Care Home: Gate House

What the care home does well The success of this home can be measured by the progress residents make including a number who have to move to more independent accommodation. It is evident from our discussions with residents, staff and manager that residents who are correctly assessed and placed settle well into the caring and therapeutic milieu. Residents told us that the manager gives them confidence and they are clearly very fond of her. The manager describes her style as providing assertive care, that is, residents are given responsibility but also reminded of their responsibility towards others and themselves and she encourages, coaxes and even cajoles residents into a healthier lifestyle and better adaptation to their illnesses. What has improved since the last inspection? What the care home could do better: On this occasion we make no requirements but make a few recommendations, including the need to change the details of the Commission in all relevant documents such as the statement of purpose and complaints procedure. We also support the residents` request for annual holidays and more outings.Gate HouseDS0000025620.V376143.R01.S.doc Version 5.2 Key inspection report CARE HOME ADULTS 18-65 Gate House 238 New Cross Road London SE14 5PL Lead Inspector Michael Williams Key Unannounced Inspection 23rd June 2009 10:15 Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gate House Address 238 New Cross Road London SE14 5PL 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) 0207 6356883 Mr Lynval Palmer Mrs Marjorie Palmer Ms Hazel May Parkinson Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia Code MD The maximum number of service users who can be accommodated is: 10 9th September 2008 2. Date of last inspection Brief Description of the Service: Gate House is a small, privately run care home providing support and accommodation for up to ten adults who have support needs due to mental ill health. Gate House is a converted semi-detached family home and is located in a residential terrace on the busy New Cross Road in South East London. It therefore has good access to London Underground, mainline rail stations and buses. Service users have access to a wide range of local amenities and community resources. Accommodation is now provided in single bedrooms with all double rooms now being occupied by a single resident; this has reduced occupancy from 10 to 7 residents. Service users admitted to the service have to be physically able because this home is not adapted for people with physical disabilities. The home has the usual facilities including a lounge and separate dining room, kitchen, shower, bathroom, toilets, a very small laundry cupboard and an exceedingly small office space. Most bedrooms are not ensuite and have just a wash-hand basin. Because this is an older, ‘existing’ care home the National Minimum Standards for bedroom accommodation are not applied in full to such homes. There is a garden to the rear of the premises and some off-street parking space to the front of the property. The owners, Mr & Mrs Palmer tell us that they are resolved to review fees to take account of the changes to resident numbers and in order to be able to meet National Minimum Standards so at the time of writing, in June 2009, the fees were being revised and renegotiated. The manager has advised us that there have been no changes to the ownership of the care home and it remains owned and operated by Mr L ‘Frank’ Palmer and Mrs M Palmer. Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This key, unannounced inspection included a visit to the Gate House on 23rd June 2009. We spoke to people who use the service (in this home they prefer to be called residents and this is the term used in this report) and any visitors; we also met with staff and the manager. The owner, Mr Palmer has outlined his plans for the future of this home on previous occasions but he was not present for our visit in 2009. We toured the building. We cross-checked information by reading various records including residents case files, staff records and other statutory records such as the accident book, the record of complaints, medication, food records and so forth. We also took account of any information provided to us since we last inspected the care home in 2008 and this included the AQAA form (the Annual Quality Assurance Assessment). We received 11 replies to our surveys. What the service does well: What has improved since the last inspection? What they could do better: On this occasion we make no requirements but make a few recommendations, including the need to change the details of the Commission in all relevant documents such as the statement of purpose and complaints procedure. We also support the residents’ request for annual holidays and more outings. Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 6 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1, 2 and 5: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is provided and choice is offered to prospective residents, so residents will get appropriate information to help them make a decision about whether or not this home could meet their needs. EVIDENCE: Gate House provides a statement of purpose that is specific to the individual home and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by a resident’s guide. The guide details what the prospective residents can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff, how to make a complaint and contains comments and experiences of residents living at the home. All residents are given a copy of the guide. When requested the service can provide a copy of the statement of purpose and guide in a format which will meet the capacity of the resident. Both the Statement of Purpose and the Resident Guide are readily available but not all the details are accurate; for example the contact details for the Commission are now in Newcastle upon Tyne and neither Pentonville Road nor Sidcup as stated in the home’s document. since these are recent changes within the Commission we are recommending the documents be reviewed at the manager’s earliest convenience. We required the service to give each new resident a contract or agreement making clear what fees are payable, this is something residents are entitled to be informed about from the outset of their Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 9 placement. The new resident was given these details upon admission. Similarly the needs of the resident were made known to the service before admission so that a provisional care plan could be drawn up without delay and this was also in place as required. Prospective residents are given the opportunity to spend time in the home. An individual member of staff, a ‘key worker’, is allocated to give them information and to help them understand how the home is organised and run and the facilities and services available. We checked the documents supporting the care of a new resident and note that very detailed assessment and care planning advice was provided to assist Gate House in assessing whether or not it could meet the needs of the resident and in formulating its own plans. Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 6, 7 and 9: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ needs are being assessed and planned for from the outset and residents are being supported to make choices about how their needs will be met so residents can be assured their voice will be listened to in meeting their individual needs. EVIDENCE: As we found last year, the manager of Gate House is ensuring that residents are involved in the planning of their care so as to reflect their preferred lifestyle and quality of life. We spoke to the manager and a care worker to confirm that they understand the importance of residents being supported to take control of their own lives in so far as it is safe and possible for them to do so. Individuals are encouraged to make their own decisions and choices, for example in how they spend their day, whether they engage in training or attend day centres, what leisure pursuits they follow and so on. The home checks and records the preferred communication style of the individual – in this home all residents have a good grasp of spoken and written English so no specialised communication tools are needed but the home checks that this is the case for each new resident. Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 11 Care plans are agreed with the individual resident and specific to their needs. A visiting Community Psychiatric Nurse confirmed last year that this was the case and commended the manager for “working with her team to develop and follow prescribed plans of care, particularly when residents present with challenging behaviour”, she said. A Nurse the year also advised us that in her survey form that the home “looks after the residents well and staff have good interaction with residents”. We saw for ourselves the good humoured interaction between staff and residents, creating a relaxed and friendly atmosphere. Plans are written in plain language, are easy to understand and look at all areas of the individual’s life. They include reference to equality and diversity and address any needs identified in a person centred way. Staff have skills and ability to support and encourage residents to be involved in the ongoing development of their plan. The manager explained that the work of developing care plans would be much simpler and more professional looking if the home had a computer. It was surprising for us to discover in 2008 that the home did not have one; this has now been rectified by Mr Palmer and computer is now on site and available for the manager, staff and residents to use. Documents are already looking much more professional as result. Care plans are being written with the involvement of the individual resident, and their representative, and the plans include a range of information that is important to them. This includes information about risk assessments, how they keep safe, their goals and aspirations, how they communicate, their skills and abilities and how they make choices in their life. They include information about their health. It is kept up to date and focuses on how individuals will develop their skills, and considers their future aspirations. Each care plan includes a risk assessment, which is reviewed regularly. The management of risk is positive in addressing safety issues while aiming for improved outcomes for people. Where there are limitations, the decisions have been made with the agreement of the person or their representative and are accurately recorded. Risks associated with mental illness not infrequently involve issues of medication and relapse as well as indicators such as change in mood and daily routines so we discussed this with the manager in some detail and conclude that any changes in mood, behaviour or cooperation are reported promptly to the mental team who visit to support the resident and advise the staff team. The home ensures that residents are consulted regularly in house meetings to gather information about their satisfaction with the home. Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: NMS 12 to 17: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect a comfortable and well supported lifestyle in Gate House with easy access to the community, support to maintain contact with family and friends and residents will be provided with suitable meals this is so that residents can expect the lifestyle that suites them. EVIDENCE: Residents have the opportunity to develop and maintain important personal and family relationships, this is particularly true where residents may have lost contact with family or have reduced contact because their illness has adversely affected family relationships. The manager works hard to rebuild these social relationships and supports residents to build new friendships. The staff promote individual rights and choices from simple matters such as smoking to more complex issues such as medication, handling their own money and personal relationships. Staff are aware of the need to consider the protection of the residents themselves and those about them, and so support them to make informed choices – the need to comply with medication and review it with a their psychiatrist being an important example. The service Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 13 respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. This is reflected in the initial planning when the home seeks to ascertain what issues are important to the resident whether is a matter of race, gender, beliefs or sexuality. The staff team help with communication skills, both within the service and in the community, to enable residents to fully participate in daily living activities. Residents are involved in some meaningful daytime but they did say in heir surveys that they would like more outings and annual holidays and the manager advised us that this is already being arranged subject only to local authorities supporting the funding for this since the current fees do not yet cover holidays. Residents have been fully involved in the planning of their lifestyle and quality of life. Where appropriate, education and occupational opportunities are encouraged, supported and promoted. Whilst it is true the home will support staff in all these aspects of leading a fulfilling and enriched life in reality residents often prefer a quiet lifestyle, just sitting with other residents in the lounge watching television or smoking in the smoking room, or walking down to the local shops. Some resident do attend day centres or undertake some voluntary work and training opportunities can be provided but in the main their social life and their mental health is maintained in a rather less dynamic way. Whilst we accept that many residents are very independent and can undertake a lot of daily tasks such as shopping, cooking cleaning, without much support there will be times when residents need support and the current staff number roster have been changed to make this possible, the staff numbers and their deployment on the duty roster is now more flexible. Support is being offered in the service by a skilled and trained team – the local Community Mental Health Team. Residents can access and enjoy the opportunities available in their local community, such as using public transport, library services, the local pub, and local leisure facilities. The service is committed to the principles of inclusion and promotes and fosters good relationships with neighbours and other members of the community. Sadly this is not always reciprocated by the school, adjacent to the home, where children are seen throwing stones and other objects towards Gate House. All residents are involved in the domestic routines of the home but they will admit that they sometimes feel ‘bullied’ into working in the home. here a balance is being drawn between support towards rehabilitation and a resident’s right to refuse to engage but we conclude some coaxing is appropriate and reflect a duty a care to ensure residents do not become isolated, too sedentary and introspective. They take responsibility for their own room, menu planning and cooking meals, making sure that they are able to enjoy the food they prefer and like. The menu is varied with a number of choices including a healthy option, especially as some residents are at risk of becoming overweight. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals including those with diabetes. Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 18 to 20: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured they will receive the health and social care support they need. EVIDENCE: The home’s stated aim is to provide residents with personal and healthcare support based upon the rights of dignity, equality, fairness, autonomy and respect and so far as we were able to judge during this visit this seems to be the case. We discussed matters of racial, gender and sexuality and the manager is confident she respects all these aspects of each resident. The staff team does now reflect the racial mix of the resident - the manager explained that she has employed some staff who are English and she has both male and female carers. All residents speak English. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each care plan. These plans give a comprehensive overview of their health needs and act as an indicator of change in health requirements, particularly mental health requirements. The statement of purpose details the specialist ‘treatments’ or support the home can deliver with a commitment to individualised care packages, and this document refers to the skills and ability of the staff group. Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 15 Residents have access to healthcare and remedial services; again this primarily mental health support from Community Psychiatric Nurses [CPN], care coordinators and psychiatrists. Staff make sure that resident are encouraged to be independent, have regular appointments and visit local health care services. Staff have access to training in health care matters and are encouraged and given time to attend seminars on specialist areas of work. The home has a medication policy supported by procedures and practice guidance, which staff understand and follow. The home is supporting some residents to self-administer their medication. A weeks supply of medication is supplied to these residents, and there are currently three sets of records kept. We found that the home has in place care plans and risk assessments and that the home maintains contact with the mental health team also supporting the resident. We found that prompt action is taken when needed including direct contact with the resident’s doctor and other support workers if relapse or change in a resident’s behaviour is noted in the home. Family and friends are kept informed in so far as this is possible and the Commission is being notified of incidents as required. Overall, it is evident that the personal care and support, including mental and physical health care, given to residents is providing very good outcomes for residents; that one resident has moved on in the last 12 months and another is ready to do so confirms this general point and the home is to be commended for its good work. Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 22 and 23: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has in place a complaints procedure and safeguarding adults procedure so residents can be assured their voice will be listened to and they will be protected form harm. EVIDENCE: This standard has been checked in some detail on previous occasion ad as we are advised there have been no substantive changes we confirmed the good arrangements for complaints and safeguarding remain in place. A copy of the complaints policy had been placed in the entrance hall of the home so it is visible to service users, their relatives and representatives. A record of complaints is in place and on the day of inspection no complaints were drawn to our attention either in person or through the survey forms. We confirmed that the home has an appropriate adult protection policy in place that addresses the different types of abuse and procedures to follow if abuse is suspected and identified. The home has a staff team of 7 carers; we interviewed one to check their understanding of the safeguarding procedures. This person was well acquainted with various possible forms of abuse and how to report incidents to his manager and how to contact the local Social Service Department (who are responsible for coordinating and investigating allegations of abuse). There have been no adult protection investigations undertaken in relation to the home since the last inspection. Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 24, 28 and 30: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst homely and conformable for residents we cannot assure residents that the Gate House is always suitable for its purpose as a care home and is not always safe for residents. EVIDENCE: During the course of this inspection we checked to ensure that the various issues we raised in 2008 have been addressed or are in progress. And this appeared to be the case. Gate House care home is a domestic dwelling house that has been converted to accommodate up to ten residents and has facilities for a member of staff to sleep-in when on night duty. Although originally it was registered for up to ten residents the manager explained that all bedrooms are now occupied by a single resident in each and this has reduced occupancy levels to seven. The owner is therefore considering extending the accommodation to add further single rooms of a more modern standard for example bedrooms with ensuite facilities. To this end we are told that Planning permission has been sought from the local authority. The home will in due course apply to the Commission to change details of registration in particular the number of bedrooms. Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 18 The home has a single large communal lounge and separate dining room. There is also a small room used by smokers. There is no private visitors’ room and no facility for residents, visitors or visiting professionals to meet with residents other than their bedroom – contrary to the guidance in the national minimum standards (NMS 28.2v.). A conservatory would greatly improve communal space and provide the recommended communal spaces. It would also give residents a choice about where to sit and with whom since this client group sometimes need ‘space’ to sit apart from others in the home. Improvements in the physical environment is now planned for. It is unfortunate that the laundry room that was sited on the first floor adjacent to bedrooms and so generates a lot of heat and humidity on this floor. The washing machines are now in a small cupboard accessed from outside the house. We assume this to be temporary and somewhat unsuitable for residents and staff - who need a more suitable and accessible laundry area. The cellar was in considerable disarray; it could be tidied and upgraded so as to provide some storage space or serve some other practical use. Storage space is at premium in this home and a suitably robust storage space/shed could be erected in the garden to replace the near derelict shed now standing in the corner of a rather unkempt garden. Again all this is planned for once planning permission is achieved. The facilities for staff are not suitable; in particular the manager has been given a large cupboard in which to work and this is quite unsuitable but she now has computer which she tells us has helped tremendously in her paperwork. The ‘office’ is still not suitable and unless it is rectified it is unlikely the home will ever manage to maintain a good standard of administration. The manager has no suitably private place to meet visitors. As before, when we were inspecting the home we were obliged to use the residents’ dining room to interview staff and check records. One of the owners, Mr ‘Frank’ Palmer, has however acknowledged the need to improve this and he is working on a number of options and we note and commend his continuing commitment to make the necessary improvements to his home. We toured a number of bedrooms and other facilities and, as we have mentioned before, this is a domestic scale care home with the advantages of homeliness but the disadvantage of limited space and an old building showing signs of wear and tear. Safety issues we identified in 2008 have been addressed including broken windows, electric plugs and fire doors. Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 32, 34 and 35: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements appear acceptable but need reviewing so as to ensure there are adequate numbers of staff on duty at all times to meet the varying needs of residents. EVIDENCE: The home caters for a group of residents with wide ranging needs as described in the first paragraph of its Statement of Purpose; from those with a risk of relapse and challenging needs to residents who are more independent and ready to move on to independent accommodation. So the home needs to vary its staffing levels according to the client group at any particular time; for example when a new resident is admitted and those risks might be at their greatest then more staff should be on duty whilst less staff might be needed if all residents are operating more independently and successfully with minimal social support. Last year the home had a fixed staff roster, 2 per shift and 1 at night, which did not reflect this variable need. The manager advises us that this is now much more flexible and the day of our visit was a good example, an extra member of staff was on duty to escort residents to hospital. Since the home makes clear, in its Statement of Purpose, it can cater for a client group with a wide range of needs range of fees should reflect this and fees also need revising to reflect extra costs of the necessary increased staffing Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 20 levels and again the owner Mr. Palmer and the manager are addressing this by writing to funding authorities. The manager advises us in the home’s AQAA [Annual Quality Assurance Assessment] that there are seven care staff of whom two have NVQ Level 2 [National Vocational Qualification] and three are working towards this qualification; the manager herself has NVQ 4 (amongst other qualifications). The staff team now reflects the resident group since the manager has employed European staff as well as staff from other ethnic backgrounds and she employs both male and female staff. We again checked procedures for recruiting staff and we are advised for example when on site and in the AQAA form that all staff have had the correct CRB [Police] checks and references taken up. The manager now has in place provision for the appraisal and regular supervision of staff as required in previous inspections. We checked staff files and spoke to staff to confirm they are getting the support they might expect of the service. In respect of the safeguarding protocols we noted in 2008 that staff were not as clear about referring allegations of abuse to the local Social Service Department but in our discussion with staff this year it was evident they ere much clearer about these details including safeguarding, protection from abuse and whistle-blowing. It is commendable that staff are undertaking NVQ at level 3 and will shortly finish their college based courses. Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 37 , 39, 41 and 43: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We have reservations about how well this home is being run, there are some strong elements but the residents cannot be assured that in all aspects of the running of Gate House leadership is skilled and competent. EVIDENCE: In respect of the running of this service we formed the impression in 2008 that whilst the registered manager and the owner Mr Palmer had a good working relationship this was not being translated into good management of the care home. The owners have appointed a manager, Mrs Hazel Parkinson who is registered with the Commission, but the owners had not delegated managerial roles to her. We find matters in this area now much improved; we form the impression that the owner Mr Palmer is intent on taking this home forward, raising standards and improving the quality of the service including the Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 22 environment. To this end he has submitted planning applications for improvement to the premises. The installation of computer in the home is clear indication of his stated commitment to raise this home from its adequate in 2008 to at least a good rating, and good outcomes for residents, in future. A number of matters are not yet fully resolved pending the physical improvements to the building such as the lack of suitable office space. We were also very concerned that the manager was allocated no supernumerary time to undertake her management duties such as the supervision of staff, updating policies and procedures, preparing care plans and so forth. This has now been addressed and the roster shows that her hours and that of staff is now more flexible depending on managerial and care needs in the service. When we checked a small sample the home’s policies and procedures in 2008 we found they were inadequate; for example, some were out of date, some were referring to the wrong national minimum standards (those for older people). These policies and procedures had not been modified to reflect the services provided in Gate House. With the computer now up and running the manager has been working hard to bring policies and procedures up to date. As part of Mr Palmer’s in-put to the service as owner he is now making regular, monthly visits and reporting on his findings and we check the records to ensure this was the case. This means he can now monitor more effectively the running of his service and identify shortcomings somewhat sooner than in previous years. Overall, we are more confident that the owner Mr Palmer and the manager Mrs Parkinson are working in partnership to raise, and we expect maintain, standards for residents. The improvements already made in the last twelve months indicate the service is now providing a good rather than adequate service to residents. Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 X 3 X 3 Version 5.2 Page 24 Gate House DS0000025620.V376143.R01.S.doc Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations Statement of Purpose and resident Guide: We recommend that these documents be further revised to reflect the Commission’s new national contact details. This is so that residents and other will have the correct contact information. Complaints policy: We recommend that this document, and any other with old NCSC and CSCI details, be further revised to reflect the Commission’s new national contact details. This is so that residents and other will have the correct contact information. Holidays: We recommend that the home renegotiate contracts on behalf of residents so as to include the holiday opportunity referred to in the Standards. This is so as to respond to the requests by residents. We acknowledge that this process has been started by manager. Social outings: we recommend that arrange social outings so as to meet the residents wishes in this respect. We acknowledge that the manager has begun addressing this matter. 2 YA22 3 YA14 4 YA14 Gate House DS0000025620.V376143.R01.S.doc Version 5.2 Page 25 Care Quality Commission National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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