Care Home: The Gables (Cambridge) Limited

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What the care home does well The care team provide a friendly and sensitive approach to assist the residents in the home. What has improved since the last inspection? A number of refurbishments and decorations have been carried out in the home. The acting manager has started to review procedures and care and support in the home. A new manager has been appointed for the home. What the care home could do better: Recording and accuracy in healthcare files must be improved. Improvements must be made regarding residents being able access to the community on a regular basis. Management arrangements must be reviewed and improved to aid communication and the delivery of consistent care and support. Key inspection report Care homes for adults (18-65 years) Name: Address: The Gables (Cambridge) Limited 93 Ely Road Littleport Ely Cambridgeshire CB6 1HJ     The quality rating for this care home is:   one star adequate 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: Andy Green     Date: 1 8 1 1 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 24 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 24 Information about the care home Name of care home: Address: The Gables (Cambridge) Limited 93 Ely Road Littleport Ely Cambridgeshire CB6 1HJ 01353861935 01353862887 gables@caringhomes.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Gables (Cambridge) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability physical disability Additional conditions: The 1 place in category PD(E) (over 65 years with a physical disability) is for 1 named individual whose primary vulnerability is physical disability The 5 places in category DE (under 65 years with dementia) are for 5 individuals, each with a primary vulnerability of learning disability Date of last inspection Brief description of the care home The Gables is a registered care home, with nursing, providing support and accommodation for up to sixteen adults with a physical and/or learning disability. The home has a respite care facility and has a number of residents using this throughout the year. The home itself is situated on the outskirts of the village of Littleport in Care Homes for Adults (18-65 years) Page 4 of 24 Over 65 0 0 1 5 16 0 0 2 1 2 2 0 0 8 Brief description of the care home Cambridgeshire near to the city of Ely. There are gardens to the rear of the property. There are parking spaces to the front and rear. The current charges for placements in the home ranges from £792 to £1468 Copies of Care Quality Commission reports are made available to residents and their relatives upon request. Care Homes for Adults (18-65 years) Page 5 of 24 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We, the Care Quality Commission , carried out an unannounced key inspection of The Gables Cambridge Ltd. on 18th November 2009. A variety of information was inspected including; assessments, care plans, staff training records, staff recruitment files, complaints records and management policies. We met a number of residents during the inspection to guage their opinion of the home. We received an AQAA (Annual Quality Assurance Assessment) that had been completed by the manager. This a self audit document which provides the service with an opportunity to assess how they are meeting standards and regulations. Surveys were also received from residents and staff. Care Homes for Adults (18-65 years) Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 24 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 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments are carried out to ensure that the home can appropriately meet the residents care and support needs . Evidence: There were twelve residents living in the home. Assessments are carried out prior to a resident being admitted to the home. There has been one admission to the home since the last inspection of the home. The resident transferred from another Consensus home as their needs were not being appropriately met. The assessment was carried out by the manager and was recorded in detail. A care plan and personal file is implemented within twenty four hours of admission, which is based on information collated during the assessment. Care Homes for Adults (18-65 years) Page 9 of 24 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. Care plans are in place to provide staff with guidance regarding the care and support needs required by residents. Evidence: Four care plans were inspected and the acting manager stated that new person centred plans are being implemented. Two care plans have been completed in the new format. There is a Care Plan File which records the daily care and support needs. There is an accompanying personal file which contains information and correspondence that is required but not used on a daily basis. Examples in the new care plan format included; personal profile and contact details, life story, initial assessment, activities, personal care, healthcare, moving & handling, maintaining relationships, continence, medication, community participation, communication, night time routines and mobility needs. An evaluation sheet is in place to review each area of need. The acting manager stated that a Life Book is being introduced which will be in a pictorial format which will assist residents with communication difficulties. Care Homes for Adults (18-65 years) Page 10 of 24 Evidence: It was noted that the remaining care plans need to be implemented in the new format and the acting manager stated that these were currently in process. A risk assessment process is in place and examples included mobility, accessing the community, eating & drinking and using the transport. Risks are updated as part of the care planning process and any areas of concern are implemented as necessary. Care Homes for Adults (18-65 years) Page 11 of 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are in place but improvements regarding access to the community need to be made. Evidence: Since the last inspection some improvements have been made to activities provided in the home. The acting manager has made efforts to improve the range of activities in the last three months but this is still work in progress. The room used previously used as a staff area has become an activities resource room and there was evidence of residents engaged in an art/crafts session during the day. An activities file is now in place to record residents participation. Each resident has an activities programme but it was noted that during the day that the majority of residents were sitting in the communal lounges mostly watching television. A number of residents attend day services locally but there have been problems with the homes vehicle which has caused problems on a number of occasions. The manager stated that taxis are used Care Homes for Adults (18-65 years) Page 12 of 24 Evidence: when possible. This issue of community access has also been raised by local healthcare professionals who are concerned that residents are not always able to access resources. The home must have suitable transport so that residents with mobility difficulties can regularly access the community. Contact has been made with a local advocacy service (Speaking Up) for specific support and to hopefully provide a befriending service for residents. It was noted that the philosophy of the home still tends to be task driven and the acting manager is working towards a more social and person centred approach. Comments in resident and staff surveys indicated access to activities and especially trips out of the home needed improvement and this should be more regularly discussed. Care Homes for Adults (18-65 years) Page 13 of 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to healthcare to meet their needs but improvements must be made to recording to ensure accurate monitoring. Evidence: Residents receive personal care and support to meet their general needs. A variety of healthcare professionals provide input to compliment the care provided by nurses and care staff. Examples included regular GP visits, community nurses, district nurses, physiotherapy and an aromatherapist. Care files evidenced fluid charts, falls risk assessments, pressure & skin care, nutritional audit and mental health monitoring. Since the acting manager has been in post weight charts have shown some improvement in the last two to three months but recording in previous months had been infrequent. It is disappointing that nurses in the home have not regularly completed these monthly records and no explanation was forthcoming. One entry in the weight records also seemed inaccurate.The acting manager stated that he will be addressing the issues regarding recording with the nursing team in the home in conjunction with the operational manager. Medication records were accurate and appropriate storage and temperature controls Care Homes for Adults (18-65 years) Page 14 of 24 Evidence: are being maintained with daily records in place. Controlled medication records were accurate. A larger cabinet for the storage of controlled medication has been installed which will appropriately meet the homes storage requirements. Comments in resident surveys indicated that the food provided in the home was of good quality. Care Homes for Adults (18-65 years) Page 15 of 24 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. The home has a complaints process to ensure that residents are listened to and can raise concerns. Evidence: The home has a complaints procedure so that residents and other stakeholders can raise any concerns about the care and support that is provided in the home. As mentioned previously in this report concerns have been raised regarding regular access to the community. The home has responded to this concern and is continuing to investigate ways this can be improved. No further concerns have been received and the Care Quality Commission has not received any further complaints or concerns. Adult protection training is provided to all staff and the acting manager stated that Deprivation of Liberty training is also being booked. Care Homes for Adults (18-65 years) Page 16 of 24 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 residents are provided with a safe and comfortable home in which to live. Evidence: The home is well maintained and kept in a clean and tidy state to meet the residents needs. Residents bedrooms are personalised to meet individual wishes and preferences. Since the last inspection a number of decoration and refurbishments have been completed. The upstairs bathroom has been completely refurbished and now includes an overhead hoist to safely aid residents who have mobility needs. Eleven bedrooms have been refurbished and new furniture has been installed where required. Repairs have been carried out to the roof and the garden fences have also been repaired. Two reclining chairs and two divan beds have been ordered. Redecoration to the front lounge is planned in the next few weeks. The window in the medication room has been given a frosted finish to aid security. Care Homes for Adults (18-65 years) Page 17 of 24 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 homes recruitment and training processes ensure that residents receive care from a competent staff team. Evidence: Three staff files were inspected and they contained evidence of appropriate checks prior to the commencement of employment. Mandatory training is organised throughout the year and nurses attend updates in training for their professional knowledge. NVQ training is also in place. There was evidence of supervision and the acting manager has been keen to ensure this area is maintained. Staff meetings are regularly organised and meetings with nursing staff are also held. Care Homes for Adults (18-65 years) Page 18 of 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of the home has been improved recently but has been lacking during the year and long term improvements need to be made. Evidence: Since the last inspection the registered manager has moved on from the home and one of the organisations project managers has been seconded as acting manager since August 2009. A new manager has been appointed and following appropriate checks it is anticipated that they will commence work in December 2009. The acting manager stated that he would be providing a handover period/induction for the new manager to ensure that they receive appropriate support. The acting manager has been keen to improve processes and procedures as management of the home during the majority of the year has been inadequate. Staff spoken with were positive about the acting manager and felt that communication and access to support had improved in the last few months. Comments in staff surveys indicated that the lack of effective management had been an issue which had caused low morale in the staff team. It is clear that the inconsistent management of the home has been an issue during the majority of the year and that this needs consistent and long term improvement to Care Homes for Adults (18-65 years) Page 19 of 24 Evidence: ensure that care and support is monitored and well delivered. It is recommended that the management structure in the home is reviewed to create a management team. A deputy manager and senior carer posts may provide a useful addition to support the manager and care team. It was also recommended that the siting of the managers office on the second floor has always created a barrier between the manager and staff and makes the manager remote from the life of the home. It was recommended that the manager should be based in the smaller office on the ground floor which is in the centre of activity and more accessible to staff and residents. It was suggested that the upstairs office could then be used as a meeting/storage room. The acting manager and operational manager stated that they would give consideration to this. Records regarding fire safety were accurate and are consistently maintained by one of the support workers. Water temperatures are also regularly recorded. Care Homes for Adults (18-65 years) Page 20 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 21 of 24 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 13 16 Arrangements must be in place to ensure that residents can regularly access the community via suitable transport This is to ensure that residents are able to be part of, and have regular access to the community as much as possible. 26/02/2010 2 19 17 Accurate recording must be 30/01/2010 maintained in residents care files This is to ensure that healthcare is monitored appropriately 3 37 24 The registered person must review and improve the management of the home. This is to ensure that residents receive good quality and well coordinated care and support 28/02/2010 Care Homes for Adults (18-65 years) Page 22 of 24 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 37 It is recommended that the management arrangements in the home are reviewed so that communication, support and access are improved to create a more cohesive team approach Care Homes for Adults (18-65 years) Page 23 of 24 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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