Inspection on 03/01/07 for Gatehouse The

This inspection was carried out on 3rd January 2007.

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

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

Other inspections for this house

Gatehouse The 01/02/06

Gatehouse The 15/12/04

Gatehouse The 30/06/04

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

CARE HOMES FOR OLDER PEOPLE Gatehouse The 9 Manor Road Harrogate North Yorkshire HG2 0HP Lead Inspector Mrs Irene Ward Key Unannounced Inspection 09:30 3rd January 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gatehouse The Address 9 Manor Road Harrogate North Yorkshire HG2 0HP 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) 01423 535730 The Franklyn Group Ltd Mr J Howard Woolsey Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 2006 Brief Description of the Service: The Gatehouse is registered to provide personal care for 31 older people aged 65 years and above who do not have any specialist requirements. It is a large converted and extended detached property, previously a private residence and located in a residential area of Harrogate. It is a short walk to local amenities and approximately one mile from the town centre. The resident’s accommodation is on three floors with a vertical lift providing level access to the upper floors. The registered provider is Franklyn Group Ltd. The registered manager is Mr Howard Woolsey. The weekly fees on 3rd January 2007 range from £423.00 to £525.00 and do not include costs for hairdressing and chiropody. This information was supplied to the Commission For Social Care Inspection during the site visit. Service users/relatives and other interested parties are able to have access to inspection reports by requesting them from the home. Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows an unannounced site visit carried out on the 3rd January 2007. This visit was carried out by one Regulation Inspector and started at 09.30 hrs and finished at 17.00 hrs with 1 hour’s preparation time. The home had not returned the pre-inspection questionnaire prior to the inspection which requests information before a site visit. Some information was obtained on the day so that surveys could be sent out to all relevant parties. Twenty-five surveys have been sent out to relatives and other professionals who had contact with the home. Ten have been returned at the time of this report being written. The site visit comprised of a full inspection of the premises, which included some service users private accommodation. The care records of four service users were looked, which included service users assessments, care plans and medication records. Staff rotas and health and safety documentation were inspected. Time was spent observing activity in the home and interaction between service users and staff, talking and listening to service users, friends and relatives visiting the home. Time was also spent talking to members of staff. There was also opportunity to speak with a visiting Chiropodist. The focus of the inspection was a number of key standards, inspecting the case records of service users in detail to establish if they corresponded with service users experiences in the home. The registered manager, the deputy manager and the head of care were available throughout the day. There were no requirements outstanding from previous inspections. There were requirements made at this inspection regarding service users contracts, care practice, quality monitoring, provider visits and reporting of any occurrences affecting the well being of service users. The last unannounced inspection was carried out on the 1st February 2006. What the service does well: The staff provide a clean, warm and comfortable home for service user to live in. Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 6 The home provides good care for service users and supports them to maintain their independence. Members of staff were observed to provide appropriate care when supporting service users in maintaining their independence in daily tasks. Service users spoken to were all positive about the home, and comments were made such as, “the home is run very well” “they look after us well” and “very jolly, very cheerful staff who get on together and are very kind to residents” were just a few of the comments made by service users. Comments from relatives/visitors and a visiting health care professional were also positive. Relatives made comments such as “the home is a godsend – a wonderful place” “ everyone is friendly”. Two visitors said, “ in our opinion this is one of the best homes in Harrogate”. A visiting health care professional said, “The home is very nice, with welcoming, helpful and informative staff”. Surveys received from General Practitioners, Care Managers and Relatives were also positive with comments such as “overall impression is of high levels of care & efficiency” “excellent retirement home” “I think The Gatehouse offers a very high standard of care and residents needs are met with a great deal of attention to their individual circumstances”. “My mother is happy in The Gatehouse – it would finish her off if she had to move aged 98 yrs old”. “ I am sure that The Gatehouse is the best place for my mother and aunt to live. They are both different in their needs but are always well cared for. They have lived at The Gatehouse for approximately 18 months and I do not have a criticism”. Service users confirmed that they could see visitors at anytime enabling them to maintain relationships with their family and friends. What has improved since the last inspection? What they could do better: The home must make sure that copies of terms and conditions given to service users are also held by the home. Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 7 Care staff should not routinely record the vital signs of service users and this practice should not continue. The organisations quality monitoring system must be followed, to ensure that the home is run in the best interests of service users. Records of visits to the home carried out by the provider must be made available to the Commission for Social Care Inspection. The home must report any incidents that may affect the wellbeing of any service user living at the home to the Commission, as required by regulation. 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 The DS0000046949.V309091.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6. Quality in this outcome area is good. Service users needs are properly assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager confirmed that a service user guide is sent to all service users/relatives when making an enquiry about the home. The Statement of Purpose and the Service User Guide remain unchanged. Pre-admission assessments are in place and held on service users individual files. These were detailed well about the needs of service users. A care needs assessment from local authorities was also in place where necessary. Four service users files were looked at. All files held initial assessments, care plans and risk assessments. The manager confirmed that contracts/terms and Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 10 conditions of residency are given to all service users or their representatives a blank copy was seen. Only one copy of a service users contract was seen which had been signed and agreed with the service user or their representative. This was discussed with the manager and agreed that a copy of service users contracts/terms and conditions of residency should be held on file by the home. The home does not provide intermediate care. Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is good. The care provided to service users was good, and all identified needs are translated into individual plans of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are well cared for and some made comments about the care they received. One service user said “they look after us very well” and another said, “Staff are very friendly ”. Another service user said, “Staff are very good here, they are always pleasant and helpful”, whilst another commented, “very jolly, very cheerful staff who get on together and are very kind to residents”. Service users commented that they treated with respect by the staff at all times. All relatives spoken to on the day spoke highly of The Gatehouse two visitors said, “in our opinion this is one of the best care homes in Harrogate”. Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 12 Another set of visitors discussed how the home had cared for a service user who was dying and said the staff were “excellent” and the service user was looked after “extremely well and nothing was too much”. Evidence showed that all identified needs that were assessed are recognised by care planning. The case records of four service users were looked at. All four care records had detailed risk assessments including reducing risks of falls. Care plans were comprehensive in detail about service users needs and how they were to be met by care staff. Daily records were detailed and gave a clear picture how both day and night care staff, meet service users care needs. Records were also in place for pressure sores, diabetic records, pulse temperature and blood pressure. The manager said that the District Nurses oversee this practice and carry out regular training with the care staff. However care staff spoken to were unclear as to why they were doing health care checks and there was no follow up recorded on service users care plans. Visits by GPs and other health and social care professionals were recorded. Service users records confirmed that appointments are made for the dentist and optician. A private chiropodist calls regularly to the home. There was an opportunity to speak with a visiting chiropodist who said, “The home is very nice, with welcoming, helpful and informative staff”. The medication system and facilities were inspected. The home operates a monitored dosage system. All medication was stored securely. Proper procedures were in place for the administration and storage of medication and a random check of medication supplies tallied with records. The medication administration records were up to date. Controlled drugs held by the home were stored securely and records were maintained in line with the recommended guidance. Systems for checking medication including controlled drugs have been improved by the home. Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. Daily routines enable service users to have control over their lives. Activities in the home are good and meets the social needs of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Various activities are organised such as crosswords and current affairs, games, cocktail hour, bingo, manicures and various entertainers visit every Friday. The hairdresser visits the home regularly. Service users spoken to on the day confirmed this. However one survey received from a relative said that they thought that the home may benefit from having a “specific staff member employed to organise daily activities, as it appears to be rather hit and miss as to actually activities happen or not”. Service users all confirmed that they are able to get up and go to bed as they wish and that visitors are able to visit them at anytime. Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 14 All service users said that the food at the home was very good. One service user said, “The food is very good here”. Another service user said, “The food is home cooked and there is variety and choices available ”. A visiting relative said “the staff always make you feel welcome and offer you a drink and the menu changes weekly”. Another relative said, “There are always fresh flowers around and bowls of fruit available”. Menus provided detail of variety and choice. There is a four weekly rotating menu that the cook works to. The menu is changed to take account of the foods in season. Special diets are catered for such as diabetics. Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. Service users are confident that their complaints and concerns will be dealt with and are safe living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Gatehouse continues to have a comprehensive complaints procedure in place. The home records all complaints they receive. No complaints have been made either to the home or the Commission For Social Care Inspection since the last inspection. Service users said that they were aware of how to raise any concerns. They said they would approach care staff or the manager and they were confident that they would put things right. Comprehensive policies and procedures on the protection of vulnerable adults were seen and the manager is aware of the local multi-agency agreement. Staff have received training on abuse awareness. On discussions held with staff they were clear of the homes procedure and what action they would take if a service user disclosed of any form of abuse. Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is excellent. People live in a safe, clean and comfortable environment that is furnished to a high standard and suitable for their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the site visit the home was warm, bright and clean. There were no offensive odours in any areas of the home. All areas seen in the home including communal areas and some service users rooms were all furnished to a high standard. Bedrooms and communal areas were also clean and tidy and furniture and fittings were well maintained. Several service users were able to show the inspector their rooms. Service users rooms had all been personalised with their personal belongings including Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 17 pieces of furniture. Some pieces of furniture or paintings belonging to service users were displayed in the corridors of the home in close proximity to their bedrooms. The manager stated that service users are able to keep their favourite possessions and walk past and see their pieces of furniture or favourite paintings if they are unable to accommodate them in their own room. Assisted bathrooms and toilets were situated near to service users bedrooms and communal areas. Service users accommodation is over three floors, which can be accessed by a passenger lift or staircase. There is level access to the home. This meant that any service users who had difficulty with mobility or used a wheelchair had access to all parts of the home. Relatives and visitors to the home said that the home was always kept “ very clean”. One service user said, “the home is always kept clean, the cleaners do a good job”. Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. Staffing levels are sufficient in meeting the assessed needs of service users. Service users are protected by the home’s vigorous recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota showed that there is usually a minimum of four care staff on duty each morning, and four on an afternoon and evening this does not include management or ancillary hours. There is the registered manager a deputy manager and a head of care. At night there are two waking night staff. Service users said that they felt that their care needs were being met and that staff are easily accessible. The home had a call bell system and service users said that the call bell requests were always attended to quickly. The staff records of three staff including a recently appointed member of staff were looked at. All records showed completed application forms, two written references, CRB (Criminal Record Bureau) checks had been obtained. A POVA first check had also been carried out. 60 of staff holds NVQ Level 2 and 3 one staff is completing NVQ Level 4. Training such as Mental Health, First Aid, Medication- Safe Handling of Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 19 Medicines, Moving and Handling, Dementia, Food Health and Hygiene, Continence and Protection of Vulnerable Adults is just some of the training that has been completed by staff. The home has a training development plan in place for the staff team. This identifies what kind of training all the staff have had and what they may need in the future to make sure that the home has a qualified and competent staff team and that the quality of care in the home continues to be good. Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. Quality in this outcome area is good. The service users and staff benefit from the ethos and leadership of the management team who safeguard service users interests and ensure their safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has eighteen years experience working with older people. He holds NVQ Level 4 Registered Managers Award. Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 21 The examination of selected health and safety documents show that regular checks to the passenger lift, gas and fire safety equipment are regularly undertaken. The ethos of the home is open and positive. Service users, relatives/visitors and health and social care professionals all commented highly about the home. Service users finances were not checked at this site visit, however historical evidence from previous reports gives evidence that service user’s financial interests are safeguarded. Staff supervision records were seen at the site visit. Staff confirmed that staff supervision and annual appraisals is carried out regular. Staff meetings are held three monthly. Regular service user meetings are held and relatives are invited to attend. The manager said that the organisations quality assurance systems are in place, however the home has not sought the views of people by sending surveys to service users, relatives, GP’s and District Nurses since last year. Although the manager said that he speaks to service users daily and is always checking with them that they are satisfied with the service. The manager was advised the importance and best practice of maintaining and recording of any quality monitoring undertaken. Which reflects that the home is regularly seeking the views of service users and other interested parties, this ensures that the home runs in the best interests of the people living there. The home had recently had an outbreak of diarrhoea and vomiting and had not reported this to the Commission For Social Care Inspection as required by Regulation. The Community Infection Control Nurse brought this to the Commissions attention. The manager was advised of what required to be reported to the Commission to ensure that in future the home complies with regulation. The manager confirmed that the organisations Operational Director carries out regular visits to the home as required. However reports following these visits were not available at the time of the site visit. Reports of visits on behalf of the registered provider have not been forwarded onto the Commission. Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 1 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 1 3 Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5(1)(b)(c) Requirement The registered provider must ensure that all service users are provided with terms and conditions of residency and a copy retained by the home. The registered provider must provide the Commission with evidence that regular visits to the home are undertaken and reports are completed on the conduct of the home. The registered provider must ensure the home notifies the Commission of any occurrences that affect the well being of service users as required by Regulation. Timescale for action 03/01/07 2. OP37 26 03/01/07 3. OP37 37 03/01/07 Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 24 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 OP8 Good Practice Recommendations The need to carry out health care checks and the actions they need to take should be recorded on the service users care plan. The home should record any quality monitoring that has been undertaken by the home. 2. OP33 Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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. Extracts may not be used or reproduced without the express permission of CSCI Gatehouse The DS0000046949.V309091.R01.S.doc Version 5.2 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!