Inspection on 27/04/07 for Gate Lodge

This inspection was carried out on 27th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Gate Lodge 21/04/06

Gate Lodge 19/01/06

Gate Lodge 16/06/05

Gate Lodge 12/04/05

Gate Lodge 04/01/05

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

CARE HOMES FOR OLDER PEOPLE Gate Lodge 1 Upper Woodcote Village Purley Surrey CR8 3HE Lead Inspector Peter Stanley Key Unannounced Inspection 27th April 2007 9:30am X10015.doc Version 1.40 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 Lodge DS0000025784.V336589.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 Older People. 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 Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gate Lodge Address 1 Upper Woodcote Village Purley Surrey CR8 3HE 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) 020 8668 7286 F/P 020 8668 7286 Mr Paramaseeven Chellun Mrs Georgia Chellun Ms Christina Thambirajah Care Home 16 Category(ies) of Dementia - over 65 years of age (16) registration, with number of places Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. For people with dementia who are over 65 Date of last inspection 21st April 2006 Brief Description of the Service: Gate Lodge provides residential care for up to 16 service users (65 and over) who have dementia. The home is an attractive detached property located on the green of Upper Woodcote Village within a pleasant residential area; it is within walking distance of a small village shop and is surrounded by several larger houses. The home has 12 single rooms and two double rooms located on two floors, ground and first floor. Gate Lodge has two adjoining lounge areas and a separate dining room. The home does not have a lift and thus access between the ground and first floor is by stairs. There is parking for three cars to the front, and parking is also available on the road outside the home. There is a well-kept garden available for the use of service users. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home is presently providing residential care for 14 elderly residents with dementia. There are two vacancies. There are plans to build a new annexe to accommodate a further five residents. This unannounced inspection was conducted over one day and involved discussion with the registered provider’s son, Mr Jason Chellun, who is assisting with the management of the home, and with Mrs Christina Thambirajah, the registered manager. The inspector spoke with a large number of residents, and with staff on duty. The inspector examined documentation including residents’ care plans, risk assessments, activity charts and daily logs, medication records, staff supervision and training records, policies and procedures, staff rotas and logs relating to incidents, accidents and complaints. The inspector carried out a full inspection of the premises and completed checks relating to health and safety. The home has continued to make good progress over the last year, with 11 of the 15 requirements issued at the last key inspection having been met by the time of the last (random) inspection on 3.11.06, and the remaining four requirements having been met at this inspection. Feedback from residents was favourable, with residents presenting as settled and well supported by staff. Questionnaires, which had been completed by relatives, indicated a high level of satisfaction with the home. The inspector also received favourable comments from staff regarding the management of the home and the training and support provided. One area identified for improvement is in the area of care planning. Whilst care plans have been improved, and are providing more detailed and individualised information, there is a need for a more person-centred approach in developing care plans. The inspector recommends, therefore, that the management and staff access training in person-centred care planning, with view to involving residents more fully in drawing up their care plans, and in developing a more structured person-centred approach. The evidence from this inspection indicates that the home is providing a generally good standard of care and support for its’ residents, and that there is respect for residents’ privacy, dignity, and rights. Under the direction of Mr Jason Chellun, the management of the home has significantly improved over the last two years, with evidence of a commitment to raising standards across the board, and the development of the necessary support and systems for ensuring the delivery of responsive and good quality services. The inspector would like to extend his thanks to Mr Jason Chellun and Mrs Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 6 Christina Thambirajah for their assistance in facilitating this inspection. What the service does well: Residents are being provided with the information, which they require, to enable an informed choice as to where they would like to live. Residents are being provided with written information detailing the terms and conditions of their placement. The home is able to demonstrate that it is obtaining full information regarding the health and support needs of prospective residents prior to their admission. Prospective residents, their friends and relatives are able to visit to assess the suitability of the home. The health care needs of residents are being fully met. Residents are being safeguarded by the home’s medication policies and procedures. All staff have completed accredited medication training. Service users feel that that they are being treated with respect and that their right to privacy is being maintained. Residents can be assured that, in the eventuality of their death, their wishes will be respected and that they and their family will be treated with care, sensitivity and respect. Residents are being provided with sufficient opportunities for meeting their social, cultural, religious and recreational needs. Residents are being encouraged to maintain contact with their family and friends and to retain links with the local community. Residents are being assisted to exercise choice and control over their day-today routines and decision-making. The meals provided are wholesome and appealing and are served at times, and in places, which are convenient for residents. Residents and their relatives can be assured that the home has an appropriate complaints policy and procedure in place, and that their complaints will be listened to, taken seriously and acted upon. The legal rights of residents within the home are being protected and promoted. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 7 The protection of residents is being safeguarded by the home’s adult protection, policies and training. Residents are living in a safe, well-maintained environment, with access to safe and comfortable facilities. Risk assessment of the home is in place for their protection. Residents’ rooms present as being safe, comfortable and pleasantly decorated, reflecting individual residents’ personal identities, and being suited to their individual needs. Residents have access to safe and comfortable communal facilities. Sufficient bathing, washing and toilet facilities are being provided for the home’s residents. Residents’ safety is being assured through the provision of sufficient aids and adaptations. Residents are living in a home that presents as being clean, pleasant and hygienic. The home has the numbers and skill mix of staff sufficient to meet the needs presented by the home’s residents, and to ensure their safety. Generally, staff are being provided with the necessary induction and training with which to perform their work duties competently, and to safely meet the needs of residents. Generally, the home is being well managed, and in a way that demonstrates that it is being run in the best interests of residents. The home is consulting widely with residents, relatives and other stakeholders, and is beginning to evidence the home’s ability to meet its aims and objectives. The interests of residents are being safeguarded by the home’s record keeping, with records being kept secure, up to date and accurate. The health, safety and welfare of residents and staff are being appropriately promoted and protected. What has improved since the last inspection? A more detailed and individualised care plan format has been developed. This needs, however, to become more fully person-centred and to reflect the involvement of each resident. Recommendation made for Person Centred Planning training. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 8 Inspection of service user files has evidenced that care reviews are now being held for all new admissions. Staff have undertaken training in working with service users who present aggressive or challenging behaviour. Accredited medication training has been completed by all care staff who administer medication. The home is meeting its commitment to increase the numbers of NVQ qualified staff, and is meeting the 50 threshold. Through the regular and appropriate supervision of staff, good practice is being promoted and the welfare and best interests of residents protected. There has been significant delegation of the supervisory workload to both deputy managers. The registered provider is completing a Section 26 visit (and report) at least once a month. There has been re-carpeting and redecoration of the lounge and dining areas in the home. There has been an OT assessment of the home, with all recommendations having been implemented. An improved Health and Safety Policy and risk assessment process has been introduced. What they could do better: While residents are having their health, personal care and social needs set out in more detailed and individualised care plans, these need to involve residents more fully and to become more person-centred in their focus. Recommendation made for Person Centred Planning training. Generally, residents are being safeguarded by satisfactory recruitment policy and procedures. However, given past concerns, the home must ensure that, in future, all the necessary recruitment and criminal records checks (including CRB and POVA) are completed before the recruitment of any new staff. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 9 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 Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 to 5 Quality in this outcome area is good. This judgement has been made using available evidence including a previous random visit to this service. Residents are being provided with the information, which they require, to enable an informed choice as to where they would like to live. Residents are being provided with written information detailing the terms and conditions of their placement. The home is able to demonstrate that it is obtaining full information regarding the health and support needs of prospective residents prior to their admission. Prospective residents, their friends and relatives are able to visit to assess the suitability of the home. EVIDENCE: Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 12 The home has a Statement of Purpose and Service User Guide that meets the information needs of residents and their relatives. These are being annually reviewed and updated. Last reviewed on 15 May 2006, a further review is due. The Service User Guide is made available to all prospective and current residents. There are presently 14 residents living in the home, with 2 vacancies. No admissions have taken place since the last inspection. Following referral, the home requests full information regarding the health, care and support needs of any prospective resident and completes its own full assessment and risk assessments. Prospective residents, their friends and relatives have the opportunity to visit the home, and to meet other residents and staff, prior to any decision regarding an admission being taken. Inspection of residents’ files evidenced that care reviews are being held, and that a review has taken place for a resident identified as requiring review at the last inspection. The inspector has noted comments from visiting relatives, and friends, which are generally very positive. The inspector spoke to a wide cross section of residents. This indicated that residents feel settled and safe in the home and that staff are perceived as caring and supportive in meeting their needs. On the previous (random) inspection, on 6.11.06, a visiting relative indicated that she is made very welcome when she visits the home, and that she had been pleased with the care provided for her mother in the four years that she had been there. The inspector also met with two recently admitted service users. Both indicated that they had settled well in the home, that they were happy with their rooms, and that they have found staff to be caring and supportive in meeting their needs. No concerns were expressed. Inspection of residents’ files evidenced that a Statement of Terms and Conditions is being issued to each resident upon their admission. This details all the relevant information required regarding the fees payable, the room and services to be provided, and the terms and conditions of the placement. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 to 11 Quality in this outcome area is good. This judgement has been made using available evidence including a previous random visit to this service. While residents are having their health, personal care and social needs set out in more detailed and individualised care plans, these need to involve residents more fully and become more person-centred in their focus. The health care needs of residents are being fully met. Residents are being safeguarded by the home’s medication policies and procedures. All staff have completed accredited medication training. Service users feel that that they are being treated with respect and that their right to privacy is being maintained. Residents can be assured that, in the eventuality of their death, their wishes will be respected and that they and their family will be treated with care, sensitivity and respect. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 14 EVIDENCE: The inspector examined a random sample of service users’ care plans, these having been compiled on the basis of initial assessment and periodic review. Care plans are being reviewed on a monthly basis and involve discussion with the service user and his/her relatives/representatives. Following a previous requirement, the home has been attempting to develop more detailed care plans. Inspection of care plans indicates the need for these to become more person-centred so as to ensure that care plans reflect a detailed breakdown of the service user’s care needs, wishes and preferences. To assist in achieving this objective, the inspector recommends that initially, the management and senior care staff undertake accredited training in Person Centred Care Planning, and that, in the longer term, training be extended to all care staff. The health care needs of service users are generally evidenced as being well met. Feedback from service users, and examination of care notes, indicated that there is good follow up of any health concerns and that health care needs are generally being well met. The home enjoys a good relationship with the local GP surgery, and a doctor visits on a regular weekly basis. A psychiatrist visits as and when required. Care plans include a health section that lists all health care professionals who are involved; this includes GPs (general practitioners), CPNs (community psychiatric nurses) and District Nurses, together with dentists, opticians and chiropodists. A chiropodist visits on a six-weekly basis, and dental and optician check-up visits take place at the home, with follow-up surgery appointments being arranged when required. A dental hygienist visits twice a year. Weight charts are used for those service users where there are concerns about weight. The inspector undertook checks on medication arrangements and examined residents’ medication records. The inspector was advised that no service users are currently taking their own medication. The home has an appropriate medication policy and procedures in place. Medication records were found to be accurate, up-to-date and well maintained. These included the receipts and returns records. MAR sheets include photos of the service users, with blister packs being used and kept in a locked cupboard. The inspector was advised that two service users are currently taking a controlled drug, and that these are being reviewed six-monthly by the home’s GP. Secure and appropriate storage of all medication, including the separate locked storage of controlled drugs, was evidenced. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 15 It has now been evidenced that all staff have completed accredited medication training, thus meeting a requirement from the last key inspection. The home has a policy for respecting the privacy and dignity of residents. On the day of inspection, staff presented as caring and respectful in their interaction with residents and were observed to knock on service users’ doors before receiving permission to enter their rooms. Feedback received from residents indicated that privacy and dignity is being respected within the home. There has been one death of a resident (in hospital) since the last inspection. The wishes of residents regarding the eventuality of their death are recorded on residents’ files, and religious and other beliefs regarding their death and funeral arrangements are respected. The home informs and involves relatives where potential life-threatening concerns arise. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 to 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are being provided with sufficient opportunities for meeting their social, cultural, religious and recreational needs. Residents are being encouraged to maintain contact with their family and friends and to retain links with the local community. Residents are being assisted to exercise choice and control over their day-today routines and decision-making. The meals provided are wholesome and appealing and are served at times, and in places, which are convenient for residents. EVIDENCE: Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 17 The home provides a wide range of activities, with a group activity such as aerobics, bingo, a quiz or a film on DVD being scheduled each afternoon. Other activities such as drawing, skittles, puzzles, ball games, listening to music and sing a longs are available together with participation in gardening, flower arranging or with baking cakes if there is a wish or interest. Residents are encouraged to identify their interests and hobbies, and to participate both in group and one-to-one activities. An activity programme and an achievement chart, which identifies goals and objectives, is in place for each resident. During the inspection the inspector observed some very positive interactions between staff and residents, with a range of activities being offered, including a sing-along which several of the residents were enjoying. Generally, residents presented as being engaged and stimulated, while residents less able to participate were observed to be receiving some individual attention and encouragement. One lady was playing the piano, having recently been encouraged to start playing again. Another lady is being encouraged to rediscover the use of some French words and phrases, having indicated an interest, while another lady enjoys doing embroidery. There is a regular monthly flower arranging session that has proved very popular over time, while several of the residents have potted plants in some attractive displays in the patio and garden areas. There are monthly visits from a group of entertainers, and occasional trips, such as a day trip to Brighton, or into the countryside, are arranged. Friends and relatives are encouraged to visit and to take residents out for lunch or tea if they wish. There are also trips out to the local park or shops for those residents who wish to do so. Religious views and beliefs are well respected in this home. Each week there is a religious hymn-singing session with a bible reading. The inspector was advised that there are not currently any residents from any faiths or beliefs other than from Christian denominations. Residents are being encouraged to exercise choice and control, with individual feedback indicating that residents are enabled to make choices in their daily routines and activities, and consulted regarding decisions which affect them. Residents are able to raise any issues they wish with the manager and provider, and there is regular contact between each resident and their key worker. Residents meetings are being held monthly, providing the opportunity for issues to be raised and addressed. A more recent development has been the introduction of three monthly meetings for relatives and friends, which residents are able to attend if they wish, and where issues affecting the lives and welfare of the residents are discussed, and information concerning forthcoming events and developments are shared. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 18 The inspector examined four-weekly menus and evidenced a varied range of food choices. The kitchen area presented as well stocked with fresh and frozen food, with appropriate hygiene standards being maintained. Residents were observed taking lunch and the food was noted to include fresh vegetables and a choice of main course. Residents indicated their satisfaction with the food provided, and individual tastes seem to be well catered for. The dining room presents as a pleasant area in which to take meals. Residents are able to take meals in the lounge, or in their own room, if they wish to do so. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 to 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be assured that the home has an appropriate complaints policy and procedure in place, and that their complaints will be listened to, taken seriously and acted upon. The legal rights of residents within the home are being protected and promoted. The protection of residents is being safeguarded by the home’s adult protection, policies and training. EVIDENCE: Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 20 The home has an appropriate complaints policy and procedure. A complaints book at the home details the outcome of any complaint and what action (if any) was taken. The complaints procedure is clear and simple and includes the stages and time scales for complaints to be managed. While no complaints have been made since the last inspection, the inspector understands that all complaints are taken seriously and would be dealt with promptly and effectively. The procedure states that any complaint will be responded to within twenty-eight days, and that that any complaint can be referred to the CSCI, local office, at any time during the course of investigation. The also has a Concerns and Compliments record, which is kept in the reception area where it is easily accessible for visitors to record their comments. Residents’ legal rights are being safeguarded in this home. The home aims to protect residents’ legal rights by involving family and friends in respect of their contracts, benefits and monies, and in discussing any issues at reviews. Responsibility for managing a resident’s finances is not undertaken by the home but by a relative, solicitor or social services. The home maintains records of residents’ personal expenditure, with monies being reclaimed on a monthly basis. All residents are registered on the electoral roll and a postal vote can be obtained in the event of an election. The home has an Adult Protection and Whistle Blowing Policy in place, together with a copy of the local statutory adult protection policy and procedures (LB Croydon), for staff to reference. All staff have undertaken training in adult abuse and have received statutory adult protection training. No adult protection concerns have been identified since the last inspection or within the last 12 months. The inspector spoke with a number of residents. Residents presented as settled and well cared for, with feedback indicating that residents feel safe and secure within the home. No concerns were identified. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 to 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are living in a safe, well-maintained environment, with access to safe and comfortable facilities. Risk assessment of the home is in place for their protection. Residents’ rooms present as being safe, comfortable and pleasantly decorated, reflecting individual residents’ personal identities, and being suited to their individual needs. Residents have access to safe and comfortable communal facilities. Sufficient bathing, washing and toilet facilities are being provided for the home’s residents. Residents’ safety is being assured through the provision of sufficient aids and adaptations. Residents are living in a home that presents as being clean, pleasant and hygienic. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 22 EVIDENCE: The inspector completed an inspection of the premises. The home has a maintenance and development programme, regarding the renewal of the fabric and decoration of the home. This lists short, medium and long-term plans. There has been an ongoing programme of redecoration and refurbishment, which has included redecoration and re-carpeting of the lounge and dining areas. A double bedroom and the bathroom on the first floor have been redecorated. The home presents as being safe and reasonably well maintained. The home is on two floors, and is accessed by stairs, no passenger lift being available. The home was found to be clean and hygienic, tidy, and decorated to a reasonable standard, and generally free of any unpleasant odours. An extension to the home is being planned which will involve the installation of a lift and an increase in the overall number of residents. The home has spacious communal areas, which present as pleasant and homely. There is a large lounge, which is divided into two distinct areas for different uses. The main area is very light and airy and overlooks the garden. Most residents were observed to be sitting here and conversation is encouraged. There is a separate smaller area, with less natural light, which is set back, and adjoins the hallway, in which there is a television and a piano. The inspector spoke with a number of residents who were sitting in the main lounge during the inspection. They expressed positive views regarding the feel of the home, and the facilities provided, and presented as being settled and very satisfied with their environment. The lounge and dining room overlook a pleasant patio and garden. This is easily accessible and is used by the residents in the summer months. None of the residents were accessing the garden on the day of inspection. The inspector was advised that some residents assist with the potting of plants, there being some attractive displays on the patio. The inspector looked at a number of residents’ bedrooms. These were observed to be comfortable and personalised, reflecting individuals’ identities and meeting their needs. The rooms present as reasonably well decorated, and are comfortably heated and ventilated. Curtains are provided for privacy in shared rooms. There are two double bedrooms (Rooms 12 and 15). The inspector was advised by Mr Chellun that the services users concerned are Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 23 happy with sharing a bedroom, and that there have been no problems in this regard. Hand basins are provided in all residents’ rooms, and there are two bathrooms, both of which present as safe and hygienic. The inspector has previously noted that there is a disused shower opposite Room 11, which could, subject to an occupational therapist assessment, be renovated and bought back into operation for the benefit of the home’s service users. There are, however, no plans to do so at present. There are accessible toilets on both floors; these were clean and free from any offensive odours. Two requirements have been met. Window restrictors have been fitted in Rooms 4 and 12, window restrictors now being in use in most upstairs bedrooms. Lockable spaces are now being provided in all bedrooms, small lockable safety boxes having been placed in those rooms (8, 10, 12 and 15) where a lockable facility was not previously being provided. All radiators in the home have been covered with “cool to touch units”. Central heating can be controlled in each individual room. There is an emergency lighting system. Hot water temperatures are being tested weekly. Risk assessment of the home and individuals are in place for their protection. An appropriate Health and Safety Risk Assessment format has now been put in place, meeting a requirement from the last inspection. The home has been assessed by an occupational therapist within the last year, on 13 June 2006, and three recommendations have been implemented. Stair rails are in place, and rails are fitted along corridors. Grab rails in toilets, raised toilet seats, commodes and adapted bath chairs are in place. Generally, the home presented as providing the necessary specialist equipment required to safety meet service users’ needs and maximise their independence. There was a requirement from the last key inspection for the home’s bath hoist to be serviced. A certificate has been produced to evidence that the home’s hoist was last serviced on 3.6.06. Mr Jason Chellun has confirmed that the manufacturer undertakes servicing on an annual basis, and has agreed that the home will complete and record hoist maintenance checks on a 3 monthly basis. The home presents as being clean and hygienic and to be meeting the necessary standards of cleanliness and hygiene. All staff at the home are provided with infection control training, and clear guidelines in this area are in place. Food hygiene training is provided for all staff who assist in preparing food. This training needs, however, to be updated. A requirement applies. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 24 Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 to 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has the numbers and skill mix of staff sufficient to meet the needs presented by the home’s residents, and to ensure their safety. Generally, residents are being safeguarded by satisfactory recruitment policy and procedures. However, given past concerns, the home must ensure that, in future, all the necessary recruitment and criminal records checks (including CRB and POVA) are completed before the recruitment of any new staff. Generally, staff are being provided with the necessary induction and training with which to perform their work duties competently, and to safely meet the needs of residents. EVIDENCE: Staffing levels are being maintained in line with Care Home Regulations, and as appropriate to the number and assessed needs of the home’s residents. There are presently 9 care staff and four auxiliary staff, which includes two cleaners and two cooks. The inspector examined the staff rota. This evidenced that there were two care staff on duty, plus the person in charge (the Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 26 registered manager) during the day with two waking staff on at night. Two ancillary workers (a cook and a cleaner) were also on duty. The inspector spoke to a number of residents. The feedback received indicated that residents find staff to be caring and supportive, and attentive in meeting their individual needs. No new staff have been recruited since the last inspection, hence it was not possible to assess this standard. Following past concerns relating to the employment of persons at the home without the completion of the necessary CRB and POVA checks, the position regarding any further non-compliance has been made clear to both Mr Jason Chellun and the registered manager, Ms Christina Thambirajah. Assurances have been provided that CRB and POVA checks will, in future, be completed before the employment of any new staff. The home has an ongoing programme of staff training and induction, which is being regularly updated. The induction programme includes the use of the ‘Skills For Care’ Induction to Adults Social Care Manual. Training includes recent courses in dementia awareness, and challenging behaviour, and training in first aid, food hygiene, infection control, manual handling, medication and adult protection. The inspector identified the need for food hygiene training to be updated for all staff, for which a requirement applies. With the assistance of a training consultancy, an organisational training and development plan has been developed, and a ‘training needs analysis’ completed, identifying specific training needs for each staff member. The home is gradually increasing the number of staff who have obtained NVQ qualifications. Of 13 staff employed at the home, 7 staff have now completed their NVQ Level 2, of whom 4 have completed their NVQ Level 3. The inspector was advised that 4 other staff have registered to do their NVQ Level 2. Feedback received indicated that residents are generally satisfied with the care and support that they are receiving from care staff, no concerns being expressed. From his observations, the inspector found staff to be caring and attentive in their interactions with residents, displaying competency and an understanding of the needs of this client group. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 to 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally, the home is being well managed, and in a way that demonstrates that it is being run in the best interests of residents. The home is consulting widely with residents, relatives and other stakeholders, and is beginning to evidence the home’s ability to meet its aims and objectives. Through the regular and appropriate supervision of staff, good practice is being promoted and the welfare and best interests of residents protected. The interests of residents are being safeguarded by the home’s record keeping, with records being kept secure, up to date and accurate. The health, safety and welfare of residents and staff are being appropriately promoted and protected. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 28 EVIDENCE: Since 2005, the home has been jointly managed by the registered manager, Christina Thambirajah, in partnership with the registered providers’ son, Jason Chellun. Mr Chellun has a business studies background and is currently studying for his NVQ Level 4 and RMA (Registered Manager’s Award). The present manager is nearing retirement, at which point Jason Chellun is intending to apply to become the registered manager for the home. In the two years that he has been involved, the home has progressed well, and has been managed in a competent and caring way. The current manager, Christina Thambirajah, presents as a fit person to be in charge, and manages the home in the best interests of the home’s service users. The management approach has been observed to be conducive to creating an open, relaxed and friendly atmosphere. The home has been developing its quality assurance processes. Questionnaires have been devised and completed with the home’s service users, for the relatives and friends of service users, and for visiting professionals and care managers. An annual audit has been completed, the results of which are presented in a report, and a Development Plan has now been put in place for 2006-07. This includes feedback from questionnaires and other sources, and identifies performance indicators measuring how well the home is doing in meeting its objectives. The Plan should aim to specify the proposed plans and time-scales for addressing any areas of unmet need or service development. The home has met a requirement from the last key inspection for the registered provider to complete an unannounced Section 26 visit at least once a month; to inspect the premises and interview service users and staff. These are now being completed on a regular monthly basis. The inspector examined staff supervision notes and evidenced that staff have been receiving supervision on a regular two-monthly basis, and that supervision is now more structured and comprehensive in scope. While supervision is still the responsibility of the manager, Christina Thambirajah, there has been some significant delegation of supervisory responsibilities from the registered manager to both deputy managers. As previously Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 29 recommended, a new supervision format, that provides a more detailed record of supervision, has been put in place. Generally, the interests of residents are being safeguarded by the home’s record keeping, with records being up to date, accurate and securely stored. Inspection of incident and accident records indicates that the home has a generally safe environment. All records that are required for regulation are in place and are maintained to a satisfactory standard. The records that were inspected included staff and service user files, medication charts, accident and incident records, complaints records, and staff rotas. The inspector completed an inspection of the premises and requested documentation regarding health and safety, and fire safety checks. The health, safety and welfare of service users and staff are evidenced as being appropriately promoted and protected. The premises present as generally well maintained, and no specific concerns were identified. A number of requirements have been met from the previous key and random inspections on 21/4/06 and 3/11/06. These included the fitting of window restrictors, regular servicing of the home’s hoist, and the need for an appropriate Health and Safety Risk Assessment format. All health and safety maintenance checks were found to be have been completed within the required time-scales. These included servicing of the gas boiler and supply (last serviced on 16/10/06), legionella inspection for the home’s water storage (21/7/06), and electrical portable appliances (2/6/06). An electrical installation inspection was last completed on 6/5/04 and is now due for a further inspection. The inspector was informed that a food hygiene inspection was last completed in February 2007. A certificate was produced to evidence that, following the previous key inspection, the home’s hoist was serviced on 3.6.06. Mr Jason Chellun advised that the hoist manufacturer confirmed that servicing would take place on an annual basis, and it was agreed that the home should complete and record its own hoist maintenance checks on a three monthly basis. Mr Chellun stated that the home has sought the assistance of an independent Health and Safety consultancy and that subsequently the home’s Health and Safety policy has been revised. Health and Safety risk assessments are being updated on a monthly basis, a new format having been introduced since the last inspection. A fire risk assessment was completed on 15/3/07, with fire safety training for staff being held at three monthly intervals, most recently on 20/2/07. A fire safety inspection was most recently carried out on 15/11/06. This included inspection of fire alarms and equipment, emergency lighting and the emergency call system. Hot water temperature checks are being completed weekly, together with weekly fridge/freezer checks. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 3 3 3 3 3 Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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 Requirement Timescale for action 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 OP7 Good Practice Recommendations To assist in achieving person-centred care plans, the inspector recommends that the management and senior care staff undertake accredited training in Person Centred Care Planning, and that, in the longer term, training be extended to all care staff. Gate Lodge DS0000025784.V336589.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Lodge DS0000025784.V336589.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. Re-publishing this information is in breach of the terms of use of that website. 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