Inspection on 18/01/08 for Gatehouse Cottages Care Home

This inspection was carried out on 18th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gatehouse Cottages Care Home 28/01/10

Gatehouse Cottages Care Home 29/09/09

Gatehouse Cottages Care Home 18/01/07

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 Mrs Jane Lyons Key Unannounced Inspection 18th January 2008 09:00 Gatehouse Cottages Care Home DS0000002786.V358327.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.V358327.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.V358327.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 www.craegmoor.co.uk Health & Care Services (UK) Ltd 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.V358327.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2007 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 a large sensory garden has been developed adjacent to The Lodge. 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 2008 the weekly fees ranged from £853 to £1153 per week. People who use the service 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.V358327.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. The site visit took place over two days in January 2008. Surveys were posted out prior to inspection; five were returned from people who use the service, nine from relatives, seven from staff and three from health/social care professionals. Some of their comments have been included in this report. Mrs Jane Lyons carried out the visit which lasted 2 days. During the site visit we spoke to the manager, deputy manager, area manager, five care staff, two qualified staff, the cook, four residents and six sets of relatives to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. Most residents had communication difficulties, which meant they were unable to complete a written questionnaire or tell the inspector about their care needs or give their views on the home. Because of this the inspector spent sometime observing staff carrying out their work with the people who use the service rather than conducting formal interviews. We also looked around the home and looked at lots of records, for example; resident care plans and risk assessments, daily records, supervision schedules, menus, 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. Prior to the visit the inspector referred to notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed AQQA document (pre-inspection questionnaire), all of which forms part of this inspection. Findings from this visit demonstrate that the home is managed very effectively by an enthusiastic and competent manager who has made significant improvements, in the eighteen months she has been in post, to the management/ administration systems and as a consequence to the quality of care for the people who live in the home. What the service does well: The registered manager is experienced and competent; she has now completed the Registered Manager’s Award, and provides management stability and support for staff and people who use the service. Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 6 There was a very relaxed and homely atmosphere in the home, residents were observed to be very settled and comfortable in their surroundings. Medicines are looked after well and staff assist people to take their medicines safely. Individuals are provided with a warm, safe and comfortable environment that welcomes visitors and makes them feel at home. There was a core group of staff that had worked at the home for several years and knew the people who use the service well, this means individuals are able to receive care and support from people they are familiar with. Relatives and parents are kept in contact with and people who use the service are helped to go and visit their relatives. People who use the service and their relatives’ concerns are listened to and staff make sure they take action to sort problems out quickly. The staff and managers know that they need to make sure individuals are protected from harm. The staff were well supported as they were provided with individual time to talk to the manager about how well they were doing, or if they needed more training or support with their work. This better ensures that they can provide a good standard of care for the people who use the service. All surveys returned from relatives and discussions with relatives confirmed that they were very satisfied with the overall care provided by the homes staff. What has improved since the last inspection? The manager had continued to move the service forward in a many ways. Compliance had been achieved with the majority of requirements outstanding from previous inspections. Staff, relatives and professional staff said through questionnaires and face-to-face discussions that the atmosphere in the home was very positive, and the improvements in the management of the home had led to improvements in the quality of the lives for many of the residents at Gatehouse. Information about the service has been updated and provided in a simpler format which means prospective residents will have accurate information which they can understand better. The needs assessment process at the home is robust and thorough, enabling people who access the service to be confident that their needs can be met. Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 7 The home provides a detailed person centred plan of care for each individual and this is regularly updated. People who use the service and their representatives are involved in the care planning process and are regularly consulted. People who use the service are helped to enjoy lots more activities both in the home, in the community and holidays that meet their diverse needs. People who use the service at Gatehouse have complicated needs and some of them present behaviours that may be a risk to themselves or others and as such have detailed plans to tell staff how to manage this behaviour and protect people. This approach is providing good outcomes for individuals in their development and quality of life. Mealtimes for people who use the service are a more positive experience; smaller sittings, increased staff support for individuals and staff training have resulted in a number of individuals having more independence in being able to assist themselves as far as practicable. New menus have been produced, individuals are offered choices, all meals are home cooked and people who use the service liked the food provided, are well fed and encouraged to eat a healthy diet. The staff have received much more training including courses on looking after people with complex needs, this will better ensure residents care needs are met. There are enough staff in the home so that the staff can meet the needs of people who use the service and carry out all of their duties safely. The management consult more regularly with the people who live in the home so they can have a say in how the home is run. A report now needs to be produced to show how they have done this and what improvements have been made. What they could do better: Areas of the home need to cleaned more regularly to provide a clean, pleasant and hygienic environment for the people who live there. Repairs and redecorative works to the exterior building and grounds are required to ensure people’s safety and provide a nice environment for people to live in. The maintenance plan for the Lodge needs updating to include all the works in progress on the kitchen ceiling and to also cover repair / redecorative work needed in residents bedrooms, toilets, bathroom and the recreation room to provide a pleasant environment for people to live in. Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 8 Staff’s individual training needs and progress needs to be formally assessed each year so the manager can determine what further training and support they need to maintain the standards of care in the home. 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.V358327.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.V358327.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. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. A full needs assessment is carried out and people are given enough information about the home and its facilities before admission, for them to be confident that their needs can be met by the service. EVIDENCE: The home had a statement of purpose and a service user guide, which give information about the home. Both these documents have been updated to show changes in management and staffing. The service user guide had been reproduced in an alternative format which has recently been reviewed, the new document is now much more user- friendly combining the use of symbols and photographs, which better enables people who use the service to understand the information. There had been a number of new admissions to the service since the previous inspection visit. 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. The manager liaises with the relevant care management teams, visits prospective service users and a full assessment is completed. A decision is then made as to whether the individual’s needs can be Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 11 met and the person is invited to visit the home with their family, this gives the individual the opportunity to see what they think about the home, before committing to a decision. There was evidence that the home now writes to potential new service users and their representatives to inform them that the home could meet their needs The care files of three service users were examined. These contained copies of the Local Authority Community care assessment and care plan and a range of assessments carried out by a variety of professionals. The home has implemented new care plan documentation for all people who use the service. A comprehensive pre- admission assessment document is completed; although this is mainly in a tick box format there was good evidence that the manager had completed detailed notes in each section where necessary to demonstrate specific individual needs. Further assessment is completed following admission and a range of care plans and risk assessments developed from this information; the new documentation format is comprehensive and reflects a person centred approach. Copies of statements of terms and conditions were held in the service users files. The manager confirmed that the company is currently renegotiating with the local authority the fee structure for many of the people who use the service and new contracts will be issued when this work is completed. Individuals 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. Their comments included “ I like the staff and they help me a lot” and “I like living here”. People who use the service 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.V358327.R01.S.doc Version 5.2 Page 12 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. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People using the service are supported to make decisions and everyday choices to promote an independent lifestyle as far as practicable. Their needs are met by the provision of individualised plans, risk assessments and an improved staff team. EVIDENCE: Three care plans were looked at during the visit. The home has implemented a new care plan format, which reflects the principles of person centred planning; the care plans for all individuals living at the home have been completed. The new format is a significant improvement; the documentation enables the staff to provide an individually tailored service to meet the service users complex needs and ensure their emotional stability and healthy lifestyle. The records evidenced that the people who use the service and their representatives where possible have been involved in the development of the Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 13 plans and their signatures were in place to support this. Discussions with relatives during the visit indicated that they had enjoyed working with the staff to produce the new care plans and associated documentation such as profiles, life plans and support circles. They said that they felt the plans were much more individualised and promoted their relatives’ choices about how they received their care and how they wanted to spend their time. The care plans were very detailed and clearly reflected the individual needs and information to direct the staff on how to deliver the care; the plans contained a lot of information about the individual’s social interests, likes/ dislikes and spiritual needs. The documentation contained clear directions about how each individual should receive their mail. There was good evidence in the individual plans to show relevant health care professionals had been consulted regarding specific care regimes and advice obtained had been incorporated into the relevant plans. Many of the plans had been recently produced; evaluation records were in place and a number of plans had been updated to reflect any changes in need. Evidence from discussions and audit records showed that the manager and deputy manager have been instrumental in the production and overseeing the development of the new documentation system; qualified and care staff have received specific support and training in this area and have received ongoing individual support from the management; audit records demonstrated that all the plans are being checked through to ensure they have been completed appropriately and are accurate. Risk management strategies were in place for all areas of need and covered daily living skills, health needs as well as specific behaviours. The documentation was detailed and there was good evidence to demonstrate they were being followed by staff to minimise risk thereby promoting the individual’s health, welfare and in some cases allowing individuals to develop and maintain some independence. The majority of people who use the service have significant communication difficulties; the new care files contain more detailed communication plans which better enable individuals to communicate their choices and decisions as far as is practicable. The manager and staff have started to develop other ways of fostering more effective communication with residents for instance some staff have accessed training in specific communication techniques and the service user guide has been produced in a more accessible format, however care plans and some key policies for those persons who reside in the Lodge and Studio could be produced in alternative format. The home accesses support for individuals from local advocacy agencies when required. Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 14 A number of the people who use the service now attend regular unit meetings in the home and also attend “Your Voice” forums at local and regional level. The home has continued to make very significant progress in the management of challenging behaviours. Detailed behaviour management plans and records of incidents were in place. The manager audits all incidents, with evidence that potential triggers have been identified and action taken with good effect to reduce these. One health care professional commented on a survey “They have managed the individual’s behaviour exceptionally well in the past 12 months and this is evidenced in how settled the individual is and the lack of challenges experienced.” All files looked at contained copies of their care review coordinated by the care management team, however these were only convened annually. The inspector advised that a 6 monthly review must be held. Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People using the service have opportunities to access a variety of leisure activities, are supported to maintain relationships and have their nutritional needs well met. EVIDENCE: Staff said the routines of the home were planned around the individual’s needs and wishes, those who reside in the main house are reliant on staff and family members recognising and identifying their likes and dislikes. Individuals who reside in the Lodge and Studio flat had more opportunities to make decisions and exercise choices. The majority of people who use the service have complex or significant needs and require a high level of support from the staff team, therefore few of the individuals would be able to participate in work/ college placements; one person has done so in the past and is choosing at present not to attend. A Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 16 small number of people who use the service are able to access day services in the community. In discussion staff displayed good knowledge of individual residents needs, likes/ dislikes, family support and records contained information on people’s religious observances. At present none of the individuals access any religious services, although the manager is currently reviewing this provision. All the people who use the service have an allocated key worker, staff in this role spend one- to one time with the individual, carryout personal shopping on their behalf and maintain family contact by sending cards at significant occasions such as birthdays and Christmas. Relatives spoken to during the visit confirmed that they valued their support and contact, they considered the relationships were very positive although one relative was upset to find recently that her daughter’s Christmas presents had not been opened; this matter was passed on to the manager who dealt with issue during the visit. Examination of records and discussions with staff and relatives evidenced that there has been some significant improvements in the provision of activities in the home since the last inspection. Detailed activity plans have now been developed for all the residents in the home, they are structured and cover sessions throughout the day including weekends. The activity co-ordinator maintains separate records to support the programme, which on examination contained some gaps however care staff also maintain detailed records in the care files, which clearly evidenced all the activity provided. The people who use the service are accessing a wider range of activities both in the home and in the local community; some of these include horse riding, ice skating, cinema, hydrotherapy, discos, structured walks (“Well Walk” community project), visits to the auditorium, meals out at local pubs and restaurants and shopping trips. Activities that take place in the home are much more structured which was observed during the visit, individuals were seen to be enjoying a variety of sessions such as manicures, music, sensory support, walks down the lane, looking at magazines, completing jigsaws and watching films. Many of the individuals were supported to use the range of communal areas in the home at different times of the day; staff interaction was observed to be very positive. One resident told the inspector how much he had enjoyed the riding that day, especially as he had helped with grooming his horse. All comments from relatives about the activity provision was very positive with the exception of one family; they identified issues around their relative’s access to swimming sessions in that they did not occur as frequently as identified in the care plan, this was looked into during the visit, records showed that one of the swimming sessions coincided with weekend visits home which the manager confirmed she would follow up and address. Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 17 The manager has been working with a local charitable organisation to look at further developing the activity programme in the community and is hoping to access a number of more unusual and exciting experiences such as gliding and ballooning for residents who want to participate. Records and discussions with staff identified that many more people who use the service were able to access a holiday last year. The manager has already organised the holidays for 2008 for all those who want to go, those individuals who choose not to have a holiday will be provided with day trips to places of interest for them. One of the residents who usually lives in the Lodge is currently being cared for in the main facility due to a change in need; it was positive to see that staff supported the individual to visit the staff and other residents in The Lodge very regularly so she could maintain those relationships. Three of the staff have accessed training in providing activities for individuals with complex needs; it is clear that the home has made some significant progress in this area and that the manager is committed to ensuring further development of the programme and providing staff with the support they need. Discussions with staff, residents and relatives during the visit identified that there had been a lot of parties, trips out and entertainment provided over the Christmas period. One relative said that “Christmas in the home was lovely, the home was decorated really nicely and the atmosphere was buzzing.” The home has two minibuses, unfortunately one of the buses has been out of action for a number of weeks as the garage is awaiting the necessary parts; the manager confirmed that the staff have been using public transport and taxis to ensure access to the community has been maintained. The management and staff at the home have worked hard since the last inspection to develop the mealtimes for the people who use the service to provide a more positive experience. The staff have received training from health care specialists in “eating and drinking” and “posture management” which has enabled many more of the individuals to have more independence with feeding themselves, albeit with considerable assistance. There are now different sittings so that smaller groups of residents are provided with the support they need; this was observed to work well during the visit. Staff interaction was very positive with individuals receiving one-to one- support in a patient, sensitive manner. A new cook has been employed at the home who has completely revised the menus with support from the community dietetic team to provide more nutritionally balanced meals. The cook has accessed a number of relevant courses in areas such as diabetic menus and presentation for pureed diets, and Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 18 demonstrated a good knowledge of the individual’s dietetic needs. All individuals are now given a choice of meals; the inspector observed a staff member showing one of the people who use the service different meals to help them make their choice. The cook has also provided photographs of many of the menu choices which staff can show the residents. One relative wrote in the survey “If the dish of the day is not what she likes something else is provided”. The home has also introduced a meal comment book. Particular progress has been made regarding one of the residents who receives his nutritional support via a Peg feed; in the past due to problems with reflux the feeding regime has taken up most of the day however the manager in consultation with the community dietetic team has completely reviewed the feeding regime, with very positive results, which now allows the resident much more flexible routines and time to participate in activities and trips out. One of the staff said “ We are so pleased ……. can now have a lie in some mornings which he really enjoys.” It was very positive during the inspection visit to see the individual looking so healthy and participating more in what was going on around him. Gatehouse Cottages Care Home DS0000002786.V358327.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 and 20. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Individual’s physical, health and emotional needs are met, by the provision of a wide range of healthcare professionals and outside agencies, improved care plan documentation and a caring team of staff that promotes their privacy, dignity and respect. The medication systems at the home are well managed ensuring the promotion of good health. EVIDENCE: All the people who use the service are registered with a GP and records of visits by health care professionals were maintained. Records showed individuals have access to chiropodists, dentists and optician services, with records of any visits being written into their care plans. The manager confirmed difficulties in accessing support from the G.P. service with regard to carrying out annual health checks and medication reviews for residents with complex needs, however following consultation with the local Primary Care Trust, support from a community psychiatrist has been secured and all Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 20 individuals have now accessed these health review checks and any concerns have been followed up as necessary. All the residents had Health Action Plans in place, examination of a sample of these showed the plans had been updated and records of visits by professional staff had been recorded. “Hospital Passport” records have been produced to support admission to hospital. There was very good evidence at this visit that the home has continued to work closely and develop very positive relations with a range of specialist health care professionals such as the speech and language therapy team, physiotherapy team, dieticians, psychiatrist and psychologist. Records showed that where these professionals had been consulted and provided advice the guidance had been incorporated into the plans. Many of the individuals had exercise programmes and daily records showed these were being followed. Significant progress has been made with one of the residents who demonstrated extreme reactions to being touched; the staff have been following a specific desensitization programme with very positive results. Feedback from health professionals was very positive, “ The current management are working well to liaise with others and develop the quality of care and support. Management seek appropriate advice and training; programmes are implemented.” and “Individual’s health care support has improved significantly over the last 18 months”. As detailed in previous sections of the report the home had recently implemented a new care documentation system which reflects the principles of person centred planning. Within the care files additional care plans have been developed to support areas of specific need; many of the individuals have these additional plans to support mobility, personal care, nutrition, communication and behaviour. Examination of a number of the plans evidenced that in general the plans were detailed to give staff clear guidance in how to provide the support needed and had been updated to reflect any changes. 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 support appropriate care provision. The new documentation system is a significant improvement, a very small number of gaps were identified through case tracking and passed on to the manager however these do not affect the overall improvements in the quality of the care plan documentation and how much more detailed and individualised it is. Staff were monitoring the weights of residents on a regular basis, the manager audits the weights monthly and evidence in the plans showed dieticians were contacted if the home had particular concerns about an individual. Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 21 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. At this visit medication systems were examined; policies and procedures were in place, which covered all areas of management, these were detailed and comprehensive. One of the qualified staff has been delegated responsibilities for this area, all aspects of the system were checked in all three areas of the home; the medication system and records were found to be accurate, up to date and well managed. Storage in the main facility is clearly limited, discussions with the manager evidenced that she had identified this issue and is looking at providing more suitable, larger facilities elsewhere in the building. Gatehouse Cottages Care Home DS0000002786.V358327.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 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. A satisfactory complaints system was in place with evidence that relatives were aware of the complaints process and felt confident in discussing issues and concerns with the staff. There were appropriate policies and procedures in place on safeguarding adults and the training undertaken by staff has increased awareness of safeguarding adults procedures and reduced the risk of abuse occurring. EVIDENCE: A complaints procedure was available. The Commission had not received any complaints since the last key inspection carried out in January 2007. At this visit the manager reported that she had dealt with one complaint in the last six months, which had been resolved satisfactorily. Examination of the records evidenced that the process of reporting, investigation and outcome management of complaints was robust. The manager had maintained detailed records to support the process. At the previous inspection visit two of the relatives had detailed on their survey that they were not aware of the complaints procedure, following this the management sent letters to all of the families detailing the procedures. In discussions during the visit with six sets of relatives, all persons told the inspector how approachable the management and staff were. They also said the manager now held regular meetings with them where they were able to Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 23 discuss issues and concerns which were promptly addressed and followed up where possible. Information provided to the commission prior to the visit 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. One referral to the safeguarding team had been made by the home since the last inspection; the matter had been fully investigated and appropriate action taken. Policies and procedures were in place to support the management of service user’s finances. The home manages a number of pocket money accounts for individuals; records to support the management of three accounts were checked. The cash balance in one account did not correspond to the records by a small amount, however following the inspection the manager completed a check on all the transactions and identified an accounting error earlier in the record. Receipts were in place for all transactions. The manager carries out regular monthly audits of these accounts. There was evidence from the home’s recruitment and selection processes, staff training records, financial management, complaints log and the use of risk assessments and behaviour management plans that the manager ensured that service users were protected and safeguarded from abuse. Training records evidenced that all existing staff had now received training on the protection of vulnerable adults and the manager confirmed that new staff recruited to the home would access this course. Gatehouse Cottages Care Home DS0000002786.V358327.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, 29 and 30. People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service felt at home at Gatehouse and the environment was warm, comfortable and suitable to their needs; the lack of maintenance to the exterior of the home is impacting on aspects of safety and the overall quality of the environment at the home, this said the new sensory garden will be a wonderful facility which all who use and visit the service will benefit from. EVIDENCE: The home has a warm and homely atmosphere, people who use the service were observed to be settled and comfortable in their surroundings. Extensive redecoration and refurbishment had taken place within the main facility in 2006, which has in general been well maintained, although the home was awaiting the replacement of a section of corridor carpet outside the dining room, which has a stale odour. Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 25 A tour of the Lodge revealed that decorative repairs were needed to two of the individual’s bedroom ceilings and areas in the toilet and bathroom. Work to replace the water tank had been completed and works to repair the ceiling in the kitchen area were in progress. The ground floor toilet had overflowed the previous week which has resulted in a very stale, damp odour in the recreation room, which was not currently in use. All bedrooms seen were generally very clean and tidy and were furnished and decorated in a homely style. Many residents had furnished their bedrooms with a range of personal items such posters, pictures, mobiles and sensory equipment. Areas in a number of the communal rooms in the main facility required more regular cleaning such as surfaces in the dining room, which were found to be “sticky”. 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 Studio and first floor of the Lodge is by use of a staircase. Discussion with the staff indicated 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. The home has experienced problems in recent weeks with the maintenance of household equipment, at the time of the visit the washing machine in the Studio had been out of use for some weeks and the tumble drier in the main facility had been out of use for three days; this had caused significant upheaval and work for the staff in travelling to the local laundrette to process the laundry. The manager has identified that lack of hand washing facilities in the laundry area and has taken action to provide this facility. Discussions with relatives during the visit and feedback from the surveys evidenced that they were very satisfied with the improvements to the interior of the building but were concerned that the exterior of the building had not been maintained. Many of the windows and exterior woodwork to both buildings now requires significant attention as the paintwork is extremely weathered and there are signs that in places some of wood is rotting, for example on one of the exterior door sills. The car park to the side of the building is now very uneven and has many potholes, which will require resurfacing work. Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 26 The path which goes around the main facility building requires attention in places where the paving has become uneven due to tree roots which could cause a potential trip hazard to both people who use the service and staff. Following a complaint to the home the ramp to the front door had been replaced, with very positive results. Many of the relatives have over the past year formed a committee to manage the resident’s fund in developing a sensory garden for the home. This has been a major project and relatives spoken to said how much they had enjoyed working to provide something so positive for the home. The garden is near completion and the inspector was given a tour; it covers a large area adjacent to the Lodge. It has been well thought out with significant planting, shaded areas, paths, decking, water features, raised beds, barbeque, workshop and an area which has been specially planted and decorated to pay tribute to those residents who lived at Gatehouse and have now passed away. This garden is without doubt a fabulous asset to the home, all parties involved in the development, project management and work to build the garden must be credited; it is clearly a facility which all persons who live, work and visit the home will enjoy and benefit from. Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 27 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): 31,32,33,34,35 and 36. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Staffing levels were appropriately maintained so that the needs of the people who use the service could be sensitively met. Staff are better trained, appropriately supervised and more competent to carry out their work. Recruitment practices afford sufficient protection for people who use the service. 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. Written and verbal feedback from the staff, residents and relatives state that they feel there is adequate staff available to support individual needs. A number of staff surveys commented that they felt the home had difficulties in covering holidays and sickness, however in discussion with the manager, the home experienced some problems in September/ October 2007 when two of the qualified staff were on extended leave and sick leave, however the Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 28 management had covered the shortfalls at the time. Further recruitment of bank staff has ensured that annual leave and sick leave is now adequately covered. Two of the relatives surveys and one returned from a health professional raised concerns regarding the employment of overseas staff in maintaining satisfactory standards of communication given the majority of residents have complex needs in this area. Discussions with the manager confirmed she was aware of these concerns and was taking action to address communication issues with individual staff members where necessary. Staff access a corporate induction programme; the programme meets Skills for Care Common Induction Standards and the existing Learning Disability Award Framework (LDAF).A workbook completed by one of the new staff members was examined , it showed all sections had been completed and signed off by the deputy manager. The home currently has 48 of the care staff trained to level 2 NVQ. Three further staff have recently enrolled and the home hopes to have achieved the standard of having 50 qualified, later in the year. The manager has developed a current training plan for the staff and records of training accessed by staff were found to be up to date and well maintained. Following the inspection visit in January 2007, statutory notices were issued in April 2007 regarding the provision of risk assessment and care planning training to all staff. Evidence was provided to the commission which demonstrated compliance with these notices in May 2007. Concerns were identified at previous inspection visits around the competencies of a number of the qualified staff, performance improvement plans have been put in place to improve professional practice and discussions with the manager evidenced that she is working through the plans with the qualified staff, and taking appropriate action where necessary. The manager is now the only qualified member of staff with a learning disability qualification; given that the home’s registration is for individuals with learning disability and the majority of residents have complex needs, the management should consider providing the qualified staff with relevant training to support their knowledge base and competency in caring for this client group. The home has made significant improvements regarding mandatory training for staff and records evidenced that the majority of staff were now up to date with training in; moving and handling, first aid, food hygiene and fire safety. The manager confirmed that courses have been planned for the outstanding staff members. The majority of staff have also accessed recent training in: infection control, safeguarding adults, COSHH and equal opportunities. Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 29 The home has made progress in providing more training for staff in working with people with multiple disabilities, many staff have accessed training courses in eating and drinking and posture management which the manager intends to provide to all care staff. Staff interviewed commented positively about these courses and said how they felt the training had helped improve the quality of their care support. Other service specific courses accessed since the last inspection have been: Autism, epilepsy, visual awareness, Makaton and challenging behaviour. 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 started work. One other staff file showed that the employee had started work before their CRB check had been obtained by the home. This person had been supervised by the senior staff member on duty to ensure that they did not have unsupervised contact with service users. There was evidence that the manager had chased up the police check with the personnel department at head office in November when she had audited all the records and was still awaiting receipt. 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. The manager has made significant progress with a full implementation of the staff supervision programme. All staff members have an allocated supervisor and all sessions are scheduled on a planner; up until November all staff members were receiving monthly supervision sessions which have now been reduced to bimonthly. There was evidence that the manager has received regular, recorded supervision from the regional manager. The manager confirmed that she had commenced the staff appraisal programme and was hoping to have completed all staff by April 2008. Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 30 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 and 43. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service benefit from living in a home that is well run and managed by a competent manager. Quality monitoring systems now allow individuals and their families to comment on and in part affect the way in which the service is operated. The safety of people who use the service and the staff at the home is generally well promoted and protected. EVIDENCE: The registered manager is a qualified learning disability nurse, has many years experience in providing care for persons with learning disabilities and demonstrates sound management practices. She has completed her Registered Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 31 Managers Award and updates her skills and knowledge through regular attendance at training sessions. The manager confirmed that when she had been appointed there were significant areas for improvement identified within the home. Evidence from this inspection is that she has made considerable progress in developing and improving the majority of the administration and management systems in the home, which has clearly resulted in improvements to the quality of life for many of the people who use the service. The manager has focused on key areas such as staff training, supervision, care plan documentation, joint working with the multi- disciplinary team, activities, nutrition and communication with very positive results. Comments from staff and relatives during the visit and feedback from health professionals identify that the manager is very popular and well respected; they recognise that her management style and commitment has improved the quality of the service at Gatehouse. One relative told the inspector “Amanda is absolutely brilliant, we just get a bit frustrated that some of the improvements take so long, such as the work to the exterior of the building”. Other comments included: “It is getting much better in all aspects, since Amanda took over.” and “I have worked at the home for five years and since the present management team has been in, the home has improved leaps and bounds i.e. better managed, cleaner and a more pleasant atmosphere for service users with more activities introduced.” 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. The manager has continued to develop a formal quality assurance system. She completes a full audit of the home every two months and also completes regular audits of key areas such as care plans, accidents, complaints/ concerns, medication, health/ safety and infection control management. Surveys have been issued to relatives and representatives; there was good evidence that views of stakeholders such as G.P.’s have been sought in recent months and the home has worked with the local PCT to improve access to health care support for the residents. Records showed that the manager analyses the results of the audits and surveys and where deficiencies have been identified, action plans have been drawn up. The manager is currently working on how best to publish the results of the audits and surveys. The home undergoes an external audit from the company each year; this took place in June 2007. There are corporate policies and procedures in place; these are reviewed and updated regularly. Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 32 Formal meetings with people who use the service and relatives have been held regularly; all people spoken to were very positive about the standards of communication in the home, although a number of relatives told the inspector that they would appreciate having the opportunity to meet senior management of the company more often. Comments from relatives on surveys included: “Very good communication between ourselves and the home” and “Whilst relations with local management is very good the company (Craigmoor) remain remote.” Relatives also expressed concern to the inspector that they are encouraged to make suggestions for improvements to the home, however when they do, for example the provision of white parking lines in the car park, this is not actioned, or they don’t receive feedback as to why the proposal has been refused or delayed. Staff confirmed that they had access to regular meetings, and that the management valued their opinion and suggestions. One staff member wrote on a survey “communication between all staff is very much better, the manager is very approachable and supportive”. The area manager undertakes regulation 26 visits on a monthly basis. The manager now needs to produce an annual development plan to support the quality assurance programme; this plan should describe the quality areas of improvement from 2007 and set out the standards to be achieved this year. General health and safety was maintained via adherence to policies and procedures, risk management, staff training and the maintenance of equipment. Examination of maintenance records identified that checks and certificates were in place for installations and equipment. The fire safety equipment, checks and risk assessment were all in place and up to date. Training records show that staff have attended safe working practice up dates. Information examined in the home corresponded to that provided in the AQAA. The staff complete regular checks of the hot water temperatures to ensure the temperature is maintained close to 43 deg C. Accident records were completed and in place; these were audited by the manager to review action taken to reduce reoccurrence. The manager has developed a comprehensive risk assessment to support the use of bed rails in the home; this covers all the areas identified by The Medical Devices Agency such as: type of rail used, height of bed, height of mattress etc. The home was utilising four sets of bed rails at the time of the visit and checks are carried out regularly. Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 33 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 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 3 30 2 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 X X 2 3 Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23 Requirement The registered person must ensure repairs and redecoration works are carried out to the exterior woodwork of the properties such as the windows, door frames and facia boards so that they are fit for purpose and people live in a nice home. The registered person must ensure repairs are carried out to the path around the home and the car- park so that the areas are safe and fit for purpose. The registered person must update the maintenance plan for The Lodge to include all the works in progress on the kitchen ceiling and to also cover repair / redecorative work needed to the ceilings in residents bedrooms, toilets, bathroom and the recreation room to ensure rooms are fit for purpose and provide a nice environment for people to live in. The registered person must ensure that satisfactory standards of cleaning are maintained in the communal DS0000002786.V358327.R01.S.doc Timescale for action 01/05/08 2. YA24 YA42 23 01/05/08 3. YA24 23 01/05/08 4. OP26 23(2) d and 16 (2) j 28/02/08 Gatehouse Cottages Care Home Version 5.2 Page 35 5. YA36 18 (i) areas of the home to provide people who use the service with a clean, hygienic environment. 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 priorities reflect the training and development needs of the staff team. Timescales of 01/11/06 and 31/03/07 not met. 30/04/08 6. YA39 24 The registered person must 31/03/08 ensure that an annual development plan is produced to support the homes formal quality assurance programme. This will show how they consult with people and the outcomes of this consultation; 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. 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 YA5 Good Practice Recommendations The registered person should issue all individuals who reside in the home with a new contract on completion of the fee negotiation work currently ongoing with the local authority. The registered person should produce care plans, risk assessments and some key policies in a format which people who use the service could better understand. DS0000002786.V358327.R01.S.doc Version 5.2 Page 36 2. YA6 Gatehouse Cottages Care Home 3. 4. 5. YA6 YA32 YA35 6. YA39 The registered person should ensure that formal care reviews for all persons who use the service are carried out six monthly. The registered person should ensure that at least 50 of staff are qualified to NVQ level 2. The registered person should provide qualified staff with appropriate training or the opportunities to gain further qualifications specific to the care of persons with a learning disability to support the homes registration. The registered person should provide opportunities for individual’s representatives and relatives to meet with senior management, which is their request. Gatehouse Cottages Care Home DS0000002786.V358327.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB 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.V358327.R01.S.doc Version 5.2 Page 38 - 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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