Care Home: The Gables

What the care home does well The Gables is managed in the best interests of the people who live there. People spoken with considered the service is well managed and that the proprietors are open and approachable. People enjoy the range of activities offered to include crafts, external entertainment, trips out to include shows, shopping, places of interest, the coast, garden centres and a boat trip. People told us they are looking forward to a wine tasting event and a trip to Botanical gardens and Hartlebury Castle. People told us they enjoy living and working at the home and consider the service does the following well: "We get very good care here, the meals and activities are good and the staff are kind and approachable" "I know I`m safe here, the staff are very good and being happy is the main thing" "Visitors are very much made welcome. I`m able to visit my wife when I want and I`m always offered a drink and have also stayed for a meal" "The care is wonderful, I get lots of support from the staff and they make me feel comfortable when I visit my husband" "It`s lovely here, I love my job to bits" Individual`s health needs are well-monitored and appropriate referrals to healthcare professionals made where necessary. Feedback gained from health professionals was very positive and comments include: "The Gables give outstanding patient centred care ...Their care of dementia patients is excellent. It`s a pleasure to visit my patients at The Gables" "The Gables is a very friendly and well run home that deals remarkably well with patients with quite significant dementia...I have been very impressed with the treatment offered to my patients in this home" What has improved since the last inspection? The last key inspection of this service was undertaken on 9th February 2007. We did an annual service review on 16th June 2008. This did not involve a visit to the home but is a summary of new information given to us, or collected by us, since the last inspection. The report is available at the home. Since we last visited the home a conservatory has been added providing additional space for people to relax or partake in activities. People we spoke with said they enjoy using this facility. People are now offered a hot choice of breakfast in addition to a range of cereals. This has proved very popular amongst residents. One resident said "The food is much better and having two choices is a good idea". Another resident said "I love the hot breakfasts"A member of staff now has designated responsibility for organising activities for people. These sessions are structured and take into account people`s personal preferences and abilities. What the care home could do better: We consider the service to be performing well. It continues to provide positive outcomes for the people using the service. Not all of the required checks have been undertaken on new staff employed to make sure they are suitable to work with vulnerable people before they start employment. Both proprietors committed to ensuring all of the required checks are undertaken with immediate effect to ensure people are safeguarded. Many areas of the home are looking tired in appearance and require redecoration. Some furniture is in need of replacement and bathrooms require refurbishment. The need to improve the environment is identified in the Annual Quality Assurance Assessment and the proprietors plan to make the necessary improvements over the next 12 months. This would provide people with a more pleasant and homely place to live. We asked the proprietor to assess the use of coded locks on the doors around the home, as this restricts freedom of movement for residents and may not be in the best interests of all individuals. Staff would also benefit from attending training in the mental capacity act and deprivation of liberty safeguards so that they are aware of their responsibilities regarding this legislation. We asked people what they thought could be improved and people said: "I can`t think what could be done better but if I did, I know that Tom and Helena would do it" "I think an additional member of staff on each shift would be good" "I`m not sure what could be done better as I see happy, well cared for residents daily and feel that is what matters". CARE HOMES FOR OLDER PEOPLE The Gables 18 Broomfield Road Kidderminster Worcestershire DY11 5PB Lead Inspector Rebecca Harrison Key Unannounced Inspection 5th March 2009 09:30 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 DS0000018522.V374427.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 DS0000018522.V374427.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address 18 Broomfield Road Kidderminster Worcestershire DY11 5PB 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) 01562 745428 Mr Tom Gawtam Ramnial Mrs Helena Maria Ramnial Mr Tom Gawtam Ramnial Mrs Helena Maria Ramnial Care Home 24 Category(ies) of Dementia (24), Mental disorder, excluding registration, with number learning disability or dementia (24), Old age, of places not falling within any other category (24) The Gables DS0000018522.V374427.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 the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 24 Mental disorder, excluding learning disability or dementia (MD) 24 Dementia (DE) 24 The maximum number of service users who can be accommodated is: 24 9th February 2007 2. Date of last inspection Brief Description of the Service: The Gables is a large, detached property situated in a pleasant residential area of Kidderminster, close to a bus route and other local amenities. The home is registered to provide residential care for a maximum of 24 older people who may also have a physical disability, dementia illness or other mental health needs. The premises have been extended and adapted for their present use as a care home. Residents are accommodated on the ground and first floor of the building in 20 single bedrooms and 2 double bedrooms. The home does not have a passenger lift. However, a stair lift is provided to enable people to have easier access to the first floor. The current proprietors have been the joint registered providers since 1990, they manage the home and have an active involvement in the day to day operations. Their own accommodation adjoins the care home and they feel that this enables them to maintain close links with both the residents and staff. People who use the service and their representatives are able to gain information about this service from the Statement of Purpose and Service User Guide. Inspection reports produced by CSCI can be obtained direct from the provider or are available on our website at www.csci.org.uk Fees charged are £390.00 per person per week. The Gables DS0000018522.V374427.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 star. This means the people who use this service experience good outcomes from the service they receive. The inspection of The Gables was unannounced and was undertaken by one inspector over a period of seven hours. A range of evidence was used to make judgements about this service to include discussions held with seven people who use the service, three visiting relatives, four staff and the proprietors. We looked at some parts of the home, reviewed the homes quality assurance processes and sampled a number of records to include complaints and protection, staff training, recruitment and health and safety records. Seven people who live at The Gables completed surveys for us informing us of their views, in addition to ten staff and three visiting health care professionals and the feedback gained has been included in our report. The Gables sent us their Annual Quality Assurance Assessment (AQAA) when we asked for it. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. By law they must complete this. Three people who live at the home were case tracked this involves establishing individuals experience of using this service, discussing their care with them, their relatives and staff on duty, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked at the outcomes for people living at the home and information to produce this report was gathered from the findings on the day and also by review of information received by CSCI prior to the inspection date. What the service does well: The Gables is managed in the best interests of the people who live there. People spoken with considered the service is well managed and that the proprietors are open and approachable. People enjoy the range of activities offered to include crafts, external entertainment, trips out to include shows, shopping, places of interest, the The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 6 coast, garden centres and a boat trip. People told us they are looking forward to a wine tasting event and a trip to Botanical gardens and Hartlebury Castle. People told us they enjoy living and working at the home and consider the service does the following well: We get very good care here, the meals and activities are good and the staff are kind and approachable I know Im safe here, the staff are very good and being happy is the main thing Visitors are very much made welcome. Im able to visit my wife when I want and Im always offered a drink and have also stayed for a meal The care is wonderful, I get lots of support from the staff and they make me feel comfortable when I visit my husband Its lovely here, I love my job to bits Individuals health needs are well-monitored and appropriate referrals to healthcare professionals made where necessary. Feedback gained from health professionals was very positive and comments include: The Gables give outstanding patient centred care …Their care of dementia patients is excellent. Its a pleasure to visit my patients at The Gables The Gables is a very friendly and well run home that deals remarkably well with patients with quite significant dementia…I have been very impressed with the treatment offered to my patients in this home What has improved since the last inspection? The last key inspection of this service was undertaken on 9th February 2007. We did an annual service review on 16th June 2008. This did not involve a visit to the home but is a summary of new information given to us, or collected by us, since the last inspection. The report is available at the home. Since we last visited the home a conservatory has been added providing additional space for people to relax or partake in activities. People we spoke with said they enjoy using this facility. People are now offered a hot choice of breakfast in addition to a range of cereals. This has proved very popular amongst residents. One resident said The food is much better and having two choices is a good idea. Another resident said I love the hot breakfasts The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 7 A member of staff now has designated responsibility for organising activities for people. These sessions are structured and take into account peoples personal preferences and abilities. 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 DS0000018522.V374427.R01.S.doc Version 5.2 Page 8 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 DS0000018522.V374427.R01.S.doc Version 5.2 Page 9 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): Key standard 3. (standard 6 does not apply to this service) Quality in this outcome area is good Information about the service is available to help prospective residents and their representatives make an informed choice about whether The Gables is an appropriate place to live. Needs assessments are obtained and undertaken and prospective residents and families are given the opportunity to visit the home to ensure the service is able to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides prospective residents and their families with information about the service in the Statement of Purpose and Service User Guide. This enables people to make an informed choice as to whether the home is suitable to meet their individual needs. The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 10 We spoke with a person recently admitted to the home and their relative and discussed the assessment and admission process with them, the proprietor and other residents. People told us that they or their representative visited the home prior to admission, to make sure the home was appropriate for them. All three care files examined showed that an assessment of needs had been obtained from the local authority prior to admission and that the home had also assessed individuals on admission. Feedback gained from the surveys completed by people who use the service or a representative supported our findings. People also told us that they had been provided with a contract which sets out fees and what these cover. The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 11 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): Key standards 7,8,9 and 10 Quality in this outcome area is good Staff have the information they need and a clear understanding of how to offer care to each person, which ensures peoples health and personal care needs are met in a way that they prefer. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We spoke with 7 people who live at the home and 3 visiting relatives about the care provided and their comments were very positive. Comments include: The care is very good I like it here The care is wonderful and I get lots of support. We case tracked three people whose needs are very different. Their care records were detailed with evidence of review. People we spoke with said that they had been involved in developing their plan of care. We spoke with 3 staff about the individual needs of the people we case tracked and they all demonstrated a clear understanding and considered that they are provided The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 12 with sufficient information to ensure peoples needs are met in a way that they prefer. Records sampled clearly evidenced that peoples health is monitored and any concerns are quickly referred to the appropriate healthcare professional and outcomes stated. We received feedback from three healthcare professionals and their comments were very positive. They consider the care service always seeks advice and acts upon it to manage and improve individuals health-care needs. One health professional stated I have every confidence in The Gables and their staff, Tom and Helena Ramnial are always available (often above the call of duty) and their staff are well supported. It is a pleasure to visit my patients at The Gables. Their care of dementia patients is excellent. Another professional stated The home treats residents as individuals and understands their different needs. The care files belonging to the people we case tracked contained information about their prescribed medication and how this is to be administered. People we spoke with told us that they are happy with how their medication is managed. We spoke with a member of staff regarding medication procedures and she demonstrated a clear understanding of the procedure and was aware of the medication held on behalf of the three people we case tracked. The proprietor stated that there have been no medication errors since our last inspection. Records evidence that a medication compliance audit was undertaken by Worcestershire PCT Residential and Nursing Home Pharmacist in October 2008 and the proprietor stated the outcome of the visit was satisfactory and that she also sought guidance from the pharmacist regarding storing medication in the kitchen, as identified in the previous inspection. The proprietor stated that this was considered satisfactory. Staff receive basic medication training however the proprietors have sourced additional training and aim for staff to commence this shortly. We advised the proprietor to undertake competency assessments on staff responsible for administering medication, this would provide greater safeguards for people who require support with their medication. The statement of purpose states The philosophy of the home includes teaching staff about maintaining dignity, the need for privacy and confidentiality, to treat each person as an individual and to always remember that this is our service users home. People told us that staff treat them with respect and that their privacy is upheld. One resident said Staff are very kind and absolutely respect my privacy and dignity and always knock on my door. Peoples preferred form of address was clearly stated on the care plans we examined and staff interacted with people they care for in a professional manner. The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 13 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): Key standards 12,13,14 and 15 Quality in this outcome area is good People living at The Gables are provided with opportunities to experience a meaningful lifestyle that ensures their self-esteem and wellbeing. People are provided with and enjoy a range of meals according to their dietary requirements and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People told us that routines are flexible, that they are able to rise and retire as the wish, that they regularly see their family and friends and that they enjoy the variety of activities available. Care plans sampled contained a brief personal history of age individual and identified peoples likes and dislikes and preferred routines. During the inspection a hairdresser was present at the home and many people enjoyed using this service. A diary of planned events is displayed in the home in addition to photographs of social activities that people have enjoyed and special events celebrated such as birthdays. People we spoke with appeared satisfied with the activities provided and said that activities are discussed at residents meetings. Relatives are also invited to attend celebrations and trips out in the community. People now benefit from the appointment of a part-time activity organiser who was present at the The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 14 inspection and engaged people in a craft session and offered manicures to female residents. People told us: I like the trips, they are well-planned and arranged. I also go out by myself I go out on my own a lot but the trips, entertainment and parties are excellent. I enjoy meeting to plan the trips The knitting club is good, I enjoy chatting with others People are confident that they are able to maintain relationships with people important to them. They told us that their relatives and friends are made welcome when they visit the home and this was evident in observations made during our inspection and the positive feedback gained from discussions we had with three visiting relatives. Their comments include: Visitors are very much made welcome here. Im able to visit my wife when I want and Im always offered a drink and have also stayed for a meal The care is wonderful, I get lots of support from the staff and the staff make me feel comfortable when I visit my husband People told us that they generally enjoy their food. The menu provides a choice of two hot meals and the home is able to cater for special dietary needs. People have a choice of where they take their meals and their preferences are documented on their care records. The views of people using the service have been listened to and people are now provided with a choice of hot breakfast in addition to a range of cereals. It is evident that people are very much enjoying this. Staff spoken with demonstrated an understanding of the dietary needs and personal preferences of the people we case tracked, for example if they are diabetic and the level of assistance individuals require. The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 15 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): Key standards 16 and 18 Quality in this outcome area is good People living at The Gables and their representatives have access to a complaints procedure, which is accessible and ensures the views of people are listened to. Staff receive training so that they have an understanding in adult protection to ensure people they support are protected from abuse, ensuring their well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People we spoke with and surveys received clearly indicate people know who to speak to if they are not happy with the service provided. The home provides a complaints and comments box and people are also given the opportunity to raise their views through residents meetings and satisfaction surveys. The AQAA states As managers we make ourselves available to listen to any problems and are able to sort out any queries/problems as they arise… the home does not view complaints or queries as a negative backstop but we find it is very effective operating in positive and open climate in which positive and negative criticisms are freely expressed. The home has received four complaints in the last 12 months and these have been appropriately dealt with. We have not received any concerns for complaints in relation to The Gables since our last inspection. The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 16 People told us that they feel safe and secure at The Gables. Staff spoken with demonstrated an awareness of safeguarding and whistle blowing procedures. There have been no referrals made under local safeguarding adult procedures since our last inspection and staff receive training on adult protection. The policy on abuse now provides more clarity on what constitutes abuse, so staff are alert and able to recognise any signs it may be occurring. We advised the provider to update their abuse policy in line with the local policy so staff are clear about the referral process and undertake a risk assessment on the use of coded locks on external doors, as this restricts peoples freedom of movement. The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 17 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): Key standards 19 and 26 Quality in this outcome area is adequate People living at The Gables are provided with a clean and homely place to live which is equipped to meet their individual needs and makes them feel safe and secure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA states The home is designed to ensure the comfort, safety and protection of service users and promote their independence and quality of life in general. People spoken with during the inspection told us that they enjoy living at The Gables and that their rooms are warm and comfortable. One person stated I know Im safe here another person said I like it here, I am quite happy. We looked at parts of the home and at the rooms of the people we case tracked. These were personalised with family photos and ornaments and appropriately equipped to meet their individual needs. Provision of ramps, grab The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 18 rails, hoists and a chairlift are available. People are provided with a range of shared areas to include a dining room, large lounge, quiet lounge and a new conservatory which has recently been fitted and overlooks the accessible and well maintained garden. The home has an on-going programme of redecoration, with rooms redecorated when they become vacant and plans for improvement in the next 12 months include the refurbishment of bathrooms and toilets, replacement carpets in some areas, redecoration of the corridors on the first floor and improvement of furnishings in the lounge and dining areas. These improvements will provide people with a more homely place to live. The providers have actioned the previous requirements made. The parts of the home we toured were generally clean however an offensive odour was detected in one of the bedrooms of the people we case tracked. The provider stated that the carpet is to be replaced shortly. Surveys we received and people we spoke with indicated they are satisfied with the cleanliness of their rooms and the communal areas. The home employs two domestic staff. One person stated that domestic staff are hard workers. Another person stated My room is kept lovely. Substances hazardous to health are appropriately stored and staff receive training in infection control procedures. The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 19 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): Key standards 27,28,29 and 30 Quality in this outcome area is adequate Staff work positively with the people they care for and receive good opportunities for training to equip them with the skills and knowledge to meet the individual needs of the people living at the home. The lack of robust recruitment procedures has potentially placed people at risk of harm because the service has not secured suitability of candidates before they have commenced working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People we spoke with were very complimentary about the care that they receive. One person we case tracked stated The staff are very good and its obvious that they are very well trained. Throughout the inspection staff were accessible, good listeners and communicated well with residents. They appeared motivated and committed to their work. The majority of people we spoke with and feedback gained through surveys indicate people consider there is enough staff on duty to meet the individual and diverse needs of the people living at the home. One person felt an additional member of staff per shift would prove beneficial. The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 20 Staff we spoke with demonstrated a clear understanding of the needs of the three people we case tracked and reported that they are provided with good training opportunities. Of the 15 care assistants employed 9 hold a nationally recognised care qualification known as NVQ at level 2 and above and three staff are currently working towards the award. This exceeds national minimum standards in providing a qualified workforce to care for the people living at the home. The proprietors have sourced equality and diversity training in addition to nutrition and aim to commence the programme shortly. We looked at the files of the three staff employed since we last visited the home. Our findings evidence that some practices have potentially placed people using the service at risk, for example staff have commenced work prior to all the pre-recruitment checks being undertaken. Such shortfalls were fully acknowledged by the providers who committed to review the homes recruitment practices immediately to ensure people are not placed at risk of harm. The provider must ensure that all the necessary checks are obtained including two written references, criminal records bureau check and full employment history. Staff receive induction training however we advised the provider to ensure it meets the required specification. The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 21 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): Key standards 31,33,35 and 38 Quality in this outcome area is good People have confidence in The Gables because it is effectively managed in the best interests of the people living and working there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered providers have numerous years experience in working in the care sector. Mr Ramnial holds professional qualifications and the Registered Manager’s Award. Mrs Ramnial has undertaken a training course in management and is a NVQ trainer and assessor. They both played an active role in the inspection process and welcomed suggestions for improvement. It is evident that they are committed to providing a quality service and everyone we spoke with was complimentary about how the service is managed. The AQAA states We believe as managers we play a crucial leadership role in the The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 22 home and that the approach taken, in particular leadership style, is likely to have a great bearing on the performance of staff, and ultimately the quality of care. People told us: The providers are always available and approachable Tom and Helena are lovely, the best managers I have ever worked for. Its a very friendly and well-run home… I have every confidence in the Gables and their staff Tom and Helena Ramnial are always available (often above the call of duty) and their staff are well supported. People using the service are provided with opportunities to express their views about the service through residents meetings and reviews. Discussions with staff clearly evidence they feel valued and their own views and suggestions are welcomed. Satisfaction surveys have been circulated to gain the views residents, relatives and professionals and a report developed based on the information collated to inform future planning, as required by the previous inspection. Feedback is positive Overall people are satisfied with the care they receive and with the management of the home and feel they are listened to and included. Comments from health care professionals include: We find the management and staff at welcoming and helpful Patient care is excellent My colleagues and I value our good working relationships with The Gables Comments from families include: An excellent service overall No problems at all, very happy with everything. My relatives is very settled here and feels at home Excellent- keep up the good work People who require support to manage their finances are safeguarded by the procedures in place. Records are available for finances held and two signatures are obtained for all transactions in addition to receipts. Staff spoken with were familiar with the procedures in place and detailed inventories of property held were available on all three files sampled. People we spoke with told us that they feel safe and secure living at The Gables. The AQAA states Health and safety and welfare of service users and staff are promoted and protected. We looked at a variety of health and safety records and the checks that staff do to prevent people from being placed at risk of harm. We found that checks are generally undertaken at the required frequency and equipment serviced to ensure that it is safe and protects people. However due to a recent problem The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 23 encountered with the water supply the temperature of the water exceeded safe levels and therefore we advised the provider to take immediate action to safeguard people which they did. We later received written confirmation that the work had been undertaken. Staff told us that they receive training in safe working practices for example moving and handling, food hygiene, fire, infection control which helps to keep people safe. The proprietors stated that there are no outstanding requirements made by the fire or environmental health departments. The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 24 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 x x 3 x x 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 4 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 3 x x 3 The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 25 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 Schedule 2 Requirement All pre-recruitment checks must be undertaken on new employees before they commence direct work. This will ensure people living at The Gables are protected by the home’s recruitment policy and practice and safeguarded from possible harm. Timescale for action 31/03/09 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 OP9 Good Practice Recommendations Staff responsible for administering medication should have their competency assessed on a regular basis, this would provide greater safeguards for people who require support with their medication. The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. Extracts may not be used or reproduced without the express permission of CSCI The Gables DS0000018522.V374427.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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