Inspection on 15/06/06 for Gate House

This inspection was carried out on 15th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 23 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gate House 09/09/08

Gate House 27/09/07

Gate House 09/02/07

Gate House 05/12/05

Gate House 19/07/05

Gate House 04/11/04

Gate House 16/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Gate House 238 New Cross Road London SE14 5PL Lead Inspector Ornella Cavuoto Unannounced Inspection 15th June 2006 10:00 Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 1 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 Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 2 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 Adults 18-65. 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 House DS0000025620.V299965.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gate House Address 238 New Cross Road London SE14 5PL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (If applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0207 6356883 Mr Lynval Palmer Mrs Marjorie Palmer Ms Hazel May Parkinson Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 2005 Brief Description of the Service: Gate House is a care home providing support and accommodation for up to nine men and women who have support needs due to mental ill health and who are aged between 18 and 65 years of age. Accommodation is provided in 5 single and 2 double rooms. Service users admitted to the service have to be relatively physically able as access to the upper floor is via a staircase. The home is privately owned and located in a residential area of New Cross Road in South East London with good access to London Underground and mainline rail stations at New Cross Gate. There are also a number of bus routes stopping close to the home. Service users also have access to a wide range of local amenities and community resources. Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over two days. The registered manager was present and took part in the inspection process. In addition, three service users and three staff members were spoken to. Other methods used included inspection of care records and a full tour of the premises was undertaken. What the service does well: What has improved since the last inspection? What they could do better: The home’s statement of purpose and service user guide need to be updated to include all required information. Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 6 Prior to new service users being admitted to the home a full needs assessment/care programme approach must be obtained to ensure the home can fully meet service users’ needs. The service user contract/statement of terms and conditions still lacks information required to protect the rights of service users. Care plans need to be improved to ensure that they fully reflect service users’ changing needs and progress. Risk assessments need to be more comprehensive and plans to manage the risks associated with mental health need to be in place. The home needs to improve activities provided to service users and need to look at organising an annual holiday. The home’s curfew policy needs to be clarified with service users and details placed in the service user guide/statement of terms and conditions so all prospective service users are aware of this. Where restrictions of movement on individual service users needs to be put in place this should be clearly addressed within their individual care plan/risk assessment. The home’s menu needs to be reviewed to include more variety and ensure that service users with specific cultural needs and on special diets are catered for. Although medication systems were generally robust, the home needs to implement a system for carrying out regular spot checks with those service users who are taking responsibility for their own medication. Although the home has undertaken extensive redecoration and refurbishment the radiators still need to be looked at to ensure they give out sufficient heat. The home needs to ensure that the policy of sharing rooms as specified within the National Minimum Standards that service users only share based on a positive decision to do so, is included in the home’s service user guide /statement of terms and conditions. Also, for those service users currently sharing who would prefer not to do so then they need to be given the opportunity to move rooms and double rooms revert to single occupancy. Items of furniture identified as broken within service user rooms need to be repaired or replaced. An occupational therapy assessment needs to be carried out with the service user whose personal care needs have changed to ensure the home can continue to fully meet their needs. Although staff have undergone some appropriate training, a plan must be drawn up based on the needs of service users and staff and induction and mandatory training must be to Sector Skills specifications. A fire risk assessment needs to be completed, water temperature checks carried out regularly to prevent risks of scalding and tests for Legionella completed to make sure the health, safety and welfare of service users are maintained. 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 House DS0000025620.V299965.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 &5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Service users do not currently have the information they need to make an informed decision about where to live. There was limited evidence available that prospective service users needs are fully assessed. Service users have still not been issued with revised individual statements of terms and conditions. EVIDENCE: The home’s statement of purpose and service user guide do not contain all the information required by regulation and the standards. For example, the statement of purpose does not include the size of the rooms whilst the service user guide does not give a full description of individual and communal space provided and the relevant experience and qualifications of the registered provider, manager and staff. It was also evident from inspecting the service user guide and statement of purpose that neither document has been reviewed and updated recently (See Requirements). Four service user files were examined. Three of the files looked at were for service users that had been living at the home for 12 years and none included evidence of a full needs assessment. The registered manager reported these had been archived. The most recent service user whose file was inspected Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 9 moved into the home three years ago and although the file included a psychiatric report that was quite detailed and an occupational therapy assessment, there was no evidence that a care management/Care Programme Approach (CPA) had been obtained from the care co-ordinator/ referrer from the community mental heath team where the service user was receiving support (See Requirements). At the last three inspections a requirement has been specified that the registered provider must ensure that service users are provided with a statement of terms and conditions that includes all the information as outlined within standard 5.2. This has still not been addressed (See Requirements). Continued non-compliance with this requirement will lead to enforcement action being considered. Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Although care plans are generally comprehensive and are reviewed regularly they do not always clearly reflect service users’ changing needs and progress. There was evidence that service users are supported to make their own decisions. Although there were risk assessments in place that addressed some general risks there was still insufficient evidence of how risks associated with mental health problems were being managed. EVIDENCE: Four care plans were inspected and generally these did cover areas required to ensure that the needs of service users are being addressed. All the care plans examined except one had been signed to indicate their involvement in the process and six monthly reviews had been carried out. However, care plans did not always reflect the changing needs or progress of service users, for example in discussing two of the service users with their key workers it became evident that information regarding their needs had not been fully addressed within their individual care plans. There was evidence that service users have regular Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 11 contact with their mental health teams in the community and attend Care Programme Approach (CPA) meetings although minutes of these meetings were not always available (See Recommendations). There was evidence that service users are supported to make their own decisions in that the majority of service users manage their own finances and one of the service users is being supported to move on towards independent living. Information regarding advocacy services was also available in the home. Although the four service users whose files were inspected had risk assessments in place that were aimed at addressing individual risks identified within the home and also within the wider community, they had not all been regularly reviewed with one not having been looked at since 2003. In addition, they did not always comprehensively address risk taking behaviour presented by individual service users, for example one service user was working locally and there were concerns about the appropriateness of this. However, this had not been clearly looked at within a risk assessment with the service user to identify risk management strategies although there was evidence that the service user was being supported to look at alternative types of employment. For another service user it was reported that there were concerns about the service user staying out late, as they would regularly inappropriately present themselves at the local hospital’s A&E department. Yet, this had not been addressed within a risk assessment or their care plan. In addition, at the last inspection it was identified that although service users had risk assessments completed as part of the Care Programme Approach (CPA) process that had highlighted risks such as self harm and violence, a risk management plan for dealing with these risks had not been completed by the home in the care plan or as a separate document. At this inspection this had still not been addressed (See Requirements). Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12, 13,14,15,16 &17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users are given opportunities for personal development. Service users are provided with opportunities to engage in appropriate opportunities for occupation and education/training Although generally service users are involved in the local community some service users need to be more supported to make use of local facilities. Although there have been some improvements in the level of activities provided to service users this still needs to be increased to meet the stimulation needs of service users. Service users are supported to maintain family links and appropriate friendships in and outside the home. Although daily routines and house rules do generally promote independence the issue of the home having a curfew time needs to be clarified with service users. The menu needs to be more varied and where alternatives are offered a record of this must be maintained. Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 13 EVIDENCE: Service user plans indicated that service users are given support with practical life skills such as budgeting. In addition, individual service users have been offered specialist interventions, for example one service user had a specific activity plan drawn up by the occupational therapist at the day centre where the service user attends. One of service users spoken to also confirmed that they regularly attend the church of their choice. There was evidence that service users are supported to undertake appropriate jobs and continue their education as well as other fulfilling activities. It was reported by the registered manager that one of the service users who is due to move into their own flat does voluntary work locally whilst another service user is being supported with the day centre to support them to find work. A number of the service users attend day centres where they are engaged in a range of social and educational activities. One service user attends music classes and does yoga. Many of the service users do participate in the local community as they wish using the local shops and transport facilities. There was also information about resources in the community available around the home. However, it was also evident that some service users have less confidence to go out and make use of the local community. In these situations the key worker system should be used to support service users to become familiar with and gain confidence in using local facilities (See Recommendations). In terms of leisure activities a previous requirement that the home needed to increase the level of activity inside and outside the home has been partially met. The home has put in place an activities folder in which the activities that each service user is involved in are recorded. This demonstrated that some of the service users have been involved in going on shopping trips, art sessions held within the home and there was a trip to the Tate Modern. However, for some service users records indicated that they had not been involved in any activities. Also, there was no evidence that service users have been involved in the other activities that were listed in the activities folder that the home aims to provide such as bingo nights, quiz nights, video nights playing board games, going to the cinema, eating out, having picnics, swimming, going to museums. Two of the service users spoken to said they would like to do more activities with one expressing they would “like bingo and to go out more to different places.” In addition, subject to a previous requirement only one service user has had a holiday and this was arranged by the service user’s family. The home is yet to make arrangements for service users to have a holiday outside the home that they choose and plan (See Requirements). A previous requirement in respect to service user meetings that they should be held at least every two months has been met. It was evident from minutes of Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 14 meetings that these had been held regularly and that service users were given an opportunity to discuss a range of different topics including activities, household chores, the menu and any general concerns/ complaints. There was evidence from service users’ files and also in speaking to service users that they are supported to maintain links with family and friends. Service users confirmed they regularly visit family that live locally. Also, one service user has a long -term partner with whom they often spend the weekend. Generally, the daily routines of the house do promote independence in that during the inspection service users were observed as coming and going from the house as they please. Also, all service users have a key to their rooms although not to the front door. It was reported by the registered manager that this is for security reasons due to an incident that occurred in the past. As a result, service users have to adhere to a curfew time. This was noted from the minutes of one of the service users’ meeting in which staff reminded them that they needed to return to the home by 10pm at night. Also, it was an issue that was raised by one of the service users spoken to in that they commented how they considered the time they were expected to return to the home was too early. The registered manager reported that apart from concerns about one particular service user staying out that has been mentioned previously service users could return late if they wanted but they need to make staff on duty aware so this can be accommodated as the door is locked at 10pm. However, it is evident that the home’s policy on this issue has not been clearly addressed with service users. In addition, where restrictions of movement are to be specified for individual service users this needs to be clearly addressed within their care plan or risk assessment (See Requirements). There was evidence that the menu is discussed within service user meetings and service users spoken to generally appeared to be happy with the food provided. Although the menu does not provide a choice of meals service users confirmed that they would be provided with an alternative meal if they did not like what was on the menu. However, there was no evidence that where service users have been given a different meal that this has been recorded. The inspector was invited to join the service users for suppertime and the meal provided was hot and nutritious and service users appeared to enjoy it. However, on inspection of the menu it was noted that in places it was repetitive, for example in one week spaghetti Bolognese was cooked on one day with lasagne cooked the following day. Also, cultural needs apart from rice and peas being offered on the menu on Sundays or special dietary needs, one service user is a diabetic had not been catered for. Therefore, the menu needs to be reviewed to include more variety (See Requirements) Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users generally receive personal support in the way they prefer although one service user’s personal care needs have changed and the home needs to ensure that they can continue to meet their needs. The physical and mental health of service users are addressed and monitored. Service users are supported to self –administer their own medication but the home does not carry out spot checks. Also, the homes medication policies and procedures do not currently protect service users and needs to be reviewed. EVIDENCE: The majority of the service users living at the home are independent with managing their own personal care and choosing their own clothes although care plans did indicate some required support in the way of prompting. The home operates a key worker system to ensure consistency of support. However, it was reported that the personal care needs of one service user have changed in that they are no longer able to use the bathroom downstairs due to experiencing difficulty getting out of the bath. At present the service user is using the shower upstairs but it is evident that an occupational therapy assessment may need to be obtained to ensure that the home has the Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 16 appropriate aids/equipment to be able to continue to meet the service user’s needs (See Requirement and details regarding Standard 29). There was evidence within service users’ care plans that service users physical and mental health needs are being met. There is regular contact with mental health professionals and Care Programme Reviews are held on a regular basis although as previously mentioned the minutes of these reviews have not always been obtained. There was some evidence that service users have had access to primary health care services such as the dentist and opticians. One service user who is a diabetic is supported to regularly attend a diabetic clinic and a district nurse attends the home to administer insulin injections. At the last inspection it was recommended that the home should carry out monthly weight monitoring as part of monitoring their health, at this inspection it was agreed that this will be only be undertaken for service users where there are concerns about their health/ weight. The home’s medication policy was inspected and found not to include procedures to be followed by staff when an error in administration of medication occurs. Also, the policy did not include that medication needs to be retained by the home for a period of seven days in the event of a death of a service user. Consequently, the policy needs to be reviewed and this information included. Some of the service users self-administer their medication whilst some are being supported by staff to work towards doing so. There was evidence that for those service users who are taking responsibility for their own medication or working towards this that this has been included in individual risk assessments. However, the home does not have in place a system for carrying out regular spot checks with service users who are self administering their own medication. This needs to be carried out on a regular basis for those in the early stages of taking responsibility for their medication although this should also be done periodically even for those that have self administered for a longer period of time and could be undertaken as part of their CPA reviews. Medication supply and records that were looked at were in order. Also, a previous requirement that an up to date homely remedies list for service users that is approved by the GP has been met. This has been completed individually for each service user (See Requirements). Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 &23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users spoken to stated they did have any complaints and the complaints policy had been altered to encourage service users to raise their concerns. The home has a comprehensive policy and procedure on adult protection and whistle blowing. Staff have been received training in this area. EVIDENCE: The home’s complaints policy includes the stages of and timescales of the process. It has also been altered as previously recommended to include a statement that complainants will not be victimised. A copy of the policy was seen on display within the entrance hall of the home visible to service users, relatives or representatives. Service users spoken to stated they have never had cause to make a complaint. They were aware of the home’s complaint policy and also stated they would address their concerns with staff if necessary. The home has not received any complaints since the last inspection. The complaint made by one service user regarding the staff sleep in room has been addressed to their satisfaction (For details see Standard 28). The home has an appropriate adult protection policy in place as well as a whistle blowing policy although it is recommended that a copy of Lewisham’s Interagency Guidelines on Adult Protection are also obtained for staffs’ information (See Recommendations). A previous requirement that all staff undergo appropriate training in adult abuse has been met. Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25,26, 28,29 &30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is comfortable and homely and has recently undergone extensive redecoration and refurbishment although the issues to do with the heating have still not been addressed. The home’s policy on sharing of rooms and sizes of rooms has not been clearly addressed within the home’s statement of purpose, service user guide/statement of terms of conditions. Some service users’ bedrooms are in need of items of furniture being replaced and the en –suite bathroom needs a new toilet. Improvements have now been made to the staff sleep in accommodation and action has been taken to reduce the disturbance of light entering into the adjoining room of a service user. The home needs to ensure that the home has all the necessary equipment/adaptations to meet the needs of all the service users living at the home. The home was generally clean and hygienic. Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 19 EVIDENCE: At the last two inspections requirements have been stated in respect to the home requiring extensive redecoration and refurbishment of communal areas and also service user bedrooms. At this inspection, it was found that the home had been completely repainted and at the time the inspection was held new carpets were being fitted throughout the home and in all the service users’ bedrooms. In respect to the heating, subject to a previous requirement that radiators should be guarded or have low surface temperatures unless risk assessments identify this as unnecessary this has not been met. The registered manager reported that the home’s insurance company has been consulted about the radiators who had stated it was unnecessary to guard them. It was also checked with the LFEPA who stated that it would need to be addressed within the home’s fire risk assessment. However, it was noted this has not been completed. In addition, the issue of the radiators giving out insufficient heat has not been dealt with and it was also seen that the radiators in service users’ rooms are not self –adjusting (See Requirements). In respect to service user bedrooms, previous inspections have required that room sizes be supplied to CSCI and that this is included in the home’s statement of purpose and service user guide. However, as mentioned previously (See details regarding Standard 1) this has not been met. Also, in respect to the issue of service users sharing of rooms it was identified at a previous inspection that two service users sharing a room had stated they would prefer not to share but there were not enough single rooms. At this inspection not all those service users who are sharing were spoken to. Yet, it was noted that there was a single room that was vacant but this had not been offered to any of the service users presently sharing. The registered manager reported that this is because the service user due to move in is female and there were no other options available for them. However, where rooms become available in the future the option of moving into a single room must be offered to service users in shared rooms. In addition, the home must address in their service user guide / statement of terms and conditions that the policy of sharing, as stated within the National Minimum Standards, is that service users will only be expected to share if they have made a positive choice to do so (See Requirements). All service users’ bedrooms were inspected and although they included the required items of furniture it was noted that a number of the items were broken and in need of being repaired or renewed, for example one service user had a wardrobe and a bedside cabinet that were broken another had a chest of drawers that was broken, two of the rooms had headboards that were loose. At a previous inspection, it was required that weekly room audits should be carried out to ensure that broken items are promptly identified and are repaired / replaced. It was evident from records that these had not taken place on a regular basis. In addition, a previous inspection identified that a toilet in Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 20 one of the en- suite bathrooms had bad lime scale. The registered manager reported that efforts to remove the lime scale had not led to an improvement and so it is planned to replace the toilet completely (See Requirements). The home has adequate communal spaces for service users with a lounge and separate dining room and also a smoking room. There is a kitchen that is domestic in nature that has recently been refurbished and a well-maintained garden at the rear of the premises. Previous inspections have required that adequate and safe sleeping facilities must be provided for staff after it was identified that the room had no opening window and only borrowed light from a small window from the adjoining room. The matter was referred to the Local Authority Health and Safety Enforcement Team who conducted an inspection at the home and agreed that a more effective ventilation system would be acceptable. This has been addressed with a ventilation and air conditioning system having been fitted. Furthermore, as identified at a previous inspection, the issue of the light from the sleep in room disturbing the service user in the adjoining room has been resolved with curtains made from a heavier fabric being put up. The service user who stays in that room was spoken to and they confirmed that they are satisfied with the situation in that the light coming through is now minimal. The home currently has a service user living at the home that is over the age of 65 years. This breached the home’s conditions of registration, which is for those service users with a mental disorder only. The home was previously informed that they needed to submit an application for variation to their registration to enable the service user to continue living at the home. At this inspection it was identified that the home had still not submitted an application for variation. An immediate requirement was issued that has since been met with the application being processed and agreed. However, as previously mentioned it was reported that the service user is no longer able to use the bathroom downstairs due to difficulties with being able to get out of the bath and the home does not have any environmental adaptations/aids in place. Although the service user now uses the shower upstairs there have been recent concerns about their health. Therefore, the home needs to ensure that an occupational therapy assessment is carried out with the service user to ensure that the home is able to continue to fully meet their needs (See Requirements). The home was clean and hygienic on the day of the inspection and laundry facilities were appropriately sited. It was found at previous inspections that several windows were dirty. At this inspection the windows were not closely inspected but those that were seen were found to be acceptably clean. Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 &36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Over 50 of the staff working at the home have completed or are in the process of working towards a National Vocational Qualification (NVQ) Level 2 or 3. Service users are protected by the home’s recruitment practices. The home’s induction training still does not meet with national minimum standards and a training plan is still not in place to address staffs’ training requirements to ensure service users’ individual and joint needs are met appropriately Staff are now receiving regular supervision. EVIDENCE: Two staff have completed a NVQ Level 2 in care and three workers have completed a NVQ Level 3 whilst one worker is due to start studying for a NVQ Level 3. This ensures that the home has reached the required target as stated within the National Minimum Standards that 50 of staff working at the home need to have attained a NVQ. Concerns regarding the home’s recruitment practices have been identified at the last two inspections with issues of Criminal Record Bureau (CRB) checks from previous employers being accepted to allow staff to commence working Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 22 within the home and POVA First checks not being obtained. Also, one CRB was identified as being only at the standard instead of the required enhanced level. Following the last inspection, a letter of serious concern was sent to the provider requiring immediate action to be taken to ensure CRB and POVA First checks were applied for. At this inspection recruitment records for all staff working within the home were checked including a member of staff that has started working at home since the last inspection. These were all found to be in order with all required documents in place. Two of the CRB checks were identified as in need of being renewed as they were obtained three years ago. Although not obligatory, it is recommended this be addressed (See Recommendations). There was some evidence within individual staff records that staff have completed some training to enable them to meet the needs of service users, for example challenging behaviour and risk assessment and management, culture and diversity and introduction to care programme approach. However, subject to a previous requirement the home still did not have a training plan in place that addresses the training needs of the staff team as a whole or individually. Also, apart from one staff member that has completed a First Aid course there was no evidence that staff have undertaken mandatory training such as food hygiene, infection control and health and safety. In addition, although there was evidence that the new staff member had completed an induction this has still not been drawn up to meet Sector Skills Council specifications as previously required (See Requirements). A previous requirement that staff must be given supervision at least six times a year and that supervision records are kept secure has been met. Records of supervision sessions that were inspected demonstrated that staff have been in receipt of supervision every two months and that appropriate topics are discussed including issues pertaining to service users that are key worked, training, performance issues, items brought by the supervisee and other general issues. Yet, it was noted that the supervisor and the supervisee had not always signed the records and it is advised that this is addressed. There was no evidence that annual appraisals with staff have been carried out. The registered manager did present a newly developed appraisal form and stated these would be completed with staff in due course (See Requirements & Recommendations). Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 &4 Quality in this outcome area is adequate. This judgement has Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The registered manager is experienced and holds appropriate qualifications to ensure the home is well run. Although service user surveys have been completed with some of the service users living at the home further improvements are still required to develop an effective quality assurance system. The health, safety and welfare of service users are not being fully promoted and protected. EVIDENCE: The registered manager is very experienced having worked for nearly thirty years within the mental health field. She has held various different posts within hospital settings and has previously managed three care homes. She has also completed the NVQ Level 4 in management. Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 24 It was reported by the registered manager that service user surveys are completed with service users every six months when care plans are reviewed with them. However, evidence could only be found on three service users files that these had been completed although it was noted that service user satisfaction feedback was included in the agenda items for service user meetings. Yet, the views of relatives, friends and professionals involved with the home have not been sought. Subject to a previous requirement, the results of surveys that have been completed had not been summarised in a report and made accessible to service users and other interested parties including CSCI. In addition, an annual development plan based on a systematic cycle of planning- action –review reflecting aims and outcomes for service users has not been completed. However, there was evidence that monthly unannounced provider visits have taken place with reports being submitted to CSCI (See Requirements). The home has comprehensive policies and procedures on health and safety. It was identified that the testing and inspection of the fire alarm and equipment, and gas safety had been carried out. Incident forms have also been completed as necessary. However, as previously mentioned within Standard 35 there was no evidence that staff have completed mandatory training such as food hygiene, which is subject to a previous requirement. Also, at the last inspection a requirement was made that the home must complete a fire risk assessment in consultation with the LFPEA (Fire Authority) that addresses the issue of door wedging identified at a problem at a previous inspection although not seen to be an issue at this inspection. This has not been met in that there although was evidence of a fire risk assessment in place this had only been partially completed with measures to address risks not identified. In addition, there was no evidence that the home has regularly tested water temperatures to prevent the risk of scalding and that the water has been tested for Legionella (See Requirements). Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 Standard No Score 1 2 2 2 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 X 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 2 X Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 YA1 Regulation 4,5,6 & Sch 1 Requirement Timescale for action 01/01/07 2. YA2 14 (1) 3. YA5 5(1c) The registered manager must ensure that the home’s statement of purpose and service user guide contains all the information required by regulation and the National Minimum Standards specifically the information included in the report and that both documents are reviewed regularly and updated. The date of review should be included on the documents. The registered manager must 01/01/07 ensure that prior to new service users being admitted to the home that a full needs assessment or a copy of the Care Programme Approach is obtained. The Registered Manager must 30/11/06 ensure the service user contract is updated to ensure it meets all areas outlined in Standard 5.2. A copy to be forwarded to CSCI (Previous timescale of 28/02/05 &31/10/05 not met) Continued noncompliance with this requirement may lead to DS0000025620.V299965.R01.S.doc Version 5.2 Gate House Page 27 4. YA6 15(2) 5. YA6 15(2) 6. YA9 13 4(c) 7. 8. YA9 YA14 14 (2) 16(m&n) 9. YA14 12 (1) (a) 10. YA17 16 (2) (i) 11. YA16 12 (3)&13 (4) (a) enforcement action being considered. The registered manager must ensure that all care plans that are drawn up are signed by service users to indicate their involvement and understanding of the care planning process. The registered manager must ensure that care plans fully reflect service users’ changing needs and progress. The registered manager must ensure that where risks have been identified a plan to manage the risks in is place. (Previous timescale of 31/03/06 not met) The registered manager must ensure that risk assessments are reviewed on a regular basis. The registered provider must ensure that the level of activity offered inside and outside the home is increased in order to meet the stimulation needs of service users. (Previous timescale of 30/11/05 and 31/03/06 not met) The registered provider must ensure that service users have as part of the basic contract price the option of a minimum seven-day annual holiday outside the home, which they choose and plan. (Previous timescale of 31/05/06 not met) The registered manager must ensure that the menu is reviewed to offer service users a varied and nutritious diet that also caters for culturally specific and special diets. Also, where an alternative meal to service users are offered that is recorded. The registered manager must ensure that the home’ s policy DS0000025620.V299965.R01.S.doc 30/11/06 30/11/06 01/01/07 01/01/07 01/01/07 01/01/07 01/01/07 01/01/07 Page 28 Gate House Version 5.2 12. YA20 13 (2) 13. YA24 23(2) (p) 14. YA25 23(2) (e) regarding a curfew time is clearly outlined to service users and should be included in the home’s service user guide/statement of terms and conditions and where restrictions may need to be put in place for individual service users this is addressed within their care plan/risk assessment. The registered manager must 01/01/07 ensure that the home introduces a system for regular spot checks to be carried out on service users who are taking responsibility for their own medication. Also the home needs to review the medication policy to ensure it includes the information specified within the report. 01/01/07 The registered provider must ensure that radiators give out sufficient heat and are guarded or of a low temperature surface unless risk assessments indicate this is unnecessary. Also radiators in service users’ bedrooms should be made self adjusting. (This is an updated requirement. Previous timescale of 31/03/06 not met) The registered manager must 01/01/07 ensure that where rooms are shared they are shared by two service users who have made a positive choice to share with each other. This needs to be included in the home’s service user guide/statement of terms and conditions. Also where single rooms become available those in shared rooms must be offered the chance to move and leave the remaining service user in single accommodation. (This is an updated DS0000025620.V299965.R01.S.doc Version 5.2 Page 29 Gate House 15. YA26 16 (2) (c) 16. 17. YA26 YA29 23(2d) 23 (2) (a) 18. YA35 18 (1) (c) 19. YA35 18 (1) (a) 20. YA36 18 (2) 21. YA39 24 requirement. Previous timescale of 31/10/05 and 31/05/06 not met). The registered provider must ensure that all broken furniture in service users’ bedrooms are either repaired or replaced and that weekly audits of the premises are conducted to ensure awareness of any breakages. The registered provider must ensure that the toilet that has bad lime scale is replaced. The registered provider must ensure that an occupational therapy assessment is carried out for the service user whose personal care needs have changed to ensure that the home has appropriate aids /equipment to be able to fully meet the service user’s needs. The registered provider must ensure that the home has a training plan to ensure that a proactive is adopted towards training and that it is based on the assessed needs of staff and service users. (Previous timescale of 30/04/06 not met) The registered provider must ensure induction and mandatory training such as food hygiene is carried out and is to Sector Skills council specifications. (This is an updated requirement. Previous timescale of 30/04/06 not met). The registered manager must ensure that all staff working at the home have an annual appraisal carried out with them. The registered provider must ensure that results of quality assurance surveys are DS0000025620.V299965.R01.S.doc 01/01/07 01/01/07 01/01/07 01/01/07 01/01/07 31/03/07 01/01/07 Gate House Version 5.2 Page 30 22. YA39 24(1b) 23. YA42 23 (2) (c)& (4) summarised and made available to service users and other interested parties including CSCI. (This is an updated requirement. Previous timescale of 31/01/06 not met) The registered provider must produce an annual development plan, based on a systematic cycle of planning-action-review, reflecting aims and outcomes for service users (Previous timescale of 31/01/06 not met). The registered manager must ensure that an up to date fire risk assessment is drawn up in consultation with the LFPEA (Fire Authority). Also that regular checks of water temperatures are carried out to prevent risks of scalding and there is evidence of checks for Legionella being carried out 01/01/07 01/01/07 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. 2. Refer to Standard YA6 YA13 Good Practice Recommendations The registered manager should try to ensure that minutes of Care Programme Approach (CPA) Review meetings are obtained. The registered manager should try to use the key worker system more effectively to enable those service users who are not presently using local facilities to be supported to get out more and become part of the local community. The registered manager should try to renew those Criminal Record Bureau checks that were originally applied for three years ago. The registered manager should try to obtain a copy of Lewisham’s Adult Protection Interagency Guidelines for DS0000025620.V299965.R01.S.doc Version 5.2 Page 31 3. 4. YA34 YA23 Gate House 5. YA36 staffs’ information. The registered manager should try to ensure that both the supervisor and the supervisee sign supervision records. Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Gate House DS0000025620.V299965.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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