Inspection on 27/06/06 for Gatehouse Cottages Care Home

This inspection was carried out on 27th June 2006.

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 32 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 18/01/07

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 27th June 2006 09:30 Gatehouse Cottages Care Home DS0000002786.V302173.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.V302173.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.V302173.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) Position Vacant Care Home 27 Category(ies) of Learning disability (27), Physical disability (20) registration, with number of places Gatehouse Cottages Care Home DS0000002786.V302173.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. 1st December 2005 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 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. Information about the home and its services can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. Information given by the manager at the visit on the 27th June 2006 indicates the home charges a fee of between £492 and £1.065 per week. The home does not charge third party top-up fees, but residents are expected to pay for hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and took place over 1 day in June 2006. The site visit was carried out by Mrs Matun Wawryk and Mrs Jane Lyons, Regulation Inspectors, the visit lasted ten and a half hours. Most residents had communication difficulties, which meant they were unable to complete a written questionnaire or tell the inspectors about their care needs and their views on the home. Therefore instead of conducting formal interviews, the inspector issued additional questionnaires to family members, key workers and local authority staff responsible for monitoring the placements of some residents to try and establish whether the residents’ needs were being met. In addition, the inspectors observed staff carrying out their work with residents and observed an activity session. One of the inspectors also spent time in the dinning room over the lunch period. The inspector issued 30 staff questionnaires of which 2 were returned, 20 relative surveys were posted out of which 16 were returned. Surveys questionnaires were also sent to the care manager responsible for 16 of the residents and 1 general practitioner (GP). Some of the comments received by these people have been included in the report. During the visit the inspectors spoke to eight residents, an area manager, two acting managers, two nurses and four care workers to 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. Following an inspection visit carried out in March and April 2006 it was found that staff practice concerning the management and recording of residents’ medication was unsafe. This put residents at risk of harm. Care plans were 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 they needed to support people properly. It was also found that not all staff had had the training and supervision they needed to carryout their role safety and competently. Because of this home 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 good quality, safe care, which meets their individual needs. The owners of the home were also asked to put systems in place to ensure staff were able to carry out their roles and responsibilities properly. The owners were told that if they did not take steps to improve things in the home over a set period of time, the Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 6 Commission would have no alternative but to consider taking further action to ensure the health, welfare and safety of residents. What the service does well: What has improved since the last inspection? The home had made significant progress in meeting requirements detailed in the last report and the statutory notices. Considerable effort had been made by staff to comply with the statutory notice issued regarding medication. Almost all aspects of medicines handling, administration and recording had improved. Considerable effort had been made to improve the individual plans for most residents. Individual plans were generally more detailed and gave staff clear guidance on what care residents should receive and when they need it. Staff appeared more enthusiastic, keen and motivated to ensure that the care provided is of a good standard. The staff were eager to develop their skills further with the relevant training and support, which results in residents being better well cared for. Staff spoken to commented on the approachability of the two acting managers. All those spoken to said the managers were friendly and efficient. Staff had accessed more medication, moving/ handling, fire safety and first aid training. This means staff are now up to date with mandatory training, this was needed to ensure the health and safety of residents and staff. Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 7 Since the last inspection the record keeping and records management system within the home had significantly improved. More care staff had gained National Vocational Qualifications. This means residents’ care is delivered in a way that is up to date and based on current good practice. Further improvements had been made in the home. A number of bedrooms had been redecorated and in some cases new bedroom furniture had also been purchased, thereby providing residents with safer and more comfortable bedrooms. What they could do better: The residents guide needs to be written in a better way to ensure residents have the information they need to help them or their relatives decide if the home is right for them. All residents or their relatives must have a contract/statement of terms and conditions, this is needed to ensure that people living at the home have the information needed to make informed choices about the services they receive. All the residents had a care plan setting out how staff should support them, but the practice of involving residents in the development of their plan was variable. The managers need to make sure that resident care plans and risk assessments state clearly the care that needs to be provided by staff and that they are updated as required to ensure that residents receive the care they need when they need it. To make sure that the home is safe and comfortable for people most of the rooms in the Lodge must be redecorated. Problems with the hot water supply in the bathroom must be sorted out and the broken shower door must be repaired. This is needed to ensure residents have a pleasant home to live in and to enable residents personal hygiene needs can be consistently met. Although there had been some improvement in staff training, further improvement is needed with regards to care planning, risk assessment and other training relevant to the needs residents who live in the home. This is needed to ensure all staff fully understand the changing needs of residents and to ensure they can do things in a proper way. The way the manager supervises staff had improved, although again further improvement is needed. Staff need to get more regular formal supervision from their managers. This is needed so that the managers can show how they are assessing and monitoring the abilities of staff in the home and to comply with a requirement in the statutory notice. Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 8 The majority of the relatives who returned a questionnaire were satisfied with the care, provided, however one relative wrote ‘overall care fluctuates’, another answered no to this question, another answered yes and no and another ticked yes to this question but wrote ‘apart from isolated incidents, often from staff shortages’. A care manager who returned a questionnaire commented that she was not satisfied with the overall care provided to some residents. Evidence was seen through records and talking to staff that action was being taken to try and address these concerns. The managers reported that they spent time talking to residents and resident meetings were held. However the managers had not yet fully implemented a formal programme of audits and surveys. This means the home does not have a structured and formal way of asking residents, their relatives, staff and relevant others about their views on the care that is provided and how the home is run. The managers now need to consider how they are going to develop the home and how they are going to ensure residents and other people are able to contribute to the running of the home. The manager must ensure efforts are made to prioritise the full implementation of a formal quality-monitoring programme within the home. The inspectors would like to thank everyone who completed a questionnaire and/or took the time to talk to them during this inspection. Their comments and input have been a valuable source of information, which has helped inform this report. 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. Gatehouse Cottages Care Home DS0000002786.V302173.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.V302173.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 Quality in this outcome area is adequate. This judgement is based on evidence gathered both during and before the visit to the home. Information needs to be made available in more appropriate formats and contracts/statement of terms and conditions need to be issued to all residents and/or their representatives. This is needed to ensure that the rights and best interests of the people living at the home are promoted and protected, and to ensure people living at the home or their representatives have the information needed to make informed choices about the services they receive. EVIDENCE: The home had a statement of purpose and a residents’ guide. Since the last inspection the residents 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 is re-looked at to ensure information is available in formats accessible for residents. Following the outcome of the inspection visit carried out in April 2006 the owners voluntarily agreed not to admit any new residents until required improvements had been made. Because of this the home had not had any recent admissions, the inspectors were unable to make a full assessment of the home’s assessment systems. Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 11 The managers stated that in the absence of a professional assessment they would ensure suitably qualified staff would undertake a needs’ assessment of prospective residents. The admission procedure was sufficient to guide staff on the actions to be taken to ensure that new residents needs are properly assessed and planned for. Each resident had their own individual file although none of the care files examined contained a signed contract/statement of terms and conditions and the managers were unable to confirm that all residents and/or their representatives had received one. The inspectors advise that a check is made to ensure contacts have been issued. Where it is identified these have not been provided the registered person must rectify this and issue one. This is needed to ensure residents have access to information on what they can expect to receive for the fee being paid and any terms and conditions of occupancy. 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. Feedback from relatives in questionnaires on the quality of care provided in the home was generally very positive. Twelve relatives commented that they were satisfied with the overall care provided. One relative said they satisfied with the overall care apart from isolated incidents, one relative commented that care fluctuates, one relative answered yes and no and one relative put an asterisk next to this question. One care manager who completed a questionnaire for sixteen residents identified a number of issues about the quality of the individual plans for residents. From records and discussion with the managers and care staff it was evident that the home was aware of these issues and were taking steps to try and resolve areas of concern. Gatehouse Cottages Care Home DS0000002786.V302173.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is poor. This judgement has been made from evidence gathered both before and during the visit to the home Progress had been made to ensure residents individual needs were being met however further improvement is still needed because the home had failed to ensure full compliance with some requirements detailed in one of the statutory notices. This said the home had demonstrated significant capacity for improvement. EVIDENCE: It was evident from the case tracking exercise including examination of records and through talking to staff that considerable effort had been made to comply with outstanding requirements and those detailed in the second statutory notice. Records and discussion with the managers and staff identified that significant improvements had been made to the care documentation. A considerable number of individual plans had been evaluated and re-written. Plans more clearly set out the identified needs of residents and detailed clear care support Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 13 directions for staff. There was also evidence to demonstrate that relevant health care professionals had been consulted regarding specific care regimes and advice obtained had been incorporated into the relevant plans. As indicated a small number of plans still required work for example: One resident had had a new Percutaneous Endoscopic Gastrostomy (PEG) feed tube fitted. Although a care plan was in place there were no records of care interventions to support rotating of the tube, wound care etc. Oral hygiene was noted on the PEG feed plan but this was not detailed and there were no records to support care support in this area. Day staff confirmed that they did not provide the resident with any mouth care; they considered that the night staff carried it out in the morning when the resident got up. The registered person must ensure care plans set out all the tasks staff are required to undertake with residents. This needed to ensure staff know what care should be provided and when. One resident had a pressure sore. Daily records did not detail sufficient information regarding the management of the pressure sore. The resident had been seen by a GP, but records only described non-compliance regarding a blood test and did not detail how cream prescribed for the sore should be applied. There were no details in records of actual wound grade, size, position etc. The inspector advises that for those residents at risk of developing pressure areas, individual care plans are developed. These must contain sufficient information to guide staff practice for example, they should set out in detail tasks staff are expected to carryout for that individual e.g. where ‘regular’ positional changes are advised care plans must be more specific in terms frequency, manoeuvres, specialist equipment and monitoring arrangements etc. This is needed to ensure staff know what care should be provided. Previous inspection findings identified care plans for named residents sanctioned use of physical interventions. Action had been taken to review the plans for named individuals and revised behaviour management plans had been developed. Records revealed ‘time out’ was being used as per the care plan with one resident. The inspector could find no mention of this in the individuals behaviour plan and records indicated that the plans had not been formally agreed with the resident and/or their representatives. The registered person must ensure individual plans, supported by risk assessments clearly set out management strategies and support arrangements. Plans must be agreed with the multi-agency care team. This is particularly important where specific interventions are advocated and to ensure the welfare and protection of residents and staff. Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 14 As with previous inspection findings, examinations of daily records identified staff were continuing to record incidents of challenging behaviour in daily logs. However there was no evidence available to demonstrate on-going monitoring or evaluation of challenging behaviour incidents. When questioned about why this was staff stated that they had only been given revised forms to record incidents the day before the inspection. The need to devise and implement a system in the establishment whereby the recorded episodes of challenging behaviour are reviewed in a way that supports a review of each episode, with a view to informing best practice in such circumstances was also identified as a requirement in the statutory notice. Efforts must now be made ensure these matters are addressed. Care plans were still being produced in standard written format and as noted in previous inspection reports, this does not assure the accessibility of these for residents. Although it is vital that plans are developed in more suitable formats it is acknowledged that priority has to be given to ensuring all care documentation is evaluated and where needed re-written to ensure all required information is available before this matter can be progressed. As most of the care plans and risk assessments examined had only just been rewritten, the inspectors were not able to assess monitoring and evaluation arrangements. At the last inspection it was noted that monitoring of plans was inconsistent and changes in needs and circumstances had not always been incorporated in individual resident plans. This matter will be followed up at the next inspection visit. The manager reported that risk assessment and care planning training had been arranged, however because the proposed programme plan did not fully reflect the training needs of staff, the training was being re-arranged. This matter will be looked into at the next inspection visit. Progress had been achieved in developing individual communication plans. One plan was very detailed and clearly set out alternative communication methods used by the resident, which staff continually built on. Other care plans were less detailed, but nevertheless there was evidence that staff were working towards developing detailed and specific plans for all the residents. To support staffs practice in this area communication training had been provided to some staff. This matter will be followed up at the next inspection visit. Discussions with care staff identified they are now more involved in care plan development and monitoring and they considered this to be positive. Records better described care provided and staff observations and there was evidence to demonstrate issues were being followed up where needed. Gatehouse Cottages Care Home DS0000002786.V302173.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15 and 17 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this home. A range of activities was provided, however some improvement is needed to ensure a more varied programme of activities and personal development opportunities are 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. EVIDENCE: Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 16 On the day the atmosphere in the home was relaxed and sociable and positive interactions between staff and residents was observed throughout the day. Staff said daily routines in the home were flexible and that choice was promoted. 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. Two of the residents spoken to said they were able to choose how to spend their day and what clothes to wear. On discussion staff displayed good knowledge of individual service users needs, likes/ dislikes and family support. All residents were well presented, clothes were clean and ironed; a number were wearing specialist boots etc. Residents’ religious needs were identified on admission in most cases. Staff said residents would be supported to access local churches or attend services held in the community where this was needed. Staff stated relatives and visitors are made welcome at any reasonable time and records seen confirmed this. Key workers helped service users to maintain family contact by sending cards at significant occasions such as birthdays and Christmas. All the relatives who returned a questionnaire confirmed staff and the owners of the home welcomed them at any time. There is an activity co-ordinator employed in the home that provides support within a group or one-one basis for residents in the main house. The activity programme includes exercise to music, games, hand massages, visiting entertainers and trips out etc. One worker now has responsibilities for arranging the residents’ holidays and had arranged two holidays to Blackpool for four residents each trip. Examination of a sample of files identified social profiles had been completed, however in some cases these were not detailed. This means staff need to look in more detail at peoples social stimulation needs in order to better tailor daily activities to individual wishes, needs and capabilities of some residents particularly those living in the Lodge and Studio apartment. Residents in the lodge and studio had attended an external day centre provided however, Craegmoor has now withdrawn this service. Feedback from staff identified that these residents would benefit from more structured support and personal development programmes and opportunities. Efforts must now be made to ensure this happens. Staff had not had any particular training in organising and arranging activity programmes, although the managers confirmed training had been arranged. This will be useful in assisting staff to assess and plan activities particularly for residents’ with complex needs. Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 17 A small number of residents attend a local authority day centre and since the last inspection the home had identified a worker to act as a liaison between the home and the day centre. This is a positive development, which will hopefully support joint activity planning and promote a more coordinated approach. 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. Staff reported that menus had recently been reviewed. The dinning room had been refurbished and this was noted to be clean and tidy. Six staff were present in the dinning room to assist those residents who needed help with eating. Support was provided in a sensitive manner and promoted the residents dignity. Staff confirmed residents were assisted on an informal rota to ensure the same residents did not have to wait. A small number of residents had liquidised meals. Residents able to feed themselves were provided with adapted cutlery. Meals appeared to have been enjoyed and again positive interactions between staff and residents were observed. Staff were observed to understand individual residents communication. Because of the number of residents who needed help with meals some food was stored in a large tray with foil cover. Staff were serving individual portions and re- heating them in the micro wave where needed. The need for a bain marie was discussed and the manager confirmed one was on order. This matter will be followed up at the next inspection visit. The inspector noted flies in the dining room at one point, windows were open for ventilation and flies were seen landing on residents. When asked staff stated that they were unable to use fly spray or other deterrents. This matter was taken up with the manager who confirmed action would be taken to address the problem. Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor. This judgement has been made from evidence gathered both before and during the visit to the home Progress had been made to ensure residents’ health and medication needs were being met although further improvement was needed because the home had failed to ensure full compliance with requirements set in one of the statutory notices. This said the home demonstrated significant capacity for improvement. EVIDENCE: All the service users were registered with a GP and records of visits by health care professionals were maintained. 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 in most cases. Staff had been provided with peg feeding training and further specialist training was being sourced. Records showed staff had requested the GP to carryout annual health checks for each resident. Health action plans had been developed, although the relevant professional worker had not signed off all the plans. This must now happen to ensure full compliance with the statutory notice. Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 19 As previously identified records and discussion with the managers and staff demonstrated that relevant health care professionals had been consulted regarding specific care regimes of some residents and guidance obtained had been incorporated into care plans. Most of the residents have significant sensory and mobility problems. Previous inspection findings identified that some residents did not have a current sensory and mobility support plan and/or where a plan was available staff had not been consistently following the plan. Records and discussion with staff indicated progress in this area and this observation was supported by a followup telephone call to a physiotherapist. The inspector was advised that two workers within the home have been identified as lead contacts and regular meetings were now are now taking place. The physiotherapist commented that this was an extremely positive development. Individual programmes were also being reviewed to ensure each resident had a current programme were needed and further reviews are planned. The physiotherapist stated some residents had not been provided with recommended sensory and mobility equipment. The inspector was advised that there was some wrangling over who was responsible for funding such equipment. The registered person must ensure all required sensory and mobility equipment is available. This is needed to ensure the home can meet all the residents’ needs. Because of this, further evidence is needed before the Commission can make a judgement about whether the requirement has been met. Whilst in the dinning room, one of the inspectors noted that one residents’ PEG tube had become disconnected and this was drawn to the attention of a nurse. The nurse obtained a new end section of giving set and she was observed attaching the tube. The inspector stopped the nurse switching the pump on, as she had not primed the line, it was also noted that the nurse did not wear gloves during this procedure. The managers were informed of this. The registered person must ensure agency nurses have the necessary competencies to carry out required nursing tasks with residents and follow safe hygiene practice at all times. This is needed to ensure the health and welfare of residents and staff and must now happen. At the visit carried out on the 9th June it was noted that one resident had blood glucose tests performed twice daily. Current guidance recommends that noninsulin diabetics do not benefit from regular blood glucose tests, but should have HbA1c tests instead. It was recommended that this resident be referred to the diabetic nurse/clinic for appropriate monitoring. Records were examined to check what action had been taken in respect of this matter. Records established that advice had been sought and records showed a test was now carried out on a weekly basis, however the individuals care plan had not been revised to reflect this change. The care plan still stated blood tests should be carried out twice daily. The registered person must ensure care plans are Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 20 current and are revised to reflect changes in needs and circumstances. Please also refer to comments detailed on page 14 of this report. At the visit carried out on the 9th June 2006 it was established that significant improvement had been achieved in all aspects of medication management and administration within the home. Nurses had been provided with relevant training, admistration records were found to be complete and well maintained and work was being undertaken to update all medication policies and procedures. At this visit medication systems were again examined; policies and procedures were now in place, which covered all areas of management. These were detailed and comprehensive. Because the documents had only just been completed not all staff had had an opportunity to read and fully digest them. It is vital that these documents be read, understood and adhered to by all members of staff responsible for the administration of medication. The registered person must evidence that staff have read and understood all medication policies and procedures and this should be documented in their supervision records. 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 generally satisfactory, although the inspector noted that transcribing of medication for one resident in the Studio apartment had not been counter signed. In order to ensure proper safeguards are in place a second member of staff should witness all hand written annotations on Medication Administration Record charts. It is imperative that staff are reminded that noticeable improvements in medication recording practice is sustained. 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. On the day of the inspection the inspectors noted that medications were left out in the dining room unattended. This matter was raised with the manager and on checking with staff this was strongly denied by the managers. One of the inspectors observed an agency nurse signing for medications prior to administration. This is unsafe practice and this must cease. The managers must ensure agency nurses understand their role and responsibilities around the recording of administration of medication and ensure staff follow agreed procedures. Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement is based on evidence gathered both during and before the visit to this service. The home had a satisfactory complaints system with evidence that the majority of relatives are aware of the complaints process. Procedures for adult protection were in place and were supported by a staff-training programme. A good outcome was spoiled by the homes failure to ensure full compliance with a requirement in the statutory notice concerning the management of challenging behaviours. EVIDENCE: A complaints procedure was available. The Commission had received one complaint about staffing in the home since the last inspection. A random inspection visit was made and it was found that the home had not breached any regulations. Fourteen relatives who returned a questionnaire confirmed they were aware of the home’s complaint procedure; two relatives were unaware of the procedure. This may reflect a shortfall in information and understanding about the process and the managers should take steps to address this. Procedures for adult protection were in place and when asked about abuse, what it was and what they would do if they suspected or saw a resident being abused, staff answered appropriately. Interviews with staff and records evidenced that staff had been provided with adult protection training. As indicated in other sections of this report a small number of residents display challenging behaviours. Revised behaviour management plans had been Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 22 devised, although some gaps were noted. Please refer to page 15 of this report. Because of this the home was not able to demonstrate full compliance with a requirement in the statutory notice concerning the recording and monitoring of challenging behaviours. This failure affects the overall quality outcome for this area. Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 and 30 Quality in this outcome area is poor. This judgement is based on evidence gathered both during and before the visit to this service. The main house had been decorated and refurbished to a good standard. However to make sure the home is safe and comfortable for all the residents rooms in the Lodge must be redecorated and problems with the hot water supply in the bathroom must be rectified. EVIDENCE: Over the last seven months extensive redecoration work had been carried out, new furnishing, carpets and bedroom furniture had also been purchased. This means residents in the main house have a comfortable and safe home to live in. Additional cleaning hours had also been allocated, which means domestic staff are now able to keep the home clean and tidy. All bedrooms seen by the inspectors 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 furniture to reflect their own individual choice and taste. Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 24 Most rooms, including bedrooms in the adjacent building known as The Lodge required redecoration and damp patches were noted in two of the bedrooms. The registered person must ensure bedrooms are redecorated and that steps are taken to investigate and rectify the damp problems. This is needed to ensure residents have a comfortable home to live in. None of the upstairs bedrooms in The Lodge had fitted wash hand basins and the inspectors advise that consideration is given to providing one in each room. Tests on hot water temperatures identified problems with the hot water supply in the main bathroom and the down stairs shower was also out of commission because of a faulty door. This compromises the personal hygiene needs of residents and steps must be taken to rectify any problems. The shower door must be repaired or replaced. The home had employed a nurse from outside of the area. This worker was utilizing a bedroom in The Lodge on a temporary basis until more suitable accommodation was found. This is unacceptable and should not continue. The home has a range of communal space, which residents and their visitors can access. Thirteen relatives who returned a questionnaire confirmed they could visit their relative in private. One commented that if they wanted to see their relative in private they had to use the persons’ bedroom, another wrote ‘we could do with a quiet room for visitors. We would also like to see more car parking’ One relative wrote ‘french doors now alarmed; even in hot weather doors are closed. Before these doors were fitted, clients had free access to the garden. It’s now more like a prison’. It is not for the Commission to determine whether doors should be open or kept locked. The need for this must be determine by the needs of residents. However, the inspector advises that managers’ look into this matter to check that restrictions on movements resulting from locked doors are in their best interests of residents. A fire risk assessment was in place and extensive work had been carried out on the homes fire systems. The inspectors were advised that a fire officer was to visit the premises to sign off completed work sometime in July 2006. Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this home. 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: Information from the pre-inspection questionnaire identified that the home provides 986 hours per week; information on specific dependency ratings of residents was not provided. It was not evident from the records how staffing hours are calculated. All of the staff spoken to said staffing in the main house was satisfactory and enabled resident needs to be met. Comments from two workers identified some concerns about staffing in the Studio Flat. Staff commented that there was a lack of consistency and that on occasions there was no night worker on the unit. This matter was discussed with the managers who stated they tried to Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 26 ensure four staff were on duty through the night, which then allows for one worker to work in the Lodge. Evidence from the sample rotas provided indicates that on occasions there is only three staff on duty. Seven out of the sixteen relatives who returned a questionnaire answered yes to the question about weather there are always sufficient numbers of staff on duty, six answered no to this question, one answered not always and one wrote ‘don’t know’. Feedback from questionnaires issued to a care manager responsible for monitoring a number of placements indicates this worker does not feel the home is meeting the needs of some residents and that the local authority is not advised of important changes. This may potentially indicate a shortfall in staffing hours. The inspector advises that the responsible local authority is contacted to establish what the issues are and to agree ways of addressing any identified problems. In the meantime evidence should be provided, which shows how staffing needs have been calculated, matched to the dependency needs of residents. This will enable informed judgements to be made about staffing levels and needs. The home had detailed guidance in place for induction, training, development and supervision. Information in the pre-inspection questionnaire states ten care workers (33 ) hold an NVQ qualification. This represents a significant improvement of previous figures. The registered person must continue with the programme to ensure 50 of care workers achieve an NVQ. The home had a detailed staff induction programme. The inspectors were advised that the induction programme meets Skills for Care specifications and the requirements of the LDAF award. The home had put all the care workers through the induction programme as parts of the homes staff development programme. This was a very positive development and has helped develop staff knowledge and skills. Records showed an induction had been completed for a recently employed nurse. A good mandatory training programme was in place and records examined identified staff were up to date with statutory training for example moving and handling, fire safety etc. Some improvement in the provision of more resident specific training was noted, the managers stated that further training was planned. Following the April inspection a requirement was detailed in the statutory notice that training needs/competency assessments of all care staff and nurses must be completed to identify any skills or knowledge gaps of staff who work with people with a learning disability. Following this to provide the Commission with a written copy of the results of the assessment together with written Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 27 details of the measures to be implemented, in order to address any deficiencies identified by the assessment A training matrix was been provided, which detailed what training staff had accessed, however further evidence is needed (as detailed in the specific requirement) before the Commission can make a judgement about whether the requirement has been met. Similarly, following the April inspection it was identified that a consistent staff supervision programme was not in place. A formal supervision programme is now in place and records identified that with the exception of one staff member all staff had had at least one supervision session. A small number of staff had had two sessions. Further progress is needed to ensure full compliance with the requirement detailed in the statutory notice. Examination of one new staff members file showed that employment and background histories had been checked (Criminal Records Bureau) and all other required records were in place. This means the home takes appropriate action to protect residents through safe recruitment practice. Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to the home. Considerable progress had been made to ensure effective management and administration of the home, however a stable management structure is needed to ensure continuous improvement. Failure to ensure full compliance with requirements set in one of the statutory notices aimed at ensuring residents benefit from a well run and safe home has affected the quality rating for this outcome group. This said the home demonstrated significant capacity for improvement. EVIDENCE: There has been no registered manager for the home in the last two years and two acting manages were now managing the home. The area manager confirmed that a permanent manager had been appointed and was due to commence sometime in July 2006. The area manger confirmed that an Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 29 application to register the manager would be submitted once the individual takes up her position. This must happen to meet legal requirements. The area manager advised of further management changes. A new Regional Director had been appointed and a new area manager was soon to be appointed. All of the staff spoken to said the current managers were organised and efficient. Staff and resident meetings were held; there was evidence that requests and suggestions made at these meetings were discussed and actioned where possible. There was evidence to demonstrate that the managers were focusing on improving and maintaining the management systems in the home, specifically care documentation, staff training, recruitment practises, supervision and staffing Staff said they would be pleased when a permanent manager was appointed to run the home, as this will ensure more consistency and continuity. Comments received from a physiotherapist and local authority staff supports this view. Although action had been taken to address requirements made by the Commission in previous inspection reports and those detailed in the statutory notices, some requirements remained outstanding with timescale for compliance being past. Steps must now be taken to address this without delay. The home did not have an effective quality assurance and monitoring system, which is based on seeking the views of residents, their representatives or relevant third parties. An annual development plan for the home was not available. This means the home was not able to demonstrate continuous selfmonitoring, involving residents to ensure continuous and sustained improvement. Managers reported that this would be an area of development within the near future. The home had a range of policies and procedures for health and safety and a current insurance certificate was on prominent display in the home. The home had current maintenance certificates for the gas, electrical system and the fire system as identified in the pre inspection questionnaire. Certificates were in place for the specialist bath and fire fighting equipment as identified in the pre inspection questionnaire. Records evidenced that checks on the hot water, emergency lights and fire alarm were carried out at frequent intervals. Accident books were filled in appropriately, although the inspectors recommend that the managers complete regular audit of these to help spot any problems or recurring themes. Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 30 The home had eleven electrical beds. Recent maintenance checks on three of these identified problems and work was recommended. When asked about why recommended work had not been carried out the managers stated they had not been advised of any problems. The registered person must have required work completed. This is needed to ensure welfare of residents. Following a tour of the home it was noted that there were problems with the hot water supply in the bathroom in the Lodge, the shower door in the downstairs bedroom was broken and damp patches were noted on the ceilings in two of the bedrooms. Action must be taken to ensure appropriate bathing and washing facilities are available and as indicated in other section of this report problems with damp must be rectified. . Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 31 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 2 3 2 4 X 5 2 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 1 25 X 26 1 27 1 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 2 1 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 2 X 2 X 1 X X 2 X Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 32 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 YA37 Regulation 8 Requirement The registered person must ensure an application to register the manager is made to the CSCI 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 not met. The registered person must ensure that service users have opportunities to participate in activities that will enable them to influence DS0000002786.V302173.R01.S.doc Timescale for action 31/12/06 2. YA6 15(2) 03/04/06 3. YA8 12 28/02/06 Gatehouse Cottages Care Home Version 5.2 Page 33 decision-making in home and contribute to the development and review of policies and procedures. Timescale of 31/08/04 and 31.6.05 not met 4. YA9 13 The registered person must ensure that risk assessments for service users are agreed to by the service users or their representative and updated regularly. The timescale of 31/3/05 not met 31/03/06 5. YA23 13 The registered person must 26/06/06 devise and implement a system in the establishment whereby incidents of challenging behaviour are reviewed with a view to informing best practice in such circumstances. Information obtained must be used to inform and support individual risk assessments and behaviour management plans. Statutory Notice The registered person must 31/03/06 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. Staff must be provided with communication skills training 6. YA7 15 & 18 7. YA32 18(1)(c)(i) The registered person must DS0000002786.V302173.R01.S.doc 31/03/06 Page 34 Gatehouse Cottages Care Home Version 5.2 ensure staff are provided with specific service user training. Timescale of 31/10/05 not met 8. YA32 18(1)(ii) The registered person must ensure 50 of care staff achieve an NVQ The registered person must carryout an environmental risk assessment for the lodge to inform decision making about whether space and facilities are sufficient to accommodate up to seven service users and two staff. Where necessary alternative provision must be made. The registered person must ensure annual appraisals 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. 31/12/05 9. YA11 23 31/01/06 10. YA36 18 28/06/06 11. YA6 15 Undertake a review of all the 26/06/06 service user care plans and following that review prepare and implement individual plans, which address all areas of identified needs. Individual plans must be sufficiently detailed to ensure staff are able to provide the right level of care to service users. Statutory Notice Consult with relevant DS0000002786.V302173.R01.S.doc 12. YA6 15 26/06/06 Version 5.2 Page 35 Gatehouse Cottages Care Home professional staff for example: physiotherapists, occupational therapists and/or speech therapists to establish which service users require specialist sensory and/or mobility programmes. Where necessary the advice and guidance issued by these professional staff must be incorporated into the service users individual plan of care. Statutory Notice 13. YA6 15 Review individual service user plans at least monthly. Individual plans must be updated to reflect any changes in needs and circumstances as necessary. Care staff must be actively involved in the evaluation process. Statutory Notice Where the outcome of such a review does not identify a need to use physical interventions strategies an agreed behaviour management plan must be developed and: Where such a review identifies a need to use physical interventions, a comprehensive intervention plan must be developed. The plan must be agreed with the plan must be agreed with the service user, their representative and the multi agency care team. This plan must be subject to regular monitoring and review as indicated in the plan Statutory Notice 26/06/06 14. YA23 15, 13 26/06/06 Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 36 15. YA19 12 Put in place health action plans for each service user that have been agreed with the service user and/or their representative and relevant local authority. Health plans must be reviewed as identified in the plan. Statutory Notice 26/06/06 16. YA35 18 Provide all staff with risk assessment training, which must be linked to the area of risk being assessed. Statutory Notice Provide all staff are provided with care planning training Statutory Notice 26/06/06 17. YA35 18 26/06/06 18. YA35 18 26/06/06 Undertake a training needs/competency assessment of all care staff to identify of any skills or knowledge gaps of staff who work with people with a learning disability. Provide the Commission with a written copy of the results of the training needs/competence assessment together with written details of the measures to be implemented, in order to address any deficiencies identified by the assessment Undertake competency assessments of all nurses working in the home in order to establish skills and deficits in their competence to lead the care of people with learning disabilities. Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 37 Provide the Commission with a written copy of the results of the competence assessment of all nurses together with written details of the measures to be implemented and the timescale within which these measures will be implemented, in order to address any deficiencies identified by the assessment. Statutory Notice 19. YA36 18 Establish and implement a system of staff supervision that will provide all nursing and care staff with monthly supervision for an initial period of three months, thereafter providing staff supervision not less than every two months. This supervision must address roles and responsibility and key tasks including clinical practice (nurses only). Statutory Notice 26/06/06 20 YA5 5 21 OP11 OP12 22 YA24 The registered person must 31/08/06 ensure residents or their representatives are provided with a contract or statement of terms and conditions 12,14,15,16,23 The registered person must 31/08/06 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. 13 The registered person must 31/07/06 ensure nurses record medication administration for each resident after DS0000002786.V302173.R01.S.doc Version 5.2 Page 38 Gatehouse Cottages Care Home 23 YA20 YA42 13 24 YA27 13, 23 25 YA26 13, 23 26 27 YA26 YA39 13, 23 24 28 OP18 OP19 12, 16 29 OP33 12, 18 medication has been administered in accordance with the Nursing & Midwifery Council guidelines The registered person must ensure that nurses observe safe hygiene practice when assisting residents with nursing tasks The registered person must ensure hot water is available in the bathroom in the Lodge and the shower door in the downstairs bedroom is repaired or replaced. The registered person must investigate the damp patches in the bedrooms in the lodge and rectify any problems. The registered person must redecorate the bedroom in the lodge 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 The registered person must ensure all required sensory and mobility equipment is available The registered person evidence how staffing needs have been calculated, matched to the dependency needs of residents. 31/07/06 31/07/06 31/07/06 31/08/06 31/11/06 31/09/06 31/08/06 Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 39 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 YA36 Good Practice Recommendations The registered person should consider a regular audit of a sample of care plans as part of the supervisory process; this would help in the The registered person should provide the activity coordinator with training in developing activity programmes for people with complex needs A second member of staff should witness all hand written annotations on Medication Administration Record charts. 2. 3. YA14 YA20 Gatehouse Cottages Care Home DS0000002786.V302173.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 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. 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