Inspection on 08/09/06 for Chatsworth Care - Dawson House

This inspection was carried out on 8th September 2006.

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chatsworth Care - Dawson House 02/10/07

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 8th September 2006 9:30am Chatsworth Care - Dawson House DS0000042620.V310855.R02.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.V310855.R02.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.V310855.R02.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 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.V310855.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd January 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. One service user presents quite challenging behaviour. Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 8th September 2006, and lasted about five hours. The inspection involved discussion with the registered manager, Stella Anyokorit, and with the deputy manager and other staff members who were on duty. The inspector also spoke with service users. The inspector examined service user and staff records, and other documentation relating to the management and running of the home. As previously evidenced, the inspector is 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. Assessments and care plans are generally being completed to a high standard, and there is every indication from this and previous inspections that service users needs are being very well met in this home. 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. As a result of this inspection, As a result of this inspection, three requirements and two recommendations have been made. One requirement, relating to training, remains outstanding from the previous inspection. 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. Service users have the opportunity to visit and stay overnight, before deciding whether the home is likely to meet their needs. The home is able to demonstrate that it has the capacity to meet service users’ assessed needs. Service users’ health, personal and social care needs are set out in an individual plan of care, and are being reviewed on a regular basis. Service users are generally being protected by appropriate recruitment policy and procedures. Staff are being provided with the training, support and knowledge base required with which to meet the needs of this service user group. 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. Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 6 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 being assisted to participate fully in the day-to-day life and routines of the home, and are supported by staff in making decisions for themselves in their daily activities. Service users are thoroughly assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. 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. 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’ wishes regarding their ageing, illness and death are being handled with respect. Staff training in bereavement and loss is being provided. 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. All staff have received statutory vulnerable adult training. Service users live in an environment, which 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. Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 7 Generally, there are sufficient aids and adaptations within the home. Service users’ rooms were observed to be safe, comfortable and pleasantly decorated, reflecting service users’ personal identities, and being suited to 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 benefiting from well-supported and supervised staff. What has improved since the last inspection? What they could do better: Whilst service users are being individually consulted regarding their views, service user meetings are failing to evidence the necessary information sharing and discussion of issues that collectively affect service users and their lives within the home. While service users are generally being protected by the home’s medication policy and procedures, there are two concerns relating to the safe storage of medication that need to be addressed. Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 8 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.V310855.R02.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.V310855.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 to 6 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the 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. Service users have the opportunity to visit and stay overnight, before deciding whether the home is likely to meet their needs. The home is able to demonstrate that it has the capacity to meet service users’ assessed needs. Service users’ health, personal and social care needs are set out in an individual plan of care, and are being reviewed on a regular basis. Staff are being provided with the training, support and knowledge base required with which to meet the needs of this service user group. 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.V310855.R02.S.doc Version 5.2 Page 11 The home’s Statement of Purpose and Service User Handbook are both very comprehensive documents, and meet all the criteria detailed in this standard. Both the Statement of Purpose and the Service User Handbook have been reviewed since the last inspection (in May 2006). The Service User Handbook provides an appropriate format (using pictures and symbols) for assisting the understanding of individual service users. 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. Once a prospective service user has been 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. The home has not admitted any service users since the last inspection. The inspector examined a sample of service users files and found that these included up-to-date care plans, with evidence of relevant care management reviews. Files include care management assessments and risk assessments, details of the service user’s history, and the home’s assessments of needs. Assessment reports from psychiatrists and psychologists are being obtained, as required. The service users’ health, personal and social care needs are set out in an individual plan of care. Reviews have been completed within prescribed time-scales. One service user, who was admitted prior to the last inspection, was evidenced to have settled very well since moving to the home. 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. The impression gained is that this is a happy and well-run home, with service users’ individual care and support needs being well met. Individual service users presented as very settled in their environment, with evidence of extensive involvement in daily routines and activities both within the home and in the wider community. Staff on duty presented as Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 12 attentive to, and enabling of individual service users, with evidence of positive and caring interactions taking place. A contract is developed and agreed with the prospective service user and his/her nearest relative, care manager or advocate, with a copy signed by the service user or his/her representative, placed on his/her file. The contract has been written in a very accessible format, using pictures and symbols, which help to facilitate the service user’s understanding of its contents. Chatsworth Care - Dawson House DS0000042620.V310855.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 to 9 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the 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 being assisted to participate fully in the day-to-day life and routines of the home, and are supported by staff in making decisions for themselves in their daily activities. Whilst service users are being individually consulted regarding their views, service user meetings are failing to evidence the necessary information-sharing and discussion of issues that collectively affect service users and their lives within the home. Service users are thoroughly assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 14 EVIDENCE: The inspector examined a number of service user files. These include detailed service user plans, which are being regularly reviewed and updated. Service user plans are comprehensive and follow a person centred plan approach. Service user plans 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. The plans describe how service users will meet aspirations and achieve goals. All service users have six-monthly and annual reviews. 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 twelve-monthly 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. There are a number of mechanisms in place for involving service users in the running of the home. Service users attend weekly meetings. These are facilitated by a member of staff, and are attended by the Manager or Deputy Manager. 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. A requirement applies. The home has set in place a risk assessment procedure which details the risks and level of risk to service users. The inspector examined four service user files. These evidenced the completion of full and detailed risk assessments, together with risk management strategies agreed with service users. Service users’ potential for developing independence is encouraged and enabled wherever possible, subject to safe strategies for managing risks being in place. Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 15 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): 11 to 17 Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the 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.V310855.R02.S.doc Version 5.2 Page 16 EVIDENCE: Service users are evidenced as being provided with extensive and varied opportunities for personal development and leisure activities. Service user files evidence that there are detailed individual programmes for service users, with service users participating in a wide range of educational, social and leisure activities. These include attendance at social clubs (run by MENCAP), during the week, and at local education and leisure centres. One service user attends the Cheam Day Centre where a range of activities is offered, including drama therapy and music therapy. Service users participate in a variety of recreational and sporting activities such as swimming, ten-pin bowling and horse-riding. 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. Service users are also able to attend a local community college where a range of courses are offered for people with learning difficulties. The home actively encourages service users to access community facilities such as the local shops, a nearby park and the local leisure centre. Service users are assisted to go shopping in Sutton or Croydon (for clothes buying), and to attend community events and fairs when these arise. Service users also go out for lunch at a local café or pub at least once a week. 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. The home also arranges occasional outings and an annual holiday, for which it has its own minibus. Last year five service users went to a holiday centre in the Isle of Wight, whilst this year all six service users went to a hotel in Weymouth for five days. Outings have included a recent day trip to Brighton. 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. Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 17 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. The inspector observed that service users’ individuality is respected, with staff on duty being respectful of service users’ individual needs and sensitivities. Mealtimes are flexible and take account of individuals’ work and activity schedules. Menus evidenced 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 are able to have an alternative dish provided if the main menu options do not appeal. Menus are agreed in service users’ meetings. The manager advised that staff work alongside service users in preparing food, and that there is a rota for this and for the tasks of laying table and clearing up. One service user is currently under the care of a dietician, with records evidencing the ongoing monitoring of her weight and diet. The manager advised that considerable improvements for the service user have resulted, with the loss of weight mirroring a subsequent improvement in the service user’s general health and well-being. Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 18 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): 18 to 21 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. 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. While service users are generally being protected by the home’s medication policy and procedures, there are two concerns relating to the safe storage of medication that need to be addressed. Service users’ wishes regarding their ageing, illness and death are being handled with respect. Staff training in bereavement and loss is being provided. EVIDENCE: Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. 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 Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 19 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. The inspector examined a sample of service user files. This indicated that there is contact with health care professionals, as and when this is required, and that personal support and healthcare needs are generally being well met. 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. The inspector was advised that one service user has recently been assessed by a psychologist and that new behavioural guidelines are currently being drafted. Service users are able to receive visits from visiting professionals in the privacy of their own rooms. All service users are registered with a local GP practice. 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 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. 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 cupboard just off the office. The home employs the Boots blister pack system. All staff receive a comprehensive induction on the administering of medication to service users. Following induction training the staff member is observed by the manager on three occasions before being allowed to administer medication to a service user. A Boots pharmacist visits six-monthly and gives advice on medication issues. The manager and deputy manager is completing weekly checks on MAR sheets. All staff who administer medication have received accredited medication training, with staff having completed accredited NCHA medication training, with NESCOT (North-East Surrey College of Technology). In-house medication awareness training is also provided for all staff. The inspector examined a sample of medication charts, which presented as being satisfactorily maintained. The inspector was advised that service users’ Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 20 medication is being reviewed annually by the home’s GP, and was last reviewed in April 2006. The inspector noted two issues in regard to medication. Firstly, the need for a CD (controlled drugs) cupboard, for which a requirement applies. In keeping with the regulations for the safe storage of medication, there is a need for the separate storage of any controlled drugs that may be prescribed. Whilst none of the home’s service users are currently being prescribed any controlled drugs, the cupboard nonetheless needs to be installed so to cover this eventuality when it arises. Alternatively, a lockable metal controlled drugs box can be purchased and fitted within the designated space in the existing medication cabinet. The inspector also recommends that a small medication fridge should be put in place for the storage of any liquid antibiotics, eye drops and any other medication requiring to be kept at a controlled temperature. None of these items should be placed within the main food fridge as was evidenced on this inspection. The inspector has viewed the home’s policy covering bereavement that is based on the NCHA (National Care Homes Association) policy. Information is obtained regarding the wishes of the service user and nearest relative when the service user is admitted to the home. Staff are being provided with ongoing training in loss and bereavement. This has proved beneficial in raising staff awareness in this area, and in supporting a service user who had suffered a family bereavement. Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 21 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): 22 and 23 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the 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. All staff have received statutory vulnerable adult training. EVIDENCE: The home has a complaints procedure that includes the relevant required information, including stages and times-scales, for the complaints process. A revised format has made this more comprehensible for service users. A complaints book has been established. No complaints have been recorded since the last inspection. Following discussion with the manager at a previous inspection, a recommendation was made for a separate log to be maintained, to detail any concerns or positive feedback received. This has been implemented. 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 Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 22 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 staff have completed Sutton’s multiagency Vulnerable Adult training. The training manager is now providing this training for staff; she has completed Sutton’s ‘Training For Trainers’ course and Vulnerable Adult training, and is based in Chatsworth Care’s other home. The inspector was advised that there is regular POVA training every six months with updates for all staff. Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 23 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): 24 to 30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in an environment, which 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, there are sufficient aids and adaptations within the home. Service users’ rooms were observed to be safe, comfortable and pleasantly decorated, reflecting service users’ personal identities, and being suited to their individual needs. EVIDENCE: Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 24 The home has been purposely refurbished for this client group and presents as suitable in meeting their needs. The home has developed an annual programme of planned maintenance and renewal for the fabric and decoration of the premises The inspector completed an inspection of the premises. There has been an ongoing programme of re-decoration at the home, with three service users rooms and the lounge areas having been redecorated since the last inspection. The home is generally very well decorated and maintained, and presents as being comfortable and homely with modern style furniture. The home has pleasantly laid out communal areas which are well used by the service users. The inspector met three service users, who were relaxing in the lounge and who presented as being happy with their environment. There is a living room, with a television, and another smaller, quiet lounge that opens out from the reception hall. The large kitchen includes a dining area. The home also has a large well-tended garden at the rear of the house, with a patio for the use of the service users. All bedrooms are individualised and personalised by the service users, with all service users having 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. Generally, the home has sufficient aids and adaptations in place. Following a previous requirement, there was been an occupational therapist assessment (on 27/9/05) regarding one service user’s safe use of the shower. Recommendations for a floor to ceiling shower pole and a bath step have not, been implemented. The registered provider has advised that following an improvement in the service user’s mobility, in part due to significant weight loss, these adaptations are no longer necessary. A new risk assessment has been carried out to evidence the safe use of the shower, and the registered provider has confirmed that an OT reassessment has been requested. On the day of inspection, the home presented as being clean, pleasant and hygienic. All areas inspected 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.V310855.R02.S.doc Version 5.2 Page 25 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): 32 to 36 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the 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. Generally, service users are generally being protected by appropriate recruitment policy and procedures. Service users are benefiting from well-supported and supervised staff. 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 a four day initial induction programme; this includes two days of training and 2 days being familiarised with the home. This is followed by a six-week period of observation and further training, with the new staff member working alongside an experienced staff member. There is a threemonth probationary period. All staff have signed and dated a record to indicate that they have read and understood each policy and procedure that has been Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 26 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. There home has experienced some staff turnover during the last twelve months. This has involved the recent recruitment and training of three new staff members. The home currently has nine full-time and seven part-time staff, of whom 7 now have an NVQ Level 2, with five other staff having registered for study leading to an NVQ level 2. This represents a considerable 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. The manager has a relevant NVQ Level 4 and RMA (Registered Managers Award), and is currently completing an A1 NVQ Assessors Award. The deputy manager holds NVQ level 3, an NVQ Assessors Award, and a PDC in Management Care, and is nearing completion of his studies for an NVQ Level 4 and an RMA (Registered Managers Award). A senior support worker is registering to undertake study leading to an NVQ Level 4. Chatsworth Care has a training manager who has responsibility for the training of staff. A comprehensive training programme has been developed. This ensures that all staff receive training in 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. A requirement for staff to receive training in Challenging Behaviour has been partly met, with 7 out of 16 staff having so far received this training. The inspector viewed the staff rota, and was satisfied that the staffing complement for the home meets appropriate DOH guidelines, with a minimum of 3 staff being on each shift during the day for 6 service users, with one sleep-in and 1 on-call at night. The home has a satisfactory recruitment policy and procedure in place. This is based on equal opportunities principles and aims to ensure the protection of service users. Three staff have been appointed since the last inspection. The inspector examined the relevant staff files and found that identity and recruitment checks were generally being evidenced. However, the CRB (Criminal Records Bureau) certificate on file for two staff members related to a previous employment, and was not an up-to-date certificate dating from the commencement of her employment at Dawson House. The inspector evidenced that the staff members had received a POVA First check prior to commencing their employment and understands that both are working under the supervision of an experienced staff member, and do not provide assistance Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 27 with personal care, or have any one-to-one contact with service users. The registered manager assured the inspector that these conditions are being met. The inspector is recommending that these conditions are detailed in writing to the two staff members so as to make these clear and transparent. The inspector evidenced from staff files that care staff are receiving regular supervision on a six to eight weekly basis. New staff receive supervision within the first four weeks following the commencement of their employment. Supervision notes indicate that there is structured discussion regarding issues that relate to staff members’ practice, training and development. Supervision is shared between the registered manager and her deputy manager. All staff are being appraised on an annual basis. The inspector spoke to two new staff members, who indicated that they are feeling well supported at the home, and are receiving the necessary induction, supervision and on-the-job support. Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 28 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): 37, 38, 39, 40, 41 and 42 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is being run competently, and in the best interests of the home’s service users, with both staff and service users commenting favourably regarding the atmosphere in the home. 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.V310855.R02.S.doc Version 5.2 Page 29 EVIDENCE: The registered manager completed her NVQ Level 4 and the RMA (Registered Managers Award) in 2005. The inspector has found that the manager has a good understanding of the needs of this client group and is very competent in her management of the home. The inspector has been impressed by the management approach within this home. The inspector’s observations, and the discussion which he has had with both service users and staff, evidences that service users needs are generally being 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 to participate in daily routines, activities and decision-making. Staff feedback indicates that they are feeling well supported by management and that their training and support needs are being addressed. 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 has been 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 were last reviewed in May 2006. 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. The inspector examined all health and safety, and maintenance records and found that, generally, these were up-to-date. Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 30 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 3 2 3 3 3 4 3 5 3 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 3 25 3 26 3 27 3 28 3 29 30 3 3 2 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000042620.V310855.R02.S.doc 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Chatsworth Care - Dawson House Score 3 3 2 3 3 3 3 3 3 2 X Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes 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 YA8 Regulation 24(3) Requirement Service user meetings must evidence that service users are being informed and consulted regarding issues that affect their daily lives and welfare. 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. 3 YA35 18(1)a & c The registered manager must ensure that training is provided for all staff in Challenging Behaviour. The inspector understands that this requirement has been partly met, with 7 out of 16 staff having so far undertaken this training. 31/12/06 Timescale for action 30/09/06 2 YA20 13(2) & (4)(c) 30/11/06 Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 32 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 YA29 Good Practice Recommendations A small medication fridge should be provided for the storage of antibiotics, eye drops and any other medication that is required to be kept at a controlled temperature. The registered manager should put in writing to the two new staff members, who have not yet received an up-todate CRB certificate, the conditions that apply for their employment until such time as these have been received. 2 YA34 Chatsworth Care - Dawson House DS0000042620.V310855.R02.S.doc Version 5.2 Page 33 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 © 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.V310855.R02.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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