We carried out an unannounced inspection of Gatooma due to concerns raised. We visited Gatooma on 26 October 2011, 24 November 2011 and 15 December 2011. On the second visit we were accompanied by an independent behavioural therapist with a specialism in working with people with learning disabilities who demonstrate behaviours that may be a challenge to themselves and others.During our visits we looked all round the home and spoke to three of the five people who lived in the home in the lounge room. We saw the other two people but did not speak with them because they were preparing their lunch or engaged in other activities. We also talked with three members of staff, the manager, and a senior member of staff and a director of Atlas Project Team Limited. We examined various records pertaining to the care of all of the people who lived in the home.
People told us that they were happy living in the home and talked to us about their interests, activities and holidays. People said they were involved and supported to make decisions about their care and support needs. They said that their care and welfare needs were being well met. We observed staff supporting people appropriately with daily living tasks, including personal care and preparation of meals. Staff were also present at all times so that they were able to respond quickly to people's changing needs. We saw a positive approach by staff in the way they involved people and respected their independence when undertaking daily living tasks. We observed interactions between the staff and people who lived in the home and saw that staff were friendly and respectful to the people they supported by involving them in activities.
However we also found documentation showing that some people's telephone calls were listened to by staff, and recorded, indicating that all staff were not respectful of people's rights to privacy, dignity and independence.
Also, during our visit on 24 November 2011, we found that comments made to us by a senior member of staff, about one person in particular, were discriminatory in that the staff member referred to the person as a "thief" and a "liar", attributing these characteristics to the person's particular needs. This also showed a lack of knowledge about particular diagnoses and associated behaviours.
During our visits to the home we looked in particular at the 'garden' room which, on our first visit, was bare and had no heating. On that visit the staff told us it was not being used and was being redecorated. On our second visit we found that a radiator had been installed and we were told by the manager it was being used by two people who lived in the home as a 'quiet' room and that one person had chosen to sleep in the room overnight in September 2011 following an incident during a trip out. The room did not have any windows that opened and the door into the garden was locked in such a way that anyone using that room would not be able to get out in an emergency, for example, fire. We found that there was no risk assessment for the use of this room to ensure appropriate use by staff members to protect people who used the service from risk of harm. Therefore we made a referral to the fire service to check that this room was safe to be used for people who lived in the home. When we visited the home on 15 December 2011 the staff told us that this room was not being used and the fire service was due to visit the next day.
We found that the way in which the care files were organised made it difficult to find a clear process of assessment, care planning, risk assessment and guidelines for staff to follow to make sure they provided care and support in a consistent manner. The files contained a lot of information about people but we found that there were significant documents missing that we would expect to find to ensure that the planning and delivery of care reflected good practice. We found that the care planning documentation was not person-centred, people were not involved in devising their own plans of care/support and these were not always provided in formats that people could understand although a start had been made using photographs. People did not have health action plans, there was no clear evidence that they were receiving annual health checks and protocols for the administration of medication to be taken 'as required' were inadequate. There were no nutritional plans in place for people with dietary needs and no evidence of involvement from a dietician. There were no communication guidelines for people and no evidence of involvement from speech and language therapists.
The management and staff team were not knowledgeable about the Mental Capacity Act and Deprivation of Liberty Safeguards and were not aware of the implications of restricting people's liberty. The risks and benefits of using the garden room as a 'quiet' room and physical intervention practices had not been assessed or agreed by any external health or social care professionals. Relatives, representatives/advocates and health/social care professionals had not been properly consulted or involved in 'best interest' decisions relating to people's care and treatment. This meant there was no proper consultation and agreement that the way in which people's behaviours were managed in the home were in the person's best interests. People's rights to autonomy and independence were not considered at all times by the staff team.
There were sufficient staff in the home who considered themselves to have the skills and training to ensure that people's health and social care needs were met. Whilst most of the staff had received essential training, none of the staff team had received any training relating to the specialist needs of the people they supported, and they were not provided with up to date information about those particular specialist needs.
The staff knew what procedures to follow, both internally and externally, should an incident of mistreatment, abuse or neglect be witnessed, suspected or alleged. However it was not clear that staff understood what practices could constitute abuse.