Inspection on 05/10/05 for Gate House

This inspection was carried out on 5th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 but made no statutory requirements on the home.

Other inspections for this house

Gate House 16/10/08

Gate House 16/11/06

Gate House 25/01/06

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 Announced Inspection 5th October 2005 10:00 Gate House DS0000064755.V256399.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.V256399.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.V256399.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.V256399.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection New registration -Previously inspected as part of main house. 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.V256399.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector carried out the Announced inspection visit to Gate House following its recent Registration change to a registered home in its own right. The inspector assessed progress made towards achieving medication requirements, issued previously to the unit by the CSCI pharmacy inspector when Gate House was still assessed as part of the main House Registration. A reduced number of key minimum standards were also assessed on this visit. The inspection lasted from 10.00 am – 5.00 p.m. During that time, the inspector toured the premises with a member of staff, viewing all bedrooms (with service users permission), and all other areas of the home. The inspector spent time in the communal area with people living at the home, some of whom were able to engage in limited conversation. One person living at the home indicated that they would prefer to be referred to in this report as a ‘client’, however, as the majority were unable to express a preference it was agreed that the term ‘people living at the home’ would be used. During the course of the visit people who live in the home came and went to and from activities either out in the community or at the day centre on-site. The inspector was able to speak with two staff as well as the manager, during the course of the visit, staff spoken with felt that there had been an improvement recently in the support they received following a change in line management. Staff confirmed access to training opportunities. Documentation viewed during the visit included care plans, risk assessments, behaviour guidelines, and staff files. Also viewed were records of personal allowance monies held on behalf of those living at the home, other documentation included accident, complaint records and the fire book. Comment cards were received from 4 care managers/representatives, 2 relatives and 2 of the people living at the home. These were helpful in clarifying some viewpoints or highlighting areas for improvement. What the service does well: The service provides a comfortable, clean and modern environment for people living in the home. Feedback from care managers indicates that the home is working well with some people admitted to the home and this has been a positive outcome for those individuals. A varied range of activities are available including access to an on site day centre. Gate House DS0000064755.V256399.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: 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.V256399.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.V256399.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): 2 New people living at the homes benefit from a full assessment prior to admission, the ability of the home to meet the needs of everyone living at the home could be compromised if the admission criteria are too broad. EVIDENCE: The home is currently full and no new people living at the home have been assessed since January for this unit. Discussion with staff indicated that the process of assessment and settling in can be lengthy and is dependent on individuals and their ability to cope with the pace of change. Assessment information was noted on user files viewed. From discussion with staff in the house, observation of service users at inspection and review of documentation relating to behaviour incident reports, the inspector has expressed the view that a review of the admission criteria should be undertaken to ensure that matching and issues of user compatibility are fully considered. Although these are not issues that have caused concern to care managers or families of service users in the house, the inspector has expressed the view that there are now clearly two disparate groups of learning disabled people living in the house, and that too broad an admission criteria may compromise the ability of staff to meet the needs of both groups effectively. Gate House DS0000064755.V256399.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 People living at the home benefit from having Care plans in place that have been agreed by their representatives/relatives where they are unable to do so themselves. Opportunities are provided for them within daily routines for decision-making and risk assessments are in place to support their daily routines and activities. EVIDENCE: Six out of seven care plans were viewed during inspection, these had risk assessments and behaviour management plans in place in all but one case, and all showed evidence of updating. The home has actively sought to engage with relatives and representatives to ensure they have had an opportunity to comment on the current care plan, and behaviour management strategies, their agreements to current care plans were noted on six files or evidence that the home was pursuing relatives/representatives to agree them. The file of one person living at the home was without a behaviour management plan, however, tracking of behaviour incidents involving this person indicated that they are routinely exhibiting aggressive outbursts towards more vulnerable people in the home, but staff are not working to any strategy in trying to manage or modify this behaviour, and this is a requirement. The inspector has previously highlighted concern that this person may be inappropriately placed and that this behaviour may be attributed to their Gate House DS0000064755.V256399.R01.S.doc Version 5.0 Page 10 incompatibility with the rest of the group, discussion with staff during the inspection indicated that the service user was happy with the environment and staff support which can meet their needs but that they do not perceive the other users they live with as their peers. It is suggested that a medium to long term goal for this individual with their consent should be to seek placement with a compatible peer group, and in the interim seek to provide stimulation and peer support elsewhere that is more commensurate with their abilities. The inspector was satisfied from discussions with staff, reviewing of documentation and observations made throughout the inspection that people living at the home are given opportunities to make basic decisions about their daily routines. The inspector has highlighted, however, a need for the home to seek advocacy input for two people with limited contact from external visitors and this is a recommendation. Risk assessments were noted, although in one instance a risk assessment was no longer accurate as the style of lock used in an individual’s bedroom had been changed, this will need updating. The inspector was also concerned that despite exhibiting a number of aggressive outbursts towards other people living in the home, a risk assessment was not in place for the individual concerned in respect of this, it is recommended that this be put in place. Gate House DS0000064755.V256399.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, 13,15,17 People living at the home have access to some appropriate activities but would benefit from more meaningful interactions with staff and more individualised activities. The home is supportive and enabling of people living at the home to maintain contacts with family and friends. The health of some people living at the home could be placed at risk if staff are not more proactive in offering interventions. EVIDENCE: Some of the more able people living in the home have a varied activity programme that affords greater access to external activities and the community at large. Sessions are also offered to all of the people living at the home at the on site day centre. The inspector has expressed concern that in respect of one person living at the home staff should be seeking access to activities suitable for a young disabled person and not those specifically developed for people with learning disabilities and this is a recommendation. Staff’ are aware of the different needs of this individual and are trying to compensate by providing more stimulation. Gate House DS0000064755.V256399.R01.S.doc Version 5.0 Page 12 The inspector would also wish to see more meaningful interaction between people living at Gate House and their staff, particularly when in house, often staff were observed monitoring people whilst in the house with more of a reactive than interactive approach, and without offering any structured activity that service users could choose to participate in or not. Feedback from representatives and relatives was mixed with relatives who are more closely involved in the home perceiving this to be an area for further development. Three of the people living at the home currently go home at weekends, others have had planned visits home and this is facilitated for them by the staff. All of the people living at the home have relatives and representatives involved to some degree although contact for some is less frequent. The inspector’ viewed a range of weekly menus’ that are rotated over a fourweek period, these appeared varied. People living at the home have been consulted about the current menus at a recent house meeting and their views and comments have been taken account of and menus are to be amended accordingly. Individual user food preferences, allergies etc were clearly available to staff in the kitchen, consideration should be given as to whether this information can be provided more discreetly in a folder, rather than openly for everyone who accesses the kitchen to see. Food is prepared by staff’, some people living in the home make snacks etc with staff support, and others participate in shopping trips for the home. The unit has its own food budget, staff spoken with felt that the current budget was adequate. Feedback from relatives in respect of one person living at the home highlighted concerns that they have lost a significant amount of weight, through an inability to always eat their meals fully owing to their condition. The home have consulted with the GP and the family in respect of concerns about weight loss in this individual and weekly monitoring of weight is being undertaken. Agreement will need to be reached by all parties concerned as to the best way of managing this current problem and whether home staff need to be more actively offering intervention to ensure adequate food is eaten in a timely manner, these are recommendations for improved practice Gate House DS0000064755.V256399.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): 18.19, 20 Staff’ demonstrate a good understanding of the needs and preferences of the people living at the home, some of whom are more able to make active choices and decisions for themselves than others. The Home actively seeks support and advice in respect of the health needs of people living at the home but could be more proactive in recognising and responding appropriately to their emotional needs. The home has made progress in addressing requirements for improved medication administration. EVIDENCE: Discussions with staff and observation of them with the people living in the home during the course of the inspection, indicated a good understanding of individual needs, and preferences in respect of daily routines and general support. An informal gender care policy is in place, but in view of the vulnerability of some of the people cared for, it is recommended that the home formalise the policy and make staff fully aware of this. The inspector was satisfied that the home are appropriately seeking advice from health professionals and actively accessing health care for those living at the home. Feedback from representatives and relatives suggests that communication is not always as good as it could be in respect of up to date health information, (see standard 38). Gate House DS0000064755.V256399.R01.S.doc Version 5.0 Page 14 The inspector was not satisfied that sufficient attention was being afforded to the needs of an individual at the home who clearly has different needs to others living at the home. The inspector has recommended that the home actively seek to develop an activity programme to improve stimulation for this individual, with peers of similar abilities and affords opportunities to maximise their potential for more independence, (see standard 6). The home has made progress in addressing a number of outstanding requirements and recommendations in respect of appropriate medication administration. One requirement remains outstanding as this has only partially been addressed by the home, they are still to provide training for staff in the administration of suppositories specific to individual users; although the home has tried to obtain training for this they have to date been unsuccessful, and further clarification as to where training can be obtained is to be sought from the CSCI Pharmacy inspector by the Home manager. The inspector viewed MAR sheets, medication storage, PRN guidelines, staff medication training and specimen signatures, and was satisfied with the current arrangements. Medication consents are in place for all but one person living at the home and it was hoped that this would be resolved following the visit of a care manager. The home have not as yet initiated monitoring of liquid medications, but on discussion with the inspector have agreed to date liquid medications upon opening which will enable the home to monitor usage better, a system for recording this is to be introduced, this remains an outstanding recommendation. Gate House DS0000064755.V256399.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 The Home has a complaints procedure, but need to actively ensure that people living at the home, their representatives, and relatives are familiarised with it. Systems are in place for the appropriate management of money belonging to people living at the home, these arrangements would benefit from better consultation with relatives and representatives in respect of expenditure with greater clarity in records kept. EVIDENCE: The Registered manager for the Eastry site has oversight of the management of Gate House, and maintains a centralised complaints record. The Home has received two complaints since the unit opened, both from neighbours. The home was able to evidence that the investigation was appropriately carried out and the issues resolved to the complainants satisfaction. Feedback from representatives and relatives was mixed, in that three out of four care managers who responded said they had not had to make complaints, and a further failed to respond to this question, relatives feedback indicated that although they had not had to make a complaint, neither were they familiar with the Homes complaints procedure. It is recommended that the home actively ensure that all relatives and representatives are fully aware of the process for making complaints. The personal allowances and savings of people living at the home are managed and held by senior staff, the inspector checked the personal allowances of two people against the records held and found these to be accurate. The inspector expressed concern that the personal allowances of some people were being allowed to mount up and that the total of monies held for the whole group amounted to a figure over that provided for in the Homes insurance cover, it is therefore, recommended that the home make provision to bank monies more Gate House DS0000064755.V256399.R01.S.doc Version 5.0 Page 16 frequently to ensure the home stays within amounts covered by insurers. It is further recommended that the home provide a safe and secure facility for personal allowance monies and the homes housekeeping float, which is lockable, in a fixed position and access is limited to those responsible for the management of the money within the staff team. Expenditure from personal allowances was supported by the provision of receipts. All people living at the home have a personal savings account, statements of individual accounts indicated some expenditure but the manager was unable to confirm at inspection what these amounts were for, concern has been expressed by a representative of someone living at the home that expenditure from client monies has been sanctioned by the home without authorisation or consultation with themselves. It is recommended that arrangements for authorisation of expenditure from the savings accounts of people living at the home is agreed with all authorised care managers, official representatives or relatives, and that all income and expenditure is clearly documented in detail. Gate House DS0000064755.V256399.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): 24-30 The home, provides a safe comfortable and clean environment for people living at the home, in which they are enabled and supported to personalise their own space in line with their own taste and preferences, the home must actively ensure that equipment brought into the home for use by individuals is appropriate and suited to their needs. EVIDENCE: A tour of the building and the bedrooms of people living at the home (with their permission), highlighted that the home was maintained to a good standard of cleanliness. There are issues of incontinence for several people living at the home, but there were no noticeable odours within the communal areas or individual bedrooms. Communal areas are free from clutter, comfortably furnished and are light and airy. One bedroom viewed is currently having a replacement bath installed, remedial works to ensure this is finished off properly ensuring the bath and pipe-work are covered will need to be undertaken in a timely manner. Bedrooms viewed were clean and tidy, some being more personalised than others dependent on the individuals and their ability to cope. Incontinence in Gate House DS0000064755.V256399.R01.S.doc Version 5.0 Page 18 one bedroom has caused some damage to an item of furniture; this has been reported and looked at with a view to replacement. It is recommended that the replacement of this item be progressed as a matter of priority, as the edges are rough where covering has peeled away and may cause an injury to the person living in that bedroom. It was evident from discussion with staff that the views of parents and representatives are taken account of in respect of the layout and look of people’s bedrooms, however, these should at no time override the wishes and preferences of the person themselves or inhibit the development of their independence, where they are able to make clear their own views. A tour of the kitchen revealed some damage to the side of worktops, this has been reported and repairs are planned, as damaged worktops can pose a risk of infection it is recommended that this be attended to at the earliest opportunity. A cot side was noted in use in one bedroom, although this has been brought from home the Registered manager and staff are responsible for ensuring that the cot side is still appropriate and that the gaps between the rails meet current requirements, this should be clarified with the district Nurse. The use of the cot side must be recorded within the individuals’ care plan, along with the outcome of consultation with the district nurse and this is a recommendation. The home are reminded that they must ensure that any equipment brought into the home by people living at the homes must be checked to ensure it is in good working order, and is in keeping with current best practice in relation to equipment specifications, and document that these checks have been made. The laundry was clean and well equipped, however, a higher level of incontinence amongst some people living at the home at times places pressure on the current equipment available, which is for domestic usage only. The home has a sluice facility but the current model of washing machine does not have a sluice cycle, The tumble dryer is inadequate to dry clothes within a reasonable period of time, this sometimes requires staff to use time in the main house laundry, which will leave a staff shortage in the home while they are away. This is not a satisfactory arrangement and it is recommended that the home consider replacing the current equipment with semi-industrial models which will cope better with the amount of increased soiled and normal laundry produced by the people living at the homes and free up staff time from laundry duties. Gate House DS0000064755.V256399.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): 33, 34, 35,36 The Home needs to ensure it maintains a satisfactory level of staff to provide consistent quality and continuity of care to the people living at the home, who could be placed at risk by a failure to adopt a more rigorous approach to recruitment checks made on staff. A programme of training is in place for staff, but people living at the home could be placed at risk by staff not having achieved all mandatory core skills training. Staff feedback indicates there has been an improvement in the support they receive, but this needs to be underpinned by regular staff supervision. EVIDENCE: Rotas provided for the inspection indicated that whilst predominantly a ratio of 5:7 staff to people living at the home is maintained where possible, this is not always the case with in some instances only 3:7 ratio in place, discussion with staff indicated that they feel that a 5:7 ratio is a satisfactory level of staffing to meet the current needs of the people living at the home, and provide flexibility to support them in their activities, a ratio less than this begins to impact on the daily routines of the house and the people living there. It is recommended that the home continue to provide a 5:7 staff ratio to ensure the continuity of care and support is maintained for those living in the home. Three staff files were viewed and confirmed that the home is adhering to recruitment legislation in respect of undertaking POVA and CRB checks, and seeking two written references. The inspector raised some concerns that the home were however, unable to evidence clearly how they had come to Gate House DS0000064755.V256399.R01.S.doc Version 5.0 Page 20 decisions in respect of some staff appointments where clearly issues had arisen from checks made. The home manager has been reminded that where issues around CRB’s arise the manager should be clearly documenting actions taken, which support and inform the decision to employ or not, and should include what measures have been put in place to monitor and supervise the individual if they are employed. Actions taken may include requiring a second interview, and the pursuit of additional references, and these are recommendations for improved practice. Staff spoken with confirmed access to training, and a programme of training is in place, however, staff turnover has meant that the current staff team have not as yet achieved all mandatory training and this will need to be prioritised over the next few months particularly Moving and Handling training, and this is a recommendation. Progress will be monitored at the next inspection. The Home has made slow progress in implementing formal staff supervision, two staff have currently received supervision to date although a programme of planned supervisions with staff was viewed at inspection, it is recommended that the Home ensure that now commenced staff are provided with regular supervision time and the frequencies of supervision should be maintained. Gate House DS0000064755.V256399.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): 37,38, 42 People living at the homes will benefit from improved oversight by the Registered manager to ensure the service is well run; more open communication between the home and their representatives/relatives some of whom feel the home makes decisions without consultation. Systems are in place to ensure the health and welfare of people living at the homes is protected, but these can be improved upon. EVIDENCE: The registered manager is an experienced and qualified manager who has oversight over the main home and several satellite homes on the site including Gate House. The manager and staff indicated that there had been some recent issues in the support offered to staff and the effectiveness of the day to day operation of the home but these had been addressed following changes to the team leader post and improved monitoring and oversight by the registered manager of the day to day operation of the home, staff confirmed they felt better supported and felt that issues raised by them were now being addressed by the management team. Gate House DS0000064755.V256399.R01.S.doc Version 5.0 Page 22 Feedback from relatives and representatives was mixed, with some relatives/representatives indicating that they are not always given clear information about their relatives/friends welfare, or notified routinely of important matters e.g. occurrence of accidents however, minor or clarification around expenditure of personal allowance or savings monies. The home manager advised that whilst close family members and care managers would be routinely informed of all of these issues should they arise, this would not be extended to interested parties unless they had some legal authority to receive such notifications(See standard 23). Other representatives spoke positively about the service provided by the home, and felt well informed regarding their respective people living at the home. Feedback from staff, indicated that recent changes to the management of the home had improved staff morale and they now felt their ideas and suggestions were being put forward, and that they were able to influence the service to some degree. Staff confirmed access to staff meetings, minutes of these were viewed at inspection. Policies and procedures, recruitment of staff, complaints etc are all dealt with centrally, with assessment of prospective people requiring admission to the home is undertaken by the client care department, the home are still to evidence how staff, people living at the home and their representatives/relatives influence change and development in the operation of the home. The inspector is aware that a quality assurance procedure and policy are currently under development by Family Care Homes Ltd, that will be disseminated across all units, progress on the development of quality assurance in this unit will be monitored at the next inspection. The inspector viewed the fire book and was satisfied that tests and checks of fire detection and fire fighting equipment are happening within expected frequencies. Fire drills’ are recorded; the home need to ensure that all staff have participated in a minimum of two drills within a twelve-month period and this is a recommendation. A record of accidents for the home was assessed, since March 2005 17 accidents have been recorded, all were of a minor nature requiring minimal intervention; none required a visit to A&E. The frequency of accidents was spread evenly between the people living at the home group. It is recommended that the home ensure that relatives and representatives who have expressed an interest in receiving regular feedback are advised of all accidents including minor accidents. Whilst the inspector is satisfied that the appropriate checks and servicing of equipment and services is happening to provide a safe environment, the home will need to ensure that the welfare of people living at the home is not compromised by a failure to provide staff with mandatory core skills and more specialised training (see standard 35), and ensure that outstanding repairs are achieved in a timely manner. Gate House DS0000064755.V256399.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 2 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score 3 X 3 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Gate House Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 2 X X X 2 X DS0000064755.V256399.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 6 Regulation 15 Requirement Timescale for action 05/11/05 2 20 13(6)&18 (1)©(i) Behaviour management guidelines to be established for people living at the home discussed at inspection, copy to be submitted to CSCI All staff administering rectal 30/11/05 diazepam and suppositories have received training specific to individual people living at the home (partially met within previous timescale of 30/6/05 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 7 9 Good Practice Recommendations Home to seek advocacy support for two people living at the home. Risk assessment in respect of changed locks to be amended for one individual. Risk assessment to be developed for another individual exhibiting aggressive outbursts towards other people living at the home For one person living at the home discussed at inspection home staff to access activities suitable for younger DS0000064755.V256399.R01.S.doc Version 5.0 Page 25 3 12 Gate House 4 15 5 6 7 8 18 20 22 23 disabled people and not those specifically developed for people with learning disabilities. Home to seek advocacy for two people living at the home with limited external contacts. Home staff need to be more actively offering intervention to ensure adequate food is eaten in a timely manner and that a people living at the home is not left with food in front of them for long periods, difficulties around eating for this people living at the home should feature in the care plan with agreed strategies for managing it by the home clearly documented. Weight loss must be closely monitored and advice sought from health professionals Gender care policy to be drafted and all staff made aware of. Liquid medications to be dated upon opening, home to introduce system for monitoring the use of liquid medications. The home is to actively ensure that relatives and representatives are familiar with the process for making a complaint. The Home to make provision to bank personal allowance monies more frequently to ensure the home stays within amounts covered by insurers. The home to provide a safe and secure facility for personal allowance monies and the homes housekeeping float, which is lockable, in a fixed position and access is limited to those responsible for the management of the money within the staff team. Arrangements for authorisation of expenditure from savings accounts and personal allowance monies of people living at the home are agreed with all representatives/relatives, and that all income and expenditure is clearly documented in detail. Damaged worktops may pose a risk of infection and need to be repaired. Home to replace damaged chest of drawers in bedroom highlighted at inspection. The use of the cot side must be recorded within the individuals care plan, in addition to the outcome of consultation with the district nurse. The home to consider replacing the washing machine/tumble dryer with semi-industrial models, that will cope better with the amount of increased soiled and normal laundry. The home to maintain 5:7 staffing ratio where possible to ensure continuity of care and support The home is reminded that where issues around CRB’s arise the manager should be clearly documenting actions DS0000064755.V256399.R01.S.doc Version 5.0 Page 26 9 10 11 12 24 26 29 30 13 14 33 34 Gate House 15 16 15 35 36 42 taken, which support and inform the decision to employ or not, and should include what measures have been put in place to monitor and supervise the individual if they are employed. Actions taken may include requiring a second interview, and the pursuit of additional references. All mandatory staff training will need to be prioritised over the next few months particularly Moving and Handling training. The Home ensure that staff are provided with regular supervision time and the frequencies of supervision should be maintained. The home to ensure that all staff have participated in a minimum of two drills within a twelve-month period. Relatives and representatives who have expressed an interest in receiving regular feedback are to be advised of all accidents including minor accidents. Gate House DS0000064755.V256399.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. Extracts may not be used or reproduced without the express permission of CSCI Gate House DS0000064755.V256399.R01.S.doc Version 5.0 Page 28 - 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. 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