Inspection on 09/09/08 for Gate House

This inspection was carried out on 9th September 2008.

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

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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gate House 27/09/07

Gate House 09/02/07

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 05/12/2008.

CARE HOME ADULTS 18-65 Gate House 238 New Cross Road London SE14 5PL Lead Inspector Michael Williams Unannounced Inspection 9 September 2008 10:45 th Gate House DS0000025620.V369055.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.V369055.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.V369055.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 ‘Frank’ Palmer Mrs Marjorie Palmer Ms Hazel May Parkinson Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia, Code MD The maximum number of service users who can be accommodated is: 10 27th September 2007 2. Date of last inspection Brief Description of the Service: Gate House is a small, privately run care home providing support and accommodation for up to ten adults who have support needs due to mental ill health. The Gate House is a converted semi-detached family home and is located in a residential terrace on the busy New Cross Road in South East London. It therefore has good access to London Underground, mainline rail stations and buses. Service users have access to a wide range of local amenities and community resources. Accommodation is now provided in single bedrooms with all double rooms now being occupied by a single resident; this has reduced occupancy from 10 to 7 residents. Service users admitted to the service have to be physically able because this home is not adapted for people with physical disabilities. The home has the usual facilities including a lounge and separate dining room, kitchen, shower, bathroom, toilets, a very small laundry cupboard and an exceedingly small office space. Most bedrooms are not ensuite and have just a wash-hand basin. Because this is an older, ‘existing’ care home the National Minimum Standards for bedroom accommodation are not applied in full to such homes. There is a garden to the rear of the premises and some off-street parking space to the front of the property. The owners, Mr & Mrs Palmer tell us that they are resolved to review fees to take account of the changes to resident numbers and in order to be able to meet National Minimum Standards; at the time of writing, in September 2008, fees ranged from £450 to £650. The owners have advised us that there have been no changes to the ownership of the care home and it remains owned and operated by Mr L ‘Frank’ Palmer and Mrs M Palmer. Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key, unannounced inspection started with a visit to the Gate House on 9th September. We spoke to people who use the service (in this home they prefer to be called residents and this is the term used in this report) and visitors; we met with staff, the manager. The owner, Mr Palmer visited the service to meet with the inspector and discuss our findings. We met with a representative of the Mental Health Team. We toured the building. We cross-checked information by reading various records including residents case files, staff records and other statutory records such as the accident book, the record of complaints, medication, food records and so forth. We also took account of any information provided to us since we last inspected the care home in 2007 and this included the AQAA form (the Annual Quality Assurance Assessment that each home now has to complete for the Commission). What the service does well: What has improved since the last inspection? The home has addressed some of the 15 requirements and 5 recommendations we made when we inspected the service in 2007. Those requirements that are wholly within the control of the manager have been addressed such as the requirement for an initial care plan to be put in place when new residents are admitted and each new resident to be given a contract, with details of fees, at the time of admission. We were advised by the manager the all staff now have police checks (CRB) before employment and we checked a sample of staff files to confirm this is the case. Periodic supervision of staff is also taking place as required; arrangements for staff training and appraisal are also in place now. The manager advises us that at present no residents need share a bedroom since double bedrooms are currently being used as single. Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 6 What they could do better: Our overall impression is that the owners, Mr & Mrs Palmer need to improve the management structure of the care home, that is, how the organisation is structured and operated. At present the manager, Hazel Parkinson has little budgetary control and minimal autonomy and delegated authority – for example in respect of staffing, maintenance, purchase of equipment and the like. Mr Palmer visits the home several times a week in a quasi-managerial role. Relations between owner and manager seem very good; we understand there are frequent meetings to discuss issues as they arise, but actual progress in making improvements and developing the service can be tardy and the resolution of issues seems slow and cumbersome; for example the repair and replacement of damaged equipment (electrical socket and broken window are examples) and, as another example, the replacement of the fax machine and telephone is a matter that could be delegated to the manager but isn’t. Despite their frequent attendance the owners are not self-auditing as well as they might. They are not conducting the monthly, unannounced visits and preparing written reports in a systematic and methodical way and nor have they have put in place systems such as quality assurance system to quickly correct problems as they are identified. The use of a very small ‘room’, a cupboard, as the office seems untenable and positively hazardous since two people are needed to replace files on a shelf to avoid everything falling off the shelf. The home has no computer despite the Commission’s recommendation to acquire one – something that would vastly improve the manager’s ability to modify records and policies to bring them up to date. At present the manager has to rely upon the owners to type documents, such as letters that she has hand-written. Staffing needs to be reviewed – in particular the manager advises us that she is deployed by the owners as a ‘carer’ and has insufficient time to ‘manage’ the service. Similarly, the home does not employ ancillary staff for deep cleaning and the main cooking – this means that care staff, are often required to undertake these duties at the expense of their care role. It is of course acceptable for care staff to support residents in their rehabilitation but this does not account for all the cleaning, catering, laundry and gardening work required to maintain the home to an acceptable standard. The residents asked us about outings and holidays and it appears that no arrangements are in place for an annual five day holiday as envisaged in the Standards; this needs to be sorted out as part of the contract arrangements. Various aspects of the environment need improving; as with other aspects of the service a more systematic and efficient system of maintenance is needed. When items need repair or replacement the manager should be in a position to deal with it quickly and effectively – within an agreed budget of course. Several lights were not working, light shades missing, electrical socket damaged, plaster-work damaged, fire doors not closing fully; these and other points need to be sorted out so as to maintain standards in the home. Some detailed points like odd (and loose) door handles on the upper landing door point to a poor appreciation of the need to maintain a good quality environment. A better way of managing these things is needed. Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 7 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.V369055.R01.S.doc Version 5.2 Page 8 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.V369055.R01.S.doc Version 5.2 Page 9 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): NMS 1, 2 and 5: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is provided, but it is not all up to date, but choice is offered to prospective residents, so residents will get some information to help them make a decision about whether or not this home could meet their needs. EVIDENCE: Gate House provides a statement of purpose that is specific to the individual home and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by a resident’s guide. The guide details what the prospective residents can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff, how to make a complaint, recent CSCI inspection findings and contains comments and experiences of residents living at the home. All residents are given a copy of the guide. When requested the service can provide a copy of the statement of purpose and guide in a format which will meet the capacity of the resident. Both the Statement of Purpose and the Resident Guide are readily available but not all the details are accurate; for example the contact details for the Commission are now in Pentonville Road not Sidcup as stated in the home’s document, the complaint section also refers to the ‘NCSC’ which no longer exists; there is no reference to fire precautions and other emergencies. This document needs to include, ideally in the same numerical order, all 18 items listed in Schedule 1 of the Regulations. Similarly, the Guide includes details no longer relevant such as the ‘additional condition of registration’. Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 10 We required the service to give each new resident a contract or agreement making clear what fees are payable, this is something residents are entitled to be informed about from the outset of their placement. The new resident was given these details upon admission. Similarly the needs of the resident were made known to the service before admission so that a provisional care plan could be drawn up without delay and this was also in place as required. Prospective residents are given the opportunity to spend time in the home. An individual member of staff, a ‘key worker’, is allocated to give them information and to help them understand how the home is organised and run and the facilities and services available. We understand that the allocated staff member will give the new resident special attention, helping them to feel comfortable in their surroundings, and enable them to ask any questions about life in the home. We spoke to residents about this admission process and this seems to be working well. A visiting professional also confirmed that they are happy with the way in which new placements are organised by the manager. We checked the documents supporting the care of a new resident and note that very detailed assessment and care planning advice was provided to assist Gate House in assessing whether or not it could meet the needs of the resident and in formulating its own plans. Areas of strength include the provision of relevant documents such as the guide and agreement and the general arrangements for assessing and admitting new residents. Matters requiring improvement include the need to revise and update the Statement of Purpose and the Resident Guide. This section, about choice about admission, is assessed as good. Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 11 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): NMS 6, 7, and 9: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ needs are being assessed and planned for from the outset and residents are being supported to make choices about how their needs will be met so residents can be assured their voice will be listened to in meeting their individual needs. EVIDENCE: The manager of Gate House is ensuring that residents are involved in the planning of their care so as to reflect their preferred lifestyle and quality of life. We spoke to the manager and a care worker to confirm that they understand the importance of residents being supported to take control of their own lives in so far as it is safe and possible for them to do so. Individuals are encouraged to make their own decisions and choices, for example in how they spend their day, whether they engage in training or attend day centres, what leisure pursuits they follow and so on. The home checks and records the preferred communication style of the individual – in this home all residents have good grasp of spoken and written English so no specialised communication tools are needed but the home checks that this is the case for each new resident. Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 12 Care plans are agreed with the individual resident and specific to their needs. A visiting Community Psychiatric Nurse confirmed this was the case and commended the manager for “working with her team to develop and follow prescribed plans of care, particularly when residents present with challenging behaviour”, she said. Plans are written in plain language, are easy to understand and look at all areas of the individual’s life. They include reference to equality and diversity and address any needs identified in a person centred way. Staff have skills and ability to support and encourage residents to be involved in the ongoing development of their plan. The manager explained that the work of developing care plans would be much simpler and more professional looking if the home had a computer. It was surprising for us to discover that the does not have one already. Care plans are be written with the individual resident, and their representative, and includes a range of information that is important to them. This includes information about risk assessments, how they keep safe, their goals and aspirations, how they communicate, their skills and abilities and how they make choices in their life. They include information about their health. It is kept up to date and focuses on how individuals will develop their skills, and considers their future aspirations. Each care plan includes a risk assessment, which is reviewed regularly. The management of risk is positive in addressing safety issues while aiming for improved outcomes for people. Where there are limitations, the decisions have been made with the agreement of the person or their representative and are accurately recorded. Risks associated with mental illness not infrequently involve issues of medication and relapse as well as indicators such as change in mood and daily routines so we discussed this with the manager in some detail and conclude that any changes in mood, behaviour or cooperation are reported promptly to the mental team who visit to support the resident and advise the staff team. The home ensures that residents are consulted regularly in house meetings to gather information about their satisfaction with the home. Areas of strength include care planning, risk assessment, liaison with the community mental health services and matters no requiring improvement arise so this section, about needs and choice, is assessed as good. Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 13 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): NMS 12, 13, 15, 16, 17: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect a comfortable and well supported lifestyle in Gate House with easy access to the community, support to maintain contact with family and friends and will be provided with suitable meals. EVIDENCE: Residents have the opportunity to develop and maintain important personal and family relationships, this is particularly true where residents may have lost contact with family or have reduced contact because their illness has adversely affected family relationships. The manager works hard to rebuild these social relationships and supports residents to build new friendships. The staff practices promote individual rights and choices from simple matters such as smoking to more complex issues such as medication and money. Staff are aware of the need to consider the protection of the residents themselves and those about them, and so support them to make informed choices – the need to comply with medication and review it with a their psychiatrist being an important example. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. This is reflected in the initial planning when Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 14 the home seeks to ascertain what issues are important to the resident whether is a matter of race, gender, beliefs or sexuality. The staff team help with communication skills, both within the service and in the community, to enable residents to fully participate in daily living activities. Residents are involved in some meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. They have been fully involved in the planning of their lifestyle and quality of life. Where appropriate, education and occupational opportunities are encouraged, supported and promoted. Whilst it is true the home will support staff in all these aspects of leading a fulfilling and enriched life in reality residents often prefer a quiet lifestyle, just sitting with other residents in the lounge watching television or smoking in the smoking room, or walking down to the local shops. Some resident do attend day centres or undertake some voluntary work and training opportunities can be provided but in the main their social life and their mental health is maintained in a rather less dynamic way. Whilst we accept that many residents are very independent and can undertake a lot of daily tasks such as shopping, bathing, cooking, without much support or guidance there will be times when residents needs one to one support and the current staff numbers suggest this will not always be possible – for example if a member of staff needs to escort a residents into the community or a resident needs one to one support for a prolonged period – the staff numbers need to be more flexible than they are at present and this is discussed in the staffing section of this report. Support is being offered in the service by a skilled and trained team – the local Community Mental Health Team. Residents can access and enjoy the opportunities available in their local community, such as using public transport, library services, the local pub, and local leisure facilities. The service is committed to the principles of inclusion and promotes and fosters good relationships with neighbours and other members of the community. Sadly this is not always reciprocated by the school, adjacent to the home, where children are seen throwing stones and other objects towards Gate House. All residents are involved in the domestic routines of the home but they will admit that they sometimes feel ‘bullied’ into working in the home. here a balance needs to be drawn between support towards rehabilitation and a resident’s right to refuse to engage but we conclude some coaxing is appropriate and reflect a duty a care to ensure residents do not become isolated, too sedentary and introspective. They take responsibility for their own room, menu planning and cooking meals, making sure that they are able to enjoy the food they prefer and like. The menu is varied with a number of choices including a healthy option, especially as some residents are at risk of becoming over-weight. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals including those with diabetes. Areas of strength include the relaxed lifestyle the residents have with opportunities to develop personal skills for daily living and to develop and maintain personal relationships. Residents say they enjoy the meals and assist in catering. No matters requiring improvement arise so this section, about lifestyle, is assessed as good. Gate House DS0000025620.V369055.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): NMS 18 to 20: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured they will receive the health and social care support they need. EVIDENCE: The home’s stated aim is to provide residents with personal and healthcare support based upon the rights of dignity, equality, fairness, autonomy and respect and so far as we were able to judge during this visit this seems to be the case. We discussed matters of racial, gender and sexuality and the manager is confident she respects all these aspects of each resident. Although the staff team does not reflect the racial mix of the resident the manager explained, as do many managers in South London, that the staff team reflects of the availability of the local work-force rather than the racial mix of resident group. Choice is available in respect of male or female carers. All residents speak English. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each care plan. These plans give a comprehensive overview of their health needs and act as an indicator of change in health requirements, particularly mental health requirements. The statement of purpose details the specialist ‘treatments’ or support the home can deliver with a commitment to individualised care packages, and this document refers to the skills and ability of the staff group. Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 16 Residents have access to healthcare and remedial services; again this primarily mental health support from Community Psychiatric Nurses [CPN], care coordinators and psychiatrists. Staff make sure that resident are encouraged to be independent, have regular appointments and visit local health care services. Staff have access to training in health care matters and are encouraged and given time to attend seminars on specialist areas of work. The home has a medication policy supported by procedures and practice guidance, which staff understand and follow. Last year a specialist pharmacist inspector from the Commission visited the home to check the general procedures for administering medication and found that ‘Medication is being managed well on the whole. No issues were found except in one area, formalising risk-assessments and how self-administration is checked/reviewed. Currently this was being done informally e.g. just prior to the visit one residents self-administration had been reviewed and stopped on a temporary basis as staff discovered he was not taking his medication as prescribed. This will continue to be reviewed until he is able to manage again, this had been documented, by the Manager on the MAR chart. The home is supporting some residents to self-administer their medication. A weeks supply of medication is supplied to these residents, and there are currently three sets of records kept’. In view of a very recent and most serious incident involving a resident we checked in some detail the document outlining the care needs of the resident, what support was in place and whether or not it was being provided and what action if any was taken when the resident appeared to be relapsing. We found that the home had in place care plan and risk assessment and that the home maintained contact with the mental health team also supporting the resident. We found that prompt action had been taken when needed including direct contact with the resident’s doctor and other support workers. Family and friends were kept informed in so far as that was possible and the commission was notified as required – albeit in a rather brief letter. Under the section about complaints and safeguarding we consider what safeguarding procedures are in place and activated at this time. Areas of strength includes the good working relationship with the Community Mental Health Team and their confirmation that the home is providing good support and responding to changing, and sometimes challenging, needs very positively. Matters requiring improvement include the need to review staffing levels discussed which in another section of this report. This section, about care, is assessed as good. Gate House DS0000025620.V369055.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): NMS 22 and 23: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has in place a complaints procedure and safeguarding adults’ procedure so residents can be assured their voice will be listened to and they will be protected from harm. EVIDENCE: This standard was assessed in some detail during our last inspection so on this occasion we checked that those arrangements remain in place. A copy of the complaints policy had been placed in the entrance hall of the home so it is visible to service users, their relatives and representatives. In earlier inspections the home had not been maintaining a log of complaints but by 2007 this was rectified and the home reports that one complaint had been recorded in the twelve up to time the home submitted its AQAA [Annual Quality Assurance Assessment form] in July 2008. We confirmed that the home has an appropriate adult protection policy in place that addresses the different types of abuse and procedures to follow if abuse is suspected and identified. The home has a staff team of 7 carers; we interviewed one to check their understanding of the safeguarding procedures. Whilst this person was well acquainted with various possible forms of abuse and how to report incidents to his manager he was less clear about when and how to contact the local Social Service Department (who are responsible for coordinating and investigating allegations of abuse) - so a recommendation is made. There have been no adult protection investigations undertaken in relation to the home since the last inspection but around the date of the inspection a very serious incident occurred that may require the intervention of the local safeguarding team and they have been kept informed of the incident as have other relevant agencies including the Commission. Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 24, 28 and 30: People using this service experience poor quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst homely and conformable for residents we cannot assure residents that the Gate House is always suitable for its purpose as a care home and is not always safe for residents. EVIDENCE: Gate House care home is a domestic dwelling house that has been converted to accommodate up to ten residents and has facilities for a member of staff to sleep-in when on night duty. Although originally it was registered for up to ten residents the manager explained that all bedrooms are now occupied by a single resident in each and this has reduced occupancy levels to seven. The owner is therefore considering extending the accommodation to add further single rooms of a more modern standard for example bedrooms with ensuite facilities. The home has a single large communal lounge and separate dining room. There is also a small room used by smokers but this room is in a very poor state of decoration. There is no private visitors room and no facility for residents, visitors or visiting professionals to meet with residents other than their bedroom – contrary to the guidance in the national minimum standards (NMS 28.2v.). A conservatory would greatly improve communal space and Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 19 provide the recommended communal spaces. It would also give residents a choice about where to sit and with whom since this client group sometimes need ‘space’ to sit apart from others in the home. It is unfortunate that the laundry room that was sited on the first floor had a leak causing damage to a resident’s bedroom ceiling. The washing machines are now in a small cupboard accessed from outside the house. We assume this to be temporary and somewhat unsuitable for residents and staff - who need a more suitable and accessible laundry area. The cellar was in considerable disarray; it could be tidied and upgraded so as to provide some storage space or serve some other practical use. Storage space is at premium in this home and a suitably robust storage space/shed could be erected in the garden to replace the near derelict shed now standing in the corner of a rather unkempt garden. The facilities for staff are not suitable; in particular the manager has been given a large cupboard in which to work and this is quite unsuitable – it is no surprise that documentation, care plans and general policies for example, have been and some still are of a poor standard since the manager has no fully functioning fax machine, no computer and not even a cordless telephone. The ‘office’ is neither safe nor suitable and unless it is rectified it is unlikely the home will ever manage to maintain a good standard of administration – even letters have to be drafted by the manager then typed by the owners elsewhere. It is wholly unsatisfactory and reflects poorly on the owners of this care home. The manager has no suitably private place to meet visitors. Whilst we were inspecting the home we were obliged to use the residents’ dining room to interview staff and check records. One of the owners present for part of the inspection, Mr ‘Frank’ Palmer, agreed there was a need to improve this and he is considering a number of options – but we are not confident at this time he will act with any alacrity since these shortcomings have been obvious for some considerable time. We toured a number of bedrooms and other facilities and, as we have mentioned before, this is a domestic scale care home with the advantages of homeliness but the disadvantage of limited space and an old building showing signs of wear and tear. Some issues were minor and merely reflect quality, or lack of quality, such as door handles that are loose and do not match (on the landing), light shades missing from overhead lights and poorly hung curtains in the dining room. Other points reflect a problem of poor maintenance arrangements such as damaged plasterwork (in the dining room), a cracked basin (in a bedroom), loose showerhead (in the ground floor bathroom). Other environmental matters are more serious and again reflect poor selfauditing and quality assurance by the owners and this includes matters of safety such as out date fire extinguisher (most had been checked in January but there was no evidence to indicate the one by the front door had been serviced); a loose electrical socket in the dining room and a loose plug inserted into this socket; a broken window also in the dining room. Two and possible more self-closing devices were not properly engaged and so two fire doors were not closing fully. The intumescent strip (to increase smoke protection) on one door was damaged and falling off. Since these safety issues are the Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 20 responsibility of the management team they are listed under the management heading as well but this section about the environment is assessed as poor. Mr Palmer advises us that he considering ways to increase bed numbers and to make better use of the accommodation and, although we make no comment as to any variation in registration that he may consider, at this stage we endorse his positive approach to making better use of what is limited space. His options might include better use of the cellar for example a laundry room; change the use of the old laundry room on the first floor; change the use of smoking room; add a small conservatory; add a robust shed/store in the back garden; use the loft space as an interim measure for non-sleeping accommodation such as a meeting/training room and secondary office (with the necessary consent of relevant agencies). Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 32, 34 and 35: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements appear acceptable but need reviewing so as to ensure there are adequate numbers of staff on duty at all times to meet the varying needs of residents. EVIDENCE: The home caters for a group of residents with wide ranging needs as described in the first paragraph of its Statement of Purpose; from those with a ‘risk of relapse and challenging needs’ to residents who are more independent and ready to move on to independent accommodation. So the home needs to vary its staffing levels according to the client group at any particular time; for example when a new resident is admitted and those risks might be at their greatest then more staff should be on duty whilst less staff might be needed if all residents are operating more independently and successfully with minimal social support. A fixed staff roster, 2 per shift and 1 at night, does not reflect this variable need. A base line staffing level needs to be agreed and if extra staff are needed for a period then this may require contractual negotiation with the placing authorities. Since the home makes clear, in its Statement of Purpose, it can cater for a client group with a wide range of needs range of fees should reflect Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 22 this and fees may also need revising to reflect extra costs of the necessary increased staffing levels. The manager advises us in the home’s AQAA [Annual Quality Assurance Assessment] that there are seven care staff of whom two have NVQ Level 2 [National Vocational Qualification] and three are working towards this qualification; the manager herself has NVQ 4 (amongst other qualifications). Two staff are male and five are female; 3 Caribbean and 2 African, all staff are between 35 and 65 years of age. We again checked procedures for recruiting staff and we are advised for example when on site and in the AQAA form that all staff have had the correct CRB [Police] checks and references taken up. We recommend that application form is revised so that applicant make clear their work history since the current application does not require this level of details and it I required that the employer is given this information so as to ascertain whether there are gaps in the applicant’s employment history and how those gaps are explained. The manager now has in place provision for the appraisal and regular supervision of staff as required in previous inspections. We checked staff files and spoke to staff to confirm they are getting the support they might expect of the service. In respect of the safeguarding protocols we noted under a previous heading that staff were not as clear about referring allegations of abuse to the local Social Service Department - indeed staff had some difficulty locating the correct contact number for the Lewisham safeguarding team; so under the heading of complaints and protection we make recommendation to provide information that is more readily accessible. Areas of strength include the residents’ and visiting professional’s, opinions that staff are very caring and, “They work hard to meet the needs of residents”; this endorsement of the staff is passed on and is very commendable. The staff member we spoke to did seem well informed and professional in his approach. Matters for review include the need to review staffing levels. This section, about staff, is assessed as good. Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 37 , 39, 41 and 43: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We have reservations about how well this home is being run, there are some strong elements but the residents cannot be assured that in all aspects of the running of Gate House leadership is skilled and competent. EVIDENCE: In respect of the running of this service we formed the impression that whilst the registered manager and the owner Mr Palmer have a good working relationship this is not being translated into good management of the care home. The owners have appointed a manager, Mrs Hazel Parkinson who is registered with the Commission, but the owners have not delegated managerial roles to her. So for example she has no budgetary control essential matters such as staffing, training, catering, maintenance and equipment. Nor has she been provided with some essential tools of management such as an office, a fully functioning fax machine, a cordless phone (since she is expected to work with residents as a ‘hands on’ carer for much of the week) and, most Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 24 surprisingly, she has no computer despite requesting one - and the Commission endorsing this request in the form of a recommendation in 2007. It is therefore clear that much of the good work achieved is without adequate support from the owners. To the credit of the owner, Mr Palmer, he has agreed to review this; perhaps with the assistance of an independent consultant – an idea he suggested when we met with him at the end of the inspection. The lack of suitable office space is of serious concern to us since it suggests the reason for repeated requirements in earlier inspection reports – Mrs Parkinson has not had the proper facilities to improve documentation and record keeping in a timely manner. As a very simple but telling example the manager drafted a short letter (a ‘Regulation 37 notification’) to the Commission informing us about a serious incident – the handwritten note had to be taken away and typed by the owners. Had the manager been given access to an online computer she would have been able to download the form we provide for this purpose. We are also concerned that, according to the manager herself and the duty roster, she has been allocated (by the owners) no supernumerary time to undertake her management duties such as the supervision of staff, updating policies and procedures, preparing care plans and so forth. When we checked a small sample the home’s policies and procedures we found they were inadequate; for example, some were out of date, some were referring to the wrong national minimum standards (those for older people), one policy referred to violent customers in Council offices and so on. These policies and procedures had not been modified to reflect the services provided in Gate House. The owner has provided a nationally recognised set of manuals with model procedures and record keeping forms but without a computer and suitable technology to modify the documents this is of no value to the manager. When we toured the premises, including a number of bedrooms, we identified a number of shortcomings – these we have listed in the earlier section about the environment. However some of them are health and safety issues that the owners are responsible for checking and putting in place systems to monitor, audit and correct. We have issued ‘Immediate Requirements’ in respect of the most serious issues, the fire extinguisher, the two fire doors that do not close properly, the broken window in the dining room and the loose electrical socket. The registered persons are required to address these matters within 48 hours of our inspection visit on the 9th September this is to protect residents from hazards. Once again it reflects poor self-auditing by the owners that they have not, as Mr Palmer admitted, written a Quality Assurance system and nor is he making monthly unannounced ‘registered provider visits’ and preparing a written report on the service (as required by Regulation 26). The owner also conceded that he did not have an annual development plan to show us when we visited on the 9th September. Because these are important managerial tools, which the Commission expects registered owner to use to maintain standards, Notices will be issued requiring the owners to put these auditing systems in place. Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 25 Areas of strength include the high regard in which the registered manager is held by visiting professionals and residents; although there has been some delay in dealing with requirements most have now been addressed; the owners are providing a homely and comfortable care home that residents tell us they appreciate very much and clearly residents have been making good progress over in recent years but a number of important Requirements and Notices may be issued, focused mainly on the providers’ role. Matters requiring improvement include the need to deal with safety issues and more widely a need to review the management structure of the service, to review the premises and how they may be better utilised to optimise care and management of the service. A number of requirements remain outstanding and need to be addressed:We required the registered persons to establish and maintain a system for reviewing and improving the quality of care provided at the care home. When we visited on 9th September Mr Palmer, one of the registered providers, stated that he had “not written anything down” when asked if he had prepared such a system of quality assurance. He was therefore unable to produce any form of quality assurance system. We note however that the manager has provided a hand-written Annual Quality Assurance Assessment form but this is not based upon any methodical and written ‘system’ for evaluating service, which the registered persons were required to do by 31st July 2007. The providers had also missed two previous deadlines of 31/01/06 & 01/01/07. Enforcement action may be taken in respect of the failure to comply with the Care Home Regulations. We required the registered provider to arrange for monthly, unannounced visits to the care home in accordance with Regulation 26 and send a copy to all registered providers and a copy to be supplied to the Commission each month. Mr Palmer told us, when we visited on the 9th September, that he “thought he did not have to prepare such reports because he visited the home several times each week”, and so no reports have been prepared or sent to Commission since we made this requirement to be complied with by 31st July 2007. Enforcement action may be taken in respect of the failure to comply with the Care Home Regulations. This section, about management and administration, is assessed as adequate again since standards 37 to 43 are only partly met. However, with more effective input from the providers they could transform this into a good service. Gate House DS0000025620.V369055.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 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 2 X 2 2 Gate House DS0000025620.V369055.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. Standard Regulation 1 YA1 4(1) and (2) Timescale for action Statements of Purpose: The registered 30/11/08 person shall compile a statements of purpose that includes all 18 items listed in Schedule 1 of the Regulations; this is so that anyone wishing to read it will have up to date and accurate information about Gate House. Service User Guide: The registered 30/11/08 person shall compile a guide that includes all the items referred to in Regulation 5 and those items listed in Standard 1.2; this is so that residents will have detailed and up to date information about the services they are paying for or being paid on their behalf. Policies and Procedures: All policies and 30/11/08 procedures used by the care home must be brought up to date and must reflect the circumstances in Gate House and other services, in particular the complaints policy and procedures must reflect gate House systems; this is so that staff and residents are protected but the correct and accurate policies and procedures for the home. Environment: The providers are to 30/11/08 submit a schedule of works to improve the accommodation including details of repair and replacement and refurbishment of décor, fixtures and DS0000025620.V369055.R01.S.doc Version 5.2 Page 28 Requirement 2 YA1 5(1) to (4) 3 YA40 22(1) and (2) 4 YA24 16 and 23 Gate House 5 YA43 25(2)a to e 6 YA39 24(1) 7 YA39 26 fittings. This is so residents will know the home is suitably safe, well maintained and comfortable at all times. Accounts: the provider must provide the 30/11/08 Commission with year’s and last years accounts; this is so the Commission can evaluate how well the business is being run. Quality Assurance: the Registered 30/11/08 persons must establish and maintain a system for reviewing and improving the quality of care provided at the care home. So that residents know the providers are monitoring all aspects of the service. (This is an outstanding requirement. Previous timescales of 31/1/06, 1/1/07 and 31/7/07 not met; enforcement action make be taken) The registered provider must ensure that 30/11/08 ‘owner’s visits’ are undertaken at least monthly and are unannounced and copies of monthly provider reports are sent to each registered person, or partner, and to CSCI. So that residents know the providers are monitoring all aspects of the service. (Previous timescales of 31/07/07 and 31/07/07 not met and enforcement action may be taken) Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 29 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 YA24 Good Practice Recommendations Fire Doors: It is recommended that fire doors be fitted with suitable magnetic door holders where it would benefit residents and the service to hold the door open; so as to improve staff observation and create a more open atmosphere in the home. Staffing: It is recommended that the providers review staffing arrangements so as to ensure care staff are not occupied with ancillary work at the expense of their care duties. Manager: It is recommended that the manager’s hours be reviewed so as to ensure he has sufficient supernumerary time to fulfil her duties including the supervision and training of staff, updating care plans, updating the home’s policies and so forth. Computer: It is recommended that the registered provider provide the manager with a computer, connected to the internet, to enable the registered manager to improve administration in the home. This is a recommendation we reiterate since it will assist the manager in improving her service to residents. 2 YA33 3 YA37 4 YA40 YA41 Gate House DS0000025620.V369055.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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.V369055.R01.S.doc Version 5.2 Page 31 - 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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