Inspection on 04/06/09 for The Gables, Truro

This inspection was carried out on 4th June 2009.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Gables, Truro 05/06/08

The Gables, Truro 28/06/07

The Gables, Truro 08/06/06

The Gables, Truro 19/01/06

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 17/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: The Gables, Truro Newquay Road Goonhavern Truro Cornwall TR4 9QD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diana Penrose     Date: 0 9 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: The Gables, Truro Newquay Road Goonhavern Truro Cornwall TR4 9QD 01872571030 08716618115 choicecareservices@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Rebecca Jane Warren,Mr John Aubrey Nicholls care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability Additional conditions: The maximum number of service users who can be accommodated is 10. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability, excluding dementia or mental disorder (Code LD) - maximum 10 places Dementia (Code DE) - maximum one (1) place Date of last inspection Brief description of the care home The Gables is registered to provide care for ten service users with learning disabilities and one with a dementia. This home offers day care; respite care and holidays for service users with a learning disability. The registered providers live on the premises. The Gables is a detached house situated in the village of Goonhavern, which is between Perranporth and Truro. It provides single accommodation for the people using Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 1 10 Brief description of the care home the service and there is a self-contained flat to accommodate one person. There is a suitable dining room and two lounges on the ground floor. There are two workshops situated at the rear of the home that predominantly provide activities for day care service users but are also utilised by all the people accommodated in the home. The home is clean, warm and comfortable. The people currently living in the home attend weekday activities assessed for and provided by the Cornwall department of adult social care. They are given ample opportunities for socialising and visitors are openly encouraged. Information about the home is available in the form of a statement of purpose / service users guide, which can be supplied to enquirers on request. A copy of the most recent inspection report is available in the home. Fees range from 400.00 to 700.00 pounds per week. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as confectionary and toiletries Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: An Inspector visited The Gables Care Home on 04 and 09 June 2009 and spent nine hours at the home. This was a key inspection and an unannounced visit. The focus was on ensuring that placements in the home result in good outcomes for the people using the service. It was also to gain an update on the progress of compliance to the requirements identified in the last inspection report dated 05 June 2008. All of the key standards were inspected. On the day of inspection six people were living in the home, one of these was on holiday. The methods used to undertake the inspection were to meet with residents, staff and the manager to gain their views on the services offered by the home. Records, policies and procedures were examined and the inspector toured the building. CQC surveys have been returned in respect of 4 residents and 4 staff and the registered manager has returned an Annual Quality Assurance Assessment; these have also informed this inspection. This report summarises the findings of this key Care Homes for Adults (18-65 years) Page 6 of 31 inspection. The people using this service expressed satisfaction with the care and services provided at the home. Feedback was given to the manager throughout this inspection. He is aware of breaches in regulations and has agreed to address the issues. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The registered persons must make efforts to comply with the requirements set in this report or enforcement action may be taken. The care planning system must be reviewed and all residents must have a care plan. The plans should be compiled with the resident or their representative, in sufficient detail to direct staff in the care to be provided and regularly reviewed and updated. The daily records need to be written on the day events took place as leaving gaps for people to complete later could lead to errors in the recording. It is important that the records accurately detail the rationale of care and the care delivered. The home should be decorated and furnished to meet the needs and lifestyle of the people accommodated. The duty rota should include the staff members job title and hours worked by each member of staff and management. It should also indicate if they are working in the Care Homes for Adults (18-65 years) Page 8 of 31 home or in the workshops. It should show the number of hours worked by the registered manager and other members of the management team and indicate the time they spend as part of the care team. Recruitment, although generally satisfactory requires some attention to ensure that interview records are kept and show that employment history has been discussed and that criminal convictions on CRB disclosures have been explored and evaluated prior to the decision to employ the person. There should be a photograph of each employee on file and relevant job descriptions included. Each employee should have a copy of their terms and conditions of employment in their file. Training for staff must improve, the records show that staff training has lapsed and statutory training has not taken place on a regular basis to keep staff up to date. Staff and the management team need to ensure that they keep up to date on issues relevant to people with learning disabilities and external courses would provide additional stimulation for staff to back up the in house training provision. There have been previous regulatory breaches in respect of training and the registered manager is fully aware that failure to comply may result in further enforcement action being taken. The quality assurance systems in place need to be improved to ensure continuous monitoring of the service and subsequent improvement. The registered manager must ensure that events that affect the welfare of residents are notified to the Commission in accordance with Regulation 37 of the Care Homes Regulations. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are given information about the home enabling them to make an informed decision on where to live. Prospective residents have a needs assessment undertaken to ensure the home can meet their needs. Evidence: We looked at the statement of purpose on the first day of this inspection and it required updating. This had been addressed by the second day of this inspection. The manager stated that prospective residents are assessed by him prior to admission and there is a form used for documenting the details. Two completed forms were seen however one was not dated. One new person had very detailed information provided by his previous care home manager. There is no evidence that the assessments are reviewed. We were told that the manager requests information from the person referring a resident for a holiday stay. Two completed profile forms were seen and detailed relevant information about the resident and their care needs. Details regarding past medical history are now included. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most people living in the home have a written care plan that includes risk assessments, this must be extended to include all residents. More detailed care plans with a multidisciplinary review, including the resident, would ensure that staff know how to meet their needs and that peoples preferences are respected. Evidence: We looked at the care files of four people receiving care at The Gables. Two were new admissions, one had lived at the home since 2002 and one was on holiday. The holiday person using the service had a detailed profile form that was dated and signed by a relative. This constituted the care plan for staff. The compilation of a more in depth care plan was discussed, in particular for those people who return to the home on a regular basis. Two people had a care plan that covered health, personal and social care needs. The forms need to be completed more fully to inform and direct staff on exactly what is Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: expected of them. This was discussed with the manager who said he would address it. One new admission to the home had no care plan commenced. The manager stated that the social worker was going to compile it with him but had not been able to as yet. The manager must ensure that a care plan is in place for this person. The manager said that relatives and social workers assist with care planning and some plans were signed by relatives. One care plan was reviewed by the care staff but there was no written evidence of multidisciplinary reviews. The manager has stated in his Annual Quality Assurance Assessment (AQAA) that they could be better at maintaining and updating Care Plans and Risk Assessments to ensure that the service users receive the best care at all times. The daily records were seen and where complete they were reasonably informative. Gaps were seen and on some occasions nothing had been recorded for part of the day. There is evidence that people are involved in making decisions about their lives from the records maintained. Surveys received are positive about the care provided at the home and that people are able to make decisions about how they live. Residents were seen moving about the home and the workshops without restriction. Some residents were out at day centres, this limits their choice of activities during the week but the manager said there is free choice at the weekends. The registered manager said that discussion regarding life in the home tends to be carried out informally. The minutes of more formal meetings were seen but these do not take place regularly. We were told that the staff manage most peoples monies and post office accounts are held for three people. He said that some people have a bank account as well. Their benefits were recorded as being paid monthly and the manager said that they receive regular money to spend as they wish. Records of transactions were seen along with receipts for expenditure on behalf of residents. The records are signed as checked by the manager. The manager said that a limited amount of money is generally held in the home, the limits should be stated in the homes policy. One person had over four hundred pounds and this was discussed with the manager who agreed to give some back to her family to put into her bank account. The security of monies held for people was discussed and should be reviewed as it accessible to all staff. Risk assessment documentation was seen in the care files, with the action to be taken by staff recorded. One resident told us he goes out to the shop and to the pub on his own. Peoples involvement in the running of the home appears to be limited; at the last inspection the manager hoped to do more about this and said he would start by Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: including people in the choice of colours for the decoration of their rooms. He told us this time that one person had chosen the colours for his room. Most of the home was painted magnolia. The manager said that one of the registered providers insists on putting patterned borders on the walls and chooses rugs and so on without consulting him or the residents. We were told that all records are stored confidentially in the owners accommodation. There was also lockable storage in the home. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are provided with good food, plenty of activities and they have contact with family, friends and the local community enabling them to enjoy a life of their choice Evidence: We saw the daily records and they show that people participate in a variety of activities. Some people were in the workshops at the back of the home during this inspection where there was instruction taking place on using computers. Some of the pottery work undertaken by the people using the service is on display and one resident told us he still enjoys the pottery. He said a new person was helping them with this now and they do different things. A member of staff told us that activities depend on the day and it varies according to the attendance of day care clients. He said they play games like connect 4 sometimes and do art and crafts. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: We saw that peoples bedrooms were personalised and various interests were evident. We saw the home cinema system in the dining room but it was not in use. The greenhouse had flowers and vegetable plants growing and we were told the residents assist with the planting and watering. We saw residents moving freely around the home and grounds. The manager said that some people were attending day centres and sheltered work placements. The manager said that residents could go out in the local community according to their assessed ability. We were told they go to the local pub sometimes for lunch on Sundays. The manager said that one resident attends the local church. We were told that one resident was taken on holiday abroad last year. The resident told us he enjoyed himself. He told us he sees his family often and goes out with them. The records show that other residents visit their families and talk to family and friends on the telephone. Trips out are arranged most days during the summer in particular. One person on holiday told us she has a lovely time at the home. She said she went shopping yesterday and today she is going to the zoo. We were shown a menu written in a book that had not been updated for a week. It was a set menu but the manager said that alternatives were available and they were recorded in a diary the kitchen. We also saw information about diet in the daily records. A resident said he could eat what he liked and the meals were good. He said they go to the pub on Sundays for lunch. Some people eat at the day centres and the manager said this is considered when deciding on the meals provided. There was a stock of fruit and vegetables but the manager said they tend to buy cakes including birthday cakes. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal support is given to people according to their needs and they have access to health care services as necessary ensuring their physical and emotional needs are met. Systems for the administration of medicines are in place, the system will have further safeguards when staff have completed their medicines training Evidence: We were told that all of the people using the service are independent and require very little personal care support. The manager said that people sometimes need prompting to shave and so on. The daily records show that support is given where necessary and staff talked about this. We were told that peoples preferences are respected and that male care staff are employed but a female is always on duty; the rota supported this. The records show that routines are flexible particularly at the weekends when residents do not go to the day centres. People are registered with a GP and their health is monitored. We saw that records are maintained of visiting health professionals and visits to the GP surgeries and so on. The manager said that people are supported with visits to the dentist and optician as required. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: The medicines policy and guidelines for care homes were not available to staff. The manager said he would make sure they are kept in the medicines room. Medicines are supplied by a local pharmacy. We saw that storage, administration and disposal records are maintained appropriately. Patient information leaflets for medicines administered were seen along with reference books for staff to refer to. The training records show that some staff have undertaken training regarding medicines. This has been through packs supplied by a training company. The manager told us that he has courses in hand for all staff to attend on the safe handling of medicines. He also told us there is no formal training in respect of medicines during induction and this needs to take place. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has satisfactory complaints and adult protection policies that ensure people are listened to and protected from possible risks of harm or abuse Evidence: We were shown a complaints procedure that had not been updated to include the latest CQC contact details. The referral of complaints to the Department of Adult Social Care was also not included and this was discussed with the manager during the last key inspection. The procedure is included in the residents guide. Thank you letters and cards are kept in a file. There have been no complaints to the home or the Commission since the last inspection. The home has an adult protection policy that includes the referral of incidents to Social Services. The training records show that all but one member of staff have attended abuse training as well as Mental Capacity Act and Deprivation of Liberties training. The manager told us he has a video for training purposes as well which he intends to make use of. There is one safeguarding issue ongoing at the moment regarding unexplained bruising found on a person using the service. This was referred to the Department of Adult Social Care from staff at the day centre. Surveys returned to us from people using the service said they are treated well in the Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: home and know how to complain if needs be. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The building and grounds seem well maintained but decoration and furniture needs to be reviewed, with the involvement of people using the service, so that they live in a pleasant, homely, comfortable environment that respects their preferences Evidence: The home provides a reasonable environment for the people using the service but is not suitable for wheelchair users; the registered providers acknowledge this. We saw bedrooms and corridors that have been decorated since the last inspection. Most of the home is painted magnolia and partway up the walls a patterned border strip of wall paper has been added. There was a stain on the ceiling of one bedroom; the manager stated that the roof had been leaking but had now been fixed. He said he will be addressing the stain on the ceiling. Some bedroom furniture has been replaced since the last inspection but most of it has just been repaired. The furniture in peoples rooms is dated and some is in a poor state of repair. New floors have been fitted in some bedrooms and new carpets provided which has made an improvement to the home. We were told that the roof of the flat has been replaced and other repairs as required. We were also told that maintenance of the home is ongoing but there is no written plan. The AQAA states that they are going to continue with the maintenance programme to complete the redecoration of the remaining bedrooms Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: The home is a non-smoking facility and none of the present residents are smokers. Bedrooms are personalised with residents belongings and fitted with Yale locks. We were told by the manager that keys can be provided according to individual risk assessment. The home is generally clean; residents are responsible for cleaning their own rooms with some supervision. The care staff are responsible for the rest of the home. Laundry facilities are suitable and each person has a dedicated day for their laundry to be done. Hand washing facilities and protective clothing such as gloves and aprons are provided for staff. The grounds are tidy with lawns and beds of flowers. There are workshops and a greenhouse at the back of the home for the provision of day-care and activities. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures are not robust enough and may not safeguard people using the service. Staff have or are working towards NVQ qualifications however other training is lacking which means staff may not have the necessary knowledge and skills to care for people using the service. The duty rota does not clearly show the qualification or seniority of care staff and the exact hours worked in the home; it is not clear there are sufficient staff numbers at all times. Evidence: The management team live on site, in the home or in a bungalow behind the home. We were told that they come and go as they wish and work as part of the care team. We were shown the duty rota which was a typed document with changes in staffing hand written. The rota shows that generally there are six staff on the day shift and one on the evening shift. It was explained that one member of staff is the administrator and one is a pottery instructor. Three managers are listed each day by initials only. There is also a list of staff who are absent for any reason. There is no rota for overnight, we were told by the manager that the registered providers spouse lives in the home and would be contactable at night, there are no staff awake at night. There are no staff on the rota for weekends other than the management team. The manager said he is permanently on-call. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: The rota should be more specific as to the job title and hours worked by each member of staff and management. It should also indicate if they are working in the home or in the workshops. It should show the number of hours worked by the registered manager and other members of the management team and indicate the time they spend as part of the care team. Staff said there are a suitable number of people on duty at all times and extra are brought in if required. During the week there is often only one resident at home and he spends a lot of time in the workshops. People using the service said there is always someone around if you need something. We were told that all care staff apart from one new member have an NVQ qualification in care to at least level 2. Some certification was seen in the staff files. The manager said that specific training in respect of learning disabilities has not yet commenced as he has been unable to source any courses as yet. The manager should supply training relevant to the current client group to enable staff to have the knowledge and skills to communicate and provide appropriate care. Courses in communication skills and managing challenging behaviour may be beneficial. The manager told us there has not been as much training as there should have been and this has been due to a range of circumstances over the past year. These include the sudden death of a person using the service, one of the providers sustaining a heart attack and other health problems within the management team. We were shown a list detailing the training requirements for all staff and management, it included the dates of some training that has already been booked. He told us of other training he has in hand and his proposals for the coming year. It would seem reasonable at this time, given the circumstances explained, to allow an extended period of time for the provision of training. We are mindful that this is the second time that regulations have been breached in respect of training and a Statutory Notice has already been served. Failure to comply with this new requirement may result in further enforcement action being taken. A completed induction pack for a new employee was seen which was detailed. The employee said that his induction was thorough and was undertaken mainly by the manager. He told us he had had training in relation to fire safety, abuse, infection control and health and safety. The AQAA states that they intend to maintain strict training schedules for all staff over the coming year. People using the service told us that staff look after them well and they spend a lot of time with them. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: Three staff files were inspected, two were for people employed since the last inspection. Relevant employment checks were seen; obtained prior to employment. One included a conviction resulting in a police caution. There was no written evidence that this had been explored or evaluated prior to the decision to employ the person. The manager told us he was aware and the employee said it was discussed with the manager. None of the files held terms and conditions of employment. Only one held induction documentation, one held an interview record, none held job descriptions and none had a photograph of the employee. The lack of important records was discussed with the manager who agreed to check all files and ensure that recruitment in future is more robust. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is competent to run the home but has not assured that issues identified at previous inspections have been addressed; training records do not show that staff are kept up to date and recruitment procedures are not robust enough to ensure that peoples health and welfare needs are met and they are safeguarded from harm. Health and safety is promoted but quality assurance systems do not show that the management strive for continual improvement. Evidence: Mr Farnan is the registered manager and is responsible for the day-to-day running of the home. He has achieved the Registered Managers Award and told us he keeps up to date with online updates from a reputable company and by using the internet. He said he has recently attended training on the Mental Capacity Act, Deprivation of Liberties and Safeguarding Adults and showed us a certificate of attendance. The registered providers are part of the management team and have owned the home for several years, they live on site so available when needed. Staff told us the home runs well and surveys received from staff said they receive Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: regular support from the manager. The atmosphere in the home is relaxed and staff said the management are very approachable. The Registered Persons have not ensured that staff training has been kept up to date or that staff receive training relevant to the people they care for. Although Criminal Records Bureau and Protection of Vulnerable Adults checks are undertaken the records do not show that any criminal convictions recorded have been investigated and satisfy the decision to employ. We were informed that a person using the service had been admitted to hospital for major surgery and that unexplained bruising had been noted on one persons arm. These issues have not been notified to the Commission in accordance with Regulation 37. This was discussed with the manager who agreed to ensure that all relevant issues are reported in future. Quality assurance questionnaires are given to residents or their representative to complete following respite care or a holiday stay, those seen were very positive about the care and services provided by The Gables. We were told that surveys for the permanent residents and their families were to be distributed soon; we were told this at the last inspection. The last completed surveys shown to us were dated 2006. The intended new format is suitable. CQC surveys were all positive about the home and services provided. Present feedback is obtained mainly on an informal basis from staff, residents and families. Staff and residents meetings take place but not regularly; minutes were seen. No audits take place at present. The registered manager completed an Annual Quality Assurance Assessment (AQAA) and returned it to the Commission within the alloted timescale. All relevant fire checks are carried out and service and equipment checks are up to date. New fire doors have been installed to comply with the fire authoritys report. Accidents are recorded and reported appropriately, the home has minimal accidents, and there has been one this year. Thermostatic controls are being fitted to the hot water system downstairs; the shower has been done. The risk assessment for Legionella was seen and the water tank is to be replaced. We were told that when this has been done thermostatic controls will be fitted upstairs. Window restrictors have been fitted where deemed appropriate. Data is provided for staff in respect of the Control of Substances Hazardous to Health (COSHH), some information was seen in the laundry. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 The registered person must 30/10/2009 ensure that all staff receive regular statutory training and training relevant to the client group This will ensure that staff are kept suitably updated and enable them to promote and make proper provision for the health and welfare of people using the service. This includes their care, and where appropriate, treatment, education and supervision. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 All people using the service should have a care plan that is written in sufficient detail to inform and direct staff on the care to be provided Care Homes for Adults (18-65 years) Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 24 The home should be decorated and furnished with the involvement of people using the service to ensure they live in a comfortable homely environment that is to their liking. The duty rota should show the number and skill mix of staff and managers on duty in the home and the time spent on management tasks; this will show there are sufficient skilled staff on duty at all times. Quality assurance systems should be implemented to monitor the service provision and strive for continual improvement 3 33 4 39 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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