Inspection on 09/02/07 for Gate House

This inspection was carried out on 9th February 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gate House 09/09/08

Gate House 27/09/07

Gate House 15/06/06

Gate House 05/12/05

Gate House 19/07/05

Gate House 04/11/04

Gate House 16/06/04

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

CARE HOME ADULTS 18-65 Gate House 238 New Cross Road London SE14 5PL Lead Inspector Ornella Cavuoto 9 - 12 th th Unannounced Inspection February 2007 10:00 Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gate House Address 238 New Cross Road London SE14 5PL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0207 6356883 Mr Lynval Palmer Mrs Marjorie Palmer Ms Hazel May Parkinson Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. As agreed on 27th June 2006, one service user over the age of 65 years, with a mental disorder, can be accommodated. 15 June 2006 Date of last inspection Brief Description of the Service: Gate House is a care home providing support and accommodation for up to nine men and women who have support needs due to mental ill health and who are aged between 18 and 65 years of age. Accommodation is provided in 5 single and 2 double rooms. Service users admitted to the service have to be relatively physically able as access to the upper floor is via a staircase. The home is privately owned and located in a residential area of New Cross Road in South East London with good access to London Underground and mainline rail stations at New Cross Gate. There are also a number of bus routes stopping close to the home. Service users also have access to a wide range of local amenities and community resources. The home makes information available about the service they provide to potential service users on request by phone or letter. Also CSCI inspection reports are made available on request. The home’s monthly fees are £650.00 as from January 2007 and no additional charges are made. This information was provided to CSCI February 2007. Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over two days. The registered manager was not available on the first day that the inspection was held but was present on the second day and helped to facilitate the inspection process. One of the registered owners was also present at the inspection. Two staff members were spoken to as part of the inspection and four service users. Case tracking methods were used with two of the service users spoken to. Other inspection methods used included inspection of care records and a full tour of the premises. It was identified at this inspection that some progress had been made by the home to comply with requirements that had been specified with seven of the previous requirements having been met. However, a number of previous requirements that have been carried over from the last two inspections have either only been partially met or not met. This needs attention with the home clearly outlining how it intends to ensure these requirements will be met as continued non –compliance will lead to enforcement action being taken. What the service does well: Service users spoken to were generally positive about the home and the support they receive from staff. One service user spoken to said, “I’m happy here” and regarding their key worker, “ She does support me well”. Another service user said regarding living at the home, “I get everything I want” and regarding staff “ If I ask them to do anything for me they’ll do it”. Service users are supported to make their own decisions and to be as independent as possible. Service users are supported to access training and employment opportunities. Service users make use of the local community and facilities. Service users are able to maintain family links and develop personal relationships. Service users receive flexible support to meet their individual needs. Physical and mental health needs of service users are addressed and monitored. The home has robust procedures in place to ensure that service users are protected from abuse and support staff have received training in this area. Support staff are supported to obtain appropriate qualifications to ensure the needs of service users are met effectively. The home ‘s recruitment practices ensure service users are protected. Staff receive regular supervision. Regular service user meetings are held to give service users an opportunity to give their views on various aspects about living in the home and surveys have also been issued to them. Gate House DS0000025620.V329927.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An updated statement of purpose has been drawn up but the service user guide still needs to be completed to ensure prospective and current service users have all the information they need about the service. Prospective service users needs have been fully assessed. Service users have been issued with terms and conditions but these have not all been signed by service users. EVIDENCE: At the last inspection it was found that the statement of purpose and the service user guide did not contain all the information required by regulation and the standards. It was also evident that neither document had been reviewed for some time. At this inspection the registered manager provided evidence of an updated statement of purpose that generally included all the information required by regulation apart from the home’s admission criteria that needs to be added. However, the registered manager reported that the service user guide had yet to be revised and updated (See Requirements). The home has had one new admission since the last inspection. The personal file of the service user was inspected and there was evidence that the service Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 9 user’s needs had been fully assessed with relevant reports and the last Care Programme Approach (CPA) review having been obtained. A requirement had been issued at the last three previous inspections that the registered provider must ensure that all service users are issued with a statement of terms and conditions that includes all the information as outlined within standard 5.2. It was found at this inspection that a statement of terms and conditions had been drawn up that generally did include all the information required apart from the room number occupied by the service user was not specified that needs to be added. All the personal files of service users included a copy of the document. Although this meets the previous requirement only one was identified as having been signed by a service user to indicate they had read and understood the document. In addition, as well as a copy being retained on their files all service users should receive their own copy. This needs to be addressed (See Requirements). Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans were comprehensive with changing needs and personal goals being reflected. There was evidence that service users have been supported to make their own decisions. Risk assessments still did not clearly address all risks presented by service users in particular how risks associated with their mental health problems were being managed EVIDENCE: At the last inspection it was identified that although care plans were comprehensively written and did cover areas of personal and social support as well as addressing health care needs, they did not always reflect the changing needs or progress of service users and not all had been signed by service users to indicate their involvement in the care plans and their understanding of the content. At this inspection the personal files of four service users were examined. All the files apart from one included a care plan. The file where the Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 11 care plan was absent belonged to a service user who had been admitted to the home approximately a month previously. It was reported by the registered manager that the care plan had not yet been completed as the service user was still undergoing a trial at the home and a period of assessment. The care plans belonging to the other three service users were found to cover areas required to ensure the needs of service users were being addressed. Care plans were signed by service users and all had been reviewed on a six monthly basis with evaluations written up against each identified need that clearly outlined whether there had been progress or the needs of the individual service users had changed. There were also progress reports written up by key workers. This addresses the previous requirement. Service users spoken to confirmed that they are supported by staff to make their own decisions and they are able to manage their own finances. Risk assessments at the previous inspection were found not to address all risk taking behaviours with service users, for example for one service that works locally on a casual basis and is potentially at risk of being exploited this had not been explored within a risk assessment or their care plan although it was noted that it had been discussed in Care Programme Approach (CPA) reviews. In addition, the last two inspections have identified that although service users had risk assessments completed as part of the CPA process that highlighted risks such as self – harming or violent and aggressive behaviour, a risk management plan for dealing with these risks had not been completed by the home either in service users’ individual care plans or within a separate document. At this inspection it was identified that action to address these areas had still not been taken. Risk assessments that were in place were specifically aimed at identifying risks presented by service users when using household equipment such as the kettle, the cooker amongst others although going out in the wider community was addressed as was risk relating to selfadministration of medication. Risk assessments inspected found two had been regularly reviewed although one had not been reviewed within the last six months (See Requirements). Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to become involved in employment and training. There was more evidence that service users are involved in the local community. Service users have been provided with more opportunities to do activities inside and outside the home although service users still need to be given the option of an annual holiday. Service users have been supported to maintain family links and personal relationships. Daily routines of the home do promote independence but the issue of the home having a curfew in place still needs to be clarified with service users. Service users are offered a varied and healthy diet. EVIDENCE: There was evidence that service users are supported to become involved in employment and training and to take part in fulfilling and valued activities. A Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 13 number of the service users attend day centres locally where they are engaged in a range of social and educational activities. It was also reported that one of the service users attends computer classes whilst one of the other service users has previously completed a food hygiene course. The majority of the service users do make use of the local community as they wish. There was evidence that one of the service users regularly goes out to eat and service users spoken to confirmed how they make use of the local shops, library and also attend church. However, for those service users who may be less confident to go out it was advised at the last inspection that the key worker system should be used to support them to go out and make use of local facilities. At this inspection it was evident from the activities folder in which activities and trips individual service users have been involved in have been recorded that key workers have been more pro active in supporting service users to go out locally to cafes, markets and also to local events such as the Lambeth Country show. In respect to leisure activities as mentioned there was evidence available that service users have been provided with more opportunities to go on trips outside of the home such as to the Country Show, to Greenwich to the Cutty Sark, to other local festivals and previously to the Tate Modern. Inside the home, activities provided include bingo, quiz nights and playing board games. Art sessions have taken place previously but not recently. Two of the service users spoken to, confirmed these activities have been held and there was evidence from the minutes of service user meetings held that service users have been encouraged to get involved in the activities. However, there was little evidence from records to indicate that service users have engaged with these. One of the service users spoken to expressed how they were not interested in the activities being provided in the home. It is evident that the home has made efforts to try to involve service users in leisure activities particularly outside the home. Yet, it is advised that activities specifically those in the home continue to be discussed within service user meetings and suggestions for activities to be held in house encouraged from service users. In respect to a previous requirement that service users should have a holiday outside the home that they choose and plan this had not been addressed. Apart from one service user who has been away with family none of the other service users living at the home have been given this opportunity. This is to be restated as a recommendation in this report (See Recommendations). Service users spoken to confirmed that they are supported to maintain family links and regularly visit family members. In respect to personal relationships, one of the service users has a long -term partner with whom they often spend the weekend and there was evidence that another service user has a friend who has visited them at the home. The daily routines of the home do generally promote independence, choice and freedom of movement. During the inspection service users were observed Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 14 coming and going from the home as they pleased. All service users have a key to their rooms and they confirmed they receive their letters unopened. Service users are also expected to undertake household chores as a means of preparing them for independent living and two of the service users stated that they occasionally cook for themselves with support from staff. However, a previous requirement that the manager must ensure the issue of a curfew time is clarified with service users has still not been addressed. The registered manager insisted that service users can go out and return as they please but it is expected that service users inform staff of the time they will be returning as the door is locked at 10pm for security reasons. However, apart from one service user all the service users spoken to still understood that there was a curfew time they needed to adhere to (See Requirements). With regards to meals provided by the home it was identified at the last inspection that the menu was repetitive in places and also that those service users with specific cultural needs and also those on a special diet were not being catered for. At this inspection the menu was inspected and generally there was more variety and meals provided were balanced and nutritious. There was also more evidence that the needs of those service users with specific cultural needs were being catered for and where service users have requested an alternative meal from those provided on the menu this had been recorded. In respect to the service user who is a diabetic although specific diabetic foods are not purchased the registered manager reported that the home does cater to their needs by ensuring any deserts are made without sugar and staff ensure they are eating healthily which was advised by the GP. The views of some of the service users on the food varied but overall they were satisfied with the meals provided and all stated that there is consultation about the menu and they are asked for suggestions in the service user meetings that are held. Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal support received by service users is flexible and appropriate to their needs. Service users’ physical and emotional health needs are met. The medication policy and procedures have still not been reviewed and further inspection of the way staff carry out spot checks for those service users being supported to self administer medication is needed. EVIDENCE: Service users living at the home are independent and manage their own personal care although some do require prompting and monitoring that they are attending to their personal hygiene and this has been addressed in individual service users’ care plans. The home operates a key worker system to ensure consistency of support is provided. Service users spoken to were satisfied with the support they were provided by staff confirming they had regular meetings with their key workers to discuss their progress and any problems or concerns they may have. Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 16 There was evidence within service users’ personal files and care plans that service users’ mental health needs have been well met. Service users have regular contact with mental health professionals and Care Programme reviews have been held regularly although as identified at the last inspection the minutes of the reviews have not always been obtained. It is advised the home make efforts to ensure copies of minutes are sent. In addition, individual crisis plans were in place that gives details of indicators that a service user maybe experiencing a relapse in their mental health and also provides contact details of professionals involved in their care. In respect to service users’ physical needs there was some evidence that service users have had contact with GPs, chiropodists, dentists and other primary health care services. One service user has been supported to lose weight with their weight monitored weekly. Another service user who is diabetic is supported to regularly attend a diabetic clinic and a district nurse attends the home to administer insulin injections (See Recommendations). A previous requirement that the home’s medication policy should be reviewed had not been met. The policy was found not to include procedures to be followed by staff when an error in the administration of medication occurs. Also, the policy did not include that medication needs to be retained by the home for a period of seven days in the event of a death of a service user. The registered manager reported that the policy was yet to be revised. In respect to a requirement regarding the home introducing a system to carry out regular spot checks on those service users being supported to self- administer their own medication this was not fully assessed. Although there was evidence of a system being used it was agreed that a referral to CSCI’s pharmacist inspector should be made to look at this system and also to do a general inspection of the home’s medication (See Requirements). Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22&23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a comprehensive complaints policy but minor complaints as well as major ones must be clearly recorded. Service users are protected from abuse. EVIDENCE: The home’s complaints policy includes the stages of and timescales of the process. A copy of the policy was seen on display within the entrance hall of the home visible to service users, relatives and representatives. The home needs to ensure that the new address and contact number for the Commission of Social Care Inspection’s (CSCI) local office of Southwark is altered on the policy. Service users spoken to stated they did not have any complaints about the home but if they had any concerns would discuss these with staff or the manager. The home had not received any formal complaints since the last inspection was held. However, it was noted within the daily records that a minor complaint from a service user had been made recently. It was recorded that this had been investigated by the registered manager and was found to be unsubstantiated. The home needs to ensure a complaints log is maintained and that all complaints minor/low level dissatisfactions as well as formal ones are recorded (See Requirements). The home has an appropriate adult protection policy and a whistle blowing policy in place. There was evidence that all support staff working at the home have completed training in adult abuse/protection. The new staff member who has recently commenced working at the home reported they had done some Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 18 training previously in this area and demonstrated a good knowledge of the different types of abuse and of procedure to follow if they suspected or became aware of abuse occurring within the home. There have been no adult protection investigations since the last inspection. The previous recommendation that the home should obtain a copy of Lewisham’s Interagency Guidelines on Adult Protection is still to be addressed (See Recommendations). Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26, 27,29 &30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is comfortable and homely and is well maintained and issues to do with the heating have mainly been addressed. The home has included its policy on sharing of rooms within the statement of terms and conditions but service users sharing had not been given the option to move on a room becoming vacant. Service users’ bedrooms are still in need of items of furniture being replaced. The home has sufficient toilets and bathrooms but the home needs to get advice about a grab rail being placed in the downstairs bathroom. The home meets the needs of all service users living at the home. The home was clean and hygienic. EVIDENCE: Last year all areas of the home underwent extensive re-decoration and refurbishment and at this inspection the home was found to be wellmaintained comfortable, homely and overall to be suitable for its stated purpose. In respect to the heating at a previous inspection it was found that Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 20 the radiators were not giving out sufficient heat. The last inspection was carried out during the summer months and so this could not be assessed. However, at this inspection the heating was on and the radiators were found to be working and sufficiently warm. Also, all service users’ rooms had selfadjusting radiators in place. However, a previous requirement that the home should address the issue of the radiators not being guarded or having a low surface temperature in a risk assessment has not been met (See Requirements). Previous inspections have required the home to provide information regarding the room sizes to CSCI and that this is included in the home’s Statement of Purpose. At this inspection it was identified that this information had been included in the new Statement of Purpose that had been drawn up (For details see Standard 1). Also, in respect to the home’s policy on sharing rooms it was required that this should be made clear to service users either within the home’s service user guide or statement of terms and conditions. As mentioned in respect to Standard 5 the home had drawn up a statement of terms and conditions that did include details of the home’s policy on sharing rooms but these had not been signed by the majority of service users. Also, in respect to this issue it was established at a previous inspection that two service users sharing a room had stated they would prefer not to but at that time there were not any single rooms available. At this inspection a room was found to be vacant but on speaking to those service users sharing they had not yet been asked if any of them would like to consider the option of moving into the room available although one of them stated they would like to move. This was discussed with both the owner of the home and the registered manager who both stated this would be supported but it is important that the home implements the policy on sharing as specified within the National Minimum Standards. This will continue to be monitored at future inspections (See Requirements). All service user bedrooms were inspected and it was found that a previous requirement that items of broken furniture identified at the last inspection should be replaced had not been met. There was evidence within the minutes of a service user’s meeting that service users themselves had also requested new wardrobes and the registered manager reported that these and other furniture to replace broken items was due to be delivered later in the week that the inspection was held. However, there was no available evidence to confirm this and so this will have to be carried over to the next inspection. Furthermore, the home has not carried out weekly audits of the premises and service users’ rooms as previously required. It was reported by the registered manager that regular checks are carried out and any repairs noted but the repairs book was not available for inspection. This will be restated as a recommendation in this report (See Requirements & Recommendations). The home has sufficient bathrooms and toilets to meet the needs of the service users. The toilet in the en-suite bathroom of one of the shared rooms that had Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 21 bad lime scale had been cleaned with most of the lime scale being removed. This meets the previous requirement. Also, at the last inspection, it was identified that one of the service users who has a room on the ground floor and is now aged over 65 years was experiencing difficulty getting in and out of the bath. It was reported they can use the shower upstairs but has continuing health problems. A requirement was made that an Occupational Therapist’s (OT) assessment should be carried out with the service user to identify if any adaptations were required. This was completed although the issue of bathing was not addressed. However, one of the support staff stated that both the service users who have rooms on the ground floor would benefit from a grab rail being placed in the bathroom. Consequently, it is advised that the home seek appropriate advice about putting this in place (See Recommendations). An immediate requirement was issued at the last inspection due to the home failing to apply for a variation to their registration to accommodate the service user who was living at the home and was over 65 years of age. This was addressed by the home shortly following the inspection meeting this requirement. Furthermore, as mentioned above the previous requirement that an OT assessment should be carried out with the service user who is aged over 65 years to ensure the home can continue to fully meet their needs had been completed. The outcome of the assessment was that the home is suitable for the service user and no adaptations or specialist equipment was recommended. The home was found to be clean and hygienic on the day the inspection was held with laundry facilities appropriately sited. It was identified that the home has had problems with the washing machine that was only recently purchased but the registered manager reported this was to be addressed shortly. Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 &36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Over 50 of the support staff working at the home have completed or are in the process of working towards a National Vocational Qualification (NVQ) Level 2 or 3. Service users are protected by the home’s recruitment practices. A training plan is still to be completed and the home’s induction programme still does not meet with National Minimum Standards but staff completing mandatory training is being addressed. Support staff are receiving regular supervision but staff are still to have an annual appraisal carried out with them. EVIDENCE: Two of the support staff have completed a NVQ Level 2 whilst the new staff member has just completed the induction part of the NVQ Level 2 course. One of the support staff has achieved the NVQ Level 3 and two are in the process of undertaking the course. Therefore, the home has reached the required target that 50 of staff have attained or are working towards a NVQ. Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 23 As mentioned the home has recruited one new staff member since the last inspection. The recruitment records of all staff including the new staff member were checked and were all found to be in order with the home having obtained all the required documents including two references and an Enhanced Criminal Bureau checks. A previous requirement that a training plan needs to be drawn up that outlines the individual and collective training needs of staff to ensure that the needs of service users are met has not been met. Also, although there was evidence that the new staff member had received an induction this still did not meet with Skills for Care Specifications. In respect to specific training there was some evidence from staff records that individual staff had received training in areas that would support them to meet the needs of service users, for example counselling skills, mental health awareness, older people and mental health and also in equalities and diversity amongst others. Furthermore, there was evidence that staff have been supported to do undertake some mandatory training in health and safety and infection control. The registered manager who is also doing the health and safety course had the work booklet to be completed. The course is linked to Hackney College. The registered manager reported that once these are completed the staff are to undertake food hygiene, in which two staff need to undertake a refresher course and the others still need to complete (See Requirements). There was evidence that staff have received regular supervision and as advised at the last inspection the supervisor and the supervisee have signed the supervision records. A previous requirement that staff should receive an annual appraisal has not been met although the timescale set had not been exceeded at the time the inspection was held (See Requirements). Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 &42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager is experienced and holds appropriate qualifications to ensure that service users benefit from a home that overall is well run. Although customer satisfaction surveys have been provided to service users there still needs to be some improvements made in respect to the way the home addresses quality assurance. The health, safety and welfare of service users has not been fully promoted and protected. EVIDENCE: The registered manager is very experienced having worked for nearly thirty years within the mental health field. She has held various different posts within hospital settings and has previously managed three care homes. She has also completed the NVQ Level in management. Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 25 In respect to quality assurance there was evidence within the personal files of service users that their views had been sought since the last inspection by issuing customer satisfaction surveys although again it was noted that the views of relatives, friends and professionals involved in the home had not been obtained. Also, a previous requirement that the results of the surveys completed should be summarised in a report and made accessible to service users and other interested parties including CSCI had not been met. Furthermore, the home has still not completed an annual development plan that should reflect aims and outcomes for service users and copies of reports of monthly provider visits have not recently been received by CSCI (See Requirements). A previous requirement that the home must ensure an up to date fire risk assessment is completed had not been met. The fire risk assessment in place was dated January 2006 and so was in need of being reviewed. Also, as specified in respect to Standard 24 the registered manager needs to include in the fire risk assessment the issue of the radiators not being guarded or having low surface temperatures and any implications this may have for service users living at the home. Also, a previous inspection noted a problem with door wedging and this should also be addressed in the fire risk assessment. In respect to fire equipment there was evidence that this had been checked and maintained and also that weekly tests of fire alarm call points had been carried out and regular fire drills held. A maintenance certificate for the gas boiler was in place although a certificate for the electrical wiring could not be identified. Furthermore, subject to a previous requirement water temperatures had still not been recorded and checks for Legionella not carried out (See Requirements). Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 2 26 2 27 2 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X 3 X 2 X X 2 X Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4,5,6 & Sch 1 Requirement Timescale for action 31/07/07 2. YA5 5(1c) 3. YA9 13 4(c) The registered manager must ensure that the home’s statement of purpose and service user guide contains all the information required by regulation and the National Minimum Standards specifically the information included in the report and that both documents are reviewed regularly and updated. The date of review should be included on the documents. (Timescale of 01/01/07 partially met) The registered manager must 31/07/07 ensure that all service users read and sign the statement of terms and conditions to indicate their understanding and agreement with its content and are issued a copy as well as one being retained on their personal files. The registered manager must 31/05/07 ensure that where risks have been identified a plan to manage the risks is in place. (Previous timescales of 31/03/06 & 01/01/07 not met.) DS0000025620.V329927.R01.S.doc Version 5.2 Gate House Page 28 4. YA9 14 (2) 5. YA16 12 (3)&13 (4) (a) 6. YA20 13 (2) 7. YA22 22 8. YA24 23(2) (p) The registered manager must ensure that risk assessments are reviewed on a regular basis. (Previous timescale of 01/01/07 partially met) The registered manager must ensure that the home’ s policy regarding a curfew time is clearly outlined to service users and should be included in the home’s service user guide/statement of terms and conditions and where restrictions may need to be put in place for individual service users this is addressed within their care plan/risk assessment. (Previous timescale of 01/01/07 not met) The registered manager must ensure that the home introduces a system for regular spot checks to be carried out on service users who are taking responsibility for their own medication. Also the home needs to review the medication policy to ensure it includes the information specified within the report. (Previous timescale of 01/01/07 regarding medication policy not met and requirement regarding spot checks not fully assessed) The registered manager must ensure all complaints both minor/low level dissatisfactions and major complaints are recorded, investigated and the outcome noted. Also, the new address of CSCI’s Southwark office must be changed on the policy. The registered provider must ensure that radiators are guarded or of a low temperature surface unless risk assessments DS0000025620.V329927.R01.S.doc 31/05/07 31/05/07 31/05/07 31/07/07 31/05/07 Gate House Version 5.2 Page 29 9. YA25 23(2) (e) 10. YA26 16 (2) (c) 11. YA35 18 (1) (c) 12. YA35 18 (1) (a) indicate this is unnecessary. (This is an updated requirement. Previous timescale of 31/03/06 & 01/01/07 not met) The registered manager must ensure that where rooms are shared they are shared by two service users who have made a positive choice to share with each other. This needs to be included in the home’s service user guide/statement of terms and conditions. Also where single rooms become available those in shared rooms must be offered the chance to move and leave the remaining service user in single accommodation. (Previous timescale of 31/10/05 and 31/05/06 not met. Timescale of 01/01/07 partially met). The registered provider must ensure that all broken furniture in service users’ bedrooms are either repaired or replaced. (This is an updated requirement. Previous timescale of 01/01/07 not met). The registered provider must ensure that the home has a training plan to ensure that a proactive is adopted towards training and that it is based on the assessed needs of staff and service users. (Previous timescale of 30/04/06 & 01/01/07 not met) The registered provider must ensure an induction that meets with Skills for Care specifications is put in place and used for all new staff and mandatory training such as food hygiene amongst others is carried out. DS0000025620.V329927.R01.S.doc 31/05/07 31/05/07 31/07/07 31/07/07 Gate House Version 5.2 Page 30 13. YA36 18 (2) 14. YA39 24 15. YA39 24(1b) 16. YA39 26 17. YA42 23 (2) (c)& (4) (This is an updated requirement. Previous timescale of 30/04/06 not met. Timescale of 01/01/07 partially met). The registered manager must ensure that all staff working at the home have an annual appraisal carried out with them. (Previous timescale of 31/03/07 not exceeded. New date for compliance to be set) The registered provider must ensure that results of quality assurance surveys are summarised and made available to service users and other interested parties including CSCI. (This is an updated requirement. Previous timescale of 31/01/06 & 01/01/07 not met) The registered provider must produce an annual development plan, based on a systematic cycle of planning-action-review, reflecting aims and outcomes for service users (Previous timescale of 31/01/06 & 01/01/07 not met). The registered provider must ensure that copies of monthly provider reports are sent to CSCI. The registered manager must ensure that:-An up to date fire risk assessment is drawn up in consultation with the LFPEA (Fire Authority). -Regular checks of water temperatures are carried out to prevent risks of scalding and there is evidence of checks for Legionella being carried out. - An up to date certificate is in DS0000025620.V329927.R01.S.doc 31/07/07 31/07/07 31/07/07 31/07/07 31/05/07 Gate House Version 5.2 Page 31 place for electrical wiring. (This is an updated requirement. Previous timescale of 01/01/07regarding fire risk assessment and water temperatures not met) 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 YA14 Good Practice Recommendations The registered manager should try to ensure that service users are regularly consulted on activities held within the home within service user meetings and suggestions for different activities obtained. The registered provider must ensure that service users have as part of the basic contract price the option of a minimum seven-day annual holiday outside the home, which they choose and plan. The registered manager should try to ensure that minutes of Care Programme Approach (CPA) Review meetings are obtained. The registered manager should try to obtain a copy of Lewisham’s Adult Protection Interagency Guidelines for staffs’ information. The registered manager should try to record checks on rooms carried out to identify any breakages or repairs required. The registered manager should try to seek some advice about placing a grab rail in the downstairs bathroom. 2. YA14 3. 4. 5. 6. YA18 YA23 YA26 YA27 Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gate House DS0000025620.V329927.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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