Inspection on 27/06/06 for Gateway House

This inspection was carried out on 27th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gateway House 19/01/06

Gateway House 19/09/05

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 Deirdre Nash Key Unannounced Inspection 27th June 2006 8:15 Gateway House DS0000004288.V299773.R01.S.doc Version 5.2 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.V299773.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V299773.R01.S.doc Version 5.2 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.V299773.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2006 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.V299773.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We looked at all of the information that we have received about this home and kept on our records over the past twelve months. The provider organisation has had appropriate contact with us about the home during that time and kept us informed about how residents are. After the last inspection in January this year, we asked them to send us an action plan detailing how they were going to improve the things that we pointed out as being below standard and they did so. We sent the home a questionnaire in April to fill in and bring us up to date with facts and figures about the home. It was properly filled in and sent back to us in good time. Comment cards were also sent to be distributed to relatives, the local health centre and to the service users to find out their views about the home. Fifteen of these have been completed and returned to us and those views are reflected in this report. The Inspector called on the home without notice early morning, mid week, spoke with some the residents, spoke to staff, spoke to the manager and the general manager of the organisation, looked around parts of the home and looked at records. The care of a sample of two particular residents was ‘tracked’ this way to see if the home is providing a service that meets the national minimum standards. What the service does well: What has improved since the last inspection? Staffing hours in the home have increased and this allows staff more time to spend with individual residents. The home is taking a systematic approach to establishing leisure and occupational opportunities for residents. Gateway House DS0000004288.V299773.R01.S.doc Version 5.2 Page 6 The home has recruited two male care workers and this has benefited some of the men living in the house. Longer serving staff are completing the first stage of their specialist NVQ and this has improved the professionalism of the team. 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.V299773.R01.S.doc Version 5.2 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.V299773.R01.S.doc Version 5.2 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, 2, 3, 5 The outcome for this group is good. Staff are have the skills, knowledge and understanding necessary for the home to meet the assessed needs of residents including those on short stay. EVIDENCE: The home has a statement of purpose and service user guide and copies of these were seen in hallway of house. The care files of two residents; one permanent and one on short stay care were looked at. Both residents had a written assessment of their needs. For each, an agreed need was Communication support and improvement. The training records of each of their key workers showed that these staff had received some recent training in communication. This means that they are better able to support and care for these residents. There were no contract/ terms and conditions for care and accommodation in either residents file. This is an outstanding requirement. The manager reports that they have been drawn up but the home is still working on consent issues with individuals and the local day centre is taking this on as a project. This is a positive and serious approach to ensuring that rights and responsibilities are transparent and our compliance date for this is extended to accommodate it, but it must make progress. Gateway House DS0000004288.V299773.R01.S.doc Version 5.2 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, 7, 9 The outcome for this group is good. The home develops written plans of care for permanent and short stay residents underpinned by written risk assessments. Residents are supported to safely go about their lives. EVIDENCE: Written service user plans were seen on file for both residents looked at and staff spoken to knew the content of each plan. Risk assessments were in place to support these residents towards some independence. There was evidence that plans are reviewed. The individual plans would benefit from systematically addressing each service aim listed in the Community Care Plan produced by social and health services for the person. In this way the home can make sure that it is meeting the needs that it is being expected and paid to meet. This would also help the home with quality assurance. A recommendation is made. Gateway House DS0000004288.V299773.R01.S.doc Version 5.2 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): 11, 12, 13,14, 15, 16, 17 The outcome for this group is good. The home is working with residents to find out how it can support them with a range of social, leisure, educational and occupational opportunities. Residents have opportunities to maintain appropriate and fulfilling lifestyles in and outside the home. EVIDENCE: The manager reports that negotiations with funding bodies are well advanced in order to enable residents who no longer wish to attend the local day centre everyday to stop doing so. Comments from a key workers were supported by records showing that the home is systematically exploring a range of leisure and occupation interests with one of the residents in our ‘tracking’ group. This means that residents will have a some real alternatives for how they can spend their time if they opt out of social services day care. Residents comment cards were generally positive about food at the home. Gateway House DS0000004288.V299773.R01.S.doc Version 5.2 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): 18, 19, 20 The outcome for this group is excellent. The home helps residents to get the routine and specialist health and therapeutic services that they individually need. Residents are well looked after. EVIDENCE: Records in care files were supported by observation of staff helping one resident to visit her G.P on morning of inspection. Comments from some residents confirmed records that many residents have got access to specialist and therapeutic services. The home has actively sought speech and language therapists for residents including one who is finding the prospect of the house being replaced with different accommodation particularly unsettling. Care files of permanent and short stay resident’s contained healthcare information including a health check document, appointments and permanent residents have a health action plan. The home is commended for its practice. Records were also seen about individuals wishes in connection with death. Gateway House DS0000004288.V299773.R01.S.doc Version 5.2 Page 12 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, 23 The outcome for this group is excellent. The home encourages feedback through a visible complaint procedure and acts appropriately against any complaint or allegation of bad practice. Residents are protected through good procedures and staff training. EVIDENCE: The home keeps a complaints log and complaints were seen to be properly documented with the investigation and the outcome recorded. Complaints included those from residents. The complaints procedure is clearly displayed in the hallway of house for any visitor to see and residents confirmed that the home holds residents meetings. Comments from a recently recruited member of staff demonstrated that staff are clear about their duty to report any suspicions or allegations of bad practice or abuse of a resident and our records show that the manager acts appropriately when alleged incidents are reported to her. Staff training records show that 5 staff have taken/updated adult protection/abuse awareness training since September 05. An adverse comment on an anonymous comment card returned to the Commission as part of this inspection was given to the manager to investigate and this was done. Gateway House DS0000004288.V299773.R01.S.doc Version 5.2 Page 13 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, 26, 29, 30 The outcome for this group is adequate. The building is large, the layout is complex and not suitable for the residents that have some mobility difficulties. Plans are in progress to replace it with more suitable and modern accommodation. Residents are being prepared for a period of considerable change in their lives. EVIDENCE: The home was clean and tidy. Some residents were seen having a little difficulty with the stairs and landings despite rails and handles. Resident’s bedrooms are generally comfortable with their own belongings but some have limited natural light. Infection control procedures are in place in the kitchens and laundry. The main house remains unsuitable with large group living and the house and flat are difficult to get around for those with limited or unconfident mobility. The provider organisation has been in regular contact with the Commission over the past 12 months to take advice and keep us informed of plans to replace the building with more suitable accommodation. Gateway House DS0000004288.V299773.R01.S.doc Version 5.2 Page 14 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, 32, 33, 34, 35, 36 The outcome for this group is excellent. Staffing levels are high and staff are properly recruited, inducted, trained and supervised. Residents experience a professional approach to their care. EVIDENCE: Newly appointed workers report that they received a very good induction programme and this was supported by evidence of induction workbooks in active use with sections properly signed off by supervisors. New and longer serving staff say they are impressed with all of the training that has been offered to them recently. The manager says that all long serving staff have nearly completed the LDAF Induction module and that she notices an improvement in professionalism. Some team leaders have undertaken the work based assessors course and this means that the programme can be a continuous process now. The home is commended for its commitment to training. Personnel files show that staff are recruited properly and all of the required information and checks are obtained before they work in the home. Gateway House DS0000004288.V299773.R01.S.doc Version 5.2 Page 15 Records support staff comments that they are receiving regular one to one supervision. The manager reports that the staffing ratio has increased to three/four staff on duty at a time in the mornings and the evenings and two at night with one remaining awake. Staff hours allocated to the home have increased. This means that staff can spend more time with individual residents. The home has recruited two male carers recently as it found that most male residents respond significantly better to a man supporting and caring for them. There was some evidence in review records that this has improved these residents’ range of communication and scope for activity outside of the home. Gateway House DS0000004288.V299773.R01.S.doc Version 5.2 Page 16 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, 38, 39, 41, 42, 43 The outcome for this group is good. The home is well run and the organisation is committed to and making good progress toward modernising the service. Resident’s benefit from a service that is being run in their best interests. EVIDENCE: Staff report that the home is well managed although going through a lot of change. A resident said ‘ Angela is ok’. Quality assurance remains to be tackled including monthly short reports to the Commission from visits to the home by the registered person. This is an outstanding requirement. The general manager said that he is working towards a total quality monitoring system for the organisation. See also comments in section one above about quality assuring service user plans. All records seen were in good order and stored properly. Gateway House DS0000004288.V299773.R01.S.doc Version 5.2 Page 17 Action on the very costly recommendations of the fire officer’s report is still under discussion, this is an outstanding requirement. The provider organisation is in dialogue with social services and the Commission for Social Care Inspection about the reconfiguration of its services to modernise and better meet current and future needs of service users in Rugby. It is committed to keeping the service at this home stable through near future changes. Gateway House DS0000004288.V299773.R01.S.doc Version 5.2 Page 18 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 3 3 4 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 3 27 x 28 x 29 2 30 3 STAFFING Standard No Score 31 3 32 3 33 4 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x 3 3 2 x 3 2 4 Gateway House DS0000004288.V299773.R01.S.doc Version 5.2 Page 19 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 for action 01/10/06 2. YA39 26 (Timescale of 1/1/05 and 12/5/05, 30/11/05, 01/03/06 not met). The registered person must carry 01/09/06 out Regulation 26 visits consistently each month and arrange for reports to be sent to the Commission. (Timescale of 14/02/06 not met) Proceed with plans to agree an action plan, with the fire officer, to address his report recommendations. (Timescale 14/02/06 not fully met) 15/08/06 4. YA42 23 (4) (a) Gateway House DS0000004288.V299773.R01.S.doc Version 5.2 Page 20 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 YA6 Good Practice Recommendations Service user plans would benefit from systematically addressing each service aim listed in the Community Care Plan produced by social and health services for the person. In this way the home can make sure that it is meeting the needs that it is being expected and paid to meet. This would also help the home with quality assurance. Gateway House DS0000004288.V299773.R01.S.doc Version 5.2 Page 21 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.V299773.R01.S.doc Version 5.2 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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