Inspection on 08/02/07 for The Gatehouse

This inspection was carried out on 8th February 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Gatehouse 13/01/10

The Gatehouse 26/09/07

The Gatehouse 08/05/07

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 Mrs Pat Trim Unannounced Inspection 8th February 2007 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 The Gatehouse DS0000012359.V324888.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.V324888.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) 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.V324888.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st August 2006 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 whom 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.V324888.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection carried out by one inspector in 7.5 hours. The key standards were assessed by case tracking 3 residents and talking with 5 people currently living in the home. Time was also spent observing staff practice and talking with 2 care staff, the cook, the registered manager and the provider. Some time was spent reviewing a random selection of documentation and a partial tour of the premises was carried out. In preparation for this visit the inspector also examined information obtained about the service including incident reports and the most recent inspection reports on the home. Comment cards were received from 9 residents, 10 relatives and 1 health care professional. Their comments have been reflected in this report. Information was also obtained from the pre-inspection questionnaire, completed by the registered manager, and a range of documents submitted with it. The people living in the home had previously expressed their wish to be called residents. This term is therefore used throughout this report. What the service does well: The home presents a warm and friendly environment where residents feel they are respected by staff and enabled to do as much as they can for themselves. Residents felt they were given information about the service, were able to give feedback about the service they received, and were confident they could make complaints. Comments included • • • ‘This home gets 10 out of 10’. ‘It’s a very nice home. You can’t beat it.’ ‘We all have very different lives. Staff respect that.’ Residents said they were given the care they needed, in the way they liked it. Comments included • • ‘I need help with putting on my stockings. I always get it.’ ‘When I ask for help it always comes very quickly.’ All residents have a single room and all but one have an en suite. Residents are encouraged to personalise their rooms and may bring their own furniture The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 6 and possessions with them when they move in. The landscaped gardens are very popular with residents who enjoying walking round them and spending time sitting there during the warmer months. The home offers a wide range of activities and trips out, which the majority of residents enjoy. Some residents felt they would like more, but others preferred to spend time doing things by themselves. All felt they could choose how they spent their time. What has improved since the last inspection? What they could do better: Care plans still contain very limited information about a resident’s mental health needs. An assessment tool has been introduced, but this is not being used correctly, or effectively, to identify any needs or to plan any ways of helping to meet them. The registered manager was aware of this and was reviewing current practice. Care plans also have limited information about residents’ social and emotional needs. Some residents are very able to decide how to spend their day and to ask for any help. However, some residents have mild to moderate dementia. Detailed information about their social and emotional needs is essential if they are to have satisfying activities to fill their time. The registered manager said The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 7 staff were attending training on dementia care and would use the information they got from this to review care plans. The policy and procedure for the protection of vulnerable adults still did not reflect current guidance and needs to be reviewed to ensure staff and the registered manager are clear about the actions they would need to take if there was an allegation of abuse. Staff still needed to have training on adult protection, and this was being arranged. The medication policy and procedure are muddled and misguiding. Staff need clear guidance to refer to on how to receive, store, dispense and dispose of medication. The current policy and procedure need to be reviewed to ensure they follow the Royal Pharmaceutical guidelines. Regular fire drills should be carried out so that residents and staff know what action to take in the event of a fire. The registered manager was talking to her fire safety officer about this. Steps should be put in place to ensure that staff who miss the twice yearly fire training have the opportunity to have in house training. The registered manager was also going to discuss this with her fire safety officer. 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.V324888.R01.S.doc Version 5.2 Page 8 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.V324888.R01.S.doc Version 5.2 Page 9 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 adequate. This judgement has been made using available evidence including a visit to this service. The home ensures prospective residents have their needs assessed before they move into the home. However, more detailed information is required in respect of mental health needs, if residents are to be confident the home will be able to meet all their needs EVIDENCE: Three residents who had recently moved into the home were case tracked to evaluate their experience of moving into the home. Two residents remembered being visited by someone from the management team prior to admission and also visiting the home for a day. The registered manager said the policy of the home was to visit prospective residents to complete a pre admission assessment and to encourage them to spend a day at the home. This information was included in the statement of purpose. The three residents who were case tracked had an assessment of need completed prior to admission. This was a simple format, which identified basic The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 10 abilities and needs. For example, whether a resident could walk unaided, with an aid, with staff assistance or was wheelchair bound. Completed forms had more information added, such as needing a referral to the district nurse because of a leg ulcer. Further information about the resident’s abilities and needs, likes and dislikes were obtained during their initial visit and during the trial period. The information about the resident’s mental health needs was very basic, identifying whether they had no confusion, were slightly forgetful, very forgetful or severely demented. The registered manager said that the home was receiving an increasing number of referrals for residents with dementia, was aware of the need to develop this aspect of the assessment and was looking for an appropriate format. The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. Care plans need to be developed to provide more detailed information about mental health, social and emotional needs if residents are to be confident all their needs will be met. Medication is now managed in a way that ensures residents are safe, but the procedure should be reviewed to make sure it reflects current practice in the home. Residents have access to a wide range of health care professionals so can be confident their health care needs will be met. EVIDENCE: The care plans for two of the residents who were case tracked were seen. These were quite basic, but identified what the resident could do for themselves and what they needed help with. For example, one plan recorded that a resident could dress herself, but needed help with choosing what to wear. Another recorded that a resident could dress herself but needed help putting cream on her legs and putting on her stockings. Staff were able to describe what help these residents needed and residents confirmed they received this assistance. The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 12 Many of the residents were able to say how they wanted to receive their care, but a number of residents have a degree of dementia. Care plans need to be developed to ensure these residents consistently receive care in the way they like it. For example, there was very little detail of how someone liked to have help with a bath. Care plans recorded ‘help with bathing’ rather than the routine that needed to be followed. There was no information about whether someone could be safely left alone in the bath or whether they required staff to stay with them. The third resident did not have a care plan as she had only recently moved to the home. This was discussed, as useful and detailed information about her needs had been recorded in the daily logs and could have been used to begin writing the plan. The registered manager said she was aware care plans needed to be developed to provide a more holistic approach to meeting residents’ needs and was currently looking at possible formats. Risk assessments were used to identify areas of concern, such as the risk of falls or to assess the risk of someone self-medicating. Residents were weighed on admission and their dietary needs monitored. Following the last inspection a tool to assess and monitor residents’ mental health needs had been introduced. This had not been used appropriately. The registered manager said she was aware they had not been used correctly and was reviewing their use. There was evidence care plans were reviewed on a monthly basis and an audit tool was used to identify changing needs. Care plans were amended as required. For example, a review identified a resident was having increasing continence problems; a referral was made to the continence advisor. Residents felt their health care needs were met and that they had the opportunity to access a wide range of health care. Daily records showed they regularly saw the chiropodist and one doctor visits the home every two weeks to see any of her patients. Health care needs identified in the assessment were followed up. For example, arrangements were made for two residents to see the district nurse on a regular basis, following admission. During the inspection, staff were observed asking residents how they were and requesting doctor’s visits for those who were unwell. The action plan sent in by the provider in response to the last inspection report stated that new procedures had been put in place to address the requirements made in respect of medication. Records seen during the inspection confirmed all medication received into the home was checked in and signed for. A record was also kept of any medication returned to the pharmacist. A delivery of medication had been received the day before the inspection. This had been locked away in a cupboard until it could be checked in. The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 13 During the inspection the local pharmacist called to carry out a review of residents’ medication. The registered manager discussed current practice in the home and the pharmacist agreed to ensure as much medication as possible was dispensed in the monitored dosage system. Medication was now taken round the home in a locked medication trolley. Staff were observed dispensing medication in accordance with Royal Pharmaceutical guidelines. Each resident was given their medication directly from the monitored dosage system with a drink of water and each individual record signed. The record for one resident was checked against the supply remaining in the monitored dosage system and found to be correct. Eye drops were now stored in a locked container in the fridge. The home now has an information leaflet about every medication held in the home. Doctors have been asked to sign a record for each resident, detailing which homely remedies are safe for them to take with their current medication. The home submitted two medication procedures with the pre inspection questionnaire. These did not give clear guidance to staff on how to manage medication within the home and were contradictory. There was reference on one to a system no longer used in the home. The policy and procedure need to be reviewed to ensure they comply with the Royal Pharmaceutical guidelines for the safe management of medication. Staff received medication training in October 2006 and further training was being arranged. The registered manager said only staff who had completed medication training were responsible for administration. It was recommended that the registered manager should also assess competence before permitting staff to give out medication unsupervised. Residents are encouraged and supported to manage their own medication. They are asked during assessment whether they wish to continue. If they wish to, information is obtained from their doctor about their ability to do so. A risk assessment is completed which identifies the level of support that may be required and an action plan is put in place. Comment cards from nine residents and information from residents spoken with during the inspection evidenced they felt staff treated them with respect at all times. Their preferred form of address was recorded in the care plan and staff were heard using these names during the inspection. Residents said staff always knocked on their bedroom doors before entering, doors could be locked and residents had a key. The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 14 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. This judgement has been made using available evidence including a visit to this service. Residents are able to make choices about all aspects of their daily living. The activities they are offered provide mental stimulation doing things they enjoy. The food provided offer a balanced diet with choices that service users like. EVIDENCE: Feedback from comment cards and from residents spoken with during the inspection evidenced the fact they felt able to make choices about all aspects of their daily living. Residents said there were no rules and they could choose what time they got up and went to bed. Some liked to spend the day in communal areas, whilst others preferred to stay in their rooms. Some liked to do both, going to their rooms for a rest after lunch or to watch a particular television programme. During the inspection several residents chose to go out for a walk round the garden. Others sat reading their newspapers or books from the mobile library. A resident said if you told the librarian the sort of books you liked they would try and make sure there was a supply of them. The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 15 Residents felt there were opportunities to join in activities such as an exercise class, craft classes, coffee mornings, games and quizzes. There is regular entertainment such as singers and pat dog therapy. Some trips out are also organised such as visits to the garden centre, pub lunches and cream teas. Recent activities included packing ‘shoe boxes’ at Christmas for ‘Operation Christmas Child’. Photographs of recent activities and trips out were displayed in the corridors. Feedback from the comment cards indicated that sometimes residents wished there were more activities. Some residents said they wished there were more trips out, but others commented that staff tried very hard to provide a variety of activities. They felt residents were often reluctant to join in. Residents felt their spiritual needs were well met. Preferences were recorded in their care plans and a local minister visited the home on a regular basis to give communion to those who wished to receive it. Other residents had made their own arrangements to receive visits from ministers of their choice. The statement of purpose tells residents they may bring personal possessions with them when they move into the home. Residents confirmed they were given this information and one resident said she was in the process of choosing what to keep. Another said she had brought all her bedroom furniture with her and felt it made her room ‘more like home’. Comment cards from relatives and comments made by visitors to the home evidenced they were always made welcome and felt able to contribute to the care of the resident. The majority of comments received about meals were very positive, although one resident felt she did not like the supper choice, but said she was offered an alternative. Residents had choice about where they ate their meals and what they had. Breakfast is served in residents’ rooms, but residents choose when they have it. Some were seen having breakfast late in the morning, whilst others commented they had it very early, as this was when they wished to have it. Staff were seen telling residents what was for lunch and asking them which choice they would like. Menus were displayed on the meal tables. Residents said lunch was a sociable affair, with drinks being served before the meal and tables set for intimate groups of four, rather than large groups. Residents were seen sitting chatting over lunch, with tea or coffee served after the meal. Residents said they had drinks and snacks throughout the day. Drinks and biscuits were served in the morning and afternoon tea was served with homemade cake. The home had a good supply of fresh fruit and vegetables. The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 16 Special diets are catered for with vegetarian options and food suitable for those with diabetes. The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents have the information they need to enable them to make complaints and to be confident they will be informed of the outcome of any investigation. The policy and procedure for the protection of vulnerable adults needs to reflect the local authority procedure if residents are to be protected against the risk of abuse. EVIDENCE: Feedback from residents, both verbally and in comment cards, showed that they had information about the complaints procedure. There was information about it in the statement of purpose and service users’ guide. Residents spoken with said they knew how to make a complaint but had not had to do so on a formal basis. They felt that informal complaints were dealt with swiftly and efficiently and thought the registered manager would treat formal complaints in the same way. The home had a log in which to record complaints, together with responses made, action taken and outcomes. The commission had received no complaints about the service since the last inspection and none were recorded in the home’s complaints log. The registered manager is in the process of arranging adult protection training for staff and had information about training courses. Some staff had already had training as part of their National Vocational Qualification (NVQ) and two staff spoken with were able to describe their responsibility to report any alleged abuse. They were aware the registered manager would be required to The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 18 report any allegation to the lead agency. The registered manager was able to demonstrate her knowledge of the adult protection procedure. The home had a copy of Hampshire’s protection of vulnerable adults procedure, but the home’s policy and procedure did not reflect its guidance. The registered manager agreed to review the policy and procedure to ensure it complied with the guidance given in the local authority procedure. The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 19 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to live in a comfortable, clean and safe environment that meets their needs and that they like. EVIDENCE: The home is well laid out and well maintained. There is a lounge, conservatory and dining room. The grounds are well maintained and residents said how much they enjoyed walking round them. Residents felt the home was kept clean and staff worked hard to keep it so well. Following the last inspection, the policy and procedure for managing laundry has been reviewed. All staff have been informed they can no longer take dirty laundry through the kitchen and notices to this effect are displayed in the laundry area. Staff were observed putting dirty laundry into bags before bringing it downstairs. A sink has been installed in the laundry for rinsing soiled linen. Staff use the hand sink in the adjacent staff toilet to wash their The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 20 hands. The home had a health and safety inspection by an environmental health officer on 1/2/07. The outcome of this inspection was that the management of health and safety was very good and the housekeeping and maintenance was to a good standard. The environmental health officer made no requirements about the floor and walls of the laundry commented on in the last inspection report. The registered manager said training was being arranged for staff in infection control procedures. Staff had a good supply of disposable gloves and aprons, which they were seen using where appropriate throughout the day. The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 21 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. This judgement has been made using available evidence including a visit to this service. Residents are supported by a sufficient number of trained staff to meet their needs. There has been an improvement since the last inspection which means there is now a detailed employment procedure in use that ensures residents are protected. EVIDENCE: A copy of the staff rota was submitted with the pre inspection questionnaire. This reflected the number of staff on duty at the time of the inspection. The rota showed that staff cover was used flexibly so that maximum support could be provided at times of high need. For example, there was extra cover during meal times and so that staff could spend time talking and playing games with residents. Since the last inspection the rota is now written in ink so that it provides an accurate and permanent record of staff working in the home. The rota showed there were three care staff working in the home during the morning, two during the afternoon, and one waking, one sleeping night staff. Another care staff joins the afternoon staff between 5 and 8 p.m. The home also employs a cook every day from 8 a.m. to 3 p.m. The registered manager and deputy manager hours are in addition to the care hours provided. The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 22 Residents and staff felt there was always sufficient staff on duty to meet their needs. Residents said calls for assistance were always answered quickly and this was seen throughout the day. Comments made about the quality of the staff included • • ‘The help and care given to my mother is excellent.’ ‘An excellent home with very caring staff.’ The home employs 20 care staff. The pre inspection questionnaire stated that 8 staff had completed a National Vocational Qualification (NVQ). The registered manager confirmed this figure was correct and that two more staff would shortly be starting their qualification. When these two staff have completed their training the home will have achieved 50 of staff qualified to NVQ 2 or above. Two staff spoken with said they did not want to undertake this qualification but enjoyed other training opportunities. A requirement was made at the last inspection that Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks must be completed on all staff prior to employment. On this inspection two new members of staff were case tracked. One of these had both checks completed prior to her employment. The other had a POVA first check completed so she could start her induction and the registered manager was waiting for the CRB to be returned. The registered manager had obtained two written references for each member of staff, one of which was from their previous employer and both staff had been required to complete an application form, giving their employment history and qualifications. Copies of any training completed prior to employment were on file. Two staff were spoken with. Both felt they had good training opportunities and listed training they had completed, as well as training planned for this year. Both had worked at the home for a number of years and said there were few staff changes. Training they had attended included first aid, food hygiene and moving and handling. The registered manager said she had arranged training in dementia care and staff confirmed they were attending this. The training programme submitted with the pre inspection questionnaire listed training already arranged for this year as mandatory courses such as first aid, food hygiene and fire training, as well as courses in medication and abuse and awareness of abuse. The registered manager said the home had an induction programme and new staff shadowed experienced staff for the first two weeks. Staff were given a workbook that listed all aspects of care working. They were assessed as competent in each task before their workbook was signed to evidence that section was complete. The registered manager said she was seeking to The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 23 improve the induction process and had information about a workbook that was based on Skills for Care guidance. She was hoping to introduce this system for new staff in the near future. The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 24 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 adequate. This judgement has been made using available evidence including a visit to this service. Some aspects of the home are well managed, but attention must be given to the issues identified in this report if the home is to be run in the residents’ best interests. Systems are in place that enable residents to give feedback about the service they receive. There are systems in place that make sure the majority of health and safety issues are addressed and residents are protected. However, some parts of fire safety must be reviewed to ensure residents are protected in all aspects of fire safety. EVIDENCE: The registered manager has many years experience of managing a care home and has achieved a National Vocational Qualification (NVQ) 4 in care and a The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 25 Registered Manager’s Award. There was evidence she has continued to develop her skills and was currently considering undertaking a further management course. Residents and staff said she had an open management style and both residents and staff were seen coming to her office to ask questions or seek advice throughout the inspection. The provider and deputy manager provide assistance in the day-to-day running of the home. The registered manager had just returned to her post following a period of absence. She was aware of the concerns raised at the last inspection and there was evidence she was actively addressing them. However, particular attention is still required to care plans, medications, and adult protection training. Residents said they had opportunities to give feedback about the service they received informally, through daily contact with the registered manager, and formally, through residents’ meetings. The registered manager said she had recently sent out a questionnaire. The responses seen were very positive about the care provided. Mrs. Price said she would normally take action to resolve any issues from the questionnaires but did not usually give feedback from them. This was discussed and it was suggested she should consider writing a brief summary to provide information to residents about the outcome of the survey. Issues relating to records raised at the last inspection had been resolved. The archived records referred to in the report had been removed to a locked storage area. Residents said the registered manager looked after some money for them. Written records were kept of income, expenditure and the balance held. Receipts were also kept. One record was checked. The balance recorded tallied with the amount held in the safe. Staff had received training in a wide range of mandatory courses such as moving and handling, food hygiene and first aid. The registered manager kept a list of training, but did not have a system that could easily identify when refresher training was required. The home employed someone to come and give fire safety training to staff twice a year. The records showed that not all staff attended both sessions. The registered manager said she did not have a system in place to ensure these staff received in house refresher training. She was required to ensure this was put in place. The pre-inspection questionnaire listed all the service and maintenance contracts with the dates on which these were last done. A random selection of records confirmed these had been carried out as listed and evidenced the health and safety of residents and staff was maintained. The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 26 Cleaning products such as bleach were now stored securely and staff were observed locking them away when they had their breaks. A risk assessment relating to the use and storage of hazardous substances had been put in place. Radiators have been covered to ensure residents are not at risk of accidental burns. All hot water outlets have thermostatic control valves to prevent the risk of accidental scalding. Upstairs windows do not have restrictors fitted but there is a risk assessment to ensure only those who are not at risk are accommodated in first floor bedrooms. The registered manager said the risk assessment would be reviewed if the windows presented a risk to any resident. The fire logbook showed that equipment was regularly tested and serviced. No fire drills had been recorded. Mrs. Price said she was aware she needed to carry out regular drills and was going to discuss how this should best be done with her fire safety officer. The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 27 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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 3 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 2 X 3 X X 2 The Gatehouse DS0000012359.V324888.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 (1) Requirement Care plans must detail how the residents’ mental health needs are to be met to ensure they are offered appropriate care and mental stimulation in a consistent way. Repeat requirement – previous timescale of 30/10/06 not met 2. OP9 13 (2) The medication policy and procedure must be reviewed to ensure it complies with the Royal Pharmaceutical guidelines and gives staff clear guidance to follow. This will ensure a consistent approach to the receipt, administration and storage of medication is maintained. The registered manager must make the adult protection procedure clearer, with regard to the role of the local authority adult services so that all staff in charge of the day to day running of the home are clear what action to take in the event of an DS0000012359.V324888.R01.S.doc Timescale for action 01/05/07 01/05/07 3. OP18 13(6) 01/05/07 The Gatehouse Version 5.2 Page 29 allegation of abuse. Repeat requirement – previous timescale of 21/11/06 not met. The registered manager must 01/04/07 make arrangements for staff who miss fire safety training sessions to have in house ones to ensure they know what action to take in the event of a fire and to ensure the safety of residents and staff. The registered manager must also make arrangements to carry out regular fire drills so that residents and staff know what action to take in the event of a fire and to ensure the safety of residents and staff. 4. OP38 23(4) 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.V324888.R01.S.doc Version 5.2 Page 30 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.V324888.R01.S.doc Version 5.2 Page 31 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!