Inspection on 26/09/07 for The Gatehouse

This inspection was carried out on 26th September 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Gatehouse 13/01/10

The Gatehouse 08/05/07

The Gatehouse 08/02/07

The Gatehouse 21/08/06

The Gatehouse 19/01/06

The Gatehouse 22/07/05

The Gatehouse 18/01/05

The Gatehouse 24/08/04

The Gatehouse 18/09/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Gatehouse 64 Becton Lane Barton-on-sea New Milton Hampshire BH25 7AG Lead Inspector Kathryn Kirk Unannounced Inspection 26th September 2007 11:00 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 The Gatehouse DS0000012359.V352056.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. The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gatehouse Address 64 Becton Lane Barton-on-sea New Milton Hampshire BH25 7AG 01425 613465 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) Sallyprice@thegatehouse.biz Mr E Breckon Mrs J Breckon Mrs Sally Price Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (21) of places The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th July 2002 Brief Description of the Service: The Gatehouse is set in a semi-rural location on the outskirts of the town of New Milton at Barton-on-Sea. It provides residential care for up to 21 elderly residents, some of who have dementia. The home is on ground and first floors and there is a stair lift between these. There are a variety of aids and adaptations to allow residents to move about more independently. Nineteen of the bedrooms are single, and one is a double. All of the bedrooms bar one single have an en-suite facility. There is a communal bathroom with toilet on the ground floor, and two bathrooms with toilets on the first floor. There are large gardens around the building, and car parking space to the front. Current fees are between £450 and £550 a week. Items not covered by the fees include hairdressing, chiropody, newspapers, personal toiletries and reflexology/massage. The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information for the report on this key inspection was gathered in the following ways: Information was reviewed that was contained in the most recent two inspection reports dated February 2007 and May 2007. A site visit to the home took place on 26 September2007. The focus of this visit to see if there had been any changes to the service and to review the three requirements made in the May 2007 inspection. This was done by talking with eight residents, the manager and two of the staff team and by looking at some paperwork The home has already completed an annual quality assurance assessment this year and CSCI have sent surveys to residents, relatives and visiting professionals. Reference is made to this information already in the report of May 2007. What the service does well: This is what was said at the last inspection: The home continues to provide a warm homely environment, where residents are able to join in activities or pursue their individual hobbies. Residents felt they were supported to maintain their independence by doing as much as they could for themselves, but were confident support was offered when they needed it. This was still found to be the case. Comments from residents during this site visit were “Its home from home” “Can’t fault it” “I wouldn’t want to live anywhere else” “I haven’t got anything else to compare it with but no real concerns, just wish sometimes we could have more to do” The Gatehouse DS0000012359.V352056.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. The Gatehouse DS0000012359.V352056.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 The Gatehouse DS0000012359.V352056.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): 3 Standard 6 does not apply Quality in this outcome area is good. Residents may be confident they will only be offered a place at the home if their needs can be met This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the last inspection report the pre admission process was considered to be good. There was no change on this occasion. One assessment was seen which related to a resident that was considering moving to the service and this included a brief history of the person, their mobility needs, personal care needs, medical information, any communication problems, social and recreational interests and family details. The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 9 Staff confirmed that people still come in for lunch and have the chance to visit the home before they decide that it is the right place for them. They then come in on a trial basis. One resident confirmed that this had been her experience. She said she had been given accurate information about the service and that it was even better than she had expected. Staff said that no people had left in last twelve months because the home could not meet their needs. This is a further indication that the pre admission process is appropriate. The manager said that she mindful about who is admitted because the home could not meet the needs of people who wander or, if no downstairs bedroom is available; people who could not use a stair lift. The Gatehouse DS0000012359.V352056.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 and 10 Quality in this outcome area is good The service provides good support to meet residents health and personal care needs This judgement has been made using available evidence including a visit to this service. EVIDENCE: Quality in this area was considered to be good at the last inspection in May. This is what was said in the previous inspection: Care plans seen contained detailed information about how individual residents liked to receive personal care, what they could do for themselves and what help was needed. The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 11 There was evidence that mental health needs were being considered. For example, care plans identified where residents needed prompting with personal care tasks due to their short-term memory loss. Social and emotional needs were assessed and care plans completed to meet them. Residents said staff gave support when it was required, but that they were encouraged to do what they could for themselves. Risk assessments are completed and regularly reviewed. These identify whether any specific action needs to be taken. For example, nutritional risk assessments identify whether someone needs a special diet or encouragement to eat. Health care needs are well met. Care plans showed referrals were made to health care professionals when required. Residents said they saw their doctors when they wanted to and were regularly visited by the district nurse when they needed to be. The medication policy and procedure gave staff clear information about ordering, receiving, storing, administering and returning medication. Medication was stored in a locked cupboard and the shift leader holds the key. A record is kept of who holds the key on each shift and spare keys are kept with the registered manager and provider. Only staff who have completed training and been assessed as competent are allowed to give out medication. Residents are supported to manage their own medication if they wish, provided a risk assessment has been completed. Residents said staff treated them with respect at all times. This was all still found to be the case during this inspection, although there have been further improvements to the care planning process. These have not been completed for all but include assessments of mental health, pressure areas, risk and behaviour assessments. Staff said they found them clear and easy to follow. Care plans are currently held in the office. Those seen had not yet been signed by service users, as the process was not yet complete (there was a space for service users to do so) It was discussed with the manager that service users should keep their care plans in their bedrooms if this is their wish and unless there is a clear and documented reason not to do so. The Gatehouse DS0000012359.V352056.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 and 15 Quality in this outcome area is good Residents are able to make choices about all aspects of their daily living. The activities they are offered provide mental stimulation doing things most enjoy. The food provided offers a balanced diet with choices that residents like. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The quality of this area was judged to be good at the last inspection in May This is some of what was said: Residents ... felt able to make choices about all aspects of their daily living. Residents said there were no rules and they chose when to get up and go to bed. Care plans recorded individual daily routines, such as what time someone liked to get up and have breakfast. Residents were seen throughout the day moving freely around the home, spending time in the communal areas and their rooms. The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 13 The home provides some organised activities, such as an exercise class, board games and visits by entertainers. The registered manager said a recent survey had indicated some residents would like more activities. Changes had been made in the daily running of the home to enable staff to have more free time to spend with residents, doing activities of their choice. Care plans record whether residents like to go to church or see the minister who calls regularly. Residents said how much they enjoyed walking in the gardens. Comments from relatives evidenced that they feel very welcome in the home. Residents said their relatives were made welcome and offered drinks when they visited. A notice in the hallway states that visitors are welcome at any time, but asked to avoid lunch if possible. Residents said they liked the food provided. The daily menu is displayed on the meal tables. Only one main meal is offered, but residents confirmed they would have something else if they wished. A vegetarian option was available. Meal times were relaxed. Residents sit at a number of small tables and drinks are served before lunch. Residents spent time over their lunch, sitting and chatting after whilst tea and coffee were served. This was also found to be the case during this visit to the home. At the time of this visit time was spent with residents in the garden, in the lounge and in the dining room. The following was noted: Staff were seen to be very attentive and had a good knowledge of residents likes and dislikes, for example: Comments were heard from staff “Is your tea strong enough?” “You don’t like chocolate do you” (resident involved confirmed that this was the case and she was offered an alternative) “Are you warm enough?” Some residents said that they enjoyed the activities provided. Others said that there still were not enough outings. The manager was aware already of these opinions and continues to try to offer more. She said that another member of staff is being employed, both to give senior staff more time to do paperwork and to give more opportunities for residents to go out. The Gatehouse DS0000012359.V352056.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 and 18 Quality in this outcome area is good Residents have the information they need to enable them to make complaints and be confident they will be informed of the outcome of any investigation. The in house policy and procedure and staff training enable staff to have the information they need to identify and report allegations of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The quality of this area was judged to be good at the last inspection in May. Residents spoken with still felt confident that staff would listen to any concern that they may have and they knew about the complaints procedure. No complaints have been received about this service by the Commission for Social Care inspection since the last visit. At the last inspection it was found that “the home had a policy and procedure for the protection of vulnerable adults. This had recently been amended and now complied with the guidance given in Hampshire’s protection of vulnerable adults procedure. Some staff had attended adult protection training as part of their national vocational qualification (NVQ) and were aware of their The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 15 responsibility to report any abuse. The registered manager said she was currently trying to find more adult protection courses so that staff could have further training.” A notice was seen in the office at the time of this visit with further information about adult protection training for staff. The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. Residents live in a clean comfortable and safe environment that meets their needs, and that they like. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The quality of this area was found to be good at the last inspection. It remains good at this time. Residents continued to be happy with the environment and said that their rooms were comfortable. The communal areas are well furnished and well maintained. There were no adverse smells detected on the day of the visit and the home was clean. The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 17 The manager said that new procedures are in place for unwashed laundry and staff have a route to the laundry that avoids any areas where food is prepared or stored. There is also a new washing machine and tumble dryer which are on contract so that there is a 24 hour repair call line. This helps to ensure that the service is not without laundry facilities. One issue that was raised by a resident during the visit was that there is no call bell in their bathroom area. This was discussed with the manager who said that this was the case in some of the private facilities. She said that the staff team had already discussed this as a possible issue and felt that it would be appropriate to install emergency call facilities in those bathrooms that do not already have them. She said that this would be discussed with the proprietor and agreed that this would be done. No requirement was therefore made regarding this issue. The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is good Residents’ needs are met by well-trained staff with the right experience and skills. Recruitment procedures are robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This area was judged to be adequate during the May inspection. The reason for this judgement being made was because of gaps in recruitment procedures. All other areas, regarding staff numbers, skills and training were found to be good. On this occasion resident s said that they felt that there were enough staff on duty during the day and night to respond to their requests for assistance. They also said that they felt that staff knew what they were doing and were confident in their skills. The concern at the last inspection was that two references were not present on the files of two recently employed staff members The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 19 The registered manager said she was aware she needed to obtain two references for employees and that she usually did so. Two files were looked at for staff that are due to start work soon at The Gatehouse. Both had complete POVA checks and one had a satisfactory full CRB check returned. One person had two satisfactory references returned and the other had one, although the manager said that she was about to telephone to chase up the second reference. There was evidence therefore that the manager has tightened up recruitment procedures. The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 20 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 and 38 Quality in this outcome area is good. The home is well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has managed the service for some years and has achieved a National Vocational Qualification (NVQ) 4 in care and the Registered Manager’s award. She has continued to develop her practice through additional training and study. The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 21 Feedback from residents and relatives indicated that she has an open management style, is approachable and committed to developing the service to meet the needs of residents. They are able to give their views about the service at residents’ meetings and through questionnaires sent out annually. The registered manager responded to feedback, as evidenced by the increased staff time to spend with residents and the arrangements for trips out and activities. Quality in this area was judged to be adequate at the last inspection because of the issues over staff recruitment, the fact that not all staff had completed a fire drill and that hazardous chemicals were not locked away. As discussed in the previous section the manager has tightened up on the recruitment process. There was fire safety training and a fire drill on the day of the unannounced visit to the home. All staff attended. The requirement made at the previous inspection is therefore met. Cleaning cupboards were all locked on the day of the visit. This requirement is therefore also met. The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 22 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 X 3 X 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Gatehouse DS0000012359.V352056.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 The Gatehouse DS0000012359.V352056.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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