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Inspection on 24/08/07 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 24th August 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.

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

Residents all spoke positively about the home. Comments included: "I am very happy with the home." "The staff are very caring." "The manager keeps the place in order." "I have everything I want." and "Its only my poor physical health that stops me from going about freely." All relatives comments from surveys sent out were positive. Comments included: "My brother and I could not wish for my mum to be in a nicer home with caring staff." "The staff are very helpful, if the home was not homely and clean my mother would not stay there...always smells fresh and homely when you go in." "I could not wish for my mother to be in a better place." There is a friendly and welcoming atmosphere in the home. Residents look happy and well cared for. The interaction between staff and residents is good. The homes care planning system is well designed and aids good care. The food in the home is attractively served and wholesome.

What has improved since the last inspection?

There is a plan of activities to provide entertainment for residents including outside entertainers and musicians visiting the home for planned special events. The manager has made changes to the way and times the staff team work to support more activities and to provide additional hours needed for food preparation and cooking. Parts of the home have been decorated and a new washable flooring has been laid in one of the bedrooms. The home smelled clean and fresh. An additional hoist has been purchased for the safety and comfort of residents. A dishwasher has been purchased and a hand basin has been installed in the laundry. A gardener has been employed for the upkeep of both gardens and a ramp has been installed for easier access. More staff are studying and have achieved NVQ level 2 and above so that over half of the team will have this qualification by the end of the study year. The manager has developed a good quality assurance system. This is running well and picking up areas that need to be improved which the manager is acting on.

What the care home could do better:

The induction training package needs to be revised to include the general core standards. The manager is including this in the homes development plan. Continue to develop the occupational and physical activities in the home for residents. Continue to pursue employing an activities coordinator.

CARE HOMES FOR OLDER PEOPLE The Gateway Rest Home 409 Folkestone Road Dover Kent CT17 9JT Lead Inspector Julie Sumner Unannounced Inspection 12:00 24 August 2007 th 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 Gateway Rest Home DS0000023559.V345934.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 Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 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 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) 01304 203650 Mrs Ann Leonard Mrs Patricia Ann Thompson Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places The Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users DE(E) whose dates of birth are 29/09/1911 17/10/1920 25/08/1916 and 03/04/1918. 24th August 2006 Date of last inspection Brief Description of the Service: The Gateway Rest Home is a residential home registered for 20 older people. The current fees for the service at the time of the visit range from £312.00 to £390.00. Information on the home’s services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User (residents) Guide. The provider does not currently have a web address and if information is required the home’s telephone number is included on the previous page. 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. There is a rear, hard surfaced area and a garden behind and at the side where residents can sit in the summer months. The home has dedicated parking facilities at the rear of the property. The Gateway Rest 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 two domestic staff. The Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information received about The Gateway including an annual quality assurance assessment completed by the manager and an unannounced site visit to the home lasting 5 hours. Information was gathered for this inspection in a variety of ways both prior to and during this visit to the home. Surveys have been sent out and completed by relatives and visiting professionals. The visit included talking with residents, the manager, and staff. General observations were made during the afternoon of how people are supported. There was a tour of the building and various records were inspected. The people living in The Gateway were able to participate in the inspection by having conversations about their lifestyle and completing the surveys prior to the visit. It was not necessary to make any requirements or recommendations at this time. The manager and staff team have worked very well to meet all previous requirements and recommendations. What the service does well: Residents all spoke positively about the home. Comments included: “I am very happy with the home.” “The staff are very caring.” “The manager keeps the place in order.” “I have everything I want.” and “Its only my poor physical health that stops me from going about freely.” All relatives comments from surveys sent out were positive. Comments included: “My brother and I could not wish for my mum to be in a nicer home with caring staff.” “The staff are very helpful, if the home was not homely and clean my mother would not stay there…always smells fresh and homely when you go in.” “I could not wish for my mother to be in a better place.” There is a friendly and welcoming atmosphere in the home. Residents look happy and well cared for. The interaction between staff and residents is good. The homes care planning system is well designed and aids good care. The food in the home is attractively served and wholesome. The Gateway Rest Home DS0000023559.V345934.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 Gateway Rest Home DS0000023559.V345934.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 Gateway Rest Home DS0000023559.V345934.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): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home understands the importance of having sufficient information when choosing a care home and have a good assessment process. EVIDENCE: The residents guide and statement of purpose have just been reviewed. A sample of assessments were viewed and discussed with the manager. People who had moved into the home recently discussed their experiences and it was also possible to talk to some relatives. All spoke positively about their welcome into the home. A comment in one of the surveys returned said: “Family and mother went around 5 homes and this came out the best. Clean. Friendly.” The Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The staff team meets the health and personal care needs of the service users and their privacy and dignity are respected. EVIDENCE: A sample of service user plans were viewed and some of the contents discussed with the manager. They continue to be well maintained. All sections contain clear and easily accessible information and all viewed were up to date. Visits from professionals are recorded in the plan of care. Health risk assessments have been completed. All service users have a GP, usually keeping the one they were registered with prior to arriving at the home. Residents said that the manager always listens to them and if they feel they would like to see a Doctor they always can. A relative commented: “If and when my mother needs a Doctor the home get one straight away.” There is input from the district nurses and contact with the local mental health team for older people. The speech and language The Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 Page 10 therapist has been involved with two residents following referral and has provided advice and some communication aids. The medication administration system has been reviewed with the new pharmacist. Storage and records were discussed with the manager. Two more staff have had training. Residents said that staff respected their privacy and were always courteous. Some residents have had new telephones installed in their rooms. All comments received in surveys from residents and relatives were positive. One example of comment: “my mother’s privacy and dignity is respected at all times and she is always dressed nicely and looks clean.” The Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has taken residents views and interests into account and provided a more interesting lifestyle with a variety of activities. Meals are wholesome and visitors are welcome. EVIDENCE: The manager has put together a plan of activities, which was viewed and discussed. This includes a variety of seasonal home entertainment including sing-a-longs, that residents said they enjoy, and music for health sessions that involve physical exercise. Morning activities in the lounge are ongoing and residents mentioned them, saying they were good. Residents’ families and friends are invited to some of the planned events. Relatives in the home at the time of the inspection visit said they feel welcome and the staff and manager are approachable. An example of one of the comments from a relative in a survey was: “The home is very friendly and welcome you at anytime.” Residents spoke about their lifestyle and talked about the way the manager and staff help them do what they want. They said that they could choose where they spend their time, whether to join in with planned activities, when The Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 Page 12 to get up and go to bed and where and what to eat. They said that staff were responsive when they called. Residents were complimentary about the food and the standard is consistently good. The manager has covered the shortfall in the hours provided by the part-time cook by increasing some of the care staff hours at their request and allocating specific shift times when they prepare and cook the meals. Relatives all commented positively in the surveys sent out and all commented on the fresh meals made with fresh vegetables: “the food is fresh and it always smells nice and they have choice”, “my mother has all fresh vegetables and she can have a hot drink when wanted”. The Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ complaints are taken seriously and acted upon and they are protected from abuse. EVIDENCE: The complaints procedure is contained within the service user guide. It is comprehensive. Residents said they are confident to use the procedure. There have been no complaints. Residents said that staff listen if they are concerned and it is sorted out before they need to make a complaint. A relative referred to the complaints procedure in one of the surveys: ”it is in my mothers statement of purpose which was given when she came into the home and it is also on the wall as you come into the home – how to make a complaint.” And when asked ‘has the care service responded appropriately if you have a concern?’ answers were: “straight away”, “staff are very pleasant and act straight away” and “the staff are always around when needed.” Adult protection training is ongoing to make sure all staff in the team have attended and know what is expected of them. Two staff were spoken to who have attended and both said they found it useful. The Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is a pleasant, safe place to live with specialist equipment provided to meet the needs of the residents. EVIDENCE: There was a tour of parts of the home with the manager. All areas of the home looked clean and smelled fresh. The furniture and fittings are arranged in a homely way and looked in good repair. The windows are double glazed and all the radiators have been covered. There is a maintenance sheet on the staff notice board so if anything goes wrong they can phone the appropriate person straight away and get it sorted out. The sitting room is spacious and airy and some of the residents participated in the inspection visit by talking about life in the home. The Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 Page 15 Some residents spoke in their bedrooms about their experiences in the home. They said they were happy with their rooms. They looked well furnished, clean and comfortable. One relative commented: “my mother has a single room with her own furniture and pictures in it. She can have what colour she likes on the walls. She also picked her own colour for carpet so it is like she was at home.” The call bells have been extended to make sure they are available at all times. Bedrooms have accessible call bells also from bed and chair to assist with people who have mobility difficulties. Equipment is provided to meet individually assessed needs. Recently an additional pressure mattress and cushion have been obtained and a new larger hoist has been purchased that is more comfortable and residents confirmed this. A gardener has been employed to keep the gardens well tended for the residents. Although residents said they had not been able to get out into the garden much this summer because of the weather. The bedroom with the strong odour of urine at the last inspection has been fitted with washable flooring and the odour is under control. A dishwasher has been fitted into kitchen as advised by EHO at their last visit. The Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home have confidence in the staff who care for them. There are well thought out and creative ways of making sure the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who live there. EVIDENCE: The manager has changed the staffing structure to accommodate increased hours for activities and meal preparation. It was not possible to employ an activities coordinator or another part time cook. Some of the current care staff have increased their hours to accommodate this need in the home. Residents said that they felt well supported by the staff. The staff said that it was working well. A sample of staff files were viewed with particular reference to new staff employed. CRB and POVA and all appropriate recruitment checks have been carried out. There is an ongoing programme of training and samples of the records were viewed. Staff discussed their training including the NVQ training. There has been good progress with NVQ training with over half the team either studying level 2 or 3 or having achieved it. All staff have had annual appraisals and said The Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 Page 17 they had found them useful in identifying what skills they would like to develop and what they would like to study. One member of staff said that it was through that process that she decided to study NVQ level 3. The Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager has good people skills, supports staff well and understands the importance of person centred care and effective outcomes for the people living in the home. There is effective implementation of risk assessments and good maintenance to provide a safe environment for residents to live in and staff to work in. EVIDENCE: The registered manager has NVQ 4 in care and management and two additional elements for registered managers award. The Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 Page 19 The quality assurance system has been developed. A policy has been written including all aspects of development of the home and around the standards. The manager carries out audits monthly and different aspects of the home are assessed. The outcome of this determines what the manager does each month and a development plan is formed. Parts of the system plans and records were viewed and discussed with the manager. For example: All annual appraisals have been updated and the quality assurance form reflects this and the manager made sure that they were completed before that part of the assessment was completed. Residents, their families or representatives control their own monies and the home does not hold, or deal with, any residents’ money. Mandatory training has been provided and is ongoing. Staff spoken to had up to date training. Training has been provided steadily in adult protection, dementia care, and all mandatory areas of first aid, food hygiene, moving and handling, health and safety, fire safety, and infection control and there has been an improvement in the number of staff having up to date training. Manual handling risk assessments have been completed for all individuals. A new hoist has been purchased which has a larger more comfortable sling and residents confirmed that they did feel safe and comfortable in it. Other equipment has also been supplied by the district nursing services to support with pressure areas and movement. The Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 Page 20 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 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 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 3 x 3 x x 3 The Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 Page 21 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. 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 Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Gateway Rest Home DS0000023559.V345934.R01.S.doc Version 5.2 Page 23 - 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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