CARE HOME ADULTS 18-65
Chatsworth Care - Dawson House 151 Stanley Park Road Carshalton Beeches Surrey SM5 3JJ Lead Inspector
Peter Stanley Unannounced Inspection 3rd January 2006 9:30 Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 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.V273774.R01.S.doc Version 5.0 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.V273774.R01.S.doc Version 5.0 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 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) Mrs 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.V273774.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th June 2005 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 accomodation with modern furniture in a clean environment. There are six bedrooms. The home is registered to support six people with learning disabilities. There are currently six service users at the home, with five female and one male service user. 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. Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over one half day. This involved discussion with the registered manager, Stella Anyokorit, and with a senior staff member. The inspector also spoke to two service users. There is currently one vacancy. The inspector examined service user and staff records, and other documentation relating to the management and running of the home. As a result of this inspection, there are 6 requirements and 1 recommendation. 4 of these remain outstanding from the previous inspection. The revised timescales are highlighted in bold italics on the requirements list. The inspector was, as previously, impressed with the standard of care and support 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. What the service does well:
The rights and best interests of service users are being safeguarded by the home’s record keeping policies and procedures. The home is able to demonstrate that the range of needs presented by service users are being properly assessed, and appropriately met. Service users’ health, personal and social care needs are set out in an individual plan of care, and are being appropriately reviewed. Service users have their health, personal and social care needs set out in an individual plan of care, and are being fully involved in the care planning process. Service users are thoroughly assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. Service users’ personal support and health care needs are being well met in this home, with support being planned and tailored according to the individual needs presented. Service users are being encouraged and enabled to develop their independent living skills, within a risk assessment framework. Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 6 Service users live in an environment that is safe, well maintained and adapted for people with disabilities. Service users have access to safe and comfortable facilities, including sufficient communal areas, bathrooms and toilets. The home presents as clean and hygienic. Staff have received infection control training. The rights and best interests of service users are being safeguarded by the home’s record keeping 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?
The health, safety and welfare of service users and staff are being appropriately promoted and protected. Fire safety training has been updated. Service users are being protected by the home’s medication policy and procedures; all staff who administer medication have now received accredited medication training. The home’s policies, procedures and practice indicate that service users are being protected from abuse and are living in a safe environment. All staff have now received statutory vulnerable adult training. Fire safety training for all staff has been updated. Training in Equality and Diversity, and anti-discriminatory practice has been provided for five staff members; this needs, however, to be extended to all other staff who work in the home. Training in Challenging Behaviour has been provided for some staff; this needs to be extended to all staff who work in the home. An Occupational Therapist has assessed a service user’s use of the shower following a deterioration in her mobility. The home is awaiting receipt of a report from the Occupational Therapist; recommendations to address this will need to be implemented. Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 7 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. Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 8 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.V273774.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home is able to demonstrate that the range of needs presented by service users are being properly assessed, and appropriately met. Service users’ health, personal and social care needs are set out in an individual plan of care, and are being appropriately reviewed. EVIDENCE: Standards 3 and 4 assessed. All standards met at the last inspection. The home has admitted one service user since the previous inspection. The inspector examined the service user file and found that this included the relevant care management assessments, details of the service user’s history, the home’s assessments of needs, together with risk assessments. The service users’ health, personal and social care needs are set out in an individual plan of care. A care management review has been completed within the prescribed time-scales; this was attended by a care manager from the funding authority. There has been positive feedback from both the care manager and nearest relative regarding the home’s capacity to meet the service users’ assessed needs. The service user presents as having settled well in the placement and no concerns have been reported. Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users have their health, personal and social care needs set out in an individual plan of care, and are being fully involved in the care planning process. Service users are thoroughly assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. EVIDENCE: Standards 6 and 9 assessed. Standards 7 and 8 met at the last inspection. Service user plans are comprehensive and follow a person centred plan approach. These evidence service user involvement and the service user’s right to make decisions in the process. All service users have a six-monthly review as well as a statutory twelve-month review. Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 11 A service user plan has been put in place for the recently admitted service user. This outlines the service user’s care and support needs and describes how the service user will meet aspirations and achieve goals. The plan evidences the involvement of the service user and her nearest relative in this process. The home has set in place a risk assessment procedure which details the risks and level of risk to service users. Service users’ potential for developing independence is encouraged and enabled wherever possible, subject to safe strategies for managing risks being in place. Inspection of the file for the recently admitted service user provided evidence of risks identified from risk assessments, together with risk management strategies agreed with the service user. Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not assessed. All standards met at the last inspection. Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users’ personal support and health care needs are being well met in this home, with support being planned and tailored according to the individual needs presented. Service users are being encouraged and enabled to develop their independent living skills, within a risk assessment framework. Service users are being protected by the home’s medication policy and procedures; all staff who administer medication have now received accredited medication training. EVIDENCE: Standards 18, 19 and 20 assessed. 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 individual needs and goals. Information provided in care plans, together with feedback provided from reviews, indicates that staff are 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. Where service users require support with personal care, this is provided privately in their bedrooms. All service users have access to either an en suite bathroom or shower room.
Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 14 All service users are registered with a General Practitioner. 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. A requirement in respect of Standard 20 has now been met, with all staff who administer medication (9) having received accredited medication training. The inspector was informed by the manager that staff have now completed accredited NCHA medication training, with NESCOT (North-East Surrey College of Technology). Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home’s policies, procedures and practice indicate that service users are being protected from abuse and are living in a safe environment. All staff have now received statutory vulnerable adult training. EVIDENCE: Standard 23 assessed. No complaints have been recorded since the previous inspection. The home has its own Protection and Prevention of Abuse policy, and Whistle Blowing policy. The registered manager has previously advised that the home has obtained Sutton’s Protection of Vulnerable Adult Policy, and that all staff have signed to indicate that they have read through the policy and procedure. Following a requirement from the last inspection all but one (recently started) staff member have completed Sutton’s multi-agency Vulnerable Adult training. The manager advised that this training is now being provided for staff by the training manager; she has completed Sutton’s ‘Training For Trainers’ course and Vulnerable Adult training, and is based in Chatsworth Care’s other home. Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users live in an environment that is safe, well maintained and adapted for people with disabilities. Service users have access to safe and comfortable facilities, including sufficient communal areas, bathrooms and toilets. Generally, the safety of service users within the home is being safeguarded by sufficient aids and adaptations. However, the decline in one service user’s mobility, and the risks involved in using the present shower, necessitates the implementation of any recommendations following a recent occupational therapist assessment. The home presents as clean and hygienic. EVIDENCE: Standards 24, 29 and 30 assessed. Standards 25 to 28 met at the last inspection. The inspector completed an inspection of the premises; one health and safety concern was identified. The kitchen has been provided with new tiled flooring; this gives the kitchen an attractive appearance and was said by a staff member to be easier to keep clean. The home has been purposely refurbished for this client group and presents as suitable in meeting their needs. Each service user
Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 17 has access to either an en suite bathroom or shower room. The home is very well decorated, comfortable and well maintained with modern style furniture. The communal areas are pleasantly decorated and furnished. Control Of Substances Hazardous to Health (COSHH) guidelines are applied within the home. While these are kept within a locked utility room, the cupboard in which these are stored was not locked. On inspection it was noted that the lock was faulty and requires repair. The manager assured the inspector that this would be attended to without delay. A requirement applies. A requirement from the previous inspection, for an occupational therapist’s assessment of a service user, with deteriorating mobility, and implementation of recommendations, remains to be met. The manager advised that an occupational therapist has visited and assessed the service user and the difficulties involving the safe use of the shower (in her bathroom). A report outlining the recommendations has yet to be received, but the inspector was advised that the current shower would be difficult to adapt and that a new walk-in shower would likely be required. Once the report has been received, the necessary recommendations required to make this safe must be implemented. The home presents as being clean and hygienic. Staff receive training in food hygiene and infection control. Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): While, generally, service users are being protected by appropriate recruitment policy and procedures, and the completion of the necessary recruitment checks, the home must ensure that up-to-date CRB checks are obtained for all new staff members. Generally, service users’ individual and joint needs are being addressed by a fairly comprehensive staff induction and training programme. However, while training in certain key areas (Equality and Diversity, Anti-Discriminatory Practice, and Challenging Behaviour) is being provided, this needs to be extended to all staff, together with training in the management of aggressive and violent behaviour. EVIDENCE: Standards 34 and 35 assessed. There have been two staff appointed since the last inspection. The inspector examined the files of two new staff members files. Identity and recruitment checks were generally evidenced. However, the CRB (Criminal Records Bureau) certificate (dated 20.10.05) on file for one staff member was one which related to a previous employment, and was not an up-to-date certificate dating from
Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 19 the commencement of her employment at Dawson House. The inspector evidenced that the staff member has received a POVA First check and understands that she is working under the supervision of an experienced staff member. No one-to-one contact, or assistance with personal care, is permitted until the CRB certificate has been obtained. The CRB certificate must be obtained and the CSCI notified; a requirement applies. A CRB certificate for another staff member, which had not been obtained at the last inspection, has now been received. The registered manager has set in place a training programme that ensures that all staff receive training in First Aid, Fire Safety, Food Hygiene, Infection Control, Moving and Handling, Health and Safety, Abuse awareness and Vulnerable Adults Procedures. The inspector discussed the episodes of anger and mood swings, which have, on occasion, been presented by a service user, and of the challenge which this can present to staff in managing this behaviour. The manager advised that some staff have attended training in Challenging Behaviour, but that four staff members still need to complete this; this is an outstanding requirement that must be fully met. The inspector further recommends that staff undertake training in Managing Aggression and Violence and in the use of restraint. The inspector identified a need for training for staff in the areas of Equality and Diversity, and Anti-Discriminatory Practice, at the last inspection. This followed an incident, which entailed ‘racist comments’ being reported by a staff member. To date, 5 staff members have undertaken this training; this must be extended to all other staff members. The requirement, therefore, remains to be fully met. Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The rights and best interests of service users are being safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users and staff are being appropriately promoted and protected. Fire safety training has been updated. EVIDENCE: Standards 41 and 42 assessed. Standards 37 to 40 met at the last inspection. Records viewed by the inspector presented as well maintained and up to date. These included risk assessments for service users, detailing the nature and level of risk, and how the risk is being managed. The rights and best interests of service users are being safeguarded by the home’s record keeping, with generally comprehensive, up to date and accurate records being maintained. Staff and service user files were found to be generally satisfactory and well maintained. Records listed in Schedule 3 of the Regulations, relating to the health, safety and welfare of service users, were checked on the previous inspection. These were found to be up-to-date and in good order.
Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 21 Fire safety training has been held for all staff in the last 3 months, thus meeting a requirement from the last inspection. No health and safety concerns were identified. Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x 3 3 x Standard No 22 23 Score x 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 x x 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x 2 3 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score 2 x x 2 2 x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Chatsworth Care - Dawson House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x 3 3 x DS0000042620.V273774.R01.S.doc Version 5.0 Page 23 Yes Are there any outstanding requirements from the last inspection? 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 YA24 Regulation 13(4)(a) & (c) Requirement The registered person must ensure that all cleaning agents and fluids are stored securely within a locked COSSH cupboard. The lock requires urgent repair. The registered manager must arrange for an occupational therapist to visit and assess a service user who has experienced some deterioration in her mobility. There must be an assessment of her need for aids and adaptations in facilitating safe use of the shower, and regarding any other aids or adaptations to assist her safety and mobility within the home. An O.T report must be obtained and all recommendations implemented. The registered manager must ensure that at least 50 of staff are qualified to NVQ Level 2. The Registered Manager must obtain a new CRB certificate for a recently recruited staff member, and the CSCI notified
DS0000042620.V273774.R01.S.doc Timescale for action 05/01/06 2 YA29 13(4)a & c 28/02/06 3 4 YA31 YA34 18(1)a & c 19(1)b Sch2 No7 31/03/06 28/02/06 Chatsworth Care - Dawson House Version 5.0 Page 24 5 YA35 18(1)a & c 18(1)a & c 6 YA35 once this has been received. No one-to-one contact between the staff member and service users is permissible until the CRB certificate has been obtained. The registered manager must ensure that training is provided for all staff in Challenging Behaviour. The registered provider must ensure that training is provided for all staff in the areas of Equality and Diversity, and AntiDiscriminatory Practice. 28/02/06 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA35 Good Practice Recommendations The inspector recommends that staff undertake training in Managing Aggression and Violence, and in the use of restraint. Chatsworth Care - Dawson House DS0000042620.V273774.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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