laundry and cleaning their bedrooms. There is some evidence of encouraging service users to take risks for example one service user goes to the shop on their own. Other possibilities for developing service user involvement were discussed. It is recommended the registered provider explores further possibilities for providing service users with further choices, and opportunities for consultation. Opportunities for further participation in community life, within a risk assessment framework, should also be explored. Some risk assessments are in place for each individual service user. These primarily cover risks service users present to themselves and to other people. The management of service user moneys / appointeeship by staff must also be covered by individual risk assessment. Issues covered should include for example, what risks are presented by service users managing their own money, what control measures are put in place, and a date when these issues will be reviewed. All records are stored confidentially in the owners’ accommodation, which is adjacent to the home, or in a locked cupboard in the home. The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 15, 17 The registered providers provide limited opportunities for service users personal development and further opportunities should be explored. Service users have appropriate opportunities to maintain personal and family relationships. Arrangements for meals are satisfactory. EVIDENCE: The registered providers said there is currently no external professionals working with service users to develop social, emotional, communication and independent living skills. Service users have some limited involvement, within the home and the community (as outlined in NMS 7-9), which should be further developed. One service user goes to church when she is staying with her sister. The registered providers said service users have some friendships with people at college or day centres, although people do not visit service users at The Gables. Some friendships are also developed with service users who come to stay at The Gables for a holiday or respite care. Service users keep in contact with their families via telephone calls or reciprocal visits. The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 13 Service users usually have their lunch at the day centre (when they attend) or have a main meal at lunchtime at the home. A three-week menu was inspected which is satisfactory. Service users have lunch at the pub on Sunday, which they enjoy. The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 Personal support and health care needs are met to a satisfactory standard. The medication system is managed appropriately. The registered provider’s death and dying policy requires expansion to include ageing and illness, as outlined in the National Minimum Standard. EVIDENCE: The registered providers said service users receive some limited support with personal care. This is documented in care plans. Service users receive a reminder to get up in the morning, if they are going to the day centre, otherwise they can get up when they want, for example, at the weekends. Service users can go to bed when they want. Service users are involved in choosing their own clothing each day and when new clothing is purchased. Service users receive support to visit the GP, dentist, chiropodist and optician. Visits are recorded in their notes. Some service users also attend outpatient appointments for various health care needs. The medication system was inspected. Medication is managed on behalf of service users. This is supplied by a local pharmacy. Storage, administration and disposal records are maintained appropriately. All staff that currently administer medication have received appropriate training. The registered providers said two staff that are awaiting training do not administer medication. The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 15 The registered provider has developed a policy regarding death and dying. This needs to be expanded to include issues of ageing and illness, as outlined in the National Minimum Standard. The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The registered providers have suitable complaints and adult protection procedures. Any cases of suspected abuse must be reported to social services at the earliest opportunity, if service users can be assured they are to be protected from abuse. EVIDENCE: The complaints procedure was inspected. A summary of this is contained within the service user guide. The registered providers have not received any complaints since the last inspection. The Commission received a complaint regarding the personal care of one service user, which was not upheld. The adult protection policy was inspected. The registered providers have not referred any alleged cases of abuse to social services since the last inspection. Staff have to read the policy when they commence employment at The Gables. Subsequently staff have to complete a test as part of their induction. At least one member of staff has also attended an external course run by social services regarding abuse. From a service user’s daily notes, the inspector picked up two incidents of alleged abuse. Both cases referred to one service user while they were attending a day centre. Although staff, at the home, are not implicated in either incident, both incidents should have been reported to social services for investigation under their adult protection procedure. One of the registered providers said a discussion had taken place with a senior member of staff, about one of the incidents, but they were unclear of the outcome. The matter has now been referred to social services to decide how to investigate the alleged incidents. The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30 The Gables provides a suitable environment for service users accommodated there. EVIDENCE: The building was inspected. The Gables provides a suitable environment for service users currently accommodated there. However, despite the current categories of registration the building is not suitable for people who are wheelchair users. The registered providers acknowledge this and do not admit service users who need to use a wheelchair. The building is well decorated, clean, well maintained and homely. Furnishings are to a good standard. The registered persons have developed an additional bedroom in the grounds for semi-independent living. This includes en suite facilities, and a kitchenette. Although not yet registered the bedroom is to an excellent standard. It will provide a highly suitable facility for a service user, who needs a transitional facility, before moving into independent living. The Commission must formally register the bedroom, before a service user can be accommodated in it. Other bedrooms are suitably furnished, and all bedrooms are lockable. Toilet and bathroom facilities are satisfactory. The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 18 Communal rooms include two lounges (one where service users can smoke) and a dining room (which also has a home ‘cinema’ facility). Laundry and kitchen facilities are satisfactory. A day activities facility is also provided in the grounds, which enables service users to carry out activities such as pottery and computer work. Space standards for communal and bedrooms are satisfactory. The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35, 36 Satisfactory staffing levels are maintained and staff are clear regarding their individual roles. Appropriate procedures to recruit staff, and evidence of this, is satisfactory. Although improving, the registered providers approach to ensuring staff receive appropriate training has been poor. Arrangements for staff supervision is adequate. EVIDENCE: The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 20 Job descriptions are available for inspection. Staff the inspector spoke to seem clear about their roles and responsibilities. Staffing levels are satisfactory to meet the needs of service users accommodated. The registered providers said there is always at least three members of staff on duty during the waking day from Monday to Saturday i.e. one care assistant, a manager and one of the registered providers. Two staff are always on duty on Sunday. A rota is maintained. A cleaner is employed on a part time basis. The registered providers said one member of staff is currently completing her National Vocational Qualification (NVQ) in Care level 2. Three other staff will be registered in February 2006. The inspector interviewed a member of staff who was on duty. She seemed pleasant, knowledgeable about her role and service users’ needs. Recruitment records for three members of staff were inspected. These contained satisfactory information. The registered providers said all members of staff have a Criminal Record Bureau Check (CRB) and a Protection of Vulnerable Adults check (POVA) as applicable. These were present for the records inspected. The registered providers stated there is always a senior member of staff on duty to supervise care assistants. Staff the inspector spoke to found management supportive. There is some evidence of formal one to one supervision, which is given by the senior carer, although her supervision arrangements are unclear. The current arrangements considering the size of the home are considered adequate. A Statutory Requirement Notice (Enforcement) was served in June 2005 to the registered providers. This was regarding failure to provide staff with training as required by regulation (i.e. fire , manual handling, first aid, infection control and food hygiene.) Staff were also required to have appropriate training in handling of medication and epilepsy. Staff induction also needed to be developed and formally recorded. The home was reinspected on 9.11.05. Although improvement was noted, the failure to fully comply with the notice was noted. After a formal meeting with the providers on 23.11.05 it was agreed to extend the deadline for compliance with the notice to 19.1.06. Although further improvements are noted there are still some gaps in training required by regulation including: • Food Handling- 2 staff still need to attend a course although this is booked for 14.2.06 • Infection Control- 3 staff still need to attend a course although these are booked for 21.2.06 and 21.3.06 The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 21 • • • Medication- 2 staff still to do. No courses have been booked. The inspector was assured these staff do not currently administer medication. However as one of the persons concerned is a registered provider who ‘sleeps in,’ they could have to administer medication in an emergency and therefore must receive appropriate training. The inspector was assured that a further person, without a certificate of attendance, had received the training. The registered provider would contact the training provider for a ‘duplicate’ certificate. First Aid- 1 member of staff still to do. No course has currently been booked. Two staff have not got certificates. The inspector was assured they had received training in December 2005, and the certificates would be received shortly. Epilepsy- The inspector was assured that the one person without a certificate of attendance had received the training. The registered provider would contact the training provider for a ‘duplicate’ certificate. The registered provider is liaising with Penzance College regarding the development of an Induction Checklist. A draft version was inspected. This must be finalised and used for any staff recruited from the date of this report. A brief statement of the registered providers’ approach to training is outlined in its policies and procedures manual. This is inadequate to meet the previous requirement. The training policy must outline for example: • What induction training staff will receive and by when. • What on going training staff will receive and by when. • The registered providers’ approach to training staff to obtain a National Vocational Qualification in Care, and by when. Although the Commission acknowledges significant improvement in the training provided to staff, it is disappointing that the enforcement notice has still not been complied with. The original date of compliance was 2nd September 2005. In a letter to the providers, from the Commission for Social Care Inspection dated 11.11.05, the registered providers were informed if for any reason they could not comply with the notice, they must inform the Commission in writing. They failed to do this. Such negligence clearly calls into question the registered providers fitness to carry on a care home. It is evidence the registered providers have failed to treat the enforcement action with the seriousness such action warrants. They have also failed to provide an adequate explanation for their failure to comply. The Commission could at this stage apply to the magistrate’s court, with a Notice of Proposal to Cancel the registered providers’ registration, or take legal action to prosecute. However, the Commission does recognise there has been significant improvement in the training provided to staff. The Commission will therefore reinspect the National Minimum Standards concerned at the end of March 2006. Failure to adhere to the requirements outlined in the Statutory Requirement Notice dated 22.6.05 could result in prosecution. The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 42 There are concerns regarding the registered providers’ fitness, due to their failure to comply with a statutory requirement notice regarding staff training, within an extended timescale. Secondly, the registered providers have failed to receive appropriate National Vocational Qualifications in care and management. Some improvements in the quality of the service are noted. Service users and staff feel positive about the culture and ethos of the home. Health and safety precautions are generally satisfactory. However the health and safety of service users could be compromised by the registered providers’ failure to take adequate precautions against the risk of Legionella. EVIDENCE: The registered providers seem very pleasant, helpful and honest. They appear to care for service users accommodated, and seem supportive of staff they employ. The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 23 The registered providers said although either of them does not have National Vocational Qualifications in care or management, at level 4, a senior member of staff is currently undertaking a Registered Manager’s Award. However it is a requirement that one of the registered providers obtain both these qualifications. Previously one of the registered provider’s enrolled to complete a Registered Manager’s Award (which covers part of the requirement), but did not complete the course. Previous inspection reports have also detailed how this standard is not met. This requirement is subsequently renotified. Failure to comply with the within the timescale set may result in the Commission for Social Care Inspection (CSCI) taking legal action. If either of the registered providers is not willing or able to complete these qualifications, a registered manager must be employed who is willing to complete both awards within a specified period. Issues raised under NMS 35 raise concerns regarding the registered providers’ fitness. A significant number of requirements are notified /renotified within this report. The registered providers must now act on the requirements made within the designated timescales. The inspector was able to interview one member of staff. The member of staff spoke positively regarding care within the home, and the supportiveness of the registered providers. Service users were also positive regarding the registered providers. Consultation between the registered providers, and staff and service users is informal. There are no staff or resident meetings. Service users and staff however said they found the registered providers approachable and supportive. The registered providers have a health and safety policy. Suitable checks are carried out regarding the testing of the fire system, the electrical hardwire circuit and portable electrical appliances. Health and safety training has significantly improved, as outlined in NMS 35, although there are still some gaps in training which require attention. A risk assessment and suitable control measures to prevent the risk of Legionella has not been implemented. Previous inspection reports have also detailed how this standard is not met. This requirement is subsequently renotified. Failure to comply with the within the timescale set may result in the Commission for Social Care Inspection (CSCI) taking legal action. The Environmental Health Department has been notified of the registered providers’ failure to meet this requirement. The registered provider has other health and safety risk assessments in place. These were last reviewed in November 2005. An external fire consultant has completed a fire risk assessment. This was completed in 2005. A number of recommendations were identified in the consultants report. The previous CSCI inspection report recommended the The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 24 registered provider liaise with the fire officer to ascertain which recommendations are legal requirements. The registered provider has said the fire consultant is currently liaising with the fire officer regarding this issue. The recommendation is repeated, and CSCI would appreciate feedback regarding this issue by the next inspection. The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 2 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 2 1 3 X X X 2 X The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 26 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 Standard YA2 Regulation 14 Requirement The registered provider must: • Develop a policy and procedure regarding assessing service users before they move into the home. • Assess all service users to ascertain whether their needs can be met before they are admitted to the home. The registered provider must issue a statement of terms and conditions of residency or contact (as applicable) to service users accommodated. A copy must be maintained on service user files. Each service user must have a care plan and there must be satisfactory arrangement for review. Daily notes kept for individual service users must be objective and care should be taken regarding terminology and language used. Risk assessments must be completed regarding individual DS0000008970.V276962.R02.S.doc Timescale for action 01/03/06 2 YA5 5 01/05/06 3 YA6 15 01/03/06 4 YA6 15 01/03/06 5 YA9 13 01/03/06 The Gables Version 5.1 Page 27 6 YA21 12, 37 7 YA23 10, 12, 13, 37 8 YA35 18 service users’ moneys (including appointeeship). This must include a date of review. Risk assessments must be reviewed at least annually. The registered provider must expand its death and dying policy, to include issues such as illness and ageing, as outlined in the National Minimum Standard The registered provider must report any cases of suspected abuse to social services for investigation as soon as they become aware of these. The registered provider must: • Provide evidence of induction and foundation training of new staff. • Provide all staff with training in food handling, infection control, manual handling (as applicable), fire and first aid. • Provide staff that handle medication with appropriate external training. • Comply with the terms of the enforcement notice dated 22.6.05 7th Notification • Develop a training policy 01/05/06 01/02/06 31/03/06 9 YA37 9, 10 2nd Notification One of the registered providers’ must obtain an NVQ 4 in both management and care. Deadline of 1.1.06 not met. Third Notification. Alternatively a registered manager must be employed who either has these qualifications or is willing to work towards them 31/12/06 The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 28 within a specified period. 10 YA42 13 The registered provider is required to liaise with the environmental health officer regarding its requirements in regard to Legionella, and implement these. Deadline of 2.9.05 not met. Third Notification 01/05/06 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 3 4 Refer to Standard YA1 YA6 YA6 YA11YA8 Good Practice Recommendations A copy of the service user guide should be issued to service users’ next of kin / representatives Service user reviews should be held at least annually with a social worker and /or other relevant professionals present. Detailed daily notes should be kept for all service users accommodated. The registered provider should explore possibilities for providing service users with further choices and opportunities for consultation within the home. Opportunities for further participation in community life, within a risk assessment framework, should also be explored. The registered provider should liaise with the fire officer regarding the recommendations outlined in the fire prevention risk assessment, and implement these if required. Please keep the Commission for Social Care Inspection updated regarding actions required, by no later than the next inspection. 5. YA42 The Gables DS0000008970.V276962.R02.S.doc Version 5.1 Page 29 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 DS0000008970.V276962.R02.S.doc Version 5.1 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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