Inspection on 17/12/08 for Gatesgarth

This inspection was carried out on 17th December 2008.

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

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

Gatesgarth 11/12/06

Gatesgarth 31/01/06

Gatesgarth 24/10/05

Gatesgarth 25/02/05

Gatesgarth 01/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Gatesgarth The Green Little Broughton Cockermouth Cumbria CA13 0YG two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ray Mowat Date: 1 7 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Gatesgarth The Green Little Broughton Cockermouth Cumbria CA13 0YG 01900828487 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Community Integrated Care Name of registered manager (if applicable) Mrs Hilary Stamper Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 4 0 0 care home 4 learning disability physical disability Additional conditions: The home is registered for a maximum of 4 service users to include: up to 4 service users in the category of LE (Learning disabilities under 65 years of age) up to 4 service users in the category of PD (Physical disabilities under 65 years of age) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection A bit about the care home Gatesgarth is owned and operated by Community Integrated Care (CIC), providing care and services for up to four people with a learning and physical disability. They operate a number of similar facilities both in Cumbria and other parts of the Country. Gatesgarth is located in a quiet residential area in the village of Little Broughton, several miles from the town of Cockermouth. It blends into the other residences in the local community. Car parking facilities are to the front of the home and there are garden areas to the back and side, with views of the Lakeland Fells. The detached premises have a ground and first floor. People living in the home only use the ground floor. There is a lounge, dining room, kitchen, shower, bathroom and toilet facilities, utility room and four private bedrooms and an office. All the ground floor rooms have level access. There is also a designated open area off the corridor that is used for a relaxing sensory facility. Specialised aids and adaptations are provided. Access into and around the home is level and appropriately designed for people who use wheelchairs. Private transport is provided to facilitate access to local amenities, facilities and appointments. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. The last key inspection on this service (The main inspection that we do) was completed on 11/12/06. Information about the home is displayed in the home and is made available on request. Weekly fees charged are agreed with individuals based on a needs assessment. During the visit we (The Commission for Social Care Inspection) met with people living in the home and spent time with the manager and supervisory staff on duty. We also met with care staff individually and talked to them as they went about their duties. The manager completed a self assessment questionnaire called an Annual Quality Assurance Assessment (AQAA) and sent it to us before the inspection visit. This provided us with information about how the home is run and the managers views on what the home does well, where they have improved and plans for the future. There is also information about the people who live in the home and the staff working there. Surveys were sent out as part of this inspection to people living in the home, staff and other professionals with their views being used to formulate the judgements in this report. We examined records relating to the running of the home that are required by law, which included care plan files that guide staff in supporting people to achieve their goals and lead independent lives. We also examined staff files and records relating to the maintenance and safety of the home. What the care home does well When someone new comes to live in the home staff complete detailed assessments and develop personalised care plans for each person. This helps staff to make sure people are well cared for in the way they prefer. Care plans are looked at on a regular basis to make sure they are up to date. The person centred care plans have a pen picture that tells you all about the person and how they like to live their lives and what is important to them. These are very important for people with limited verbal communication skills. The plans have been made easier for people to understand with the use of photographs, which also helps to maintain a good consistent service. Staff have become skilled at communicating with people and understanding them despite their limited verbal communication. Staff support people to take part in a variety of suitable activities that they have chosen or are known to enjoy. A weekly planner is used to make sure people are given equal access to activities both in the home and in the local community. Due to the limited communication and complex needs of some of the people, communication and planning are very important to make sure people can safely access activities. Good health and personal care records support and guide staff in making sure peoples individual or specialist needs are responded to and people have access to relevant health professionals and agencies. Behaviour strategies that guide staff have been developed with input from relevant professionals to make sure the support provided to people is consistent and appropriate. Staff receive good training to make sure they have the skills and knowledge for their roles and responsibilities. Staff respect peoples views and make sure they are protected from mistreatment and abuse in all aspects of their lives. What has got better from the last inspection The staff have worked hard to find out what people like to do and to improve the number and range of activities for people to take part in. Annual team building days are held to agree ‘care pathways’ for people that make sure staff know what people want to do and what support they need. The system for supporting new staff has improved making sure they get the right training for their role. Policies, procedures and paper work are now looked at regularly. People are supported to make more use of their personal space to relax or just have some private time. An extra senior staff has been employed who is providing good support for the staff team and makes sure people receive a consistent service. What the care home could do better Action plans that are agreed at care plan reviews contain personal and some confidential information and were displayed on the notice board. This practice should be looked at to make sure all personal and confidential information is securely stored and confidences are kept. A system should be in place that records all medication coming into or leaving the home to make sure all medication can be accounted for. Once the annual consultation/survey has been completed the results should be put together and given to all interested parties. The recording of fire drills should be monitored to make sure they are accurate and all staff receive regular training. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Ray Mowat Unit 1, Tustin Court Port Way Preston PR2 2YQ 017 7273 0100 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Detailed assessments and care plans make sure peoples needs and personal aspirations are assessed and responded to appropriately. Evidence: There have been no new service users admitted to the home since the last inspection. All the service users have been issued with a large print version of the service user guide. This included relevant information about the philosophy of the home and the range of services it provides. A key element of this is to support people to achieve an independent and valued lifestyle. Although a contract of terms and conditions is issued separately it is recommended information about the terms and conditions of residence and fees are included in the service user guide. This will provide relevant information to prospective new people allowing them to make an informed choice about moving into the home. Social work assesments are completed for all new people moving into the home in addition to the home completing their own assessment of need and working closely with other agencies or professionals when specialist needs are identified such as Physiotherapy, Behaviour Intervention Team and the Community Health Services. There was evidence people’s needs are kept under review to make sure behaviour management strategies and the type of support provided are adjusted to meet peoples changing needs and preferences. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Good care plan records have been developed that make sure staff can meet peoples assessed and changing needs and their personal choices and dignity are respected at all times. Evidence: The staff have developed very detailed care plans for each person living in the home, these are based on a range of assessments that identify peoples needs and personal preferences helping and guiding staff in providing a consistent service. Informative pen pictures give staff a real insight to the person and what is important in their lives. Three of the people have no verbal communication so it is vitally important that the care plans identify how people communicate their needs and choices and how staff can communicate with them. The home work closely with a number of other professionals and agencies to develop individual behaviour strategies to guide and support staff with all aspects of communication including dealing with any challenging behaviours. This has involved staff monitoring behaviours, completing records and assessments and reviewing outcomes to develop meaningful and effective management strategies to support people and promote their independence. It was evident that staff are skilled at understanding and communicating with people despite their limited communication skills. With one person it involved the use of eye movements and head shaking to check out their preference and make sure they were happy. Despite peoples severe and complex needs independence, choice and community participation are encouraged and promoted in all aspects of peoples lives. Risk assessments have been completed to support this independent lifestyle with positive risk management strategies being agreed to support the chosen activities. Photographs are used in peoples manual handling risk assessments to improve the Evidence: consistency among the staff team. Three monthly care pathways, which identify priorities for each person are agreed with them and significant others and kept under review to make sure peoples changing needs are responded to in a timely manner. These contain sensitive, personal and confidential information and were displayed on the homes notice board, where they can be seen by anyone with access to the home. This practice should be reviewed to make sure peoples confidentiality is respected at all times. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are enjoying a good quality of life and are involved with a good range of activities both in the home and local community. Evidence: Because of the limited communication skills and complex needs of people living in the home, communication and planning are of utmost importance in providing day to day support to people. There are good systems in place to make sure relevant information is recorded and staff learn from previous experiences and what works well for each individual. People are provided with opportunities for personal development and are supported with peer, age and culturally appropriate activities. A weekly planner is used to make sure each person has equal opportunity to participate in activities both in the home and in the local community. We examined the agreed plan for the week commencing 15/12/08, which provided a good range of activities for each person. On a typical week activities include helping with household chores, listening to music, watching a DVD film, visiting relatives, craft activities, swimming, shopping and day trips. One person goes to a local day service one day each week, which provides opportunities to meet with their peer group otherwise people are supported by staff from the home. The home has an adapted vehicle that enables good access to the local community and surrounding areas. Meals and mealtimes are very flexible with good records in place about peoples personal preferences, likes and dislikes. We joined a group of people for lunch, which was served in the dining room. The meal was well presented despite being liquidised Evidence: and was well balanced and nutritious. Nutrition and weight are monitored with staff liaising with specialist services for advice and guidance regarding individual concerns. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Personal and healthcare needs are well documented with staff providing support to make sure individual physical and health needs are met. Evidence: Health and personal care needs are well documented within the care plan and health action plan, which is a record of all health related needs and interventions with a record of the outcome from appointments and consultations. Specialist programmes are in place to support individual needs such as, Physiotherapy programmes, Behaviour Team support, Speech Therapy programmes and dietary advice and guidance. Staff had a good understanding about individual needs and the importance of following the agreed programmes to maintain a consistent service to people. A good example of this is the Epilepsy management plan. Although people have complex needs they are enjoying good health and have access to relevant services when needs arise. Each person has a hospital admission assessment All about me, that provides medical staff with pertinent information about caring for them. We spot checked the content of the medication cabinet against the individual records held. It was evident the system for recording medication coming into or leaving the home should be reviewed, as now that it is delivered to the home an ongoing stock record has not been maintained. All medication was clearly labelled in the prescribing Pharmacists container. PRN (As and when required medication) is recorded with protocols in place to guide staff when to administer it. Epilepsy is closely monitored and again clear guidance is in place for staff. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The policies and procedures of the home make sure peoples rights are respected and they are safeguarded from abuse, neglect or self harm. Evidence: The home has a suitable complaints policy and procedure, which is included in the service user guide. There were no formal complaints recorded since the last inspection. Staff spoken to during this visit showed a good awareness of their role and responsibility in supporting people in relation to raising a concern or complaint. One of them gave an example of a relative who raised an issue, which was referred up to a senior Manager who looked into the concern and fedback to the relative, who then did not wish to pursue a formal complaint. The manager has completed training the trainer safeguarding training enabling her to provide training to the staff team. All the current staff team have completed basic training, which is refreshed annually. Based on our discussions with staff they demonstrated a good understanding of the different types of abuse particularly for people with very limited communication skills. They talked about the reporting procedures and understood their role in the referral process. There have been two safeguarding referrals since the last inspection. These were well managed by the home making sure people were safeguarded throughout the investigation process. Policies and procedures are in place and accessible to staff and service users if required. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Gatesgarth provides a safe and comfortable home that is well maintained and decorated and furnished to a good standard. Evidence: The AQAA confirmed all routine maintenance and servicing were taking place as required. We also conducted a tour of the building with manager. People’s rooms are all on the ground floor and fully accessible. All areas of the home were free from hazards and were well maintained and decorated and furnished to a good standard. The home was tastefully decorated for the festive season. Personal Bedrooms are spacious and well equipped with each one having an adjustable height bed with good access all around to enable manual handling manoeuvres to take place safely. Rooms were individually decorated with service users having their personal belongings and decor. Communal areas are also well maintained and provide good space for people to relax and enjoy their home. There is a large lounge with patio doors leading onto an accessible patio and garden, which overlook the nearby Lake District Fells. There is a good size dining room with a serving hatch from the kitchen. There is a well ordered laundry with suitable equipment to ensure soiled clothing is thoroughly cleaned to control the risk from cross infection. Bathrooms were also well equipped and fully accessible to service users. The upstairs of the home is used by staff for storage of equipment and a meeting/training room. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has a settled, competent and well trained staff team who provide a personalised package of support to the people living in the home. Evidence: The majority of the staff team have now completed their NVQ 2 qualification (National Vocational Qualification) and senior staff are also receiving suitable supervisory training for their role and responsibilities. The home has a good training programme in place to make sure all staff training is up to date and relevant including both core skills and specialist areas, such as tube feeding and Epilepsy management. This ensures the staff team have the skills and knowledge to meet peoples individual needs. The manager monitors and records all staff training identifying any shortfalls and arranging relevant courses when required. The home enjoys the benefits of having a low turnover of staff. Care staff have developed good relationships with service users and have a good understanding about individual needs and preferences about how people like to live their lives. Staff feel valued and well supported by the manager and feel confident that their views are respected and they can contribute to the smooth running of the home. We examined supervision records that confirmed staff receive regular support and guidance and have the opportunity to reflect on their practice and identify training and development opportunities. Regular staff meetings are also used to share information and make sure staff are kept up to date about all aspects of home life and the changing needs of service users. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The manager and staff ensure the home is run in the best interests of service users and that their safety and welfare are promoted and protected. Evidence: The manager provides clear leadership to the staff team and is managing the home both efficiently and effectively, ensuring the people living there enjoy a fulfilling and independent lifestyle. Staff feel valued and are well motivated and are working toward common goals, which are agreed with the person and their representatives through the review process and the use of care pathways. The home liaises with people and their families regularly on an informal basis through day to day contact and the formal review of care plans. In addition an annual quality assurance questionnaire is used to gain feedback from people. We examined the most recent surveys from people’s families and other professionals, which were very positive. The results of the survey should now be collated and published and made available to people who contributed to it. We also received positive responses from our own surveys sent out as part of this key inspection process. The manager and the organisation have good systems in place to monitor and maintain a safe living and working environment. Servicing and maintenance records are up to date with audit systems in place to check them. Risk assessments are used effectively to identify potential hazards and put suitable control measures in place to keep service users and staff safe. Regular safety checks are taking place and are recorded in line with Health and safety good practice guidelines. A new fire risk assessment has been completed in line with changes to the Fire Regulations. The fire log was examined, which reflected the fact regular systems checks are taking place to make sure all equipment is serviced and fit for purpose. However the record of fire drills was inconsistent and not in date order and should now be monitored. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 10 20 Sensitive and confidential information should be appropriately stored at all times. Medication records should be in place to make sure there is a clear record of all medication entering or leaving the home and the balance that remains. The results of the annual quality survey should now be collated and published and made available to people who contributed to it. The recording of fire drills should be monitored to make sure records are up to date and all staff are receiving instruction on a regular basis. 3 39 4 42 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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