Care Home: Gate Lodge

What the care home does well Residents are being provided with all the information they require to enable an informed choice as to where they would like to live. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 7Residents are being provided with written information detailing the terms and conditions of their placement. The home is able to demonstrate that it is obtaining full information regarding the health and support needs of prospective residents prior to their admission. Prospective residents, their friends and relatives are able to visit to assess the suitability of the home The health care needs of residents are being fully met. Residents are being safeguarded by the home`s medication policies and procedures. All staff have completed accredited medication training. Residents feel that that they are being treated with respect and that their right to privacy is being maintained. Residents can be assured that, in the eventuality of their death, their wishes will be respected and that they and their family will be treated with care, sensitivity and respect. Residents are being provided with many and varied opportunities for meeting their social, cultural, religious and recreational needs. Residents are being actively encouraged to maintain contact with their family and friends and to retain links with the local community. Residents are being actively assisted to exercise choice and control over their day-to-day routines and decision-making. The meals provided are wholesome and appealing and are served at times, and in places, which are convenient for residents. Residents and their relatives can be assured that the home has an appropriate complaints policy and procedure in place, and that their complaints will be listened to, taken seriously and acted upon. The legal rights of residents within the home are being well protected and promoted. The protection of residents is being well safeguarded by the home`s adult protection, policies and training. Residents are living in a safe, well-maintained environment, with access to safe and comfortable facilities. Risk assessment of the home is in place for their protection.Residents` rooms present as being safe, comfortable and pleasantly decorated, reflecting individual residents` personal identities, and being suited to their individual needs. Residents have access to safe and comfortable communal facilities. Sufficient bathing, washing and toilet facilities are being provided for the home`s residents. Residents` safety is being assured through the provision of sufficient aids and adaptations. Residents are living in a home that presents as being clean, pleasant and hygienic. The home has the numbers and skill mix of staff sufficient with which to safely and appropriately meet the needs presented by the home`s residents. Residents are being safeguarded by satisfactory recruitment policy and procedures, and by the necessary recruitment and criminal records checks. Staff are being provided with appropriate induction and training with which to perform their work duties competently, and with which to safely and fully meet the needs of residents. The home is being very well managed, and in a way that demonstrates that it is being run in the best interests of residents. The home is consulting widely with residents, relatives and other stakeholders, and is evidencing the home`s ability to meet its aims and objectives. Through the regular and appropriate supervision of staff, good practice is being promoted and the welfare and best interests of residents protected. The interests of residents are being safeguarded by the home`s record keeping, with records being kept secure, up to date and accurate. The health, safety and welfare of residents and staff are being appropriately promoted and protected. What has improved since the last inspection? Residents are having their health, personal care and social needs set out in detailed and individualised care plans. These have become more personcentred in their focus. What the care home could do better: Mr Chellun needs to complete his management studies qualification and complete his registration with the CSCI. CARE HOMES FOR OLDER PEOPLE Gate Lodge 1 Upper Woodcote Village Purley Surrey CR8 3HE Lead Inspector Peter Stanley Key Unannounced Inspection 24th April 2008 09:30 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 Gate Lodge DS0000025784.V362075.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. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gate Lodge Address 1 Upper Woodcote Village Purley Surrey CR8 3HE 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) 020 8668 7286 F/P 020 8668 7286 gatelodgeresthome@yahoo.co.uk Mr Paramaseeven Chellun Mrs Georgia Chellun Care Home 16 Category(ies) of Dementia (16) registration, with number of places Gate Lodge DS0000025784.V362075.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 (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 16 27th April 2007 Date of last inspection Brief Description of the Service: Gate Lodge provides residential care for up to 16 elderly service users who have dementia. The home’s registration was revised on 17/12/07 to allow the admission of service users under the age of 65. The home is an attractive detached property located on the green of Upper Woodcote Village within a pleasant residential area; it is within walking distance of a small village shop and is surrounded by several larger houses. The home has 12 single rooms and two double rooms located on two floors, ground and first floor. Gate Lodge has two adjoining lounge areas and a separate dining room. The home does not have a lift and thus access between the ground and first floor is by stairs. There is parking for three cars to the front, and parking is also available on the road outside the home. There is a well-kept garden available for the use of service users. Gate Lodge DS0000025784.V362075.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 3 stars. This means the people who use this service experience excellent quality outcomes. This key inspection was conducted over one day and involved discussion with the registered provider’s son, Mr Jason Chellun, who is presently managing the home following the retirement of the registered manager, Mrs Christina Thambirajah, in December 2007. Mr Chellun is in the process of applying to the CSCI to become the home’s new registered manager, and has to complete the required interviewing process. He is also nearing the completion of his studies for an NVQ Level 4 and Registered Manager Award social care management qualification. On the basis of this inspection, the home is evidenced to have built on its previous good progress and has been assessed as having achieved excellence on four of the seven sets of standards (Choice of Home, Health & Personal Care, Daily Life & Social Activities and Complaints & Protection). The other three sets of standards have been assessed as good (Environment, Staffing and Management & Admin). Gate Lodge provides residential care for up to 16 older residents with dementia, the preferred age-range being from 60 upwards. While there are no vacancies at present, there are plans to build a new annexe to accommodate a further 3 residents. The inspector spoke with a large number of residents, which included some residents who have been admitted to the home in recent months. The inspector also spoke to a senior care worker and to other staff who were on duty. The inspector also received completed questionnaires from four relatives and three residents. The home has placed considerable emphasis on developing a person-centred approach to providing care, with staff receiving training and consultation from a PSP trainer from the local authority (in Croydon). This approach has aimed to identify residents’ wishes, interests and choices and to involve individuals as fully as possible in the delivery of their care and support. This is reflected in detailed and personalised individual care plans, and individualised activity programmes, these being reviewed on a regular basis. The home has a varied range of activities, and is evidenced to be respecting individual wishes and choices, and their privacy, dignity and rights. The feedback received has been generally very positive, with favourable comments being made about the home and the support being provided by staff. Views expressed by relatives indicated that Gate Lodge provides a safe, Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 6 pleasant and welcoming environment, and that the home is providing a good standard of care and support. Feedback indicated that visitors feel very welcome when they visit the home, and that there is good communication with relatives regarding residents’ health, welfare and support needs. Food was perceived as being very good, with options being offered to suit individuals’ preferences and dietary needs. The inspector examined documentation including residents’ care plans, risk assessments, activity charts and daily logs, medication records, staff supervision and training records, policies and procedures, staff rotas and logs relating to incidents, accidents and complaints. Care records and other documentation were examined, and the records of 7 residents, who have been admitted during the last 12 months, were case-tracked. Information was also available from the Annual Quality Assurance Assessment (AQAA) This was completed prior to the inspection by the home’s manager. The inspector carried out a full inspection of the premises and completed checks relating to health and safety. There is just the one requirement from this inspection- for Mr Chellun to obtain his management studies qualifications (NVQ Level 4 and Registered Manager’s Award), and to complete his registration with the CSCI (which he is in the process of doing). There are two recommendations from this inspection, both of which were discussed with the manager. The inspector feels that the support and development of staff would benefit from the two deputy managers extending their involvement from staff supervisory responsibilities to becoming involved in the staff appraisal process. To assist in meeting the needs of residents who may become confused or disorientated, the inspector recommends that the door frames of bathrooms and toilets are covered in fluorescent yellow strips, and that appropriate signage is placed on doors. This would assist residents to be able to more readily identifying these facilities. The inspector would like to extend his thanks to the manager, Jason Chellun, and to staff and residents, for their assistance in helping to facilitate this inspection. What the service does well: Residents are being provided with all the information they require to enable an informed choice as to where they would like to live. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 7 Residents are being provided with written information detailing the terms and conditions of their placement. The home is able to demonstrate that it is obtaining full information regarding the health and support needs of prospective residents prior to their admission. Prospective residents, their friends and relatives are able to visit to assess the suitability of the home The health care needs of residents are being fully met. Residents are being safeguarded by the home’s medication policies and procedures. All staff have completed accredited medication training. Residents feel that that they are being treated with respect and that their right to privacy is being maintained. Residents can be assured that, in the eventuality of their death, their wishes will be respected and that they and their family will be treated with care, sensitivity and respect. Residents are being provided with many and varied opportunities for meeting their social, cultural, religious and recreational needs. Residents are being actively encouraged to maintain contact with their family and friends and to retain links with the local community. Residents are being actively assisted to exercise choice and control over their day-to-day routines and decision-making. The meals provided are wholesome and appealing and are served at times, and in places, which are convenient for residents. Residents and their relatives can be assured that the home has an appropriate complaints policy and procedure in place, and that their complaints will be listened to, taken seriously and acted upon. The legal rights of residents within the home are being well protected and promoted. The protection of residents is being well safeguarded by the home’s adult protection, policies and training. Residents are living in a safe, well-maintained environment, with access to safe and comfortable facilities. Risk assessment of the home is in place for their protection. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 8 Residents’ rooms present as being safe, comfortable and pleasantly decorated, reflecting individual residents’ personal identities, and being suited to their individual needs. Residents have access to safe and comfortable communal facilities. Sufficient bathing, washing and toilet facilities are being provided for the home’s residents. Residents’ safety is being assured through the provision of sufficient aids and adaptations. Residents are living in a home that presents as being clean, pleasant and hygienic. The home has the numbers and skill mix of staff sufficient with which to safely and appropriately meet the needs presented by the home’s residents. Residents are being safeguarded by satisfactory recruitment policy and procedures, and by the necessary recruitment and criminal records checks. Staff are being provided with appropriate induction and training with which to perform their work duties competently, and with which to safely and fully meet the needs of residents. The home is being very well managed, and in a way that demonstrates that it is being run in the best interests of residents. The home is consulting widely with residents, relatives and other stakeholders, and is evidencing the home’s ability to meet its aims and objectives. Through the regular and appropriate supervision of staff, good practice is being promoted and the welfare and best interests of residents protected. The interests of residents are being safeguarded by the home’s record keeping, with records being kept secure, up to date and accurate. The health, safety and welfare of residents and staff are being appropriately promoted and protected. What has improved since the last inspection? Residents are having their health, personal care and social needs set out in detailed and individualised care plans. These have become more personcentred in their focus. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 9 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. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 10 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 Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 11 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): 1 to 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are being provided with all the information they require to enable an informed choice as to where they would like to live. Residents are being provided with written information detailing the terms and conditions of their placement. The home is able to demonstrate that it is obtaining full information regarding the health and support needs of prospective residents prior to their admission. Prospective residents, their friends and relatives are able to visit to assess the suitability of the home EVIDENCE: Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 12 The home has a Statement of Purpose and Service User Guide that meets the information needs of residents and their relatives. These have been reviewed and updated, and includes reference to the change in the Home’s registration. Though still primarily meeting the needs of residents, over the age of 65, who have dementia, the change allows for the admission of adults with dementia who are under the age of 65. The Home is not, however, intending to admit any younger adults in this category, but to remain focussed on meeting the needs of older persons. Following referral, the home requests full information regarding the health, care and support needs of any prospective resident and completes its own full assessment and risk assessments. Prospective residents, their friends and relatives have the opportunity to visit the home, and to meet other residents and staff, prior to any decision regarding an admission being taken. Time is given for the prospective resident, and relative(s), to see the home and ask questions, a pre-assessment meeting being held to discuss the proposed admission. There are presently 16 residents living in the home, 7 admissions having taken place since the last inspection on 27/4/07. The residents’ files were examined. The relevant care management assessments and care plans were evidenced, together with the home’s own assessments and risk assessments. The inspector also evidenced that care reviews had taken place following the initial settling in period, with the resident, his/her close relatives and their care manager attending. The home has admitted two adults who are both in their early sixties. Both residents have indicated that they have settled well into the home, and there have been no apparent difficulties with integrating into the resident group. The inspector spoke to a wide range of residents, including 3 residents who have been admitted within recent months. The views expressed indicated that residents are generally happy living in the home, and that they perceive staff to be caring and considerate, and to be meeting their needs. Comments received from relatives were also very favourable, the home being seen to be providing a good standard of care and to be meeting individuals’ needs. Inspection of residents’ files evidenced that a Statement of Terms and Conditions is being issued to each resident upon their admission. This details all the relevant information required regarding the fees payable, the room and services to be provided, and the terms and conditions of the placement. The current fees charged have been confirmed as ranging from £448 to £512 per week. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 to 11 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are having their health, personal care and social needs set out in detailed and individualised care plans. These have become more personcentred in their focus. The health care needs of residents are being fully met. Residents are being safeguarded by the home’s medication policies and procedures. All staff have completed accredited medication training. Residents feel that that they are being treated with respect and that their right to privacy is being maintained. Residents can be assured that, in the eventuality of their death, their wishes will be respected and that they and their family will be treated with care, sensitivity and respect. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 14 EVIDENCE: The inspector examined a sample of residents’ care plans, these having been compiled on the basis of initial assessment and periodic review. Care plans are being reviewed on a monthly basis and involve discussion with the individual resident and his/her relatives/representatives. The home has been developing more detailed and person-centred care plans so as to reflect a more detailed breakdown of the resident’s care needs, wishes and preferences. Each resident, and their relative/representative, are being involved in the process of developing their care plan (in line with the resident’s wishes), and in making choices and decisions regarding the resident’s engagement in day to day routines and activities. An action plan, detailing how each person’s wishes can be met, is drawn up with each resident, and communication profiles are developed for those residents who find it difficult to communicate. Goals are agreed with each individual so as to try and assist residents to exercise choice and achieve greater independence wherever this is possible. Residents are encouraged to make decisions for themselves wherever this is possible. To assist this process, the manager and staff have undertaken training in Person Centred Care Planning. The health care needs of residents are generally evidenced as being well met. Views expressed by residents, and inspection of care notes, indicate that there is good follow up of any health concerns and that health care needs are generally being well met. Care plans include a health section that lists all health care professionals who are involved; this includes GPs (general practitioners), CPNs (community psychiatric nurses) and District Nurses, together with dentists, opticians and chiropodists. The home enjoys a good relationship with the local GP surgery, and a doctor visits on a regular weekly basis. A psychiatrist visits as and when this is required. A chiropodist visits on a six-weekly basis, and dental and optician check-up visits take place at the home, with follow-up surgery appointments being arranged as and when these are required. A dental hygienist visits twice a year. Weight charts are used for those residents where there are concerns about weight. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 15 There have been two deaths (one in hospital) since the last inspection. The wishes of residents regarding the eventuality of their death are recorded on residents’ files, and religious and other beliefs regarding their death and funeral arrangements are respected. The home informs and involves relatives where potential life-threatening concerns arise. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 to 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are being provided with many and varied opportunities for meeting their social, cultural, religious and recreational needs. Residents are being actively encouraged to maintain contact with their family and friends and to retain links with the local community. Residents are being actively assisted to exercise choice and control over their day-to-day routines and decision-making. The meals provided are wholesome and appealing and are served at times, and in places, which are convenient for residents. EVIDENCE: Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 17 The home has excelled in this area, and is continuing to build on its good practice. The home has developed an activity programme and achievement chart, which identifies goals and objectives for each resident. In line with the personcentred approach to care planning that the home is developing, each resident’s programme reflects their interests and preferences, with goals being set and reviewed on a quarterly basis. Residents’ goals are based on what is realistically achievable in terms of individual abilities and capabilities. Individual residents are encouraged to pursue and develop their interests and hobbies. Examples of this have so far included learning to play the piano, gardening, learning French, and helping to set the table for lunch. The progress made in striving for, and achieving goals is recorded and kept under review. The home provides a wide range of activities, which include both group and one-to-one activities. There are group activities such as aerobics, bingo, ball games, quizzes, skittles, dancing, listening to music, sing a longs, and reminiscence sessions. A film on DVD is scheduled for each afternoon. Other activities include drawing or colouring, puzzles, board games, together with participation in gardening, flower arranging or with baking cakes if there is a wish or interest. There is a strong ethos in this home to creating an active and stimulating environment for the home’s residents, with staff being pro-active in initiating and promoting activities. One-to-one time with residents is encouraged, staff being observed by the inspector to engage individual residents in conversation and to encourage their participation in song, dance and individual pursuits. During the inspection the inspector again observed some very positive interactions between staff and residents, with residents presenting as being engaged and stimulated. Residents less able to participate were observed to be receiving some individual attention and encouragement. One lady has been encouraged to play the piano, whilst another lady has been encouraged to rediscover the use of some French words and phrases. There is a regular monthly flower arranging session that has proved very popular over time, while several of the residents have potted plants in some attractive displays in the patio and garden areas. There are also plans to develop a vegetable patch. There are monthly visits from a group of entertainers, and occasional trips, such as a day trip to Brighton, or into the countryside, are arranged. Friends and relatives are encouraged to visit and to take residents out for lunch or tea if they wish. There are also trips out to the local park or shops for those residents who wish to do so. The home tries to provide an escort out for any resident who wishes to go for a short walk up to the post office or around the nearby green. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 18 The home is also trying to plan individual visits for those residents who have a specific wish or interest. Trips to a garden centre or park are arranged, while for another resident, a trip to visit his old haunts near London Bridge is being planned. Religious views and beliefs are well respected in this home. Each week there is a religious hymn-singing session with a bible reading. At Easter and Christmas, there are special events, including plays, to which relatives are invite. There are not currently any residents from any faiths or beliefs other than from Christian denominations. The home has been holding regular tea parties for residents two to three times a week, these being held in the dining room or garden. There is an emphasis on staff involvement and the development of a lively social and communal atmosphere, with the tea party being followed by activities for all those who wish to participate. Residents are being encouraged to exercise choice and control, with individual feedback indicating that residents are enabled to make choices in their daily routines and activities, and consulted regarding decisions which affect them. Residents are able to raise any issues they wish with the manager and provider, and there is regular contact between each resident and their key worker. Residents meetings are being held monthly, providing the opportunity for issues to be raised and addressed. In 2007, the home stated having three monthly meetings for relatives and friends, which residents are able to attend if they wish, and where issues affecting the lives and welfare of the residents are discussed, and information concerning forthcoming events and developments are shared. These meetings have proved very successful in encouraging good communication with relatives, with ideas that have been raised having been discussed and taken on board. The inspector examined four-weekly menus and evidenced a varied range of food choices. The kitchen area presented as well stocked with fresh and frozen food, with appropriate hygiene standards being maintained. The food is homecooked, and was observed to include plenty of fresh vegetables and fruit, and a choice of main course. Residents have indicated that they are very happy with the food that is being provided, and individual tastes seem to be well catered for. The dining room presents as a pleasant area in which to take meals. Residents are able to take meals in the lounge, or in their own room, if they wish to do so. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 to 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be assured that the home has an appropriate complaints policy and procedure in place, and that their complaints will be listened to, taken seriously and acted upon. The legal rights of residents within the home are being well protected and promoted. The protection of residents is being well safeguarded by the home’s adult protection, policies and training. EVIDENCE: Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 20 The home has an appropriate complaints policy and procedure. A complaints book at the home details the outcome of any complaint and what action (if any) was taken. The complaints procedure is clear and simple and includes the stages and time scales for complaints to be managed. The procedure states that any complaint will be responded to within twenty-eight days, and that that any complaint can be referred to the CSCI, local office, at any time during the course of investigation. Each new resident and their relative or representative are informed about the complaints procedure and provided with a copy. Should there be a complaint, the home is concerned to ensure that this is taken seriously and that the resident and his representative are kept informed regarding the investigation and outcome. A copy of the procedure is distributed at relatives’ meetings. While no complaints have been made since the last inspection, the inspector understands that any complaint would be taken seriously and dealt with promptly and effectively. All residents are encouraged to raise any concerns that may arise. There is a laminated notice in each room giving details of the procedure for raising concerns and whom to approach. The inspector spent time talking with a number of residents. Residents indicated that they feel able to raise any concerns they might have with the manager or staff. No specific problems or concerns were raised. The home also has a Concerns and Compliments record, which is kept in the reception area where it is easily accessible for visitors to record their comments. The inspector was shown letters from the relatives of two recently deceased residents expressing their appreciation of the care that was provided to their loved ones. This is a home that places a high priority on protecting residents’ rights and to promoting their involvement in decisions that affect their day-to-day lives. Any issues that arise can be discussed individually with the resident’s key worker, or with the manager. Regular monthly meetings are held where residents are able to freely air their views, and to raise any issues or suggestions for improvement. There are also 3 monthly relatives’ meetings, which residents can attend if they wish, and at which questionnaires are handed out. The manager, Jason Chellun, chairs these meetings. The manager also maintains regular phone contact with residents’ representatives to check out whether there are any issues or concerns they might wish to raise. Residents’ legal rights are being safeguarded in this home. The home aims to protect residents’ legal rights by involving family and friends in respect of their contracts, benefits and monies, and in discussing any issues at reviews. Responsibility for managing a resident’s finances is not undertaken by the home but by a relative, solicitor or social services. The home maintains records of residents’ personal expenditure, with monies being reclaimed on a monthly Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 21 basis. All residents are registered on the electoral roll and a postal vote can be obtained in the event of an election. The home has an Adult Protection and Whistle Blowing Policy in place, together with a copy of the local statutory adult protection policy and procedures (LB Croydon), for staff to reference. All staff have undertaken training in adult abuse and have received statutory adult protection training. Through training and regular monthly staff meetings, care staff are actively encouraged to develop their understanding and awareness of the needs of adults with dementia, of the need to respect their dignity and rights, and of the need to be proactive in preventing any possibility of abuse from occurring. No adult protection concerns have been identified since the last inspection or within the last 12 months. The inspector spoke with a number of residents. Residents presented as settled and well cared for, with feedback indicating that residents feel safe and secure within the home. No concerns were identified. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 to 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are living in a safe, well-maintained environment, with access to safe and comfortable facilities. Risk assessment of the home is in place for their protection. Residents’ rooms present as being safe, comfortable and pleasantly decorated, reflecting individual residents’ personal identities, and being suited to their individual needs. Residents have access to safe and comfortable communal facilities. Sufficient bathing, washing and toilet facilities are being provided for the home’s residents. Residents’ safety is being assured through the provision of sufficient aids and adaptations. Residents are living in a home that presents as being clean, pleasant and hygienic. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 23 EVIDENCE: The inspector completed an inspection of the premises. The home has a maintenance and development programme, regarding the renewal of the fabric and decoration of the home. This lists short, medium and long-term plans. There has been an ongoing programme of redecoration and refurbishment, which has included redecoration and re-carpeting of both the lounge and dining areas, and the redecoration of the corridors and hallway. There has also been some refurbishment, with the replacement of worn armchairs in the lounge, and the replacement of furnishings and fittings throughout the home. There has been ongoing redecoration of residents’ bedrooms, 3 having been completed within the last 12 months, and further bedrooms scheduled to be done. the redecoration and renovation of The upstairs bathroom has also been redecorated and renovated, with new lino and the replacement of the toilet. The home’s owners are planning to install double-glazing throughout, starting at the front of the building and working through to the back. A number of residents’ bedrooms were inspected. These were observed to be comfortable and personalised, reflecting individuals’ identities and meeting their needs. The rooms present as reasonably well decorated, and are comfortably heated and ventilated. Curtains are provided for privacy in shared rooms. There are two double bedrooms (Rooms 12 and 15). Window restrictors are in use in most upstairs bedrooms. Lockable spaces are being provided in all bedrooms, with small lockable safety boxes having been placed in those rooms (8, 10, 12 and 15) where an alternative lockable facility is not available. There are accessible toilets on both floors, which are being kept clean and free from any offensive odours. Hand basins are provided in all residents’ rooms, and there are two bathrooms, both of which present as safe and hygienic. The inspector has previously noted that there is a disused shower opposite Room 11, which could, subject to an occupational therapist assessment, be renovated and bought back into operation for the benefit of the home’s residents. There are, however, no plans to do so at present. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 24 Heating and lighting throughout the home is satisfactory, lighting being domestic in character. All radiators in the home have been covered with “cool to touch units”. Central heating can be controlled in each individual room. There is an emergency lighting system. Hot water temperatures are being tested on a weekly basis. Risk assessment of the home, and individual residents, are in place for their protection. There are appropriate Health and Safety and Fire Risk assessments in place, these being reviewed and updated on an annual basis. The home was last assessed by an occupational therapist on 13 June 2006. Stair rails are in place, and rails are fitted along corridors. Grab rails in toilets, raised toilet seats, commodes and adapted bath chairs are in place. Generally, the home is providing the necessary specialist equipment required to safety meet residents’ needs and maximise their independence. Mr Jason Chellun has confirmed that the home’s bath hoist is being serviced on a six-month basis, and that the home is completing and recording hoist maintenance checks on a 3 monthly basis. The most recent servicing of the bath hoist, in January 2008, has been evidenced. The home presents as being clean and hygienic and to be meeting the necessary standards of cleanliness and hygiene. All staff at the home are provided with infection control training, and clear guidelines in this area are in place. Food hygiene training is provided for all staff who assist with the preparation of food. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 to 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has the numbers and skill mix of staff sufficient with which to safely and appropriately meet the needs presented by the home’s residents. Residents are being safeguarded by satisfactory recruitment policy and procedures, and by the necessary recruitment and criminal records checks. Staff are being provided with appropriate induction and training with which to perform their work duties competently, and with which to safely and fully meet the needs of residents. EVIDENCE: Staffing levels are being maintained in line with Care Home Regulations, and as appropriate to the number and assessed needs of the home’s residents. There are presently 2 senior care staff (both deputy managers), 10 care staff, 2 cooks and a cleaner. The inspector examined the staff rota. This evidenced that there were three care staff on duty, plus the person in charge (the registered manager) during the day with two waking staff on at night. Two ancillary workers (a cook and a cleaner) are also on duty. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 26 The home has very low staff turnover with just one new care worker having been recruited to cover for a care worker who is on maternity leave. The inspector completed CRB, identity and recruitment checks and found that these had been satisfactorily completed. Staff present as being skilled and competent, and to be interacting in a positive and caring way with residents. Staff spoken to by the inspector indicate that they enjoy working in the home, and that they feel valued and well supported in performing their duties. Views expressed by residents indicate that they have good relationships with care staff, and that they feel that they are being well supported in their day-to-day lives. The home has an ongoing programme of staff training and induction, which is being regularly updated. The induction programme includes the use of the ‘Skills For Care’ Induction to Adults Social Care Manual. With the assistance of a training consultancy, an organisational training and development plan has been developed, and a ‘training needs analysis’ completed, identifying specific training needs for each staff member. The home has developed a comprehensive training programme, all staff being required to complete training in areas such as first aid, food hygiene, infection control, manual handling, adult protection, dementia awareness, challenging behaviour, medication, first aid and infection control. Following a requirement from the last inspection, all staff have now completed updated training in food hygiene. 11 of the Home’s care staff have also undertaken training in personcentred care, this having been provided at the Home by a PCP (Person Centred Planning) trainer from the London Borough of Croydon. The home has aimed to increase the number of staff who have obtained their NVQ qualifications. Of 10 care staff employed in the home, all have now obtained their NVQ Level 2 care qualification. The manager advised that 5 staff (including both deputy managers) have completed their NVQ Level 3, and that a further 3 staff have registered to do their NVQ Level 3. He also advised that one of the deputy managers has obtained her NVQ Level 4, while the other deputy manager is due to commence study for this qualification. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 to 33, 35 to 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being well managed, and in a way that demonstrates that it is being run in the best interests of residents. The home is consulting widely with residents, relatives and other stakeholders, and is evidencing the home’s ability to meet its aims and objectives. Through the regular and appropriate supervision of staff, good practice is being promoted and the welfare and best interests of residents protected. The interests of residents are being safeguarded by the home’s record keeping, with records being kept secure, up to date and accurate. The health, safety and welfare of residents and staff are being appropriately promoted and protected. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 28 EVIDENCE: Following the retirement of the Home’s registered manager, Mrs Christina Thambirajah, in December 2007, Mr Jason Chellun has applied to the Commission For Social Care Inspection (CSCI) to become the Home’s new registered manager. He has a business studies background and is currently studying for his NVQ Level 4 and RMA (Registered Manager’s Award). Mr Chellun has been jointly managing the home with Mrs Thambirajah since 2005. In becoming the Home’s registered manager, Mr Chellun needs to complete his NVQ Level 4 and RMA, and complete his registration with the CSCI. A requirement applies. In the three years that Mr Jason Chellun has been involved in managing the home, the home has progressed very well. Throughout this period, the home has been evidenced to have been managed efficiently and in the best interests of the home’s residents. The management approach has been observed to be conducive to fostering good communication between management, staff, residents and their relatives, and to creating an open, relaxed and friendly atmosphere within the home. Mr Chellun has been pro-active in seeking advice regarding good practice and, through training and staff development, to have applied this for the betterment of the home’s residents. This is demonstrated by the commitment he has shown to developing a more person-centred ethos and approach within the home. This has assisted in enabling residents to be more able to identify their needs, wishes and aspirations, and to have the possibility of leading fuller, more interesting and varied lives. The home has been developing its quality assurance processes. Questionnaires have been devised and completed with the home’s residents, for their relatives and friends, and for visiting professionals and care managers. Views are also expressed in residents’ and relatives’ meetings, and from periodic phone contact with relatives. An annual audit has been completed, the results of which are presented in a report, and a Development Plan has now been put in place for 2007-08. This includes feedback from questionnaires and other sources, and identifies performance indicators measuring how well the home is doing in meeting its objectives. The Plan aims to specify the proposed plans and time-scales for addressing any areas of unmet need or service development. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 29 The manager and two deputy managers are undertaking supervision. The inspector examined a sample of staff supervision notes and evidenced that staff have been receiving supervision on a regular two-monthly basis. Supervision is both structured and comprehensive in scope. The supervision format provides a detailed record of supervision, supervision notes being well maintained. Each staff member receives an annual appraisal, appraisals being undertaken by the manager. The inspector discussed with the manager the advantages of involving the two deputy managers in this process, and recommends that they are involved in the next round of staff appraisals. Generally, the interests of residents are being safeguarded by the home’s record keeping, with records being up to date, accurate and securely stored. Inspection of incident and accident records indicates that the home has a generally safe environment. All records that are required for regulation are in place and are maintained to a satisfactory standard. The records that were inspected included staff and service user files, medication charts, accident and incident records, complaints records, and staff rotas. The inspector completed an inspection of the premises and requested documentation regarding health and safety, and fire safety checks. The health, safety and welfare of residents and staff are evidenced as being appropriately promoted and protected. The premises present as generally well maintained, and no specific concerns were identified. Inspection of the Home’s records evidenced that fridge/freezer and hot water temperature checks are being completed on a regular daily basis. All health and safety maintenance checks were found to be have been completed within the required time-scales. These included servicing of the gas boiler and supply in June 2007, the inspection of the home’s water storage in October 2007, and inspection of electrical portable appliances in July 2007. The 3-yearly electrical installation inspection was completed in September 2007. An environmental health inspection is due in May 2008. The Home’s bath hoist was serviced in July 2007, and again in February 2008. The home has a Health and Safety policy, which was drawn up with the assistance of an independent Health and Safety consultancy. This has been reviewed within the last 12 months, in June 2007. Health and Safety risk assessments are being updated on a monthly basis. A Fire Risk assessment was completed in February 2008, with fire safety training for staff being held at three monthly intervals, most recently in February 2008. A fire safety inspection was last carried out in July 2007. This included inspection of fire alarms and equipment, emergency lighting and the emergency call system. Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 30 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 4 3 4 3 4 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 4 18 4 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 4 4 3 Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 31 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. 1 Standard OP31 Regulation 9(1) & (2) Requirement The manager needs to complete his NVQ Level 4 and RMA, and complete his registration with the CSCI. Timescale for action 30/09/08 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 OP19 Good Practice Recommendations To assist in meeting the needs of residents, the inspector recommends that the door frames of bathrooms and toilets are covered in fluorescent yellow strips, and that appropriate signage is placed on doors. The inspector recommends that the two deputy managers become involved in the staff appraisal process. 2 OP36 Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Gate Lodge DS0000025784.V362075.R01.S.doc Version 5.2 Page 33 - 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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