Care Home: The Gables

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What the care home does well Staff had positive relationships with the people using in the service and this was evident on the day of the visit. There was a stable staff group, many of whom had worked at the service for several years, which helped to ensure consistency of care. The staff team were committed and competent and were knowledgeable about the care needs and preferences of people using the service. Many of the staff had either completed National Vocational Qualification training to level 2 in care or were undertaking the training. A staff survey commented that ‘I really enjoy working at the Gables. It is a friendly place to be’. People using the service and their relatives praised the standard of care with comments such as ‘I like it here’, ‘I get the help I need’ and staff are ‘ever so good’. A visiting professional described the s care as ‘pretty good’ and said people were looked after ‘really well’.The GablesDS0000001975.V377525.R01.S.docVersion 5.2Meals were well presented, with a choice offered and the food received very positive feedback from people. It was described as ‘very good’ and ‘good meals with choice’. The Gables was maintained to a high standard and provided attractive and comfortable indoor and outdoor facilities for the people that lived there. Visitors commented favourably on its appearance and its level of cleanliness and two commented that there was ‘no smell’. A relatives’ survey commented that ‘cleanliness and hygiene are excellent’. What has improved since the last inspection? The service had improved its care planning to ensure that there was guidance for staff on how to deal with the risk of pressure sores and falls. Medication procedures had also improved and were accurate. Staff recruitment procedures were better and all the information legally required by the Care Homes Regulations 2001 was in place. Staff health and safety training had improved and there was an ongoing training programme for all key areas, such as in food hygiene, first aid and moving and handling. What the care home could do better: A care plan must be in place for everyone using the service regardless of their length of stay. All staff must receive safeguarding training and mandatory health and safety training as soon as possible after commencing employment. There should be more staff training in care related subjects such as visual and hearing awareness, skin care, dementia and nutrition. Eye drops should be labelled with the date of opening to ensure they are still being used within recommended timescales. Medication risk assessments should be more specific about a persons’ ability to manage their own medicines. The service should be more proactive in ensuring that people know how to make a complaint. The service should obtain a copy of the most up to date Derby and Derbyshire safeguarding procedures. The kitchen should be refurbished to provide a better working environment.The GablesDS0000001975.V377525.R01.S.doc Version 5.2 A wider range of activities and outings should be arranged to ensure there is more stimulation for people. Key inspection report CARE HOMES FOR OLDER PEOPLE The Gables 161 Morley Road Oakwood Derby Derbyshire DE21 4QY Lead Inspector Janet Morrow Key Unannounced Inspection 3rd September 2009 09:55 DS0000001975.V377525.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Gables DS0000001975.V377525.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Gables DS0000001975.V377525.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address 161 Morley Road Oakwood Derby Derbyshire DE21 4QY 01332 280106 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) www.gableshome.co.uk Ms Margaret Valerie Morris Ms Margaret Valerie Morris Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places The Gables DS0000001975.V377525.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 4 Day Care places Date of last inspection 2nd September 2008 Brief Description of the Service: The Gables is a 28 bedded service for older people situated in the residential area of Oakwood in the suburbs of Derby. The property was originally a farm, which has been converted into a care home. Residents’ bedrooms are located on the ground and first floor and are accessed by a shaft passenger lift. There are 28 single rooms, 16 are en suite and 12 are non-en suite, 1 of which is a double room used as a single. There is an attractive garden area with garden furniture. A wide range of health services are available including a choice of General Practitioner, district nurse, chiropody, dentist and optician. Staff training takes place to inform and enable staff to care for service users appropriately. A programme of leisure activities and social events is in place. The current scale of charges at the service at the time of this inspection were: £400 - £420 per week. Items not covered by the weekly fee included: Newspapers, hairdressing services, chiropodist, dentist, personal clothing, personal toiletries, telephone costs/calls and personal transport arrangements. Further information regarding the service can be provided by contacting the registered provider- Mrs Margaret Morris on Tel: 01332 280106 or by email at: jayne@gableshome.co.uk Information regarding the home and the services provided are also available on the service’s website at: www.gableshome.co.uk The Gables DS0000001975.V377525.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 quality outcomes. This inspection visit took place over one day for a total of 6.5 hours and concentrated on all the key standards and on the progress made towards achieving the requirements and recommendations made at the last inspection visit in September 2008. The manager/owner, six staff, two sets of relatives, one visiting professional and nine people currently using the service were spoken with during the inspection visit. One visiting professional and three relatives were contacted by telephone after the inspection visit. Sixteen surveys were received shortly after the inspection visit; five from relatives, seven from staff and four from people using in the service. Care records, a sample of policies and procedures and staff information were examined. A partial tour of the building took place. Written information in the form of an Annual Quality Assurance Assessment was received prior to the visit and informed the inspection process. What the service does well: Staff had positive relationships with the people using in the service and this was evident on the day of the visit. There was a stable staff group, many of whom had worked at the service for several years, which helped to ensure consistency of care. The staff team were committed and competent and were knowledgeable about the care needs and preferences of people using the service. Many of the staff had either completed National Vocational Qualification training to level 2 in care or were undertaking the training. A staff survey commented that ‘I really enjoy working at the Gables. It is a friendly place to be’. People using the service and their relatives praised the standard of care with comments such as ‘I like it here’, ‘I get the help I need’ and staff are ‘ever so good’. A visiting professional described the s care as ‘pretty good’ and said people were looked after ‘really well’. The Gables DS0000001975.V377525.R01.S.doc Version 5.2 Page 6 Meals were well presented, with a choice offered and the food received very positive feedback from people. It was described as ‘very good’ and ‘good meals with choice’. The Gables was maintained to a high standard and provided attractive and comfortable indoor and outdoor facilities for the people that lived there. Visitors commented favourably on its appearance and its level of cleanliness and two commented that there was ‘no smell’. A relatives’ survey commented that ‘cleanliness and hygiene are excellent’. What has improved since the last inspection? What they could do better: A care plan must be in place for everyone using the service regardless of their length of stay. All staff must receive safeguarding training and mandatory health and safety training as soon as possible after commencing employment. There should be more staff training in care related subjects such as visual and hearing awareness, skin care, dementia and nutrition. Eye drops should be labelled with the date of opening to ensure they are still being used within recommended timescales. Medication risk assessments should be more specific about a persons’ ability to manage their own medicines. The service should be more proactive in ensuring that people know how to make a complaint. The service should obtain a copy of the most up to date Derby and Derbyshire safeguarding procedures. The kitchen should be refurbished to provide a better working environment. The Gables DS0000001975.V377525.R01.S.doc Version 5.2 Page 7 A wider range of activities and outings should be arranged to ensure there is more stimulation for people. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Gables DS0000001975.V377525.R01.S.doc Version 5.3 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 DS0000001975.V377525.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was sufficient admission information in place to establish that the service was able to meet peoples’ needs. EVIDENCE: The Annual Quality Assurance Assessment provided by the service stated that ‘Before a service user moves into the home their needs are assessed, documented and communicated to other senior members of staff to ensure their needs are met.’ The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 10 Two peoples’ care records were examined and showed that there was sufficient information to establish that needs could be met. There was a completed assessment document on both files examined and information available from the assessment and care management process on two files. All seven staff surveys responded that they were ‘always’ given up to date information about the needs of people. Risk assessments were in place on one file for nutrition and moving and handing, risk of falls and pressure sores. The second file did not contain this information. The deputy manager explained that this was because the person concerned was in for a short respite period and these would be completed at a later stage if the person became a permanent resident. Another file was randomly selected and had all the necessary assessment information in it. The Gables did not provide intermediate care; therefore standard 6 was not assessed. The Gables DS0000001975.V377525.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear systems of care planning and medication administration ensured that peoples’ health and personal care needs were met. EVIDENCE: The Annual Quality Assurance Assessment said ‘Care plans and records relating to their health and personal care are kept constantly up to date and treated with confidentiality. These records reflect any changes in their condition, which we then act upon and review on a continuing basis. Service users have access to specialist medical services and we involve service users The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 12 in discussions that affect their wellbeing.’ Two care files were examined and one had a detailed care plan in place. These covered a range of areas such as cultural needs, physical needs, social needs and mobility needs. The care plan seen looked at the area of need/support and the goal to be achieved, and stated the intervention/support that was required for this goal to be achieved. It was reviewed on a monthly basis. The plan detailed what to do if a risk was identified; for example, where a risk of pressure sores was identified, there were instructions for staff to ensure the risk was minimised, such as using special equipment and maintaining good skin hygiene. Pressure relieving equipment was in use and a visiting professional spoken with said that the service requested specialist help regarding pressure sores promptly. The second care file did not have a care plan, although there was assessment information available that said how some needs were to be met. For example, it stated that continence needs were to be met by use of appropriate aids. Staff spoken with stated that a care plan had not been developed as the person was resident for a short respite period and a care plan would be developed if they became a permanent resident. A third file was then randomly selected and showed that a detailed care plan was in place and staff spoken with confirmed that this occurred for all people, except people admitted for respite care where more minimal information was documented. The care plans seen recorded visits from professionals such as General Practitioners (GP), dentists and opticians. Weight was recorded monthly. People spoken with praised the care saying it was ‘very good’ and a visiting professional spoken with confirmed that they were called out when needed and that any advice given was acted on. Another visiting professional said it was ‘definitely a good service’. A relative spoken with said they were ‘quite satisfied’ with the care provided and commented how their relative had improved and was much happier since using the service. Three of the four surveys received from people using the service responded that they ‘usually’ received the care support required and one said they ‘always’ did. Four of the five relatives’ surveys received said the service ‘usually’ provided the care expected and one said it ‘always’ did. One commented that ‘we are quite happy with the quality of the care provided’ and that ‘residents are treated as individuals, their likes and dislikes taken into account’. Medication administration record (MAR) charts were checked for accuracy of recording. A random examination of four records showed that charts were signed properly and the amount of medicines received was recorded. Two people were signing handwritten charts to ensure they were accurate. The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 13 Three peoples’ charts were then examined in more detail. These were accurate and corresponded with the dispensing system and codes were being used properly to explain why someone had not received a medicine. However, eye drops were not consistently being dated when opened so it was unclear whether they had been in use for longer than the recommended period of twenty-eight days. There was a risk assessment in place for people who wished to self medicate. Although this contained useful information, it did not specify clearly how it established that the person concerned was competent to administer their own medication. For example, it stated ‘ensure medication taken’ but did not say how to do this. Medicine storage was satisfactory and a random sample of medicines examined were within their expiry dates. Refrigerator temperatures were recorded daily and were within safe limits. There was secure storage for controlled drugs. The controlled drugs record was examined and was accurate, with the amount of drugs held corresponding with the written record. The majority of people spoken with said that they were treated respectfully by the staff and confirmed that their privacy and dignity was maintained. One relative spoken with described the staff as ‘friendly’. However, in discussion, one person made comments that they had been shouted at on one occasion. The manager was informed of this during the inspection visit and commenced enquiries about it but information received following the inspection visit did not substantiate this. Observation during the visit confirmed that staff practice was respectful. The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Well managed meals and activities enhanced the quality of peoples’ lives. EVIDENCE: People spoken with stated that they had their own routines and had choice in how they spent their day. Observation during the inspection visit showed that people continued with hobbies such as reading and some opted to stay in their rooms. There were photograph albums that featured some of the activities and outings that took place. Movement to music took place during the inspection visit and a barbecue night had been arranged. However, there was mixed feedback about activities as follows: two people suggested more quizzes would be beneficial and a relative spoken with commented that there could be ‘more stimulation’. A staff survey commented The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 15 that one way the service could improve was to have ‘more outings’. One of the four surveys from people using the service said there were ‘always’ activities arranged, two said there ‘sometimes’ were and one did not provide a response but commented that there were ‘plenty of activities’. A relatives’ survey commented ‘I think a more wide ranging activity programme might be beneficial’ and another said the manager ‘goes out of her way to make sure the residents have plenty of activities if they require them’. The Annual Quality Assurance Assessment stated that ‘Service users are always encouraged to take part in activities that we hold in house most afternoons. We arrange events outside the home at weekends as well as occasional evenings.’ The manager stated that she tried to take some people out at weekends whenver possible. Relatives spoken with confirmed that they were able to visit at any time and stated that they were always made to feel welcome. Visitors were observed to be calling throughout the inspection visit. A visiting professional spoken with stated that the home was ‘welcoming’. The Annual Quality Assurance Assessment provided by the service stated that ‘We have an advocacy service that we subscribe to’. Senior staff spoken with confirmed that training on the Mental Capacity Act 2005 had taken place and there was information available about it in the service. Feedback from people using the service was positive about the quality of meals at the home and all people spoken with described the food as ‘good’ and stated that they enjoyed the food on offer. The Annual Quality Assurance Assessment stated ‘We provide good, wholesome, nutritional, appetising meals with choices seven days a week. Residents are encouraged to eat and drink on a regular basis throughout the day.’ There were two choices provided at the main lunchtime meal and people spoken with confirmed that if they did not want the meals on offer they were able to chose an alternative. The menus were examined and showed that a good range of wholesome food was available. Food stocks were satisfactory with a wide range of fresh fruit and vegetables. Two of the four surveys received from people living in the home responded that they ‘usually’ liked the meals, one responded that they ‘always’ did and one did not provide a response. The serving of the lunchtime meal was observed; this showed that food was well presented and the dining room was pleasant with tables attractively decorated. The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures for handling complaints and safeguarding people were comprehensive and ensured that peoples’ concerns were listened to and that they were safeguarded. EVIDENCE: The complaints procedure was examined and this showed that complaints would be responded to within twenty-eight days. It was on display in the entrance of the home and had also been printed in the home’s newsletter. However, two of the four surveys from people using the service responded that they did not know how to make a complaint and two of the five surveys from relatives responded that they did not know. The Annual Quality Assurance Assessment supplied by the service stated that ‘We make sure the service users and families are well aware of the complaints procedure’. Examination of the complaints record showed that one complaint had been received at the service since the previous inspection in September The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 17 2008. It was clear from the record what action had been taken in response to the complaint and whether or not the complainant was satisfied. There had been no complaints received at the office of the Care Quality Commission (previously the Commission for Social Care Inspection) since the last inspection visit in September 2008. There was relevant information in the service on how to safeguard people, including how to refer to the Protection of Vulnerable Adults list. The service had a copy of the Derby and Derbyshire Local Authority procedures, although this was not the most up to date version. All staff spoken with were aware of their responsibilty to report any suspicions of abuse and confirmed that they had undertaken training in this since the last inspection visit in September 2008. Training certificates seen confirmed that this had occurred in December 2008 and May 2009. However, one member of staff who commenced employment at the service in 2009 had not yet undertaken the training. All seven staff surveys responded that they knew what to do if anyone had concerns about the service. There had been one allegation reported to the Local Authoriity under safeguarding procedures in 2009.This had been addressed properly by the service and the Local Authority were satsified with its response. An issue raised by a person uslng the service during the inspection visit was reported to the manager, who was aware of her responsibilties in reporting allegations and took appropriate action to deal with the concern raised.. The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises were well maintained, which ensured that people using the service had safe and comfortable accommodation. EVIDENCE: The Annual Quality Assurance Assessment stated that ‘The home is very pleasantly decorated, with a homely atmosphere, every endeavour is made to The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 19 keep the home clean and smelling nice. The gardens are always well maintained and nice looking from every view from the home.’ The home was clean, tidy and odour free at the time of the inspection visit. Fittings and furnishing were of good quality and there was an ongoing programme of maintenance. There were pleasant well kept gardens for people to use and enjoy. One survey from a person using the service commented that there were ‘nice gardens’. Three of the four surveys received from people living at the home responded that the home was ‘always’ fresh and clean and one responded that it ‘usually’ was. All areas seen, with the exception of the kitchen, were well maintained and decorated to a good standard. The kitchen was in need of some refurbishment as cupboards and fittings looked worn. Two peoples’ bedrooms were seen and showed that rooms were personalised and attractively decorated. One person’s survey commented, however, that a prompter response to minor repairs would be an improvement and said their drawer unit and toilet seat had been ‘broken for some time’. Staff spoken with confirmed that they had undertaken infection control training and there were also certificates on their files that verified this had occurred in April 2009. They were knowledgeable on how to prevent the spread of infection and confirmed that there was always a plentiful supply of protective equipment, such as gloves and aprons. The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service had sufficient staff, appropriately recruited and trained to ensure people were safeguarded and their needs were met. EVIDENCE: The rota for the week 3rd – 8th September 2009 was examined. This showed that there were four care staff, including the deputy manager and a senior, on the morning and afternoon shift and two care staff at night. There was a chef and kitchen assistant in the morning and a kitchen assistant at tea-time. There were also two domestic staff and a housekeeper on shift each day, with an additional person when carpet cleaning was being undertaken. This was consistent with the number of staff on duty during the inspection. No –one spoken with, including people living at the home, relatives, staff and visiting professionals, indicated that there were any issues with staffing and all said that there were sufficient staff to meet the peoples’ needs. One member of staff spoken with commented that ‘we work well together as a team’ and another said there was ‘good teamwork’. The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 21 The Annual Quality Assurance Assessment stated that ‘The staff are trained, are competent and understand the aims of the home. We have a good team who are long serving and the majority are National Vocational Qualification (NVQ) trained.’ It also stated that senior staff were hoping to undertake NVQ4 training. Training certificates seen showed that manadatory health and safety training had been undertaken since the last inspection visit in September 2008. A training matrix was provided and showed that regular training was organised for staff throughout the year. The Annual Quality Assurance Assessment stated that one way the service hoped to improve was through providing more training on care related issues. The matirx showed that courses on falls prevention, medication and deprivation of liberty had occurred in 2009. Six of the seven staff surveys received responded that training relevant to their role was provided. One survey did not provide a response. One survey commented that staff were ‘well trained’. Staff spoken with confirmed that training occurred and that National Vocational Qualification (NVQ) training was undertaken. The Annual Quality Assurance Assessment stated that thirteen of seventeen care staff had achieved an NVQ at level 2 or above. This meant that the service had exceeded the target of having a minimum of 50 of care staff with an NVQ2 and it is therefore commended for its commitment to qualification training. Three staff files were examined and showed evidence of good recruitment processes. All of the documentation required by Schedule 2 of the Care Homes Regulations 2001 was in place on all three files, including a Criminal Record Bureau (CRB) check and Protection of Vulnerable Adults (POVA) check, evidence of identity and two written references. The manager was also in the process of renewing staff CRB checks if the checks were three years old. All seven staff surveys received confirmed that checks were undertaken before they commenced employment at the service. The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service was well managed in the best interests of people living there. EVIDENCE: The registered manager/provider had worked in care since 1986 and had owned/managed the Gables since 1990. She had achieved an NVQ 4 in care The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 23 and a management certificate and presented as competent and approachable. She was supported by a deputy manager and administration staff. Staff surveys made favourable comments on how the home was run; one said ‘the home runs very well’, another ‘management are approachable always’ and another ‘I think the Gables is run very well’. Five of the seven surveys received responded that they received support from the manager ‘regularly’ and two responded that they ‘often’ did. There was a quality assurance process in place that sent out surveys to people using the service and their relatives. The survey covered the appearance of the home, meals, activities, staff attitude and management. Feedback from the most recent survey undertaken in August 2009 was positive, with high levels of satisfaction. This was also verified by positive comments received during the inspection visit such as ‘our relative is happier and enjoys the personal attention’, ‘I like it here’, ‘ever so good’, ‘staff are helpful’ and ‘impressed with the care’. The manager stated that she was not acting as appointee for anyone’s finances. Personal allowance transactions were recorded. Three peoples’ financial records were examined and corresponded accurately with the cash held. Receipts were available for individual purchases. The cash held was stored securely. The Annual Quality Assurance Assessment supplied by the service stated that maintenance checks were up to date. It stated gas safety was checked in July 2008, although the manager stated that this had been updated in August 2009, hoists in January 2009 and portable electrical appliances in November 2008. A random sample of records confirmed this during the inspection visit. Staff training records and staff spoken with confirmed that mandatory health and safety training had been undertaken. There had been an incident of inappropriate moving and handling procedures resulting in an injury to one person reported in January 2009. This was discussed with senior staff who confirmed that they knew the correct procedures and that further training had been organised. Records showed that moving and handling training had occurred in April 2009 and ten staff had attended this. Courses in food hygiene, fire safety, infection control and first aid had also occurred in 2009. However, one member of staff who commenced employment in 2009 had not undertaken any training in the service and this included fire safety and infection control. There was no indication on any records or in discussion that these courses were organised for that staff member and their name did not appear on the staff training matrix. However, they had a current food hygiene certificate from a previous employer, which was relevant to the work undertaken. The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 24 The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 25 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 26 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 OP7 Regulation 15 (1) Requirement A care plan must be in place for everyone using the service regardless of their length of stay. This is to ensure that all needs can be met and the person concerned receives the right support. 2. OP18 13 (6) All staff must receive safeguarding training as soon as possible after commencing work at the service. This is to ensure they are competent in their work and keep people safe. 3. OP38 18 (1) (c) All staff must receive mandatory health and safety training as soon as possible after commencing work at the service. This is to ensure they are competent in their work and keep themselves and people using the service safe. 01/11/09 01/11/09 Timescale for action 01/11/09 The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 27 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 Medication risk assessments should be more detailed to instruct staff how to check a person’s ability to manage their own medication. Eye drops should be labelled with date of opening to ensure they are still safe to use. A wider range of activities and outings should be arranged to ensure there is more stimulation for people. The service must ensure that all people and their relatives know how to make a complaint. The service should obtain a copy of the most up to date Derby and Derbyshire safeguarding procedures. Minor repairs should be attended to promptly. The kitchen should be refurbished to provide a better working environment. All staff must be included on the staff training matrix to ensure they receive all necessary training. Training in areas related to care should be arranged; for example in skin care, nutrition, dementia and visual and hearing awareness. 2. 3. 4. 5. 6. 7. 8. 9. OP9 OP12 OP16 OP18 OP19 OP19 OP30 OP30 The Gables DS0000001975.V377525.R01.S.doc Version 5.3 Page 28 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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