Care Home: Gable Court Nursing Home

What the care home does well Maintain effective relationships with external professionals to ensure the health and well-being of residents living at Gable Court. Encourage and engage relatives, service users and/or their representatives in key aspects in the promotion of residents` interests and welfare. Provide activities that are consistent with residents` interest, choice and satisfaction. Residents are very satisfied with the meal provision at the home in terms of choice, taste, diversity and meeting their specialist nutritional needs. The registered manager and staff team are committed to providing a good service at Gable Court. In this respect responding sensitively to residents changing needs and circumstances is key. e.g. staff popping in to see residents when they are in hospital. Provide a good range of training for all levels and layers of staff in the home. Develop good risk assessments to promote the safety without compromising the residents` levels of independence. What has improved since the last inspection? The new care planning was fully in place and used as a working tool in the delivery of care and support to residents. As a result care plans were updated and reflective of residents` needs. Cultural and religious needs were now clearly recorded and acted upon for most residents. There was no evidence that residents` rooms were used as a storage facility for excess nutritional supplements. There have been refurbishment and re decorative works noted. Residents have indicated that they now receive better individualised care, nutrition and activities amongst other things. What the care home could do better: Enhance the robustness of recruitment practices in the home for all staff. Ensure that when monthly provider visits take place, that a record is available at the home for inspection. Key inspection report Care homes for older people Name: Address: Gable Court Nursing Home 111 Roxy Avenue Chadwell Heath Lane Romford Essex RM6 4AZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Stanley Phipps     Date: 1 6 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Gable Court Nursing Home 111 Roxy Avenue Chadwell Heath Lane Romford Essex RM6 4AZ 02085976041 02085999257 soobenn@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Nalini Sooben Type of registration: Number of places registered: care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 52 The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other categroy - Code OP (maximum number of places: 52) Physical disability - Code PD (maximum number of places: 8) Date of last inspection Brief description of the care home Gable Court Nursing Home is operated by a BUPA owned company. The home is registered to provide accommodation with personal care and nursing for up to 52 Care Homes for Older People Page 4 of 29 Over 65 52 0 0 8 Brief description of the care home residents. The majority of the residents are over the age of sixty-five years, but the home is also registered to provide care for up to six people between the ages of 18-65 years who have a physical disability. The home is a purpose built three storey building situated in a busy residential area of Chadwell Heath, with access to community facilities: via public transport links a short walk away. All the rooms are single occupancy and the majority have en-suite facilities. Not all the rooms are large enough to accommodate wheel chair users. The current manager has worked at the home for a number of years and has the qualifications and experience to understand and meet the needs of the residents. On the day of the inspection the range of fees for the home was between £545.00 and £700.00 per week. A copy of the Statement of Purpose and Service Guide to the home is made available to both the resident and the family. There is a copy of the guide in each bedroom, and copies of both these documents are available at the main reception. A copy of the most recent inspection report is also available at reception or on request. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection of the service that was unannounced and carried out over two separate visits to the home, beginning on the 22/10/09 and ending on the 16/11/09. The registered manager was available throughout the course of the inspection and an interview and several discussions were held with her as part of the process. Interviews and discussions were held with a broad spectrum of staff to include nurses, care staff, the head chef, the housekeeper, the activity coordinator, the administrator and the maintenance officer. Interviews and discussions were also held with a number of residents and relatives to determine their experience of the care and support provided at Gable Court. The delivery of all aspects of the service was observed and commented upon in this report. An assessment was made of the: premises, records required by regulation, activities, Care Homes for Older People Page 6 of 29 meals, care plans, health and Safety documentation, staffing files to include recruitment, risk assessments, staffing rosters, quality assurance documentation, medication and maintenance records. Consideration was also given to the information provided in the Annual Quality Assurance Assessment document submitted by the registered persons. Feedback was also taken from external professionals that were involved in the home. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 29 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to benefit from having a detailed assessment carried out prior to taking up residence at Gable Court. The assessment details are then used to ensure that residents needs are identified, understood and carefully planned for. Intermediate Care is not provided at Gable Court. Evidence: On examining the individual files of five of the most recently admitted residents, detailed assessment information was in place in all cases. These assessments formed the basis on which individual care plans were drawn up for each resident following their admission to the home. Where possible residents and their relatives/representatives contributed to the assessment process and summary information from placement authorities was available and considered - where appropriate. The registered manager and staff nurses are involved in most of the assessments and from the evidence seen - residents were admitted to Gable Court, on Care Homes for Older People Page 11 of 29 Evidence: the basis that the home has the resources to meet their assessed needs. Intermediate care is not provided at Gable Court and so National Minimum Standard (6) for Older People does not apply and hence was not assessed. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health, personal and social care needs are detailed in their individual care plans. Improvements in the recording of specifics such as; religious and cultural needs with clear outcomes for residents, now ensure that a better standard of care is provided at Gable Court. This was enhanced also, by keeping care plans regularly updated to reflect residents changing needs. Medication practises continue to provide residents with safe and good healthcare support. Evidence: At the time of the inspection, the organisations care planning system (QUEST) was in full swing, which was evidenced in the all six care plans inspected. They contained all the intense details to include residents religious and cultural needs,apart from one case, where nothing had yet been recorded under religious beliefs. This was explored with the manager, who acknowledged that it was missed, but would be followed up as a matter of urgency. It was noted that the individual concerned had only been recently admitted to the home. Apart from this, there was good evidence to confirm that religious and cultural beliefs were an integral part of residents activities, meals, social and health needs.In one case a high-dependency resident had the benefit of working Care Homes for Older People Page 13 of 29 Evidence: with a Punjabi speaking staff, eating vegetarian meals, and listening to Indian music. Care plans bore evidence of catheter care, peg-feeding, diabetic monitoring, mobility and transfer arrangements, dietary requirements, pain management, end-of-life arrangements, preferred routines, lifestyle profiles and specific night care plans. Relatives were involved in the care planning process and this was particularly noted around end-of-life planning. Staff interviewed had a good understanding of the specific needs of residents and most of the care plans were maintained to a high standard, although two entries(9/11/09, 10/11/09) in a short term plan could have been more detailed in terms of the actions taken with the resident concerned. Care plans were regularly reviewed and evaluated and staff were generally confident in using them as working tools. Assessments of the care plans and daily records indicated that the health care needs of residents were met. In most cases residents had a combination of complex and specific needs, including those residents with a physical disability. Despite this comments were mostly positive from residents and relatives spoken to. One resident summed up her experience by stating: Look at me - everything seems wrong, but I am still going strong, thanks to the nurses here. Another stated: It is good to have staff that make you feel that they care - it makes a world of difference to me, as it keeps me going. The relatives of one resident stated: Our dad has been so much better since he has been in here.The management and staff have been fantastic in meeting his needs. The healthcare documentation on up to five residents were examined and were in good order. Food and fluid monitoring was good, as were most other monitoring charts e.g. turning and blood glucose. There was evidence that the nursing staff were equipped with the skills and knowledge to meet the healthcare needs of the residents. Where appropriate, the services of the: dietitian, physiotherapist (who spends up to half a day weekly in the home), consultant pediatrician, dentist, speech and language therapist, diabetic nurse therapist, dentist, opticians, and tissue viability nurse were sought to ensure improved outcomes in relation to residents healthcare needs. It was noted that pressure sore prevention and general management of pressure sores was of quite a good standard in the home. At the time of the visit none of the residents were able to take responsibility for their medication and so an audit was undertaken of the quality of support that was provided by the home. Staff interviewed had a thorough understanding of the medications used in each case and carried their interventions in a very clinical and generally safe manner. There was one case in which an anti-biotic was stored in the medicine cabinet Care Homes for Older People Page 14 of 29 Evidence: for a short period, pending an alternative intervention. This was raised with the registered manager and the staff concerned who showed a good awareness that it should have been handled differently. All other medication including that of controlled drugs were handled appropriately. Good documentation supported the view that residents were receiving effective support with their medication, which was in line with the homes policies and procedures. From observation and speaking with residents and their relatives, staff were professional in their interactions/interventions with residents. In speaking with some staff members they demonstrated an understanding of the need to promote residents dignity, in all aspects of their engagement with them. This was observed at various times when staff were providing personal care, activities and at meal times. Staff were also aware and sensitive to the preferences and limitations of residents and so, did everything possible for example, being gentle, reassuring, sensitive and respectful to ensure that the residents dignity was preserved. Their interventions could be summed up from one of the relatives comments. which stated: The caring nature of the staff at Gable Court leaves my dad and the family reassured that, he would be safe and comfortable here. As stated earlier End-of-Life planning was now up and running in the home and relatives were observed to play an active part in this respect. In one or two cases, residents and their relatives preferred to discuss the issues around death and dying at a time best suited to them. What was important was that staff were prepared with training in areas such as: bereavement, end-of-life and palliative care, the latter of which is done in conjunction with the UK McMillan nurses. Although the inspector did not witness the staff supporting any resident in the end stages of their life, from talking to them, they showed a good understanding of the sensitive and dignity issues involved supporting residents and their families going through this experience. Sound arrangements are also in place to enable relatives involvement in this area. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to have access to a range of activities that matches their lifestyle. They have the benefit of maintaining their friends and families network and able to exercise choice and control in their lives. Meals provided at Gable Court are of a high standard, and reflective of residents choice, taste, culture and nutritional requirements. Evidence: An activity coordinator continues to provide a planned programme of activities for residents in the home. Activities were specifically provided individually, in small and/or larger groups and as far possible a life story is done on each individual when they come in. This helps to determine personal and individual interests. Residents also have a request day when they do a group activity of their choice and on the day of the visit, a group was watching the movie- Singing in the rain. This was an evening activity that most seemed to enjoy. The activity coordinator has the support of a volunteer on a part time basis, who started earlier in 2009. Levels of residents participation are recorded in individual care plans and it was positive to see that the cultural and religious persuasions were taken into account in providing activities. Residents continue to enjoy activities from professional entertainers on a regular basis Care Homes for Older People Page 16 of 29 Evidence: and the annual summer fete remains largely popular. Records indicated events take place at Christmas in line with residents wishes and relatives do attend in support of these events. Some good examples were seen where residents are supported to undertake their individual activity in their personal spaces and in one such case, an individual was observed viewing an Asian movie. It was noted that the individuals room was adorned with religious effects that were chosen by the resident, which was positive. Residents and relatives spoken to were quite pleased with the range of activities provided by the home. From the evidence gathered, it was clear that friends and families were encouraged to participate in the welfare, personal and social interests of residents at Gable Court. A visiting policy is in place to support this and throughout the inspection relatives were observed moving in and out of the home. Firm arrangements continue in place whereby the local senior school invites residents from the home to join in their annual Christmas party. There was evidence to confirm that residents are supported to celebrate Remembrance Day and relatives are also invited. One resident visits a temple every Sunday with her son, which is something she looks forward to. From the records seen there were relatives who act as representatives for their loved ones. Residents and relatives meetings are held regularly the most recent being 14/09/09, which is positive. Residents are given good opportunities to exercises choice and control in their lives. Risk assessments were in place to ensure that a reasonable balance is placed between, minimising residents freedom and promoting their safety and independence. As such where there are restrictions - evidence is in place as to how they came about. This has become more important with the introduction of the Mental Capacity Act and the Deprivation of Liberty Safeguards (DOLS), to ensure that the infringement of residents rights and capacity is not based primarily on assumptions, or taken for granted. A good example is where greater emphasis is now being placed on residents- End of Life wishes and staff had already attended training related to this. Other key areas where residents influence choice and control included: their food, dress, activities, what they do in general and to personalise their rooms with personal effects that mattered to them. Forums that were used to attract residents views included: complaints, surveys, residents meetings, and residents reviews. Meals at Gable Court were again provided at a very high standard as evidenced by the views of all the residents spoken to. All residents have a formal nutritional screening assessment along with their weight being monitored. Meal preferences are taken seriously, particularly in relation to cultural and specialist diets, to ensure that residents choice and nutritional requirements are fully met. On the first day the Care Homes for Older People Page 17 of 29 Evidence: evening meal was examined and most of the residents were enjoying a chicken curry with freshly prepared vegetables. Alternative vegetarian dishes were also available on the day along with desserts chosen by the residents. The atmosphere at mealtimes was relaxed and the aroma of the food gave a good feel to the experience of dining. Staff worked well and reassuringly with those residents requiring assistance with their meals. Residents could eat in their rooms and in one case, sound arrangements were in place to ensure that one of the residents who could take up to one hour to feed - had her meal in good time. The fact that the resident was over one hundred years old did not mean that she was less important, as the ethos of the home was very inclusive. A night - bite menu was well advertised for the residents and some indicated that they do look forward to this. Seasonal fruit platters are also available with fruit choices available on request. The head chef had a sound understanding of residents nutritional heeds and a strong emphasis was placed on ensuring they were met, regardless of the complexity. Residents benefit from freshly prepared food that is wholesome and nutritious. They had good access to hot and cold drinks to include supplements where required. Food hygiene was of a high standard and this was supported through the home achieving a five star award for Food Safety in December 2008. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and staff make every effort to resolve concerns and complaints as they arise in the home. As a result, residents and their relatives feel assured that their issues would be taken seriously. Sound protocols and practices are in place to safeguard residents, which is enhanced by prompt responses whenever a safeguarding matter arises in the home. Evidence: An updated complaints and accessible procedure remained in place at Gable Court. Staff spoken to, showed an awareness of this policy as well as their role in supporting residents to raise a complaint. The registered manager acted upon a previous recommendation to record concerns in a central log. The complaints log was examined and a number of complaints/concerns and compliments were recorded. Complaints were generally handled appropriately and it was noted a safeguarding matter arose out a complaint made to the local authority in sumer 2009. In discussion with the manager she demonstrated a positive approach to complaints, i.e. as a way of evaluating and improving the service. Residents and their relatives were clear about their right to complain. An updated safeguarding protocol was in place for the benefit of staff and residents and it was noted that all staff had appropriate training in the; safeguarding of vulnerable adults. The safeguarding matter in summer 2009 was in the main unsubstantiated, although two key and direct recommendations were made i.e. to:1) Care Homes for Older People Page 19 of 29 Evidence: remind staff to ensure that residents are not left unattended in any sling apparatus, and 2) ensure that two (2) staff work with the resident concerned at all times. It was noted that the resident concerned was happy to remain in the home, where she has the benefit of receiving care and support from Hindi-speaking staff. One indirect outcome of the safeguarding matter was that a protocol was put in place to ensure that a member of staff was accessible and available to the residents in the main lounge at all times. It must be noted that the registered persons were cooperative throughout the process, which reflected the view that they take safeguarding vulnerable adults seriously. This is supported by the robust recruitment practices undertaken in recruiting staff in the home, as well as the training and support arrangements that are in place for all levels of staff. The Commission was made aware of one other safeguarding that came about as a result of a review, following the inspection. However, the registered manager has since confirmed that the matter was unsubstantiated, although steps have been taken to further enhance safeguards for the resident concerned. Staff spoken to, showed a good understanding of their role in safeguarding vulnerable adults. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There continues to be a warm and welcoming atmosphere at Gable Court, one which is clean, comfortable and accessible to its users. Some improvements to the environment have been undertaken, with plans in place to continue to improve the overall quality and comfort in the home. It however remains a safe place to for residents and staff to live and work. Evidence: An inspection of the premises took place and this included some of the bedrooms, by personal invitation. All bedrooms seen, were personalised, from a cultural and religious perspective.They were clean and carried a pleasant scent. The communal areas were: generally clean, bright and airy, despite the fact that there were individuals with continence problems. The decor, furnishings and fittings were maintained to a good standard. This was achieved through the employment of ancillary staff to include domestics and a maintenance officer who picks up issues as they come along. A good recording and reporting system is in place to ensure that the home remains well-maintained. A routine programme of maintenance is also in place and the environment is an area of the quality assurance audit that is carried out by the registered persons. On the day of the visit small items of repair were noted, most of which had already identified by the manager. Plans were in place for example to: refurbish the staff room Care Homes for Older People Page 21 of 29 Evidence: and toilet in November 2009,replace lampshades in the small lounge along the corridor and remove the build up of moss on the external aspect of the bay window lounge. The external grounds were in good condition and a ground floor decking next to the managers office is available for residents to sit out. Residents also have good access to a hairdressing salon and it was noted that the pictures along the hallway and throughout the home were appreciated by the residents. Plans were in place for further enhancements as part of a rolling refurbishment programme. Feedback received from residents, relatives and external professionals indicated that Gable Court was homely and welcoming. The laundry area was inspected and this was found to be clean, with soiled articles, including clothing and bed-linen being appropriately stored - pending washing. The laundry staff were aware of health and safety measures including infection control, and the handling and storage of chemicals. The laundry floor covering was suitable and the facility is cited well away from the kitchen. Relatives were complimentary about the quality of the laundry services and some of whom were happy that their relatives always get their clothing back. It was clear that all aspects of the home internal and external were well-maintained in that it was safe, clean and hygienic. Sluice rooms were also well-maintained. Gable Court therefore generally remains fit for its purpose in providing care and support to both the elderly and younger adults with a physical disability. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At Gable Court the staffing levels and skill mix are based on the needs of residents. A dedicated and well-trained staff team is in place to provide good quality care to the resident group. Recruitment practices were generally robust and provide good safeguards for residents. Evidence: The staffing rosters were examined with regard to the skill mix and levels on each of the floors. The inspector was satisfied that generally deployment was based on the assessed needs of the resident group (thirty-three at the time of the inspection) - both personal and nursing. The manager continues to retain a stable workforce and it was noted that ancillary staff have opportunities to join the care staff, with appropriate training provided. The deployment of staff ensured that residents irregardless of their specialist needs got the care and support as specified in their care plan. Good team work was observed throughout the inspection and residents and their relatives were pleased with the levels and skill mix of the staff team. All staff have a thorough induction and this includes ancillary staff. This means that care staff could concentrate on matters of care and support including catering for peak times in the service. There has been an increase in the number of staff holding an NVQ Level 2 in Care and care staff have access to the General Social care Councils Code of Conduct. From this inspection there was greater evidence of the home Care Homes for Older People Page 23 of 29 Evidence: meeting the diverse needs of residents, including from a cultural and language point of view, as well from a religious standpoint. Staff were better able to provide person centred care in meeting the personal, social and healthcare needs of residents. Records demonstrated that they were also capable of making appropriate referrals to alternative agencies and professionals to ensure the health, safety and welfare of all residents. Five recruitment files were examined and they were generally found to be in good order, apart from one in which obtaining two credible references proved a bit of a challenge. In this case there was some difficulty in obtaining an employment reference and one of the references was brought in by hand while awaiting a second verifiable reference. The staff member concerned had started employment, and although not providing direct care would have been in contact with residents. A minimum of two satisfactory references must be obtained prior to staff taking up employment. All other checks required by regulation e.g. Criminal Records Bureau, identification, Immigration and Nursing and Midwifery Council checks along with completed application forms were in place. A sound training and development plan was in place for all levels and categories of staff in the home, to include the ancillary staff. It was noted that ninety-eight per cent of the staff had achieved at least an NVQ Level 2 in Care, which is a fourteen per cent increase since the last inspection. Some of the key areas of in which training was provided included: Mental Capacity Act, End-of- Life Care, Palliative Care, Safeguarding Vulnerable Adults, Health and Safety, Manual Handling, Infection Control, Fire Safety, First Aid, Medication and Cot Sides. It was noted that Dementia was planned, but not yet delivered. This was pointed out to the manager for quick action as one of the residents had started exhibiting symptoms of this illness. Staff spoken to, had a good understanding of residents needs, which they were generally able to provide for. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At Gable Court, residents have an assurance that the home is managed and run by an individual who is committed and fit to so do. The implementation of quality assurance mechanisms ensure that the service is reviewed and developed. Good financial, and health and safety practices promote and protect the health, safety and welfare of staff and residents in the home. Evidence: The registered manager is very experienced and well-qualified to run the home. Despite this, she has demonstrated a willingness to update her knowledge and skills with the view to driving up standards in the home. In this respect she has undertaken training in areas such as the Team Building, Mental Capacity Act, Palliative Care, Safeguarding, Legal and Financial matters. She has in place, a good system of supervision, engagement and monitoring of all layers and levels of her staff and as such, has a very strong team in place at Gable Court. She is also very knowledgeable of the needs of the residents in her care and maintains a good dialogue with them. Relatives and professionals spoken to were satisfied with her management of the Care Homes for Older People Page 25 of 29 Evidence: service, where she is regarded as someone who is responsive and inclusive. She also has good support from her line manager. It was clear that quality assurance monitoring was taking place in the home. This included; regular residents surveys, Regulation (26) monitoring visits, an annual internal audit and regular feedback from staff team through team meetings and supervision. Feedback was also obtained from; relatives formally and informally, external professionals at reviews and safeguarding meetings. Monthly health and safety and maintenance audits were also carried out. A business and development plan was in place, which covered outcomes for residents, staff and the service as a whole. From the most recent survey residents reported back a general improvement in all key areas. The greatest levels of satisfaction were in Food, Individualised Care and Activities, with Food and Care rated at one hundred per cent. Activities jumped the highest by thirty-three percent to ninety-five per cent. A record of the monthly provider visit for July 2009, was unavailable for inspection. Records of this nature must be available to fully comply with Regulation 26 of the Care Homes Regulations 2001. From looking at the financial records and interviewing the homes administrator, residents monies were managed in a safe manner. As part of the assessment process, decisions are taken around how personal funds are handled. In the main, residents financial affairs were handled by their relatives and/or representatives. Receipts and signatures were in place for monies going in and out of residents personal funds, which were audited monthly and annually by a senior staff from BUPA. The petty cash float and a random sample of residents funds were checked and found to be in order. Secure facilities remain in place for the safekeeping of money and valuables held on behalf of residents. The homes insurance was appropriate for the purpose of the business carried on by the registered persons. A full range of health and safety records were assessed to include: accident/incident records, fire and food safety, water temperature checks, bedside rails safety checks, emergency lighting, hoist and lift maintenance and pest control. They were found to be in order. To add to this there were risk assessments on hazards, a monthly maintenance audit and an internal health and safety audit to include policies, fire safety, wheelchair and bedside rails. There were checklists in place for pest control, wheelchair safety and weekly cleaning of the kitchen. Safety signs were appropriately placed throughout the home and given the level of compliance with health and safety, it was clear that great efforts have been put in place to provide a safe service at Gable Court. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 28 19 The registered persons are 20/06/2010 required to ensure that two satisfactory references are obtained at all times prior to the employment of staff. To ensure maximum safeguard for all residents. 2 33 26 The registered persons ae required to have avaialble for inspection a record of their monthly provider monitoring report at all times. To demonstrate full compliance with Regulation 26 of the Care Homes Regulations 2001. 20/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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