Inspection on 19/09/05 for Gateway House

This inspection was carried out on 19th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gateway House 27/06/06

Gateway House 19/01/06

Gateway House 12/01/05

Gateway House 03/08/04

Gateway House 30/03/04

Gateway House 12/11/03

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

CARE HOME ADULTS 18-65 Gateway House 14 Bilton Road Rugby Warwickshire CV22 7AN Lead Inspector Kevin Ward Unannounced Inspection 19th September 2005 08:00 Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 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.V249472.R01.S.doc Version 5.0 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.V249472.R01.S.doc Version 5.0 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.V249472.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12 January 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.V249472.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection involved talking with service users at breakfast time before they went out to day services and again in the early evening following their return home. Similarly the inspector talked with staff on duty during the inspection and met with the manager to review the home’s progress in meeting the requirements of previous inspections. Given the significant number of outstanding requirements from previous inspections, the new manager was given prior notice of this inspection to ensure she was available to update the inspector. The inspection also involved looking at a number of care plans, records and policies and a new member of staff’s recruitment file. What the service does well: What has improved since the last inspection? Since the last inspection positive work has taken place to re-assess people’s needs and to introduce new care plans for staff to record how needs are to be met. Staff have received training to help them with this change and the manager said that she is going to monitor and support the development of this work through staff supervision sessions. Service user meetings have recently started at the home, providing people with an opportunity to contribute to decisions about life in the home, such as choosing décor. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 6 The manager said that she is also planning to involve service users in staff probationary reviews so that they are able to express their feelings about new staff employed at the home. The new manager explained that a reviewing officer (social worker) is helping to identify an advocate to assist one person living at the home. Suitable arrangements are in place for accounting for people’s medication and medication training is currently ongoing with staff. Staff are being given training to help them to recognise and respond to any concerns relating to adult abuse. Procedures are in place at the home to support this important area of practice. What they could do better: Helpful information is in place to tell people about the home. Some minor amendments are needed to this information, such as the details of the new manager. The new manager agreed to check that this document contains all the information required by the Care Homes Regulations 2001. There remains a need to provide people with contracts, outlining the terms and conditions of their residency at the home, so that this is clear to them and their relatives. Positive work has started to review people’s needs with the involvement of social workers, however there is a need to ensure that the outcomes of these meetings are properly recorded by staff at the home and that changes are made to the care plan if necessary. The manager has also agreed to refer people with high communication needs to a speech therapy service for assistance to devise a communication dictionary for these people to explain how they communicate their needs to others. People’s health needs have been re-assessed by the home since the last inspection and people are supported to attend general health appointments, such as dentist and opticians. Action is required to arrange well person health checks for everyone living at the home. Positive work has taken place to devise questionnaires for professionals to fill in to comment on the quality of the service. It is recommended that a quality assurance questionnaire is also devised for service users to complete with the assistance of relatives or advocates so that they are part of the formal process for monitoring the quality of the service. Some monitoring visits have taken place. However there is a need to ensure that these visits are carried out consistently each month and for the reports of the visits to be forwarded to the Commission for Social Care Inspection. Work is still needed to ascertain the arrangements that people would like see in place, in the event of their death, e.g. funeral arrangements. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 7 Since the last inspection one new person has been recruited to the staff team. The manager explained that appropriate vetting procedures are in place at the home, however there was some evidence missing from the home’s file, such as Criminal Record Bureau Check and references. The manager explained that this information was on file at the head office and agreed to ensure that it is available for future inspections. The manager said that a review of staff job descriptions is ongoing and indicated that the organisation is placing an increased emphases on supporting and involving service users so that they are able to exercise greater control of their lives. Overall the home has good systems in place for assessing health and safety issues and for maintaining fire safety equipment. The manager stated that hot water regulator valves are to be fitted to some hot water outlets to remove any potential risks of scalding. 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.V249472.R01.S.doc Version 5.0 Page 8 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.V249472.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 The ability of people to make a judgment about the home may be compromised if the information about the service is not fully up to date. Service user needs are being assessed so that the home has satisfactory information on which to base plans to meet people’s requirements. The home does not currently provide people with a clear contract in order that their entitlements may be made clear to them. EVIDENCE: A Statement of Purpose is available at the home containing details about the home. This document needs to be amended to include the details of the new manager and any staff recruited to the home since the information was last reviewed. An illustrated service user guide is available in the home and has been shared with the people living at Gateway House. The home currently provides a respite care service, however there are plans for this function to move to Richmond Lodge, where an area of the property has recently been extended to provide a small separate respite care unit. Since the last inspection positive work has taken place by the home to reassess people’s health and social care needs, using new assessment tools. Three people’s assessments were examined and found to contain satisfactory levels of information to provide a sound basis for care planning. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 10 A social work assessment was seen on file for a new service user who had been attending respite care at the home, providing as basis for the home’s care plan. The manager explained that she is still seeking community care plans from social workers. There remains a need to devise a service user contract detailing the terms and conditions of their stay at the home. Service users should be provided with support from relatives or advocates to understand the contents of the contract. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Better recording of reviews will ensure that changes in need are reflected in care plans on an ongoing basis. Improvements have started to increase the extent to which people are involved in decisions that affect their daily lives. Evidence of audits of service users’ finances is necessary to confirm that people’s monies are properly accounted for by the home. Risk assessments are carried out to support people to express their independence in a safe manner and receive support where necessary. EVIDENCE: In addition to re-assessing peoples needs, work has taken place to devise new care plans in the home. The new care plan format was seen to provide a reasonable framework for recording people’s needs. Some new documents had not been dated and the manager agreed to address this with staff. The new care plans are still in the early stages of use and currently some files contain the old care plans. Consequently some of the new assessment information has yet to be included in the care plans. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 12 The manager confirmed that everyone’s needs will be recorded on the new care plans in the coming weeks and explained that all staff have been given care planning training recently to help them to understand the new care planning system. The manager said that she would be reviewing care plans as part of her supervision with team leaders. Diary records confirmed that care plan reviews are just starting to take place involving social workers. Service user and their relatives are also being invited to attend these meetings. The manager confirmed an intention to ensure that reviews take place at least twice a year, which has not previously been the case. The review notes of one person’s recent review had not yet been received from the social worker. The manager agreed to ensure that staff at the home make a record of any review meetings so that everyone is clear about what has been agreed and so that there is a record from which care plans can be updated. The manager explained that an agreement has been reached with Warwickshire Social Services for Person Centred Planning to take place with service users at the home in the coming months, to help people to plan for their future. The manager agreed to send a referral to the speech therapy service, specifically for the service users with high communication needs, with a view to developing communication dictionaries for these people. Staff have recently attended communication training. The manager stated that she has plans to devise accessible care plan summaries for service users after staff have had the opportunity to effectively implement the new care plans. The manager explained that service users’ meetings had just started at the home. This was confirmed by service users. An examination of the notes of a recent meeting confirmed that people had been consulted about changes to the décor and furniture in the music room and other aspects of daily life at the home. Comments made by service users confirmed that they are supported to go shopping for their own clothes. Some service users are supported to take part in daily living activities, such as food preparation, setting tables and laundry. The manager confirmed that a separate food budget is available for three people living in the top floor flat to shop for their own groceries. A separate kitchen is also available for these people to prepare their own meals with staff support. As previously noted service users are being involved in care reviews so that they can contribute to decisions about their lives with support from relatives and staff. The new care plans contain a section for staff to record how service users’ have been involved in making choices and decisions for staff to complete. The manager said that she intends to seek the views of service users when reviewing a new staff member’s probationary period shortly. The new manager confirmed that she has started to carry out sample audits of service users monies to ensure that monies are correctly recorded and accounted for. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 13 The manager explained that an administrator acts as appointee for most people and undertook to send evidence to confirm that service user’s finances have been audited by the organisation. A number of staff and service users were booked to attend the “fair play” advocacy day being run at Warwick University, the day following the inspection, to contribute to advocacy plans for Warwickshire. The manager confirmed that a reviewing officer is helping the home to identify an advocate to help one person living at the home to represent her interests. New risk assessments were seen to be in place addressing risks that have been identified in people’s care plans. These documents were found to be generally informative and to provide reasonable levels of information for reducing risks to people. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 14 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): 12,13,15 and 17 The home supports people to have reasonable access to social activities at day services and in the wider community. The home supports people to maintain relationships with relatives. Sexuality and personal relationships training would be beneficial to underpin this area of practice. The people living at the home are consulted over the menu and so that they have access to meals they enjoy. EVIDENCE: Service users attend a day service between Monday and Friday each week. This includes the provision of activities and access to some college courses. Comments made by staff and service users confirmed that people are supported by the home to go on holidays, unless this is not in keeping with their wishes or needs. Currently this applies to two people. As a consequence the home is providing day trips instead of a holiday. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 15 On the day of the inspection one person enjoyed a day out at Cadbury’s world. Comments made by service users indicate that they are supported to have reasonable access to social activities, over and above that provided by the day service. Examples of activities include local shopping, skittles, disco, church groups, Gateway club, pop quiz, meals out and occasional outings. One service user was seen to enjoy listening to pop music on his return to the home from an outing. Comments made by service users and the manager confirm that people are encouraged and supported to maintain contact with relatives. On the day of the inspection one person received a visit from a relative who stopped for tea. Service user’s relatives are being encouraged to attend planned reviews that have just started to take place. The manager stated that she is trying is identify suitable sexuality training for staff with the assistance of a health professional. Comments made by people indicate that they enjoy the food provided by the home and confirmed that they are consulted about the menu each week. The current weeks menu was seen to be on a notice board for service users in the dining area and one person was seen to help staff in the kitchen preparing the evening meal. Comments made by service users and staff also indicate that people are provided with alternatives to the main menu if they do not like what has been planned. One service user has recently been referred for support from a dietician. A good record is being maintained of this person’s food intake and a weight record is being appropriately maintained staff. Suitable dining furniture is in place for people to eat in small groups and some people take part in food preparation. As previously noted, three people live in a flat at the top of the house and have access to their own food budget and cooking facilities, which provides them more opportunities to cater for themselves with assistance from staff. A fruit bowl was available in the lounge for people to help themselves. People’s food preferences have been recorded in the new care plans. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 16 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): 19,20 and 21 People are supported to access health services to monitor and treat identified health needs. Access to well person checks would provide an opportunity to screen and identify any developing health needs at an early stage. Procedures are in place and training is provided to support staff in the delivery of safe medication practices. The home has yet to ascertain the wishes of service users regarding arrangements to be made in the event of their death, so that their wishes can be respected. EVIDENCE: Since the last inspection positive work has taken place to re-assess people’s health needs. A sample examination of service user’s records indicates that people are being supported to attend general health related appointments, such as dentist, GP and opticians appointments. Discussions with the manager indicate that overall service users are generally healthy. Three people have epilepsy but in all cases this is very stable and well controlled by medication. Good work is taking place to support one service user to attend hospital appointments to monitor and treat her health condition. Conversations with Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 17 this person’s keyworker demonstrated satisfactory awareness of the roles of health professionals involved in this person’s treatment and whom to approach for advice. It was agreed that the community nurse should be kept involved in this person’s care to help to access other health services should this prove necessary later. Service users have not been offered well person checks. The manager undertook to address this matter with people’s GP’s A sample examination of service user’s medication records indicates that staff are recording people’s medication satisfactorily. Since the last inspection good work has taken place to devise individual guidance for people receiving “as necessary” medication so that staff are clear when this is to be given. A medication returns book is being retained at the home to appropriately account for all medication returned to the chemist. Good work has taken place to provide a number of staff with medication training since the last inspection and the manager stated that further training is planned for the remainder of the team. Checklists have been devised by the manager for assessing staff competency in this area of practice. The manager advised that work is yet to take place to seek service user wishes regarding the arrangements they wish to be made in the event of their death. The manager advised that consideration is currently being given to how this matter will be approached by the organisation. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Information and procedures are in place in the home to support service users and relatives to raise concerns and complaints so that their views may be listened to and addressed. Training and procedures are in place to support staff to identify and respond to any suspicions of abuse that may come to their attention, so that service users may be protected from harm. EVIDENCE: The manager stated that there have been no complaints made to the home since the last inspection. The complaints log was examined and found to contain satisfactory records of a previous complaint investigation dealt with by the organisation, prior to the last inspection. A copy of the complaint investigation was sent to the Commission for Social Care Inspection, as required. A complaints policy was seen to be available in the home and a more accessible summary of the procedure was seen in the service user guide in the hallway. Complaints forms were seen to be available for service users and visitors to use in the hallway of the home. The manager agreed to include a standing agenda item in service users’ meeting for concerns and complaints to provide them a regular opportunity to raise any issues they may have. There have been no adult protection investigations at the home since the last inspection. An adult protection policy and procedure was seen to be available in the home and staff training records confirm that staff are being provided with adult protection training. A whistle blowing policy is also in place advising staff how to raise concerns they may hold about the home. Since the last inspection good work has taken place to devise a policy addressing the management of service users’ finances and wills. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 19 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 Overall the home provides a comfortable and clean environment for people to live in. EVIDENCE: This inspection included a partial inspection of the living environment and a fuller inspection of the accommodation will take place at the next inspection. 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. Since the last inspection positive work has taken place to decorate the music room and the dining area. Comments made by service user’s and entries in their meeting records confirmed that they have been 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. Costings were seen for some maintenance work to the fire escape and the removal of asbestos from within the cellar and the manager explained that authorisation has been obtained for this work to proceed. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 20 The manager advised of plans to redecorate another person’s bedroom later this year when they go on holiday. All the service users are ambulant and do not require the use of specialist lifting equipment. Equipment has been made available to assist one person to get in and out of the bath safely. As previously noted reviews have just started to take place with service users, including the involvement of social workers. The manager also explained that Person Centred Planning is planned to take place, starting with three service users living in the flat. This will provide an opportunity to consider service users’ long-term aspirations and housing needs, in keeping with a requirement made at previous inspections. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 21 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): 31, 34 and 35 Job descriptions are being reviewed so that staff are clear about their changing role at the home. Insufficient information was available at the home to confirm that appropriate staff vetting procedures have been followed recently. Staff are being provided with training to equip them appropriately to meet the needs of the people living at the home. EVIDENCE: The manager stated that a review of job descriptions is ongoing, which includes an increased emphasis on supporting and encouraging service user involvement. Since the last inspection staff have been issued with a copy of the General Social Care Council code of conduct to prepare them for the time they are required to register with this body. There has been one new person employed at the home since the last inspection. The manager explained that appropriate recruitment procedures are followed, including taking up references and Criminal Record Bureau checks. Evidence was on file to confirm that identity checks had been carried out. However the Criminal Record Bureau Disclosure Certificate and references were not included in the file. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 22 The manager explained that these were located with the administration officer at the head office and were not accessible on the day of the inspection. Evidence was seen to confirm that a brief in house induction had been completed by the new member of staff. This member of staff also confirmed he has been placed on the Learning Disability Award Framework induction training. Comments made by staff and an examination of staff training information and certificates held at the home indicate that a good programme of staff training is now underway at the home. This has included the provision of health and safety related training, such as first aid, fire safety, adult abuse and food hygiene as well as practice courses, including, communication and care planning. The manager had also identified the need for training in dementia care and epilepsy. The manager reported that 4 staff have now completed NVQ 2 training and one group leader has completed her NVQ 3 qualification. Also one person is said to have started this training recently and all staff are undertaking learning disability award framework training. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 An appropriately qualified manager has been appointed and staff supervision is being provided in order that service users can benefit from a well run home. Positive work is taking place to develop opportunities for service users to contribute to decision making in the home. This could be improved further by providing the opportunity for service users and relatives to complete quality assurance questionnaires. Appropriate arrangements are in place for maintaining equipment in the home so that the health and welfare of service users is protected. Fitting hot water regulator valves will remove the potential for scalding. EVIDENCE: Since the last inspection a new manager has been appointed for the home and registered with the Commission for Social care Inspection. The manager holds a nursing qualification and the Registered Managers Award and has previous experience of managing a home in accordance with the Care Homes Regulations 2001. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 24 Since the last inspection positive progress has taken place to address the significant number of requirements outstanding from previous inspections. Comments made by staff confirmed that they receive planned supervision from the group leaders and that the manager supervises group leaders on a regular basis. A sample examination of staff supervision records indicates that issues discussed at these meetings are being recorded. Since the last inspection the organisation has devised questionnaires for visiting professionals to complete so that they may pass comment on the quality of the service. The manager agreed to devise questionnaires for service users to complete with support from relatives / advocates, as appropriate, in order that they too may have an opportunity to express their views about the home. As previously noted, service users’ meetings have recently started to take place at the home, to encourage people to take part in decisions within the home, such as choosing décor and furniture. Some Regulation 33 visits, on behalf of the Responsible Individual, have taken place. However there is a need to ensure that these visits are carried out consistently each month and for the reports of the visits to be forwarded to the Commission for Social care Inspection. Positive work has taken place to review a significant number of policy documents at the home since the last inspection. An examination of fire safety records confirmed that arrangements are in place for the testing and maintenance of fire safety equipment. Electrical equipment test records confirm that electrical equipment has been tested and is not due to be checked again until next year. An examination of the accident book and comments by the manager confirmed that there have been no serious accidents to service users at the home since the last inspection. The manager confirmed that the cellar is being kept locked so that it cannot be entered until plans to remove asbestos have been carried out. The manager explained that attempts to regulate the hot water temperature in the home using boiler controls proved unsuccessful and said that hot water regulator valves are to be fitted to a number of hot water outlets, shortly, where they may present a potential risk to service users. Since the inspection the manager has sent a copy of the recent legionella risk assessment carried out by the home and the action plan to be implemented at then home. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 25 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 x x 1 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score 2 x x 2 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Gateway House Score x 2 3 1 Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 2 x DS0000004288.V249472.R01.S.doc Version 5.0 Page 26 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 YA1 Regulation 4 Timescale for action Review the Statement of Purpose 20/12/05 to ensure it meets the requirements of Schedule 1 of the Care Homes Regulations. (Timescale of 1/1/05 and 12/5/05 not met). Include the details of the new manager and any other staff recruited to the home since the document was originally produced. Issue service users with a 30/11/05 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 not met). Maintain a clear record of the outcomes of review meetings and ensure that care plans are amended as necessary following these meetings. Arrange well person checks for people living at the home. 30/10/05 Requirement 2 YA5 5 3 YA6 15 (2) 4 YA19 12 (1) (b) 30/10/05 Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 27 5 YA34 18 6 YA39 33 7 YA42 13 (4) (c) Ensure that staff files held at the home contain the information necessary to confirm that recruitment checks, required by Schedule 2 of the Care Homes Regulations 2001, have been carried out. Carry out Regulation 33 visits consistently each month and arrange for reports to be sent to the Commission. Proceed with plans to fit hot water regulator valves at outlets that have been assessed as presenting a potential risk of scalding. 30/10/05 30/10/05 30/10/05 Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 28 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 6 7 15 21 22 33 Good Practice Recommendations Refer people with high communication needs for a speech therapy service to develop communication dictionaries for these people. Provide evidence to confirm that service users’ monies have been audited by the organisation. Provide staff with training in sexuality and personal relationships. Seek the views of service users and their relatives regarding the arrangements to be made in the event of their death. The manager is recommended to proceed with plans to include the opportunity to raise concerns or complaints as a standing item on the agenda for service user’s meetings. Complete the review of staff job descriptions. Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 29 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 © 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 Gateway House DS0000004288.V249472.R01.S.doc Version 5.0 Page 30 - 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. 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