Inspection on 14/03/07 for White Gables Residential Home

This inspection was carried out on 14th March 2007.

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 Residential Home 06/03/06

White Gables Residential Home 02/06/05

White Gables Residential Home 09/12/04

White Gables Residential Home 28/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE White Gables Residential Home 16 Stanley Road Felixstowe Suffolk IP11 7DE Lead Inspector Kathryn Moss Unannounced Inspection 14th March 2007 09:40 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 Residential Home DS0000024525.V333681.R02.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 Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service White Gables Residential Home Address 16 Stanley Road Felixstowe Suffolk IP11 7DE 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) 01394 282620 01394 283847 Mr. C Lewis & Mrs. J Lewis Mr Clifford Lewis Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th March 2006 Brief Description of the Service: White Gables is a private, family run care home for older persons, which has operated since 1982. The Home was first registered in 1984 for 15 service users. A conversion and extension provided a further 10 places, and a further extension into the adjacent property in 2004 enabled the provision of a further 12 beds. The home is now registered under the provisions of the Care Standards Act 2000 to accommodate a maximum of 37 older persons. The home is located in the coastal town of Felixstowe and is within walking distance to the town centre. The local amenities include the post office, shops, community centre, doctors’ surgeries, churches, theatre and leisure centre. The home is also close to the main bus routes that serve the town centre. The southern aspect of the home faces the promenade, gardens, lawns and sea views. Access to the home is by a main side entrance where car parking is available. All bedrooms are single accommodation, with en suite toilet facilities in thirtysix of the rooms. There are three lounges: a large downstairs lounge provides the main communal area where the daily social activities take place there, and a small side lounge and a small first floor lounge are available for people wanting a quieter area or a place to receive guests. As committed Christians the proprietors are involved with the church life in Felixstowe, and a daily bible reading and weekly service take place in the lounge for those who wish to participate. The registered providers are Mr Clifford Lewis and Mrs Jacquie Lewis, who are both involved in the day-to-day running of the home, Mr Lewis as the registered manager, and Mrs Lewis leading on care management issues. Mr Lewis reported that a copy of the home’s service user guide will be made available to residents and visitors in the dining area of the home. The current fees for the home, as reported at the time of this inspection, range from £490 to £550. White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place on the 14/4/07, lasting 8 hours. Mrs Lewis (registered provider) was present on the inspection visit to the home. The inspection process included: • The site visit to the home, which included: o a tour of the premises o discussion with Mrs Lewis; o discussion with two senior care staff o discussion with six residents o an inspection of a sample of records A subsequent meeting and discussion with Mr Lewis (registered manager) at the CSCI office, and inspection of some further records provided by Mr Lewis; Feedback questionnaires distributed by the home, and received back from: o one healthcare professional, o six residents, and o nine relatives/representatives of residents; • • The end date for the inspection process was 22/3/07, to provide time for survey forms to be returned by residents and their representatives. For the purpose of this report, the term ‘manager’ has been used to refer to either registered provider. 26 Standards were covered, and 2 requirements and 7 recommendations have been made, with some additional good practice recommendations made within the report. What the service does well: The home provides a welcoming and very well maintained environment. This was commented on by residents spoken to during the inspection, and also by several relatives who provided feedback. One relative described it as ‘comfortable and homely’ and another felt the home provides ‘an excellent well-maintained environment’. Relatives and residents were unanimous in their praise of staff at the home, with one relative stating that staff always put residents’ needs first, and another highlighting that staff ‘have the welfare of the people at heart’. Other comments from relatives and residents included ‘the carers are always cheerful White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 6 and helpful’, ‘there is a loving, caring atmosphere and people are always treated with dignity’ and ‘I have nothing but praise for the kindness and efficiency of all concerned with this home’. The managers and staff are commended on this. Residents were extremely positive about the quality of the meals served at White Gables, and one relative commented on the ‘excellent food’. Of particular note was the variety of food provided at the main meals (including home made soups or fruit juice available as a starter), and the fact that staff served vegetables individually to residents at their tables, making the food service and presentation more personal. What has improved since the last inspection? What they could do better: Most of the issues highlighted by this inspection indicate a need for the home to develop some of its recording practices, and to develop systems for evidencing and monitoring the practices that are in place. Whilst the home clearly provides good care, some practices were not sufficiently reflected in the home’s records (e.g. care plans, pressure area risk assessments, medication risk assessments, etc.). The home also needs to develop formal ways for monitoring practices (i.e. quality assurance processes). Many of these issues are important elements in promoting the protection of vulnerable adults, and also form part of the development of systems for quality assurance. White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 7 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 summary of this inspection report can be made available in other formats on request. White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 8 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 Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 4 (Standard 6 is not applicable at White Gables) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home appropriately assesses the needs of prospective residents, and ensures that they can meet their needs. EVIDENCE: The home was full (accommodating 37 residents) at the time of this inspection: the manager reported that this is generally the case, and that the home has a waiting list. The home’s statement of purpose and service user guide were not specifically reviewed as part of this inspection, but the manager confirmed that prospective residents are given a copy of the service user guide as part of the admission process. Residents providing feedback as part of this inspection felt they had received enough information about the home to help them to decide if it was the right place for them. White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 10 The manager stated that prospective residents are always encouraged to visit the home before deciding to come and live there, and saw this as a way of ensuring the person was making a positive and informed choice. This is good practice, and several residents spoken to confirmed that they had visited the home and that this had helped them see if the home could meet their needs. The manager reported that the home always carries out its own assessment of a person’s need before their admission to the home, as well as obtaining available care management information. The manager stated that they prefer to do this assessment whilst the person is visiting the care home, but will visit them in their own home (or hospital) if required. The home’s pre-admission assessment form was seen to provide scope to assess all key areas of need, including family, social, cultural and religious needs. However, an example inspected showed very little information about the individual recorded (just ‘Yes’ or ‘No’ responses alongside each issue). The manager acknowledged that this example had not been well completed, and it is recommended that pre-admission assessments contain as much detail as possible, as (particularly in the case of privately referred residents), this may be the main form of information about the person available to care staff on the person’s day of admission. The manager was clear about the levels of needs the home can meet, and provided an example of the home taking positive and responsible action to seek a more appropriate placement for someone whose needs had changed and the home was no longer able to satisfactorily meet their needs. A new resident spoken to during the inspection felt they had been made welcome in the home, and was satisfied that staff could meet their needs. The home has equipment, facilities and appropriately trained staff to meet the needs of people who it aims to accommodate. No residents had any specific needs arising from ethnicity or culture at the time of this inspection. The home’s Service User Guide states that the owners are committed Christians and that major annual Christian festivals are celebrated in the public areas of the home, but also states that care will also be taken to try ‘to meet the needs of service users from minority faiths’. Written contracts (terms and conditions of residence) were not specifically inspected on this occasion. However, residents who completed a written feedback questionnaire were asked if they had received a contract, and of the six who returned completed questionnaires, only two said Yes (two said No, and two did not respond). A person spoken to during the inspection also appeared uncertain about some aspects of their stay in the home (e.g. whether they had a key worker, whether alcohol was allowed in the home). As it can be difficult for people to retain all the information given to them when they first come to live in the home, the home may wish to consider whether it would be helpful to periodically remind residents of key terms and conditions of residence. White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 11 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. 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 this service. Residents’ personal and health care needs are well met in the home; however, records do not satisfactorily reflect the care provided. The home’s medication practices protect residents, but procedures to facilitate self-administration require review. Residents are treated with dignity and respect. Key Standards are generally met, and where issues have been highlighted for action, the CSCI is confidant the provider can manage areas of improvement. EVIDENCE: Residents consulted as part of this inspection were all very satisfied with the personal care and health care support provided by staff at White Gables. Residents’ relatives and representatives particularly praised the high level of care given, with comments including ‘the owners and staff care about all their residents and look after them extremely well’. A healthcare professional providing feedback as part of this inspection felt that that the home responds White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 12 appropriately to medical needs, that ‘carers are attentive and monitor the healthcare needs of clients’, and confirmed that the home seeks their advice when necessary. It was observed during the inspection that people’s hygiene needs were wellsupported by the home: residents looked in good general health (e.g. nails, hair, skin, nutrition, etc.), and those spoken to felt there were sufficient staff on duty to meet their needs, and said they did not have to wait long when they pressed their call bell. People were observed mobilising and it was good to see that everyone was provided with individual call-alarm pendants, which clearly gave them confidence in maintaining independence. Notifications of falls and accidents sent to the CSCI over the last year showed only two falls that had resulted in an injury during that time. Senior staff reported that, due to their dependency levels, a couple of residents were at risk of developing pressure sores. However, no residents had any pressure areas at the time of this inspection, which indicates good care and monitoring by staff. The manager reported that the home is well supported by local district nurses and GPs, and that staff support residents to attend the local surgery where possible, and to attend regular diabetic clinics if required. Residents reported receiving all the regular health checks required (e.g. opticians, dentist, etc.). Service user plans were present in the home, but these need some further development. Whilst it is stressed that care outcomes for residents are very good at White Gables, it is important that records accurately reflect the care being provided. The reason for this is to ensure that staff have clear guidance on how to meet individual needs, that individual wishes and preferences are identified, and that the home can evidence that correct care is being given. Two service user plans were inspected: whilst these contained sections relating to most key needs, including social and emotional needs, in both cases the level of detail was quite brief and did not describe in sufficient detail the action required by staff to support the person’s needs. For example, one person was at risk of developing pressure areas, but the care plan did not refer to this or describe the preventative care being provided (including pressure relief equipment in use); the plan also did not reflect that the person needed assistance with feeding (or describe the level of assistance), and although it identified an emotional need, it did not describe the action required by staff to meet this need. It was good to see that care plans had been signed by service users and/or their representatives, showing their involvement in the process, and there was evidence of dates showing that care plans were regularly reviewed. It is recommended that evidence of reviews also show the outcome of the review (e.g. at minimum, ‘no change’ or ‘care plan updated’), so that staff can see at a glance whether there has been any change to care plans without having to read each care plan. Care plans had generally been updated with any changes, although in one instance did not reflect when a person had been provided with a different mobility aid. White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 13 There were clear moving and handling risk assessments present on files viewed. However, no other specific health care assessment or monitoring forms are currently used in the home (e.g. assessment of risk of pressure areas, continence, nutrition, etc.). It is therefore strongly recommended that the home implement forms for assessing and monitoring specific health care issues. Individual nutrition records are not currently maintained, other than menus and daily meal choices, and it was recommended that the home explore ways of keeping basic individual nutrition records (e.g. by updating the meal choice records after each meal, to reflect any changes). It was good to see the home monitoring the weights of residents; residents felt they were very well fed, and menus showed nutritionally balanced meals. Residents reported feeling that they were treated with dignity and respect by staff, and a visiting health care professional also commented on this. Care records clearly identified each person’s preferred name. Staff were observed to show a respectful approach to residents, to relate well to them, and to respect their privacy (e.g. knocking on doors before entering). Medication policies and procedures were not reviewed on this occasion, however, medication was seen to be safely and appropriately stored, with stocks maintained in an orderly manner. Bottles of liquid medications were not routinely dated on opening: whilst it is recognised that most were finished or disposed of by the end of the month they were supplied, as good practice it is recommended that liquid medication is dated on opening, especially medication that may last several months. Senior staff had received appropriate training; a senior carer took prompt action to resolve issues raised during the inspection. Medication Administration Records (MAR) were printed by the pharmacist with medication details. Quantities of medication received by the home were clearly recorded on these forms by staff, as were details of any additional medications received by the home during the course of the month or for new residents. MAR inspected were well completed, with no omissions observed and clear symbols used for non-administration. Where the dosage of a medication was changed during the course of a month, the original medication entry on the MAR had been amended: it is recommended that in these situations, a new entry be made on the MAR for each revised dosage of the medication. The home maintained a clear record of all medication returned to the pharmacist. It was good to see the home promoting and facilitating self-administration of medication, and several residents were managing part or all of their own medication. However, although the home had a questionnaire for assessing capacity to self medicate, there was no evidence of this on a sample file inspected. A senior carer reported that whether someone has taken their medication is monitored when new supplies are delivered each month, but there are no formal systems currently in place to monitor and review a person’s capacity to safely manage their medication. It is recommended that a White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 14 more formal risk assessment form be developed, incorporating space to record details of any action taken to minimise risks, and evidence of review. During a tour of the premises, medication that included a controlled drug was observed on display in a person’s room. Staff were not aware that the person had been prescribed this medication, as that they attended their GP independently. The home needs to review current procedures relating to self-medication in order to ensure the safety of all residents (e.g. regarding whether staff need to be aware of all medication prescribed to an individual, in case they suffer adverse affects, are admitted to hospital, or in case any other resident should accidentally take this; and how the home monitors residents’ ability to keep their medication secure, etc.). White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a lifestyle that promotes choice and satisfies residents’ social, religious recreational and dietary needs. EVIDENCE: Daily routines at White Gables appeared flexible, with residents able to make choices about how and where they spent their day. It was noted that the home provides a good level of staffing, with a higher staffing level in the morning when two staff are assigned time to organise activities. The manager confirmed that this time can be used for staff to take residents out individually if required. At the time of the inspection, there was a list of possible activities displayed by the lounge, and staff reported that they selected ideas from this each day. Records of activities carried out on the previous two days showed that ‘nail care’ had been provided both days; on the day of the inspection a carer organised a quiz, and it was good to see one resident playing the piano and another going out to a meeting in the community. White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 16 Residents spoken to were generally positive about the activities available, although one person felt that there was not enough going on for them. Several residents said they enjoyed the weekly visits by a volunteer, and it was noted that there was a weekly church service and monthly entertainment. Feedback questionnaires asked residents whether activities were arranged by the home that they could take part in: of the six who responded, three said ‘Always’, two said ‘Usually’ and one said ‘Sometimes’. One relative consulted felt that the home provides ‘sufficient staff and a good variety of choices for different activities’; another suggested that there could be more trips out. Although there generally appeared to be a good level of activities and interaction by staff, the manager felt that the range of activities had been less varied since the home had moved away from having a set weekly activities programme. Subsequent to the inspection, the manager submitted evidence of a good range of activities that had taken place during the previous year (including several trips out, and entertainment coming in to the home), and advised that they had decided to reinstate a planned weekly programme that included a range of varied activities. Residents meetings had recently been implemented, and it is recommended that these could be used in future to involve residents in suggesting and reviewing activities. The home’s visitors’ book showed regular visitors to the home; residents confirmed that they could receive visitors at any time, and in the privacy of their own rooms. Feedback from relatives about the home was extremely positive, and reflected a good relationship with staff and owners. Local churches are involved in the home, and there was evidence that several residents were still able to go out independently and accessed the local community. Service users spoken to were clear they had choices in daily life, and many still retained control over aspects of their personal affairs (e.g. their own money). Rooms seen were well personalised, and the manager was clear that would encourage people to bring own possessions into the home with them. Information on a local advocacy service is available in the home. All residents consulted were very positive about the food served at White Gables, reporting that they had both variety and choice, and that food was provided in both quality and quantity. The home operates a four weekly menu, with a varied range of options available at lunch and tea. One resident reported that if they wished they could have a four-course lunch, as there was soup or fruit juice to start and they could have cheese and biscuits afterwards if they wished! The manager confirmed that the home uses fresh vegetables, and makes home made soups and cakes. Specific dietary needs were not discussed, but records of food choices showed that the home was willing and able to meet individual wishes and choices. Meals were served in a dining room with tables attractively laid, creating a pleasant mealtime atmosphere. The manager stated that staff take vegetable serving dishes round the tables White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 17 to serve individually, which is commended. A service user who required some assistance reported that they felt that staff were discrete when helping them. White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 18 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. 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 this service. The home responds promptly to concerns, and protects residents from abuse. EVIDENCE: White Gables has a complaints policy that is available to residents in the home and is included in the introductory pack sent to relatives. Residents and consulted as part of the inspection all knew who to speak to if they were not happy, and knew how to make a complaint. Residents spoken to were confident that they could voice concerns, said they would speak to the managers, who they felt were available and approachable. One said they had previously voiced a concern, and felt that this was dealt with promptly and well. Of the nine relatives or representatives who provided feedback, seven said they knew how to make a complaint and one said they did not (and one did not respond to the question). Three said they had not needed to raise any concerns with the home, and the others felt that the service had responded appropriately to any concerns they had raised. The home does not currently maintain a central record of complaints and concerns received. The manager stated that details of any serious complaints would be recorded on the relevant staff member or resident’s file, but said that they had not previously considered the need to record more minor White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 19 concerns or complaints because these were generally dealt with promptly as they arose. From examples provided, and relatives’ feedback, it is clear that this is the case. However, the home does need to record and monitor all complaints, even those less serious ones: this is partly so the home can demonstrate that concerns are addressed, but can also form a useful part of the home’s quality assurance processes. The home also needs to be able to meet regulatory requirements to produce a record of complaints, if requested by the CSCI. At a subsequent meeting with the CSCI, the manager provided evidence that they have already implemented a complaint record form to use in future. The manager is advised to ensure that this form shows the action taken, and the outcome, as well as the details of the complaint. The home has a protection of vulnerable adults (POVA) policy, which was seen on previous inspections and so was not reviewed on this occasion. The manager confirmed that the home also has information on Suffolk County Council’s Vulnerable Adult Referral process, which is available to staff. The manager reported that training on POVA is currently provided to staff as part of their induction, covered by the deputy manager as part of the Skills for Care Common Induction Standards, which incorporates video and workbook input. There was no other POVA training currently provided by the home on an ongoing basis, although this is covered as part of NVQ training and the manager confirmed that this is also a topic of discussion in staff meetings and supervisions. Subsequent to the inspection the manager confirmed that the home have now organised additional internal training sessions to complement the POVA training covered by induction and NVQ training, using a DVD on ‘Abuse in the Care Home’ and other training resources. It is recommended that the home also explore and access any available external training on POVA and adult abuse, in order provide wider opportunities for learning and awareness raising amongst the staff team. White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is safe, well maintained and hygienic. Residents are provided with comfortable individual and communal facilities, which are suitably furnished and meet their needs. EVIDENCE: White Gables provides a range of facilities appropriate to the needs of the residents it accommodates. One relative commented that the home provides a ‘comfortable, homely environment’. All areas viewed, both personal and communal, were well decorated, attractive and in a very good state of repair. The manager reported that corridors and three bedrooms had been decorated during the last year (records of redecoration and refurbishment were not viewed on this occasion). The home had a variety of communal space available to residents. The main lounge was warm, clean, bright and airy, and White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 21 was clearly well used; a side lounge provided quiet space for residents and visitors. A small upstairs quiet lounge available to residents was attractive, cosy, and equipped with a TV. Additional seating was available in an upstairs landing area, where a service user was observed being served morning coffee. There was an attractively presented separate dining area. Bedrooms viewed were attractive, personalised, clean, warm and well decorated. Furniture supplied by the home was modern and of good quality and condition. All bedrooms are single rooms, and all apart from one have an ensuite toilet; ensuites were fitted with cabinets and mirrors, and toilet frames where required. Bedrooms had suitable and sufficient furnishings and fittings, covered radiators, window opening restraints, and sufficient electric sockets. The manager stated that when rooms are decorated, service users are asked if they have a preference about colour schemes; rooms viewed were individually decorated. A few rooms had inter-connecting doors so they could be used for married couples: in one instance two adjacent rooms were being used by a couple as a bedroom and sitting room, which was good to see. The home is well lit and heated. Rooms were naturally ventilated, and radiators were protected to prevent risk of scalding from hot surfaces. The temperatures of all bath water run are tested and recorded. Hot taps were fitted with thermostatic temperature control valves: prior to the inspection there was no recording of the routine testing of hot tap temperatures to check that valves were working effectively, but subsequent to the inspection the manager confirmed that they had now implemented a system for recording this in future. Central hot water storage temperatures were checked annually when the boilers were serviced, but there was no system for monitoring that hot water storage temperatures remained at over 60°C to prevent risk of Legionella. The manager was advised to implement systems for checking this. On the day of the inspection the home was observed to be very clean and tidy; residents consulted all stated that the home was always kept clean and fresh. The home had basic universal infection control policies/procedures, and many staff had received training in infection control. A small laundry area is equipped with sufficient washing machines and dryers, sited away from areas where food is prepared or stored. The home operates appropriate infection control practices: red bags were used to collect soiled or infected linen and placed directly into a washing machine; one washing machine has a sluice wash cycle and temperature cycles that meet infection control standards. The laundry area contains the only sluice sink in the home, and the manager confirmed that this is sometimes used for cleaning commodes: although the home has a procedure for cleaning commodes, this did not address the potential risk of cross-contamination from cleaning soiled items in a confined area where clean linen may be present. It was noted that few commodes are used in the home and most could be cleaned in the ensuite of the room where they are used, but it was recommended that the home review procedures or risk assessments for cleaning commodes. White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 22 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. 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 this service. Staffing levels meet the needs of residents, and levels of training ensure that residents are in safe hands. Recruitment practices protect residents. EVIDENCE: On the morning of the day of the inspection there were six care assistants on duty, plus a senior carer and the manager; in the afternoon three care assistants and a senior were on duty, plus an additional care assistant from 5pm; three staff are on duty at night (10pm –8am). A sample rota for the previous week confirmed this as the usual level of staffing. A senior carer stated that there were higher staffing levels in the mornings because they had observed that residents preferred to do activities in the mornings. It is good to see the home applying staffing flexibly to meet residents’ needs, and this shows a good staffing level. Residents spoken to felt that there were sufficient staff on duty, and noted that staff always came promptly when they pressed a call bell. The home also provided a good level of ancillary staffing (i.e. domestic, catering and maintenance staff). Recruitment records were inspected for two staff recruited in the last six months, and generally showed that satisfactory checks were being carried out White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 23 to protect residents, although a few areas for improvement were highlighted. Both records contained completed application forms: although these contained very little space for employment history, the manager had implemented an additional form on which applicants could record training, employment and experience. However, in one case there was an unexplained gap in the employment history, and the manager was advised to ensure all gaps are explained, and to request applicants to provide employment start and finish dates (not just the year) to aid the checking of employment histories. The manager subsequently confirmed that the application form has been amended to specifically request a full employment history. Application forms contained a criminal record declaration, a health declaration, and the names of two referees; both files contained two written references (including last employer) received before the person started work, and photos of the applicant. Files contained a Criminal Records Bureau Check, although neither had been obtained before the applicant started work and there was no evidence that a POVAfirst check had been obtained. The manager subsequently advised that POVAfirst checks had previously been obtained but not been retained by the home, and confirmed these will be retained in future. Neither file contained proof of identity, and the provider was advised to retain this on file in future. The manager provided a summary record showing all core training completed by staff. Of 28 care staff currently employed, the training summary showed that the deputy manager had completed National Vocational Qualification (NVQ) level 4, and eight staff had completed NVQ levels 2 or 3; a further five staff were in the process of doing NVQ level 2. Although the home does not currently meet the minimum standard for NVQ training, it should achieve this once staff currently undergoing training have completed this; it is noted that some staff who had achieved NVQ had since left. The manager confirmed that they expect all new staff to complete NVQ training. Training records showed a good level of training completed within the home, giving staff the skills to meet residents’ needs. All staff had completed an inhouse induction, and care staff recruited over the last few years had completed an induction based on the relevant National Training Organisation (currently ‘Skills for Care’) induction standards. Core training included food hygiene, Moving and Handling, fire safety, first aid, care of medicines, infection control, and dispelling myths of the funeral profession; POVA training was not specified separately as it was been previously covered as part of induction and NVQ training (see Protection section). The records showed a good level of Moving and Handling and fire safety training completed by all staff, and other training had been completed by an appropriate range of staff, as relevant to their roles (e.g. not all staff had completed food hygiene training, but all night staff had as they are more likely to be preparing snacks for residents). The manager stated that fire and moving and handling training is provided annually, and the White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 24 home has its own manual handling trainer. It was also noted that dementia awareness course was planned. White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed, and is run in the best interests of residents. Health and safety practice promotes the safety of both staff and residents. Key Standards are generally met, and where action has been identified, the CSCI is confident the provider can manage any improvement required. EVIDENCE: Both proprietors manage the home, and have many years experience of managing a care home. Mr Lewis is the registered manager, and has completed the Registered Manager’s Award (NVQ level 4); Mrs Lewis is a registered nurse, and focuses on the management of care within the home. White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 26 There is a deputy manager who has also completed NVQ level 4. Residents were very positive about the management of the home, finding the managers approachable and supportive. The managers show an ongoing commitment to improving the home, and are responsive to any issues raised by the CSCI, promptly actioning any requirements and recommendations. The home holds regular staff meetings, with all groups of staff. Staff and residents confirmed that the owners were approachable and available, and clearly felt able to talk with them openly and felt confidant they would be listened to. The manager reported that the home had just held its first residents’ meeting, felt that this had given residents the opportunity to comment on aspects of the home, and confirmed their intention to continue these meetings at regular intervals. The home has a very articulate and able group of residents, and it was suggested that residents could be invited to be more involved in the running of the home (e.g. in interviewing new staff). In relation to quality assurance processes, the home has a questionnaire that is used to survey residents’ views, and which had recently been sent out to residents (or to their relatives, if they needed assistance to complete this) to obtain feedback on the service. The manager stated that all responses had been read and any comments followed up, but that the home has not previously produced any report summarising the outcomes from their quality assurance surveys, or any other review of care in the home. No other surveys are currently used by the home, and it was suggested that the views of relatives and other people involved in the home (e.g. healthcare professionals) could also be sought as part of the home’s formal quality assurance processes. The home does not currently have a formal annual development plan as part of Quality Assurance processes (i.e. setting annual goals for the home, with a cycle of action and review). The home has achieved Investors in People in relation to its employment processes, and records viewed provided evidence of the routine monitoring of aspects of health and safety in the home. However, there was a lack of evidence of other formal quality assurance monitoring and auditing processes in place in the home (e.g. evidence of the auditing of medication, service users’ monies, accident records, etc.), and this should be developed. It was noted that good informal monitoring of practices took place on a day-to-day basis through the owners’ daily involvement in the home, and feedback from residents and relatives indicated that the home always puts residents’ needs first. The need to develop the home’s formal quality assurance and monitoring systems was discussed with the manager during the inspection, and they were advised to review the Standard relating to this. The home has recently revised its arrangements for safekeeping residents’ monies. It no longer looks after money on behalf of residents, but will provide money to purchase any items requested by individuals, and invoice them (or their representatives) each month for any money spent on their behalf. Staff White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 27 obtain receipts for purchases made, and the home maintains clear individual records of any expenditure on personal items. The home has a clear Health and Safety policy statement, describing employer and employee responsibilities. Areas of the home viewed appeared safe and well maintained, and staff training records showed that staff had received training in areas of health and safety relevant to their work. A well-organised file of records was maintained relating to the facilities and equipment used in the home, which provided evidence that utilities and equipment were regularly serviced. There were also records showing the internal testing of equipment (e.g. fire alarms, emergency lighting, bath temperatures, etc.). The home had a clear fire procedure and relevant fire safety information, and a new fire risk assessment had been completed. No specific evidence of fire drills was maintained in the home, but the manager stated that drills are carried out each week when the fire alarms are tested, and that staff rotas on fire drills days would therefore reflect who attended. The manager subsequently advised the inspector that a separate system would be implemented to more clearly record attendance at fire drills, and it is recommended that this include scope to record any outcome from the drill. The need to ensure that night staff also attend fire drills each year was also discussed with the manager. Accident records were not inspected on this occasion. The home has a general risk assessment on safe working practices, which identifies key hazards and contained brief information on preventative action. The manager advised that risk assessments are reviewed each year; it is recommended that the risk assessment is dated when it is reviewed. Product safety information was maintained for chemicals used within the home. White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 28 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 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X X 3 White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 29 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 OP8 Regulation 15(1) Requirement The registered persons must ensure that any residents at risk of developing pressure sores are assessed and identified, and that appropriate intervention/ preventative care is recorded in their individual plan of care. The registered persons must review procedures for managing the self-administration of medication within the home, in order to ensure that practices protect all residents. They must ensure that risk assessments are completed and regularly reviewed, and monitor residents’ capacity to keep medication safe. Timescale for action 31/05/07 2 OP9 13 (2) and (4) 31/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 30 No. 1 Refer to Standard OP3 Good Practice Recommendations It is recommended that pre-admission assessments contain full details of a person’s needs, so that staff have sufficient information available to support the person at the time of admission. The home should ensure that individual service user plans provided suitably detailed information of the action to be taken by care staff to ensure that all aspects of the resident’s health, personal and social care needs are met. The manager should ensure that all complaints are recorded, even more minor concerns, and that a central record of complaints maintained. This demonstrates how the home deals with complaints and concerns, as well as providing information that may be required by the CSCI. The registered provider should ensure that the home retains evidence of all recruitment checks required by Regulation (ref Reg 19, schedule 2). This particularly relates to evidence of ID, written explanation of any gaps in employment history, and evidence of when POVAfirst checks are obtained. It is recommended that the registered person develop the home’s formal quality assurance processes in accordance with Standard 33, in order to demonstrate the formal monitoring and review of the service provided. The registered person should also produce a report in respect of any review of care conducted in the home, and make this available to the CSCI and to residents (reference Regulation 24). The home should ensure that money looked after on behalf of residents is stored individually and is not pooled. This is in order to promote a person centred approach, and to safeguard residents through enabling the auditing of any monies held for safekeeping. The manager should ensure that all night staff attend sufficient fire drills each year. 2 OP7 3 OP16 4 OP29 5 OP33 6 OP35 7 OP38 White Gables Residential Home DS0000024525.V333681.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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