Care Home: The Gables

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What the care home does well People only move into the home following an assessment of their needs and involving the other people in the home asking their views. People have individual plans of their care and support needs and are involved in their development. People tell us they are able to make decisions in their daily lives. People who use the service are supported to take risks and lead an ordinary life. People living in the home are able to participate in activities which interest them in the home and in the community. People tell us they are able to see the people who are important to them, they also tell us their rights are respected in their daily lives. People who use the service are supported to maintain a healthy diet. People tell us they are support in the way they prefer, which means that they are listened to about what is important to them about their personal routines. People have access to a complaints process and tell us they are listened to. Staff receive the training they need to understand the importance of protecting people from harm. People live in a homely and comfortable place. The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Recruitment is thorough and ensures that policy is put into practice. What has improved since the last inspection? At the end of the inspection in August 2007 there were no requirements and three recommendations. The carpet on the stair is clean but marked. All staff have completed mandatory training such as food hygiene, infection control, and first aid and moving and handling, which means the health and safety of the people living in the home, is protected. What the care home could do better: At the end of this inspection there is one requirement and five recommendations. To ensure that good systems of infection control are maintained it is important that the home seek advice on using the laundry room as an office for staff. Where nutritional assessments have been completed it is important that information is clearly written and staff understand precisely what action to take if someone is unwell. To ensure that people`s health care needs are fully met it is necessary to write down clearly to outcome of any appointments and the action to be taken as well as clear instructions for staff on how they are to support someone to attend an appointment. It is important that the cabinet used to store medication follows current good practice guidance to ensure the safety of the people in the service. People working in the home should be supported to participate in the learning disability qualification this will enhance their skills and support their work with individuals living in the home. The quality assurance process should be further developed to ensure that the aims and objectives of the home are being met and people living in the home are being listened to and their views acted upon.The GablesDS0000026806.V376647.R01.S.docVersion 5.2It is important that staff are supported to participate in the learning disability qualification which will support their professional development in working with the people living in the home. Key inspection report CARE HOME ADULTS 18-65 The Gables 7 West Moors Road Ferndown Dorset BH22 9SA Lead Inspector Tracey Cockburn Unannounced Inspection 23rd July 2009 09:45 The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 2 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 The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address 7 West Moors Road Ferndown Dorset BH22 9SA 01202 855909 01202 872885 ferndown@gables7.fsnet.co.uk 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) H & H Partners Manager post vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who may be accommodated is 8. 6th August 2007 Date of last inspection Brief Description of the Service: The Gables is a registered care home for 8 adults of both sexes between the ages of 18 and 65 years who have a learning disability. It is owned by H & H Partners. The Gables is situated in a residential area of Ferndown, Dorset. It is a large detached house in keeping with other properties in the vicinity. You approach the property via electric gates, and there are gardens to the front and rear of the home. The property is split into two. One side is The Gables residential home, with the other part of the property being a private Day Centre named Avatar (also owned by H & H partners). Avatar is a separate service and if people choose to attend Avatar, this requires additional funding and assessment. Accommodation in the residential home consists of a large lounge, dining area, and kitchen. Everyone using the service has single rooms with 7, which are en-suite, and the 8th has use of an adjacent bathroom. There is a supermarket close by, and the town centre of Ferndown is within walking distance. The larger towns of Poole and Bournemouth are accessible by public transport with a bus stop near the home. Current fees are between £892 and £900 per week. Fees do not include personal items such as toiletries, hairdressing, magazines. For further information on fee levels and fair terms of contracts you are advised to refer to the Office of Fair Trading website: www.oft.gov.uk. The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 5 The home keeps copies of all inspection reports that are available in the office and can be seen by service users, relatives and professionals at their request. The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means that the people who use this service experience good outcomes. This was the first key inspection of this service since August 2007. We asked the home to send us their annual quality assurance assessment, which they did on time. We used the information in this document to help us plan the inspection. We sent surveys to people who use the service and to people who work in the service as well as other interested parties such as health and social care professionals. We have had eight surveys back for people who use the service and five from people who work in the service. We have had one survey returned from a health care professional. Their comments will be used throughout the report. We spoke to people who use the service and observed life in the home. We spoke to staff that work in the home as well as the manager. We looked at a variety of documentation to help us evidence outcomes for people who live in the service. We looked at care plans, staff recruitment, recording of incidents, training records and health and safety. What the service does well: People only move into the home following an assessment of their needs and involving the other people in the home asking their views. People have individual plans of their care and support needs and are involved in their development. People tell us they are able to make decisions in their daily lives. People who use the service are supported to take risks and lead an ordinary life. People living in the home are able to participate in activities which interest them in the home and in the community. People tell us they are able to see the people who are important to them, they also tell us their rights are respected in their daily lives. People who use the service are supported to maintain a healthy diet. People tell us they are support in the way they prefer, which means that they are listened to about what is important to them about their personal routines. People have access to a complaints process and tell us they are listened to. Staff receive the training they need to understand the importance of protecting people from harm. People live in a homely and comfortable place. The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 7 Recruitment is thorough and ensures that policy is put into practice. What has improved since the last inspection? What they could do better: At the end of this inspection there is one requirement and five recommendations. To ensure that good systems of infection control are maintained it is important that the home seek advice on using the laundry room as an office for staff. Where nutritional assessments have been completed it is important that information is clearly written and staff understand precisely what action to take if someone is unwell. To ensure that people’s health care needs are fully met it is necessary to write down clearly to outcome of any appointments and the action to be taken as well as clear instructions for staff on how they are to support someone to attend an appointment. It is important that the cabinet used to store medication follows current good practice guidance to ensure the safety of the people in the service. People working in the home should be supported to participate in the learning disability qualification this will enhance their skills and support their work with individuals living in the home. The quality assurance process should be further developed to ensure that the aims and objectives of the home are being met and people living in the home are being listened to and their views acted upon. The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 8 It is important that staff are supported to participate in the learning disability qualification which will support their professional development in working with the people living in the home. 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. The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 are considering using the service will have the information they need to make an informed choice. No one moves into the home until they have had an assessment of their needs. EVIDENCE: Since the last key inspection the home has increased in size from seven to eight. We found that all the rooms are accommodated. The manager explained that three people moved into the home from the providers other home which closed. These people moved following consultation will everyone concerned and taking into account the views of the other people living in the home. The annual quality assurance assessment submitted to us by the home said: “We provide a home that is warm and welcoming and needs led to the individuals that use the service. We are open to any opinion on how we can improve our service and always strive to do so. Parents and relatives are always made to feel welcome and invited to take part in events held at the home throughout the year.” During the visit we asked people who live in the service how they felt about several people moving in at once and they each said they get on well with the The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 11 people who moved in. We asked one person if they we happy about the decision they made to move into the home and they said ‘yes’. The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives and play an active role in planning the care and support they receive. EVIDENCE: The annual quality assurance assessment submitted by the home said: “We have regular meetings with the residents to discuss issues. Residents have one to one time with their Key workers to discuss any issues they may have and things that they would like to change. Any decisions about a resident are discussed with them and they are included in this process. All reviews that take place are planned with the resident they take an active role in their review meeting and it is ensured that their views are recognised and any action points are carried out within the set timescales” The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 13 A health care professional who returned a survey form said: “Some improvement recently in individual care and programmes” We looked at two files for people who use the service, both contained care plans which cover their needs and the support they require. Both plans had recently been reviewed and updated. The new manager has introduced new paperwork for both care plans and risk assessments. Each person has a communication plan and an all about me file. Each person has a placement plan with the aims of the placement. There is also a daily living plan which details the daily routines for people and is person centred. There is further information in the care and support plan on specific areas where people need clear support and staff need to understand triggers for specific types of behaviour. This gives very clear and concise information for staff such as specific triggers such as bathing or making sandwiches and then it identifies the type of behaviour which might happen such as crying or obsessing about a specific thing. Further information in the care plan about how to distract the person would be useful for staff. The plans were signed by the individual and dated. We spoke to several people about how the staff support them; they told us the staff were nice and listened to them. We observed staff during our visit directing individuals by gentle reminder and encouraging them to make their own decisions about what they did next. We looked at the risk assessments in place for two people which covered areas both inside the home such as medication, bathing, infection control and outside the home such as, out in the community, finances. There were also risk assessments around specific health conditions and what action needed to be taken by staff. The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the 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 are able to make choices about their life style and are supported to develop their life skills. EVIDENCE: The annual quality assurance assessment submitted by the home said: “We have activity plans in place and regular meetings to discuss planning and any issues that may have arisen. We have daily logs that document what individual service users are doing and how their needs are being met. We have an approach that relies on boundaries and routines but staff are developing the knowledge to allow them to offer flexibility within them. Staff ensure that they work to the statement of purpose of the home and to the policy and procedures set out. Family contact is a very important part of the home and we pride ourselves in the relationship the families have with the The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 15 home I feel that parent’s friends and family are always made to feel welcome and we try to have various events during the year that can be attended at the Gables. All our residents attend day services and have a very full curriculum at the services they attend. When going out from the Gables although we have our own transport available residents are encouraged to use public transport and be part of the community by accessing local facilities available to them. We have a menu plan that is discussed with all residents to ensure that likes and dislikes are taken into consideration and also that the food we are offering is healthy and balanced. The menus change on a regular basis and new recipes are tried and different types of food offered. Residents are encouraged to help out in the kitchen and take part in the food preparation. Residents are responsible for the cleanliness of their own rooms and staff support to be sure that this is being maintained.” A member of staff who returned a survey form said under ‘what does the home do well’: “Empower the service user to do things for themselves and be part of the ‘team’ be involved in and have a say in what is happening in their home” We spoke to several people who told us that they are going on holiday later in the summer; they told us that they have been able to choose whether they go on holiday on their own or with their friends. People told us they are able to see their families and friends when they want to and the manager told us that they are planning to have a regular newsletter for families about activities which are happening in the home and involving people in that. People told us about what they like to do such as going to the pub and going shopping and visiting family. While we visited people in the evening they were playing football in the back garden, other people had chosen to stay in their room. One person who works in the home and returned a survey form thought that menus could be improved. One person who lives in the home said that they would like to go out a bit more. Every person who lives in the home returned a survey form which said they like living in the home. Another person who lives in the home said they would like to go to car boot sales more. In conversation with some of the people who live in the service during an evening visit they told us about the different trips they have been on including a visit to Marwell Zoo. One person told us that he was looking forward to the opening of a new shop in the town which he was keen to visit. The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 16 We asked people if they liked the food and were involved in the preparing of it, several people said they did like the food and will we visited in the evening several people were involved with staff support in the preparing of the evening meal. There was lots of fresh fruit available for people to eat when they wanted; we saw that the notice board in the dining room has a photograph of the evening meal. There were also photographs of the staff on duty that day. The home uses the ‘safer food better business’ pack. The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The annual quality assurance assessment submitted by the home said: “All of our residents access healthcare provision when it is required this is on an individual basis. We have good links with our medical services and are able to call on specialist services when needed. Regular appointments are made and these are diarised and arranged so that the needs of the individual resident are recognised. In relation to personal care all residents are encouraged to do as much as is possible by themselves and staff input is minimal. Where staff are involved the privacy respect and dignity of the resident is maintained at all times. A resident may choose to have a different member of staff offering support and where we are able this is always offered. All staff are trained in the administration of medication and further training is given in the safe handling of medication. If we had specific needs for a The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 18 resident then appropriate training would be sought to ensure that we could offer the best service possible. We have a monthly management check on medication this is completed by our service manager. The manager also completes a weekly check to ensure that medication records are accurate. We also ensure that if a resident is identified as having a specific need this is investigated quickly so they have the aids or adaptations they require.” One member of staff wrote under the heading what does the home do well: “Cares for the service user to a very high standard and always has their best interests at heart” We looked at the records for two people who live in the home and found that there was evidence that they attended appointments with health care professionals which necessary. The care plan also documented the difficulties in supporting one person to attend some medical appointments; however there was not enough detail on how staff were working with the individual to attend those appointments. One person is receiving monthly visits from a health care professional and this is clearly documented with the agreed actions. In another persons file there weight was no longer recorded but the care plan did not record why this had stopped. Medication is stored in a lockable metal cabinet; this was not found to be secured to a solid wall. All staff have completed medication training organised by a pharmacy. The manager told us that they have recently had a medication review by the pharmacy and there were no issues identified. We looked at the medication administration records and found no gaps; we looked at the records for one person and found that the medication left was in keeping with the written record. The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 are able to express their concerns and have access to a robust, effective complaints procedure and are protected from abuse and have their rights protected. EVIDENCE: The annual quality assurance assessment submitted by the home said: “I am looking to source accredited training in the use of intervention with a view to this being more about de-escalation techniques. I am hoping to be able to undertake a course that will then make me qualified to train the staff team which will mean that we can offer a better package and offer refresher days when required. (Accreditation to BILD guidelines) We have not received any complaints internally or externally for a considerable time if however we did so we have a robust complaints policy in place and a clear written policy. All residents are aware of how they can make a complaint and if this happened they would be supported to do so. All staff are aware of the complaints procedure and the actions that they need to take as appropriate. Staff are aware of who they can complain to and the procedure that they need to follow. Staff are trained in issues concerning the protection of vulnerable adults and managers receive further specific training. We have a restraint policy in place but we have not had any to use any form of restraint for the past year.” The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 20 Each person who lives in the service returned a survey form which said they knew who to speak to if they were unhappy about the service. We looked at the training for staff and all have completed safeguarding training in the past two years and are now starting refresher training. There has been one safeguarding investigation since the last inspection following an incident in the home. No further action was taken and the person was safe. The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people to live in a safe, well maintained and comfortable environment which encourages independence. The home is clean and infection control measures are in place however to ensure these measures are fully in place consideration must be given to where the office is situated. EVIDENCE: The annual quality assurance assessment submitted by the home said: “The home is well maintained clean and well decorated if items become damaged or broken these are replaced as soon as it is practible to do so. All residents with the exception of one have a room with on suite faculties the service user that does not have on suite have their own bathroom directly opposite their bedroom. We encourage our residents to personalise their The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 22 rooms and have their personal items as they wish. Privacy is maintained and respected at all times when a resident is in their room. The communal lounge dining area is a large space that has facilities that can be shared by all. Bedroom to be redecorated. New decoration of the communal areas with input from residents. Gazebo to be purchased for the garden to provide a further area to sit when it is particularly warm.” The lounge has a variety of seating including chairs and a sofa. There are two large tables in the dining area which would comfortably seat all eight people living in the home. The kitchen provides enough space so that several people could be using the kitchen comfortably. We looked round the building but did not look in people’s rooms as we did not have their permission. However we know from previous visits that rooms are individualised and one person told us they have their own things in their room and are looking to buy a new duvet cover for their bed. We found that there are two laundry rooms one on the first floor and one on the ground floor, the one on the ground floor has a large industrial machine for soiled clothing, this laundry room is also used as an office for staff, there are two large filing cabinets and one small one in the room as well as a storage cabinet for various files. We did not think this was a good idea as there are issues of infection control and the potential for cross infection. When we visited the home there was clothing drying in the laundry room which did not leave any space for staff to work. We also found that the computer which staff use is in the communal dining room. This is not a computer which is used by the people living in the home and we therefore did not think it was appropriate for staff to be working on confidential information about people while in the communal dining room. The manager told us that he has been prioritising working on their flu pandemic plan and now has one in place. The staff toilet had liquid hand soap but not paper towels or a pedal bin. At the last inspection there was one recommendation in this outcome area that the carpet on the stair and landing was cleaned. The carpet was clean but there are stains indicative of normal wear. The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support people using the service. EVIDENCE: The annual quality assurance assessment submitted by the home said: “The staff are respected and valued for the work they do within the home. Regular team meetings take place and staff receive regular supervision where they are able to discuss issues and feedback is given constructively. The staff opinion is valued and this is fed back during team meetings and supervisions. We have a well balanced rota and the use of agency staff is kept to a minimum. Rotas are checked to ensure that staff are not overworking and therefore able to complete their duties to the best of their abilities. All staff receive statutory training and are encouraged to take part in extra training provided to increase their knowledge base The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 24 We looked at the recruitment files for two people who started work in the home since the last key inspection. We found that all the documentation required in schedule 2 of the NMS was in place including two written references, criminal records bureau check and POVA 1st check. One person had completed mandatory training but it was not clear if their induction was to the skills for care induction standards. We looked at the other person’s file and we could see a detailed induction following skills for care induction. There should be a consistent approach to the recording of induction. The annual quality assurance assessment also says: “More training to be made available also networking with other local service providers to link in with training. We are also building our own bank of staff to enable us to further reduce the need for agency staff.” We found that although mandatory training is now covered, there are still gaps in specialist training such as challenging behaviour, autism and epilepsy, however in discussion with the manager there are training dates for challenging behaviour and the manager told us that the training in this area was cancelled at the last minute in January 2009. The manager also told us he is sourcing other specialist training using organisations such as partners in care and through partnerships with other homes in the area. Two staff thought this about the need for training: One person who works in the home said in a survey form under the heading ‘what could the home do better: “Training to help understand individual needs e.g. autism” Another member of staff wrote: “Keep up to date with challenging behaviour training” At the last key inspection there were two recommendations in this outcome area, one that all staff would be up to date with mandatory training and two that staff would undertake the Qualification in learning disability. We found that the mandatory training was up to date but that not everyone is working towards the qualification in learning disability. A health care professional said in a survey form: “Recent improvement in support and training of staff and awareness of individual needs” This person also thought that they could improve if they: “Work as a team re care plans” but also noted “this is gradually improving” The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 administration of the home is based on openness and respect and systems are being developed by a qualified and competent manager. EVIDENCE: The annual quality assurance assessment submitted by the home said: “I have been the manager of the Gables for eight months and am currently in the application process to become the registered manager. I am currently undertaking the new city in guilds qualification for leadership and management in the care sector.” The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 26 “As a manager I am seeking further training for staff and valuing the work they do. I am ensuring that staff have regular team meeting and that supervisions are taking place. I have a professional pride in the home and wish to achieve the highest possible standards for the home residents and staff. I receive regular supervisions from my line manager and the home is also monitored by them on a monthly basis. All policy and procedures are up to date and the administration for the running of the home is completed. All residents care plans and risk assessments are up to date and reviewed on a regular basis. As much as is possible residents manage their own finances and are encouraged to do so. Any decisions made are done so with the resident as well.” The manager has been in post since October 2008, he is aware that he needs to submit his registration application. The quality assurance process needs to be developed to ensure the views of people living in the home are taken into account and form part of the development of the service. The manager submitted the annual quality assurance assessment and information within it was used to plan the site visit. We looked at fire records; there is a fire risk assessment in place which was reviewed on 28/01/09. The last fire drill took place on 19/07/09 in the morning and everyone was successfully evacuated. The fire alarm system was serviced in June 2009 and we saw the certificate. The home record all accidents and incidents and forward this to the commission. The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X X X 2 X X 3 X Version 5.2 Page 28 The Gables DS0000026806.V376647.R01.S.doc 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. 2 Standard YA30 Regulation 16 (2) (j) Requirement The registered provider must consult with the environmental health authority with regard to satisfactory standards of hygiene being maintained in the home, specifically in relation to the laundry room doubling as an office for staff. Timescale for action 30/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA17 Good Practice Recommendations The registered provider should ensure that where an individual has had their nutritional needs assessed, this is regularly reviewed and information in the care plan is precise about the action needed if they become unwell. The registered provider should ensure that health care information about an individual is clearly recorded with the outcome of any consultation and the actions which need to be taken by staff to support the individual to meet their health care needs. The registered provider should ensure that the cabinet in which medication is stored meets current Royal DS0000026806.V376647.R01.S.doc Version 5.2 Page 29 2 YA19 3 YA20 The Gables 4 YA35 Pharmaceutical guidance. The registered provider should make sure that all staff undertake the Learning Disability Award Framework training. The registered provider should ensure that the quality assurance process in the home is effective in seeking the views of the people who live there as well as other interested stakeholders in the community. From this information the service should be able to demonstrate that the aims and objectives of the service are being met. 5 YA39 The Gables DS0000026806.V376647.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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