Care Home: The Gables

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What the care home does well The Gables is a small home providing individualised care and the people who live there expressed a very high level of satisfaction with the service they receive. People`s comments to the inspector were all positive and included, "They look after us exceptionally well " "I`m very happy here, it`s a very friendly environment." Many people also stressed the homely atmosphere of `The Gables`, "I knew this was a home from home as soon as I walked in this place and my opinion hasn`t changed". "You`d have to go a long way before you`d find a better atmosphere than this one" "This is my home" Good arrangements are in place to help people to make an informed decision about coming to live in the home. People are able to spend a day at the home to meet staff and the other people living there; this also enables staff to assess whether they can meet that person`s needs.Staff spend time interacting with people and a selection of activities such as board games are always available. One person commented that "we don`t really watch much television here, we prefer to do other things". Once a fortnight an outing to the local pub for lunch is arranged. However people said that they were not obliged to join in with any activity if they didn`t want to. There is a very flexible approach to meals with people`s individual tastes and dietary requirements being well met. People can choose to eat in their own rooms or in the dining room and a choice of food is offered. All food is cooked on the premises and organic vegetables from a local supplier are used. Fresh fruit is always available. People are able to prepare their own meals and drinks if they wish and are able to do so. Many positive comments were made about the food including, "I`ve never had a meal here that I didn`t like". What has improved since the last inspection? Eight recommendations were made at the previous inspection. Of these six have been met. Assessments of need are made prior to people coming to live at the Gables and care plans and risk assessments are also in place for all the people who live in the home. Staff training records are kept and staff supervision and appraisal is recorded. Arrangements are in place to allow for access to records if the acting manager is absent. CARE HOMES FOR OLDER PEOPLE The Gables 29 Leicester Road Market Harborough Leicestershire LE16 7AX Lead Inspector Ruth Wood Unannounced Inspection 27th March 2008 09:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address 29 Leicester Road Market Harborough Leicestershire LE16 7AX 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) 01858 464612 gablesreshome@aol.com Niscar Limited Vacant Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To be able to admit the person of category SI(E) identified in correspondence from the previous registration authority dated 9th May 1997. 25th October 2006 Date of last inspection Brief Description of the Service: The Gables is a care home registered for up to ten people who require care and support due to age related needs. The home is on the outskirts of Market Harborough. There is car parking to the rear of the home and on-the-street parking. There is a spacious lounge, dining and quiet room and bedrooms are situated on the ground and first floors, close to bathrooms and toilets. The first floor is accessible with a stair lift. Outside is a small garden to the front and there is a patio to the rear of the property. Fees are £500 per week. Information about the home’s services is available in the Service Users’ Guide. The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection visit took place on a weekday between 09:30 and 14:50. During the visit the home’s communal areas were seen as well as the bedrooms of two people who live in the home. The care notes of two people were looked at in detail and how their needs were met was discussed with the care manager, staff members and in one the people themselves. Records relating to staff recruitment and training and medication were also examined and interaction between the staff and the people who live in the home was observed. Four of the eight people currently living in the home spoke with the inspector about what it was like to live at The Gables and two staff discussed their experience of training and support and their understanding of the home’s policies. As well as the inspection visit, this report reflects information sent to the Commission since the previous inspection, including the Annual Quality Assurance Assessment (AQAA). This is a self-assessment questionnaire completed and returned to the Commission for Social Care Inspection (CSCI) by the owners of the home. What the service does well: The Gables is a small home providing individualised care and the people who live there expressed a very high level of satisfaction with the service they receive. People’s comments to the inspector were all positive and included, “They look after us exceptionally well ” “I’m very happy here, it’s a very friendly environment.” Many people also stressed the homely atmosphere of ‘The Gables’, “I knew this was a home from home as soon as I walked in this place and my opinion hasn’t changed”. “You’d have to go a long way before you’d find a better atmosphere than this one” “This is my home” Good arrangements are in place to help people to make an informed decision about coming to live in the home. People are able to spend a day at the home to meet staff and the other people living there; this also enables staff to assess whether they can meet that person’s needs. The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 6 Staff spend time interacting with people and a selection of activities such as board games are always available. One person commented that “we don’t really watch much television here, we prefer to do other things”. Once a fortnight an outing to the local pub for lunch is arranged. However people said that they were not obliged to join in with any activity if they didn’t want to. There is a very flexible approach to meals with people’s individual tastes and dietary requirements being well met. People can choose to eat in their own rooms or in the dining room and a choice of food is offered. All food is cooked on the premises and organic vegetables from a local supplier are used. Fresh fruit is always available. People are able to prepare their own meals and drinks if they wish and are able to do so. Many positive comments were made about the food including, “I’ve never had a meal here that I didn’t like”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, The home does not offer intermediate care. Quality in this outcome area is good The availability of accurate information and the opportunity to visit the home enables people to make an informed decision about living there. Good systems of assessment ensure that their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Service Users’ Guide accurately outlines the services and facilities available in the home. The home’s owner hopes to update the guide to include photographs of the home. One person who had recently moved to the Gables described the admission process. The care manager had visited them at their previous residential home, discussed their needs and given them information about the Gables. They had visited for a day prior to moving in, to get to know the people who live and work in the home and see if they felt they would be comfortable living there. “I knew this was a home from home as soon as I walked in and my opinion hasn’t changed”. The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 9 The care manager confirmed that this was the usual admission process and this enabled staff to assess whether the home would be suitable for a person’s needs. From the information gained during these visits an assessment and care plan is documented which details social as well as physical care needs. Contracts for privately funded service users are clearly written and contain all the information required by the Regulations. The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good People are treated with respect and care plans are an accurate reflection of their needs, ensuring that they receive good, consistent care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two people’s care plans were looked at. One person had recently returned from hospital with an infection and a pressure sore and their care plan detailed their level of need when readmitted to the Gables. It detailed all aspects of care paying particular attention to infection control, nutrition and pressure area care. A special mattress obtained by the home was being used and district nurses were offering additional support. The care plan had been updated to show the improvement and changes in the person’s condition and the care manager and a staff member demonstrated a good understanding of the person’s needs. The second person also had a detailed care plan in place and the information contained in it was verified through direct discussion with the person and with members of staff on duty. Although a key worker system does not operate in the home, each staff member is allocated responsibility for ensuring that a The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 11 particular person’s care needs are met on each shift. One staff member commented that this system worked very well. The majority of people come from the local area and retain their existing dentist and GP. People had complained that the chiropody service was too expensive, so staff now provide basic foot and nail care and a chiropodist is arranged when necessary. Certificates and training programmes demonstrated that staff had received training in foot and nail care, the training informed staff which problems should be referred to a professional chiropodist. The care manager stated that a domiciliary optician visits the home but was unable to locate the prescriptions issued. It is recommended that these be kept together with the care plans. Only staff that have received appropriate training administer medication. The senior staff member’s training file contained evidence that she had received this training and she administered medication after lunch. The staff member was observed to be competent, checking the record, checking the medication before administration, giving the service user plenty of time to take their medication before signing the record on completion. Medication records appeared accurate and were fully completed. At all times the interaction between staff and the people living in the home was very positive with staff speaking in a calm and respectful way and allowing people time to respond. Staff were seen to knock and wait for a response before entering people’s rooms. Some people choose to use ‘Do not disturb’ signs when they wish to be left alone and their wishes are respected. One person said, “Staff are here straight away” if they pressed their call bell but respect their privacy at all other times. There is a cordless telephone for people to use in private if they wish and some people have their own separate telephone lines in their rooms. The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good People are supported to have a lifestyle of their choosing. They enjoy a choice of freshly cooked meals and can choose when and where they wish to eat them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service takes account of people’s individual needs and interests and following feedback from people and their relatives has sought to increase the level of structured activity in the home. An outside agency provides physical motivation sessions once every fortnight, which involves singing, physical floor games and gentle exercise. Again on a fortnightly basis staff support people to go out for lunch to the local pub. Two service users told the inspector how much they enjoyed these particular outings, others said they were always asked if they wanted to take part in activities but never felt obliged to do so and could choose to be by themselves. During the inspection there was a very high level of interaction between the people who live and work in the home. Male service users exchanged banter and seemed comfortable and relaxed in each other’s company. Staff were observed playing chess, dominoes and Scrabble with people at various points during the day (and losing at all three) and people said that they regularly played these games and enjoyed them. A jigsaw was also being completed. The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 13 One person was listening to light classical music and reading a magazine. At no time during the inspection was the television on. Two people told the inspector that they didn’t really like the television much as they preferred to read, talk or play games. One person, who has developed dementia since coming to live in the home, enjoys looking through a “treasure box” of significant items such as photographs that have been gathered together for them. Most people said that they have contact with their families, and relatives can visit them at any time. Menus have recently been updated following feedback from the people who live at The Gables. For example more cooked teas are now being served. There is a very flexible approach to the provision of meals; on the day of the inspection three different meals were cooked for the eight people living in the home. An individual record is kept of what each person eats to ensure that they are receiving a balanced diet. Fresh vegetables are obtained from a local organic supplier and there was a large quantity of fresh fruit in the kitchen. People can choose when and where to eat lunch, in their rooms or in the dining room. One person likes to make her own evening meal in the kitchen. People were very positive about the standard of food, “I’ve never had a meal here that I didn’t like” “They’re wonderful, excellent meals in here.” The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good People’s concerns are listened to and procedures are in place to protect them from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA states that all service users, family and visitors have access to the complaints procedure and this is clearly set out in the Service Users’ Guide. People said that they could take any concerns to the home’s providers and, “they respond very quickly to concerns. For example I said that I was a little cold in my room and they immediately put and extra heater in place.” No formal complaints have been received by the service or by CSCI since the previous inspection. The providers are aware of their responsibilities with regards to safeguarding and since the previous inspection have reported one safeguarding incident to social services for investigation; the investigation has now been concluded. One staff member displayed a good understanding of their responsibilities under the home’s whistle blowing procedures and was aware of the outside agencies to report concerns to if they were not satisfactorily resolved within the home. The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate The Gables provides a comfortable and clean environment, which meets people’s needs. Some areas are in need of redecoration. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All communal areas were seen and two bedrooms. The latter were personalised and people are encouraged to bring personal items when they come to live at The Gables. Improvement is needed to some of the décor and floor coverings in some areas, such as the area where fridges and freezers are kept and the hall, stairs and landing. The care manager stated that this was going to be addressed. The home’s lounge and dining room were comfortable and warm and offered plenty of natural light. The home was fresh and clean and there were good systems in place with regards to infection control. External areas surrounding the home have been improved and the garden area and pathways were well maintained. The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good Staffing levels enable people’s needs to be met but recruitment procedures must be consistently followed to ensure people are not placed at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff members are responsible for cooking and cleaning in the home as well as care duties and there are least three staff members on duty during the day, with four or five being more usual. As well as staffing the residential home, staff are available to respond to any emergency calls from the people living in the flats built alongside the residential home (these are also owned by The Gables). The care manager stated that responding to these requests never compromises The Gables’ staffing levels. Staff were observed to respond immediately to people’s requests for assistance and were able to spend time chatting to and playing games with people. One person commented, “The staff are beautiful – I have a buzzer and I can call for help, I don’t have to be alone, they’re here just like that”. The care manager is consolidating staff files and each staff member has an individual training record. Arrangements have been made for senior staff to attend team management training and one staff member said they had completed their induction programme and were due to begin a National Vocational Qualification in care at level 2. Staff training has included moving and handling (including use of hoist) fire safety and dementia care. The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 17 As part of the recruitment process the care manager works alongside prospective staff for two shifts before they are formally offered a position. Recruitment records of three of the most recently employed staff showed that two had Criminal Record Bureau (CRB) checks from previous employers. There was evidence that new checks had been applied for but not yet received. A letter of urgent concern was sent to the responsible individuals, requesting that these staff’s names be checked against the Vulnerable Adults Register and that they do not work unsupervised in home until new CRBs are obtained. An appropriate response has been made to this letter. Examination of the current staff rota demonstrated that these staff do not work unsupervised in the home The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good Systems are in place to ensure that the home is currently run in the best interests of the people who live there. Clearer management structures would ensure this position is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Gables has never had a registered manager since its initial registration with CSCI’s predecessor, the National Care Standards Commission in 2002. One of the owners has taken on the role of care manager since the previous acting manager left in February 2008. She has a professional nursing qualification and holds a National Vocational Qualification in management at level 4. A requirement has been made that a formal application be made for registration. Changes have been made in some aspects of the service following feedback from the people who live at the Gables and their relatives. The care manager The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 19 says that she speaks with people whenever she is in the home (approximately 60 hours per week) and also conducts regular supervision and appraisals with staff (records of these were available for inspection). Although it was evident that people who live and work at the home are regularly consulted by the owners about their views, results from the written questionnaires used were not available. A requirement was made that these be made available to CSCI. A system, administered by the care manager, is in place to record transactions where people need support with managing their finances. It is recommended that people sign their own financial records alongside the manager, where they are able. Records demonstrated that staff have received training in moving and handling (including use of the hoist) and fire safety and discussion with staff confirmed that this is regularly updated. One staff member confirmed that a fire drill had been held the previous week. Information sent to CSCI by the owners of The Gables indicated that appliances and systems are regularly serviced. A new stair lift was fitted the day before the inspection. The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 3 X The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 Requirement A new Criminal Records Bureau check must be obtained for all staff members before they commence work in the home. Their names must also be checked against the vulnerable adults register. The current acting manager must submit an application for registration. Information from quality assurance questionnaires must be made available to CSCI. Timescale for action 27/03/08 2. 3. OP31 OP33 8 24 16/05/08 30/04/08 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 2 Refer to Standard OP1 OP19 Good Practice Recommendations Service users’ comments about the home should be included in the Service Users’ Guide A clear refurbishment plan should be put in place for the areas in the home that need re-decoration and the floor coverings that need replacement DS0000001774.V359801.R01.S.doc Version 5.2 Page 22 The Gables 3 OP35 People, where capable, should sign their financial records alongside the acting manager The Gables DS0000001774.V359801.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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