Inspection on 07/06/05 for The Gables, Truro

This inspection was carried out on 7th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 12 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 19/01/06

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 Turo Cornwall TR4 9QD Lead Inspector Ian Wright Unannounced 07 June 2005 2:00 pm 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Gables Address Newquay Road Goonhavern Truro Cornwall TR4 9QD 01872 571030 01872 571030 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) John Aubrey Nicholls Mrs Rebecca Jane Warren Mr John Aubrey Nicholls Care Home 9 Category(ies) of Learning Disability (9), Physical Disabililty (4) registration, with number of places The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5.1.2005 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 D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over seven and a quarter hours. The inspection was carried out on an unannounced basis. The primary focus was regarding requirements from the previous inspection, which was completed 5th January 2005. The inspector was able to speak to the majority of 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: The registered providers must be clear e.g. through the homes statement of purpose and assessment procedure, they can meet the needs of service users they admit to the home. It is clear staffing and staff training was insufficient to meet the needs of one service user admitted since the last inspection. Although there were clear failings on the part of the statutory authorities in placing this service user, the registered provider must be clear they make the ultimate decision regarding who they admit to the home. The decision to place the service user could have resulted in fatal consequences for the person due to lack of facilities, training and skills of the providers and their staff. The inspector has since received appropriate written assurances from the The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 6 healthcare trust, social services and the home that an appropriate action plan has been put in place to ensure the service user’s health and safety. Staff induction and training is inadequate. The home has been notified regarding this issue on at least five occasions. The failure of the registered provider to act to improve this situation has resulted in an enforcement notice being issued to the registered providers to improve induction and training. If they fail to provide satisfactory induction and training by 2.9.05 legal action will follow. Some health and safety precautions must also be improved. For example regarding the prevention of Legionella, and the testing of emergency lighting. 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 D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 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 standard(s) 1,2,3 Suitable information is available regarding services offered and this is issued to service users. However the Statement of Purpose requires updating and must be available to staff. The registered providers cannot sufficiently demonstrate they can meet the needs of service users for example in terms of providing suitable training for staff, and providing suitable support for service users who have epilepsy. This potentially places service users at risk of harm as staff do not have suitable skills and knowledge to care for these service users. EVIDENCE: The Statement of Purpose presented to the inspector was primarily for the day care service, and although this contains most of the information required by regulation, it must be adapted for the care home. The registered provider has developed and issued a service user guide to all service users. There was evidence of service users being assessed before admission. However in regard to two service users it was not apparent staff had sufficient skills and knowledge to work with them e.g. epilepsy training. This must be provided as a matter of priority, and the inspector has been assured epilepsy training has been arranged. Concerns have also been expressed elsewhere in the report regarding staff receiving appropriate induction and training. Similarly there is a lack of appropriate aids and adaptations to work with people who have epilepsy. The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 9 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 standard(s) 6,9,10 Care plans and risk assessments are generally satisfactory, although were insufficient for two service users with epilepsy. This could put service users at risk. Information is stored appropriately so service users can be assured information about them is kept confidentially. EVIDENCE: All service users have a care plan for which there is evidence of regular review. Care plans however did not contain sufficient information regarding how staff care for service users with epilepsy. Similarly there is insufficient risk assessments regarding service users with epilepsy, and a risk assessment completed by the epilepsy nurse did not appear to have been implemented. This could put service users at considerable risk. Support from social services for the service user with epilepsy was poor. The Inspector has since expressed these concerns to the General Manager and appropriate action was subsequently taken. Records are stored confidentially in the office. The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 10 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 standard(s) 12-14, 16 The registered providers facilitate a suitable range of activities in the home and in the community for service users. EVIDENCE: Service users participate in a suitable range of activities. Service users said they attended a range of community resources. These included day centres, sheltered work placements and adult colleges. The home also has a small day centre, which is used by service users living in the home. Activities include pottery, flower arranging and the use of computers. The home has its own transport, which enables service users to go out on a range of day trips. Service users said routines were flexible, and tailored towards individual needs. The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 11 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 standard(s) 18,19, 20 Service users health and personal care needs are generally satisfactory although concerns regarding the support given to people with epilepsy are documented elsewhere in the report. A suitable medication system is provided although staff training in this area must be improved. EVIDENCE: Support for service users with personal care and health care needs is generally satisfactory, although concerns have been expressed elsewhere in the report regarding the home’s ability to meet people’s needs with epilepsy. Similarly support provided to the home regarding these needs has been inadequate. This combination of inappropriate support has put one service user at considerable risk. The home and appropriate statutory authorities have assured the inspector that an action plan is in place to ensure support for the individual is improved. Service users said times for getting up/ going to bed are flexible. Service users are registered with GP’s, and the providers have support from other professionals such as community nurses. The inspector observed the providers medication system, which was satisfactory. Similarly records e.g. regarding the receipt, administration and The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 12 disposal of medication were satisfactory. However a previous requirement to improve staff training regarding the administration of medication must be implemented. The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 13 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 standard(s) 22-23 Appropriate policies and procedures are in place regarding complaints and adult protection. EVIDENCE: The inspector observed suitable adult protection and complaints procedures which are available to staff and service users. All staff have received a criminal records bureau and, where appropriate, a protection of vulnerable adults check. Service users the inspector spoke to were generally happy with care provided although one service user said he wanted to return to the area where he previously lived. The possibility of this is being looked into by social services. The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 14 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 standard(s) 24-30 The Gables provides a comfortable and homely environment for service users accommodated there. Suitable aids and adaptations for service users with epilepsy must be provided if service users with this diagnosis are accommodated. EVIDENCE: The Gables provides a homely environment for service users accommodated there. On the day of the inspection, the home was clean, well maintained and there was sufficient space to meet the needs of service users. The inspector and the epilepsy nurse have expressed concerns about appropriate aids and adaptations for service users with epilepsy. Television reception in one ladies bedroom was very poor and the registered provider said he would rectify this situation. The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32-36 Staffing levels are generally satisfactory, although these have been increased following the inspection, to provide waking night cover due to the needs of one service user. Induction and training are inadequate, and an enforcement notice has been issued regarding this. The registered provider must develop and implement a strategy regarding how they intend to ensure 50 of staff are qualified to NVQ 2 by 31.12.2005. The registered provider has suitable recruitment and supervision procedures. EVIDENCE: Staff the inspector observed and spoke to appeared to be friendly and approachable, and worked with service users in an appropriate manner. However there was insufficient evidence staff have received appropriate induction and training. This is required by regulation to meet the needs of service users. The registered providers have been notified regarding this issue on five occasions. Subsequently an enforcement notice has been issued to the registered providers. There is insufficient evidence that staff are enrolled in National Vocational Training (NVQ2) so the providers will meet National Minimum Standard 32.6 by 31.12.05. Action must be taken to rectify this situation. The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 16 Sufficient staffing is provided on a day to day basis (i.e. at least one member of staff on duty at all times). However due to insufficient assessment, inappropriate placement by statutory authorities, and inadequate aids and adaptations in the home; waking night cover has been provided for one service user with epilepsy to ensure their safety. This staffing must continue until the home, in liaison with health and social services agree the risk to the service user is suitably minimised for sleep in cover to recommence. The Commission for Social Care Inspection must be kept informed of developments and consulted regarding this issue. The recruitment process appears to be satisfactory. There is appropriate evidence that personnel information required by regulation is maintained (e.g. an application form, two references, proof of identity etc.) The registered providers, and senior carers provide appropriate day to day supervision of staff, and there is appropriate evidence of one to one supervision of care staff. The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37-42, Although the registered provider has suitable experience, action must be taken to complete appropriate training in management and care as required by regulation. This must be completed so that the registered providers can demonstrate they have suitable knowledge and qualifications to manage the home. Staff and service users are positive about the ethos and care provided. Policies and procedures, and record keeping are satisfactory. Health and safety precautions must be improved as current precautions could put service users and staff at risk. EVIDENCE: Mrs Warren said she has enrolled to complete a Registered Manager Award. She must note however that a NVQ 4 in care is also required. Otherwise both Mr Nichols and Mrs Warren have suitable experience to manage the home. The inspector spoke to several staff who all stated the Gables is a good place to work. Staff the inspector spoke to said the owners had an appropriate ethos to provide a caring and supportive environment for service users. The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 18 The registered providers have implemented a questionnaire system to ascertain service user satisfaction. The Commission for Social Care Inspection also carried out a survey of service users, their representatives and professionals involved with the home. The result of the survey was that stakeholders are positive about care provided. Although brief, policies provided are currently adequate. Record keeping is satisfactory. Suitable health and safety risk assessments are in place. These were last updated in October 2004 and should be reviewed at least annually. Testing of the electrical circuit (hardwire) was last completed in August 2001 and must be completed at least every 5 years. Fire alarms are tested weekly, although regular testing of emergency lighting is inadequate (last recorded test December 2004). Portable appliance testing was completed on 14.6.2005 after the inspection. This must be completed annually. The home does not have an appropriate policy regarding the prevention of Legionella. The previous requirement is renotified, and appropriate measures must be implemented as a matter of priority. The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 2 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 2 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x 3 x Standard No 31 32 33 34 35 36 Score x 2 3 3 1 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Gables Score x x x x Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 1 x D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 20 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 YA 3,20, 35, 42 Regulation 13, 18 Requirement Timescale for action 2.9.05 2. YA37 9 3. YA42 13, 23 The registered provider must:· * Provide evidence of induction and foundation training of new staff. * Provide all staff with training in food handling, health and safety; infection control, manual handling (as applicable), fire and first aid. * Provide staff who handle medication with appropriate external training. This must be clearly evidenced 5th Notification The registered provider must 1.1.06 complete NVQ 4 in management and care. 2nd Notification The registered provider must 2.9.05 ensure suitable precautions are taken to protect staff and service users. For example: * Emergency lighting must be tested at suitable intervals as recommended by the fire officer. *Staff must receive appropriate health and safety training as required by regulation. *Portable electrical appliances must be tested at suitable intervals as recommended by the Version 1.40 The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Page 21 4. YA42 5. YA1 6. YA2, YA3 7. YA3, YA35 8. YA6,9, 18, 19 9. YA29 10. YA32 environmental health officer (health and safety) 13 The registered provider is required to liaise with the environmental health officer regarding its requirements in regard to Legionella, and implement these. 2nd Notification 4,6 The registered providers must Schedule develop a Statement of Purpose 1 for the home containing information required by regulation 14 Pre admission assessments must contain sufficient detail so the registered providers can ascertain they have sufficient skills, knowledge and experience to meet the needs of the service user e.g to meet the needs of service users with epilepsy. 12,13,14, Appropriate staff training, aids 18 and adaptations must be provided to meet the needs of service users e.g. people with epilepsy. 12, 13, 15 Care plans and risk assessments must contain suitable information to meet the needs of service users e.g. people with epilepsy. Suitable strategies must be implemented to meet individual personal and health care needs. 16,23 The registered provider must provide suitable aids and adaptations for service users accommodated. E.g for service users with epilepsy 18 The registered provider must develop and impliment a strategy to ensure 50 of staff have NVQ 2 in care by 31.12.2005. A copy of the strategy must be submitted to the commission. D52-D04 S8970 The Gables V215888 070605 Stage 4.doc 2.9.05 2.9.05 1.7.05 1.7.05 1.7.05 1.7.05 31.7.05 The Gables Version 1.40 Page 22 11. YA33 18 The registered provider must maintain waking night cover to ensure the safety of one service user with epilepsy. This must be maintained until the registered provider, in liason with health and social services, agree the risk to the service user is suitably minimised for sleep in cover only to recommence. The commission must be kept informed of developments 1.7.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA42 Good Practice Recommendations The registered provider should liaise with the fire officer regarding the recommendations outlined in the fire prevention risk assessment and implement these if required. 2. The Gables D52-D04 S8970 The Gables V215888 070605 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 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. 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