Inspection on 01/12/09 for Dainton House

This inspection was carried out on 1st December 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dainton House 17/02/09

Dainton House 18/04/08

Dainton House 09/11/07

Dainton House 26/04/06

Dainton House 13/08/05

Dainton House 19/04/05

Dainton House 28/09/04

Dainton House 04/05/04

Dainton House 17/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Dainton House 1a Upper Brighton Road Surbiton Surrey KT6 6LQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jon Fry     Date: 0 2 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Dainton House 1a Upper Brighton Road Surbiton Surrey KT6 6LQ 02083900545 02083900545 dainton@cht.org.uk www.cht.org.uk Community Housing and Therapy Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Yin Ping Leung Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: A variation has been granted to allow one specified service user over the age of 65 to be accommodated. Because of the rehabilitive nature of this project and the aims and objectives set by Community Housing and Therapy, the project wishes to maintain the provision of night time cover of one care worker being on the premises providing a sleeping-in duty in which they are on-call to the residents. Room 7 is undersized measuring 9.73sqm and it`s use will be reviewed at regular intervals by the inspector. Date of last inspection Brief description of the care home Dainton house is a large, detached house. It is situated on a busy main road in a residential area of Surbiton. The house is within walking distance of Surbitons main shopping area and train station. Dainton House is managed by the voluntary Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 12 2 0 0 2 2 0 0 9 Brief description of the care home organisation Community Housing and Therapy. It is a residential care resource for up to twelve adults with mental health problems and associated complex needs including for example drug and alcohol related issues. The service is run as a therapeutic community providing support in the form of therapeutic groups and meetings aimed at preparing people to move on to more independent accommodation. The estimated length of stay is three years for their programme of rehabilitation. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: One inspector made an unannounced visit to Dainton House on the 1st December 2009. A further short announced visit was made on the 2nd December 2009 to look at records and other documentation. We spoke with four people who live at the service, four staff members and the manager. The service sent us their Annual Quality Assurance Assessment (AQAA) when we asked for it. This gives us information about outcomes for people who use the service as well as some numerical data. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each persons needs are assessed by the home before they can come to live there. A guide gives good information to individuals about the service provided. Evidence: The AQAA stated that Dainton House provides a therapeutic environment for clients to come to terms with their mental health difficulites. We provide group therapy and individual therapy for clients to work through their psychological and emotional difficulites and find more healthy ways of dealing with their difficulites. Comments from the people we spoke to included Im quite happy, Its not too bad and I do feel well supported here. One person said they felt a bit disappointed at the therapeutic programme on offer and felt that there could be more sessions offered to people. A guide about the home is available and this gives good information about how the community works at Daintondifficultiesdifficultiesdifficulties House. We have recommended that further input be sought from people living there to make the guide Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: as user friendly as possible. More pictures and photographs may help to do this. We looked at the care files for three people and saw that full assessments are completed before someone can come to live at the home. These documents contain good information about the individual and we saw that this is used to inform each persons therapy (care) plan. The home also obtains copies of assessments from the placing authority and other involved professionals. Care Homes for Adults (18-65 years) Page 10 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Therapy plans contain detailed information about individuals and their support needs. Risk assessments need development to make sure they address any identified risks with actions clearly stated. Evidence: The AQAA told us that when clients start their placement at Dainton House an individual care plan is created with the clients which describes in detail clients rehabilitative goals and how the community can help the client achieve his or her goals. We looked at the therapy plans for two people and saw that these provided good information about the individual and their support needs. The plans were up to date and areas covered include education., health, dialogue and future goals. The plans we looked at had been agreed with, and signed by, the person concerned. Risk assessments are completed by the home to help keep people living and working Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: there safe. The assessments we looked at clearly identified any risks but did not record any actions required apart from the ongoing dialogue within the therapeutic programme. We talked to the managers about improving the assessments to make sure they include practical steps to reduce any identified risks. They home produced some revised risk assessments by the second day of our inspection and we saw improvements had been made. An issue raised by three people who live there was about there not being clear boundaries around behaviour within the service. Comments included there are no repercussions, more rules and boundaries and it feels like Im treading on egg shells all the time. We looked at recent incidents within the service and discussed them with the managers. It is important that the service looks carefully at the safety of everyone within the service after any incident and makes sure that clear boundaries are set for all around acceptable behaviour. These boundaries need to be reinforced with all new people coming into the service and clearly stated in the guide and the licence to occupy. Care Homes for Adults (18-65 years) Page 12 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service tries to help people develop their social, emotional and independent living skills. There are opportunities to further improve the group programme on offer. Evidence: The AQAA stated we provide a rehabilitation programme i.e. cleaning group, catering group, maintenance group for clients to regain independent living skills and we have recently revised the therapeutic programme to provide more creative groups to meet the needs of the current clients. We asked for their input in making decisions about this programme. Comments from the people who live there included theres not enough to do, we need more varied groups and it can be a bit boring. As stated above, staff members told us that they were working to develop the Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: programme on offer with the people who live there. Some people who live there talked about the low attendance at some groups and their comments included only half the people turn up and they dont enforce it. The manager spoke of the ongoing challenge in encouraging people to participate and her plans to achieve this. We have recommended that there be a more structured evaluation of attendance and what works well with individuals. Other improvements planned by the service include getting people more involved with the local community and for more days out. The people who live at Dainton House are responsible for all aspects of food preparation including the menus, shopping and cooking. This is done on a rota and staff assist as part of the community. Feedback about the food included theres always plenty to eat, variable - it depends on whos cooking and the food is great. Care Homes for Adults (18-65 years) Page 14 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported with their health and personal care as required. The systems for administering medication require further improvement. Evidence: The AQAA told us that the overall needs of the clients in regards to their health is being carefully maintained. They are encouraged to follow up all appointments in regards to their own individual health care needs. This has resulted in clients taking a more active role in their own health matters relating to things such as contraception appointments, dental matters or chiropody. As stated previously, we saw that each person has a therapy plan and these address their support needs. Everybody living at the home has an allocated key worker and they meet regularly with the person in addition to the scheduled weekly therapy session. We looked at the system in place that supports people to take their medication. There were three instances where the quantity of medication left did not match with the records being kept by staff. All other records looked at were satisfactory and we saw Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: that medication was stored securely on behalf of the people who live there. We have made a Requirement for the home to further improve its practice in this area in this area. Audit systems need to be in place to pick up issues quickly and take the required action. Care Homes for Adults (18-65 years) Page 16 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual concerns or complaints are addressed by the service. staff receive training around safeguarding vulnerable people. Evidence: The guide about the service includes a copy of the complaints procedure. The manager told us in the AQAA that the service has received two complaints in the last twelve months. We looked at one issue during our visit and saw that the manager had responded in writing to address the issues raised. The Care Quality Commission received one concern since the last inspection took place in February 2009. This was referred to the home who responded directly to the person concerned. We have recommended that all concerns be recorded in the homes complaint record and the timescales and action taken. This will allow for a clear audit trail if required. The service lets us know about any incidents or accidents that happen and we saw that appropriate referrals are made to the Local Authority team in the case of Safeguarding allegations. The staff records we looked at showed that training has been provided to care staff around this important area of practice as required at the last inspection. Care Homes for Adults (18-65 years) Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable and has a programme to improve the decoration, fixtures and fittings. The bathrooms and toilets could be made more pleasant for people to use. Evidence: The people who live there said good, its pretty good and its alright. We saw that the home provides generally satisfactory accommodation and there is ongoing work to improve the environment for the people who live there. The two bedrooms we saw were well maintained and personalised to the individual. One concern was raised by an external professional around people being asked to share rooms. Two people we spoke to said they were happy to share their room whereas another individual reported Im really glad to have my own room after a period of sharing. The licence to occupy issued to each person does state that the organisation can give notice to the individual to move rooms and the manager told us that this was only done if the individual concerned is happy to move rooms. We have recommended that the home give careful consideration to this issue particularly where a person has previously occupied a single room. The current standards ask that the two people involved make a positive choice to share. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: We have also recommended that the service look at renovating the bathrooms. These provide adequate facilities but could be made much more pleasant. One bathroom may be more suited to being a shower / wet room. The lounge of the home would also benefit from the provision of more furniture. The home was generally clean and hygienic when we visited. The daily cleaning group continues and professional cleaners have also been used for deep cleaning. one external professional told us that they thought this was an area for improvement and that the service should employ regular domestic staff. Care Homes for Adults (18-65 years) Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live there are supported by sufficient numbers of well trained staff. Overnight staffing arrangements need to be reviewed to ensure people are kept safe. Evidence: Comments about the staff included the staff are nice, there are enough around, you can always speak to them and I have regular key working sessions. One person thought there should be more individual therapy sessions and felt disappointed at the therapeutic programme in place. An external professional said the manager and staff were very professional. Staff members we spoke to said that there had been a recent increase in staffing levels and this had benefited the service. Comments from staff included the atmosphere is really good - always someone to go to for support, its a very good team and fine. One staff member sleeps in at night and they can be called on by the people who live there during the night. We have asked the home to look again at the issue of staff working alone at night in order to ensure they are kept safe. We saw that staff are well trained and receive regular supervision. Staff members we Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: spoke to said they had good access to training and felt well supported in their day to day work. Two staff files were looked at during our visit and these contained all necessary recruitment checks. Training records showed that each staff member receives a structured induction and recent training courses attended included Safeguarding Adults, medication, infection control and fire safety. Care Homes for Adults (18-65 years) Page 21 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An experienced management team is in post. More work is needed to improve and develop systems that monitor practice and compliance with the plans, policies and procedures of the home. Evidence: An experienced staff team is in place at Dainton House. The manager and her deputy have previously worked at another service run by the organisation and have been in their current posts since September 2008. As stated previously, the staff we spoke to said that they feel well supported in their day to day roles. This is achieved through regular staff groups and individual supervision sessions. The AQAA told us that CHT has a quality assurance audit on a yearly basis for all projects. This review includes therapeutic operations of the project, staff management, as well as looking at reviewing the progress of clients from research data. Also CHT has its own internal clinical audit on a yearly basis for all projects. We Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: saw records of these audits and the service also supplies us with reports of the monthly visits made by the Clinical Director. Health and Safety checks take place but the frequency of these needs improvement. We were concerned that Fire Alarm testing has not been happening on a weekly basis with only one monthly check made in October and November 2009. Hot water temperatures had also last been checked in October 2009. We made an Immediate Requirement that the home must make sure that weekly fire alarm checks take place and the home informed us that this was now happening following our inspection visit. A further Requirement has been made to make sure that an effective audit system is in place to make sure that important Health and Safety checks are being completed as required. Care Homes for Adults (18-65 years) Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Risk assessments must clearly state all actions required in response to Any identified risks. Actions specified should be linked to the therapy plan in place giving clear guidance for staff members. This will help to make sure everyone within the service is kept safe. 05/02/2010 2 20 13 Full and accurate medication 05/02/2010 records must be kept by the home. Effective systems need to be in place to make sure that people are receiving their medication as prescribed with regular audits undertaken to confirm this. To ensure that individuals receive the right medication at the right time. Care Homes for Adults (18-65 years) Page 25 of 28 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 33 18 Overnight staffing levels and 05/02/2010 procedures must be reviewed. This is to ensure all individuals living and working at the home are kept safe at all times. 4 41 13 An effective audit system must be in place around Health and Safety checks. To make sure that these important checks take place when required. 05/02/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 We recommend that the user guide to the home be developed with input from the people who live there. This could include more pictures, photographs and additional information from the people who use the service to help people settle into the community. Clear boundaries need to be set within the home. This is with particular reference to behaviour that affects the safety and wellbeing of others. The home should continue to develop the programme of groups available to individuals living at Dainton House. A more structured evaluation of attendance and what works well / what doesnt may help to develop the programme on offer. The home should ensure that all concerns or complaints are recorded with timescales and actions clearly documented. The lounge would benefit from the provision of additional 2 9 3 11 4 5 22 24 Care Homes for Adults (18-65 years) Page 26 of 28 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations furniture. 6 7 25 27 People should only be asked to share rooms if both individuals are making a positive choice to do so. The bathrooms should be made more pleasant places for people to use. The provision of a shower / wet room should be considered. Further consideration should be given to the employment of regular domestic staff. 8 30 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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