CARE HOME ADULTS 18-65
Gateholme Old Bradford Road Carr Gate Wakefield West Yorks WF2 0QW Lead Inspector
Tony Railton Unannounced Inspection 29th September 2006 10:00 Gateholme DS0000006181.V312786.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 Gateholme DS0000006181.V312786.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. Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Gateholme Address Old Bradford Road Carr Gate Wakefield West Yorks WF2 0QW 01924 880918 01924 872705 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) www.craegmoor.co.uk J C Care Ltd Mrs Julie Pemberton (Acting Manager) Care Home 31 Category(ies) of Learning disability (31) registration, with number of places Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 10th November 2005 Brief Description of the Service: Gateholme provides accommodation and personal care for 27 adults who have a learning disability. The home consists of three buildings, one large unit and two smaller units. Set back in its own grounds the home is surrounded by very large gardens with a very large lawn to the front. There is also a very large drive with parking to the front. Each unit operates independently having its own lounges, kitchens, bathrooms and toilets. The home only provides single accommodation. Bedrooms are personalised and homely. Most residents attend care services, however, activities are organised on a regular basis for those who wish to participate. Some residents are very able and can travel independently. The home is close to a main bus route and is only a few minutes journey from the centre of Wakefield and all services and amenities. The home is also close to the M1and M62 motorways. On 29th September 2006 the providers said that the range of fees for living in the home was between £373.00 and £872.00 per week with separate cost for hairdressing (£4.00), chiropody (£5.00) and horse riding (£7.00). The Statement of Purpose containing additional information about the service provided for prospective residents and their relatives is available from the home or from the providers website, www.craegmoor.co.uk Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit to the home forms part of the inspection process and the judgments made in this report are based on evidence gathered both before and during the visit. The visit commenced at 09.00 and ended at 13.30. During the visit there was the opportunity to speak to nine residents, manager, deputy manager and all care staff. There was also the opportunity to meet Peter Cavanagh the Managing Director Specialist for the North & East Division of Craegmoor Healthcare and the Area Manager Sharon Hoole. The visit included looking at six residents records including assessments, care plans, medical and daily records. Six staff files were also seen and included their recruitment details, training and supervision records. A tour of the home was undertaken and included looking at bedrooms, lounges, dining rooms kitchens, bathrooms/shower rooms and toilets. It was noted that the home has not received any complaints since the previous visit to the home, however, there was the opportunity to discuss some concerns raised by the local Social Services Department about care practices within the home. The inspector would like to take the opportunity to thank residents and staff for their warm welcome and hospitality throughout this visit to the home. It was noted that there are no outstanding requirements, however, there are a few outstanding recommendations. The quality rating for the home remains good. What the service does well:
The environment continues to be maintained to a good standard and in particular the lounges, dining rooms and residents bedrooms. One resident said that she ’likes her bedroom’ and another said that he ‘likes living in the home’ with ‘his friends’. Residents appeared to be happy and comfortable. There was enough staff available to meet residents care needs and a good positive relationship between residents and staff was observed. The staff recruitment and selection practices make sure that residents are safe and all staff has POVA training. The acting manager undertakes an Overview Audit of the home and a copy of an audit carried out on 28th September 2006 was obtained. Residents continue to enjoy being part of the local community and attend different day care services at Wakefield, West Ardsley and Leeds with some residents visiting the local garden centre and public house and churches on a regular basis. Two residents said that they like going to college in Leeds and said that they are currently learning and helping to make tie and dye t-shirts. The deputy manager said that most residents have been on holiday this year and photographs on display on the notice board shows residents relaxing and enjoying themselves. Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Six residents records looked at along with the homes Overview Audit document show that residents care plans are not reviewed or updated on a regular basis. Six staff records including supervision notes show that staff are not receiving a minimum of six line management supervision sessions or an annual appraisal. The manager said that she has already started staff supervision and all staff has had at least one line management supervision so far. The new manager said that these issues have been identified and will be addressed. Staff training records also show that only five staff have a National Vocational Qualification Level 2 or above. The deputy manager said that there have been problems finding NVQ Assessors. The new manager said that she intends to carry out a training audit and provide a training and development plan for all staff. Although all residents have an activities plan/timetable the daily records would benefit from the use of descriptive words to reflect residents choices and preferences and any decisions they make about the way they live their day-today lives. The manager said that there is a need to promote Quality Assurance and that her recent Audit shows that residents, relatives, friends, advocates and other visitors views on the quality of care provided needs to be sought. All residents should be provided with a Service User Guide. Gateholme DS0000006181.V312786.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. Gateholme DS0000006181.V312786.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 Gateholme DS0000006181.V312786.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Prospective residents needs are assessed before they are admitted. Quality in this outcome area is good. This judgement is based on evidence gathered before and during this visit to the home. EVIDENCE: Examination of six residents’ records shows that they are admitted with an Integrated Care Planning Assessment or an ‘Easy Care’ assessment completed by the placing local authority. However, the acting manager said that there are plans to introduce a Person Centred Planning Assessment, which will improve the information gathered by the home, and involve the resident, their relatives and other stakeholders. It was also noted from the previous visit to the home that only two of the six residents have been given a Service User Guide. The manager said that all residents would be issued with their own copy of the Service User Guide. Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Residents’ personal and healthcare needs are outlined in their care plans. However, residents would benefit from having their care plans reviewed on a regular basis. Residents do make choices, are consulted and participate in the running of the home. Residents are supported to take risks as part of living an independent lifestyle. Quality in this outcome area is good. This judgement is based on evidence gathered both before and during this visit to the home. EVIDENCE: Throughout the visit residents were observed being asked what they wanted to do. A positive relationship was observed between residents and staff. The daily records would benefit from an increase in the use of descriptive words to show and reflect residents’ choices and preferences. This is an outstanding recommendation from the previous inspection. Examination of six residents care plans show that their personal and healthcare needs are identified and care planned accordingly. However, records show that these are not always reviewed, dated and signed. The manager said that this is currently being addressed as it was identified through the home audit carried out on 28th September this year. Issues raised by one Social Worker regarding one resident choosing to go out shopping was discussed with the acting manager. The resident in question said that she had been out shopping and was happy living in the home.
Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 11 . There was evidence in the daily records that residents do go out of the home and have opportunities to participate in ordinary community based activities. The manager said that there are plans to introduce ‘Person Centred Planning documentation within the coming months. She also said that Person Centred Planning training is going to be provided for staff. The minutes of the residents meetings show that residents have the opportunity to comment on the running of the home. Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Residents have opportunities for personal development and to take part in age appropriate activities. Residents are part of the local community and engage in ordinary community based leisure activities. Their rights are respected and they are offered a healthy diet and enjoy their meals. Quality in this outcome area is good. This judgement is based on information gathered before and during this visit to the home. EVIDENCE: Six residents records including schedule of activities, care plans and daily records show that they are supported and encouraged to participate in ordinary community based activities. Records show that residents enjoy visits to the local garden centre and public house, cinema and shopping in Wakefield. Records and photographs also show that residents enjoy outings and holidays to the seaside. Care plans also show that most attend community based local authority run day services. Some attend colleges in Leeds. Two resident’s explained that they are currently learning how to make tie-and –dye t-shirts and both said that they enjoy going to college. One resident said that they usually take a packed lunch to college. The manager said that most residents have a packed lunch but all have a substantial evening meal. The new menus show that there is a varied and balance diet offered to residents. The manager said that the home has recently changed the food suppliers to a high
Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 13 street supermarket and that fresh fruit and vegetables are delivered from local greengrocers. The quality of the fresh meat, fruit and vegetables on this unannounced visit was observed to be good. Staff said that the quality of the meals has improved tremendously since changing the suppliers. One resident said that the meals are ‘great’. Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Residents personal support is provided in a way they prefer and require including their emotional and healthcare needs. Residents are safeguarded and protected by the homes policies and practices regarding the administration of medicines. Quality in this outcome area is good. This judgement is based on evidence gathered during and before this visit to the home. EVIDENCE: Six residents records including assessments, care plans, daily and medical records show that they are supported to use ordinary community based healthcare services. Some records show that they are also supported by hospital-based consultants and community based nurses and social workers. Records also show visits to the opticians, dentists and chiropodist. One residents case notes show that there is also support from the advocacy service and psychology department if required. Examination of the medication ordering, storage, administration and recording systems show that residents are protected by the practices adopted by the home. The medicine administration list shows the staff that are trained to give medicines properly. Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Resident’s views are listened to and acted upon and residents are safeguarded and protected from abuse. The quality in this outcome area is adequate. This judgement is based on evidence gathered both before and during this visit to the home. EVIDENCE: The new manager said that there have been no complaints received by the home since the last inspection. However, the CSCI service history shows that concerns have been expressed by a Social Worker about the care practices adopted regarding one resident. This issue was discussed at length and it was found that the Social Work Department had not made any representation to the home about these concerns. This resident’s records show that these issues were dealt with through the care management reviewing process. Records show that the issues raised were unfounded as the resident does have opportunities to go shopping. Discussion with this resident shows that she does go out and ‘enjoys shopping in Wakefield’ accompanied by care staff. There was also other evidence in the daily records to show that she also enjoys other ordinary community based leisure pursuits. The manager’s home audit shows that despite not having received any complaints for some time there is a need to keep a proper log of all complaint’s, which will be reviewed and monitored. The homes safeguarding procedure and practices show that residents are protected and safeguarded from abuse. Staff records show that abuse training forms part of the induction training for all staff. Training records show that staff also receive POVA (Protection of Vulnerable Adults) training and update training. The CSCI service record shows that there was one reportable incident in July this year that involved contacting Social Care Direct and other authorities. Records show that this was appropriately dealt with by the home.
Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 Residents live in a homely, comfortable and safe environment. Quality in this outcome area is good. This judgement is based on evidence gathered both before and during this visit to the home. EVIDENCE: A tour of the home showed that it is decorated and maintained to a good standard and all areas were observed to be clean and free from any unpleasant odours. Residents were observed to be relaxed and comfortable and their bedrooms are personalised and as residents’ want them. The manager said that all the corridors have been decorated since the last inspection along with the dining room and shower rooms. A new refrigerator has been provided for the kitchen and a large fruit and vegetable rack. Unfortunately one bedroom was suffering from water damage following a leak to the wash hand basin. The manager said that the bedroom wall needs to be repaired and redecorated the carpet cleaning or replacing. The damage observed was recent and action was been taken to put this right. The manager said that she is going to provide an annual programme of maintenance and re-decoration for the home. Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 35 and 36 Residents are supported and protected by the homes recruitment policy and practices. Residents may benefit from having more staff with NVQ training and who are appropriately supervised. Quality in this outcome group is adequate. This judgement is based on evidence gathered before and during this visit to the home. EVIDENCE: Six staff files show that residents are protected by the staff selection and recruitment policies and practices as they include references, health checks, POVA and CRB checks. The last inspection report shows that five staff have a National Vocational Qualification Level 2 or above. However, discussion with the deputy manager found that there have been problems with NVQ assessors and although staff are registered on NVQ courses these have not been completed. This is an outstanding recommendation from the last visit to the home. The new manager said that it is her intention to provide a training and development plan for all staff based on supervision and assessed training needs. The homes audit carried out by the new manager shows that staff also need update training in a number of other areas including fire, health and safety, moving and handling and food hygiene. Examination of six staff supervision records show that they do not receive the recommended six line management supervision sessions per year. The new manager and the homes audit document indicate that these issues are currently being addressed including annual appraisals for all staff.
Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 18 The deputy manager said that since the registered manager left there have been issues around supporting staff, but things have improved tremendously since the new manager has been appointed. Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Resident benefit from living in a well run home where they know that their views will be listened to and acted upon. The health, safety and welfare of residents and staff are promoted and protected. Quality in this outcome area is good. This judgement is based upon evidence gathered both before and during this visit to the home. EVIDENCE: Following a suspension and subsequent investigation into the homes finances, the previous manager has been dismissed. Discussion with the Managing Director for the service providers said that it is their intention, and a application to the CSCI has been made, to have the Registered Manager of Farmholome also managing Gateholme (as both share the same site). The deputy manager said that since having the new acting manager staff moral has improved tremendously and that despite the previous manager leaving there is no evidence that this has impacted on the quality of life of residents or the general day to day running of the home. One staff said that “it has been difficult” but she “has confidence in the new manager”. There is evidence to show that the acting manager is very experienced and has been Registered by the CSCI for a number of years.
Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 20 The deputy manager said that no quality assurance questionnaires have been completed since last year. The new acting manager said that she intends to issue quality assurance questionnaires to residents, relatives and other visitors to the home and publish the results. The daily records and minutes of the residents meetings show that residents do have a say in the running of the home and in how they live their daily lives. Residents were observed throughout the visit making decisions about their lives and experiencing choices and preferences. Records show that appropriate fire alarm, electric and gas checks are carried out and found to be satisfactory. Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 21 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 1 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 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 X X 3 X Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 22 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. 1 Standard YA1 Regulation 5 Requirement All residents should be provided with a service user guide, which is in an appropriate format for that persons level of understanding. Timescale for action 01/01/07 2 YA26 23 (2)(c) & (d) For the comfort and benefit of residents, the wall and the 01/01/07 carpet in the bedroom identified as having water damage need to be repaired, replaced and redecorated as soon as is practicable. Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA7 Good Practice Recommendations Residents would benefit by having all of their care plans reviewed on a regular basis, which should include a date and signature. The daily records would benefit from an increase in the use of descriptive words to show and reflect residents’ choices, preferences, likes and dislikes. A minimum ratio of 50 of care staff should have a NVQ Level 2 or above. All staff that require it should receive update training in fire, moving and handling and health and safety. A proper log or complaints book should be provided which records the date, type of complaint, any action taken by the home and the outcome. The manager should provide a training and development plan for all staff. All care staff should have 6 planned line management supervision sessions per year and a record kept for inspection. All staff should have an annual appraisal with a record maintained for inspection. The views of residents, their relatives and other visiting professionals should be actively sought The information gathered from the quality assurance questionnaires should be collated by the manager and a report provided for residents. 2 YA7 3 4 5 YA32 YA35 YA22 6 7. YA35 YA36 8. 9. YA36 YA39 Gateholme DS0000006181.V312786.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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