Inspection on 03/08/06 for White Gables Nursing And Residential Home

This inspection was carried out on 3rd August 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... 16/01/06

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 3rd August 2006 09:15 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.V306770.R01.S.doc Version 5.2 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.V306770.R01.S.doc Version 5.2 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.V306770.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2006 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. 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. Information provided prior to the site visit on 13th July 2006 indicated that the current range of fees is from £400 - £540 per week. Hairdressing and chiropody are charged additionally to the fees. White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home was undertaken by one inspector and formed part of a “key” inspection. A “key” inspection is the checking of those standards considered to be “key” in terms of the health, safety and welfare of residents. It started at 09:15 and lasted 6 hours. Information already held on file was used to plan the visit and produce this report. This included, records of any significant incidents that had been notified to the CSCI since the last inspection and any correspondence received. “Have your say questionnaires” giving residents and/or their relatives opinions about the service had been returned from nine people prior to the inspection and information from these is also included in the report. The site visit also included checking whether issues raised at the previous inspection had been addressed. The main method used at the site visit was tracking the care and support received of a sample of three residents with a range of needs via their records, discussion with them, three staff members on duty and the manager. Three residents also agreed to the inspector visiting their bedrooms as part of this process. General feedback about the outcomes of the visit was given to the manager at the end of the visit. What the service does well: The home is being well staffed to meet the needs of current residents by a consistent staff team, which residents said they appreciated. There are training opportunities for staff to ensure that they have the skills and knowledge to care for residents appropriately and residents made complimentary comments about the care and support provided by the care team. The home is well maintained, clean and comfortably furnished and residents can make their rooms more homely by being able to bring with them their own personal items if they wish. Residents commented that they found their rooms comfortable. Residents and relatives comments indicated that they found the home to be “very good”. White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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.V306770.R01.S.doc Version 5.2 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.V306770.R01.S.doc Version 5.2 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): 3 (standard 6 does not apply to this service). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There are satisfactory systems in place for residents care needs to be assessed prior to admission. Information about the service is not available in different formats. EVIDENCE: There has been no further review of the statement of purpose, which gives information about the home and it remains on display in hall for anyone to refer to. The manager said that all residents are given a service users guide and a comment from a resident seen confirmed this. Manager said that information about the home could be made available in large print but currently no other formats other than written is available. Information provided prior to the inspection indicated that there are 17 residents with a visual impairment and the manager agreed to develop other formats such as providing information on audiotape. White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 9 There have been some admissions since the last inspection. A record of a recent admission to the home demonstrated an assessment had been carried out but the detail that was included varied in some files to others e.g. one residents assessment did not include detail about sleep patterns, or dietary preferences although this information had been included for another resident. The manager again agreed to address the matter. Information held on files also demonstrated that residents were given information about the terms and conditions of residency. White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The care planning system in place promotes the health, welfare, privacy and dignity of residents. There are satisfactory systems in place to ensure that residents are protected by the medication procedures in place. EVIDENCE: All residents files checked contained a care plan and risk assessments were in place in some instances such as manual handling, tissue viability and falls. Evidence was on files of residents or relatives’ signatures to denote their involvement with them and of at least monthly reviews of care plans by staff. A monitoring system was noted in use for a resident for health and safety reasons however there was no information recorded to demonstrate that this had been agreed by the resident or their relatives. The manager agreed that this would be rectified. Discussions with staff and the manager, records checked and comments from questionnaires completed by residents or their relatives provided information White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 11 that residents’ health is promoted. For example, one comment was that a referral had been made to a community psychiatric nurse to assess a resident, another that residents could have G.P. visits when needed or requested. There are policies and procedures in relation to the administration and safe keeping of medication. Comments from staff indicated the trained nurses on duty only carry out this task. Discussion with a staff member, the checking of records kept of medicines administered and storage systems were satisfactory. There is a community pharmacist who visits the home periodically. At the last visit the pharmacist had delivered a training session to staff on drug therapy in older persons at which 12 staff attended. Staff were noted to knock on residents doors before entering and had a good rapport with residents. Residents said that they felt that they had their privacy respected in the home and a resident who required staff assistance when moving was noticed to receive this support in a manner which respected her dignity. White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The social and recreational opportunities provided do not meet the needs of all residents. Visitors are made welcome and residents have as far as possible choices as to how they lead their lives. The meals provided are well balanced and take into account residents personal preferences and special dietary requirements. EVIDENCE: The range of comments from the questionnaires received varied about whether there are activities arranged by the home that residents could participate in. One said “ I don’t want any activities” another “ most of the time there is not enough to occupy residents”. Records are kept of any activities and entertainment that the home arranges. Staff said that they had time on occasions to spend with residents however a comment was made that this was an area that could be further developed in the home particularly for residents who have a degree of dementia. In discussion with the manager she agreed White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 13 to obtain residents views about the social and recreational activities available and develop them further in the home. Residents said that they had choice as to their particular routines e.g. times when they got up or went to bed and whether they chose to join in with any events planned. One resident said she attended some clubs in the community another the communion service held in the home. There was information provided that there is a weekly bingo session and weekly visits by a hairdresser to the home who has also included a monthly manicure should residents wish to have their nails done which residents had appreciated. Residents were seen to be able to come and go as they pleased around the home. Residents said that they were able to have visitors when they wished and that they were made to feel welcome by staff. Comments received about the meals provided ranged from “usually” to “always” liking the meals at the home. Discussion with staff on the day of the visit indicated that they knew the individual dietary requirements of residents. There is a choice of breakfast options such as cereals, toast and marmalade, porridge, fruit or boiled eggs and a resident said she could choose to have it in her own room if she wished. The main meal is generally a set menu incorporating residents’ individual preferences and dietary requirements and drinks and snacks are available on request. White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There are satisfactory procedures in place to ensure residents are as far as possible, protected and to ensure any complaints are appropriately addressed. EVIDENCE: Information provided prior to the inspection and confirmed by the manager indicated no formal complaints had been received in the last 12 months. Previous inspections have indicated that there is a satisfactory complaints procedure in place. There was discussion and agreement with the manager that this will be reviewed to reflect recent changes to the CSCI’s own procedures as there is now a team within the CSCI that any concerns, complaints, allegations or registration matters can be referred to as follows: CRCT, CSCI, The Pavilions, 5 Smithy Way, Grove Park, Enderby, Leicestershire. LE 19 1SX . Tel. 0116 281 5930. All questionnaires received except one indicated that residents knew who to complain to. The one that didn’t said her relative would deal with any concerns she may have. No matters have been investigated under adult protection procedures in the last 12 months. Information seen at the previous visit to the home indicated here are satisfactory procedures and systems in place to report such matters. White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 15 Information provided prior to the site visit indicated that adult abuse training had occurred on 24/02/06. White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A clean, comfortable and well-maintained environment is provided for residents. There are good standards of hygiene in place that help ensure residents health and welfare. EVIDENCE: The areas of the home seen during the case tracking process indicated that there is a clean, tidy and well maintained environment provided for residents. Those bedrooms seen demonstrated that residents had been able to bring with them their own personal effects and possessions to make their rooms more homely. Residents commented that they found their rooms comfortable. There is an on-going programme of maintenance and refurbishment. Information provided prior to the inspection indicated that 4 bedrooms and the hall had been refurbished since the last site visit as has the kitchen. Comments from all the questionnaires received were that the home was “always fresh and White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 17 clean”. Equipment was seen to assist residents who have mobility needs such as hoists and information provided demonstrated that equipment that required servicing had been. Stocks of gloves and aprons were available for staff to use to ensure good hygiene and infection control procedures. White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 18 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, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is being well staffed to meet the needs of current residents by a consistent staff team who have regular training to ensure that they have the necessary knowledge and skills to care for residents safely. The recruitment procedure ensures that residents are as far as possible protected from any potential risks. EVIDENCE: Comments from residents were complimentary about the care and support they received from staff. They felt that they were attended to promptly and appreciated that there was a consistent staff team. A system is in place for assessing the needs of residents to ensure that staffing levels are appropriate. There is always a qualified nurse on duty, and a team of carers. In addition there are catering, domestic, laundry and maintenance staff employed. All questionnaires received indicated that residents “always” received the care and support they needed and the majority that staff were “always” available when needed. One specific comment was “the home seems well staffed and all are willing to help”. Records and staff comments confirmed that there is a training programme in place which includes regular updates for staff on some issues such as manual White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 19 handling and some training which is specific to the needs of residents such as dementia training and drug therapy in older people. Information provided prior to the inspection indicated that 33 of care staff had obtained at least a vocational award in care at level II or above. In addition there are 7 qualified nurses working in the home. Records also demonstrated that staff had had equal opportunities training. Residents’ comments about the staff team were complimentary. There has been one new staff member employed since the last inspection and records checked of the recruitment process demonstrated that this had been thorough, included references and a criminal records bureau check being undertaken prior to employment and was based on equal opportunities. Action has been taken since the last inspection to address the issue raised in relation to the recruitment procedure of a specific staff member. White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 20 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): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. 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. There are satisfactory measures in place to promote residents’ health and safety. The procedures in place for auditing aspects of the service are inadequate to ensure residents are fully protected from any potential risks. EVIDENCE: There has been no change to the management arrangements. The registered manager is a qualified nurse and has extensive experience in the care profession. She has achieved the NVQ level IV award and the D32 and D33 assessors award. Staff described her as approachable and felt valued and White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 21 supported. Residents were aware of the management arrangements and said could raise concerns if needed. There are a variety of means of obtaining residents and relatives’ views about the service. As one of the owners also manages the home she is able to gain residents views about the service individually. The manager said no further questionnaires had been used with residents in the past year but showed the development plan for the home for 2006/2007. It was discussed and the manager agreed to incorporate into the plan information, which demonstrates how the views of residents had been incorporated into it. The manager also agreed to undertake an audit of residents’ views about the recreational and social activities provided. There is a satisfactory system in place to ensure staff are supported and supervised. There needs to be some review of the procedure in place for auditing money held in safe keeping to ensure that records kept are up to date and accurate, which the manager agreed to do at the time of the visit. Storage arrangements for money and valuables are satisfactory. Information provided prior to the site visit demonstrated that there are regular checks undertaken to ensure that health and safety issues are monitored e.g. service certificates are in place to demonstrate when equipment such as hoists, fire alarms and equipment and the central heating system have been checked. There are a range of health and safety policies and risk assessments of the environment in place to help ensure that residents’ health and safety is promoted. White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 22 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 White Gables Nursing And Residential Home DS0000002561.V306770.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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.V306770.R01.S.doc Version 5.2 Page 24 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. 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