Inspection on 02/10/07 for Chatsworth Care - Dawson House

This inspection was carried out on 2nd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chatsworth Care - Dawson House 08/09/06

Chatsworth Care - Dawson House 03/01/06

Chatsworth Care - Dawson House 13/06/05

Chatsworth Care - Dawson House 26/11/04

Chatsworth Care - Dawson House 25/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Whitworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Chatsworth Care - Dawson House 151 Stanley Park Road Carshalton Beeches Surrey SM5 3JJ Lead Inspector Peter Stanley Key Unannounced Inspection 2nd October 2007 09:30 Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 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 Chatsworth Care - Dawson House DS0000042620.V351498.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 Adults 18-65. 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. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chatsworth Care - Dawson House Address 151 Stanley Park Road Carshalton Beeches Surrey SM5 3JJ 020 8395 5724 020 8395 4309 chatsworthcare@talk21.com 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) Gabrielle Anne Smith Mr G P Smith Ms Stella Anyokorit Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th September 2006 Brief Description of the Service: Dawson House was registered on 26 June 2003 and was inspected for the first time by the NCSC on 4 November 2003. The home is an attractive detached property set back from a fairly busy road in a residential area of Carshalton. The property is close to bus routes to Croydon and Sutton. The home offers very comfortable, well-maintained accommodation with modern furniture in a clean environment. There are six bedrooms. The home is registered to support six people with learning disabilities. All rooms are single occupancy with en-suite facilities, with four rooms offering an en-suite showering facility and the other two have baths. The ground floor has a sizeable lounge, which overlooks the patio and garden. The home also offers a quiet room and a dining area. Access to the gardens is possible via the kitchen or through one of the service users patio doors. There is a portable phone for the use of service users if required. The home presently has six service users with learning disabilities. These range from being moderate to severe, and include service users with specific needs such as autism, asthma and sight impairment. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 2nd October 2007, and lasted about five hours. The home’s registered manager, Stella Anyokorit, facilitated the inspection. The inspector spoke with both service users and staff on duty, and completed an inspection of the premises. The inspector had wide-ranging discussion regarding the home, and examined both service user and staff records. These included residents’ assessments and profiles, person-centred care plans, risk assessments, health action plans, review minutes and activity programmes, Staff records examined included staff rotas, supervision, appraisal and training records. Recruitment records and criminal records checks were examined - there have been six new staff members recruited since the last inspection. The inspector looked at documentation relating to the day-to-day running and management of the home. This included quality assurance questionnaires and records, policies and procedures and records relating to the logging of any accidents, incidents or complaints. Documentation relating to health and safety including the home’s risk assessments, servicing and maintenance certification, were also examined. Information was also available from the AQAA (Annual Quality Assurance Audit), which is completed by the home’s manager. Since the last inspection, one of the home’s residents has transferred to another home, and there has been one new admission. The new service user has settled in well, and all appropriate documentation relating to the admission, including a transition plan and a person-centred care plan, is in place. All documentation examined was satisfactory and well maintained and in compliance with the national minimum care standards. The evidence from this inspection, including feedback from surveys and reviews, indicates that the home is providing a homely, enabling and inclusive home environment. Service users’ rights are being respected, with service users presenting as settled and well supported. There is also evidence of an extensive and varied range of community-based activities and opportunities being offered with which to assist service users to develop their interests, abilities, and social skills. The inspector was, once again, impressed with the standard of care and support being provided to service users, and with the open-ness and commitment shown by the home’s provider and manager in creating an enabling and inclusive home environment. Assessments and care plans are being completed to a high standard, with the development of a well-structured and person-centred approach to all aspects of care planning. Staff work with service users in a caring, focussed and enabling way, and feedback from service users, relatives and other parties has generally been very positive. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 6 The home is seeking to build on its’ good practice and to achieve standards of excellence in its’ operation. The home has been re-accredited for the Investors In People Award, and, in September 2006, was assessed by the NAS (National Autistic Society) as having achieved the Autism Accreditation Award. From this inspection, there are two requirements, one of which dates from the previous inspection, and which is due to be met. What the service does well: Prospective service users are being provided with the information they require, in order to make an informed choice as to where to live. This information is being presented in a format that is appropriate to the communication needs of the service user. Prospective service users have the opportunity to visit and stay overnight, before deciding whether the home is likely to meet their needs. Service users who have been admitted to the home are being fully assessed, and are having their health, personal and social care needs identified in an individual person-centred plan of care. A transition plan is completed with each individual prior to his or her admission. Service users are being fully involved in this process. Each service user is provided with a service agreement. This is written in a format that is appropriate to the communication needs of the service user. Service users are having their health, personal and social care needs set out in an individual plan of care, and are being fully involved in the process of review and care planning. Service users are assisted to participate fully in the day-to-day life and routines of the home, and to participate fully in decisions that affect their individual and collective welfare. Service users are thoroughly assessed regarding potential risks to their health and safety, and are enabled to take responsible risks as part of their individual lifestyles. Service users are being encouraged and enabled to develop personal and independent living skills, and have opportunities for accessing appropriate education, training and work experience. Service users are being provided with a wide and varied range of opportunities for participating in recreational and leisure activities, and have extensive contact and links with the local community. The home actively encourages service users to maintain family links and friendships both inside and outside of the home. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 7 Service users’ rights and responsibilities are being recognised in their daily lives. Service users are being enabled to be as independent as possible within the constraints associated with their disabilities. Service users are being offered a nutritious and healthy diet in a congenial setting and at flexible times. The health, personal and social care needs of service users are being fully met, and their privacy respected. Service users are being protected by the home’s medication policy and procedures, and by the provision of accredited medication training for all care staff. The home has an appropriate and well-publicised complaints policy and procedure in place. Clear information for raising complaints is made available, and service users and their relatives/friends are encouraged to raise any concerns that they may have. The home’s policies, procedures and practice indicate that service users are being protected from abuse and are living in a safe environment. Service users are living in a safe, clean, hygienic and well-maintained environment with access to appropriate and sufficient communal facilities. Service users’ rooms present as being safe, comfortable, well decorated, and pleasantly arranged, reflecting individuals’ identities, and meeting their individual needs. Staff have clearly defined roles and responsibilities, and are sufficient in numbers to meet service users’ needs. Service users are having their needs well met by an appropriately trained and qualified staff group. Service users are being protected by appropriate recruitment policy and procedures, and by the completion of the necessary criminal records checks. Service users are benefiting from well-supported and supervised staff. A system of staff appraisal is in place. The home is being run competently, and in the best interests of the home’s service users. The home is demonstrating, through the development of its quality assurance processes, that it is seeking the views of service users, relatives and professionals, and that these are informing the home’s review of its ability to meet its aims and objectives. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 8 Service users’ rights and best interests are being safeguarded by the home’s record keeping, and by its policies and procedures. The health, safety and welfare of service users and staff are being appropriately promoted and protected. What has improved since the last inspection? 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. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 to 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective service users are being provided with the information they require, in order to make an informed choice as to where to live. This information is being presented in a format that is appropriate to the communication needs of the service user. Prospective service users have the opportunity to visit and stay overnight, before deciding whether the home is likely to meet their needs. Service users who have been admitted to the home are being fully assessed, and are having their health, personal and social care needs identified in an individual person-centred plan of care. A transition plan is completed with each individual prior to his or her admission. Service users are being fully involved in this process. Each service user is provided with a service agreement. This is written in a format that is appropriate to the communication needs of the service user. EVIDENCE: Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 11 The home’s Statement of Purpose and Service User Guide are both very comprehensive documents, and meet all the criteria detailed in this standard. The Statement of Purpose has been reviewed since the last inspection (in 2007), and the Service User Guide is currently being reviewed. The Service User Guide provides an appropriate format (using pictures and symbols) for assisting the understanding of individual service users. A copy of the Service User Guide (in English & Symbols) together with a Statement of Purpose and a copy of the latest CSCI Inspection Report, are provided upon request to relatives and care managers. The homes admissions policy is for the home’s manager or owner to ensure compatibility with other service users living at the home. The procedure involves visiting the prospective service user, completing their own assessment and requesting psychiatric or psychological reports where necessary. Wherever possible, the home tries to involve the care manager or close relative as an advocate, or seek an independent advocate from within the local area. A Transition Meeting takes place with the care manager and relevant professionals, and including the relative or advocate. A Transition Plan is drawn up, which includes medication, behavoural guidelines and all crucial information which will be required until the service user moves in to the home. Once a prospective service user has been fully assessed, and found to be compatible with others living at the home, he or she is encouraged to visit the home, then stay overnight, followed by another possible overnight stay, and culminating in a weekend stay. This process is designed to enable the prospective service user to become familiarised with the home prior to making a decision on whether to move in on a permanent basis. The registered manager has confirmed that the service user, his/her nearest relative, and care manager or advocate, are fully consulted and involved in the process leading up to admission. Since the last inspection the home has admitted one new service user (in June 2007). The inspector discussed the admission with the manager and examined the service user’s file. This included records relating to the individual’s personal profile, the assessment and risk assessment, the transition plan, and personcentred care plans. This indicated that there had been a thorough assessment of the individual’s needs and that appropriate care plans had been developed. The service user visited the home, and met with staff and other service users before deciding to move in. The inspector met the service user and observed that he presented as content and settled in his new environment. Review notes indicated that the service user has settled well in the placement. The inspector examined a sample of service users files. These included care management assessments and risk assessments, details of the service user’s Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 12 life history, details of their personal likes and dislikes, and the home’s assessment of their health, care and support needs. They also included relevant care management and care plan reviews, and assessment reports from psychiatrists and psychologists. The service users’ health, personal and social care needs are being set out in a comprehensive person-centred plan of care; this reflects the involvement and ownership of the service user in developing the plan. Review meetings are being completed within prescribed time-scales. These include a 12 monthly care management review meeting, which include the service user, his/her family members (or advocate), the service user’s key worker, and the social services’ care manager or reviewing officer. There is also an internal six-monthly care plan review meeting. Review notes generally indicate that there has been positive feedback from care managers and relatives regarding the home’s capacity to meet service users’ assessed needs, and help facilitate their independence and personal development. The inspector spent some time observing and engaging with service users and staff. The home has six service users, which vary from being moderate to severe in their diagnoses. Individual service users presented as being content and settled in their environment, and involved in their daily routines and activities. Some service users were not present on the day, as they were accessing activities within the wider community. The inspector observed staff on duty, who presented as being caring, focussed and supportive, and to be interacting in a positive way with service users. The inspector witnessed the very homely atmosphere and the attention given by staff in effecting good communication and in helping to facilitate individual self-expression. Each service user is party to a three-way contract with the Home and Social Services. The Home also has its own contract, which is made available to service users in symbol format, and includes details of the terms and conditions of their residency. The contract is developed and agreed with the prospective service user and his/her nearest relative, care manager or advocate, with a copy being signed by the service user or his/her representative, and placed on his/her file. The contract is written in an accessible format, using pictures and symbols, which help to facilitate the service user’s understanding of its contents. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6 to 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are having their health, personal and social care needs set out in an individual plan of care, and are being fully involved in the process of review and care planning. Service users are assisted to participate fully in the day-to-day life and routines of the home, and to participate fully in decisions that affect their individual and collective welfare. Service users are thoroughly assessed regarding potential risks to their health and safety, and are enabled to take responsible risks as part of their individual lifestyles. EVIDENCE: Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 14 Service user plans are comprehensive and follow a person centred plan approach. These provide information evidencing how service users’ care and support needs are being addressed, the involvement of service users and their relatives/representatives in drawing these up, and the service user’s right to make decisions in the process. Plans detail information relating to all aspects of the service users life, their personal profile, likes and dislikes, their personal goals and objectives, and how they communicate. They also provide comprehensive information on how the service will be able to support them in meeting their needs, goals and objectives. Monitoring forms which are completed daily, link into various parts of the Plan. These highlight any behavioural or general health issues, where changes have been observed. The plans are working documents and are designed to ensure that any issues highlighted are addressed and appropriate actions taken. The inspector examined a sample of service user files. These include detailed and service user plans, which are being reviewed and updated. The plans describe how service users aim to meet their aspirations and achieve their goals. The inspector discussed the value to be obtained from attending PCP Facilitator training in Sutton, with view to further developing the person-centred approach to care planning. He recommends that the manager and possibly one other senior staff member attend this training. Each resident who lives in the home has their care plan reviewed at least once every six months, these being updated to reflect any changing needs. This is in accordance with Standard 6.10. The service user and the key worker attend review meetings, with close family members, friends and/or representatives being invited. The care manager is also invited for the statutory twelvemonthly review. Service users are encouraged to make decisions regarding their day-to-day routines, activities and choices. There is substantial evidence of service users’ right to make decisions being respected, whether this is in the choice of activities, the use of leisure, choosing clothing or in developing skills and interests. As evidenced in care plans, service users are being consulted in respect of their day-to-day routines, their choice of food, and their choice of activities. Service users, who have very restricted verbal communication, are supported with their preferred method of communication to make their own choices. Person centred communication methods have been developed, and are in line with the NAS (National Autistic Society) Accreditation programme. Their preferred method of communication is used in any activity selection process, which all staff are familiarised with through training and observation. As part of the NAS Accreditation Programme, goals and targets are set and incorporated into each person’s service user plan. Certificates are awarded to service users Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 15 for achievements in developing their life skills, activities and community based interests. There are a number of mechanisms in place for involving service users in the running of the home. Service users attend weekly meetings, the minutes of which are being recorded. These meetings are facilitated by a member of staff, and are attended by the Manager or Deputy Manager. From the inspection of the minutes, these meetings have been successfully widened out within the last year so as to facilitate consultation with service users regarding their desired choice of activities, outings and future events. Each service user has a key worker who consults on a one to one basis and provides individualised support. Service users also receive regular weekly visits from the home’s owner, who consults with both service users and staff. The home has a risk assessment procedure which details the risks and level of risk to service users. The inspection of a sample of service user files evidenced that full and detailed risk assessments have been completed, together with risk management strategies agreed with service users. Service users’ potential for developing their independence is actively encouraged and enabled wherever possible, subject to safe strategies for managing risks having been put in place. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11 to 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are being encouraged and enabled to develop personal and independent living skills, and have opportunities for accessing appropriate education, training and work experience. Service users are being provided with a wide and varied range of opportunities for participating in recreational and leisure activities, and have extensive contact and links with the local community. The home actively encourages service users to maintain family links and friendships both inside and outside of the home. Service users’ rights and responsibilities are being recognised in their daily lives. Service users are being enabled to be as independent as possible within the constraints associated with their disabilities. Service users are being offered a nutritious and healthy diet in a congenial setting and at flexible times. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 17 EVIDENCE: The home places great emphasis on creating opportunities for personal development and leisure activities. Each service user has a detailed individual programme, which is based on his wishes, choices and needs. Service users participate in a wide range of educational, social and leisure activities. Feedback from service users, staff and family/friends, through the Home’s Quality Assurance Assessment, indicates that the home is achieving successful outcomes with its’ person centred structured daily programmes. Activities include attendance at social clubs (run by MENCAP), during the week, and at local education and leisure centres. Service users are supported to access and participate in local community activities, attending the local leisure centre for Snoozelem, gym and aerobics. There is participation within the local community where service users visit shops and attend fetes and Church events. There are also trips to the cinema, theatre, and pantomime, and outings to local pubs, cafes or restaurants. Four of the six service users attend a local Church of England church once a week (on Sundays), whilst one service user attends a local Roman Catholic church. Visits are made to the park to feed the ducks, to childrens animal farms, and to nature trails (including Richmond Park) for rambles and a pub lunch. The home arranges occasional outings and an annual holiday, for which it has its own minibus. Last year service users went to a hotel in Weymouth for five days. Day visits are arranged to attractions in London such as the London Aquarium and Buckingham Palace, as well as visits to seaside resorts along the South Coast and other places of interest. Service users are encouraged to participate in a variety of recreational and sporting activities such as swimming, ten-pin bowling and horse-riding, aerobics, snoozelem, gym, rambling, football, billiards, table tennis, swimming & hydro pool. Four service users attend the gymnasium each week, whilst two service users regularly go swimming, and two regularly go horse riding at a riding centre in Epsom. Service users are also evidenced from activity programmes to be pursuing activities such as art, beauty therapy, music and dance. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 18 Service users are encouraged to maintain contact with family and friends, with opportunities for service users to visit family at home for occasional weekends, and to receive visits at the home. There is a small, quiet second lounge that is set aside for visits (if this is preferred to the service user’s bedroom). The home has a portable phone that service users can use in their bedroom to make phone contact when required. Feedback from relatives has been very positive, and indicates that relatives are kept well informed and are made to feel welcome when they visit the home. The inspector observed that service users’ individuality being respected, with staff on duty being respectful of service users’ individual needs and sensitivities. The ethos of the home is orientated towards promoting independence and maximising choice and opportunities for service users. Service users are encouraged to take responsibility for undertaking daily tasks such as cleaning and tidying their rooms, and preparing drinks, food and snacks. Service users rights and responsibilities are evidenced from care plans as being respected and recognised in their daily lives, with service users being enabled to be as independent as possible within the constraints associated with their disabilities. Staff at the home work with service users with the aim of increasing their motivation and confidence, and developing their independent living skills. Service users are able to attend a local community college (North East Surrey College of Technology) where a wide range of courses are offered for people with learning difficulties. An open day is arranged before commencement of the term which helps to familiarise the individual with the college environment, and reduce their anxieties. Service users are reported to have shown an improvement in their social skills, confidence and life skills since being a part of this college environment. This progress is charted in service users’ files, and evidenced in feedback provided at reviews. Service users daily programmes have been devised with their input to reflect their choice and interests. TEACCH style boards are in use for each service user who can see their daily programme a morning, afternoon, day or week ahead, depending on level of ability. A picture can be removed if a non-verbal service user does not wish to participate on that occasion and it enables them to indicate an alternative activity with a picture of their choice. When an activity has been completed, the service user is able to remove the picture from the board and place it in the box at the bottom of the board. Goals and targets are set and a star reward system and certification have been put in place to reward achievement. Mealtimes are flexible and take account of individuals’ work and activity schedules. Staff work alongside service users in preparing food, and there is a rota for this and for the tasks of laying table and clearing up. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 19 Menus evidence a wide choice of foods, offering a varied and nutritional diet. Service users are consulted as to which foods they would like purchased, and 2 or 3 service users regularly assist with the main weekly shop at a local supermarket. Service users are able to have an alternative dish provided if the main menu options do not appeal. Menus are agreed in service users’ meetings. Staff have had accredited training in food hygiene and healthy eating, and service users are encouraged to adopt healthy life-styles. Weight charts are maintained, with problems of overweight being addressed with the help of a dietician. Service users usually have dinner together in the evenings, though there is flexibility to accommodate individuals’ social arrangements. The home encourages preparation of a wide variety of foods, reflecting different ethnic cuisines, and arranges occasional International evenings where the food, music and dress are all part of the scene for the evening. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 20 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 to 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of service users are being well met, with support being planned and tailored according to the individual needs presented. Privacy and dignity is being respected. Service users are being protected by the home’s medication policy and procedures, and by the provision of accredited medication training for all care staff. EVIDENCE: The range of personal support needs presented by service users, as outlined in assessments and care plans, is varied with support being tailored according to individually defined needs and goals. Information provided in care plans, together with feedback provided from reviews, indicates that staff are Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 21 providing flexible and focussed support, with the emphasis being on encouraging and enabling individuals to maintain their own personal hygiene and develop independence in their daily activities. Guidelines are set out for preferred routines, likes or dislikes as well as guidance and support for personal hygiene. There is daily recording of all personal care support to ensure continuity of care. All service users have their own en-suite bathroom or shower room, and are provided with personal care in the privacy of their bedrooms by staff of the same gender, and at a time to suit the preference of the individual service user. As detailed in residents’ assessments and care plans, there is a varied range of personal support needs that are being presented. The support offered is provided according to individuals’ needs, wishes and goals. Service users are able to receive visits from visiting professionals in the privacy of their own rooms. Where required, technical aids or equipment are provided.Occupational therapists, physiotherapists, etc. are consulted on behalf of service users if advice is needed regarding modification or supply of specialist equipment. The evidence from care plans, review notes, survey feedback and other data indicates that service users’ personal support and healthcare needs are being well met in this home. The inspector examined a number of service users’ files. These evidenced that there is detailed recording of service users’ personal support and health care needs in person-centred care plans, monthly summaries, and daily logs. A Health Action Plan, involving the service user and relevant health care professionals, has been developed with each individual. The Health Action Plan, medication profile, treatment Plan, and any relevant guidelines are incorporated into the service users Person Centred Care Plan. Referral and contact takes place with relevant health care professionals, according to assessed needs, and as and when concerns are identified. All service users are registered with a local GP practice, with healthcare facilities in the local community being accessed through the service users GP and local community care team. This includes referral for medical, psychology and psychiatric services. Service users’ emotional, behavioural and physical health needs are closely monitored, and individuals are reminded to receive visits and to attend appointments as and when these are required. Service users are supported by staff in attending for any routine or emergency hospital and outpatient appointments. The home is registered with a local dentist who specifically provides services for people with learning difficulties. An optician provides eye tests once a year for all service users. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 22 There is a diverse range of health conditions relevant to the service users in the care of the home. Training and advice for staff, relating to specialist needs such as autism, sensory impairment and challenging behaviour, have been made available to staff. The registered manager demonstrates a sound awareness of the healthcare needs of the home’s service users, and this is evidenced in the home’s records and procedures. The home has a clear policy and procedures in place for the receipt, recording, storage, handling, administration and disposal of medicines. Medication is kept in a locked cabinet adjacent to the office; following a previous requirement, the manager advised that a new medication cabinet, including a lockable box for controlled drugs, has been ordered and is awaiting delivery. The home employs the Boots blister pack system. All staff are provided with a comprehensive induction on the administration of medication to service users. All staff who administer medication receive accredited medication training, with NESCOT (North-East Surrey College of Technology). In-house medication awareness training is also provided for all staff. Practice and shadowing sessions are carried out by the Manager, and monitored through a checklist, until such time as the staff member is deemed sufficiently competent to administer medication. The Boots blister pack system is used for administration and MAR sheet record keeping is in place. The manager and deputy manager complete weekly checks on MAR sheets. A Boots pharmacist visits six-monthly and gives advice on medication issues. A second staff member shadows each staff member who administers medication, with two signatures being recorded for each medication administered. The inspector examined a sample of medication records, which evidenced that this good practice is being consistently implemented, and that medication charts are being appropriately maintained. The home aims to ensure that the consent of the service user is sought at all times when administering medication. Guidelines are in place for health professionals to act in the best interests of the service user, where it is difficult for a service user to make a decision about their medication. The manager has advised that each service user’s medication is being reviewed annually by the home’s GP. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 23 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an appropriate and well-publicised complaints policy and procedure in place. Clear information for raising complaints is made available, and service users and their relatives/friends are encouraged to raise any concerns that they may have. The home’s policies, procedures and practice indicate that service users are being protected from abuse and are living in a safe environment. EVIDENCE: The home has a complaints procedure that includes the relevant required information, including stages and times-scales, for the complaints process. The information given to residents and their relatives is up to date, and comprehensive, providing details as to how, and to whom they should complain. Service users are provided with the complaints procedure in a simplified symbols format. This includes help on how to complain to the CSCI at any stage if they wish to do so. All written complaints are acknowledged within two working days and Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 24 investigations into written complaints are held within 28 days. All complaints are responded to in writing by the home. No complaints have been recorded since the last inspection. The home aims to encourage an open culture, and individual free expression, so as to ensure that service users feel free to express any concerns or anxieties, and to assist in safeguarding them from any form of abuse. Service users are encouraged to approach anyone within the home with whom they feel comfortable if they wish to raise any concerns. No allegations of abuse have been recorded at this home, and service users present as being well supported and assured as to their safety. The home has its own Protection and Prevention of Abuse policy, and Whistle Blowing policy. All staff are required to sign to indicate that they have read through Sutton’s Protection of Vulnerable Adults Policy. The training manager for Chatsworth Care has completed Sutton’s ‘Training For Trainers’ course and provides statutory vulnerable adult training to all care staff on a rolling basis. Protection of Vulnerable Adults training is carried out every six months, together with regular training updates on abuse. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 25 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 to 29 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are living in a safe, clean, hygienic and well-maintained environment with access to appropriate and sufficient communal facilities. Service users’ rooms present as being safe, comfortable, well decorated, and pleasantly arranged, reflecting individuals’ identities, and meeting their individual needs. EVIDENCE: Dawson House provides a pleasant, comfortable and safe environment, refurbished to the standards required for meeting the needs of the home’s residents. The home presents as clean, hygienic and comfortable throughout. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 26 Residents present as settled and comfortable in their surroundings, and the environment is observed to have a very ‘homely’ feel. The inspector completed an inspection of the premises. There has been an ongoing programme of re-decoration at the home. The home is generally very well decorated and maintained, and presents as being comfortable and homely with modern style furniture. Several bedrooms have been redecorated in the last 12 months, together with the kitchen, main lounge and office, redecoration reflecting the preferences and wishes of the service users. There is an annual programme of planned maintenance and renewal for the fabric and decoration of the premises. The home has pleasantly laid out communal areas, which are well used by the service users. There is a main lounge, with a television, and another smaller, quiet lounge that opens out from the reception hall. Two service users were observed relaxing in the main lounge, both of whom presented as being very settled in their environment. Another service user was observed taking part in an aromatherapy session in the smaller lounge. The large kitchen includes a dining area. A visual rota (PECS) for sharing daily tasks in the kitchen is visible on the wall along with a visual rota of staff on duty a day at a time. The home has a large well-tended garden at the rear of the house, with a patio for the use of the service users. The home has its own gardener. All bedrooms are individualised and pleasantly arranged. The inspector observed that service users are encouraged to personalise their rooms, with photos of family and friends, and personal possessions, and by their choice of décor and colour scheme. All service users have a locked cupboard in their rooms. Each service user has a bedroom, which has more than reasonable useable floor space to meet individual needs and lifestyles. Each service user has access to either an en suite bathroom or a shower room. All furniture, including a comfortable chair, bedding, TV and electrical equipment is supplied by the proprietors unless a service user wishes to supply their own. Ensuite bathrooms provide pleasant facilities and privacy for service users. One of the original two bathrooms has been replaced, retiled and redecorated. All but one of the six bathrooms have now been refurbished, with one bathroom due to be replaced and redecorated within the next 12 months. The home has sufficient aids and adaptations in place, and provides a safe environment. Apart from emergency call systems, bath seats and rails, the current residents do not require any specialist adaptations or aids, and are able to move freely around the home and garden. On the day of inspection, the home presented as being bright, clean, pleasant and hygienic, and to be free from any offensive odours. All areas inspected Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 27 including the kitchen, laundry room, and communal areas, were satisfactory, with no hygiene concerns being identified. Staff are required to attend food hygiene and infection control training, and there are policies and procedures that relate to the maintenance of hygiene in the home. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 28 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 to 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have clearly defined roles and responsibilities, and are sufficient in numbers to meet service users’ needs. Service users are having their needs well met by an appropriately trained and qualified staff group. Service users are being protected by appropriate recruitment policy and procedures, and by the completion of the necessary criminal records checks. Service users are benefiting from well-supported and supervised staff. A system of staff appraisal is in place. EVIDENCE: Inspection of staff files provided evidence of clearly defined job descriptions having been put in place. On commencing their employment, all staff are required to attend an initial four day induction programme; this includes two days of training and 2 days being familiarised with the home. This is followed Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 29 by a six-week period of observation and further training, with the new staff member working alongside an experienced staff member. Chatsworth Care has a training manager who has responsibility for the training of staff. Staff are required to work through the Common Induction Standards (including all mandatory training and some specialist training in Autism and Challenging Behaviour). Workbooks accompany each section of the Induction process to ensure that training and knowledge has been assimilated. After a three months probationary period, the home’s manager and the training manager draw up an individual training plan with the staff member. The training plan indicates the person’s identified training needs, their personal and organisational learning objectives, timescale and evaluation outcome. At this stage, the staff member commences an Autism Focus Workbook, which is mentored and supported through to completion. The training manager plans interactive training sessions in autism throughout the year. A comprehensive training programme has been developed. This ensures that all staff receive training in Autism, First Aid, Fire Safety, Food Hygiene, Infection Control, Moving and Handling, Health and Safety, Abuse awareness and POVA (Protection of Vulnerable Adults). Training has also been extended to include the management of aggression and violence, challenging behaviour, equality and diversity, and anti-discriminatory practice. Through the home’s Autism Accreditation Programme, more effective person centred communication methods are being developed for each service user. This has encouraged staff to be consistent in their approach and to develop their understanding of service users’ communication needs. Training is ongoing with PECS and TEACCH, as well as Makaton, storyboards, visual rotas and menus. All staff have signed and dated a record to indicate that they have read and understood each policy and procedure that has been put in place and reviewed. Staff Meetings provide a forum for discussing issues that relate to practice and the running of the home; these are being held on a regular monthly basis. The home has experienced a significant degree of staff turnover during the last twelve months. This has involved the recruitment and training of six new staff members, out of a total staff complement of 16 staff. The inspector examined the files of the new staff recruited during the last 12 months. This evidenced that all recruitment, criminal records (CRB and POVA), and identity checks had been satisfactorily completed. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 30 The home currently has 16 care staff, of whom 7 have achieved an NVQ Level 2 in social care, with 7 other staff having registered for study leading to an NVQ level 2. This represents a continuing improvement in terms of the number of staff holding relevant care qualifications, and the home is on track for meeting the 50 target in this regard. 3 staff are studying for an NVQ Level 3 qualification. The manager has a relevant NVQ Level 4 and RMA (Registered Managers Award), and has completed an A1 NVQ Assessors Award. The home has a satisfactory recruitment policy and procedure is in place. This is based on equal opportunities principles and aims to ensure the protection of service users. The inspector inspected a sample of staff files. This evidenced that care staff are receiving regular supervision on a six to eight weekly basis. Supervision is shared between the registered manager, her deputy manager and a senior care worker. New staff receive supervision within the first four weeks following the commencement of their employment. Supervision records are signed by the supervisee following each supervision session. Records indicate that there is structured discussion regarding issues that relate to staff members’ practice, training and development. All staff receive a comprehensive appraisal, this being completed on an annual basis with the home’s manager and the training manager for Chatsworth Care. Care workers complete a pre-appraisal selfevaluation form prior to their appraisal session taking place. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 31 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 run competently, and in the best interests of the home’s service users. The home is demonstrating, through the development of its quality assurance processes, that it is seeking the views of service users, relatives and professionals, and that these are informing the home’s review of its ability to meet its aims and objectives. Service users’ rights and best interests are being safeguarded by the home’s record keeping, and by its policies and procedures. The health, safety and welfare of service users and staff are being appropriately promoted and protected. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 32 EVIDENCE: The registered manager, Stella Anyokorit, completed her NVQ Level 4 and the RMA (Registered Managers Award) in 2005. Throughout the inspection the manager displayed a good knowledge and understanding of the needs of this client group, and was able to demonstrate a high level of competency regarding issues that relate to the day-to-day running and management of the home. The inspector has been impressed by the management approach within this home. From the evidence of care plans, reviews and survey feedback, and from the inspector’s own observations and discussion, it is clear that service users needs are generally being very well met, and that there is a positive and enabling approach within the home. Service users present as settled and happy within the home and are being encouraged and enabled, in a number of ways, to communicate their wishes and needs, and to participate, as fully as possible, in daily routines, activities and decision-making. Views expressed by staff, from this and previous inspections, indicates that staff feel well supported by the home’s management and that their training and support needs are being well met. The home has developed its quality assurance processes, with feedback being obtained from questionnaires for service users, relatives/representatives, care managers/professionals and staff. The questionnaire for service users is presented in a suitable format for service users, and has been very well thought through and presented. This includes the use of Makaton and verbal prompts. An audit report has been developed which includes feedback from questionnaires. This is produced at the end of each calendar year. References to the outcomes from the quality assurance audit are included in the Service User Guide. From the evidence of this and previous inspections, service users’ and staff records are generally being well maintained. Records examined by the inspector have been found to be comprehensive, up to date and accurate. Service users are able to gain access to their records and any information held about them. In line with data protection, all records are being kept securely in lockable filing cabinets within an office. The home has a comprehensive range of policies and procedures in place. These are reviewed annually, and have all been reviewed within the last 12 months. A full record is maintained, which indicates the date when each staff member staff has read each policy and procedure that has been initiated or reviewed. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 33 The home presents as a safe environment in which to live, with up-to-date health and safety and fire risk assessments having been completed. The inspector evidenced up-to-date health and safety certificates for electrical installation, portable electrical appliances, fire alarm installation, emergency lighting and gas safety. An environmental health inspection (including food hygiene) was last completed on 29/6/05; this will need to be renewed. Fire safety training is undertaken twice a year, most recently in August 2007, and records evidence monthly fire drills. Other health and safety checks such as water temperature and fridge/freezer checks, and fire alarms tests, are being completed on a regular basis. The inspector examined incident and accident records, and noted that there have been 22 incidents recorded over the last 12 months. The inspector was concerned that the home had not been forwarding notifications of incidents to the CSCI. The manager was advised that, in accordance with Regulation 37, all events that significantly affect the health, safety or well being of any service user must be notified to the CSCI. A requirement applies. A separate incident record sheet is completed for each incident that occurs. This provides full details of each incident and the actions taken. Given the need for regular monitoring of incidents, the inspector recommends that the manager maintain a front page checklist of all incident record sheets, giving brief details of each incident and the actions taken. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 4 2 4 3 4 4 4 5 4 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 4 28 4 29 4 30 4 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 4 4 3 3 3 3 X Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? Yes (1) 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 YA20 Regulation 13(2) & (4)(c) Requirement There must be provision for the separate storage of any controlled drugs. A lockable metal controlled drugs box must be purchased and fitted within the designated space in the existing medication cabinet. The registered manager advised that a new medication cupboard, which will meet this requirement, has been ordered and is awaiting delivery. 2 YA42 37 All events which significantly affect the health, safety or wellbeing of any service user must be notified to the CSCI. 09/10/07 Timescale for action 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 36 No. 1 Refer to Standard YA35 Good Practice Recommendations The inspector recommends that the manager, and possibly one other senior staff member, attend PCP Facilitator training in Sutton. The inspector recommends that the manager maintains a front page checklist of all accidents and incidents, so as to assist in monitoring the health and safety of service users, and the actions taken to address any concerns that arise. 2 YA42 Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Chatsworth Care - Dawson House DS0000042620.V351498.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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