Inspection on 16/01/06 for White Gables Nursing And Residential Home

This inspection was carried out on 16th January 2006.

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 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

White Gables Nursing And... 03/08/06

White Gables Nursing And... 23/05/05

White Gables Nursing And... 27/10/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE White Gables Nursing And Residential Home 21 Willington Road Kirton Lincs PE20 1EP Lead Inspector Sue Hayward Unannounced Inspection 16th January 2006 09:35 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address White Gables Nursing And Residential Home DS0000002561.V278089.R01.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service White Gables Nursing And Residential Home Address 21 Willington Road Kirton Lincs PE20 1EP 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) 01205 723874 Mrs Joan E Nix Mrs A H Hughes, Mrs H J Newton Mrs H J Newton Care Home 20 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (18) of places White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2005 Brief Description of the Service: White Gables Nursing and Residential care home is a bungalow, which has been extended to form a single storey building. The home is situated in the village of Kirton and is near the local shops and amenities. The market town of Boston is four miles away. There is a courtyard area to the rear and a small car parking area to the front of the home. White Gables is registered to provide personal and nursing care for up to 20 residents over the age of 65, two of these having dementia care needs. On the day of the inspection 17 residents were at the home, 8 of which have nursing care needs. One twin room is currently being occupied as a single. The home is family owned and run, one of the owners also being the manager. The manager was present throughout the inspection. White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the second of two required by law for 2005/6. It took place over 5½ hours. Two inspectors were present on this occasion, one as part of her introduction to the area. It consisted of checking the records of three residents and tracking the care and support they receive through discussion with them and four staff on duty. It also included checking a sample of records and policies and procedures and viewing three residents rooms and some of the communal areas of the home including the laundry and kitchen. Three other residents were also spoken to. What the service does well: What has improved since the last inspection? Since the last inspection there has been a programme to fit thermostatic mixer valves to wash hand basins in residents bedrooms and bathrooms reducing the risk to residents of scalds. The manager and a staff member confirmed there is now only one wash hand basin that remains to have a mixer valve fitted. The requirements and recommendations of the last inspection have been addressed. These related to risk assessments being documented for those radiators that are not guarded, keeping a fuller record of the social and leisure activities that residents participate in and obtaining a copy of the Local authority revised adult protection procedure. White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 6 There is an on-going programme of redecoration and the manager confirmed that a further two bedrooms had been decorated since the last inspection and that the lounge carpet had been renewed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected. EVIDENCE: This standard was not inspected on this occasion, other than to note that the statement of purpose and service users guide, which gives information about the home was on display in the hall and had been reviewed since the last inspection. Standard 3 was checked during the previous inspection of 23/05/05 and was met. Standard 6 does not apply, as the home does not offer an intermediate care service. During discussion with a resident a comment was made which indicated that the resident had been happy for relatives to make the decision on their behalf about the suitability of the home. Records checked contained information to demonstrate that residents had had an assessment of their needs made from which a plan of care is developed. White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 11 The care planning system in place ensures there is sufficient information to inform staff in order for them to meet residents’ health and care needs. The medication administration system in place does not fully ensure residents safety. EVIDENCE: All residents files checked contained a detailed plan of care, which had been developed from assessments made and included information to demonstrate that other health and social care professionals were consulted as needed. Residents had signed to denote their agreement with their care plan and they were being reviewed by staff on a monthly basis. Individual risk assessments are in place relating for example to residents manual handling needs. Assessments are done in relation to residents’ dependency levels and also include matters such as nutritional needs and tissue viability. Records and residents comments confirmed that their health care needs are being met in the home and they have visits from other professionals such as G.P’s, district nurses and opticians when needed. Staff had a good knowledge White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 10 of the needs of residents asked about which reflected their care records and said that they were kept up to date with information at shift handovers. The medication storage arrangements are satisfactory as are the procedures in place for stock control and disposal. However, some review of administration systems is needed to ensure that there is no element of secondary dispensing to ensure residents safety. The manager agreed at the time of the inspection that this matter would be addressed. A pharmacist visits the home on a regular basis to check the systems in place. The last visit was conducted on 19/12/05 and systems were considered to be satisfactory although a recommendation was made in relation to ensuring some medication protocols are reviewed which the manager confirmed is in the process of being addressed. Qualified nurses are responsible for medication. Discussion indicated that training is provided periodically to ensure that staff are kept up to date, for example training had taken place last year in relation to the use of inhalers. Residents made positive comments about the care they receive, indicating that their privacy was respected. Bedrooms seen were lockable if residents wished to do so. Staff gave clear examples of how they try and ensure residents privacy, choice and dignity is met in the home and they were observed to have a good rapport with residents and were kind, courteous and attentive. White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 There are opportunities for residents to participate in social and recreational activities. Residents have choices and are able to make decisions about how they lead their life at the home. Residents are provided with well-balanced meals, which cater for their individual needs and preferences. EVIDENCE: All residents commented positively about the care and accommodation provided at the home. Comments were made which indicated that residents are enabled as much as possible to make decisions as to their preferred routines and how they lead their lives in the home. Records included information about residents’ personal preferences such as food. Comments from staff indicated that breakfast times for example were flexible to accommodate residents’ preferred times of rising. There is a system in place, which records any activities or social events that occur. Staff said that spending time with residents is seen as part of their role and that there was sufficient time to do so. Records and staff comments also demonstrated that residents are able to attend local clubs if able and have a choice as to whether they participate in social activities within the home and community. White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 12 Two letters have been received by the home from relatives since the last inspection. Both were very complimentary about the service. Comments from residents about the quality of meals provided were in all but one instance positive, for example “the food is very good, I can’t complain about the food, I look forward to mealtimes, and I get an alternative if there is something on the menu I don’t like”. One comment made was that a resident thought the meals were “okay but a little repetitive”. There are satisfactory records kept of the meals provided which indicate that the menus are well balanced. Staff were observed to assist residents who needed help with their meals in a manner that respected their dignity. Staff had an awareness of residents individual food preferences and individual dietary requirements to maintain their health, such as those associated with diabetic conditions. There are satisfactory food hygiene and infection control procedures in place. An environmental health officer visited the home on 05/01/05 and conducted a food safety inspection. The manager confirmed that action is taken to implement any recommendations made. Comments and records confirmed that basic food hygiene training is provided for staff. White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 There are satisfactory systems in place for dealing with complaints and adult protection matters that ensure residents are as far as possible protected. EVIDENCE: The home has a complaints and adult protection procedure in place and since the last inspection has obtained a copy of the reviewed Local Authority adult protection procedure. There is a system in place for recording any complaints received. The record checked indicated that the home had not received any complaints since 25/04/03. Staff seen gave satisfactory answers in relation to the action they would take should any concerns, complaints or matters of an adult protection nature be raised and were aware of who to report such matters to. Staff have training in relation to adult protection procedures. Information about how to make a complaint is included in the homes statement of purpose and service users guide, which is on display in the hall. Comments received from residents indicated that they knew who was in charge and said would feel comfortable to raise concerns if they had any. They thought that the manager would listen to any complaints and would try and put them right. One resident made the comment that they did not think there would ever be cause to complain about the home or care. White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The home provides a clean, comfortable and well-maintained environment for residents. There are good standards of hygiene that help to ensure residents health and welfare. EVIDENCE: Those areas of the home seen on this occasion included the lounge, sun lounge and dining areas, four residents bedrooms, laundry and kitchen. All parts of the home seen were clean, tidy well decorated and well maintained. Bedrooms contained personal items demonstrating that residents can furnish them to their own tastes if they wish. Residents made comments that they found their rooms to be comfortable. There is an on-going programme of redecoration and refurbishment and since the last inspection two bedrooms have been redecorated and thermostatic mixer valves have been provided to wash hand basins in residents’ bedrooms. Comments from visitors’ letters of satisfaction seen at the time indicated that, “the home provided comfortable surroundings with high quality care”. White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 15 Documented risk assessments are in place in relation to the environment such as fire risk assessments and in relation to risks posed to residents from hot surfaces although most radiators have now been guarded. Discussion with the maintenance person confirmed that temperatures of radiators are generally checked fortnightly. It is recommended that these be recorded and also demonstrate any action taken if needed to ensure that they are maintained at a safe level. The home has procedures relating to infection control and equipment such as gloves and aprons are provided for staff. Staff comments indicated that they were aware of how to ensure good hygiene practices are maintained in the home. There are satisfactory laundry arrangements in place. White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 The home is being well staffed to meet the needs of current residents by a staff team who have regular training to ensure that they have the necessary knowledge and skills to care for residents safely. The recruitment procedure in one instance was not thorough enough to ensure that residents are as far as possible protected from any potential risks. EVIDENCE: Residents’ and relatives’ comments about the staff team were very positive and complimentary. Comments such as “I don’t think I will ever have cause for complaint”, staff are a really good lot”, “a nice friendly place”, “professional care is provided”, “happy and welcoming staff” and “high quality care” all demonstrate satisfaction with the service. The staff team comprises of registered nurses and care staff plus laundry, domestic, catering and a maintenance person during the day. At night there is always a qualified nurse and a care staff member. In addition there is an administrator. Staff and residents comments were that staffing levels were sufficient to meet needs and enabled staff time to socialise with residents. Staffing levels at the time of the inspection were the manager who is also a registered nurse; four care staff, two domestics, a cook, and laundry assistant and maintenance person. Staff and records confirmed that there is an ongoing training programme, which includes regular updates such as manual handling plus training that is White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 17 more specific to meet the needs of residents such as medical conditions in the elderly. Six staff have achieved National Vocational Qualification (NVQ) awards at level II and three staff are currently in the process of working towards this award. One has achieved level III. Whilst staff comments indicated that the recruitment process included the taking up of two references and criminal records bureau (CRB) checks the record of a recently employed staff member only demonstrated that one written reference had been obtained. A copy of the second reference was provided following the inspection. It was also noted that whilst a CRB check had been obtained in relation to a staff member from a previous occupation the home had not undertaken its own check. For the recruitment procedure to as far as possible protect residents from any potential risks the home is required to undertake its own CRB which includes a Protection of Vulnerable Adults register check prior to employment in the home. White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 and 38 There are satisfactory processes in place to ensure that the views of residents, relatives and staff are sought to improve the quality of the service. The policies and procedures in place and training opportunities for staff all help to ensure residents health and safety, however procedures for recording residents money held in safe keeping need to be reviewed to ensure residents are fully protected from any potential risks. EVIDENCE: The home has a variety of means of obtaining residents and relatives views about the service. As one of the providers is also the manager she is able to gain residents views about the service individually. Comments from residents were that they knew who was in charge and would feel able to raise any problems or concerns. One resident said that any comments would be listened to. The home undertook a questionnaire about the quality of the service with residents and relatives between April and May 2005. Comments were White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 19 generally positive about the service provided. In addition staff questionnaires and staff meetings are held. There is a development plan for the home and in February 2005 the home was successful in gaining “Investors in People” a quality award. Staff comments were also positive about the service for example one said, “This is one of the nicest place I have seen” and “here there is time to spend with residents”. The home has a range of health and safety policies and risk assessments of the environment as well as in relation to individuals that are reviewed regularly. In addition the sample of record keeping systems inspected are generally well maintained in relation to health and safety matters such as tests of fire alarms on a weekly basis and records to demonstrate that seven staff had had fire drill on 04/01/06. No safety issues were noted in relation to the environment with the exception of water softening tablets, which were not being kept securely in the laundry. Approximately 50 of care staff have achieved or are in the process of achieving an NVQ Level II award. The manager and a registered general nurse are assessors for this and there is an ongoing staff-training programme, which covers health and safety, matters. Generally procedures in place and storage arrangements for the safe keeping of any monies of residents are satisfactory however record keeping systems need to be reviewed to ensure that all transactions are recorded as on this occasion one of the three records checked was not up to date. White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 4 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 2 X X 3 White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13 (2) Requirement The procedure for adminstering medicines must be reviewed to ensure there are no elements of secondary dispensing. Records must be available to demonstrate that the registered persons have not employed staff to work in the home until they have sought and obtained a satisfactory CRB or POVAFirst check, pending a satisfactory CRB check. Records of any monies held in safe keeping on behalf of residents must be kept up to date and detail all transactions. Timescale for action 31/03/06 2 OP29 19 (1) & schedule 2 31/03/06 3 OP35 17(2)&(3) & Sch 4-9 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 White Gables Nursing And Residential Home DS0000002561.V278089.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!