Care Home: The Gables, Truro

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What the care home does well The home provides a relaxed environment for permanent, respite and holiday residents and their comments show that they are happy living in the home. The grounds are tidy and people can access them easily. There is a suitable system in place for the use of medicines in the home. People using the service have access to a variety of activities at the home and via day centres and work placements. The home has its own transport, which enables residents to go out on a wide range of day trips and outings. An annual holiday is also offered. Some of the pottery work undertaken by the people using the service is on display in the home. Recruitment procedures are robust and the checks required by law are undertaken. What the care home could do better: It is a requirement that people are assessed before being admitted to the home to ensure that the home has the facilities and staffing available to meet their individual needs. We found that not all people had an assessment undertaken by the manager or staff at the home, held within their file. If the assessment paperwork accompanies a person to hospital, for example, there should be evidence in the home to show this with assurance that it will be returned. Each resident must have a detailed care plan that fully guides and directs staff on the care to be provided.The daily records need to be written on the day events took place as leaving gaps for people to complete later could lead to errors in the recording. It is important that the records accurately detail the rationale of care and the care delivered. The environment lets the home down and needs to be upgraded with furniture, furnishings and bedding replaced as necessary. A full environmental audit needs to be undertaken with a plan for improvements. Random inspection report Care homes for adults (18-65 years) Name: Address: The Gables, Truro Newquay Road Goonhavern Truro Cornwall TR4 9QD one star adequate service 09/06/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Diana Penrose Date: 1 8 0 5 2 0 1 0 Information about the care home Name of care home: Address: The Gables, Truro Newquay Road Goonhavern Truro Cornwall TR4 9QD 01872571030 08716618115 choicecareservices@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Dean Russel Farnan Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Rebecca Jane Warren,Mr John Aubrey Nicholls care home 10 Number of places (if applicable): Under 65 Over 65 0 0 dementia learning disability Conditions of registration: 1 10 The maximum number of service users who can be accommodated is 10. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability, excluding dementia or mental disorder (Code LD) - maximum 10 places Dementia (Code DE) - maximum one (1) place Date of last inspection 0 9 0 6 2 0 0 9 Care Homes for Adults (18-65 years) Page 2 of 11 Brief description of the care home The Gables is registered to provide care for ten service users with learning disabilities and one with a dementia. This home offers day care; respite care and holidays for service users with a learning disability. The registered providers live on the premises. The Gables is a detached house situated in the village of Goonhavern, which is between Perranporth and Truro. It provides single accommodation for the people using the service and there is a self-contained flat to accommodate one person. There is a suitable dining room and two lounges on the ground floor. There are two workshops situated at the rear of the home that predominantly provide activities for day care service users but are also utilised by all the people accommodated in the home. The home is clean, warm and comfortable. The people currently living in the home attend weekday activities assessed for and provided by the Cornwall department of adult social care. They are given ample opportunities for socialising and visitors are openly encouraged. Information about the home is available in the form of a statement of purpose / service users guide, which can be supplied to enquirers on request. A copy of the most recent inspection report is available in the home. Fees range from 450 to 575 pounds per week. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as confectionary and toiletries Care Homes for Adults (18-65 years) Page 3 of 11 What we found: A Regulatory Inspector visited The Gables Care Home on 18 May 2010 and spent four and a quarter hours at the home. In accordance with the amendments to the Care Standards Act inspection programme this was a random inspection and an unannounced visit. The purpose of the inspection was to ensure that residents needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on the inspection of certain standards and reviewing compliance with the requirements notified at the last inspection. On the day of inspection six people were living in the home, two were receiving respite care. A day-care service was provided for a total of fifteen people but we were told that only 2-3 attended at any one time. They utilised the workshops at the rear of the home and the manager told us they also use the dining facility. The inspector met with one member of staff, one resident and the registered persons to gain their views on the services offered by the home. Records were examined and the inspector toured the building. This report summarises the findings of this inspection. We received a completed Annual Quality Assurance Assessment (AQAA) from the registered manager, 5 surveys completed by people using the service and 2 from staff, prior to this inspection; this information has also been used to inform this inspection. One requirement and two recommendations have been notified following this inspection. Residents and staff expressed satisfaction with the care and services provided at the home. We looked at the care files for the two most recent admissions to the home but neither were currently living in the home. We also looked at the care file for a resident receiving respite care and spoke to him during this inspection. Only one person had an assessment in their file undertaken by the registered manager. We were told that one resident had been admitted to hospital and his file had gone with him, also that the respite resident had been visiting the home for many years and had not had an assessment. The manager told us he would undertake an assessment for this person as part of the review of the care plan. Assessment information from the Department of Adult Care and Support was seen in the files. The respite resident had a written care plan that was dated 2006 it contained suitable information but there was no evidence of reviews taking place. The manager said there had been no changes to the plan so nothing had been recorded on the review page. No multi disciplinary team reviews were seen. The AQAA stated that the manager intended to improve by reviewing all care plans and risk assessments to maintain a good service to the residents ensuring that their needs and aspirations were well catered for. It also stated that multi disciplinary reviews would be included. Various risk assessment documentation was seen but not all was completed. None of the files contained a photograph of the resident and this needs to be rectified. The daily records were seen for the newest admissions but the manager told us they did not maintain daily records for people receiving respite care. This was discussed and he agreed to do this from now on. The daily records were variable, some were very detailed Care Homes for Adults (18-65 years) Page 4 of 11 and extensive, others were vague and there were gaps where nothing had been recorded for some days. This had been discussed with the manager at the last inspection who now needs to fully address it with the care staff. Residents told us they were well cared for in the home and the surveys we received from residents were positive. When asked what the home does well comments included: They look after me when my mum and dad are having respite from looking after me, Keep it clean, Help people, Look after me well, Pottery class and Going out. One person said they would like to have some food in the evening in addition to the main evening meal; the manager told us this was always possible if they asked the staff. A hot water urn had recently been provided in the dining room so that residents could make hot drinks when they wished. A resident told us that he could do as he wished in the home and that he went out on trips sometimes. The registered persons said that residents could go out where they wished, for example, they went shopping, out for meals and to the pub. In the summer they visited many of the holiday attractions as there were residents receiving respite care from out of the county. The residents had use of the workshops at the rear of the home and a member of staff told us she enjoyed working with residents in the greenhouse. The AQAA stated that the home could do better by assisting service users to attend clubs which cater for people with similar needs and to encourage them to take more part in village life. The manager stated that he plans to encourage service users to attend clubs and encourage them to take more interest in their surroundings especially in their rooms, choosing decoration etc. The medication records for two residents were examined and showed that the administration of medicines was up to date with no gaps in the records. The medicines policy was seen and it had been reviewed in March 2010. A copy of the Guidelines for the Handling of Medicines in Social Care was seen and was available to staff. We were told there were no controlled drugs in the home. We saw records that showed that all staff had undertaken medicines training. The Inspector toured the building with the registered manager. He pointed out some redecoration that had taken place since the last inspection and we saw that the fire escape steps had been re-surfaced and made safer. The decor of the home was very dated in some areas and the residents have not chosen this for themselves. The minutes of a recent residents meeting do show that they were involved in a change to the colour scheme in a downstairs corridor. As stated in previous inspection reports the furniture in residents rooms is also dated and some is in a very poor state of repair. We saw drawers that had the fronts falling off and handles missing. We saw pillows that were very thin and stained and in need of replacement. The laundry was seen and was very untidy and dirty. The manager told us of plans to refurbish the laundry and to move the driers; he said this would be done as soon as possible. He was reminded that detergents and cleaning materials should be stored securely and not easily accessible to people using the service. The registered persons need to undertake a full environmental audit of the home with a plan that includes timescales for refurbishment, replacement of furniture, fittings, bedding and so on. A copy of the plan should be sent to the Care Quality Commission so Care Homes for Adults (18-65 years) Page 5 of 11 that they can monitor progress. The manager explained that he has not been allocated a budget for running the home, he said he discusses issues with the provider who decides how the money is spent. We examined the personnel file of the most recent employee and it contained the documents required by legislation apart from a recent photograph. We saw interview records, certificates of training and completed induction records. We spoke to the newest member of staff who told us she had had a good induction to the home. She said she enjoyed her work and felt that the residents were well cared for by a suitable number of staff. The manager has reported incidents to the Commission according to Regulation 37; the last accident recorded in the home was in November 2009. Surveys from staff were generally positive about the home and services provided. When asked what the home does well comments included: I think we can pride ourselves of a quality one to one friendly relationship with our clients, meeting their needs within our scope, Supplies a conscientious staff and transparent environment for clients (both residential and day-care), Supplies variation, choice and stimuli for clients and As a whole I think this is a familiar, friendly and supportive environment to work in When asked what the home could do better comments included: I think maintenance and repairs of equipment could do with quicker response times and Motivate the staff on a regular basis, bearing in mind the challenging nature of some clients. What the care home does well: What they could do better: It is a requirement that people are assessed before being admitted to the home to ensure that the home has the facilities and staffing available to meet their individual needs. We found that not all people had an assessment undertaken by the manager or staff at the home, held within their file. If the assessment paperwork accompanies a person to hospital, for example, there should be evidence in the home to show this with assurance that it will be returned. Each resident must have a detailed care plan that fully guides and directs staff on the care to be provided. Care Homes for Adults (18-65 years) Page 6 of 11 The daily records need to be written on the day events took place as leaving gaps for people to complete later could lead to errors in the recording. It is important that the records accurately detail the rationale of care and the care delivered. The environment lets the home down and needs to be upgraded with furniture, furnishings and bedding replaced as necessary. A full environmental audit needs to be undertaken with a plan for improvements. 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 set out on page 2. Care Homes for Adults (18-65 years) Page 7 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 8 of 11 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, 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 6 15 All of the people using the 20/09/2010 service must have a written care plan that details how their individual care needs are to be met. It must be available to them and must be kept under review. This will ensure that staff are informed and directed on how to meet the changing care needs of people using the service. 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 2 The pre-assessment documentation for each person using the service should be available in the home; if for any reason it is removed from the home this should be evidenced with assurance that it will be returned. There needs to be a full environmental audit with an improvement plan compiled that includes timescales for work to be undertaken. The plan should be sent to the CQC for monitoring. This will ensure that issues are prioritised and improvements to the home take place. Page 9 of 11 2 24 Care Homes for Adults (18-65 years) Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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