Inspection on 25/01/06 for Gate House

This inspection was carried out on 25th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gate House 16/10/08

Gate House 16/11/06

Gate House 05/10/05

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

CARE HOME ADULTS 18-65 Gate House High Street Eastry Sandwich Kent CT13 0HE Lead Inspector Michele Etherton Unannounced Inspection 25th January 2006 09:55 Gate House DS0000064755.V269032.R01.S.doc Version 5.0 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 DS0000064755.V269032.R01.S.doc Version 5.0 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 DS0000064755.V269032.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Gate House Address High Street Eastry Sandwich Kent CT13 0HE 01304 611600 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) Family Care Homes Limited Miss Rosemary Chapman Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th October 2005 Brief Description of the Service: Gate House is a purpose built unit within the grounds of Eastry House. Gate House offers a service to a mixed sex group of seven younger adults with learning disabilities, complex needs and challenging behaviour. Gate House has recently obtained its own registration, although the Manager of Eastry House will retain the overall management responsibility for the home. The unit is modern in design, and this is reflected in the minimalist style of the décor 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. The staffing ratio of the unit is on a 5:7 basis. Currently there is one waking night staff with access to back up from the main house if needed in emergency. An on-call person is also available by phone if required. People living at the home have access to a range of activities in community and educational opportunities through college attendance for specific courses, they are also able to access the day centre next door for sessions of particular interest to them. Access to Gate house is either via the main house or through the main gates into the grounds of the main house and the day centre and one other unit, the main gates are usually kept locked. 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 also available. A bus service is available to Eastry and runs through the high street, the village has a number of small shops, two pubs, and a post office. Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit undertaken over approximately 4 hours between 9.55 am and 2.05 p.m. The focus of the inspection was to assess the progress made by the home towards achieving outstanding requirements and implementing good practice recommendations. A reduced number of remaining key inspection standards were also assessed at this visit. The inspector made a tour of the premises, met and spoke with the registered manager and three care staff. The inspector met and observed all but one of the current user group (one person being away at college). The inspector spoke in more depth with one service user, unfamiliarity with the inspector and communication difficulties made it difficult for the inspector to engage in any meaningful conversation with the rest of the user group although, the inspector made observations of them and their interactions with staff and each other during the course of the visit. What the service does well: What has improved since the last inspection? What they could do better: The Inspector has highlighted a need for the home to evidence an induction training programme is in place that is in keeping with sector skills council standards, and to ensure core skills training has been achieved for all staff within six months of employment at the home, a failure to provide basic core skills training could compromise the health and safety of service users and Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 6 staff. The home is still to develop a quality assurance programme and systems for self-auditing, and the home is unable to evidence any link between user, staff, other interested parties feedback and how this might be influential to the development of the service. In the inspectors view, the home places an over reliance on the use of psychiatry input in the management of behaviour and should give greater consideration to the equal role of psychology services in the management of user behaviour and the establishment of appropriate staff guidelines, particularly in those cases where service users behaviour has failed to respond positively to established staff behaviour management guidelines and medication reviews. 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 DS0000064755.V269032.R01.S.doc Version 5.0 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 DS0000064755.V269032.R01.S.doc Version 5.0 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): New service users benefit from a full assessment of their needs prior to admission, this will be enhanced by the proposed improvements to the involvement of staff and existing service users. EVIDENCE: Although assessed at the last inspection, the occurrence of a vacancy within the unit has precipitated the assessment of prospective service users. The client care department deals with new referrals initially; only those deemed appropriate to the unit will be progressed. The inspector was assured that previous concerns raised at inspection, as to the degree of involvement of unit staff and existing service users in the assessment process and its final outcome, have been taken into consideration by the client care department who will be actively involving staff and seeking feedback from them and either observed or verbal user interactions/feedback with prospective service users during the assessment period. The inspector welcomed this development and will be monitoring how this has worked in practice at the next visit. Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 9 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 Individualised support plans are in place that are reflective of current behaviours and risks EVIDENCE: The inspector viewed three service user files, to assess whether the home had adequately addressed areas for improvement highlighted at the last inspection. The inspector was satisfied that up to date and accurate behaviour plans and risk assessments are currently in place for service users discussed at the last inspection, and that a previous requirement and recommendation have been addressed in respect of standards 6 and 9. Discussion with staff indicated that concerns expressed previously at the lack of involvement of unit staff in the development of behaviour management guidelines have been taken into consideration by the client care department who are now actively involving staff, feedback from staff in respect of this change was very positive, with staff feeling listened too and their input valued. The home has made little progress in identifying advocacy support for two service users identified at the last inspection, one service user has now moved on, and discussion focused on the importance of enabling the remaining Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 10 individual to access appropriate advocacy support in keeping with their needs, the home have agreed to establish whether a local Headway group will be able to provide this and this remains an outstanding recommendation. Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 11 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): 12, 15, 16 Individualised activity programmes are in place for all service users, and the home is actively engaged in seeking needs appropriate activities for one user, over and above that currently available in house. Service users benefit from the development of menus that offer a healthy and varied diet in keeping with their preferences, and supports weight reduction plans. Service users rights are respected and upheld where this does not compromise their safety or the safety of others. EVIDENCE: Service users are offered an individualised programme of activities that incorporates use of the day centre on site, access to college and also external activities that includes use of community facilities to undertake, swimming, trampolining, etc. The home has actively taken on board a previous recommendation and concern expressed that the needs of one user could not be met satisfactorily within activities established to meet the needs of learning disabled adults. As a consequence of this the home have made contact with a local Headway group, and enabled two visits to take place, further visits are subject to funding from the local authority concerned, and the home will actively pursue this on the service users behalf at their next review. Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 12 The inspector was pleased to note an increased interaction between staff and residents at this visit, discussion with staff indicated that there was a reduced reliance on agency staff, therefore staff knew the service users well and were able to interact with them and offer appropriate activities to provide stimulation. A previous recommendation in respect of meals, staff intervention at meal times and weight monitoring was specific to an individual who has now left. The inspector viewed the menus, these are varied and staff indicated they have been developed with the involvement of service users; none of the present user group have difficulties in eating their meals although discreet staff intervention is available where needed. Staff indicated that users are weighed monthly using a sit down scale at the main house. The inspector was made aware that two users are to commence a weight reduction diet and this has been discussed with their GP, menus will be adjusted to reduce those meals with a high fat content and replace them with healthier alternatives. Observation of service users at inspection, their interactions with staff and feedback from staff indicated that service users are restricted from unsupervised access to the kitchen area although moved freely around the home and accessed the garden area without any noticeable restriction. Staff indicated that service users are enabled to access the kitchen to make snacks and drinks where able to or participate in the laundry process all with staff support, users were observed going to their rooms, and staff noted respecting their privacy. Clearly many of the people living in the house have complex behaviours that require a greater degree of staff supervision, and involvement with day to day activities, within these limitations and the need to ensure the safety of all service users the inspector took the view that staff try to uphold the rights of the service users and to enable them to be as independent as possible. Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 13 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, 20 The development of a formal gender care policy by the company would support good practice within the house. The integrity of improved practice recommendations in the administration and recording of medication could be compromised by a superficial adherence to them. EVIDENCE: The unit has addressed a gender care issue in the home identified at the last inspection, this is an arrangement specific to the unit and would best be supported within a formal gender care policy across all units, discussion with the manager indicated this is still under development and remains an outstanding recommendation. A previous requirement in respect of the administration of suppositories and rectal diazepam has been partially addressed in that the home are aware that CSCI have been advised by a PCT representative that the administration of suppositories are a function that should be undertaken by a district nurse, and that in the case of one service user their PRN guideline for this medication should clearly state this and need amending and this is a recommendation, the home has been proactive in seeking training for staff in the administration of rectal diazepam, but have been unable to find any that deals with the needs of specific service users, and the local health authority has indicated this is not available, as such this part of the requirement has been referred back to CSCI Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 14 pharmacy inspectors for further clarification. The inspector noted that PRN medication has been administered to another service user, although PRN guidelines have not been drafted for staff to follow in this case, it is a recommendation that this is addressed. The inspector whilst pleased that the unit had partially implemented a previous recommendation to improve the administration and recording of medication in the home, by the dating of all liquid medications upon opening, the additional recommendation to develop and implement a recording system for the usage of liquid medications, however, had been less effective, although in use, the recording system was not being actively monitored. There was little clarity as to who was responsible for monitoring, how recording should be undertaken, and the detail contained on the record sheet, was inadequate to inform the auditor and enable easy identification of anomalies. This was discussed fully at inspection and it was agreed with the manager that the recording system and procedure needed strengthening if this was to be an accurate auditing tool for medication usage, Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 15 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 Service users have access to a copy of the complaints procedure, but their authorised representatives and relatives would also benefit from access to and familiarisation with the complaints procedure. Arrangements for the management of user personal allowances within the home have been strengthened to provide additional safeguards for service users from financial abuse, and further improvements can be made. The appropriate management of behaviour could be compromised by a failure to seek professional psychology input for those service users whose behaviour continues to deteriorate or fail to respond to behaviour management strategies. EVIDENCE: A copy of the complaints procedure provided in widget is displayed in the home and accessible to service users, no progress has been made to date in providing copies of complaint information to relatives, or authorised representatives who have indicated in previous feedback that they are unaware of the complaints procedure. The Home manager has agreed to make copies of the procedure available to existing users relatives/care managers etc would be provided with a copy within the user guide. This remains an outstanding recommendation until this has been addressed. The previous inspection highlighted several issues in respect of the management of user finances. The inspector was pleased that the home had responded positively to these issues and has introduced a £50 limit for each service user on the amount of cash that can be held for them at any time. The Team leader for the home audits records of user finances on a weekly basis and it is recommended that a counter signature be obtained from another staff member who should witness this procedure. The home have reviewed the safety and security of their lockable facilities and who has access to it, senior staff need to ensure that they adhere to their own security arrangements and Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 16 that this is kept locked at all times other than when in use. The Home manager stated that agreement was in place with all representatives and relatives as to what amount the home is allowed to spend without seeking additional authorisation. More detail is still needed however, in documenting expenditure and income, this was discussed with the manager at inspection and remains an outstanding recommendation. Discussion with staff indicated that they are more actively involved in the development of behaviour management guidelines, and that the providers are providing training for staff in the development and implementation of behaviour management for specific service users in the unit. Feedback indicated that service users received psychiatry input, with some behaviour management managed through medication review, however, where service users behaviour was continuing to deteriorate or was not responsive to established guidelines, the home should actively be involving professional psychology services, to look more closely at functional assessment information, analysis of behaviour and the formulating of a behaviour management strategy. Discussion with staff in respect of a present users behaviour indicated that there has been no psychology input despite current behaviour strategies failing to address increasing levels of aggression. It is a recommendation that the home involve psychology services or seeks referral to psychology input via care managers, where behaviour strategies have proved ineffective. Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 17 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): 24,26,29,30 The home has been proactive in addressing the majority of environment shortfalls highlighted at the last inspection, and this has been of direct benefit to service users and staff. EVIDENCE: Damaged edging to kitchen worktops highlighted at the last inspection is receiving attention by the home whose maintenance team are investigating the best options for addressing this damage without the need to replace the work tops themselves, which are less than 2 years old. Discussion with the manager indicated the delay is due to the need to ascertain the likely longevity of any repair, or impact that it may have on service users who use the kitchen in respect of health & safety. This remains an outstanding recommendation. A damaged chest of drawers within a service user bedroom has been replaced temporarily whilst another is sought that more appropriately meets their specific behavioural needs. A previous recommendation in respect of a cot side was addressed by the home by the involvement of the district nurse. The home have replaced both the washing machine and tumble dryer for the home, the new models are semi-industrial and can cope with a greater load Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 18 capacity. Staff spoke positively of this change that had freed up their time significantly from having to utilise the main house laundry, thus reducing staff numbers in the house. Staff’ were confident that the current facilities adequately met the laundry needs of the unit without recourse to the main house laundry and as a consequence more staff were available in the house to spend time with service users. On the day of this visit the home was clean, warm and well maintained. Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 19 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): 32,33,34,35,36 Service users are supported by a satisfactory number of wellsupervised staff that have been appropriately recruited, their health and well being could be compromised by shortfalls within the induction, core skills, and qualification training programmes within the home. EVIDENCE: Since the last inspection, there has been a further loss of some staff, whilst this was causing some shortfalls in staffing hours, existing senior staff, spoken with at inspection felt that the move to reduce the use of agency workers, and cover shortfalls in staffing hours from within the existing staff team was a positive move; it provided greater continuity for service users and Staff’ were favourable of this arrangement finding little value in having to continually supervise agency workers unfamiliar with service users or their routines. Staff feedback indicated that with the departure of a service user who required 1:1 staffing, a reduction in staff numbers by one on a weekday basis is satisfactory for the present number and dependency of users, this figure is reduced at weekends to reflect the fact that at least two service users regularly go home on some weekends, one of these being the only other 1:1 user. The inspector was satisfied that the home is adjusting staffing levels appropriately to reflect the numbers and dependency of users. The home is currently recruiting to existing vacancies. A new staff member was met with at inspection, and confirmed that they felt well supported and supervised, they were familiarising themselves with service user files and Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 20 routines and were reading policies and procedures, they did not understand that they were participating in an induction programme and there was no evidence within their staffing documentation to indicate this was occurring formally and being documented. Staff recruitment information relating to the newest staff member was assessed on this occasion and found to contain relevant documentation required by schedule 2 of the Care Homes regulations 2001, 2 recorded verbal references and one written reference were in place, the home has not received a response for request for a second written reference. The inspector has recommended that where prospective staff give more than two referees the home should actively pursue all referees. As a result of staff turnover the home has not achieved the qualified staff target, although a training programme is in place for those who have been in post for more than six months, and an NVQ assessor was observed in the home, undertaking assessment of some staff currently on the training programme. A review of staff training records indicated shortfalls for a number of existing staff in respect of achieving core skills training. It is a requirement that staff receive the necessary 12-week induction in keeping with sector skills council induction (and for staff new to Learning disability this should include LDAF training, in addition mandatory core skills training is to be provided within 6 months of commencing employment. Discussion with staff indicated that a regular programme of formal recorded supervision is happening, staff spoke positively about these sessions, which they found useful and supportive. Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 21 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): 39,42 Minimal progress has been made to implement a quality assurance system within the unit or to evidence how service users and other stakeholders feedback influences service development. The home has taken on board shortfalls in systems within the home to protect and promote the health and safety of users, but further improvements are suggested. EVIDENCE: Discussion with the manager and staff within the unit indicated that although user meetings are happening, there is currently no forum or system for engaging with other interested parties e.g. relatives and authorised representatives, a service development plan is not currently in place, and there is currently no link between feedback from staff, users and other parties into its development. The inspector is satisfied that the provider is developing a quality assurance system to operate across all of the homes within the group, but this has not as yet been extended to Gate House, this remains an outstanding recommendation and its implementation will be monitored at the next inspection. Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 22 The inspector assessed progress made by the home in addressing participation by staff in fire drills. The fire book was assessed, whilst generally recording of equipment and alarm systems are undertaken regularly, there was a two week break noted for both the emergency lighting and fire alarm systems tests. Visual checks of fire’ fighting equipment is routinely being recorded in keeping with expected timescales. An improvement in the recording and number of staff participating in a minimum of two fire drills every 12 months was noted at this visit, improvements to the clarity were recommended in that staff commencement of employment dates should be included, and staff initials used on subsequent pages to aid tracking. Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X 3 X X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Gate House Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score X X 2 3 X 3 X DS0000064755.V269032.R01.S.doc Version 5.0 Page 24 Yes 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 YA20 Regulation Requirement Timescale for action 31/03/06 2 YA35 13(2)13(6)18(1)© All staff administering rectal diazepam have received training specific to the needs of individual people living at the home (partially met within previous timescale, awaiting clarification by CSCI Pharmacy inspectors). 18(1)(c ) That staff receive the necessary 12-week induction in keeping with sector skills council induction (and for staff new to Learning disability this should include LDAF training, in addition mandatory core skills training is to be provided within 6 months of commencing employment. 31/03/06 Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 25 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 YA7 Good Practice Recommendations Home to access appropriate advocacy support from local Headway or physical disability group in keeping with a service users needs. (Outstanding from previous inspection) Formal gender care policy still to be developed across all units. (Outstanding from previous inspection) Home to strengthen system for recording usage of liquid medications, and to actively monitor these records for anomalies (as discussed at inspection)(Partially addressed from previous inspection) PRN guideline for a suppository medication should clearly state this is to be administered by the District Nurse or a GP. PRN guidelines are needed for service user discussed at inspection in respect of Paracetamol. Home to actively ensure that relatives and authorised representatives are familiar with the process for making a complaint. (Outstanding from previous inspection) Senior staff need to ensure that they adhere to their own security arrangements in respect of the lockable facility for monies held within the unit and that this is kept locked at all times other than when in use. A counter signature is recommended when auditing weekly finance records from another staff member involved in the procedure. More detail is still needed however, in documenting expenditure and income, this was discussed with the manager at inspection and remains an outstanding recommendation (partially addressed from previous inspection) That the home involve psychology services or seeks referral to psychology input via care managers, where behaviour strategies have proved ineffective. Where prospective staff give more than two referees the home should actively pursue all referees. The home is to implement a quality assurance and self audit system and can evidence how and when service user, staff and other interested party’s feedback is influential in service development. Staff commencement of employment dates should be DS0000064755.V269032.R01.S.doc Version 5.0 Page 26 2 3 YA18 YA20 4 5 YA22 YA23 6 7 YA34 YA39 8 YA42 Gate House included in the fire drill/instruction record, and staff initials used on subsequent pages to aid tracking of frequency of participation. Gate House DS0000064755.V269032.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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. 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