Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Gladstone House Address: 28 West Street Scarborough North Yorkshire YO11 2QP The quality rating for this care home is: two star good service 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: Date: Pauline O'Rourke 2 2 0 7 2 0 0 9
Transcript
Inspecting for better lives
Key inspection report
Care homes for adults (18-65 years)
Name: Gladstone House
Address: 28 West Street ScarboroughNorth YorkshireYO11 2QP
The quality rating for this care home is: two star good service
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: Date:
Pauline O'Rourke 2 2 0 7 2 0 0 9
Care Homes for Adults (18-65 years) Page 2 of 29
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.
Address: 28 West StreetScarboroughNorth YorkshireYO11 2QP
Telephone number: 01723373638
Fax number:
Email address:
Provider web address:
Name of registered provider(s): Mrs Madoomatee Emambocus,Mr Hessan Emambocus
Name of registered manager (if applicable)
Type of registration: care home
Number of places registered: 12
Conditions of registration:
Category(ies) : Number of places (if applicable):
Under 65 Over 65
mental disorder, excluding learning disability or dementia
12 0
Additional conditions:
The maximum number of service users who can be accommodated is:12
The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Mental disorder, excluding learning disability or dementia - Code MD, maximum number of places: 12
Date of last inspection
Brief description of the care home
Gladstone House is registered to provide accommodation and personal care for up to 12 people who have or have had mental health problems who may also be over 65 years of age.The home is situated on the south cliff of Scarborough in walking distance of local shops and the seafront and close to a bus route to the centre of the town. Free on street parking is available close to the home.
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Brief description of the care home Two sitting rooms, the home's dining room and kitchen are on the ground floor. The laundry is situated to the rear of the home on the ground floor as is the new office. There is a covered area outside for those people who smoke. People's bedrooms, bathrooms and toilets are situated on the ground, first and second floors, and the top floor accommodates a staff sleeping in room.
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SummaryThis is an overview of what we found during the inspection.
The quality rating for this care home is: two star good service
Our judgement for each outcome:
Choice of home
Individual needs and choices
Lifestyle
Personal and healthcare support
Concerns, complaints and protection
Environment
Staffing
Conduct and management of the home
peterchart
Poor Adequate Good Excellent
How we did our inspection:
The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Care Quality Commission inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been
deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The key inspection has used information from different sources to provide evidence for this report. These sources include: Reviewing information that has been received about the home since the last inspection. Information provided by the registered person in an Annual Quality Assurance Assessment form (AQAA) Comment cards returned from people living at Gladstone House and from other people with an interest in the service. A visit to the home by one inspector that lasted for six hours. During the visit to the home twelve people who live there, four staff and two relatives were spoken with. Care records relating to four people who live at Gladstone House four staff members and the management activities of the home were inspected. Care practices were observed, where appropriate, and time was also spent watching the general activity within the home. This enabled the inspector to gain an insight of what life is like at Gladstone House for the people living there. Information about the home is available in a Service User Guide and the weekly cost of staying at Gladstone House is between three hundred and ninety pounds and four hundred and fifty pounds. The amount payable is dependent on a financial assessment. The Registered Providers was available for feedback at the close.
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What the care home does well:
The home provides a service that enables people to live the lives they want to. People are supported to be as independent as possible and are encouraged to make their own decisions about how they want to spend their time. People are encouraged not only to look after themselves but assist others in the running and maintenance of the home. People spoken with said they enjoyed helping with household chores such as washing pots, preparing drinks and setting tables. One person said "I like being busy, helping with the washing up and setting the tables and I can do what I want to during the day". The providers and staff work together to ensure the support provided is appropriate to the needs of the people living at Gladstone House. People spoken with said "the staff are nice and treat me with respect" and "the staff seem to be hard working" The management activities of the home are properly completed to ensure the health and safety of people who live their and staff are protected. Since the registered manager left Gladstone House Mr and Mrs Emambocus have managed the home on a day-to- day basis.
What has improved since the last inspection?
Since the last inspection the way in which new staff are recruited and selected has been improved, this means that the application form has been expanded to include a full employment history. Since the last inspection their has been an extension built and this has increased the communal space available to people in the home. The extension also includes a downstairs bathroom with toilet which means as people get older and less mobile they can stay at the home longer. An outside covered area has been provided for the people that smoke. Several areas of the home have been updated and this is to continue as part of a rolling programme of improvements.
What they could do better:
The information provided to people looking to move in to Gladstone House should include an equality and diversity statement that outlines the different strands of the larger community whose needs could be met at Gladstone House. The storage of medication must be moved to a more suitable location as described in the guidance provided by The Royal Pharmaceutical Society of Great Britain in the document The Handling of Medicines in Social Care the medication must be moved from its current location to a more suitable storage place. The guidance says "also the storage of medicines needs to be in the right place. Filing cabinets are not suitable for storing medicines, neither are: kitchens, bathrooms, toilets, sluices, windowsills, or areas next to heaters" Controlled drugs must be stored according to current guidance and safe custody regulations. This provides the extra security needed for this type of medicine and will help to prevent loss or diversion.
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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.cqc.org.uk. You can get printed copies from [email protected] or by telephoning our order line –0870 240 7535.
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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
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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.
People who decide to use this service can be assured their needs will be met.
Evidence:
The case files for four people who live at Gladstone House were seen and they each contained an assessment of the help and support required by the individual concerned. All admissions made to Gladstone House are done so in conjunction with a placing authority. The placing authority provides a full assessment of need from which a basic care plan is developed. Any placements made are reviewed within the first six weeks to check the placement is suitable. Information about Gladstone House is provided is a Service User Guide and a Statement of Purpose and it is recommended these documents are updated annually. These documents could also be further improved by including an equality and diversity statement that outlines the different strands of the larger community whose needs could be met at Gladstone House. People spoken with said they had been able to visit the home before moving in. Staff said that adequate information was provided about
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Evidence:
people moving in and they received appropriate support from the providers and social care professionals who organise the placements.
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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 are supported and encouraged to make their own decisions about how they live their lives.
Evidence:
Each of the four case files contained a care plan. Only the people most recently admitted to Gladstone House had an individual plan devised by the providers, whilst they all had a care plan provided by their placing authority. The care plans seen were specific to the individual concerned and had been signed by both the provider and the person they were about. One person spoken with was aware of their plan and was in full agreement with the arrangements of the plan. Staff spoken with were knowledgeable about the people in the home and of the care plans. These plans are reviewed monthly to ensure they remain appropriate. Throughout the day people in the home were seen to be making their own choices, either to go out, or where they spent their time in the home and if they assisted with
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Evidence:
any of the household tasks. One person had decided to go to York using their bus pass, another was helping in the kitchen before they went out for a walk. One person received support with their money and this was documented in their care plan and the records seen were appropriate. Surveys were received from two staff and they indicated that information was always shared about the people in the home when necessary. Staff spoken with said that when necessary the providers always seek advice from other professionals and keep the staff informed of any changes to the care plans. The registered provider is an appointed agent for one person living in the home. Risks associated with the personal needs of people, the provision of care or activities have been recognised and recorded, and detailed how risks were to be minimised. One person said 'I like it now there is a downstairs toilet it is easier to use' and 'we are asked what we want to do and they help us do this' Feedback from a relative indicated that they were happy their relative had settled but also felt there could be more motivational activities for them to participate in. Staff were aware of this but said that the person concerned was not always cooperative with their plans.
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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.
People are supported to live meaningful lives and have good access to a range of social and therapeutic activities.
Evidence:
People said that they were happy with the activities provided at the home. They talked about days out they had enjoyed and how they planned future trips. People said they are asked where they want to go and what they want to do. One person keeps in touch with their friends by visiting and ringing. Other people keep in touch with their relatives by phone on a regular basis. One person said they went for a walk when their relative visited each Sunday. People access the local community using local cafes and shops. People in the home said there were no restrictions on them coming and going from the home as long as they told someone where they were going. Staff spoken with said that people usually followed their own routine and used the local shops on a
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Evidence:
regular basis. One relative spoken with felt there could be more organised activities available to offer more structure to the day. Written surveys received from people living in the home said that they could do what they wanted at anytime during the day. Visitors are welcome at any time and they are asked to sign in on and out when they arrive and leave. Visits can take place in the communal areas or in the person's own room. People can lock their bedrooms to ensure their privacy. The providers are usually available to visitors. People spoken with said that they enjoyed the food. One person had got up after breakfast had finished but they went and helped themselves to cereals and toast. There is a four week menu that staff work off and where people don't like what is offered an alternative is provided. Several people said that they enjoyed Monday Nights, which have become a curry night. Others said they were not fond of the curry but something else was always provided. A hot meal was provided during the inspection and it looked appetising. People spoken with said there was always plenty of food available. Staff knew what each person liked and disliked and were sensitive to their needs when serving the meal. Staff spoken with said that snacks, hot and cold drinks are available throughout the day and night. Staff were also aware of the issues that medication can cause where diet and weight gain and loss are concerned. People in the home assist the provider with the preparation of the meals and clearing up after the meals. They have their own rota for these jobs so that they are all responsible for these tasks.
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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.
People can be assured that their health care needs will be recognised and addressed and that any care provided will be sensitive to their own preferences.
Evidence:
Care plans showed that people's personal and health care needs are properly met. The way in which care is given is reflected in these plans and through individual choice. Written surveys from people living at Gladstone House said that the staff and managers always treat them well. Their privacy is promoted and if they want a key to their bedroom door they can have one. Where people share a room this is usually with the agreement of the two people. Recently someone had to be moved downstairs because their health had deteriorated and they could no longer manage the stairs. This was done as sensitively as possible. People are encouraged to be responsible for their own health care and can make their own appointments with the doctor if they want to. Recently staff have worked with the local mental health team in the care of someone whose health was deteriorating until they went to hospital. Social care professionals involved with the home said that the
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Evidence:
staff had done everything they could and should have done to ensure the person concerned received the level of care and support they required. Records of the receipt and administration of medication were clear and accurate and recording was up to date. A monitored dosage system is used which allows for the recording of short term medication. The medication is currently stored in the kitchen, in line with the guidelines provided by The Royal Pharmaceutical Society of Great Britain in the document The Handling of Medicines in Social Care the medication must be moved from its current location to a more suitable storage place. The guidance says "the storage of medicines needs to be in the right place. Filing cabinets are not suitable for storing medicines, neither are: kitchens, bathrooms, toilets, sluices, windowsills, or areas next to heaters" Staff who manage medication have completed a Distance learning course in The Safe Handling of Medicines. There is no storage for controlled drugs and whilst no-one currently requires any controlled medicines storage must be provided. Care records detailed when staff had discussed medication with people living at the home and recorded individual choices about whether people wanted to manage their own medication. No one at this time manages their own medication.
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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.
People have access to information if they wish to make a complaint or raise any concern about their service and are protected by the awareness of staff of potential abuse.
Evidence:
Written survey information confirmed that people knew how to make a complaint if they wished. People said that they could speak to staff, or the owners if they were unhappy about anything. There is a whistle blowing policy for staff so that they may disclose poor practice without fear of being victimised. Several complaints about Gladstone House have been received by the Commission in the last year, none of these have been upheld. One person said that they would go to the providers if they had any concerns or they were unhappy. All staff employed at Gladstone House have been thoroughly vetted prior to the commencement of their employment to ensure they are suitable to work with vulnerable people. Staff are also aware of their responsibility to report any incident that constitutes abuse. There is information in place to inform the staff of how to refer any incidents where abuse is suspected or alleged to the local authority. A recent concern brought to the attention is being investigated by the local authority.
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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 live in a safe and homely environment which is maintained to a good standard of comfort and safety and has been adapted to promote people's independence.
Evidence:
All communal areas of the home were seen including people's bedrooms, the kitchen and laundry facilities. The laundry facilities have been improved and people are encouraged to be independent in doing their own laundry. Further facilities have been provided on the ground floor including a bathroom with toilet facilities. These facilities are available to be used all the people in the home and will assist people as they get older to have level access and more space should they need the assistance of care staff. Other improvements over the last year include, replacing the carpets in all communal areas, stairs and landing. Three bedrooms have been redecorated. The fire alarm system has been updated to meet new fire regulations and the wired nurse call system has been updated to a wireless system. People who live at the home chose decorations and paint colour for their own rooms and are consulted when other areas of the home are decorated. The registered providers ensure that the building is maintained in compliance with the regulations required by the Fire and Rescue Service and Environmental Health departments.
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Evidence:
All areas of the home seen were well decorated and furnished and was light and airy. The home has developed a covered area outside as people have to go outside to smoke since the ban on smoking in the work place was introduced.
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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.
People are supported by a caring staff team and are protected by the recruitment process.
Evidence:
Information provided in the annual quality assurance assessment showed that there are sufficient staff to provide the level of support required by people in the home. Four of the five staff have an National Vocational Qualification in care at level two. The staff team is varied in age and matches the age range of the people the support. One member of staff spoken with said that there were always two people on duty and this was sufficient to meet the needs of the people in the home. The files for four staff were seen and they contained an application form, two written references, evidence of a criminal records bureau disclosure, evidence of supervision and training. The application form now asks for a full employment history. Written surveys received from staff said that the proper checks were carried out before they commenced their employment and the induction they had mostly covered everything they needed to do the job. All staff receive supervision at least six times a year and this is an opportunity to identify any training needs. Staff have completed their mandatory training and cover other topics as necessary. The written surveys also said
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Evidence:
that staff receive good support from the providers. Feedback for people in the home said "the staff are nice and treat me with respect" and "the staff seem to be hard working" There is currently one vacancy and the providers are working to cover this shortfall until an appointment can be made.
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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 home is managed well and people who live at the home have a say about how the home is run.
Evidence:
The registered manager has recently left Gladstone House and the home is now being managed on a day-to-day basis by the providers Mr and Mrs Emambocus. They are qualified RMN's and Mrs Emambocus is also a specialist nurse in mental health teaching. People spoken to in the home said that they didn't miss the manager and that Mr and Mrs Emambocus are very nice. Written surveys from people living in the home said that the staff and managers listen to them and act on what they say. A survey received from a staff member said "Gladstone House is a very happy caring home now the owners are managing the home" There is a simple quality assurance system in place and this consists of questionnaires being sent to the people who live at Gladstone House, their relatives, the staff and health and social care professionals. The information gathered is used in an annual
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Evidence:
development plan for the home. Comments from the surveys include: "They help me a lot, I like living in this home it is very friendly" and "I am very happy at Gladstone House. I am treated very well by the staff" There are policies and procedures in place and these are currently under review to ensure they remain in line with current good practice and legislation. A selection of health and safety records were checked and these included the fire records, emergency call system and the gas safety certificate. These were up to date although the gas certificate is due for renewal in the near future. A record is kept of accidents and incidents and it is recommended that a new book is obtained to ensure that the records kept allow for personal information to be kept separately. When necessary accidents and incidents are reported to the Commission.
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Are there any outstanding requirements from the last inspection?
Yes £ No R
Outstanding statutory requirementsThese 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
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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 Requirement 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 Requirement Timescale for
action
1 20 13 The storage of medication must be moved to a more suitable location as described in the guidance provided by The Royal Pharmaceutical Society of Great Britain in the document The Handling of Medicines in Social Care. The guidance says "also the storage of medicines needs to be in the right place. Filing cabinets are not suitable for storing medicines, neither are: kitchens, bathrooms, toilets, sluices, windowsills, or areas next to heaters" This will ensure the medicines remain at their optimum strength when used.
25/09/2009
2 20 13 Controlled drugs must be stored according to current guidance and safe custody regulations.
23/10/2009
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This provides the extra security needed for this type of medicine and will help to prevent loss or diversion.
RecommendationsThese 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 1 Information provided to people thinking about moving in to the home should include an equality and diversity statement that outlines the different strands of the larger community whose needs could be met at Gladstone House.
2 42 It is recommended the accident book is replaced with something that allows for an individual's personal information to be kept confidential.
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