Care Home: Three Gables

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What the care home does well Three Gables provides a high quality service to the people it accommodates. The home has a relaxed and friendly environment where people are supported to live their lives as they choose. Feedback received described the quality of service as `ten out of ten` and `they go the extra mile`. The Registered Providers are skilled and experienced practitioners who are entirely dedicated to ensuring residents receive a high standard of care. The home has an experienced team of staff who are committed to their work and have a good understanding of the needs of the people living at the home. Feedback received spoke highly of the support received by staff and positive relationships between staff and residents were observed. Staff was observed to deliver care with dignity and respect. The resident spoken with felt the care provided respected their privacy and dignity and were happy with the overall care provided. Residents have the opportunity to participate in a range of activities and social events. An activities agency visits the home three afternoons each week to provide structured activities, in addition to further activities and entertainers organised by the home. Residents live in a clean and homely environment, with their private accommodation personalised to suit their taste. What has improved since the last inspection? Uniforms for the care workers have been introduced to give a more professional appearance. Bedrooms and communal areas continue to be re-decorated. A contingency plan has been put in place for removing residents to an outside place for safety in the event of a fire. . What the care home could do better: One Requirement has been made following this inspection. Where issues have been highlighted to be addressed the Manager has stated these would be addressed or evidence was provided that the issue was already in the process of being addressed. All residents should have a falls risk assessment completed on admission and a risk assessment completed where residents go out independently from the home. This is to highlight any risks and ensure actions are put in place to minimise these. A robust recruitment process should be maintained to ensure staff do not commence work in the home before all the required recruitment checks have been completed to protect the residents. The information gathered for quality monitoring should be maintained and made available to interested parties with recorded evidence of action taken in response to demonstrate ongoing review and improvement to the quality of care and services in the home. Staff training and or updates should be maintained to ensure the staff continue to have the skills to meet individual resident`s care needs. Key inspection report Care homes for older people Name: Address: Three Gables 2 Brand Road Eastbourne East Sussex BN22 9PX     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: Judy Gossedge     Date: 1 9 0 2 2 0 1 0 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 Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Three Gables 2 Brand Road Eastbourne East Sussex BN22 9PX 01323501883 01323511083 threegablescare@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Miss Caroline Shirley,Mrs Jennifer Shirley Name of registered manager (if applicable) Miss Caroline Shirley Type of registration: Number of places registered: care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 19 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: Mental Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home Three Gables is a large, detached, three storey property situated in a quiet residential area of Hampden Park. The location of the home is within walking distance of local shops, health services and public transport links. Care is provided to residents over the age of sixty-five. 19 Over 65 0 Care Homes for Older People Page 4 of 28 Brief description of the care home Resident accommodation is provided in single bedrooms on all floors in home, many of which have en-suite facilities. Bathroom and toilets provide assisted facilities. One bedroom is located on the second floor and the resident who occupies this room, must be able to manage the stairs from the first floor independently. The home has a range of communal areas, including a dining room and two lounges, one of which has an extended sunroom, and the other with a dining area. The external grounds offer attractive front and rear gardens. A passenger lift provides level access to the first floor of the home. Three Gables mission statement is To provide excellent care for older people with a past or present mental health need within a relaxed and homely environment. Information provided by the Provider details that the current range of fees at Three Gables is between £408.00 and £550.00 per week. Additional charges are payable for personal items including; toiletries, hair dressing, chiropody and newspapers. More detailed information about the services provided at Three Gables can be found in the homes Statement of Purpose and Service User Guide - copies of these documents, along with the latest inspection reports are available in the reception area of the home or on request directly from the Provider. Care Homes for Older People Page 5 of 28 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001 uses the term service users to describe those living in care home settings. For the purpose of this report, those living at Three Gables will be referred to as residents. The Provider had been asked to complete an Annual Quality Assurance Assessment (AQAA), information from which is quoted in this report. The detail provided in the AQAA would benefit from further development. This was discussed with the Provider who agreed to review the detail provided for any future submissions. This report reflects a key inspection based on the collation of information received since the last key inspection undertaken on 20 March 2007, annual service reviews undertaken on 14 March 2008 and 15 March 2009, feedback from representatives and an unannounced key inspection which took place between 10.45 am and 4.45 pm, over Care Homes for Older People Page 6 of 28 six hours on 19 February 2010. The communal areas and a selection of residents bedrooms were viewed and a selection of care records, medication records,staff recruitment and training records and health and safety records and are further detailed in the report. Eighteen people were resident in the home, one resident was spoken with individually in their bedroom, and two in the lounge. The care that four of the residents received was reviewed. The opportunity was also taken to observe the interaction between staff and residents in the communal areas. Information was sought from two care workers, a junior care worker, the cook, the maintenance person, the activities co-ordinator, the Registered Provider/Manager and the Provider. No residents or care workers surveys were sent out on this occasion. Two health care professionals and two relatives were spoken with during the inspection. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: One Requirement has been made following this inspection. Where issues have been highlighted to be addressed the Manager has stated these would be addressed or evidence was provided that the issue was already in the process of being addressed. All residents should have a falls risk assessment completed on admission and a risk assessment completed where residents go out independently from the home. This is to highlight any risks and ensure actions are put in place to minimise these. A robust recruitment process should be maintained to ensure staff do not commence work in the home before all the required recruitment checks have been completed to protect the residents. The information gathered for quality monitoring should be maintained and made available to interested parties with recorded evidence of action taken in response to demonstrate ongoing review and improvement to the quality of care and services in the home. Staff training and or updates should be maintained to ensure the staff Care Homes for Older People Page 8 of 28 continue to have the skills to meet individual residents care needs. 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 Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. Potential new residents are individually assessed prior to an admission to ensure that their care needs can be met in the home. Intermediate care is not provided in the home. Evidence: The AQAA detailed that a pre-admission assessment is completed, and potential residents are invited to visit the home for tea, lunch or for the day. The Provider or the Manager visits all potential new residents prior to any admission, and a preadmission and assessment format, which is in place, is completed. This is to ensure individual residents care needs can be met in the home and to provide staff with information on the care to be provided. A copy of the assessment undertaken by the local authority is also received and available to reference. The documentation for two new residents admitted to the home since the last inspection was viewed and there was detailed pre-admission information in place and supporting information from the local authority. One of the relatives spoken with confirmed they had had the Care Homes for Older People Page 11 of 28 Evidence: opportunity to look around the home prior to their relatives admission. Intermediate care is not provided in the home. Care Homes for Older People Page 12 of 28 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Residents are protected by individual plan of care being in place, where all their personal, social and health care needs are identified at the start of their stay and which informs staff of the care, which needs to be provided and with supporting risk assessments completed. Medication policies and procedures are in place, but it should be ensured that these are followed to protect residents and staff. Evidence: The AQAA detailed that all of the residents have a comprehensive care plan in place. Four of the residents individual care plans were viewed. All were detailed, but would benefit from continued development to further detail residents health and personal care needs, dietary needs, and social and leisure interests. Supporting risk assessments were in place. One new resident did not have a risk assessment completed in relation to falls. Where residents go out independently a risk assessment should be completed. This was discussed with the Provider, who agreed to put the risk assessments in place. So a Requirement has not been made on this occasion. These documents recorded they had been regularly reviewed two monthly. The Provider agreed to increase the frequency of these reviews to ensure current requirements are Care Homes for Older People Page 13 of 28 Evidence: being met. The resident spoken with stated they always received the care and support that they needed. The relatives spoken with also stated they felt that there relative received the care and support that they needed. The care worker stated that they always received up-to date information about the residents care needs. Records viewed detailed that residents are registered with a local General Practitioner (GP) and have access to other health care professionals, including district nurses, via the surgeries. It was noted, in care plans that were examined, those appointments with or visits by health care professionals are recorded. The resident spoken with confirmed that their health care needs were met in the home. The atmosphere of the home was comfortable, open and relaxed and residents are encouraged to remain independent and to exercise choice over their daily lives. Staff were observed to deliver care to ensure residents are treated with dignity and respect. The resident spoken with felt the care provided respected their privacy and dignity, and that they were pleased with the overall care provided in the home. Both of the relatives spoken with stated they were very happy with the care provided in the home. The AQAA detailed that medication policies and procedures are in place, which includes receiving, recording, storage, handling, administration and disposal of medicine. None of the residents self medicated at the time of the inspection. A pharmacist regularly visits the home. A record of the last visit was not available to be viewed on this occasion. The Manager stated there had been no issues to address following the visit. Medication is stored in a lockable facility and sample of the recording of medication administered was viewed. There were a number of omissions in the recording of medication administration. This was discussed with the Provider, Manager and the Independent Adviser, who stated the omissions would be investigated and rectified. The Manager was subsequently contacted and stated that the omissions had been looked in to and rectified and further discussions have been had with staff as to the recording requirements. A list of signatures of staff who administer medication was in place to ensure a clear audit trail of administration to protect residents is in place. The resident spoken with stated their medication needs were met in the home. One care worker spoken with who administered medication confirmed that they had received medication training. The Independent Adviser produced a training plan for 2010/2011 and stated that further medication training and update is planned during this period. Care Homes for Older People Page 14 of 28 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. 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. Where possible residents are enabled to exercise choice in their lives whist resident in the home, there are opportunities to participate in social and recreational activities provided, residents are encouraged to maintain contact with family and friends as they wish and a varied diet is provided. Evidence: The AQAA detailed that a varied and flexible activity programme is in place to meet individual residents care needs, and includes exercises, games, music, crafts, reminiscence and periodic music shows either as a group activity or as a one-to-one. There is a two to three monthly visit by suppliers of clothing, footwear and toiletries. A copy of the weeks activities programme was available to view in the home. On the day of the inspection an activities co-ordinator, who visits three times a week from an activities agency, came during the afternoon to entertain the residents. She stated that there is normally around ten residents who like to participate in the activities and during the afternoon the residents played bingo, participated in exercises to music and then over tea and cake the co-ordinator spent time individually talking to the residents. The Inspector spent time in the lounge and residents were observed enjoying the activities provided and there was a relaxed atmosphere with residents clearly enjoying themselves. One resident is able to go out independently and when Care Homes for Older People Page 15 of 28 Evidence: speaking with the Inspector, the resident confirmed that Three Gables allows her to maintain her independence and keep in contact with friends. The AQAA details that residents are able to meet visitors in private, either in their own room or in the communal areas. Guests are made welcome, and offered light refreshment and can eat a meal with their friend or family member. The resident and relatives spoken with confirmed there was flexible visiting, that the staff are very welcoming and they could see their relative or friend in private if they wished. One relative spoken with stated that there had been the opportunity for their relatives partner to stay and eat at the home. The AQAA details that a church service and holy communion is arranged for residents to attend if they wish and the Providers are committed to supporting peoples spiritual needs within various faiths. The care and support provided was observed to enable residents where possible to exercise choice whilst at Three Gables. The four residents files viewed, and feedback from staff and the resident, relatives and health care professionals spoken with confirmed this. The cook was spoken with who stated they had a basic food hygiene certificate. A rotating menu is place and alternatives available at all the meals. Residents have a nutrition assessment completed and which is reviewed. Lunch on the day was fried or baked fish, with chips, peas and sweetcorn, or a jacket potato and followed by chocolate sponge and custard. Special diets are catered for. Residents were observed eating their lunch in one of the dining areas and it was a relaxed environment taking into account the different length of time that individual residents would need to finish their meal. Residents were offered support with their meal if required. Records are kept of food consumed individually by each resident to ensure they are receiving an adequate diet. The resident spoken with was very happy with the meals provided. Visitors spoke of the nice cakes provided. Care Homes for Older People Page 16 of 28 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Policies and procedures are in place to enable residents or their representatives to raise any concerns about the care being provided and to ensure that residents are protected from abuse. Evidence: The AQAA details that there is a complaints policy and procedure in place and that no complaints had been received during the last year. The CQC have not been made aware of any concerns in relation to the care provided at Three Gables. The resident spoken with stated they knew who to speak to, how to make a complaint and felt it was an environment where they could raise any concerns. Both the care workers spoken with stated they knew what to do if a resident has any concerns. The AQAA detailed that there are policies and procedures in place in relation to the protection of vulnerable adults. The Independent Adviser has attended training to provide safeguarding adults training to staff in the home. The two care workers spoken with confirmed an awareness of the policies and procedures to protect residents. Care Homes for Older People Page 17 of 28 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, 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. 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. Residents live in a clean, comfortable and homely environment, decorated and furnished to a good standard. Private accommodation is equipped to provide comfort and privacy and to meet the assessed needs of those people residing in the room. Evidence: Three Gables is an attractive three storey property situated in a quiet residential area of Hampden Park. The home is decorated and furnished in a homely style, with a good standard of the decor, carpeting and furnishings. The AQAA detailed that there has been an annual deep cleaning of the kitchen. The maintenance person stated that over the next twelve months it is planned to paint the rear of the home, and the first floor and second floor hallways, the carpet on the first floor hallway will be re-laid and some areas replaced ,en-suite facilities provided to a further bedroom and the laundry room is to be extended. There was a range of individual aids and adaptations to assist residents mobility and independence, including a passenger lift, walking aids, assisted baths and grab rails. Fitted throughout the home are call points, which enable assistance to be summoned when required. The telephone system in the home allows residents to make and receive calls anywhere in the home and there is also a pay phone in the hallway. There are nineteen single bedrooms on all floors in the home. A number of bedrooms Care Homes for Older People Page 18 of 28 Evidence: were viewed and displayed the residents style and interests. The resident spoken with was very happy with their accommodation. The Provider stated that prior to moving in to the home the residents bedroom is decorated, re-carpeted and a new bed provided. The resident can then personalise the room with their own effects. Fourteen of the bedrooms have en-suite facilities of a toilet and wash-hand-basin. Bathroom facilities are provided throughout the home. Residents are able to control the temperature in their own bedrooms. Records viewed did not evidence the regular testing of the hot water temperatures at outlets accessed by residents to ensure it is maintained close to the recommended safe temperature of 43 degrees centigrade. This was discussed with the Provider, who stated that further advice and guidance would be sought from the Environmental Health Department as to the frequency of the required checks and these would be implemented. So a Requirement has not been made on this occasion. The resident spoken with confirmed there is adequate heating and hot water in the home. A passenger lift is available from the ground floor providing level access to the first floor. Access to the second floor is by way of a stairway and residents accessing the bedroom on this floor will need to be fully mobile. There is one lounge with a large conservatory, a separate dining room and a second lounge with a dining area on the ground floor. There is an attractive well maintained front garden and a large rear garden making this a very attractive area to use and overlook. There is a ramp from the conservatory to the rear garden to aid access. One of the relatives spoken with stated they had enjoyed walking with their relative in the garden in the better weather. The AQAA details that there is a policy and action plan in place for managing infection control. The home has an odour control system in place. The majority of the home was clean and free from offensive odours at the time of the inspection. There was an odour in two of the residents bedrooms and some staining of the carpets. The Provider stated that the home was due for its regular three monthly deep clean of the homes carpets undertaken by an external contractor. The resident, relatives and healthcare professionals spoken with stated home was always fresh and clean. The AQAA detailed that sixteen staff had received training in the prevention of infection and the management of infection control. the care worker spoken with confirmed they had attended this training. Care workers confirmed that there was good access to protective clothing, liquid soap and paper towels. A sample of recording was viewed of routine fire checks that had been carried out in Care Homes for Older People Page 19 of 28 Evidence: the home. Checks of the emergency lighting had not been undertaken and recorded as detailed to be undertaken in the homes fire risk assessment. This was discussed with the Manager who stated this would be addressed. So a Requirement has not been made on this occasion. There was some wedging open of doors on the ground floor. The Provider and maintenance person stated that new door closures have been purchased and received and were due to be fitted that weekend to resolve this issue. Care Homes for Older People Page 20 of 28 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. A robust recruitment procedure should be followed to ensure residents are in safe hands at all times. Staff are being provided with the required training or updates to ensure they have the skills to meet all the residents care needs. Evidence: The AQAA details that there has been a period of change over the last twelve months, with a number of staff leaving working in the home and new staff being recruited. The Provider stated this had been a difficult time with all the changes and there has been some difficulty in recruiting new care workers to work in the home. A record is kept of who has worked in the home and evidence the staffing levels in the home. This was not viewed on this occasion. The Provider, Manager, care workers and feedback from the visitors to the home confirmed the staffing levels in place. All staff were found to have a good rapport with residents, which promoted a relaxed atmosphere in the home. The Provider was on duty during the day, with two care workers and a junior care worker on duty during the morning, and two care workers on duty during the afternoon. The Manager and Independent Adviser also came to the home to help facilitate the inspection. At night there are two waking night members of staff. Agency staff are not employed to work in the home. The Provider stated that the dependency of the residents in the home is increasing and the staffing levels provided should be kept under review to ensure that the residents care needs continue to be met. Cooks are employed in the home and between them provide catering cover each Care Homes for Older People Page 21 of 28 Evidence: day. Domestic and laundry tasks in the home are undertaken domestic staff and by the care workers. The resident spoken with stated staff were always available and answer the call bell promptly. The AQAA detailed that three of the twelve care workers working in the home holds an NVQ Level 2 in Care. The Independent Adviser stated that there has been a decrease in the number of staff holding this qualification due to the staff changes in the home. A further care worker is due to start working towards this qualification shortly. The AQAA detailed that the procedures followed for the recruitment of staff is the completion of an application form, a medical assessment form, two persons interviewing prospective staff and prior to engagement two references and a Criminal Records Bureau Check is completed. The documentation was viewed for the four new care workers, who had been recruited since the last inspection. The records were well structured. All demonstrated the completion of an application form, none recorded that two written references had been received prior to a care worker commencing work in the home, none had had a completed CRB and or a Pova First or an Independent Safeguarding Authority (ISA) check prior to commencing work in the home. This was discussed with the Manager and a Requirement made to ensure that robust recruitment procedures are followed to protect residents. The Manager has subsequently confirmed that a check from the Independent Safeguarding Authority has now been received for all the new care workers. The AQAA detailed that induction training for new members of staff is in place, that this meets the requirements of the General Skills for Care induction standards and that all twelve care workers have completed this induction. The Independent Adviser stated that all three of the new care workers were booked to complete this training facilitated by an external provider. The new care worker spoken with stated they had been shown around the home and informed of procedures in the home including the fire procedures and were aware they are booked to attend induction training. Care Homes for Older People Page 22 of 28 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. The management team has strived to create an atmosphere within the home, which is open, relaxed, homely and caring. Quality assurance systems in the home should be maintained to enable ongoing feedback about the care provided in the home. Systems in place to ensure a safe environment for staff and residents should be maintained. Evidence: Three Gables is a family owned and run home and the management team provides two highly skilled and qualified practitioners. The Registered Manager, (who is also one of the Owners) is a Registered General Nurse (RGN), who holds the Registered Managers Award, Advanced Management for Care and a Diploma in Gerontology. The other Proprietor is a Registered Mental Nurse (RMN). Both owners work in the home on a full-time basis and they each work alternate weekends in a hands-on-capacity. Both the Owners are supported by an Independent Adviser who takes the lead in staff training, supervision and appraisal and the quality assurance processes in the home. The inspection highlighted that a robust recruitment procedure should be put in place Care Homes for Older People Page 23 of 28 Evidence: and followed to ensure the safety of the residents. Health and safety procedures in the home should be maintained to protect residents and staff. Staff training and updates should be maintained to ensure that staff continue to have the skills to meet individual residents care needs. The Manager stated she has an awareness of the Mental Capacity Act and the Deprivation of Liberty, and no applications have been made under the Deprivation of Liberty. That she will seek further guidance/training to ensure compliance with any requirements. A quality assurance system has been developed. the Independent Adviser stated that feedback was in the process of being sought from residents, relatives and representatives through surveys. The last survey undertaken was recorded as being in 2007. It should be ensured that regular feedback is sought and feedback from the outcome of the quality assurance process be collated and available to read with other documentation in the home. This was discussed with the Independent Adviser who stated this would be addressed. The AQAA detailed that policies and procedures are in place to protect residents and staff and were reviewed last year. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or another responsible person external to the home. For those residents that are supported by the home, a sample of the record of incomings and outgoings maintained and entries backed up with receipts was viewed was found to be satisfactory. The AQAA details that care workers receive regular supervision and appraisals. The Independent Adviser stated that care workers receive individual supervision two monthly and there are regular staff meetings. Currently the Independent Adviser has a plan for the completion of appraisals with staff which is being worked through. The care worker spoken with confirmed they had regular supervision with their manager and had recently had an appraisal completed. A sample of staff training records was viewed and a training matrix which detailed who is due to undertake training or further refresher training. This should be further developed to also record when the training has been undertaken. Records viewed detailed all the care workers have undertaken moving and handling training, but that not all had attended or the training was due to refreshed in basic food hygiene and first aid. The Independent Adviser stated there had been no training completed the previous year and evidenced a plan of training for 2010-2011, which will enable care Care Homes for Older People Page 24 of 28 Evidence: workers to complete the required training to protect residents and staff. An environmental risk assessment of the building was undertaken of the building in February 2008. The Independent Adviser stated this was due for a review and that this would be addressed. So a Requirement has not been made on this occasion. The Independent Adviser stated that there are health and safety checks of the building but that these are not recorded. This was discussed with the Provider who stated that this would be addressed. So a Requirement has not been made on this occasion. The AQAA detailed that the maintenance of equipment and services has been carried out. A fire risk assessment of the building was undertaken of the building in March 2008. The Independent Adviser stated this was due for a review and that this would be addressed. A sample of records was viewed of fire training and fire drills undertaken by staff in the home. Although there was a record of regular fire training being provided by an external agency not all the care workers had undertaken this training during the last year. This was discussed with the Independent Adviser who stated this would be addressed. The care worker spoken with confirmed they had undertaken fire training. The health and safety procedures in the home were subsequently discussed with the Manager who stated that with the change over of staff in the home this was not as up-to-date and that work would be undertaken to address this and ensure systems are maintained. So a Requirement has not been made on this occasion. A sample of recording was viewed of incidents and accidents, which had occurred in the home. Care Homes for Older People Page 25 of 28 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 Older People Page 26 of 28 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 29 19 That the recruitment 31/03/2010 procedure ensures that new staff do not commence working in the home until all the required recruitment checks have been received and are satisfactory. To protect the residents. 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 Older People Page 27 of 28 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). 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. 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