Care Home: Gables Nursing & Residential Home

What the care home does well Prior to admission to the home the manager provides written information to prospective residents to read before making up their mind to move in. All prospective residents or there family are invited to visit the home before the manager meets up with them. People have their initial care needs assessed to ensure the staff are able to look after them appropriately and obtain any specialist equipment required beforehand. The home has a mix of residents requiring nursing care or residential care with either nursing staff or senior care staff to provide the level of care assessed. It was observed that people are treated with respect and dignity by the staff team, and that they are encouraged to make their own choices throughout the day in respect of meals, activities and where they wish to spend the day. The home continues to provide an excellent range of meals and continues to monitor frailer residents who have little appetite. Any complaints or concerns that people raise are listened to and acted upon appropriately. The home is well managed by a competent and experienced manager who is supported by a large well trained staff team. What has improved since the last inspection? The last key inspection was carried out in June 2007 and issued no requirements. There has been some new areas added to the home comprising of a new rear lounge with direct access out to the patio. The old lounge has been converted to a spacious dining room that can seat four people at each table. As well as several bedrooms, bathrooms and hallways being redecorated there is an additional shower room situated on the ground floor. The manager confirmed that there has been an increase in the number of electric profiling beds so residents can adjust there position while in bed. The staff team continue to attend training to keep up to date with current trends, and have a very high percentage of care staff achieving the recommended NVQ coursework. What the care home could do better: The Gables is an old three storey building overlooking the Gorleston seafront. The bedrooms come in a variety of shapes and sizes with some looking a little `tired`. The manager has the appropriate plans in place for these to be redecorated and is looking at reducing the number of shared bedrooms, so no requirements were issued during this inspection. After the inspection there are plans in place to completely refurbish the lift, and the Commission was notified about the arrangements over the three week period while this was to be carried out. Alternative arrangements were being implemented to reduce the upheaval for residents during this time. Key inspection report Care homes for older people Name: Address: Gables Nursing & Residential Home 6 Marine Parade Gorleston Norfolk NR31 6DU     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: Hilda Stephenson     Date: 2 0 0 5 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 24 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Gables Nursing & Residential Home 6 Marine Parade Gorleston Norfolk NR31 6DU 01493667839 01493601646 manager@thegables.healthcarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Pri-Med Group Ltd. care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: One named resident may be accommodated who has a diagnosis of dementia Date of last inspection Brief description of the care home The Gables is a large detached Victorian property, overlooking the esplanade and beach at Gorleston on Sea. The care home offers accommodation on three floors, in a mixture of single and double rooms to a maximum of 43 older persons. Service users may fall within the category of older people, or the category of older people with physical disabilities. The town centre and seaside recreational amenities are within walking distance of the care home. The home has been owned by Healthcare Homes Limited since March 2006. The fees range from #500 to #703. 0 43 Over 65 43 0 Care Homes for Older People Page 4 of 24 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: Care services are judged against outcome groups, which assess how well the provider delivers outcomes for people using the service. The unannounced key inspection of this service has been carried out by using information from previous inspections, written information provided by the manager, some residents and their relatives and others who work in or visit the service. This unannounced visit took place during the day of Wednesday 20th May 2009. The manager was in attendance during the day. It is usual practice for the manager to complete an Annual Quality Assurance Assessment (AQAA) unfortunately this was not sent to the manager beforehand, so the details of the homes strengths and weaknesses were obtained during this visit. During the inspection a tour of the building was undertaken, staff practices was observed, records and files were read and residents, staff and relatives were consulted. Care Homes for Older People Page 5 of 24 What the care home does well: What has improved since the last inspection? What they could do better: The Gables is an old three storey building overlooking the Gorleston seafront. The bedrooms come in a variety of shapes and sizes with some looking a little tired. The manager has the appropriate plans in place for these to be redecorated and is looking at reducing the number of shared bedrooms, so no requirements were issued during this inspection. After the inspection there are plans in place to completely refurbish the lift, and the Commission was notified about the arrangements over the three week period while this was to be carried out. Alternative arrangements were being implemented to reduce the upheaval for residents during this time. Care Homes for Older People Page 6 of 24 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. 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 7 of 24 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 8 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager provides good clear information about the service and facilities offered at The Gables to assist prospective residents to make up their mind before moving in. People have their care, nursing and social needs assessed and are provided with a contract which clearly tells them about the service and care they will receive. Evidence: The statement of purpose, welcome pack and last inspection report was displayed and made available for all prospective residents and their family. They were well written and clearly presented. The manager explained that all prospective residents are invited to visit the home before making up their mind to move in. They are visited by the manager who asks about their individual care, nursing and social care needs to ensure that the home and staff can care for them appropriately. These details make up the pre-admission care plan. A copy of the latest resident to move into the home was seen and included details of the activities of daily living including initial risk assessments on how to prevent falls, mobility needs and personal care needs. Details Care Homes for Older People Page 9 of 24 Evidence: of the initial assessment were read and the resident was spoken to regarding their admission process. The resident confirmed that they had been visited and asked questions about what to expect when moving into the home, and was supported by the nursing staff during the initial settling in period. A detailed contract was in place for the resident containing the fees charged for the service, extra charges for chiropody and personal items such as hairdressing and newspapers and the room number that was to be occupied. The current fees for the year for 09/10 is £366:00 - £715:00 per week, depending on level of dependency. Within the welcome pack this explains the four weekly initial assessment and settling in period when a review of care meeting would be arranged with them so they could make there mind up whether they wished to stay at The Gables. Evidence for some of the frailer residents having received assistance from their families or their social worker to help them make up their mind. Care Homes for Older People Page 10 of 24 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. Health and personal care are based on peoples individuals needs and the principles of dignity and respect are put into practice. Evidence: A sample of care plans were read and the same residents were spoken to using the method of case tracking to obtain the required evidence to ensure that these residents were appropriately care for. All care plans inspected were of a good standard and included risk assessments to assist residents with there daily living. The care plans contained details of health, nursing, social and mental health needs although, some of the life history records were brief. Evidence of how staff implement nutritional needs assisting the chef in reviewing these was read, especially those who are most vulnerable, and how the staff act on the results by encouraging a higher calorific and fluid intake to reduce the effects of dehydration and malnutrition, the staff should be commended for this. The care plans and risk assessments are reviewed on a monthly basis or when needs Care Homes for Older People Page 11 of 24 Evidence: change by the nursing staff. There were approximately half of the residents requiring nursing care during this visit, and half assessed as requiring residential care. Residential care are usually looked after by the care staff and if they require any nursing needs are visited by the district nurses, who work alongside the homes own nursing staff. Medication is administered by the qualified nursing staff on duty. Three records for medication were case tracked and found to be in good order. Medication is stored safely, checked in and out of the home and reviewed regularly by the GP. The nurse on duty demonstrated how medication is audited and this had recently been carried out by the PCT with the requirements having been implemented. Overall, the medication within the home is stored and monitored in a safe manner. During the visit it was observed that staff treated residents with respect and courtesy at all times, one visitor confirmed that this was consistent practice. The home has a high proportion of shared bedrooms although, some were being used as single, there was appropriate screening providing privacy for personal care. Care Homes for Older People Page 12 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Gables are encouraged to make their own choices regarding food, social activities and where they want to spend the day, visitors are welcomed into the home. Evidence: The manager explained that they employ an Activities Co-ordinator to organise, carry out and delegate to care staff some of the daily activities. The co-ordinator is a trained reflexologist and incorporates this in with the list of activities. Recent activities that had taken place included bingo, countdown, word quiz, reflexology, one to ones, make up sessions, exercise to music and singalongs as well as twice monthly outings. The home makes use of the companies minibus where past outings have included a trip to the pantomime, cinema and local garden centre. Some of the residents have taken the lead in planting up the patio. Some visitors confirmed that they see staff spending time with residents especially the frailer ones who stay in there rooms, and liked how the staff talk about the residents family and take an interest in there past life. Evidence was seen that residents go out to visit local shops and the seafront. Care Homes for Older People Page 13 of 24 Evidence: The chef was spoken to and the kitchen records seen. The chef is well qualified and caters for approximately seven various dietary needs of residents. He also monitors closely the nutritional requirements especially those residents who are frail and require a higher calorie intake. Residents are asked there preference from the menu each day, and the chef caters for all three main meals. The new dining room can seat four residents at each table and was nicely set out for lunch, there is a second dining room at the front of the building. Comments received from some residents were you can choose what you want from the menu, the food is very tasty here, its of a good standard and is served hot. Lunch time was observed as a sociable occasion with care staff assisting frail residents with there food either in the dining room or there own rooms. Care Homes for Older People Page 14 of 24 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. People who use the service have access to a clear complaints procedure and are protected by a well trained staff team. Evidence: The manager discussed the past complaints and how they had been dealt with, one of these having not yet reached a conclusion. The complaints policy was included within the statement of purpose and welcome pack and these were given to all new residents. A visitor confirmed that any minor concerns were dealt with straight away and was given the opportunity to discuss these in private. Discussion with residents, staff and visitors showed that no concerns were raised during this visit. Evidence was seen of how staff training in adult protection and whistle blowing had been implemented by looking through staff files and discussion. The manager explained a recent adult protection issue and had a good understanding of his role in the protection of vulnerable adults. Care Homes for Older People Page 15 of 24 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. People live in an fairly well maintained environment which is homely and comfortable. Evidence: A tour of the building was undertaken which showed that the bedrooms are various different sizes and shapes. There are three floors containing a mix of single and shared bedrooms, some have views overlooking the sea. The manager stated that there were plans to reduce the number of shared rooms in the future. There are bathroom and toilet facilities on each floor with an additional wet room on the ground floor. There was evidence of refurbishment and redecoration being currently done, and plans were in place to change the current lift. The manager stated that a wheelchair lift was to be fitted on the stairs to allow residents to carry on moving from one floor to the other. Although, the first floor lounge was being developed in case residents did not wish to go to the ground floor during this proposed upheaval. Since the previous inspection there has been a new lounge with direct access out to a patio area. The old rear lounge has been changed into a separate dining room seating four to each table. A walk in shower room is situated on the ground floor, the manager now uses the office in the middle of the building and the nurses use the front office. There is a variety of sitting areas throughout the home all of which are comfortably furnished. Care Homes for Older People Page 16 of 24 Evidence: The home has dedicated staff who oversee the laundry for residents and comply with the COSHH regulations in keeping chemicals safely stored. Overall, the environment is comfortable some of the bedrooms were still looking rather tired although the manager stated that there were plans for these to be redecorated. Care Homes for Older People Page 17 of 24 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. There are sufficient numbers of well trained staff to look after people living at the home. Evidence: Inspection of the staff rotas, observation during this visit and discussion with residents and visitors demonstrated that the majority of time there are enough staff to care for the residents. The home has a large staff team with several having worked at the home for many years. There are currently five nursing staff as well as the manager, twenty five care staff, fifteen domestic staff, two chefs, one admin and one maintenance staff to care for the current thirty eight residents. The manager has always encouraged the care staff to attend training to keep up to date and staff files showed evidence that this continues. The home has a high ratio of care staff who have achieved the accredited NVQ training and they should be commended for this. The nurses keep up to date with their own professional body and all attend the organised mandatory training. Through discussion with residents and visitors, they confirmed that there was usually plenty of staff around the home, with one stating even though they are usually very Care Homes for Older People Page 18 of 24 Evidence: busy, they always help if you need it. The manager showed copies of recorded staff supervision sessions and staff spoken to stated that these individual sessions were beneficial towards planning ahead. Care Homes for Older People Page 19 of 24 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. The home is well managed with peoples opinions of those who live and work there taken into consideration when planning for the future.. Evidence: The manager Bill Mason was in attendance during this visit. He had been unable to complete a copy of the AQAA (Annual Quality Assurance Audit) because this had not been sent out from the CQC, so the evidence obtained had been collected from this visit by speaking to residents and their visitors, staff and from the written notifications sent to CQC during the year. The manager has worked at the home for two years and is a qualified nurse, he has several years of past management experience. It was observed that he has a good rapport with residents, visitors and staff. He confirmed that he organizes meetings for nurses, senior carers and a separate meeting for the whole staff to keep everyone up to date with changes. The residents have their own meetings arranged. The quality assurance survey had been completed for this year and this was read. It Care Homes for Older People Page 20 of 24 Evidence: showed the results of the comments received from residents, visitors, other professionals and staff how items were to be taken forward which is a sign of good practice. The results were displayed in the front hall. There is some money held on behalf of residents within the safe and a sample was checked and found to be in good order. Staff files showed that staff receive regular supervision and through discussion with staff confirmed that they found these individual sessions beneficial for planning ahead. A sample of the maintenance records were checked including monitoring water temperatures, heating and boiler maintenance, fire equipment and fire safety, COSHH risk assessments and infection control as well as the monthly regulation visits undertaken by one of the company managers. Overall, the home is well managed and shows that the staff have the residents best interests at heart. Care Homes for Older People Page 21 of 24 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 22 of 24 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 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 23 of 24 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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