Inspection on 24/10/05 for Gatesgarth

This inspection was carried out on 24th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Gatesgarth 17/12/08

Gatesgarth 11/12/06

Gatesgarth 31/01/06

Gatesgarth 25/02/05

Gatesgarth 01/06/04

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

CARE HOME ADULTS 18-65 Gatesgarth The Green Little Broughton Cockermouth Cumbria CA13 0YG Lead Inspector Gordon Chivers Unannounced 24 October 2005 09:30 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 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 Stationary 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. Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Gatesgarth Address The Green Little Broughton Cockermouth Cumbria CA13 0YG 01900 828487 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Community Integrated Care Hilary Stamper Care Home 4 Category(ies) of LD - Learning Disability registration, with number PD - Physical Disability of places Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 4 people over 18 years of age with a learning disability (LD) some of whom may also have a physical disability (PD) Date of last inspection 25 February 2005 Brief Description of the Service: Community Integrated Care are the Responsible Company for Gatesgarth and provide 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, which is 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 garden areas to the back and side. The detached premises have a ground and first floor. Service users 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 rooms used by service users 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. Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, commencing at 09.30 and lasting seven hours. The inspection took place in the presence of the Manager, Hilary Stamper. The inspection included: • a tour of the premises, • reference to a range of documents including a sample of service users’ case files, • an interview with three members of staff, and • observation of the service users, all of whom are very disabled and have very limited communication. The inspection focused upon the requirement and recommendation made, and those standards which were not assessed, by the last inspection. The inspector would like to thank the service users and staff of Gatesgarth for their welcome and cooperation during this inspection. What the service does well: What has improved since the last inspection? What they could do better: Ensure that care plans are written clearly and fully. Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 6 Reviews should focus on whether the care plan is appropriate and whether it has been carried out as it should have been. If the home should had a third support worker on duty in the mornings the service users who get up first would get more attention whilst the others are getting up. The manager should produce an annual Development Plan which states what improvements will be made to and in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 8 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 standard(s) 1,2,3,4,5. The home makes full assessments of the service users’ needs and keeps good records of what is done to meet those needs. The manager is developing a person centred planning system, but this will be a long job and in the meantime the care plans need to be recorded better and the reviews need to be focused properly. There is information about the home and the service available for service users and their families. EVIDENCE: The home provides information for service users and their families in a Statement of Purpose and Service user Guide. There is no copy of the most recent inspection report available for each service user and their family. There is a policy and procedure in place which requires the manager to make full assessments of any prospective service user. These assessments determine whether their needs and aspirations can be met by the home and whether they would be appropriately placed in the home. These assessments include information given by the family, social workers and other involved professionals, and the service user’s previous placement. There are full assessments of need and risk assessments in place about all of the present service users; these are reviewed at least every six months and updated if necessary. The home has care plans which set out how the staff will support the service users in meeting their social and health needs. The forms provided by CIC for this purpose do not allow enough space to put in all the details clearly and fully. This makes it very difficult to read and understand the care plans. The manager is in the process of introducing Person Centred Planning which will Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 9 take the place of the present care planning system eventually. But this is a long and slow process because it involves working directly with all the service users individually, and that requires the manager and the staff to be sure (as much as possible) that the service users understand and agree with what is written on their behalf. Staff maintain a daily report book and a weekly summary of what the service users do and how they have been. The manager also reviews the care plans, but these reviews tend to focus upon the assessment of needs rather than whether the care plan is appropriate and whether it is implemented effectively. The families of the service users are informed about the reviews but rarely attend. They are sent copies of the reviews for their information. The manager could not find the procedure for admission of a service user to the home, but she assured me that there is one. The home has not had any new admissions since it was opened in 1996. The manager understands what is involved in the process of admission and how to undertake it effectively, including a series of increasingly longer visits and stays followed by a trial placement before any formal decision is made about permanency. All of the service users have contracts with CIC for the provision of their residential care. But these are out of date because some of the details have changed since they were issued and signed. Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 10 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 standard(s) 7,9 Service users are supported in making decisions and taking risks so as to be as independent as possible. EVIDENCE: All of the service users have severe difficulties in communicating, but the staff have developed means of communicating with each of them, often using signs and symbols. Through this the service users are helped to indicate their wishes and make decisions as to what they would like to do (or not as the case might be). The manager gave several examples of how she and the staff have taken reasonable risks in testing out service users in activities and situations which were previously considered inappropriate. The application of certain physiotherapeutic techniques has enabled one service user who lost the use of his legs to experience situations which were assumed to be beyond his capabilities. With the right preparation and support, service users have been able to experience and enjoy things like holidays and other leisure activities for the first time and which they can repeat again. Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 11 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 standard(s) 12,13,16,17. The service users are able to take part in leisure activities in the home and in the community, and the staff are constantly looking to increase the options available to them. They are offered varied and balanced meals and their dietary needs are constantly monitored. EVIDENCE: The staff develop an understanding of what the service users like doing, and what they are capable of, through communication and observation. The home has identified a range of suitable activities for each of the service users and staff plan ahead what they will do on a weekly basis. These plans have to be flexible in case the service users are unwilling or unable to take part in any of the activities, and they are then supported in doing something else instead. One member of staff has the lead role to organise activities and to be on the look out for new ideas and possibilities to increase the range of options. All of the service users access the local community to differing degrees. Another member of staff has taken on the responsibility to explore what possibilities exist within the local community and this had led to one of the female service users going to darts matches with the local ladies team. Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 12 The principle of recognising the rights and responsibilities are at the heart of how the staff team operate. The service users are responsible for paying for certain personal items and activities themselves and staff support them in understanding this and managing their spending money. The home has a four weekly rolling menu of meals which are varied and balanced. This changes every six months. As well as knowing the service users’ individual preferences, the home also refers to a set of calorific guidelines and the manager maintains regular liaison with the local NHS dietician. All of the staff have had training in dysphagia (swallowing issues). Three of the service users have liquidised meals and the fourth service user takes his meals directly through the PEG system. Three of the service users had lunch together in the dining room, with direct support from the staff, during this inspection. Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 13 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 standard(s) 18 Staff make every effort to provide personal support in the way service users prefer and they also look for ways to do things better. EVIDENCE: The staff have to provide the service users with all of their personal support needs. All of the staff have been trained in the moving and handling of service users. They are constantly checking with service users as to whether this is done in the way they prefer; and they also liaise closely with physiotherapists and other health professionals with a view to finding better ways of doing it. Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 14 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 standard(s) These standards were not assessed as they were considered satisfactory by the last inspection. EVIDENCE: Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 15 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 standard(s) 25,29 The service users’ bedrooms are well decorated, furnished and personalised. The home has a range of modern specialist equipment to meet the service users’ needs fully. EVIDENCE: All the service users have their own bedrooms, and all the bedrooms are big enough for their needs. The bedrooms are individually decorated and furnished to a high standard, and are personalised with photos, pictures and other items such as books and music systems. The home has a very sophisticated hoist which is used to get the service users in and out bed and to take them to the bathroom. Some of the service users have ‘hi-lo’ beds which can also adjust so that the service user’s head can be tilted upwards. The bath is also ‘hi-lo’ so that it can be raised upwards to the service user rather than them being lowered into it. This makes it easier for staff to assist the service user when in the bathwater. All of the service users have wheelchairs designed to meet their personal needs. The home also has a second hoist which can be used in emergencies and when one of the service users goes on holiday. Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,34 The staff are well qualified, well trained, and work well together, although the service users would benefit from a third member of staff on duty in the mornings. All of the staff have had the statutory checks on them to ensure they are suitable to work with vulnerable people. EVIDENCE: Of the eleven members of staff (not including the manager), seven have qualified to NVQ level 2 or above, one is currently doing that course and the other three will be nominated to do it in 2006. The manager has a particular interest in training and tries to ensure that her staff undertake as much training as possible. Each member of staff has a personal training audit with a plan of training for the future. The manager is a NVQ assessor, an accredited trainer in ‘moving and handling’ and ‘positive communication’, and is training to be a Person Centred Planning facilitator. Consequently she is able to provide a lot of training and assistance directly to staff whilst they are at work. All of the staff have received training in administering medication, pressure care and tissue viability. The last inspection on the 25 February, 2005.made a requirement that ‘the registered manager must review night staff cover in light of the complex needs of service users to ensure the safety and welfare of service users and staff could be maintained at all times’. CIC managers have undertaken this review and concluded that the single waking night staff is sufficient to ensure the Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 17 safety and welfare of the service users because CIC provide an ‘on-call’ system of first line managers who respond to requests for assistance. The manager has the authority to arrange for two members of staff to be on duty at night if circumstances require; this has only been necessary on three occasions since the last inspection. Cumbria Social Services are currently reviewing the changing health needs of the service users in order to decide whether the service needs three members of staff (excluding the manager) on duty in the mornings when it takes two members of staff to get each service user up, bathed and given physiotherapy in turn. The Commission would support such an arrangement so that the service users who get up first could receive more attention whilst the others get up, and the manager could then use all of her time attending to her management duties. The staff, including one who was recently appointed, confirmed that the recruitment procedures are thorough and properly implemented. The new member of staff does not work unsupervised whilst on her probationary period. All staff have received clearance from the CRB or POVA checks. Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38,39,43 The service, the staff and the finances are all well managed. The manager intends to produce an annual Development Plan for the home aimed at making improvements every year. EVIDENCE: The manager has gained the Registered Managers Award and hopes to take some training in leadership skills in the future. It was clear during the inspection that she has developed a culture of care and support based upon the values and principles of dignity, respect, choice and independence. The three members of staff who were interviewed all said that morale within the staff team was good, as were the standards of care and support; and they had a positive opinion of her management style. Individual service user views are being better understood through the person centred planning system but, as mentioned previously in this report, implementing this system is a long and slow process. Service users attend the monthly staff meetings as and when they want to. The manager keeps in contact with the families of the service users, and CIC survey the families once Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 19 a year, although the manager does not see the returns. The Service Manager, Carol Baker, undertakes the monthly ‘Regulation 26’ visits to the home. There is a Quality Audit tool to check on the relevance and effectiveness of policies and procedures but this has not been completed. The manager intends to produce an Annual Development Plan for the home based upon the feedback from service users, their families, staff, Social Services and the Commission. The manager is responsible for an annual budget, although some areas of expenditure are more within her direct control than others. She kept expenditure on the home within the budget for the last financial year. She discusses expenditure and cost control with the Service Manager in her supervision sessions. The manager maintains her own record of expenditure in order to check against the statements she receives from CIC head office, which are usually a month ‘behind’. Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 2 3 2 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x 3 x x x 3 x Standard No 11 12 13 14 15 16 17 x 3 3 x x 3 3 Standard No 31 32 33 34 35 36 Score x 3 2 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Gatesgarth Score 3 x x x Standard No 37 38 39 40 41 42 43 Score x 3 2 x x x 3 F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 21 no 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 5 Regulation 5 Requirement The contract between CIC and each service user must be updated. Timescale for action 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 1 3 3 33 39 39 Good Practice Recommendations The Service Usere Guide should contain a copy of the most recent inspection report. Care plans should be written clearly and fully. Reviews should focus on whether the care plan is appropriate and whether it has been implemented effectively. The home should deploy a third support worker in the mornings so that the service users who get up first receive sufficient attention whilst the others are getting up. The manager should produce an annual Development Plan which states what improvements will be made to and in the home. The survey of the families of service users should be made available to the manager so that any key issues arising can be addressed in the Development Plan. Gatesgarth F58 F10 s22574 gatesgarth v247799 241005 ui stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP 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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