Inspection on 04/01/08 for Gattison House

This inspection was carried out on 4th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Gattison House 15/01/07

Gattison House 07/12/05

Gattison House 30/08/05

Gattison House 30/11/04

Gattison House 22/07/04

Gattison House 12/03/04

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

CARE HOMES FOR OLDER PEOPLE Gattison House Gattison Lane Rossington Doncaster DN11 0NQ Lead Inspector Ian Hall Key Unannounced Inspection 4th January 2008 09:00 X10015.doc Version 1.40 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 Gattison House DS0000032092.V355673.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 Older People. 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. Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gattison House Address Gattison Lane Rossington Doncaster DN11 0NQ 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) 01302 864993 01302 866520 NONE Doncaster Metropolitan Borough Council Mrs Norma Cooke Care Home 36 Category(ies) of Dementia (36), Old age, not falling within any registration, with number other category (36) of places Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia - Code DE The maximum number of service users who can be accommodated is: 36 15th January 2007 2. Date of last inspection Brief Description of the Service: Gattison House is a care home that provides personal care for up to 36 people who are aged over 65 years. There are 18 places for people whose care needs are those of an elderly person with dementia. Gattison House is owned and operated by Doncaster Metropolitan Borough Council (DMBC). Gattison House is a purpose built home. Access to the separate dementia care area is via the main house. There is level access throughout the home. All people are accommodated in single bedrooms. Toilets and bathrooms are readily accessible. The main dining area is adjacent to the kitchen. There is a range of lounge seating areas that vary in size and use. A copy of the last Commission For Social Care Inspection report is kept in the entrance hall for people to read. Information gained on the 4th January 2008 indicated the current fees range from £350.00 to £490.00 per week. Additional charges are made for newspapers, hairdressing and chiropody. These fee charges only applied at the time of inspection, more up to date information may be obtained from the manager of the home. Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate, quality outcomes. The unannounced site visit undertaken as part of the inspection started at 08:10 am and concluded at 13:15 pm on the 4th January 2008. The site visit included a tour of the building, reading records, discussions with staff, visitors, people who use the service and observation of the meals provided. We also met with the deputy manager and other members of staff. In addition the inspection took account of information received about the service since the last key inspection on 15th January 2007. This included records of telephone conversations with staff, events notified to CSCI and records of DMBC management visits to the home. Prior to the site visit the home carried out a self-assessment of the service. This is called the annual quality assurance assessment (AQAA). People spoken with were happy to assist with the inspection. Comments were positive when describing the care and motivation of the staff, these included: “I like living here,” “they are good to me”, “the staff do go the extra mile to make sure things are right” and “its lovely here the girls are wonderful”. At the end of the site visit verbal feedback was given to the deputy manager. What the service does well: Gattison House was overall well presented, clean and fresh smelling. We observed good interaction between the staff and people living at the home. Staff took every opportunity to maintain people’s independence and enable them to exercise choice. People’s care needs were clearly known and anticipated. Staff were heard and observed to offer people choice of meals, drinks and activities. The staff group were enthusiastic and keen to update and extend their knowledge and skills. Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6. People who use the service experience good quality outcomes in this area. This judgment has been made using available evidence, including a visit to this service. The service provides people with detailed information so they can choose whether the home is the one for them. Detailed assessments show that the home ensures people’s needs can be met before offering them a place. EVIDENCE: An information pack is available that provides details of the standard of care and services available at Gattison House. This includes useful information about staff, their qualifications, visiting the home, choosing meals, the laundry service and how to raise concerns. We checked three case files. Each contained a detailed needs assessment and included such things as daily living, personal care, health care, social interests and areas of risk when appropriate. Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 9 People said they had been able to discuss their wishes and the type of help they needed before they made the decision to live at Gattison House. This was confirmed by written entries in the case files. Copies of contracts, social work referrals and assessments were available and kept in the case file. Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. People who use the service experience good quality outcomes in this area. This judgment has been made using available evidence, including a visit to this service. Clear information is provided to guide staff meeting people’s needs. Care staff ensure that people are able to access health services as they need them. Staff attitude and approach to care is based on respect for the person, this helps to safeguard and promote people’s rights and dignity. Staff work to the home’s policies for the administration of medication, this promotes the wellbeing of people who live at the home. EVIDENCE: People’s care needs had been assessed; there were detailed care plans to tell staff how to meet these needs. These had been reviewed regularly. Most people we spoke to knew about their care plan. Relatives said they were kept informed and involved whenever possible. Care plans detailed people’s Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 11 religious and cultural needs and the gender of staff that they wanted to support them with their personal care. There were records of visits by the GP, community nurse, occupational therapist, dentist, opticians and chiropodist. People said staff help them to see the doctors when they need to. All people are registered with a family doctor; there are good relationships with the doctors and the district nurses. The home provides wheelchairs, aids and equipment needed to meet people’s moving and handling needs. We saw that some bathing and toilet areas need more aids and adaptations so people can use them independently and safely. People are able to manage their own medication if they wish. No one was currently doing this. People spoken with said that they were happy for staff to manage their medication on their behalf. Medicines were stored safely. We saw people being helped to take medicines according to the doctor’s instructions. Policies and procedures to inform staff and protect people taking medications were current and readily available. Staff had received additional training to assist people to take their medication safely People living at the home and their visitors said that “staff were caring and helpful” and that “nothing was too much trouble, they were always willing and keen to help”. People said that the staff promoted their privacy and dignity. We saw staff knocking upon bedroom doors and waiting to be invited before entering. We observed interactions between staff and people living at the home. These were warm relationships with each person having respect for the other. Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Suitable activities are provided at the home to keep people stimulated, these were limited by lack of staff time to help them. Visits from relatives and friends were encouraged so people kept in touch with people who were important to them. There was a good catering service, which met people’s nutritional needs and food preference. People who live at the home were encouraged to eat a healthy and varied diet. EVIDENCE: Three care files and care plans were checked. These show that people were involved in a range of social activities. People were reading, listening to music and watching television. No one currently leaves the home unless accompanied by members of their family or staff. There have been few opportunities for staff to accompany people to places of local interest. The home does not employ an activity organiser to stimulate and encourage social interaction, leaving care staff to organise activities on the occasions that staffing levels Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 13 permit. Guest performers including an organist provide entertainment each week for people’s enjoyment. People said that they were able to go to bed and rise as they chose. A multi denominational service is held regularly for service users who wish to follow their religious faith. Visitors confirmed that they were able to visit at any time and were always welcomed by staff. They said when they called to collect someone for an outing staff were supportive and helped people to prepare in good time. The meals provided were appealing and smelled appetising. People said they enjoy their meals and they can always choose other meals if they do not like the meal provided. The menu was clearly displayed in the dining room. People were seen and heard to exercise choice at mealtimes. Staff were observed to encourage and help people with their meals as needed. Mealtimes were unhurried with extra portions provided as required. People’s personal dietary likes and dislikes were documented and known by staff. Special diets were available if required. Staff confirmed that they sought the dietician’s advice when necessary. Drinks and snacks were readily available throughout the twenty-four hour period. Adapted cutlery was available to assist people to maintain their independence. People living at the home and their visitors confirmed that drinks and snacks were provided throughout the day and night time as needed. Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home had a complaints procedure to allow service users to raise any concerns. The staff had been trained in the recognition and reporting of abuse and relevant checks were made prior to them starting work, this reduced the risk of harm to vulnerable service users. EVIDENCE: Visiting relatives and some people living at the home were able to describe how they would raise concerns with staff. They stated that any matters they raise however trivial they may seem were acted upon promptly by staff and that they were satisfied with the outcome. The complaints procedure was available for people living at the home, their relatives and staff. No allegations of abuse have been made to the CSCI since the last inspection. People who had no advocate or next of kin have been provided with access to advocacy services provided by Age Concern. Staff had been provided with training in adult protection procedures to ensure people were safe, and to inform staff what to do if an allegation was made. The inspector’s discussions with staff demonstrated that they felt confident and able to respond to concerns or complaints effectively. Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,26. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home was clean, tidy and generally well maintained ensuring that people live in pleasant and safe surroundings. The bedrooms were clean and reflected personal choice. Redecoration and refurbishment of the home has improved the environment. Décor and furnishings in some parts of the home was poor. EVIDENCE: People said the home was always clean, warm, well lit and there was always enough hot water. A number of bedrooms continue to require redecoration and replacement of carpets. Beds and mattresses are worn and in need of replacement. Some Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 16 bedrooms had been personalised to a high level reflecting the interests and personality of the person who lives there. There is level access throughout the home with handrails provided to assist people to maintain their independence and mobility. Toilets were easily accessible as they were close to both lounge and dining areas. Not all toilets had been adapted to enable people with physical disabilities to maintain their independence. Extractor fans need cleaning and many failed to work when tested. There was an adequate number of baths, with an assisted bath within each area of the home. One bath was badly stained; another presents a moving and handling risk to staff assisting people. People living at the home are able to smoke in a designated smoking area. Appropriate seating has been provided in the garden for people wishing to sit outside whenever the weather permitted. The home had a proactive infection control policy and they work closely with external specialists e.g. the Health Authority, Environmental Health and their own staff to ensure spread of infection was minimised. Clinical waste was properly managed and stored. Staff confirmed that they were provided with protective clothing if they needed it and that equipment was in working order, being serviced as required. Low surface temperature radiators had been provided to reduce risk to people of being burnt. Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Minimum staffing levels were not consistently deployed to meet people’s care and social needs. Staff had received training to meet general and specific needs. Appropriate support and guidance was provided to new staff, enabling them to safely care for people who lived at the home. Staff files included the required information. The home operated a recruitment policy that promoted people’s protection. EVIDENCE: We met with seven members of staff including the acting manager during the course of this inspection. We also observed them working with people and noted that there was an atmosphere of mutual respect the conversations were relaxed and friendly. The staff group were well motivated and enthusiastic about their work. They confirmed that they were supported by the manager and encouraged to train and update their skills. This had been difficult for the manager and her staff to achieve due to the number of persistent ongoing staff vacancies. Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 18 Recruitment problems had caused Gattison House to be reliant upon the care team to work many hours in excess of their contracted hours. The prolonged period and number of vacancies has a detrimental effect upon staff morale. The dependency level of people living at the home and their needs has continued to increase; this has placed additional pressures upon staff. Staff confirmed that they had difficulty fulfilling more than basic care needs. Holidays, days out, one to one quality time is consequently restricted. Staff are clearly unhappy and disappointed with this ongoing situation, they are keen to improve the standards of care and service offered. There is no activities person employed, this is a key component of maintaining independence and personal skills. Two new members of staff we interviewed were able to provide evidence both written and verbal of their induction training and developing knowledge of the care needs of people at Gattison House. They confirmed that they had been required to provide two satisfactory written references and a Criminal Records Bureau check before commencing employment with these vulnerable people. Personnel files sampled confirmed that the home follows the DMBC staff recruitment procedures. Records of staff supervision and identified training needs were examined. The majority of staff had achieved National Vocational Qualifications; the remaining staff are working to achieve the award. Skills for prevention of infection and fire and health and safety were updated each year. This ensures that staff are trained to meet people’s care needs safely. Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff said their managers were supportive and approachable and there was a well-established system of professional supervision. People were involved in making decisions about their care and had control over most issues that affected their lives. Systems were in place to protect people’s financial interests. Checks had been made on the major systems in the home such as fire and gas installations to ensure the home was safe for people. . Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 20 EVIDENCE: We saw that there was always a senior member of staff on duty at the home with advice and support readily available. Responsibilities for the day-to- day operation of Gattison House are shared between senior members of the team. The people, relatives and staff said the manager was approachable, very professional and they felt confident in her. The manager had a job description that clearly defines her roles and responsibilities and staff were aware of her role. Staff had received management supervision at regular monthly intervals; this is required to fully ensure individual staff development and monitoring care practices. The responsible individual visits the home on a regular basis, a report is written following the visits. A copy of the responsible individuals monthly report is sent to the local office of the Commission for Social Care Inspection. There is no recognised quality assurance system used by DMBC to seek the views of people and relatives. Regular meetings are held for staff and people who live at the home. These give people living at the home a voice and chance to say how the home should be run. People felt that their views and opinions were taken into account by the staff The manager handles money on behalf of some people, account sheets were kept, receipts were available for all transactions, and all transactions were witnessed by a second individual. DMBC auditors audit these accounts annually. The policies and procedures met the required standards. Records were mainly up to date and well ordered to ensure the best interest of people. No fire exits were obstructed and hazardous substances were securely stored. Statutory servicing and checks of equipment were complete. Risk assessments had been completed and were being reviewed regularly to maintain a safe environment. Service records for the moving and handling equipment, fire safety records and other maintenance records were up to date; personal finances were properly recorded and personal allowances provided. The manager and deputy had received training in the Mental Capacity Act. This training has not been provided for all staff to ensure they are aware of the changes needed to fully protect vulnerable people at the home. Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x 3 x X x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 3 3 2 Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP27 OP14 Regulation 18 Requirement Timescale for action 01/03/08 2. OP19 23 3. OP33 24 People living at the home must have their needs reassessed to help determine the staffing levels required to meet their current needs (requirement outstanding from 01/03/06, 01/03/07) Renewal and refurbishment of 01/04/08 the fabric, furnishings and decoration of the building must be actioned to deal with the shortcomings identified in this and previous report. (Requirement outstanding from 01/04/07) Effective quality assurance and 01/04/08 quality monitoring systems, based on seeking the views of service users must be implemented to measure success in meeting the aims, objectives and statement of purpose of the home. (Requirement outstanding from 01/03/07) Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 23 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 OP38 Good Practice Recommendations Staff must receive training in the Mental Capacity Act 2007. Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Gattison House DS0000032092.V355673.R01.S.doc Version 5.2 Page 25 - 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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