CARE HOME ADULTS 18-65
Gateway House 14 Bilton Road Rugby Warwickshire CV22 7AN Lead Inspector
Kevin Ward Unannounced Inspection 19th January 2006 07:55 Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 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 Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Gateway House Address 14 Bilton Road Rugby Warwickshire CV22 7AN 01788 547781 01788 573410 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) RMH Homes Mrs Angela Courtney Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th September 2005 Brief Description of the Service: Gateway House is a large detached Victorian town house that provides residential care for 15 younger adults with learning disabilities. The service provides respite and emergency placements when necessary. There are 11 single bedrooms and 1 double bedroom in the main house. There is a top floor flat that caters for 3 people in single rooms. Most residents are out at a social services department day service during the day and the home is not routinely staffed during these hours. The service is operated by Rugby Mencap Hostels, an organisation run by parents and is one of 4 separate establishments in Rugby. Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was time limited and focused on reviewing the home’s progress in relation to the requirements made at previous inspections and assessing a small number of core Standards that were not inspected at the last inspection, 19th September 05. On the morning of the inspection the inspector met with all the people who live at the home, as they went about their morning routine and waited to be picked up to go to their day services. The inspection also involved talking with al the staff on duty and meeting with the manager. A number of records were inspected, including a recent staff recruitment file, as well as care plans, health notes and some policies. What the service does well: What has improved since the last inspection?
At the last inspection good work had started to introduce new care plans for a number of people at the home. This work has now been completed for the remaining people. The new care plans provide good levels of information and advice to help staff deliver the correct care and support to the people at the home. Since the last inspection the manager has reviewed the home’s Statement of Purpose so that information about the service is up to date, including staff changes that have taken place over the last few years. Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 6 At the last inspection one staff members file did not contain evidence that a Criminal Record Bureau check had been carried out. This has now been properly addressed. What they could do better: 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. Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 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 the following standard(s): 1 and 5 Information about the home has been updated to help new people decide if Gateway House is the place they would like to live. Contracts have not been issued for service users. This is necessary in order that people are clear about their entitlements so that their rights are protected EVIDENCE: A Statement of Purpose is available at the home containing details about the home. Since the last inspection the manager has taken action to review the home’s Statement of Purpose, to include the name of the new manager. A staff list has also been added to take account of new staff at the home. An illustrated service user guide is available in the home and has been shared with the people living at Gateway House. Since the last inspection positive action has been taken to devise a service users contract, detailing the terms and conditions of residency for people staying at the home. The manager stated an intention to share the contracts with service users and their relatives and to make arrangements for them to sign the contracts. One person does not currently have any relative involvement and the manager agreed to send a copy of the contract to the social work team responsible for her placement, in order that they may pass comment on her behalf. Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 People’s needs are being planned for and reviewed by the home and relevant professionals, in order that people’s changing requirements are met. EVIDENCE: A sample examination of care plans confirms that positive progress has been made to improve the levels of information in these documents during the last year. These documents were seen to contain the essential information necessary to help staff to provide effective care and support to people. A good range of risk assessments, addressing everyday living hazards, are in place, to assist staff to support people safely. The care plans and the risk assessments were seen to be dated, providing evidence that the information had been recently reviewed and updated as necessary. Since the last inspection the home has started to keep satisfactory records of the outcomes of review meetings, involving social workers, which have taken place in recent months. The manager explained that plans are in place for the people living at the home to take part in person centred planning during the year, with support from external trainers, to help them make plans for their future. Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 People are being increasingly encouraged to take part in everyday decisions at the home, so that their rights and choices are respected. EVIDENCE: Comments made by service users and the manager confirmed that periodic service user meetings are taking place at the home. An examination of the draft notes of a recent meeting confirmed that people are being encouraged to raise any concerns they may have and to contribute their ideas. Earlier in the year service users were consulted about changes to the décor and furniture in the music room and other aspects of daily life at the home. More recently service users were involved in agreeing changes to the positioning of music playing equipment within the home. Some service users are supported to take part in daily living activities, such as food preparation, setting tables and laundry. Three people live together in a semi independent flat in the home and are provided with their own food budget to shop separately for their own groceries. Some service users confirmed that they hold keys to their own bedrooms, whilst other people indicated that they had chosen no to do so. Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 21 People are supported by the home to access health services to monitor and treat their health needs. The wishes of service users and close relatives, regarding arrangements to be made in the event of their death, are being gathered so that their wishes can be respected. EVIDENCE: Comments made by the people living at the home confirmed that they are able to exercise control over their bedtimes and are able to sleep in later at the weekends, where they wish to do so. A sample examination of people’s health notes confirmed that people are being supported to gain access to community health services, such as opticians, chiropodist and flu vaccinations. Since the last inspection positive action has taken place to support people to gain access to well person’s checks. The manager said that one local GP surgery has said that these checks will be provided every two years, rather than annually, as is normally the case. The manager agreed to contact the Health Authority to clarify the correct frequency that people are entitled to receive these checks. Good records were seen to be in place on the file of one person who receives regular consultant monitoring for a health condition. These records provide a good record of the consultant’s views and recommendations.
Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 12 Since the last inspection good work has taken place to refer a number of people for a speech therapy service, to assess their communication needs and to identify appropriate communication tools to assist with these needs. The manager explained that work has started to take place to seek service user wishes regarding the arrangements they wish to be made in the event of their death. Two people’s files were seen containing these details. The manager stated that this work will be ongoing in the coming months. Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These Standards were assessed as met at the last inspection, 19/9/05 and were not inspected on this occasion. EVIDENCE: Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Overall the home provides a comfortable and clean environment for people to live in. Suitable procedures and cleaning routines are in place so that people benefit from a hygienic home. EVIDENCE: Gateway House is a large Victorian House that provides large group living for up to 11 service users. The top floor of the house provides accommodation for three people that includes access to separate cooking facilities. During the last year good work has taken place to decorate the music room and the dining area. Comments previously made by service users and entries in their meeting records, confirmed that they were encouraged to take part in choosing the décor and furniture. Overall the communal areas of the home are comfortable with domestic style furniture in place albeit some carpets and décor are rather old fashioned. A group leader confirmed that since the last inspection work has taken place to strip asbestos from within the cellar, so that it does not present any potential health hazard. The Responsible Individual has informed the commission of proposals to modernise and improve the home to provide more individualised living accommodation at Gateway House.
Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 15 A comprehensive infection control policy was seen on file at the home and protective aprons and gloves were seen to be in place for staff to use where necessary. The manager explained that the needs of people are such that there is no need for staff to manage any significant amounts of continent laundry. The laundry is situated away from the kitchen area; hence there is no need to carry laundry through food preparation areas (which could otherwise pose a threat of infection). Cleaning schedules are in place, which are monitored for effectiveness by the manager as part of her monthly auditing arrangements. Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 New staff are vetted so that service users are protected by the home’s recruitment procedures. EVIDENCE: At the last inspection on person’s file did not contain evidence to confirm that a Criminal Record Bureau check had been carried out for a new starter. A copy of the disclosure certificate was seen at this inspection. The manager confirmed that there have been no new starters at the home since the last inspection. Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42 and 43 The home is developing systems to encourage people to comment on the work of the home and to contribute to the home’s quality assurance system. The home’s quality assurance would be improved by regular monitoring visits. Overall the home takes appropriate measures to address health and safety issues within the home so people live and work in a safe environment. Work remains to agree an action plan to address the fire officer’s recommendations. EVIDENCE: Since the last inspection the manager has started to send a small number of questionnaires to visiting professionals to pass comment on the home. To date three people have responded. Similarly, two service users have completed questionnaires to assess their satisfaction with the service provided at Gateway House. The manager agreed to support other service users to complete questionnaires shortly. Occasional service user meetings are also being carried out with the involvement of the manager so that she can receive direct feedback from the people living at the home and so that they contribute to decisions in the home, e.g. choose décor and equipment. Monthly audits are
Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 18 being carried out by the manager to check essential aspects of care, e.g. service user’s monies and medication. Since last inspection the chief executive has confirmed that service users monies will be included in financial audit at end of financial year. Manager audits monies each month. There have been no recent monitoring visits carried out by the chief executive. The manager explained that this had been due to competing workload priorities on the part of the chief executive. Since the last inspection the home has taken action to risk assess the dangers of people being scalded by hot water and regulator valves have been fitted in some rooms as a result. A fire officer report was carried out earlier on this year and contains a number of recommendations that the home is required to address. Ongoing discussions are taking place between the manager and the fire officer to agree satisfactory measures to address the issues identified. The home’s fire log demonstrates that fire alarms and lights are being tested at the correct frequencies and that fire safety equipment is being maintained by an appropriate contractor. At the time of the inspection the chief executive explained that funding negotiations with Warwickshire Social Services department have broken down. The chief executive has written to Warwickshire Social Services Department forewarning them that failure to resolve this matter promptly will necessitate the closure of the home on financial grounds and given notice that the home closure process ill commence from, 31/1/06. Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 x 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 3 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 x 2 x x 2 x x 2 x Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 5 Requirement Issue service users with a contract of terms and conditions relating to their rights, entitlements and responsibilities at the home. Guidance can be found in Standard 5 of the National Minimum Standards for younger adults. (Timescale of 1/1/05 and 12/5/05, 30/11/05 not met). The Responsible Individual must carry out Regulation 26 visits consistently each month and arrange for reports to be sent to the Commission. Continue with plans to survey the remaining service users views about he home. (Ongoing from last inspection) Proceed with plans to agree an action plan, with the fire officer, to address his report recommendations. Timescale for action 01/03/06 2 YA39 26 14/02/06 3 YA39 24 (3) 31/03/06 4 YA42 23 (4) (a) 14/02/06 Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 21 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 YA21 Good Practice Recommendations Continue to seek the views of service users and their relatives regarding the arrangements to be made in he event of their death. Gateway House DS0000004288.V278533.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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