CARE HOMES FOR OLDER PEOPLE
Gate Cottage Bazehill Road Rottingdean Brighton East Sussex BN2 7DB Lead Inspector
Merle Blakeley Unannounced 1 September 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Gate Cottage Address Bazehill Road Rottingdean Brighton East Sussex BN2 7DB 01273 301890 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr M M Sodeau and Mrs B G Sodeau Mrs Brenda Sodeau Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (OP), 11 of places Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The number of people accommodated must not exceed 11 2. The people accommodated will be aged 65 years or over on admission. Date of last inspection 6 January 2005 Brief Description of the Service: Gate Cottage is registered to provide care and accommodation for up to eleven older people who do not have high dependency needs. The home is located in a quiet residential area of Rottingdean and it is close to public transport, local shops, amenities and the seafront. The home is an attractive two-storey property built on a slight incline and comprises of eleven single en suite rooms, lounge and dining area, a conservatory and very pleasant garden areas. A lift is available to the first floor. The property is furnished and maintained to a very high standard and provides a very warm, caring and friendly environment for residents. Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Unannounced Inspection took place over a period of four hours on 1st September 2005. The inspection process included speaking with seven of the nine residents and joining three of them for lunch, document reading, informal talks with staff and a tour of the premises. What the service does well: What has improved since the last inspection? What they could do better:
Reviews of resident’s care plans need to be clearly dated and state if no changes have been made to them. Residents risk assessments also need to be updated on a more frequent basis. The administration of medicines is an area where the home must improve, as this was highlighted in a previous report during 2004. Some staff members are still not correctly completing medication sheets and they will be required to attend a recognised training course as soon as possible. Several residents did state that they are not interested in participating in any activities during the day, however the home must still provide a varied programme of activities for residents who may wish to participate. There was a query regarding the number of staff on duty on the morning of the inspection; the senior staff member stated that she felt the staffing levels were adequate. The home needs to remain aware of the current assessed needs of residents and staff the home accordingly. Staff are receiving supervision sessions, however this only appears to be every six months. Staff supervision must be carried out at least six times a year. Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 6 A chair and a folded wheelchair were seen to be obstructing a fire exit on the ground floor; the home must always ensure that all fire exits remain free of any obstacles or obstructions. It was also noted that none of the fire exit doors in the home had the correct signage above them. A completed action plan was received prior to publication, which indicates how the home will address the requirements and recommendations made during this inspection. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4 & 5 New residents receive terms and conditions. Prospective new residents are invited to visit the home on a trial basis. EVIDENCE: On moving into the home all new residents receive terms and conditions. Residents who were spoken to on the day felt that the home is currently meeting there needs. Prospective new residents are invited to visit the home on a trial basis. Trail visits are available for between one and four weeks. The home is not registered to provide intermediate care. Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9 & 11 Care plans need to clearly indicate when reviews have been carried out. Medication charts are not being correctly maintained. Resident’s final wishes are recorded in their care plans. EVIDENCE: Several residents care plans were viewed during the inspection and although the home is generally maintaining these plans to a good standard it is not evident when reviews are being held. Care plan reviews need to be dated when they are carried out and if there is no change to a residents care plan then this should be recorded as such. Risk assessments also need to be carried out on a more frequent basis and not just when a resident is admitted to the home. Several records showed that risk assessments had not been updated on some residents care plans for over two years. Medication records that were viewed showed a lot of irregularities and this is an area where the home must improve. Some resident’s records had gaps where medication had either been missed of refused but there was no recorded reason why the resident had not taken the medication. The home was required to address this situation in September 2004, as it was noted during the inspection that medication charts were not being correctly recorded. It will be a requirement for all staff who administer medications that they are provided with effective medication training as soon as possible.
Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 10 The home has produced a policy regarding death and dying and all resident’s wishes have been recorded in their care plans. Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 & 15 Residents need to be provided with a more varied programme of daily activities. Residents are provided with autonomy and are able to make choices. Meals provided by the home are of a very high quality. EVIDENCE: Although many of the residents are independent and like to organise their own social activities the home still needs to provide a few more activities in the afternoon for those residents who do not have anything to do. At present residents are offered a video exercise class on Monday afternoons and local walks, if staff members are available on Thursday afternoons. Table games are available at most times in the lounge. Whilst talking to residents it was apparent that they feel they have autonomy and choice within the home and that they are able to make their own decisions about certain matters. All residents handle their own finances with the help of family and friends. The home continues to provide residents with a well-balanced and nutritious diet and meals are cooked to a high standard. At lunchtime the inspector was able to share an enjoyable lunch with three of the residents. The remaining six residents took lunch in their rooms. All residents that were spoken to stated that they enjoyed the meals that were provided. Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The home has produced a policy and procedure regarding Adult Protection. EVIDENCE: The home has a policy and procedure regarding any forms of adult abuse and this includes a whistle blowing policy. Staff have attended training in Adult Protection and this was carried out in August 2005. Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20, 22 & 24 Residents have access to several safe communal areas. The home has been assessed by an occupational therapist for additional aids. The home provides residents with well-furnished and comfortable en suite rooms. EVIDENCE: Within the home residents have access to a number of communal areas, which include a nicely decorated large lounge and separate dining room and a very pleasant rear garden that has a small patio and two seating areas. There is a slope down to the garden, which would make it suitable for wheelchair access. The home has been assessed by a qualified occupational therapist to ensure that any additional aids that residents may require are in place. All bedrooms that were viewed appeared very homely and comfortable and they were decorated and furnished to a very high standard. All bedrooms within the home have en suite facilities. Residents are able to individualise their rooms by bringing in small pieces of furniture and other personal belongings. Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 30 There was a query on the day as to whether sufficient care staff were on duty for the morning shift. Staff are continuing with training at NVQ Level 2. Staff are receiving adequate training. EVIDENCE: There are currently nine residents who mainly have a fairly low level of need, however there is also a resident whose daily needs have increased. On the day of the inspection there was one senior carer, a cleaner/carer and the cook on duty. The inspector discussed with the senior carer as to whether there were sufficient staff on duty to meet the assessed needs of the residents. The senior carer stated that she felt the staffing numbers were adequate, as the vast majority of residents had quite low needs and that she could call on the cleaner if she required help. There is one resident who now has additional care needs and he is no longer able to mobilise. The home must always ensure that adequate staffing levels are available during peak times of the day, particularly if any emergency should arise. Residents who were spoken felt that sometimes there could be more staff on duty but overall they were very happy with the staff team and felt they were very well cared for. Currently one senior carer has obtained the NVQ Level 2 training and is hoping to commence Level 3 this year. Five other staff members are in the process of completing NVQ Level 2. There are two RGN’s on the staff team and they work mainly on night duty or at weekends. Two new staff members joined the team on a part-time basis in June 2005. The home has a very caring and stable staff team who all work well together. Training that staff have recently attended includes fire training, adult protection and manual handling.
Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 15 On this particular day all the staff team were attending an in-house food hygiene course. Training that staff will be required to attend immediately is medication training, staff need to be fully aware of how medications must be administered and recorded correctly. There are some staff members who are not recording details of when residents have either missed medications or refused to take them. Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35, 36 & 38 The home carries out suitable financial procedures. Residents take control of their own finances. Staff supervision needs to be carried out at least six times a year. The home must ensure that fire exits are kept clear of any obstructions and that all fire exits are clearly marked as such. EVIDENCE: The home appears to be carrying out suitable accounting and financial procedures to safeguard residents who live there. Residents take care of their own finances with the help of family and friends and therefore the home is not responsible for any resident’s monies. Staff are receiving supervision sessions but these are only being carried out once every six months; staff must receive supervision sessions at least six times per year. During a tour of the building it was noted that a fire exit door on the ground floor was blocked with a chair and a folded wheelchair. The home must ensure that all fire exits remain free of any obstructions.
Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 17 It was also noted that fire exits doors did not have any of the correct signage above them and the home needs to address both these issues immediately. There were no other health and safety issues found on the day. Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 3 15 3
COMPLAINTS AND PROTECTION x 3 x 3 x 3 x x STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x 3 3 2 x 2 Gate Cottage H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 19 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(b)(d) Requirement Timescale for action Immediate 2. 3. 4. 5. OP9 OP12 OP36 OP38 That service user care plans and risk assessments are regularly reviewed and dated even if no changes have been made. 13(2) That all staff attend a recognised training course in the administration of medications. 16(2)(m) To consult with service users and provide them with a more varied programme of activities. 18(2) To ensure that all staff members receive supervision at least six times a year. (23)(4)(b) To ensure that all fire exits are kept free of obstructions and that all fire exits display the correct signage. Immediate 1/10/05 Immediate Immediate RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP27 Good Practice Recommendations That the home continues to ensure that adequate numbers of staff are on duty according to current service users assessed needs.
H59-H10 s14200 Gate Cottage v238196 010905 Stage 4.doc Version 1.40 Page 20 Gate Cottage Commission for Social Care Inspection Ivy House 3 Ivy Terrace Eastbourne East Susssex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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