Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 18/04/05 for The Gateway Rest Home

Also see our care home review for The Gateway Rest Home for more information

This inspection was carried out on 18th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

This is a care home for older people and service users all looked happy and well cared for. Comments received from service users included "the care is marvellous", "the staff are wonderful" and "the food is excellent". The staff demonstrated an appropriately pleasant approach to service users and treated them with respect. The meal witnessed was wholesome and nutritious and individual choices were taken into consideration. Staff administering medication followed correct procedures and approached service users with sensitivity.

What has improved since the last inspection?

Since the last inspection two requirements have been met and the practice of storing some foodstuffs in the laundry has been discontinued; and footplates are now being used on wheelchairs when moving service users around the home. Staff training has also increased since the last inspection, although it is still not up to an acceptable standard.

What the care home could do better:

In order to ensure that service users health, welfare and interests are properly looked after there are several improvements that need to be made. The registered provider needs to visit the home on a monthly basis and provide a report of the visit with a copy being sent to the commission. Only service users whose needs fall within the registration category of the home should be accommodated. Radiators throughout the home need to be covered. The laundry area needs to be reviewed and it is suggested that a sluice facility washing machine be fitted and the hand wash sink be reinstated. Staffing levels need to be increased and recruitment procedures and effective training of staff should be addressed. Some medication procedures need to be tightened up. It would also benefit the home to have a dishwasher fitted in the kitchen, as recommended by the environmental health officer

CARE HOMES FOR OLDER PEOPLE The Gateway Rest Home 409 Folkestone Road Dover Kent CT17 9JT Lead Inspector Chris Randall Unannounced 18 April 2005 09.25 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 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 Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service The Gateway Rest Home Address 409 Folkestone Road, Dover, Kent, CT17 9JT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01304 203650 Mrs Ann Leonard Mrs Patricia Ann Thompson CRH 20 Category(ies) of OP x 20 registration, with number of places The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16.11.04 Brief Description of the Service: The Gateway Rest Home,is a residential home registered for 20 older people. The home is a large two-storey property situated on the outskirts of the town of Dover. Public amenities are within easy reach such as public transport, a church, shops and a public house. The home comprises of 12 single bedrooms and 4 double bedrooms. There is a passenger lift providing access to the first floor for those who need it. In addition to bedrooms there is a large, bright, spacious communal lounge which includes a dining area. The home has a small front garden and a rear, hard surfaced area where service users can sit in the summer months. The home has dedicated parking facilities at the rear of the property. The home is owned by Mrs. Ann Leonard and managed on a daily basis by Mrs. Patricia Thompson. In addition there is a dedicated care team, a cook who works Monday to Friday, and esignated domestic staff. The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which started at 09.25 a.m. and took place over 10.25 hours, 5.25 of these being spent in the home. The inspector spoke to 11 service users, 4 visitors and 6 members of staff, had a tour of the home; and examined documentation. Generally the home was found to be clean, tidy and well maintained with the exception of an unacceptable odour in one room. The manager was unavailable on the day as she was at a training course. What the service does well: What has improved since the last inspection? Since the last inspection two requirements have been met and the practice of storing some foodstuffs in the laundry has been discontinued; and footplates are now being used on wheelchairs when moving service users around the home. Staff training has also increased since the last inspection, although it is still not up to an acceptable standard. The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) This category was not examined during this inspection EVIDENCE: The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, & 10 Care planning is satisfactory. Health care needs are generally being met. The home needs to address the issue of out of category service users. Some medication procedures need attention. Service users are treated with respect by the staff. EVIDENCE: The home has introduced new, more comprehensive, plans of care giving details of actions to be taken by care staff to ensure that the needs of the service users are fully met. These care plans are being regularly reviewed. Of the plans inspected there were very few general or fall risk assessments and this is an area that needs closer attention. Service users health care needs were on the whole demonstrated as being met with input from G.P.’s, specialists, opticians, continence nurse, and district nurse where needed. However it was noted that the home accommodates several service users who have been diagnosed with dementia and these service users do not come within the category of registration for the home. This area needs to be addressed promptly. If the home wishes to gain an amendment to its registration to retain these specific residents it will need to prove that the staff have the skills and training needed to cope with their assessed needs. Medication administration was witnessed and sound procedures were being The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 10 followed. Any medicine brought into the home by family members is checked with the pharmacist prior to administration. Storage of medication was appropriate. It was witnessed that drugs for the current month had not been signed as received on the medication administration record sheet although those for the coming month had been checked and recorded. All service users asked considered that they are treated with respect and that their privacy is upheld. Two service users currently have their own personal telephone lines and the carers were able to explain how they assist the remainder of the service users when they wish to access a telephone. All service users looked clean and well cared for and the staff interacted with them in an appropriate manner. Visiting health professionals see service users in their own rooms and a screen is available for use in shared rooms when needed. The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 It was identified that a programme of activity and stimulation needed to be introduced. Service users choices are respected. A wholesome and balanced diet is provided Visitors are actively encouraged and are very happy with the home and the care given EVIDENCE: Most service users spoken to said that they did not partake in activities. One said “we are going to have a sewing class but it has not started yet”. One service user was witnessed doing 1:1 activities with carers. There is no specific activities programme, no dedicated activities co-ordinator, only very occasional visiting entertainers; and no planned outings or excursions, although service users families and friends do take them out. A proper activities programme with dedicated staff time needs to be introduced. Service users can eat their meals where they choose i.e. dining room, own room, or chair in the lounge. Religious observance is arranged when required to meet specific service users requirements. Visitors are welcome at times to suit the service users and several visitors were present in the home during the. time of the inspection, all expressing the opinion that the home offers good care and that the service users are happy. One visitor commented that “it gets better and better”.. 11 service users were spoken to on the day of the inspection and all but 1 praised the food with several comments of “excellent food” being made. The home provides three full meals each day and drinks are readily available throughout the day although some service users would prefer a hot The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 12 drink mid afternoon to the cold drinks currently offered and it is recommended that this practice is introduced. Special diets are catered for and service users personal choices are taken into account when planning the menus. The menu is changed weekly and there is no set rotation of menu choice. The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) This section was not evidenced at this inspection EVIDENCE: The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 24, 25, & 26 The standard of the environment within the home was satisfactory. Arrangements for protecting service users/staff are not satisfactory with regard to infection control procedures. EVIDENCE: Facilities provided are generally satisfactory. The home is comfortable, homely and generally well maintained throughout, but there was an odour of urine in one service users room. The grounds were not looking at their best due to the time of year but once outside seating is provided it will be satisfactory. The home has had a recent inspection of its kitchen by the Environmental Health Officer who has recommended the fitting of a dishwasher and this recommendation is strongly supported. The home has a large, pleasant lounge/dining area with double aspect windows and access via either steps or a wheelchair ramp to the upper lounge. The upper lounge is available for use by smokers. Furnishings, lighting and ventilation throughout the home are appropriate, with some service users preferring to provide their own bedroom furniture. Although there are no en-suite facilities provided in the home toilet The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 15 and bathrooms are easily accessible and commodes and urine bottles are provided where necessary. There is a lift available for access to the first floor when needed. Unfortunately this lift had been out of commission for a while restricting less mobile service user movements and meaning that they were marooned on the first floor, however the lift is now back in working order. Handrails have been fitted where appropriate in corridors; approved fire door restrictors are fitted allowing easier access to rooms for service users with more limited mobility; screens are available for use in shared room when needed; and a call bell system is fitted in all rooms. Unfortunately the home has not addressed previous requirements to cover all radiators and to reinstate the hand wash sink in the laundry. To comply with infection control procedures all soiled linen needs to be dealt with in the correct manner. There are no red sacks for the collection of soiled linen, there is no sluice facility on the washing machine; and staff are not washing soiled linen at a minimum of 65oc for at least 10 minutes in compliance with infection control procedures. The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 Staffing levels and skills mix are not maintained to a satisfactory level, especially at weekends. Staffing must be assessed against dependency levels of the service3 users. Staff require training to undertake their roles. EVIDENCE: In addition to the manager there are normally 2 care staff on duty each weekday morning and an additional member of care staff for 3 hours on weekend mornings. On afternoon shifts there are normally three carers and at night there are two carers awake and working. However on the day of the inspection the manager was on a training course and one afternoon carer was on holiday leaving only 2 carers on duty throughout the day. In addition to the care staff there is a cook employed Monday to Friday from 08.00 a.m.– 1.00 p.m., and dedicated domestic staff. Care staff are responsible for preparing. breakfasts (with the exception of 2),and teas, during the week and all meals at weekends. This arrangement leaves unacceptably low staffing ratios to cope with the dependency needs of the service users and to provide adequate mental stimulation for them. A staff training matrix was displayed in the office which demonstrates the training that has been completed but unfortunately there are far too many gaps. Adult protection training is not included on the matrix; statutory training has not been completed and where it has been undertaken much of it is out of date (i.e. courses undertaken in 2001); the home currently accommodates several residents who have been diagnosed with dementia but only 7 of the 19 staff shown on the matrix have undertaken any dementia training; there is only one member of staff recorded as having undertaken NVQ2 although there is a requirement that 50 of the care staff should have undertaken this training by 2005. One carer explained that she The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 17 did not want to attend college one day a week to do her NVQ and it was explained that such courses could be accessed in other ways than day release to college. Newer members of staff explained how their induction had consisted of shadowing other members of staff but were unable to confirm that they had completed National training organisation induction training. As the manager was unavailable these issues were not able to be discussed fully. The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) This section was not inspected at this time. However the previous requirement for Regulation 26 visits and reports is reiterated as at present the registered provider is failing in her duties to the home. EVIDENCE: Requirement for Regulation 26 visits has been noted on several inspection reports but to date no reports have been received by the Commission for Social Care Inspection. The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 1 3 3 3 x 3 1 2 STAFFING Standard No Score 27 1 28 x 29 x 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 1 x x x x x The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 25 Regulation 13 (6) & 23 (p) Requirement Timescale for action 31 May 2005 31 May 2005 31 May 2005 2. 26 3. 27 4. 29 5. 30 6. 33 7. 4&8 All radiators throughout the home should be guarded (previous timescale of 01/04/05 not met) 23 (j) A handwash basin should be reinstated in the laundry room (previous timescale of 03/04/05 not met). 18 (a) The home is staffed with sufficient staff to meet the minimum standard as recommended by the Residential Forum (previous timescale of 20/12/04 not met) 19 (1) (b) The manager operates a & thorough recruitment procedure, and ensures the protection of the Schedule 2 (1 - 9) service users (previous timescale of 20/12/04 not met) 18 (1) (c) All staff to receive national (i) & (ii) training organisation workforce training. All staff to receive the minimum of three days paid training per year 26 (1), The registered provider to (3) (4) (a) complete Regulation 26 visits to (b) (c) & the home on a regular basis and 5 (a) forward a copy of the report to CSCI (previous timescale of 30/12/04 not met) 4 (3) (b) The registered person shall H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc 31 May 2005 31 May 2005 31 May 2005 31 May Page 21 The Gateway Rest Home Version 1.20 & Schedule 1 (6) 8. 9 13 (2) 9. 12 16 (2) (n) 10. 26 16 (2) (j) 11. 12. 13. 30 26 26 18 (1) (c) (i) & (ii) 13 (3) 13 (3) provide accommodationonly to service users who fall within the registration category of the home. Records are kept of all medicines received, administered and leaving the home or disposed of to ensure that there is no mishandling. The registered person shall produce a programme of activities to provide facilities for recreation suitable for the assessed needs of the service users. Foul laundry must be washed at appropriate temperatures (minimum 65oC for 10 minutes) to thoroughly clean linen and control risk of infection All staff working at the home shall receive training appropriate to the work they are to perform Red sacks must be used for soiled linen in the interests of infection control. A washing machine with sluicing facility should be installed in the interests of infection control 2005 31 May 2005 31 June, 2005 31 May, 2005 31 July, 2005 31 May 2005 31 July 2005 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 1 Good Practice Recommendations Statement of Purpose to include name and address of registered provider. Service User Guide to provide details of individual accommodation and to be written in a format suitable for those it is intended. (This was a recommendation at the last inspection but has been reiterated as it was unable to be inspected on this occasion) A hot drink should be introduced mid afternoon to supplement the cold drinks currently on offer. H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 22 2. 12 The Gateway Rest Home 3. 4. 5. 6. 7. 19 26 26 A dishwasher be provided in the kitchen in accordance with the recommendation of the environmental health officer. A sluice facility washing machine be installed in the interests of infection control. The odour which is present in one bedroom should be addressed The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent, TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Gateway Rest Home H56-H05 S23559 The Gateway V221776 180405 Stage 4.doc Version 1.20 Page 24 - 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!