Inspection on 16/10/08 for Gate House

This inspection was carried out on 16th October 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Gate House 16/11/06

Gate House 25/01/06

Gate House 05/10/05

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Gate House High Street Eastry Sandwich Kent CT13 0HE     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Sumner     Date: 1 6 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Gate House High Street Eastry Sandwich Kent CT13 0HE 01304611600 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Family Care Homes Ltd care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category 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 category: Learning disability - LD Date of last inspection Brief description of the care home Gate House is a purpose built unit within the grounds of Eastry House. Gate House provides a service to 7 men and women with learning disabilities, complex needs and challenging behaviour. Gate House has its own registration, although the registered manager of Eastry House and Eastry Villas has retained the overall management responsibility for the home. The unit is modern in design, and this is reflected in the minimalist style of the decor and furnishings, which are of good quality. The accommodation is arranged around the centralised open plan communal spaces, with bedrooms, kitchen, laundry and staff office coming off this. All people living at the home have single occupancy bedrooms with en-suite facilities of either a shower or bath dependent on their preference. Limited parking is available in the main car park although there is a free car park in the village high street and some street parking is Care Homes for Adults (18-65 years) Page 4 of 27 7 Over 65 0 Brief description of the care home also available. A bus service is available to Eastry and runs through the the high street. The village has a number of small shops, two pubs, and a post office. The current fees for the service at the time of the visit range from 480.29 to 971.00 pounds. Information on the homes services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. The provider web address is included in the previous page with other contact details. Care Homes for Adults (18-65 years) Page 5 of 27 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This report is based on information received about Gate House including an annual quality assurance assessment (AQAA) completed by the registered manager and a visit to the home lasting around 7 hours. The visit was unannounced, which means that the people living in the home, staff and homeowners did not know that we (the commission for social care inspection - CSCI) were calling. Information was gathered for this inspection in a variety of ways throughout the year, since the last inspection visit and during the visit to the home. Surveys were sent to visiting professionals and easy read surveys were given to the people living in the home, who were helped by their families to complete them. The information in the surveys received have been included in this report. Care Homes for Adults (18-65 years) Page 6 of 27 The visit included talking with people living in the home with the use of a variey of communcation aids and talking to members of the staff team. We spoke to the team leader who is based in the home and the registered manager who oversees the home and others on the same site. General observations were made during the day of how people are supported. We walked round and looked at the home and grounds and various records were looked at and talked about. What the care home does well: What has improved since the last inspection? What they could do better: The service provided is really good. Person centred planning is well underway. This is a work in progress and needs to continue, so that everyone living in the home has their own plan that they have been involved in and understand as much as possible. The home is open plan and if people want to go somewhere quieter they can go to their bedroom. It would be beneficial to the people living in the home to have another room to go to if they want to do something different or be quieter. The team leader said they are looking into having an extension to provide another room for this. No requirements or recommendations were made as a result of this visit as the registered manager, team leader and staff were well aware of how they plan to develop Care Homes for Adults (18-65 years) Page 8 of 27 the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not move into the home without a thorough assessment and everyone else in the home has had the chance to see if they can get on. Evidence: Assessment information was looked at and discussed with the staff. The assessments contain clear information to form the basis of the individual support plan. The people living in the home are given the opportunity to meet and get to know prospective people before they move in. Care managers, learning disability nurses and other professionals that have supported individuals have been involved in the assessments of the people living in the home. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service recognises the right of individuals to make their own decisions and supports people in a positive way. Evidence: There were a variety of communication aids around the home. Each service user has been assessed and they each have appropriate communication aids. We spoke to the people in the home using a mixture of their communication aids and our photo book called the inspector calls. People answered the questions indicating that they are given choices throughout their day to day life. The records in the home also demonstrated this. Each person has a support plan. The company has recently introduced a new person centred style plan. The team leader and key workers are in the process of transferring relevant information into the new format whilst reviewing each persons needs. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: Staff working practice was observed. They demonstrated that they had got to know each person and responded appropriately to their behaviour. A variety of information in support plans, risk assessments and daily records was looked at and discussed with the team leader and staff. Staff were observed to follow the guidelines for support written in the plans and risk assessments. The staff demonstrated their commitment to positive behaviour support by their interaction with the people in the home. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are able to enjoy a full a stimulating lifestyle with a variety of options to choose from. Evidence: A range of occupational and leisure activities are organised for the people living in the home. Different individuals participate in different activities depending on their interests and assessed needs. On the day of the visit, four people went to a soft play big ball adventure park in Faversham. This is a new activity has been introduced in the last few weeks. It provides a secure, safe and fun sensory experience. One of the people spoke about his interests including football. He likes to go to football matches and went to a Dover football match last week. People use the company day centre on site that provides various activities. They go swimming both in the hotel where they privately hire it and at the local community fun pool at Deal. They go bowling in Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: Margate. They go into the village to the local shops and pubs. They also go into the local towns of Deal and Dover so that there is a mixture of specialist activities and community based activities. Many of the families are in close contact with the people in the home and are involved with their care and support. There are contact details in each persons folder. The home has received positive feedback from the families. The registered manager oversees the production of a news letter about the homes in Eastry to keep everyone up to date and sometimes families contribute to them. The people who live in the home are able to access all parts of the home. All bedrooms are single and have ensuite showers or bathrooms. Bedroom areas are considered private. The environment has been risk assessed. The kitchen is open. Where risk assessments have indicated a need, measures have been taken to protect the safety of individuals. An example is that sharp knives are locked away separately and care is taken to account for them when they are in use. Mealtimes are flexible around individual activities and preferences. Some people eat in the dining room and some next to the kitchen so that everyone has sufficient space and are able to eat in a relaxed atmosphere. The menu is varied and people are involved in choosing what they like. Alternatives are also provided. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal support is responsive to the varied and individual needs and preferences of the people who live in the homes. Aids and equipment are provided to encourage maximum independence for people using the service. Evidence: The people living in the home are supported to access the local health care facilities. Staff support individuals using a person centred approach. All are registered with a GP in the village. In house as well as community based clinics are available for dental, chiropodist and optical care. Four people also have a psychiatrist review on a regular basis. This outcome group has been rated excellent because the service has maintained the good practice they demonstrated at the last key inspection visit. They have also made improvements by becoming more person centred and providing a responsive overall service to support peoples health and personal care needs. The people living in the home have had the support of the occupational therapist, Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: physiotherapist and the speech and language therapist. Their advice has been included in the persons support plan. People were observed using communication aids with success. Staff get to know individuals and are able to judge by responses and behaviour, as well as the use of the communication aids to find out what people want. The Boots monitored dosage system is used to administer medication. At present none of the people living in the home administer their own medication. The registered manager audits medication. The operations manager also carries out an audit during the monthly visits and additionally if she feels there is a need. There are clear instructions and clear information about medication in the administration folder. Staff are given specialist training to support individuals health needs, including training to support people with hearing impairment, legal aspects of learning disability and sexuality and depression and learning disability. Training is also planned in understanding and supporting people with Tourettes. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service are given the means to express their feelings and wishes and are protected by the policies and procedures for safeguarding in the home. Evidence: A copy of the complaints procedure provided in widget is displayed in the home and accessible to the people living in the home. Families are also aware of the procedure and there is reference to it and how to give feedback in the company newsletter. People are able to use their communication aids to assist with making their needs known. Staff know the people very well and are also able to interpret behaviour when individuals are unhappy. Staff spoke about recent safeguarding training and demonstrated an awareness of what abuse is and what they would do about it. Training in safeguarding is included in the ongoing staff training programme and everyone has attended or is planned to attend. The company have also produced a new flow chart of their safeguarding procedure. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is spacious and well designed to suit the needs of the people who live there. Evidence: We looked around the home at the beginning of the visit with one of the staff. The home was clean, spacious and a comfortable temperature. There is an open plan central lounge with a dining area and all other rooms go from here. There is a plan of redecoration to make sure the inside of the home looks clean and fresh and furniture is replaced when needed. Since the last key inspection some furniture has been replaced due to wear and tear. All bedrooms have been decorated with peoples own things and in colours they like. The flooring in one of the rooms has been changed to be more suitable. There is a development plan for the environment and there was talk about a conservatory or similar to create a quiet room space. The home is clean and equipment and procedures have been put into place to meet good practice guidelines for infection control. Care Homes for Adults (18-65 years) Page 19 of 27 Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team have a strong commitment to enabling the people living in the home to develop their skills, including social, emotional, communication, and independent living skills. Evidence: The company have a recruitment procedure, which includes all safety and identity checks required by law for care homes. One of the staff files was looked at to check this. New staff have induction training that includes the Skills for Care common induction standards. We looked at an induction training pack that a new member of staff was in the process of. Staff do not work alone and unsupervised until their criminal records bureau check has been processed and they have had essential training for health and safety. The duty rota was looked at. Staff talked about the hours they work and how their shifts are organised. Staff start and finish at different times so that there are enough staff at busy times and to support arranged activities.There is an ongoing programme of training to make sure all essential training identified is given and is up to date. This was confirmed by staff comments and the training records, which were looked at in the Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: files in the office. There was a discussion with the staff about some training given by the Kent Association for the Blind (KAB) where they had been given experience of being partially sighted and blind. They said it gave them a good insight. Some of the staff have also attended interactive communication training and all the staff have had training in Makaton which is a supportive sign language for people with learning disabilities. The company provide National Vocational Qualification (NVQ) training to all staff. More that half the staff team have this qualification. From the surveys and interviews the staff team sound happy and motivated. They have one to one supervision meetings with the team leader. She said she has found it a useful way to get to know the staff. Staff said they found supervisions helpful and they were able to talk about how they would like to develop and what training they would like to do. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager and team leader are able to describe a clear vision of the home and a clear sense of direction. They have good people skills and understand the importance of person centred care and effective outcomes for the people who use the service. Evidence: Gate House is one of a group of 5 homes on the same site overseen by the same registered manager. The registered manager has the required qualifications and experience to meet this standard. Gate House has a team leader who is based in the home and carries out the management of the home under the direction of the registered manager. Both the team leader and the registered manager participated in the visit as part of the inspection. The registered manager has set up a quality audit that includes health and safety, security, equipment and refurbishment of the home. This generates action points and discussions and plans to implement improvement. We looked at the quality monitoring folder. There were minutes from the first quality meeting held and well attended by Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: relatives and interested people connected with the home. We also looked at surveys given to the home from relatives. All information looked at contained positive comments about the home. The registered manager and team leader have written a development plan for the home following the meetings and information gathered during the quality audit. The plan is clearly laid out with straight forward achievable action points. Some of these had already been achieved as the plan had been in action for some months. The team were able to demonstrate that they are looking at ways to continue to develop the service. There are clear records in the home that are easy to find in the office when needed. The staff know where the policy file is to refer to when needed. The home has risk assessments for the building and working practicies. Staff receive necessary training for the health and safety of the people living in the home and working in the home. Records are kept for precautions regarding fire safety and for environmental health. This outcome group has been rated excellent because the registered manager and team leader have made sure that each persons needs have been properly assessed and have provided the equipment, activities and support to meet their needs. They have also demonstrated that they are committed to reviewing and improving the service provided to the people living in the home. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 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 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 Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - 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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