Care Home: The Gables

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What the care home does well You have food to eat that you like and helps to keep you healthy. There are lots of things for you to do. All the right checks are done to make sure the right people are chosen to support you and keep you safe. People said the staff were very nice and good at their job. They try hard to make it a homely place for you to live. What has improved since the last inspection? Staff have the right training to support you and keep you safe. The home has a new manager, she is working hard to make sure you have healthy food, a nice place to live and have plenty to do. What the care home could do better: The document that tells staff how you like to be cared for needs more detail. This is so that staff know how to keep you safe and well. The kitchen and bathrooms need some work to make them bright and fresh. Key inspection report Care homes for adults (18-65 years) Name: Address: The Gables 262 Ipswich Road Colchester Essex CO4 0ER     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: Jane Greaves     Date: 0 8 0 4 2 0 1 0 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 Adults (18-65 years) 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: The Gables 262 Ipswich Road Colchester Essex CO4 0ER 01206841515 01206841515 manager_gables@careaspirations.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care Aspirations Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home Code PC to service users of the following gender: Either, whose primary care needs on admission to the home are within the following category: Learning disability - Code LD The maximum number of service users who can be accommodated is: 7 Date of last inspection Brief description of the care home The Gables is a detached, two-storey house on the busy Ipswich Road in Colchester. There is parking for three vehicles at the front of the property. Each person has their own fully en-suite bedroom, with either bath or shower. Communal areas consist of a lounge and a conservatory extension, which also serves as a dining room. There is also a large, enclosed garden to the rear of the house. Five people lived at the home at the time of this inspection. The weekly charge for a room at The Gables is between £969.41 and £1533.54 Care Homes for Adults (18-65 years) Page 4 of 29 1 5 0 4 2 0 0 9 7 Over 65 0 Brief description of the care home dependent on the level of support required. This was the information provided at the time of key inspection, people considering moving to this home may wish to obtain more up to date information from the care home. An extra charge is made for hairdressing, toiletries and chiropody. Care Homes for Adults (18-65 years) 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited The Gables without telling them we were coming. The last time we visited this home was 15th April 2009. We looked at paperwork the home needs to keep to make sure you are being properly and safely looked after. We spoke to some relatives of people living at the home. The manager and staff helped us with our inspection. The manager sent us information called an Annual Quality Assurance Assessment or AQAA. This gave us information about how the home is run. Care Homes for Adults (18-65 years) Page 6 of 29 There is a service User Guide that the home can let you have. This tells you all about the home and what they can do for you. Care Homes for Adults (18-65 years) 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. 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 Adults (18-65 years) Page 8 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. A full and detailed assessment of prospective residents wishes and requirements ensures the home can meet their needs. Evidence: The Organisation had developed a Statement of Purpose and Service Users Guide, setting out the aims and objectives of the service, the accommodation and facilities and How to Complain procedure. The information was available both in a basic format and in an easy read format with to meet the needs of those with cognitive impairment. There have been no admissions to the home since the previous inspection visit so it was not possible to assess the admission procedures at this visit. However, information provided in the managers AQAA and verified at the inspection by the manager and Regional Operations Manager confirmed that no person would be admitted to the home without having a full assessment of their needs and wishes undertaken. The managers AQAA stated: The prospective service user is required to spend some time within the home before placement allowing for assessment as to the compatibility of the individual to live within the existing client group. On completion of Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: assessment a placement could be offered and the client or their representative would have the choice of acceptance or refusal. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 will have their needs and personal goals reflected in their individual care plans and will be supported to take risks as part of an independent lifestyle. Evidence: We looked at the care plans for two people living at the home. We saw these were well organised, person centred and agreed with the individual where possible. The information flowed smoothly through the care plan from assessment of needs to risk assessment and the care and support needed to meet peoples needs and keep them safe. Where risks had been identified corresponding support plans had been developed to provide strategies to manage the risk. The care plans included a description of the support and interventions required by staff to maximise the individuals independence and to keep them safe. In some areas the information was basic such as (persons name) requires assistance regarding personal hygiene but with encouragement can carry out and maintain their own Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: personal hygiene and staff should therefore offer (persons name) full support and empower them to achieve this goal. Staff we spoke with were able to tell us what they would do to support and empower the person however care plans did not include this information. Potentially new staff members or agency staff would not have the information necessary to ensure the person received consistent care and support appropriate to meet their needs. We looked at daily records to assess if the care and support provided for people was in accordance with their care plans. There was good information showing what people had done with their day such as went to the shops, did supermarket shopping with the staff, helped decorate biscuits in the afternoon and relaxed watching television in the evening. The statement All personal hygiene attended to was seen in daily records, this did not provide any information about the level of support the person needed and received from day to day. Staff we spoke with told us that this could vary considerably depending on the persons state of mind on the day. Detailed daily records would provide an audit trail of the care and support provided and would contribute to effective care plan reviews by showing a clear picture of how peoples needs changed over time. There was a noted improvement in the care planning since the previous inspection in relation to identifying triggers for violent, destructive or self injurious behaviours and how to de-escalate potentially charged situations. People living at The Gables were consulted about their care and the running of the service. Minutes of case reviews and annual service reviews, attended by the individual, their representative and social workers confirmed care plans were kept under regular review ensuring people were receiving care and support in line with their current needs. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. People receive support to live meaningful lives, both in the home and in the community. Evidence: Observation and discussion with staff showed that people living at The Gables were supported to follow their interests and be integrated into community life. A schedule on the notice board in the dining area of the home showed that people attended regular weekly activities, such as day care services, swimming, and attending the Gateway club. Other leisure activities people took part in included pub and restaurant lunches, trips out in the minibus, music therapy and college. The service encouraged and supported people to be independent and take part in all areas of daily living in the home, including cleaning their own rooms, planning, shopping and preparing meals. Mealtimes were varied and flexible to fit in with Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: peoples activities. An example of this was seen on the day of this visit. People chose to have a light lunch out in the community so the planned main meal was rescheduled for the evening. We were provided with copies of the menu, these showed that people were offered a varied, interesting and nutritious diet. There was a choice of two main meals daily, staff told us that where people did not fancy the choices offered they chose something else. The manager told us that the food shopping procedure had changed from a once a week supermarket shop, the people living at the home were now much more involved with the day to day food shopping. The manager was still new in post and shared many plans for introducing new experiences for the people living at the home. These included encouraging people to be involved in gardening and growing herbs, painting the garden shed, installing a barbecue for residents to enjoy during the summer and opening up the gate at the rear of the garden so that people can enjoy walks in High Woods Country Park. Records showed that the home continued to support people to maintain regular contact with friends and relatives. Relatives we spoke with praised the home for the way they were kept up to date with the lives of people living there. The manager and relatives told us how people were supported to have family visits using the homes own transport. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. The health and personal care people receive is based on their individual needs and preferences. Evidence: Information provided in the managers AQAA and verified at this inspection site visit showed that people living at The Gables were supported to have access to health care services. Care plans included individual health plans providing clear information about peoples health, physical and mental health needs and how these were to be met. Health charts were seen, which monitored peoples health and where potential complications or problems were identified these were dealt with. Observation and discussion with the manager and staff members confirmed that they were fully aware of the individual needs of people using the service and were able to provide a verbal account of each persons health and well being. Observation on the day of this visit, discussion with the staff team and daily records showed that the principles of respect, dignity and privacy were put into practice. Provision of personal care was responsive to the needs and preferences of the individual however daily recording did not provide an audit trail of the care and Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: support provided for people. Personal care was delivered in the privacy of peoples bedrooms, all of which had full en-suite facilities. There was a comprehensive medication policy and procedure in place for the ordering, storing and administration of medication and practice is well managed. Medication Administration Records were completed correctly, with no gaps. Medications to be taken as required and homely medications were appropriately documented. There was a new medication trolley since the previous inspection visit. This was a customised trolley designed to support a new comprehensive monitored dosage system, the manager and Regional Operations Director reported that the new system meant there had been very few incidents of medication errors, almost non existent. The home did not have a facility to safely store controlled medications, the manager reported that no person living at The Gables was prescribed controlled drugs at this time. Discussion was held with the manager and Regional Operations Director that should controlled drugs be prescribed for one or more persons, it is a legal requirement that the home had a separate metal cupboard of specified gauge with a double locking mechanism, which is fixed to a solid wall, with either rawl or rag bolts. It was agreed that this situation could occur with little or no notice therefore it would be good practice to ensure the facility was installed at the home. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 safe, secure and can be confident that their welfare and safety needs are always promoted. Evidence: Information provided in the AQAA and verified at the inspection confirmed that the home had a clear complaints procedure and an appropriate adult safeguarding policy in place, which included clear guidance of the procedures staff must take to report allegations of abuse. The complaints, comments and suggestions procedure described the stages of making an informal and formal complaint. The managers AQAA stated: Service users are provided with and have explained to them, a Service User Guide in a format that the individual can understand. Staff are trained to respond to Service users concerns or complaints in line with the companys abuse policy, which was written in response to the Department of Health No Secrets policy which ensures the highest standards of openness, honesty and accountability are maintained. There were no formal complaints documented at The Gables. A discussion was held with the manager about the recording of verbal dissatisfaction and how this could be a positive element to feed into the homes annual quality assurance process to drive forward improvements in the service. We saw letters of compliment received from family members praising the changes brought about in the home over recent months and identifying that the people living Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: there seem to be much more content, maybe because they are not sitting around bored. The staff training matrix showed that all staff had attended refresher training in the Safeguarding of Vulnerable Adults during September and October 2009. The staff training schedule for this year showed there was ongoing training provided to ensure staff skills and knowledge was kept up to date. 2 referrals had been made by the manager to the Essex Adults Safeguarding team in recent months confirmed that she knew the right actions to take to promote the residents rights and safety. The service has robust recruitment procedures in place. Staff files seen confirmed all staff were subject to Criminal Records Bureau (CRB) and Safeguarding Vulnerable Adults (SOVA) checks, prior to commencing employment. Care Homes for Adults (18-65 years) Page 19 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe home that is clean and hygienic, some areas would benefit from refurbishment. Evidence: The Gables provided safe, comfortable and warm accommodation for the people living there. The building was fully in keeping with neighbouring proprieties and had a good sized garden accessible to all residents. The premises were bright, airy and free from any unpleasant odours. Peoples bedrooms were furnished with appropriate furniture and fittings, including suitable lighting, window restrictors and safe radiators. Peoples rooms reflected their individual personalities, hobbies and interest. All rooms were single and had en-suite bathing and toilet facilities, there was one communal toilet. As reported at the previous 2 inspections, the cushion covers on the lounge suite had shrunk with frequent laundering. This continued to be a problem creating an ucared for feel to the communal lounge area. The manager reported that one of the sofas and one of the chairs was being moved out of the lounge to be replaced by a piano. This will allow for re-arrangement of the furniture to create a more homely feel but the matter of the unkempt looking seating remains. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: The previous inspection report identified that one en suite bathroom had unsightly black marks on the mastic surrounding the bath. The new manager had addressed this issue as much as possible however all the bathroom facilities were due for refurbishment. The manager was able to report that an audit had been undertaken by the organisation in the week prior to this key inspection site visit and agreement had been reached to commence a refurbishment programme for all the en suite bathroom facilities. As at the previous visit to this service, we saw a Staff clocking in machine in the entrance hall that was not in keeping with a homely atmosphere. The manager reported that the machine had not been in working order since she had started to work at the home in October 2009. The Regional Operations Director told us that the use of the clocking on machine was currently under review. There was a grey metal cabinet in the entrance hall at the bottom of the staircase, this bank of lockers was used for staff to keep their personal items safe whilst they were on duty. The manager told us she had found an alternative space to keep staff personal effects and that this bank of lockers would be removed within a month. This will remove a potential hazard to peoples safety as well as create a more welcoming ambience. We saw a number of noticeboards around the home, some of these included information relevant to the residents however we saw examples of information that was not appropriate to be displayed in the residents home, such as staff meeting minutes, health and safety information for staff and corporate information for staff. This information was not relevant to the people living at the home and therefore should not be on display in a communal area. The manager was able to tell us of plans to transfer all information relevant to staff to the training room in the garden. As identified at the previous inspection visit of 2009, the kitchen facilities were very small, compact and in need of refurbishment. The units were tired and some door fronts were ill fitting. The downstairs communal toilet radiator was corroded. The managers AQAA stated that in the past 12 months new net curtians had been installed throughout the home and a flat screen T.V. had been purchased for the communal lounge. The Patio area had been re-laid and extended and all rooms had been deep cleaned. The AQAA stated that the managers plans for next 12 months include refurbishment of clients bedrooms, replacing communal area furniture and replacing the units mini bus. Care Homes for Adults (18-65 years) Page 21 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 are supported by a staff team that are safely recruited, trained, skilled and in sufficient numbers. Evidence: We received 4 completed staff surveys as part of this inspection process. In these completed surveys 2 staff responded they felt there were sometimes enough staff on duty and 2 staff responded there were usually enough staff on duty. We looked at staff rotas, these confirmed that the minimum staffing provision to support the 5 people living at the home was 3 staff on duty during the day with a further member of staff to assist with outings and activities either 10am - 6pm or 1pm - 9pm dependent on the planned activities. There were 2 waking staff on duty overnight. The managers hours were Monday to Friday and were supernumerary to the support hours. The home was carrying 2 vacancies at the time of this inspection, the manager and Regional Operations Manager told us that staffing numbers would need to be reviewed, when the vacant rooms were filled, to take into account the needs and dependencies of new residents. The managers AQAA stated: We employ a diverse, competent and qualified staff team, with a majority of the team having worked with the group of service users for between 2 to 5 years. With the exception of 3 staff members all staff have NVQ 2 and Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: completed or nearly completed NVQ3. New staff members will start NVQ2 as soon as possible. Senior Care have all completed NVQ3. Service users are supported by a key worker network within the team to ensure interrupted work with individuals and the collective needs of all the service users. Whilst the commissioning authorities do not fund for 1:1 care of clients. We do endeavour to have a ratio of care staff to service user on shift, appropriate to the service users assessed needs. The company employs a team of bank staff, some of whom are allocated to The Gables and this ensures continuity for the service users and also alleviates the need for agency staff except in extreme circumstances. The organisation had developed a training manual and a copy had been given to each individual staff member. The programme was divided up into 4 areas with a section to be dealt with during each quarter of the year. The four sections addressed 1) Legal aspects of care provision, 2) Matters relating to physical intervention 3) General practice issues 4) Residents and their rights. This programme ensured that all staff had refresher training in all the basic core aspects of care provision annually. We looked at recruitment documentation for a member of staff employed to work at the home since the previous inspection site visit. This showed that the manager operated a sound recruitment practice ensuring that all the checks necessary, to promote the safety and welfare of the residents, were made before the person started to work at the home. The managers AQAA and records seen at the home on the day of the inspection showed that 9 of the 12 staff employed to work at the home had achieved a minimum of NVQ level 2 in care. 3 staff members were awaiting funding in order to commence the NVQ level 2 qualification. The manager reported that all staff working at the home received formal monthly supervisions. The manager supervised the senior support workers and they, in turn, undertook supervisions for the remaining staff team. The documentation reflected that these sessions included discussion of general work objectives, performance and development and identified training needs. Staff told us: the manager has empowered senior staff, given them more information and knowledge to help them do their jobs. Staff go to the manager, she is very approachable and deals with things straight away. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 benefit from living in a well managed home that is safe and meets their needs. Evidence: There had been a change of manager at the service since the previous inspection. The new manager had previously worked at another Care Aspirations home and was familiar with the organisations ways of working, policies and procedures. The managers AQAA stated: The manager is trained to NVQ3 and near completion of NVQ4 with 2 1/2 years in place managerial experience and 8 years care work experience. Management of the home follows the objectives as set out in our Statement of Purpose and complies with our companys policies and procedures. The home and service users finances are the responsibility of the manager, with the overall budget for the home being set and controlled by Care Aspirations directors/Head office. The manager had completed the AQAA when we asked for it. The AQAA lets us know Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: about the changes they have made to the service and the areas, which they have identified the need to improve. During the inspection the manager told us of many plans she has to improve the service, the living conditions and experiences of the people living at the home. Discussion was held with the manager about how this information should be included within the AQAA with some detail about how these changes were planned to be brought about. Staff spoken with as part of this inspection provided positive feedback about the manager, they told us the home was running smoothly, with a supportive and friendly atmosphere. This was confirmed by speaking with professionals involved with the service and some family members of people living at the home. People told us they were impressed with the manager and the staff and that they were very happy with the care and support that residents were receiving and they felt that things had improved under the new management. People told us: Definite change for the better brought about by the new manager and her team and The word no doesnt seem to be in their vocabulary and Since the new management regime it feels like a different place and We have nothing but admiration for the whole team. The organisation had an external quality assurance process undertaken by an external consultant involving the views of all people involved with the home including the residents, their families and representatives. We noted that the most recent process had been undertaken in 2008, a member of the management team reported that external consultants were currently being sourced and the process would be undertaken imminently. In addition to this there was a monthly audit of the service undertaken by another manager from within the organisation as well as the separate monthly visit from the organisations Responsible Individual. The managers AQAA stated: The home is inspected monthly as required under Regulation 26, plus monthly internal inspections by our companys Health and Safety manager and yearly there is an external survey of the service conducted by an independent company. Confidential records for both service users and the home are maintained in lockable cabinets. The managers AQAA and evidence viewed on the day of the inspection visit confirmed that all routine health and safety checks were undertaken to protect and promote the health, safety and welfare of the people living at the home. People who use the service were supported to obtain, secure and spend their own personal money. Records of two people tracked as part of the inspection showed a clear audit trail of all financial transactions. Monies held for each person were checked Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: against the balance sheets and were found to be accurate. Care Homes for Adults (18-65 years) 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 Adults (18-65 years) 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 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 1 6 It is a recommendation of good practice that care plans continue to be developed to include specific information about how individuals want and need their personal care and support provided and for daily records to include detail of how the care and support was delivered. Detailed daily records will enable an audit of the care provided to ensure people are receiving the care and support in the way they want and need. Care Homes for Adults (18-65 years) 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. 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. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!