Inspection on 18/01/07 for Gatehouse Cottages Care Home

This inspection was carried out on 18th January 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gatehouse Cottages Care Home 28/01/10

Gatehouse Cottages Care Home 29/09/09

Gatehouse Cottages Care Home 18/01/08

Gatehouse Cottages Care Home 27/06/06

Gatehouse Cottages Care Home 01/12/05

Gatehouse Cottages Care Home 10/06/05

Gatehouse Cottages Care Home 20/12/04

Gatehouse Cottages Care Home 29/04/04

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

CARE HOME ADULTS 18-65 Gatehouse Cottages Care Home Stallingborough Road Immingham Grimsby North East Lincs DN41 8BP Lead Inspector Ms Matun Wawryk Unannounced Inspection 18th January 2007 09:00 Gatehouse Cottages Care Home DS0000002786.V325589.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 Gatehouse Cottages Care Home DS0000002786.V325589.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. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gatehouse Cottages Care Home Address Stallingborough Road Immingham Grimsby North East Lincs DN41 8BP 01469 574010 01469 574005 gatehouse.cottages@craegmoor.co.uk Blair.house@craegmoor.co.uk Health & Care Services (UK) Limited 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) Amanda Griffiths Care Home 27 Category(ies) of Learning disability (27), Physical disability (20) registration, with number of places Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Residents with physical disability must not reside in The Lodge. Residents with physical disability must not reside on the first floor of the main building. One (1) named service user over the age of 65 years may be accommodated in the home for as long as his needs can be met or until his circumstances change. 27th June 2006 Date of last inspection Brief Description of the Service: Gatehouse Cottages is a care home providing personal care with nursing and accommodation for up to 27 adults aged 18-65 with moderate and severe learning disabilities, 20 of these places are for service users with physical disabilities. Gatehouse Cottages is owned by Health and Care Services (UK) Limited/Craegmoor healthcare. The home is situated in the countryside a few miles outside Immingham in a fairly isolated position; there is only one neighbouring property. There is a regular bus service and the home has its own transport. An enclosed garden is to the rear of the building and parking space is provided at the front of the home. The accommodation comprises of 3 separate units; there is a purpose built ground floor main facility, the first floor of this is the Studio and there is a separate 3-bedroom house nearby which is called the Lodge. There are two shared bedrooms in the main facility and one in the Studio the rest being single. None of the bedrooms have en-suite facilities. A range of aids, adaptations and equipment are provided in the main facility. As at 18th January 2007 the weekly fees ranged from £492 to £1.065 per week. Residents will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these can be obtained from the manager. Information on the service is made available to prospective and current residents via the homes statement of purpose, service user guide and inspection report. Copies of these documents can be obtained from the home. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Inspection visits were made to the home in March and April 2006. At these visits it was established that staff were not following good practice regarding the management and recording of residents’ medication. This potentially put residents at risk of harm. In addition to this care plans were found to very basic and in some cases information contained in these was not accurate and up to date. This meant that staff did not have all the information about what care residents needed. It was also found that not all staff had had the training and supervision they needed to carryout their role properly. Because of this the Commission issued the owners of the home with two Statutory Notices. These notices detailed a number of things that needed to be done to ensure residents received safe and good quality care. The owners were told that if they did not take steps to improve things in the home over an agreed period, the Commission would have no alternative but to consider taking further action to ensure the health, welfare and safety of residents was protected and promoted. The Commission has monitored the plan the owners put in place to address all these matters. A full inspection (key) of the home was carried out on 27th June 2006. At this visit it was established that significant improvements had been made, however further improvement was still needed. Following this visit two further unannounced visits were made in August and November 2006. Whilst progress had been made, the owners of the home had still not fully completed all the things the Commission had asked them to do. This is the homes second key inspection of 2006/07. The inspection visit took place over 1 day in January 2006. Mrs Matun Wawryk and Mrs Jane Lyons carried out the visit. Prior to visiting to the home the inspector sent survey questionnaires to twenty one residents of which 5 (23 ) were returned, fifteen relative questionnaires of which 10 (66 ) were returned, forty staff questionnaires of which eleven (27 ) were returned, thirty care managers/health care professionals questionnaires of which twenty four (80 ) were returned to try and establish whether the residents’ needs were being met Some of the comments received by these people have been included in the report. Most residents had communication difficulties, which meant they were unable to complete a written questionnaire or tell the inspectors about their care needs or give their views on the home. Because of this the inspectors spent sometime observing staff carrying out their work with residents rather than conducting formal interviews. During the visit the inspectors spoke to four residents, one relative, the manager, deputy manager, one nurse, three care workers and one domestic to Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 6 find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspectors also looked around the home and looked at lots of records, including resident care plans, staff training records and other records relating to the running of the home. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. Since the last visit in November 2006 the manager and staff had worked extremely hard to improve things. A number of outstanding requirements and recommendations from previous inspections have now been met and work is progressing to achieve others. What the service does well: What has improved since the last inspection? The new manager had moved the service forward in a number of ways. Staff, relatives and professional staff said through questionnaires and face-to-face discussions that the atmosphere in the home was more positive, which they felt, had led to improved client care. The manager and owners of the home had looked at staffing levels and now there are sufficient staff on duty to meet the needs of residents. This was confirmed in discussions and questionnaires from relatives, professional staff and the homes staff. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 7 What they could do better: Information about the home is made available to prospective residents and their representatives through a statement of purpose and service user guide. Both these documents need to be updated to show changes of managers, staff and fees charged. This is needed to ensure that the rights and best interests of the people living in the home are promoted and to ensure prospective residents and or their representatives have all the information needed to help make informed choices about the homes ability to meet their needs. Although care plans were in place for each resident some plans had not been updated as the residents needs had changed. It is important that care plans are kept up to date, because staff need to have access to all necessary guidance to tell them what help the person needs, when they need it. Although staff training had generally improved, not many care staff had had much specialist training in areas appropriate to the needs of residents for example; communication skills, care of people with diabetes or in working with people with learning disabilities or those with multiple disabilities. Failure to provide this training may mean staff do not have all the knowledge and skills they need to meet the needs of residents and this could impact on the care they receive. Some staff needed to have training on what to do in the event of a fire and how to move people safely. This was needed to protect both residents and staff from potential harm and to meet legal health and safety requirements. Although the staff in the home were trying to improve things, the home did not have a proper plan in place to monitor the quality of care and services provided to residents. The home did not have system in place to show how they consulted with residents, staff, relatives and others for example social services care managers and physiotherapists. The home must now produce an annual development plan, which details how they consult with people and the outcomes of this consultation. A report then needs to be produced showing how the comments from these individuals have shaped or altered the practices within the home, and show how the home is run in the resident’s best interests. The inspectors would like to thank everyone who completed a questionnaire and/or took the time to talk to then during this visit. Your comments and input have been a valuable source of information, which has helped create this report. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 8 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. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 9 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 Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The homes statement of purpose and service user guide does not provide all the information prospective residents or their carers need to make informed decisions about the homes capacity to meet their needs. Residents have their needs assessed prior to admission to the home. EVIDENCE: There had been no new admissions to the home in the last year. Assessment of this outcome group was based on examination of records and information given by people in face-to-face discussions and questionnaires. The home had a statement of purpose and a service user guide, which give information about the home. Both these documents needed updating to show recent changes in managers and staffing and to include more information about fees and charges. The service user guide had been reproduced using Makaton symbols, however there was too much information, which rendered the document almost illegible. The inspectors advise that the document be re-looked at to ensure information Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 11 is available in more appropriate formats, thereby promoting the rights and best interests of residents. The admission procedure was sufficient to guide staff on the actions to be taken to ensure prospective residents needs are properly assessed and planned for. Records evidenced that the manager obtains a copy of the care management assessment and care plan for new residents and she was aware of the need to complete a needs assessment in the absence of a professional assessment. Individual care plans had been developed identifying the persons needs and abilities using the information in the assessments and other information obtained from discussions with the resident and/or their families. Records showed some residents had been issued with a statement of terms and conditions in 2003. However there was nothing to show these has been updated and re-issued and in some cases they had not been agreed with the resident and/or their representative. It is important that each resident knows what he or she is paying for and any terms of residency. The manager is advised to ensure everyone who is coming to live in the home is given a personalised statement specifically relating to the care, accommodation etc that they will receive for the fee being paid. This should be supplied, at the latest, at the point at which someone takes up residence in the home and should be updated as fees change. Full details about what needs to be included can be found in the revised Care Homes Regulations. There was nothing to show that residents or their representatives were formally advised that the home could meet their needs, this should now happen for new admissions. Residents at the home who received nursing care had had an assessment by a NHS registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual and to determine the amount of financial support they would receive. None of the residents spoken to were able to give detailed information about their care needs and the input they required from the staff and outside professionals. One resident said ‘I like it here’ another said ‘ I like the people I live with’ Feedback from relatives in questionnaires on the quality of care provided was generally very positive. Ten relatives returned a questionnaire, all ten said that they were satisfied with the overall care provided. Two relatives commented that there had been significant improvements to care delivery since the current manager took over the home. Information from the Pre-Inspection Questionnaire completed in June 2006 and discussion with the manager, staff and observation on the day indicates that all of the residents were white/British. The manager said the home is able to support individuals with specific cultural or diverse needs following a needs assessment being completed. And where necessary additional training and Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 12 guidance would to provided to staff to enable them to be responsive to the resident’s needs. Service users are able to have a choice of staff gender when receiving personal care as far as practicable, as the home employs both male and female staff at the present time. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All the residents had a range of care plans and these were supported by written risk assessments. In some cases records had not been updated to reflect changes in the needs, this potentially puts residents at risk of harm. Further works needs to be undertaken to ensure individuals are involved in decisions about their lives as far as practicable. EVIDENCE: Case tracking took place for four residents. The methodology used was a physical examination of care plans, risk assessments, daily records, written surveys to residents, staff, and some health and social care professionals, and direct observation on the day of the visit. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 14 Records and discussion with the manager and staff established that significant improvements had been made to the quality of care documentation. Plans looked at were found to be more detailed and generally gave good information about the identified needs of the resident together with clear information about what care needed to be given by staff in most cases. Information about the resident’s social interests, likes and dislikes, spiritual needs were also included within the individuals care plan. There was evidence in the individual plans to show relevant health care professionals had been consulted regarding specific care regimes and advice obtained had in most cases been incorporated into the relevant plans. Specific examples of where this had not happened were provided to the manager during the visit. Care plans looked at had been regularly evaluated, however changes recorded in monthly evaluations of some plans had not always been written into the residents care plans. Again specific examples of where this had not happened were provided to the manager during the visit. It was evident from records that there had been a significant improvement in the quality of risk assessments produced by staff. However some risk assessments needed to be more detailed, to more clearly show how they related to the care needed by the resident. For example, one resident had a high Water Low Assessment score, this showed the resident would be at risk of developing skin problems (pressures sores), despite this no detailed care plan to address this potential problem had been put in place. It is important for those residents at risk of developing pressure areas, individual care plans be developed. These must contain sufficient information to guide staffs practices for example; plans should set out in detail tasks staff are expected to carryout for that individual e.g. where ‘regular’ positional changes are advised guidance must be specific in terms frequency, manoeuvres and monitoring arrangements. The manager reported that whilst some progress had been achieved in developing individual communication plans for service users, further work was needed. The inspectors concur with this statement. Examination of a sample of communication plans showed these varied in depth and quality. One plan was very detailed and clearly set out alternative communication methods used by the resident; others were less detailed. There remains a need to develop clear and detailed communication plans as most residents have significant communication difficulties; these are needed to enable residents to communicate their choices and decisions as far practicable. The manager and staff also need to develop other ways of fostering more effective communication with residents, including making more information available in more suitable formats. The manager indicated that she was aware Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 15 of the areas needing improvement and is planning how this can be achieved within the next few months. There was limited evidence of the involvement of residents or their representatives in the development of their individual plans other than at the reviews held with the funding authority. This said one relative spoken to gave an example of how they had been actively involved in the development of their daughters care plans, which had been a very positive experience. Some residents had signed agreement to their plans, but this was not happening in the majority of cases. This is an area where the care plans could be further improved by ensuring residents or their representatives (as appropriate) sign care plans to indicate they have had input to these and agreed the contents. At previous inspection visits there were concerns about the management of challenging behaviours and the recording and monitoring of challenging behaviour incidents. Significant progress in this area had been achieved. Behaviour management plans had been developed and the quality of record keeping had improved. There was evidence that incidents were being monitored and records showed that over the past few months there has been a reduction in the number of recorded incidents. Care plans were still being produced in standard written format as noted in previous inspection report’s, this does not assure the accessibility of these important documents for residents particularly for those who reside in the Lodge and Studio and action now needs to be taken to address this. Notwithstanding this it’s important that the manager puts in place individual plans, which reflect the principles of person centred planning. Comments received from relatives and professional staff indicated that over the last few months they have noticed significant improvements in care practices and in staff attitudes. One relative wrote ‘the atmosphere within the home is more positive and up beat’ One professional who returned a questionnaire wrote ‘staff seem to be working together better as a team, which means that the care provided to residents is more consistent and to a higher standard’. Staff spoken to were knowledgeable about the needs of each resident and had a good understanding of their specific problems/abilities and the care given on a daily basis. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff ensure the residents dignity and privacy is respected and promoted. A range of activities was provided, however some improvement is needed to ensure a more varied programme of activities and personal development opportunities are made available to some residents. Residents are enabled to keep in contact with family and friends and residents receive a healthy, varied diet according to their assessed needs and choices. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 17 EVIDENCE: Staff said the routines of the home were planned around the resident’s needs and wishes. Residents in the main house are reliant on staff and family members recognising and identifying their likes and dislikes. Residents in the Lodge and Studio flat had more opportunities to make decisions and exercise choices. In discussion staff displayed good knowledge of individual residents needs, likes/ dislikes and family support and records contained information on people’s religious observances. Staff said residents would be supported to access local churches or to attend services held in the community where this was needed. Key workers helped residents to maintain family contact by sending cards at significant occasions such as birthdays and Christmas. Staff said most residents had contact with their families and that residents were able to see visitors in the lounge or in the privacy of their own room. One relative spoken to confirmed she was always made welcome when visiting the home. All of the ten relatives, who returned a questionnaire, said they were able to visit their relative in private. There was an activity co-ordinator employed in the home and activities were provided to residents within a group or one-one basis. The activity programme included exercise to music, games, hand massages, visiting entertainers and trips out. The activity co-ordinator maintained records of activities provided although these were not up to date in all cases. Little information was documented in the care plans about individual wishes and needs regarding social and emotional care. Examination of a sample of files established social profiles had been completed, however in some cases these were not detailed. This together with information from discussions with people showed there is a need to look in more detail at people’s social stimulation needs in order to better tailor daily activities to the individual wishes, needs and capabilities of some residents. The manager was aware of the need to improve this area of practice. Staff had not had any particular training in organising and arranging activity programmes for people with complex needs. Consideration needs to be given to providing relevant training in this area. Residents are provided with three meals a day and a varied menu was available. Staff spoken to said the meals were of good quality and confirmed a choice of food was available, including fresh vegetables and fruit. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 18 The dinning room had been refurbished and this was noted to be clean and tidy. Staff were present in the dinning room to assist those residents who needed help with eating. Observation of the lunchtime meal showed that individuals needing help with eating and drinking received this assistance in a sensitive and timely manner. Residents able to feed themselves were provided with adapted cutlery. Meals appeared to have been enjoyed and positive interactions between staff and residents was observed. A number of staff spoken to commented that they had recently attended a training session on eating and drinking, which they had found extremely useful. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made from evidence gathered both before and during the visit to the home Residents received personal care in the way they needed to. Progress had been made to ensure the health needs of residents were being met, however some residents care plans had not been updated to reflect changes in health needs. The arrangements for the management and administration of resident’s medication were found to be satisfactory. EVIDENCE: All the residents were registered with a GP and records of visits by health care professionals were maintained. Records showed residents had access to chiropodists, dentists and optician services, with records of any visits being written into their care plans. There were risk assessment tools for mobility, falls, tissue viability, bed rail provision, medication, nutrition and general issues; high risk areas had been identified and care plans were in place to Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 20 support appropriate care provision in most cases. Some gaps were noted for example one service users risk assessment identified they were at significant risk of developing pressure sores, a detailed intervention plan to address this was not in place. Please refer to comments detailed on page 13 of this report. One service user had a plan for diabetes; again this plan had not been updated. Specific issues with this plan were discussed with the manager during the visit. Another service user had had acute abdominal problems again this individuals care plan had not been updated to show changes in health needs and current monitoring arrangements. Staff were monitoring the weights of residents on a regular basis and evidence in the plans showed dieticians were contacted if the home had particular concerns about an individual. All the service users had health action plans. Examination of a sample of these showed some plans had not been updated and records of visits by some professional staff had not been recorded. These are important documents and it is important that they are kept up to date. The manager gave an assurance that she would address this with staff. Discussion with the manager showed plans were in place to review the quality of the health action plans with input from relevant staff and involvement of the resident or their representative. This is a welcomed development because health plans need to not only detail peoples health needs they need to focus on improving peoples lives. Evidence from discussion with staff and observation showed residents’ personal aids were well maintained and the home provided the necessary aids and equipment to support both staff and residents in daily living. The majority of residents living in the home had significant sensory and mobility problems. Previous inspection findings identified staff had not always been following specialist support plans for some individuals. Significant progress has now been achieved. Individual resident plans had been reviewed and additional equipment had been purchased and the inspectors received very positive feedback about this from a visiting physiotherapist. Prior to the inspection visit the Commission had been notified of one medication error. The manager had dealt with this matter with the staff member concerned. At this visit medication systems were again examined; policies and procedures were in place, which covered all areas of management, these were detailed and comprehensive. Storage of all medications was found to be satisfactory. External and internal medications were stored separately and stock control was effective. Transcribing records were checked and found to be satisfactory. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 21 A sample of medication administration records, were examined and these were found to be satisfactory. Records were complete and well maintained and no errors or omissions were noted. One resident in the Lodge and one resident in the main facility did not have written guidance for use of as and when medication (PRN protocols). Action should be taken to address this. Written guidance for all the other residents using as and when medication was in place. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints system was in place with evidence that the majority of relatives were aware of the complaints process. The home had adult protection policies and procedures in place. The manager now needs to ensure all staff receive adult protection training. EVIDENCE: A complaints procedure was available. The Commission had not received any complaints since the last key inspection carried out in June 2006. At this visit the manager reported that she had dealt with two complaints in the last six months, both had been resolved satisfactorily. Staff spoken to said that they had no complaints about the home and felt confident to raise issues of concern if they arose and that and the manager or deputy manager was always available for them to talk to if needed. Ten relatives returned a questionnaire eight confirmed they were aware of the complaints procedure; two relatives stated were unaware of the procedure. This may reflect a shortfall of information and understanding about the complaints process and the managers should take steps to address this. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 23 Information from the Pre-Inspection Questionnaire and discussion with the manager indicated the home had policies and procedures to cover adult protection and prevention of abuse, whistle blowing, management of challenging behaviours and management of residents money and financial affairs. When asked about abuse, what it was and what they would do if they suspected or saw or suspected any abuse staff stated that they would report it to the nurse in charge or manager. Not all staff spoken to were aware of the multi-agency adult protection procedures concerning referral and investigation of allegations of suspected abuse. Training records evidenced that a number of staff had had adult protection training, however approximately one third of the staff group still needed to receive this training. The need to ensure all staff receive this training was discussed with the manager who gave an assurance that training was planned. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had been decorated and refurbished to a good standard, thereby providing residents with a safe and comfortable home to live in. EVIDENCE: Over the last twelve months extensive redecoration work had been carried out, new furnishings, carpets and bedroom furniture had also been purchased. Action had been taken to carryout repairs, redecoration and refurbishment work highlighted in the environment section of the June 2006 report. This included redecoration of some bedrooms, ensuring a hot water supply to some bedrooms and repairs to a bathroom and shower room. This means residents Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 25 now have a cleaner, comfortable and safer home to live in. It is important that these improvements are maintained. Following a tour of the premises a number of minor matters needed attention. The kitchen window latch was broken and therefore requires repair or replacement and rain appeared to be leaking through a door in the dinning room; this again needs repair or replacement. All bedrooms seen were clean and tidy and were furnished and decorated in a homely style. Many residents had furnished their bedrooms with a range of personal items, some bringing in items of personal furniture. A tour of the home showed that the main facility can meet the needs of people with physical disabilities. Doorways to bedrooms, communal space, corridors and toilet/bathing facilities are wide enough for people in wheelchairs or with walking frames to pass by comfortably. Access to the Lodge is by use of a staircase. Discussion with the staff indicates that there is a wide range of equipment provided to help with the moving and handling of the residents and to encourage their independence within the home. This includes mobile hoists, stand aids, slide sheets, moving belts and handrails. A fire risk assessment was in place and extensive work had been carried out on the homes fire systems. The fire risk assessment was last reviewed in May 2005; the manager is advised that this be looked at again to determine if it remains appropriate. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 26 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): 31, 32, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Progress had been made to ensure a competent staff team supports residents and that they benefit from staff who are well-supported and supervised, further improvement is needed because the home had failed to ensure full compliance with requirements in one of the statutory notices. This said the home had demonstrated capacity for improvement. EVIDENCE: The roles and responsibilities of staff were clearly defined and in discussion with the inspectors staff demonstrated understanding of the management and reporting structures for the home. Inspection of the duty rota and discussion with the manager and other staff indicated that staffing levels are generally satisfactory. All of the staff spoken Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 27 to said there was sufficient numbers of staff on duty at any one time to enable resident needs to be met. Ten nurses/care workers returned a questionnaire. In response to the question do you feel there enough staff on duty to meet residents needs on all shifts? Nine said yes, one said no. One ancillary worker wrote ‘don’t know’. Ten relatives returned a questionnaire, in response to the question ‘in your opinion are there always sufficient numbers of staff on duty, six said yes and four said no. None of the professionals who returned a questionnaire indicated they had any concerns about staffing levels. The home uses a corporate induction programme. One staff member spoken to said her induction had been ‘good’. The inspector asked to see the induction records for two staff. The manager was not able to produce records for one worker, as it was thought the worker might have taken it home. Examination of the other workers file showed no ongoing assessment of the induction process by the responsible supervisor. Induction programmes need to reflect assessment of competency on an ongoing basis. This matter was discussed with the manager, who gave an assurance that she would address this. It was not evident from records that staff were following the existing Learning Disability Award Framework (LDAF). The manager needs to ensure this happens. The induction record was produced in March 2006 and looked detailed, however since it was produced before the introduction of the Common Induction Standards by Skills for Care the manager is advised to review the content of the corporate programme against the new induction standards to ensure compliance. A training plan to incorporate mandatory training and updates was in place. However records indicated that some staff were not up to date with all required training for example moving and handling, fire safety, first aid and health and safety. This training must be provided. This is needed to ensure the health and safety of both service users and staff. All the nurses had attended a one-day training session on risk assessment and care planning. In order to fully comply with a requirement detailed in the statutory notice this training must now be provided to care workers without delay. Records, and feedback from face to face discussions and feedback received from one visiting professional identified a need to provide staff with more specialist training in working with people with multiple disabilities. Information given by staff showed some staff had received some resident specific training for example; autism training and more recently eating and drinking training, all the staff spoken to said they had benefited from this training. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 28 It was difficult to establish how much training some individuals had received because individual training records were not in place. Annual appraisals were also not up to date. The manager was aware of the need to address these matters and had produced a rolling programme of training and was looking to introduce more specialised subjects. The manager has to do further work to complete a formal training plan and was aware of what aspects of the programme needed to be developed and reviewed. The manager stated that she hopes to accomplish this within the next six months. The home had an National Vocational Qualification (NVQ) training programme and a number of staff had successfully completed an award. Individual competency assessments had been completed in compliance with a requirement detailed in the statutory notice. Information obtained now needs to be reflected in the homes training and development plan once finalised. Discussion with the staff revealed they were extremely positive about the learning and development they have been able to access, individuals are motivated and enthusiastic about their training experiences. The home had a recruitment and selection policy and procedure that the manager understood and uses when appointing new members of staff. Checks of four staff files showed that Protection of Vulnerable Adult register checks, police (Criminal Records Bureau) checks, written references, health checks and past work histories are all obtained and satisfactory before the individual start work. The home had an equal opportunities policy and procedure. Feedback from the manager, staff and information in personnel and training records showed the procedure is followed when employing new staff and throughout the homes working practices and staffs access to training. A staff supervision programme was in place and each staff member had an allocated supervisor. Examination of a sample of supervision records showed some staff were in receipt of regular supervision. However there was nothing to show that the manager of the home was receiving formal and recorded supervision, this must now be provided. It is important that systems are in place to show proper management oversight of the home and to ensure the manager receives the support and direction she needs. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 & 43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Significant improvements in the overall management and organisation of the home were noted. However service users health and welfare would be increased with improved care documentation, staff training, resident information and development of a structured quality assurance programme. EVIDENCE: The current manager is a qualified nurse and has now completed the registration process with the Commission. The manager now needs to complete an appropriate management qualification. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 30 Discussion with the staff and feedback in questionnaires from relatives and professional staff indicated that they feel the day-to-day management of the home had improved greatly. Staff and one relative spoken to described the manager and deputy manager as approachable and friendly, staff said they take all issues raised seriously and take prompt action to resolve matters where this is needed. Since the last visit in June 2006 the manager and deputy manager had made improvements in a number of key areas including; changes to care documentation, training and care practices. It is important that this momentum is maintained. Comments from the surveys indicate that staff are able to express their views openly, and the manager and deputy manager listen and offer help where needed. Staff said they are treated with respect and there was evidence of improved teamwork between the manager, nurses and staff. Individuals spoken to during this visit said that ‘the atmosphere within the home had improved over the past six months’, ‘the home is much calmer and the staff working together as a team has made it much more pleasant for the residents. One relative commented that she had also seen improvements to team working and that the staff attitude towards service users is now much better. The manager carries out a number of audits of the homes environment and care documentation. However the manager did not have a structured plan in place to monitor the quality of care and services provided to residents, nor were there systems in place to show how they consulted with residents, staff and others for example relatives, social services care managers and healthcare professionals. The home must now produce an annual development plan, which details how they consult with people and the outcomes of this consultation. A report then needs to be produced showing how the comments from these individuals have shaped or altered the practices within the home, and show how the home is run in the resident’s best interests. General health and safety was maintained via adherence to policies and procedures, staff training and the maintenance of equipment. Information provided in the pre inspection questionnaire indicates servicing of equipment was up to date. Records of accidents were maintained and regulation 37 reports were sent on to the Commission where appropriate. As indicated in other sections of this report the manager had devised a basic training plan to incorporate mandatory training and updates. Records showed some staff needed to receive training in safe working practices for example, moving and handling, first aid, health and safety, fire safety and infection control. Failure to ensure all staff receive timely training in safe working Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 31 practices potentially puts both residents and staff at risk of harm and action must now be taken to address this. A fire risk assessment was in place and extensive work had been carried out on the homes fire systems. The fire risk assessment was last reviewed in May 2006; the manager is advised that this be looked at again to determine if it remains appropriate. Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 32 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 2 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 x 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 2 3 1 X X 2 X Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 33 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15(2) Requirement The registered person must ensure that all service users and their representatives are involved in the development of their individual plan and that the plan is available in an accessible format or explained to them. The individual plan of care must be reviewed with the service user (involving family, friends, advocate and significant professionals as agreed by the service user) at least 6-monthly. The timescale of 30/9/04 and 31.7.05 and 01/11/06 not met. Timescale for action 31/03/07 2 YA8 16(m) The registered person must ensure that service users have opportunities to participate in activities that will enable them to influence decision-making in home and contribute to the development and review of DS0000002786.V325589.R01.S.doc 30/06/07 Gatehouse Cottages Care Home Version 5.2 Page 34 policies and procedures. Timescale of 31/08/04 and 31.6.05 and 01/11/06 not met 3 YA9 13 (3) (c ) The registered person must ensure that service user risk assessments are agreed with the service users or their representative and that they are updated regularly. The timescale of 31/3/05 and 01/11/06 not met The registered person must ensure for those service users with communication difficulties a detailed communication plan is developed. This must include details of any specific communication methods used by the service users. Timescale of 01/11/06 31/03/07 4 YA7 15, 18(1) 31/03/07 5 YA32 18(1)(c)(i) The registered person must ensure staff are provided with specific service user training. Timescale of 31/10/05 and 01/11/06 not met 30/06/07 7 YA36 18 (i) The registered person must ensure annual appraisals are completed and that these give clear information on the training and development needs of the worker to ensure training plans and DS0000002786.V325589.R01.S.doc 31/03/07 Gatehouse Cottages Care Home Version 5.2 Page 35 priorities reflect the training and development needs of the staff team. Timescale of 01/11/06 8 YA35 18 (i) Provide all staff with risk assessment training, which must be linked to the area of risk being assessed. Statutory Notice 18/01/07 9 YA35 18 (i) Provide all staff with care planning training Statutory Notice 18/01/07 10 OP12 16(m) The registered person must ensure all residents have opportunities for personal development and have access to appropriate and stimulating leisure and social activities linked to an assessment of their individual needs. Timescale of 01/11/06 The registered person must revise the homes service user guide to provide general fee information and to provide details of the registered manager and current staffing. The guide must be produced in more accessible formats to ensure residents or their representatives have access to all the information they need to help them decide if the home is right for them DS0000002786.V325589.R01.S.doc 31/05/07 11 OP1 5 (1) (b) 31/03/07 Gatehouse Cottages Care Home Version 5.2 Page 36 12 OP1 5 (1) (b) 13 YA6 YA19 15 (c ), 12 (b) 14 OP9 13 (c ) 15 YA23 13(6) Each resident must be given a personalised statement specifically relating to the care, accommodation etc that they will receive for the fee being paid. This should be supplied, at the latest, at the point at which someone takes up residence in the home. Information must be updated when there is any change to fees or charges. It is important that this fee information is widely available at an early stage to support people to make informed choices. Further information about this can be found in the revised Care Homes Regulations The manager must ensure each resident has a detailed care plan(s) which sets out all the residents care needs. When needs change the plan must be updated. Plans must be kept up to date to ensure staff have access to all the information about what care the resident needs, when they need it. The manager must ensure where specific risks are identified, a support plan is put in place to ensure staff have all the information needed to help them eliminate or minimise any identified risk. The registered person must ensure all staff complete adult protection training to ensure staff know how to recognise potential abusive practices and to ensure they know how to report 31/03/07 31/03/07 31/03/07 31/03/07 Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 37 16. YA39 24 allegations of suspected abuse The registered person must ensure there are effective quality assurance and quality monitoring systems in place to measure the success of the home in meeting the aims, objectives as set out in the statement of purpose for the home. Timescale of 01/11/06 not met 31/05/07 14 YA42 13 ( c ) (5) 15 YA42 18(1)(c ) 12(4)(b 16 OP36 18 (2) The registered person must 31/03/07 ensure all staff are provided with training in fire safety, first aid and health and safety including infection control. This is needed to ensure staff know what to do in the event of a fire, to ensure they understand the need to follow safe hygiene practice and to ensure they know what to do in the event that a resident has an accident. There must be at least one qualified first aider on duty at all times. 31/03/07 The registered person must ensure staff are provided with manual handling training including hoist training. A competently trained person must facilitate training. This is needed to ensure staff know how to move and handle residents safely. Timescale of 30/04/05 not met The registered person must 31/03/07 ensure the manager receives formal, documented supervision as a minimum of six times a year and has an appraisal. This is needed to ensure proper management DS0000002786.V325589.R01.S.doc Version 5.2 Page 38 Gatehouse Cottages Care Home 17 YA24 23(b) oversight of the home and to ensure the manager receives the guidance and support she needs to manage the home and to have her training needed identified and planned for. The registered person must 31/03/07 repair or replace the broken window latch in the kitchen and leaking door in the dinning room. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA37 YA14 Good Practice Recommendations The manager should hold NVQ level 4 or equivalent in Management. The manager should provide the activity coordinator with training in developing activity programmes for people with complex needs The manager should review the corporate induction programme to check whether this meets Skills for Care Common Induction Standards and to check whether staff are enrolled to complete the Learning Disability Award framework and should take action to ensure this happens where needed. The manager should put in place care plans which reflect the principles of person centred planning 3 YA35 4 YA6 Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Gatehouse Cottages Care Home DS0000002786.V325589.R01.S.doc Version 5.2 Page 40 - 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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