Care Home: The Gables

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What the care home does well The expert by experience summarised her findings as: `I liked this home; it felt comfortable, was clean, the staff were welcoming and friendly, they had a pleasant, friendly attitude with the residents who said things like; `I get on with the staff` and if they had a problem `I`d go to the staff room`. They were also keen to improve things and welcomed my suggestions.` The service has good processes in place to assess prospective users prior to admission, with opportunities to visit the service beforehand to ensure it meets their needs. The pace of admission was geared toward individual needs. There is good regard for the diverse needs of the people living at the service and their requirements related to their disabilities, lifestyle choices and personal preferences are sought, recorded and met by the staff team, respecting their rights, choices and individuality. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met. The health and personal care needs of people living at the service are well met, promoting health, well-being, taking into account their preferences and ensuring that they receive medication in a safe and consistent manner. Complaints and safeguarding are effectively managed to listen to views of people who live at the service and reducing the risk of harm to them. The premises are clean and homely, promoting a positive environment for the people who live at The Gables and which are suitable for the range of disabilities that people have. The service provides staff cover to meet needs and undertakes thorough recruitment procedures to protect people from harm. The management and administration of the service promotes continuity and quality of care for the people who live there and ensures that risk is safely managed to reduce the likelihood of injury or harm. What has improved since the last inspection? Risk assessments for one of the service users had been written, to make sure that identified hazards were noted and risk of injury or harm reduced. People were being weighed regularly and any concerns passed to their doctor, to keep them well. Written guidance had been prepared for `as required` medicines to make sure that staff know what they are prescribed for and the circumstances in which to give them. What the care home could do better: Advice has been given to add photographs of staff to their recruitment files for easy identification. Advice has been given to put safeguards in place where staff start with preliminary clearance prior to a full Criminal Records Bureau check, to make sure that staff in these circumstances fully understand the limitations to their work and that shift leaders are also made aware. Staff training records need to demonstrate that staff have the full range of mandatory training and updates as necessary. This is to ensure they have the right skills and competencies to meet people`s needs. Key inspection report Care homes for adults (18-65 years) Name: Address: The Gables Moreland Drive Gerrards Cross Bucks SL9 8BB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Chris Schwarz     Date: 0 3 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: The Gables Moreland Drive Gerrards Cross Bucks SL9 8BB 01753890399 01753890399 manager.thegables@fremantletrust.org www.fremantletrust.org The Fremantle Trust The registered provider is responsible for running the service care home 7 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Date of last inspection Brief description of the care home The Gables provides accommodation for seven adults with learning disabilities and high care needs. It is situated within close proximity of Gerrards Cross town centre. There is a main bus route from the town centre to nearby towns. Accommodation is arranged over two floors with stair lift access to the upstairs areas, however the majority of service users have bedrooms on the ground floor. There are two bedrooms upstairs for the more mobile service users. All bedrooms are individually decorated to personal taste. There is a large communal lounge, dining room and a separate sensory room. Care Homes for Adults (18-65 years) Page 4 of 32 2 6 0 2 2 0 0 9 7 Over 65 0 Brief description of the care home There is a large enclosed garden at the rear of the building and some parking spaces at the front. The property is not identifiable from the outside as a care service. Fees for the service were £1083.95 per week. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of a day from 9.50 am until 7.00 pm and covered all of the key national minimum standards for younger adults. The last key inspection of the service took place on 26 February 2009. Prior to this inspection, a detailed self-assessment questionnaire, the Annual Quality Assurance Assessment (AQAA), was sent to the manager for completion. It provided information about the service and statistical information needed to plan the visit and assess standards of care being provided. Surveys were sent to relatives, staff and visiting professionals. Ten completed surveys were received, five from relatives, two from health care professionals, two from staff and one from a social care professional. We were aware that people using the service have complex communication needs and involved an expert by experience with this visit. An expert by experience is a person who, because of their shared experience of Care Homes for Adults (18-65 years) Page 6 of 32 using a service and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Feedback from the surveys and the expert by experience has helped us to form judgements about the service. Information received by the Commission since the last inspection was also taken into account, such as notifications and any complaints or safeguarding issues. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, examination of some of the required records such as care plans, medication administration records, staff recruitment files, policies and procedures and risk assessments. We also observed practice and toured the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? Risk assessments for one of the service users had been written, to make sure that identified hazards were noted and risk of injury or harm reduced. People were being weighed regularly and any concerns passed to their doctor, to keep them well. Written guidance had been prepared for as required medicines to make sure that staff know what they are prescribed for and the circumstances in which to give them. Care Homes for Adults (18-65 years) Page 8 of 32 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are thoroughly assessed prior to admission and are given opportunity to visit the service beforehand to ensure it meets their needs. Evidence: We were advised in the Annual Quality Assurance Assessment that there had not been any new admissions to the service since the last inspection. Information indicated that someone was being considered for a placement. The manager advised us that there was a service users guide and statement of purpose in place. We were told that people being referred for a placement would be assessed and that the person being referred, their family and Social Services would all be involved in the admissions process. The manager told us that visits to the service and overnight stays are encouraged and arranged to suit individuals needs and at a pace suitable to them. Relatives said in surveys that they had received enough information about the service to help with the decision making process. During the visit we were able to see a copy of the statement of purpose was available Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: in the hallway alongside other information that people would find useful such as the philosophy of care, the complaints procedure and a statement of equal opportunities. The statement of purpose covered all required areas and had information such as the arrangements for people to receive support with their health and personal care, laundry, meeting dietary requirements and arrangements for meals, how they could expect their care to be delivered (choice, privacy, dignity, respect and independence) and included a service users charter, the aims and objectives, qualifications of staff, the admissions process, the complaints procedure and information on equality and diversity. There was also a pictorial version of the service users guide which made use of photographs and colour to explain the service to people. The file of the last person to be admitted to The Gables was read. It contained guidance on admitting people to the service and a referral form was in place. The reason for referral was noted and there were details of practical and personal support, health care needs, the home environment, mobility, compatibility and views of other service users, day care, risks and staffing implications. This information was signed and dated. The file also contained a copy of a letter from the local authority advising of the prospective placement. The manager had initiated a tracking form to outline the sequence of events leading up to the admission and this provided valuable evidence of how an admission is handled. In discussion with the manager and assistant manager, both were clear in demonstrating that admissions processes are tailored to individual needs and move at a pace which is suitable to the person being considered and their family. The tracking form showed that a visit was made to the parental home and that copies of the statement of purpose and service users guide were taken out. A second visit took place to meet the prospective service user and to complete a care needs assessment. The prospective service user then visited the service with his parents and stayed for tea and cake and had opportunity to meet people using the service and some of the relatives. Further visits to the service took place including one where it was suggested to the family that the vacant room at The Gables be decorated in the same colour as the persons room at the parental home and to bring some items in so that there would be familiar objects around, and a visit which included staying for lunch. Written information about the persons care needs was detailed, thorough and took into account needs arising from equality and diversity and had been signed and dated. There was a contract on the persons file which made clear what is included in the fees and items which incur an additional charge such as toiletries and hairdressing. This had been signed by the persons parents. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good regard for the diverse needs of the people living at the service and their requirements related to their disabilities, lifestyle choices and personal preferences are sought, recorded and met by the staff team, respecting their rights, choices and individuality. Evidence: We were advised in the Annual Quality Assurance Assessment that care plans were in place for each person living at The Gables and that risk assessments were in place. The manager informed us that communication plans were in place and that visual prompts and objects of reference are used with people using the service as well as staff being familiar with peoples body language. We were advised that one of the staff is now a trained communication link worker. We were also told that there had been more input from speech and language therapy to aid communication. Relatives who completed surveys said the service usually met the needs of service users. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Care plans of three people were read. Each person had two files, one a comprehensive main file and the other a daily more light weight file. Files included a photograph of the person for easy identification and a tick list at the front to show monthly reviewing (which was up to date). An essential information sheet recorded peoples preferred name, date of birth, their ethnic origin, next of kin, doctor, significant friends and family, their care manager from the local authority, any aids or equipment they required, a pen picture and a brief summary of their needs. Peoples preferred daily routines were noted, as were their likes and dislikes. Needs relating to areas such as mobility, communication, washing and bathing, continence, food and drink, getting up and going to bed, social skills and physical health were noted. Information was recorded to a good level, such as listing which type of incontinence products were needed and at what time of day, listing all equipment needed to assist with daily living and cross referral to speech and language therapy guidance. Each file contained an additional communication plan. These showed how the person shows pleasure, anger, discomfort, amusement, when they are upset and frustrated. In one communication plan there was a strategy for calming the person when they start to become frustrated and staff were guided to make use of objects of reference that the person associates with daily living tasks. Staff were seen doing this in practice. One member of staff had undertaken training on communication and showed a plan he had put in place as a result of this, with intention to roll out for all people using the service. All assessments in peoples files were signed and dated. Copies of local authority care plans were also in place. The manager said that input for staff on writing effective care plans would be beneficial, to add to their knowledge, which we would support. People were seen being offered choices such as what to have for breakfast and lunch, when to get up if they did not need to go out for the day and what activities they took part in. No one was managing their own money or medication due to cognitive impairments. A range of risk assessments was seen on peoples files covering areas such as epilepsy, use of bed rails, choking, travelling alone in taxis, eating, moving and handling, trips and outings and vulnerability to abuse. All had been kept up to date with evidence of review. A requirement made at the previous key inspection about risk assessments had been met. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met. Evidence: Information in the Annual Quality Assurance Assessment showed that people living at The Gables have regular contact with their families and that relatives views are included in peoples care plans. We were advised that group and individual activities are arranged for service users and special occasions and birthdays are celebrated. The manager advised that horse riding was being looked into for two people and that there were plans to involve the speech and language therapist to assist in re-introducing service users meetings. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: Relatives said in surveys that the service helped them to keep in touch with service users and that they are kept up to date with important issues affecting them. One considered the service could improve by having more activities at weekends; the manager advised that this is being addressed. A social care professional commented that the service offers regular activities. During the visit to the service it was observed that people attend day services during the week; one person has limited attendance which the manager is trying to increase via the local authority. People were seen being collected and returned by transport from the day services and a call was taken in the afternoon from one of the day services to advise that a service user had a seizure whilst he was with them. The manager and assistant manager described good working relationships between The Gables and day services and said that communication was good. One person who was around during the day got up when he was ready to, late morning, and was offered a choice of food and drink for his breakfast. Staff took an interest in him and chatted to him. He was seen engaged in a puzzle with staff in the afternoon and also listening to a Last Night of the Proms compact disc, which was his choice, and reading the newspaper he has delivered. One person was enjoying the sensory room when she returned from day services. Staff have maintained an activity folder to log events which service users have taken part in. This was a colourful and attractively presented record for people to look back on. It showed that a range of events have been enjoyed such as sports, using the sensory room, gardening, going to the theatre, swimming, playing board games, having meals out at the pub, going to a concert, celebrating Halloween and a holiday in Cornwall which two people went on. Photographs and programmes were included in the folder. It was also possible to see from a photograph one of the service users being assessed for horse riding. People had also enjoyed having manicures and pedicures and reflexology sessions were noted in two of the care plan files that were looked at; the manager advised that this had been a particular success. One of the service users likes to go to church and is supported to attend when he wishes. He also attends a Causeway group when he wishes. The service had communal television and music equipment and it was noted that people have their own equipment in their rooms as well. One service user opted to watch television in his room after the evening meal. We had opportunity to observe the evening meal which was a freshly prepared chicken hotpot with mashed potato. The manager identified in the Annual Quality Assurance Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Assessment that everyone at The Gables needs help, supervision or prompts to eat and we saw this to be the case with all staff helping to assist people and requiring two sittings for the meal. The manager assured us that the two people who ate during the second sitting are not always the last to be offered food. She also advised that the option of having two dining tables to enable one sitting had been tried but was not successful because of space restrictions and the bulkiness of some of the wheelchairs. People seemed to enjoy their meal and were offered dessert and drinks. Clothes protectors were used for some of the service users where necessary to keep their clothes fresh and staff used wipes to preserve their dignity. Menus showed that each person is supported to select an evening meal, the main meal of the day, for the weekly menu. There was plenty of fresh fruit available for people to eat. The expert by experience commented I talked to several residents about what they do and also saw photos and asked staff about what those who have communication problems do. There was a wide range of activities from pubs to shopping, horse riding, housework and so on. Good use was made of local facilities with a wide range of transport. This was also apparent at holiday time; the residents had gone by train to their accommodation in Cornwall. I saw lots of picture evidence of different activities, including abseiling, it included all the residents. I saw that staff recorded residents responses to activities, especially new ones for those who cannot communicate well. This was then used to see whether to try the activity again. It was good to see the staffs enthusiasm for improving communication through courses (which they were putting into practice) and the effort they made throughout our time there (which felt natural, like they did it all the time). Staff listened to residents wishes, for example over bed times and meals, but showed me how they had to take notice of peoples needs as well (for instance, when medication makes someone sleepy, or when they need to spend time lying down out of their wheelchair). I saw staff offering choices of drinks and what to eat to residents. They helped people choose their clothes and when asked, the residents said that they liked the clothes they have. It was good to see that only some folk used bibs at mealtimes, on the basis of need, rather than having to wear one just because of having a profound disability. Contact with friends and family was referred to by staff (and residents); they said relations were good with families; they have a regular meeting at The Gables and are listened to in regard to the running of the home and their sons and daughters needs. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the service are well met, promoting health, well-being, taking into account their preferences and ensuring that they receive medication in a safe and consistent manner. Evidence: We were advised in the Annual Quality Assurance Assessment that people living at The Gables have input from a range of health care professionals such as a speech and language therapist, the consultant psychiatrist and community team for people with learning disabilities. The manager told us that reflexology has been introduced for two people and that the service now has in-house chiropody and foot massage. We were informed that peoples privacy and dignity are respected and that service users are supported with their personal care at a pace and time suitable to their needs. The manager told us that doctors review people using the service annually and that there are regular dental and optical checks. We were advised that support plans were in place for people with epilepsy and that specialist input is sought as necessary. The manager told us in the Annual Quality Assurance Assessment that medication was being stored correctly and that staff who handle medicines had been trained to do so. We were advised that people now have individual medicines cabinets in their rooms Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: and that improvement had been made to medication administration records and instructions for use of as required medications. Statistical information showed that nutritional screening is carried out on everyone admitted to the service and this is repeated where people are at risk of malnutrition, with action taken to meet the needs of people at risk. Relatives who completed surveys said the service always gives the support and care that they expect or was agreed. They considered needs arising from equality and diversity were being met and that people were usually being supported to live the life they choose. Additional comments included residents receive individual care and attention. Staff very flexible towards residents needs, always keep us informed of health problems verbally or by diary notes, residents kept clean and comfortable and (name of person) seems very happy and I am satisfied. Two health care professionals completed surveys. They said the services assessment arrangements always ensure that accurate information is gathered and that the right service is planned for people. They considered that peoples social and health care needs were being properly monitored, reviewed and met and that advice was always sought to meet peoples needs and improve their well being. They said that peoples privacy and dignity were always respected and the service always responded to the diverse needs of people such as those arising from gender, faith, ethnicity and race. One identified the following as areas the service does well: very vigilant about changes in health care needs, administers complex medication regimes, understand needs of individuals. The care plan files that were looked at during the visit showed that staff had kept records up to date to reflect the support people needed with their personal and health care needs. Assessments were in place for nutritional screening and likelihood of developing pressure damage and we saw detailed moving and handling assessments in place. These had all been kept up to date. Dependency level assessments had also been completed. Records were being kept of health care appointments and these looked up to date. There was evidence of preventative screening, such as influenza vaccination, and of specialist involvement, such as the consultant in learning disabilities. People were being weighed regularly and where one person was losing weight the records showed she had been referred to her doctor and the dietician. Records of challenging behaviour and seizures were seen in peoples files. Staff were maintaining tick lists to show at a glance what personal care had been given. Assessments were in place supporting the need for staff to handle peoples medicines on their behalf due to cognitive impairments. We saw that individual medicines Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: cabinets have been added to peoples bedrooms to store their own medicines and records. These were kept secure and locked when not in use. Medication administration records were up to date and in good order. Record sheets showed that a tally is kept of medicines which are not supplied in blister packs, such as pain relief for occasional use, and a daily check sheet was in use to make sure that medicines are given and signed for at the prescribed dose times. One persons care plan file contained a protocol for administering his medication in food which had been agreed by his doctor, relatives and other interested parties. Two of the care plan files that were looked at contained guidance on use of rectal diazepam, one endorsed by the doctor and other interested parties and the other still needing some signatures to be obtained. Guidance had been written on the use of as required medicines. Side effects of medicines were noted. When looking at staff training records we saw that twenty staff had received input on epilepsy and there was evidence of training on safe medication practice. The manager said that input for staff on autism would be beneficial, to add to their knowledge, which we would support. Requirements made at the last key inspection in relation to weighing people and providing guidance on use of as required medicines had been met. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and safeguarding are effectively managed to listen to views of people who live at the service and reducing the risk of harm to them. Evidence: Statistical information provided by the manager in the Annual Quality Assurance Assessment showed that there had not been any complaints about the service, no use of restraint and no safeguarding issues. (The manager confirmed during the inspection this was still the case). We were advised that the service had a complaints and compliments procedure and that visitors were made aware of this. We were told that there was information about making complaints on the notice board and in peoples rooms. The manager told us that all compliments and complaints are logged, responded to promptly and to a satisfactory conclusion. We were advised that the service had a safeguarding procedure and that staff receive training on safeguarding. The manager advised us that both the complaints and safeguarding policies are regularly on the agenda for staff meetings. Relatives who completed surveys said they knew how to make a complaint if they needed to and that the service has responded appropriately if they have raised any concerns. Health care professionals who returned surveys also said the service had responded appropriately if concerns were raised. Staff who returned surveys said they knew what to do if someone had concerns about the service. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: During the visit we were able to see that the complaints procedure was displayed in the service and included in the statement of purpose and service users guide. A log book was in place for complaints and compliments and we could see that there had not been any recent complaints, only compliments about the service. The service had a copy of the local authority multi agency safeguarding guidance and its own procedure in the operations manual. Training records showed that most staff had received safeguarding training in 2008 or 2009. A safeguarding update was noted in minutes of a sample of staff meetings that was looked at. Peoples money was being managed in the providers residents savings scheme. There was restricted access to the computerised records which are also password protected. Receipts were being kept to verify expenditure on service users behalf. A financial audit by external auditors took place recently and a copy of the draft report was seen. This did not identify concerns about how peoples money was being managed. Recruitment practice at The Gables was seen to be robust enough to protect vulnerable people from the risk of abuse but advice has been given under the staffing section regarding putting in safeguards where staff commence work on preliminary clearance only. The expert by experience commented residents said they felt they could make complaints and that staff would help them with this, the comment that Id go to the staff room with a problem was very telling; showing that the resident felt confident in any member of staffs help. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are clean and homely, promoting a positive environment for the people who live at The Gables and which are suitable for the range of disabilities that people have. Evidence: We were advised in the Annual Quality Assurance Assessment that service users rooms are decorated to meet their needs and tastes and that families are consulted where people have limited communication skills. Information showed that there is a sensory room and that the service is maintained in a clean, safe and homely manner. The manager told us that the lounge, dining room, downstairs hallway and stairs had been redecorated and new carpet fitted. The manager also advised us of areas where improvement was needed such as a new kitchen and new bath and hoist for the upstairs bathroom. A relative commented that the service provides a pleasant homely environment. The Gables is located next to a school in a residential road behind the common in Gerrards Cross. It is a short distance from the town centre where there is a range of shops, cafes, restaurants, pubs, churches, banks and other facilities. There are bus and rail links close by and access to medical centres. The building blends in with other Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: properties in the road and has parking for a few cars at the front. There is a ramp for wheelchair access. Accommodation is on two floors with stair lift access to the upstairs areas. All bedrooms are single and have been personalised to reflect peoples different tastes. Bedrooms are near to toilet and bathroom facilities, which have adaptations to meet peoples needs. Communal areas are pleasantly arranged and look homely and seating was comfortable. The service has a sensory room leading off from the lounge with a range of equipment for people to enjoy. There is access to the rear garden from the dining room and the lounge. The kitchen and laundry were fitted with all necessary equipment and had non permeable flooring covers. The manager advised that three peoples bedrooms are due to be redecorated before the end of the financial year. She highlighted the need for the kitchen and upstairs bathroom to be refurbished and was hoping that the laundry room would be updated and windows replaced to improve the environment. We would support these improvements being made. The building was being kept warm and there was good odour control. Measures were in place for clinical waste disposable. It was clean throughout. Windows have been fitted with restrictors to prevent people falling out. The expert by experience commented the home was pleasant and seemed well equipped for the needs of the people living there, although there were a few problems: 1) The dining area was rather small to cope with 3 people in wheelchairs all dining together. 2) The upstairs bathroom was rather battered looking and had several chipped tiles. 3) The downstairs bathroom needed a bathing cradle to enable some of the residents to really enjoy a bath. It was good to see, however, that residents had their rooms decorated and furnished in a manner of their own choosing. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides staff cover to meet needs and undertakes thorough recruitment procedures to protect people from harm. There is a good training programme for staff but records at the service do not show that all staff have kept up to date with training, which could mean that their skills need to be refreshed if they are to fully meet care needs. Evidence: Statistical information in the Annual Quality Assurance Assessment showed that nine of the fifteen permanent care staff had achieved National Vocational Qualification at level 2 or above. No agency or temporary staff had been providing support during the three month period prior to completing the Annual Quality Assurance Assessment. The manager confirmed that all staff recruited in the past year have satisfactory preemployment checks and that there was a staff development programme which meets the national minimum standards. The manager told us in the Annual Quality Assurance Assessment that new staff undertake a five day induction at head office and in-house training. We were advised that the manager ensures there are adequate and trained staff on duty at all times and that staff receive supervision and appraisals. We were told that people using the service can be cared for by same sex carers when this is requested. We were also advised that vacant staff hours had been filled and that there were regular staff meetings at the service. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: Relatives who completed surveys said that staff always have the right skills and experience to look after people properly. One person added happy with the help and support we receive from management and staff. Health care professionals who returned surveys said that care staff always support people to live the life they choose and had the right skills and experience to support peoples social and health care needs. Additional comments included the staff address the individual needs of residents in a very understanding way and some staff are inexperienced and under pressure. Staff who completed surveys said they are always given up to date information about the needs of people they support. They said employment checks had been carried out before they started working and that their induction covered the areas they needed to know about very well. They said they receive training relevant to their role, which helps them understand and meet the individual needs of people, keeps them up to date with new ways of working and gives then enough knowledge about health care and medication. They considered they regularly meet with their manager to discuss how they are working and have enough support and considered the ways in which information is shared always work well. They said there are always enough staff to meet the individual needs of people and they felt they had enough support, experience and knowledge to meet peoples different needs, such as those arising from equality and diversity. One said the home is a very friendly place for all service users. All needs are catered for under the question what does the home do well? Rotas were being maintained at the service to provide staffing across the 24 hour day. The manager confirmed that no agency staff were being used to cover shifts. There was evidence of new staff undertaking an induction in line with the Skills for Care common induction standards. The recruitment files of three new staff were seen. The full range of required checks had been undertaken such as Criminal Records Bureau clearance and two written references. The manager was advised to add a photograph of staff to their files for easy identification. It was evident from start dates that two of the three staff had started work whilst they were waiting for their Criminal Records Bureau check to be returned. The manager was unable to show that staff had been made aware of limitations to their work until full clearance was received and she was advised to address this if future staff are taken on before full clearance comes through. A training log and matrix were being kept at the service. There was evidence of staff training being updated in some areas but there were some gaps or out of date courses Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: which did not look as though they had been addressed. An example of this was for safeguarding training where there were eleven up to date certificates in place. The training matrix showed that for a further six staff they did their training in 2005 or 2006 without a further update and for two staff there were no certificates or entries on the matrix. At the previous inspection we set a requirement for all staff to receive up to date training in core subjects including moving and handling, safeguarding, fire safety and basic food hygiene and for up to date records to be kept of all training completed. The records that were seen on the day of the visit did not show us that this has been met. A further requirement is made with a short timescale for completion, to ensure that this is fully addressed. Staff met during the visit to The Gables were friendly, polite and understood users needs and were seen updating and making use of their care plans. The expert by experience commented staff attitude was really good. There was an easy, friendly relationship between staff and residents. Staff were friendly and respectful, but able to help residents whose behaviour may cause themselves or others problems. They explained how they offer choices to those who cannot talk and had several ways of doing this; I saw someone being shown the object to clue him in to what was happening. I asked the staff about a couple of residents having to wait to have their dinner and was given some very good replies that showed the residents needs were being taken into account. Care Homes for Adults (18-65 years) Page 27 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the service promotes continuity and quality of care for the people who live there and ensures that risk is safely managed to reduce the likelihood of injury or harm. Evidence: We were advised in the Annual Quality Assurance Assessment that the service was well managed with consistent care delivered. The manager said she had completed National Vocational Qualification level 4 and was working towards the Registered Managers Award. We were told that there are annual quality audits and that health and safety issues are monitored and maintained. Generic and fire risk assessments were said to be in place. Statistical information showed that maintenance of equipment such as the electrical circuits, portable electrical appliances and gas appliances was up to date and that the service had written assessments for hazardous substances. The manager informed us that there was an action plan to deliver best practice in the prevention and control of infection and that all staff had received training on infection control. Statistical information showed that most staff had been trained in safe food handling. Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: A health care professional said in a survey the managers set themselves very high standards in all aspects of care and health and safety issues - I enjoy working here, the atmosphere is very friendly and relaxed. Another health care professional said very well run care home with excellent long term relationship largely due to leadership/management at The Gables. A social care professional described The Gables as a caring, well run home. The manager is registered and has many years experience of working with people with learning disabilities. On the day of the visit one of the staff said we have a good manager here and interaction between staff and the manager was relaxed. We were able to see that the manager had attended training on deprivation of liberty safeguards this year and is working through the Registered Managers Award. The Annual Quality Assurance Assessment had been filled in to a satisfactory standard and provided the information we asked for. The certificate of registration was being displayed and was accurate. The inspection process showed that the service was being run in line with its statement of purpose. There were reports to show that the provider visits the service on a regular basis to assess quality of care. A quality audit had also taken place in July this year. A range of health and safety and servicing checks had been undertaken. There were certificates to show the service has a pest control contract and that gas appliances are safe to use. The last environmental health visit was carried out in April 2007 with good standard noted for a kitchen inspection. Checks had been carried out for thermostatic valves and hoisting equipment. The electrical hard wiring was checked and found satisfactory this year and portable electrical appliances tested this year also. Testing took place of the water supply for Legionella species and other microbial content with a satisfactory result noted. Risk assessments were in place for the premises and for individuals. A fire risk assessment was also in place. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 35 18 The registered person is 30/06/2009 required to ensure that all care staff receive up to date training in core subjects.This must include moving and handling, SOVA, fire safety and basic food hygiene. Up to date records must be kept of all training completed by staff. To ensure that care staff are trained and competent to carry out their job. Care Homes for Adults (18-65 years) Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 35 18 Records at the service need to demonstrate that staff have the full range of mandatory training and updates as necessary. This is to ensure they have the right skills and competencies to meet peoples needs. 31/03/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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