Care Home: Three Gates

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Three Gates (Amber Project) 62 Cloves Hill Morley Derbyshire DE7 6DH two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anthony Barker Date: 2 1 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Three Gates (Amber Project) 62 Cloves Hill Morley Derbyshire DE7 6DH (01332)880584 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): United Response Name of registered manager (if applicable) Caroline Lee Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 0 care home 4 learning disability Additional conditions: 1. The registered person may provide the following category/ies 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: Learning disability Code LD 2. The maximum number of service users who can be accommodated is: 4 Date of last inspection 2 2 1 1 2 0 0 6 A bit about the care home Three Gates is a detached bungalow in a rural position on the edge of a village. People living at the Service are provided with spacious accommodation and single rooms. There is a large rear garden. Three Gates offers personal and social care to people with a severe learning disability with associated conditions that may include autism, sensory disability or challenging behaviour. Activities are planned to meet individual needs, and people experience a wide range of community-based activities. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home This key inspection was unannounced and took place over one day. The last key inspection at this service was on 22nd November 2006. The Commission had requested the Service to complete an Annual Quality Assurance Assessment (AQAA) before this inspection. We had also received five completed survey forms from staff. The information provided in these documents is included in this report. The people living at the Service all had high levels of dependency and therefore were not able to contribute directly to the inspection process, though they were observed working with and being cared for by staff. One particular persons experience of the quality of the service was focussed on, through their personal records and discussion with staff. The Manager and one support worker were spoken with at this inspection and records were inspected. There was also a tour of the premises. The weekly fees at the time of this inspection ranged from 1064 pounds to 1476 pounds. What the care home does well Individual written needs assessments and plans of care were in place showing that peoples health, personal and social care need were being met. The Service provided activities, personal support and other services that were valued by people and promoted their independence in a person centred way Good procedures for handling complaints and abuse were in place ensuring people were fully protected. People were living in a homely, comfortable and safe environment that was furnished and maintained to a high standard. The Service had a good level of welltrained and well-recruited staff to ensure that people living here were safe and their needs were met. The Service was well managed so that people living there were protected and their best interests were promoted by the systems in place. What has got better from the last inspection The care planning system had improved and safe practices were being followed in the recruitment of new staff. Regular audit visits to the Service were being made and the views of all stakeholders were being sought as to the quality of the service provided. There were new sofas in the lounge and one of the bedrooms had been redecorated. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Tony Barker CSCI CPC1, Capital Business Park Fulbourn Cambridge CB21 5XE Tel: 01223 771300 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: 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 . Individual written needs assessments were in place before people were admitted to the Service so that their diverse needs were identified and planned for. Evidence: Information supplied by the Manager before the inspection showed that the four people had lived at this Service for several years. A full assessment of their needs was made prior to their admission, as confirmed by detailed examination of care records at a previous inspection. The contract between United Response and each person who lives at the Service was personalised and each person had been supplied with a copy. It had been updated to reflect management changes, as recommended at the last inspection. The contract contained mainly widget symbols and a few photographs to aid peoples understanding of the document. The Manager said that she plans to further individualise contracts to further reflect peoples differing degrees of comprehension. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: 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 . People who use the Service had comprehensive and individual plans of care which demonstrated that their health, personal and social care needs were being met. Evidence: The care plan of the person case tracked was examined. It contained four comprehensive, holistic and person centred areas with associated goals. These goals are highlighted at regular person-centred review meetings, which ensures that regular monitoring of peoples needs and preferences is taking place. Copies of all four peoples goals were displayed in the office, which keeps them clearly in mind. People who live at the Service attend these review meetings along with relatives, care managers and day centre staff, if appropriate. One staff member, who completed one of our pre-inspection questionnaires, stated that she had attended a two-day course on person-centred thinking which was very useful, she added. Another staff member said, Care plans are person centred and reviewed on a regular basis. Peoples likes and dislikes were recorded on care plans. These care plans documents were therefore a valuable guide to staff and ensured that peoples needs were being met and regularly reviewed. All care plan entries were being signed and kept up to date - an improvement from the last inspection. There was evidence that the Manager was improving the Services care planning system by analysing peoples needs and interactions and adjusting the approach that staff take. Information supplied by the Manager before the inspection stated that, People are making more choices and decisions in their lives. At the inspection the Manager produced a record sheet that encouraged staff to record how, in a person centred way, people should be supported to make decisions such as choosing clothes or where to go Evidence: out. There was also evidence, at the inspection, of people making choices and decisions regarding their everyday life. Staff members, who completed our preinspection questionnaires, made supporting comments such as, we offer choice and empowerment in (peoples) day to day lives and, I feel everybody works well to promote each individuals choices. There was a comprehensive range of recorded risk assessments that were worded in a person centred way. These showed that the Service was aware of potential risks to which people were exposed and indicated ways of managing these risks. The senior support worker spoken with showed a good understanding of the concept, and use, of responsible risk taking in order to increase peoples independence. For instance, paying attention to road safety for one person and swimming in a local pool for another. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: 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 Service provided activities and services that were age-appropriate and valued by the people who live here, and promoted their independence. Evidence: All of the people living at the Service were receiving some form of day service, either at an external day service provision or one provided by United Response, based at the Service. The person case tracked was attending a Social Services Day Service and had recently become involved in a local community group for young people where the person was preparing snacks and drinks one evening a week, supported by staff from the service. The Manager also spoke about another person, living at the Service, who was involved in two voluntary jobs - one as a dog walker and one as a volunteer caretaker at United Responses office in Ilkeston. This latter post is being advertised as a paid job and the person concerned is applying for this post. This person was also soon to start working in a local charity shop. These examples show how the Service is making good efforts to find valued work in the community for the people living here. The senior support worker was able to provide further evidence of people being involved in valued and fulfilling activities. This evidence included the enjoyment shown by particular individuals when going to church or when at the bowling alley. The preinspection questionnaire, completed by the Manager, included a range of community facilities used by people at the Service. These included shops, pubs, library and leisure centre. The Manager gave further examples at the Inspection and there was clear evidence of positive thinking by the staff group to bring about social networking for the people they support. Staff who completed the pre-inspection questionnaires provided Evidence: further evidence of their role in supporting service users in the community and promoting a positive presence. The people living at the Service had varying degrees of contact with relatives. There was evidence of considerable thought being given to improving contact between the person case tracked and their relatives. There was contact from ex-staff from an establishment one person previously lived in. Friendships with other ex-service users from that establishment were being re-established too. The Manager described how one person, living at the Service, had met someone while out collecting eggs at a local farm and had struck up a friendship. This had resulted in an invitation to take tea with this other person at their house. The senior support worker gave examples of how peoples involvement in daily routines reinforces their personal development. She spoke about empowering them to be involved in domestic routines. She said they all take their own dirty laundry to the laundry room and place them in the washing machine and they all help to prepare food. The Services rolling menu indicated that people were being provided with a varied and nutritious diet. Choices were evident and there were good dietary notes. The menu was based on peoples individual preferences and a Likes and Dislikes list was recorded. Food stocks were found to be at a good level and these included fresh fruit and vegetables. Staff accompany the people they support to a range of supermarkets, when food shopping, to widen their social networks as well as maintained lower costs. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: 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 Service was providing people with personal support in the way they preferred and required and was meeting their physical and emotional health needs. Evidence: One staff member who completed one of our surveys said, we give service users the service and dignity they should be given. The senior support worker spoken with gave examples of how staff meet the dignity and privacy needs of people living at the Service. For example, female staff provide personal, intimate care for females living at the Service and staff ensure that bedroom and bathroom doors are kept shut as appropriate. She also gave examples of how routines are flexible to meet peoples individual needs and circumstances. For example, she said, There are always enough staff to accommodate a persons change of mind if they dont wish to go to day services. The Manager had stated, in the questionnaire she completed before this Inspection, that the Service was working on a new photo format communication system. There were several examples, during this Inspection, of people pointing to photographs when they wanted something. The person case tracked had a set of photographs depicting activities they were previously involved in and staff used these to reinforce information being given to the person. One staff member was well versed in Makaton sign language. She teaches this to other staff and has helped one person who lives at the Service to expand their signs significantly, so increasing their independence. For instance, the person has learned Makaton signs for filling up the Services vehicle with fuel. The Manager gave examples of the levels and type of informal advocacy support provided to each person by external people, including relatives, and showed her awareness of the Derbyshire Advocacy Service. Health appointments sheets were in place and, being an at-a-glance document, they provided a good monitoring tool. Also, peoples medical appointments and contacts Evidence: were being recorded on Health Appointment Feedback sheets. A My Health File was in place for each person and this was an appropriate person centred document. Overall, there was a good system of recording health needs and the management of these. There was evidence on files of involvement of a range of external health professionals and of good levels of liaison with Social Services professionals. From discussion with the Manager it was clear that a well-thought through and creative approach had been taken to meeting the health needs of the person who was case tracked. The Manager had informed us, in the questionnaire she completed before this Inspection, that one person had continence management needs. Although this was not a major issue for the person, the Service had no written policy on continence promotion. The Medication Administration Record (MAR) sheets, of the people who live at the Service, were examined and found to be satisfactory. There was a record of staff signatures/initials with the medicine records to ensure that signatures can be crossreferenced against staff names. Medicines were securely stored. There was no prn, when required, medication being administered except for pain killers. No controlled drugs were prescribed. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: 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 . Good procedures for handling complaints and abuse were in place ensuring that people were fully protected. Evidence: The Services complaints procedure was displayed in the hallway. It used widgets (symbols) that could be better understood by people who live at the Service. The Manager said there had been no complaints made within the previous 12 months. The complaints file was set out in a satisfactory manner. The Service had an extensive written policy and procedure on prevention of abuse linked to the statutory procedures and prepared by United Response. It was clear on the point that the Social Services Department should be the first point of contact - an improvement from previous inspections. Staff had been provided with training on the subject of Safeguarding Adults and the Manager was pursuing her own attendance at this training, provided by Derbyshire Social Services. The case tracked persons recorded money balance was cross-referenced against cash held and found to be accurate Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: 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 . People were living in a comfortable and safe environment that was clean and hygienic. Evidence: The Service had a homely environment with good quality furnishings and decoration. The questionnaire, completed by the Manager before this inspection, indicated that there were new sofas in the lounge and one of the bedrooms had been re-decorated since the last inspection. The person accommodated in this room had been involved in choosing the new colour scheme and, with another person living at the Service, had been involved in roller-painting the room. The bedrooms of these two people were seen, in their presence, and the rooms were found to be suitably personalised. The lounge was comfortable. There was one photo-collage on the dining room walls though they were rather bare. The benefits of placing some more wall pictures in this room, and in corridors, were discussed with the Manager. She spoke of plans to hang canvasses, painted by the people who live here, in the dining room. The bathroom was bright and attractive. There was a large spa bath in the rear garden that had been well used by the people who live at the Service, the Manager said. From the tour of the premises there was evidence of good standards of cleanliness and hygiene throughout, with no unpleasant odours. People living at the Service, supported by staff, carried out household cleaning duties at the Service, according to their capability. There was an industrial-type washing machine and dryer which were appropriate for peoples needs. The laundry was kept locked when not in use. An infection control risk assessment was in place and this addressed the issue of moving infected material around the premises. The Manager said that soiled bedding is brought to the laundry room in appropriate bags. One person, who lives at the Service, brings their own personal underwear to the laundry room and places it in a basket. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: 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 Service had a good level of well-trained and well-recruited staff to ensure that people living here were safe and their needs were met. Evidence: The Manager showed, in the pre inspection questionnaire, that 62 of the care staff had achieved a National Vocational Qualification (NVQ) to level 2 or above. This met the National Minimum Standard to maintain a staff group with at least 50 qualified staff. The Manager stated, in the pre inspection questionnaire, that people who live at the Service are involved in the recruitment and selection of staff. The file of a member of care staff appointed in December 2007 was examined. It was found to contain all of the elements, required by current Regulations, regarding recruitment practices. There was recorded evidence of this same recently appointed staff member being provided with induction training to Skills for Care Common Induction Standards. Her training booklet had been appropriately completed, signed and dated. The senior support worker spoken with confirmed that her own induction was a good experience. She described a comprehensive range of training courses she had attended during the eleven months working at the Service and training records confirmed that staff had been provided with all mandatory training. The Manager is a credited trainer, including fire training. She described an in-house information pack being drawn up regarding autism - adding, that this topic is already part of United Responses staff induction training package. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: 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 Service was well managed so that people living here were protected and their best interests were promoted by the systems in place. Evidence: The Manager had achieved her National Vocational Qualification (NVQ) in Care at level 4 and the Registered Managers Award. She had worked with people with learning disabilities for 8.5 years. There was evidence from this inspection that the Manager was enthusiastic and imaginative within her role. She was being well supported by the Services Senior Support Worker with Additional Responsibilities (SSWAR). Monthly independent audit visits to the Service, on behalf of the Registered Provider, as required by Regulation 26, were now taking place - an improvement from the last inspection. The Services current annual Service Plan was examined. This was holistic with objectives and target dates. Quality assurance questionnaires were being sent to relatives, staff and external professionals, for their views on the quality of service provided. This was also an improvement from the last inspection. The Manager remarked that the person-centred care plan review system means that responses from relatives who attend reviews are now more meaningful. Good food hygiene practices were noted and the Manager said all work recommended, in November 2007, by the visiting Environmental Health Officer had been undertaken. The safe storage of cleaning materials was observed, along with the product data sheets required by the Control Of Substances Hazardous to Health (COSHH) Regulations. Weekly fire alarm tests were recorded as well as monthly fire drills - with night time fire drills being held every six months. There were written risk assessments for the Services environment. The pre-inspection questionnaire, completed by the Evidence: Manager, indicated that equipment in the Home was being maintained and good Health and Safety practices followed. Exterior lighting to the premises had been improved, so providing more safety to staff. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 19 23 Service should have a written policy on continence promotion. The Manager should attend Safeguarding Adults training provided by Derbyshire Social Services. Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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