Inspection on 13/08/05 for Dainton House

This inspection was carried out on 13th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 but made no statutory requirements on the home.

Other inspections for this house

Dainton House 01/12/09

Dainton House 17/02/09

Dainton House 18/04/08

Dainton House 09/11/07

Dainton House 26/04/06

Dainton House 19/04/05

Dainton House 28/09/04

Dainton House 04/05/04

Dainton House 17/02/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Dainton House 1a Upper Brighton Road Surbiton Surrey KT6 6LQ Lead Inspector Michael Williams Unannounced Inspection 13th September 2005 10:45 Dainton House DS0000013383.V249912.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 Dainton House DS0000013383.V249912.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. Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Dainton House Address 1a Upper Brighton Road Surbiton Surrey KT6 6LQ 020 8390 0545 020 8390 0545 dainton@cht.org.uk 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) Community Housing and Therapy Laura Liverotti Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. A variation has been granted to allow one specified service user over the age of 65 to be accommodated. 19th April 2005 2. 3. Date of last inspection Brief Description of the Service: 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 organisation Community Housing and Therapy which has six projects registered with the National Care Standards Commission. Dainton House 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. It is run as a ‘therapeutic community’ providing support in the form of therapeutic groups and meetings aimed at preparing service users to move on to more independent accommodation where that is possible. The estimated length of stay is three years for their programme of rehabilitation. Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is an established mental health service providing an intensive, time limited programme of rehabilitation. The service users are therefore expected to participate fully in the regime of meetings, groups, individual support and life skills such as shopping, cooking and money management. Those service users who chose to assist in the inspection spoke well of the home; how helpful the staff are and how the general environment has improved since my first visit in April 2005. This inspection was also used to investigate a complaint about the garden and another about the support provided to service users at night. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 6 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 Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 7 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): 2 New service users are being admitted only on the basis of a full assessment that involves the service user or, in some cases, their advocate or representative. EVIDENCE: Service users do have their needs assessed at the point of admission but a requirement was made in April to ensure this initial information is filed clearly and methodically in the service users’ case files so that their needs are clearly known from the outset and can be referred to at a later stage to assess progress and change. This is now the case. A sample of the care plans was checked and the care plans seen make clear the service users’ needs and associated risks and a clear plan of action is in place. Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 8 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): 679 Care plans are in place to ensure service users’ changing needs are identified and goals set to met those needs; all service users meet daily to assist in decision making about the home, the environment and about their own lives. Risk assessments now more clearly identified in the care plans and service users are supported in taking appropriate risks and avoiding risks that jeopardise their well being. EVIDENCE: Service users are involved in the initial decision-making about their admission and then are involved in the review process. They are fully involved in decision-making about the care and support to be provided by the home. Service users are also involved in the day-to-day running of the home including shopping, cooking, cleaning and gardening responsibilities. Involvement in this manner is seen as helping service users develop a better understanding of, and involvement in, life around them and by this means increase self-awareness and confidence. When service users risk taking becomes unacceptable then the home, with the involvement of the service user and their care manager, reviews the placement in the home. Two service users confirmed this to be the case and are now planning to move on. Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 9 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 The key standards listed above were assessed in April and judged to have been met. On this occasion the service users’ opportunities for personal development was explored in more detail and again found to be met. EVIDENCE: The increased clarity in the care plans and risk assessments helps guide person development; the revision of the home’s policy on ‘drug and alcohol misuse’ also helps give direction to staff and service users themselves and provides clear boundaries for their personal development. The changes to the daily routines to deal with domestic chores also provides opportunities for service users’ personal development and skills in daily living and social interaction. The home has an annexe that can be used to give service users even greater opportunity to increase their person development and self-help skills. In this home personal development is also nurtured through counselling groups and individual support sessions. Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 10 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 Whilst the staff team does not reflect the same ethnic and cultural background of many service users it has employed male and female staff so as to provide care that is sensitive to the gender needs of service users when providing personal support. Other key standards were not inspected on this occasion but in April the inspector made the following observations: the physical, emotional and health care needs of service users are clearly identified in care plans so as to ensure support is provided in a manner that suites service users. The procedures and policies for the administration of medication ensure the safety of service users. EVIDENCE: Following a complaint made to the organisation about the gender of night staff this standard was discussed in some detail with the manager. The manager advises the CSCI that the home very rarely provides personal care, it provides counselling and social support and not help with intimate, personal care such as bathing and dressing. The manager therefore feels that the gender of staff will be a matter for service users to decide who they feel comfortable with when needing social support. As there is only one member of staff on duty at night a recommendation is made to review the home’s policy of night staff so as to ensure care can be provided by a person of the same gender where possible. Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 11 Those findings were based upon information gathered at the time including the following observations; the case files of service users are used to record their health care needs and this includes details about specialist mental health services that need to be provided under the ‘care programme approach’ (for people who have been in hospital and are therefore entitled to psychiatric aftercare). Staff support service users in controlling their own medication when this is appropriate otherwise the staff administer medication as prescribed by the doctors. Many service users are capable acting independently and can ask for medical advice if they feel unwell. Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 12 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 Complaints: The home has a clear and simple procedure for dealing with complaints so service users’ are confident their concerns will be dealt with promptly and effectively. The CSCI investigated a complaint during this visit and found it upheld. The arrangements for protecting service users from abused were not reexamined on this occasion but were found to be satisfactory in April. EVIDENCE: A record of complaints is in place. Three complaints have arisen since the previous inspection; the first was made directly to the company was about the care and support of service users; the second and third were sent directly to the CSCI and were about the garden with an additional point about the support of service users at night. The complaints about the garden and the support of service users were found to be upheld in that the garden needs to be improved to remove weeds and deal with trees that cause a nuisance to neighbours. The arrangements for support at night also need to be improved so that service users have easier access to the member of staff who is on duty but is permitted to sleep on the premises – this person must be more readily accessible to service users at night because at present the staff sleeping in the annexe, which is not linked to the house by an accessible internal door. None of these complaints needed to be dealt with under the procedures for dealing with the protection of vulnerable adults. No complaints were made by service users, or their relatives, during the course of this inspection. In contrast several compliments were paid to the home by appreciative service users. Standard 22 is assessed as met in so far as the home has in place policies and procedures for dealing with complaints in a prompt and sensitive manner. The subjects of the complaints are dealt with under other headings. Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 13 In the earlier inspection the CSCI noted that the home has written policies and procedures about the protection of service users and their property to ensure vulnerable service users are safeguarded from abuse the home; this includes procedures for passing on concerns to the relevant authorities including the CSCI. Staff are given training to ensure they know how to respond appropriately to allegations of abuse. Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 14 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 28 30 The home provides a safe, well-maintained environment so service users have access to safe and comfortable facilities. The grounds are improving but there is scope for further improvement to the rear garden if the service users are to have the use of a safe and well maintained garden. The home is now a lot cleaner, this will ensure service users have a hygienic environment in which to live. EVIDENCE: Dainton House is an “existing” home (one that was registered before 2002) and so it does not have, and is not required to have, all the facilities that might be expected of a modern care home. However, it is to be noted that the CSCI takes a flexible approach to specialised services such as Dainton House – which does not provide long-term care, all service users will move on within about three years. The Manager has advised the inspector that the company is reviewing the premises with a view to making improvements where possible and this will include re-landscaping the garden so that service users can make better use of it as part of their rehabilitation and so cause less nuisance to neighbours – in particular the large number of tall conifers will be reconsidered. The home is now being maintained in a better state and was clean and tidy and free of offensive odours when inspected. Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 15 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): 33 The key standards were checked during the previous inspection and found that the home’s recruitment practices and the investment in staff training and support ensures that service users are protected and their care needs meet. Whilst the support and supervision provided for service users seems adequate during the day, and was assessed as satisfactory during the previous inspection, arrangements for staff support at night are less so. EVIDENCE: Standard 33 was re-assessed following a complaint about the manner in which a service user called for assistance during the night – which caused a disturbance in the garden and distressed neighbours. Staff are on duty during the night but have recently moved to the annexe which does not have direct access to the main house. The present call-bell system was inadequate on this occasion so a requirement is made to review the on-call arrangements so that staff are more readily available in the main house so they can monitor the home and make themselves available for service users in the night. Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 16 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): 40 42 The key standards 37 and 39 were assessed during the previous inspection and were not re-evaluated on this occasion. Standard 42, health and safety was checked and the home is ensuring that in so far as it is reasonably practical to do so, the health, safety and welfare of service users, and staff, is being promoted and protected but a number of matters of safety need to be addressed and they are listed in the requirements table below. One policy about drug and alcohol misuse was checked and requires refinement to ensure the guidance will protect service users by making clear the home’s approach to breaches of this policy. EVIDENCE: The findings of the previous inspection were that service users’ contribution to the running of the home is vital to the whole ethos and style of the therapeutic community in this home and this remain the case. Requirements made at the previous inspection, such as the need to improve hygiene and to improve the garden, were discussed with the group of service users to find solutions that the whole group could work with. In respect of health and safety, a review of door-locking mechanisms needed to be undertaken throughout the home and, with the exception of the doorDainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 17 locks in the annexe, suitable locks have now been fitted in the main house. Cleanliness in the home is now much improved, particularly in the kitchen area, but the home must replace the dishwasher without delay as this provides the means for ensuring kitchen utensils and crockery are effectively cleaned. The manager has revised the drug and alcohol policy, as recommended, but further revision is needed to make clear the home’s specific position rather than the company’s generalised therapeutic stance in these matters. Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 18 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 3 X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X 2 X 3 LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 2 X X x CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Dainton House Score 3 X X X Standard No 37 38 39 40 41 42 43 Score X X X 2 X 2 X DS0000013383.V249912.R01.S.doc Version 5.0 Page 19 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 40 Regulation 13(4) Requirement Risks: The home must make clear its position regarding the misuse of drugs (that are not prescribed and are illegal to use, sell or allowed to be used). Whilst this policy has been revised refinement is still needed and so this remains an oustanding requirement from 31/7/05 Staff facilities: The home must provide adequate facilities for staff - including sleeping accommodation that it is within the main building. Staff facilities remains an oustanding requirement from 30/12/05 Garden: It is required that the garden is properly maintained to ensure it provides an agreeable space for service users and does not cause a nuisance to neighbours. Health & Safety: final exits must be available without the use of a key, including exits from the annexe. Hygiene:the home must install a dishwasher in the kitchen. Timescale for action 30/11/05 2 33 12(1)(b) & 23(3) 30/12/05 3 28 23(2)(o) 30/12/05 4 42 23(4)ciii 30/10/05 5 42 23(2)c & 16(2)j 30/10/05 Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 20 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 18.3 Good Practice Recommendations Staff: it is recommended that the home review its policy in respect of staff so as to ensure it is sensitive to the gender of the service users and their needs; this will be particularly important at night when only one member of staff is on the premises. Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 21 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 Dainton House DS0000013383.V249912.R01.S.doc Version 5.0 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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