Inspection on 17/02/09 for Dainton House

This inspection was carried out on 17th February 2009.

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

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

Other inspections for this house

Dainton House 01/12/09

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 12/10/2009.

Inspecting for better lives 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, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Halliwell     Date: 2 0 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 38 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 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Community Housing and Therapy Name of registered manager (if applicable) Miss Yin Ping Leung Type of registration: Number of places registered: 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 organisation Community Housing and Therapy which has six projects registered with Care Homes for Adults (18-65 years) Page 4 of 38 care home 12 Over 65 0 12 Brief description of the care home 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. Care Homes for Adults (18-65 years) Page 5 of 38 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: The star quality rating for this service is adequate. This means that people who use these services experience adequate quality outcomes. This was an unannounced inspection visit of the services being provided at Dainton House, made over the period of 2 days. The Inspection covered all the key standards and involved a tour of the home, a review of all the homes records and formal interviews with the Manager and a senior member of staff and 3 residents at Dainton House. A completed AQAA was received. No enforcement activity has occurred since the last inspection in April 2008. Since the last inspection a new Manager has been appointed on 1st September 2008 Care Homes for Adults (18-65 years) Page 6 of 38 and they will now need to register with the Commission for Social Care Inspection. As a result of this inspection 10 areas requiring improvements have been identified, 5 requirements and 5 recommendations. People who use the services at Dainton House said they like to be called residents. We found the residents and staff most helpful and they are to be thanked for the assistance that they gave him over the course of this inspection visit. What the care home does well: What has improved since the last inspection? What they could do better: The following areas were identified at this inspection requiring improvement and either appears in this report as a requirement or a recommendation. They are as follows 1. A formal review of residents care plans and risk assessments should be undertaken and recorded at least once every 6 months. This is so as to ensure that care plans remain appropriate to the needs of the resident. 2. Risk assessments should be regularly reviewed so as to assist residents to lead as independent a lifestyle as possible. The clinical care teams should be involved in these assessments appropriately. 3. It is recommended that Health Action Plans (HAPs) be drawn up for each of the residents and held on their files. 4. It is required that a record is always completed at the time the medication is prescribed to be given. In cases where a resident arrives later to receive their medication the actual time that they take their medication should be recorded on the MAR sheets. 5. It is required that photographs of each of the residents must be attached to their respective MAR sheets as this helps to ensure that staff administer medications to the right resident. 6. It is required that the Manager ensures an effective stock control system is implemented that ensures correct levels of medication are recorded in and out of the home and that secondary checks are put in place that monitor the effectiveness of the systems in place. 7. All food in the fridge once opened must be labelled as to when it was opened and the expiry date given. This is to avoid potential health hazards. 8. The Registration Certificate for Dainton House with the Commission for Social Care Inspection is out of date in terms of the information displayed about the Manager. This must be renewed. Care Homes for Adults (18-65 years) Page 8 of 38 9. Hot water temperatures must be maintained within the prescribed limits; temperature controls must be put in place to ensure correct water temperatures are maintained within the acceptable range. All hot water outlets / taps should be checked over the period of one month. 10. It is required that those staff who have not received specific POVA training do so within the new timescale. Evidence in certificated form will be required for those staff members who attend the next training in this important area of work. 11. It is recommended that supervision records should be improved by being more detailed to include all the issues discussed and that any agreed actions are included in the records. Records should include discussions to do with specific residents issues and the key working process, monthly reports on progress being made by residents and key workers with care plan objectives as well as staff training needs. 12. Emergency lighting needs to be tested by contractors and checks must be certificated. 13. Water Legionnaires testing was last carried out in 2007 now needs re testing. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 38 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 10 of 38 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. Residents and prospective residents may be assured that their needs will be assessed and that their views, aspirations and wishes will be taken into account as a part of this process. Evidence: Standard 2 We reviewed 6 of the 12 residents files. Assessments of the residents needs had been undertaken and the needs assessments covered the essential areas of the persons life including their religious and cultural needs. In addition there was also assessment and care planning information supplied by the referring agencies most usually the hospital or community mental health teams. Care Programme Approach documentation was seen on the residents files that also outlines the clinical teams assessment of the residents needs and care plan objectives. This helps to ensure that staff at Dainton House have all the available information about a resident and are enabled to make a fully informed decision about how best a residents needs will be met. Care Homes for Adults (18-65 years) Page 11 of 38 Evidence: Residents sign their assessments in agreement with the contents and they express their comments and views about their needs as a part of the assessment. Care Homes for Adults (18-65 years) Page 12 of 38 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. The individual service user plans seen on the residents files reflect the assessed needs and personal goals of the residents. However more regular reviews would ensure that where there are changing needs of the residents, they are appropriately addressed in the care plans.Service users can be assured that they will be supported to make decisions about their lives with assistance as needed and that they will be supported to take risks as part of an independent lifestyle. Evidence: Standard 6 6 residents files were inspected and we spoke to 3 residents formally over the course of this inspection. The Manager informed us that once a prospective service user has taken up a place at Dainton House the clinical multi disciplinary care teams (MDTs) continue to provide their support to the resident together with that of the therapeutic care team at Dainton House. The Manager also informed us that the Dainton House care team base the service user Care Homes for Adults (18-65 years) Page 13 of 38 Evidence: plans they devise for residents on the information provided to them by the MDTs as well as from their own assessment of the resident. As circumstances and the needs of the residents change, the Manager told us that staff review the residents needs assessments and amend the care plans as appropriate. However inspection of the residents files did not evidence that regular reviews had happened in the last 6 months. Although care plans seen on the residents files inspected included a good level of detail it is recommended that a formal review is recorded at least once every 6 months in the residents file. This is so as to ensure that care plans remain appropriate to the needs of the resident. The 3 residents who we spoke to told us that they are involved in their care planning with their key worker. One resident said, I am going to be moving out from Dainton House in the next few months to live more independently and therefore the care plan is an important way for me to realise how that is going to happen. Another resident told us that he had been involved in the care planning meetings ever since he moved in to Dainton House. He said it was a useful process for him. Standard 7 3 residents interviewed by us confirmed that the staff at Dainton House do respect their rights to make their own decisions where appropriate. Staff also made it clear that they involve the residents wherever possible in making their own decisions in order to assist in supporting a positive move towards independence. The Manager told us about the daily meetings and the community meetings that are held in the unit which involve the residents as much as is possible, to make decisions about different aspects of their lives. This includes menu planning and daily activities as well as planning the routine maintenance tasks that have to be undertaken every day and which involves the residents. Residents confirmed with us that they attend the daily meetings and the community meetings together with staff. We were shown minutes of the community meetings that showed us these meetings are well attended and the agenda covers house issues and therapy issues. Minutes indicated that meetings are held on a regular basis. While the Inspection was in progress a community meeting was held with the residents. Standard 9 The Manager informed us that risk assessments are undertaken for each resident to assist in their taking responsible risks. Inspection of the 6 residents files confirmed that risk assessments are undertaken but that they are not regularly reviewed. This is important because these risk assessments should assist residents to lead as independent a lifestyle as possible. The clinical care teams should be involved in these assessments appropriately. Care Homes for Adults (18-65 years) Page 14 of 38 Care Homes for Adults (18-65 years) Page 15 of 38 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. Residents are able to take part in appropriate activities and are, to a reasonable extent, involved in local activities. Residents have appropriate relationships and their rights and responsibilities in their daily lives are recognised and respected by the staff in the unit.Residents are assisted in learning cooking and food preparation skills. Evidence: Standard 12 The Manager told us that staff encourage residents to maintain their relationships with their family and friends where ever they express a wish to do so. We were told that visitors to the home are encouraged and that they use the visitors book to sign in. The visitors book was seen in the hall and was evidently in regular use. The Manager also said that residents are enabled to take part in appropriate activities by the staff. We were told how 8 of the 12 residents are involved in a variety of ways with further education and local activities and events. Residents confirmed with us that they Care Homes for Adults (18-65 years) Page 16 of 38 Evidence: are actively encouraged by staff to take a part in these activities. Amongst those residents that attend college, one is doing a degree course in English Literature, another is studying motor cycle mechanics and another is studying on a business management course with a view to starting up a business and living independently. One of these residents told us that they were really enjoying their studies and this together with the support they receive at Dainton House they feel quite confident that they will be able to move on successfully this year. This all means that residents are enabled to take part in appropriate activities in the community and where appropriate to move on to more independent accommodation. Standard 13 Interviews with residents demonstrated that they do attend local community events and that they enjoy doing so. Residents spoken to said they enjoy an active community social life while living at Dainton House. Residents make full use of local public transport facilities in order to get out and about and to see friends and family. Residents interviewed said that they thought local transport facilities were good. The Manager told us that all the residents except the 3 people most recently admitted to Dainton House are registered to vote in elections and are supported by staff to do so if they wish. She said that these 3 residents would be registered to vote in the near future. Standard 15 3 of the residents told us that they keep in regular contact with their families and friends. Evidence from the staff who we spoke to also confirmed that they actively support residents to maintain contact with their family members and to have personal relationships. Relatives are able to visit the home when they would like to do so and some of the residents spend weekends at home with their family. There is no visitors room in the house so residents tend to entertain people in their rooms. This all means that residents may have appropriate personal relationships if they wish. Standard 16 Policies seen by us to be established within the unit ensure that service users rights to privacy, respect and dignity are respected. Residents who were interviewed confirmed that they felt staff respected these rights. Residents said that they have a key to their own bedrooms, their mail is unopened, their preferred form of address is used by staff and staff do knock on their doors before entering. We observed staff to be interacting with residents in a friendly and respectful manner. Care Homes for Adults (18-65 years) Page 17 of 38 Evidence: The Manager explained to us about the daily cleaning group. This is where residents (together with staff who support and monitor the work) clean all the communal areas of the house. At this inspection the cleaning group was in full swing and residents were seen to be busy cleaning and doing housework in all the communal areas of the house. Interviews both with staff and residents confirmed that residents participate in household chores as a part of the community living experience and weekly chores are detailed in the records. There is not a specific room for smokers in the house and it was evident during the course of this inspection that residents have smoked in their bedrooms even though they are asked not to do so by staff. There are appropriate policies regarding drug and alcohol taking on the premises. Standard 17 With regards to meals and meal times in this home it is the residents themselves who prepare the menus, shop for food, prepare the meals and maintain the kitchen. As mentioned above under Standard 16 during the course of this inspection residents were seen cleaning all areas of the home including the kitchen. The Manager told us that this experience is part of the therapeutic regime and is in part designed to expand the residents independence skills in these areas. All the residents that we spoke with said the meals are to their liking. No complaints about the food were received by the Commission. Care Homes for Adults (18-65 years) Page 18 of 38 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. Service users may be assured that they will receive personal support in the way they prefer and require. They may also be assured that their physical and healthcare needs will be appropriately met.Service users are protected by the homes policies and procedures for dealing with medicines however implementation of these policies and procedures needs improved enforcement. Evidence: Standard 18 Residents who were interviewed at this inspection confirmed with us that they receive their care in the way they prefer. They said that, as far as they are able to, they decide themselves about their daily routines and this was backed up by staff who were also interviewed by us. Staff ensure that care support at Dainton House is person led, flexible, consistent and is able to meet the changing needs of the residents. It was confirmed by the staff and the residents that they are able to choose when they get up, when they go to bed, when they have a bath, what they wear and what they will do during the day. A member of staff had explained how when drawing up the Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: weekly activities chart, which is based on the care plan, they always sit down with the resident and go through the programme in order to gain the residents approval and to understand their choices. Residents at Dainton House continue to receive regular input from their Community Psychiatric Nurses and from other professionals in their clinical teams. Standard 19 With regards to the health care of the residents the Manager told us that all residents are supported to keep well through accessing appropriate healthcare and associated mental health care support. The AQAA completed by Dainton House confirms this. Dainton House operates a key worker system to ensure that there is consistency of support provided to residents. Those residents that we spoke to were aware of who their key workers were and there was evidence on the resident files that regular key worker sessions had been held with them. Residents told us that they were satisfied with the support they had received from staff. The Manager told us about the Thursday Well Being Group that runs each week at Dainton House. This group looks at how best to meet the physical and nutritional needs of the residents. With this in mind it is recommended that Health Action Plans (HAPs) be drawn up for each of the residents and held on their files. HAPs should be aimed at detailing service users physical and emotional health care needs and should be reviewed and updated appropriately. Information contained within the individual residents files should indicate where there has been liaison with health professionals such as GPs, psychologists and psychiatrists and also with primary health care services such as chiropodists, dentists and opticians. This all helps to ensure that residents physical and healthcare needs are met as well as their emotional and mental health needs. The Manager told us that all the residents are signed up with the local GP surgery and some are registered with local dentists. Residents who spoke with us said that they go to see their GPs as and when necessary. The Manager told us that they also see an optician. Standard 20 In 2007 the policies and procedures to do with the safe administration and handling of medications for residents were completely revised. The Clinical Team at Tolworth Hospital and Boots the Chemists - pharmacists for Dainton House were fully involved in a review of staff practices to do with medication at Dainton House and all the new policies and procedures were drawn up with their assistance and support to ensure that they are in line with national guidance. At this inspection we were again shown the policies and procedures and after a review Care Homes for Adults (18-65 years) Page 20 of 38 Evidence: it is clear that they are appropriate for the control of medication but are not at present being implemented effectively so as to fully ensure the protection of the residents. We reviewed the records for the administration of medication to residents (MAR sheets). Several gaps were found in these records for 2 residents. We were told that this error happens where a resident fails to arrive on time to have their medication and staff wait to make a record in case that resident arrives later for their medication. As a result of this what happens is that no record is actually made and it becomes unclear as to whether the medication has been given or refused. It is required therefore that a record is always completed at the time the medication is prescribed to be given. In cases where a resident arrives later to receive their medication the actual time that they take their medication should be recorded on the MAR sheets. It is also required that photographs of each of the residents must be attached to their respective MAR sheets as this helps to ensure that staff administer medications to the right resident. We were shown guidance that is provided for staff about PRN medications where it is used for residents. This states when PRN medication should be used and the potential side effects for the individual resident. The residents GPs were involved in this process and the information was placed together with a medication profile for each resident. We carried out a spot audit check on the stock control system and this proved unsatisfactory since the levels of medications being as stated on the control sheets did not match what was held in the medication cabinet. It is therefore required that the Manager ensures an effective stock control system is implemented that ensures correct levels of medication are recorded in and out of the home and that secondary checks are put in place that monitor the effectiveness of the systems in place. A check on the storage facilities for the medication was seen to be appropriate. The Manager told us that controlled drugs are not currently in use within the home. Where a resident has a need for these drugs they are administered in conjunction with the pharmacist, Boots. The Manager told us that training has been provided for all the staff to do with the new policies and procedures for medication. This was confirmed by 2 of the staff group who we spoke to and who said they had both received this training and that they had found it interesting and useful. At present some residents are unable to administer their own medication. The home actively supports service users who wish to self medicate. Care Homes for Adults (18-65 years) Page 21 of 38 Care Homes for Adults (18-65 years) Page 22 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users may be assured that their views will be listened to and that they will be protected from abuse, neglect and self-harm. Evidence: Standard 22 The Manager informed us that a record is being kept of any complaints that are received by the unit. This record was inspected showing that there have been no complaints made since the last inspection. At the last inspection it was required that the complaints policy and procedure should include timescales for each stage of the complaints process so that a complainant may know approximately how long the stages of the complaint will take to resolve. It was also recommended that a copy of the complaints process be posted on the notice board and a copy given to each of the residents. At this inspection we were told that the procedure had been revised as required however inspection of the homes records showed that the new procedures had not been implemented. The matter was addressed with the Clinical Director who said that she would ensure that the new procedures would be implemented without any further delay. This was carried out as promised and it was made an agenda item at the following House Meeting for all the residents information. Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: The revised procedures explains the timescale in which a complainant can expect their concerns and complaints to be dealt with. The previous procedure was open ended with no timescale stated. With the new policy and procedure in place this should now mean that residents views and complaints are listened to and acted upon appropriately. Standard 23 The Manager advised us that the policy for the Protection of Vulnerable Adults is in place and is aligned with the Royal Borough of Kingston own procedure. Since the last inspection there have been a number of new staff join the staff team. This means that not all the staff team have been provided with training and guidance about what actions they need to take if the need arises. The Manager told us that this training would be provided in the near future. Inspection of 7 staffing files showed that only 2 staff had had POVA training. It is therefore required that those staff who have not received specific POVA training do so within the new timescale. Evidence in certificated form will be required for those staff members who attend the next training in this important area of work. The Manager is reminded that all Dainton Houses staff team should receive refresher training at least once every 3 years. This will help ensure that all staff are up to date with the policies and procedures and other issues to do with the protection and safeguarding of adults at Dainton House. As has already been indicated we saw the policy in the Units policies and procedures file, the procedures are robust for responding to suspicion or evidence of abuse or neglect and they include a whistle blowing procedure for staff. The Manager told us that no allegations of abuse had been made at the home since the last inspection. Care Homes for Adults (18-65 years) Page 24 of 38 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. Service users at Dainton House are able to live in a homely, comfortable and safe environment. The home is also relatively clean and hygienic but would benefit from a programme of redecoration and refurbishment. Evidence: Together with a senior member of staff we reviewed all areas of the home to assess the quality of the environment and decor. There is generally a comfortable atmosphere and residents bedrooms are individually decorated with input from them with regard to choice of colour and furniture. Those residents that we spoke to about this said they were generally happy with their rooms. Although the home was found to be relatively clean and hygienic, there is a tired feel to the decor and a programme of refurbishment and redecoration would help improve this. 3 residents bedrooms were inspected with the permission of those residents. They all told us that they are happy with their rooms and that they like living at Dainton House. At the last inspection food in the fridge was opened but had not been labelled. This was still the case at this inspection. The Manager told us that appropriate labels have been provided in order for residents to do the labelling but these had not been used for all the food that had been opened on the day of this inspection. The Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: Manager is strongly recommended that all food once opened should be labelled on the same day as to when it was opened and what the expiry date is. This is to avoid potential health hazards. In the main hall the area under the stairs was again being used as a storage place. This presented a potential fire hazard. The area was cleared during the course of this inspection. General maintenance throughout the home was seen to be good. We met with the handyman who carries out all the homes maintenance. Any faults or repairs are noted in the homes maintenance book by staff and they are then attended to by the handyman. No problems were identified with this system at this inspection. The home was seen to be relatively clean and no unpleasant odours were noted. We noted that regular checks for each hot water outlet are not being carried out despite a requirement made at the last inspection for this. A procedure has been drawn up that now needs to be implemented and monitored with findings recorded to ensure that hot water temperatures are maintained within the prescribed limits. The requirement is therefore repeated here. This is to ensure the safety of the residents. A senior member of staff must ensure that faults are reported immediately where temperatures exceed the prescribed limits so that immediate action is taken to rectify the problem. Standard 30 The Manager showed us the homes infection control procedure, which seems to be working effectively. This means that the residents live in a hygienic home. The laundry area is well laid out and there is an impermeable floor laid down to prevent water ingress and easy cleaning. We were told that laundry is not taken through areas where food is prepared. Care Homes for Adults (18-65 years) Page 26 of 38 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. Service users benefit from the clarity of staffing roles and responsibilities and they can be assured that they are supported by competent, appropriately trained, qualified and supervised staff. The homes recruitment policy and procedures helps protect the residents. Evidence: Standard 32 The Manager told us that as a part of the induction process all staff are issued with job descriptions and are asked to read and discuss the homes policies and procedures. Evidence of this was seen by us on the 5 staff files inspected. Those new staff who were interviewed confirmed that they had completed an induction programme covering these areas. The Manager explained that there is 1 student social worker currently working at Dainton House. She said that students are routinely CRB checked and also receive induction training. One member of staff told us that she had found the induction process very useful in helping her to understand her role. Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: Residents interviewed by us said that staff are approachable and we saw staff taking time to deal with residents questions. Standard 34 The Manager told us that the home does have a recruitment policy and procedure and that all staffing posts are filled by application and interview. Evidence of these processes being used was seen on the staffing files. A review of 5 of the staffing files at this inspection evidenced that suitable application forms are completed and were seen on the files inspected; 2 references are obtained including one from the last employer; CRB checks have been carried out for staff employed within this unit; staff contracts are held on file; appropriate forms of identification are evidenced on the staffing files; Job Descriptions are held on each file inspected and all the information referred to under Standard 34 was seen on the staffing files inspected. The result of this is that there is at Dainton House a staff team that has a balance of the skills, knowledge and experience to meet the needs of the residents. Staff interviewed confirmed that all have a contract of employment and that they understand their terms and conditions as well as their roles and responsibilities within the home. Standard 35 The Manager said that a structured induction programme is offered to all new staff. At this inspection the staff who were interviewed confirmed that they had attended this induction training. We gained the impression over the course of this inspection that all the staff are committed to ensuring that their skills and knowledge are continually being developed by appropriate levels of training so that they can best meet the needs of the residents. The Manager showed us the homes staff training records. Each staff member has a training profile that identifies their training experiences and achievements. Certificated evidence is also held within the file. Training records were examined and evidence was seen of staff having completed the following training courses: 1st aid Fire training Food and hygiene POVA Health & safety Safe handling of medications Infection control In addition to this training all the staff continue with their professional development and training in group work and therapy. Staff who were interviewed said that they had been on training courses covering key Care Homes for Adults (18-65 years) Page 28 of 38 Evidence: areas such as the Protection of Vulnerable Adults, safe handling of medications; 1st aid, food hygiene, fire safety, health and safety and infection control. Standard 36 The Manager told us that there is a properly structured staff supervision policy and procedure. Records were inspected and both the policy and the supervision tools cover the areas that are required in order to implement an effective supervision process. Inspection of the supervision records that are held on staffing files showed that staff have received some formal supervision but the records did not demonstrate that this is a regular and consistent practice. Areas of discussion were recorded very briefly indeed and it is recommended that these records should be considerably improved by being more detailed to include all the issues discussed and any agreed actions. Notes of discussions had in staff supervision should include specific residents issues and the key working process, monthly reports on progress being made by residents and key workers with care plan objectives as well as staff training needs. This will mean that all the key and important areas for the review and monitoring of the work being done in the home to meet the needs of both the residents and the staff groups will then be properly met. The Manager told us that staff receive a copy of their supervision notes. This was confirmed by those staff who were interviewed as a part of the inspection. Care Homes for Adults (18-65 years) Page 29 of 38 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users may be assured that they will benefit from a well run home. With the quality assurance system that is now in place stakeholders can be confident that their views underpin all developments in the home. They should also be assured that their health, safety and welfare will be promoted. Evidence: Standard 37 There is a new Manager in place at Dainton House since 1st September 2008. She told us that she has transferred from another CHT care home where she worked as a manager for 3 1/2 years. She holds her management award at NVQ level 4 and she has a Masters Degree in Psychotherapeutic Counselling. Interviews with staff reflected a positive and caring approach towards the residents. Residents can be assured that they are benefiting from a well run home. At this inspection the Registration Certificate for Dainton House was inspected and was seen to be out of date in terms of the information displayed about the Manager. This Care Homes for Adults (18-65 years) Page 30 of 38 Evidence: will need to be renewed. This is recommended. Standard 39 The Clinical Director and the Manager explained that there are a number of systems in place that assist the home and CHT, the parent organisation to ensure that the service users and other key stakeholders can be confident their views underpin self monitoring, review and developments by the home. It was explained that a residents survey was carried out in 2008 that sought the views of residents on different aspects of the care and support being provided at Dainton House. The same sort of format was also used to gain feedback from relatives and referring professionals working with residents at Dainton House. We were told that a new questionnaire is being worked on for 2009. As well as this there are the weekly and monthly audits carried out by the Manager and the Clinical Director. The Manager carries out checks regularly on administration and recording systems that are used for the running and management of the home, clients financial procedures, healthcare appointments, concerns and complaints, and other health and safety checks. A summary and analysis of the key points arising from these areas mentioned above has been used to inform an annual development plan for the home. Different areas or themes are targeted that inform all the key areas of service provision. Supporting documentation was provided for us to review. This confirms that Dainton House and CHT have in place a good quality assurance system and service users and other stakeholders can be confident that their views underpin all developments in the home. Standard 42 We were shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. The Manager informed us that all staff receive training in fire safety, first aid, food hygiene, and infection control. This was supported by staff interviewed and who confirmed that they had received training in these areas. Up to date and satisfactory pass certificates were seen for Boiler & Gas 16th February 2009 Electricity installation 15th July 2008 PAT Testing 30th January 2009 Fire equipment 2nd September 2008 Fire alarms 12th January 2009 Emergency lighting, September 2008, this needs to be tested by contractors and checks need to be certificated. Water Legionnaires testing was last carried out in 2007and is now due. Records were seen that confirmed regular in house tests had been carried out for the Fire alarm weekly Fire extinguishers weekly Emergency lighting 6 monthly last Fridge Care Homes for Adults (18-65 years) Page 31 of 38 Evidence: and freezer temperatures records were checked and records indicate that they came within the acceptable ranges. Fridge and freezer temperature records were checked, no problems noted. At the time of this inspection no fire doors were seen to be wedged open and the building appeared to be secure. Care Homes for Adults (18-65 years) Page 32 of 38 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 22 22 The complaints procedure 01/05/2008 should include timescales for each stage of the process so that a complainant may know approximately how long the stages of the complaint will take to resolve. The Registration Certificate 01/09/2008 for Dainton House is out of date in terms of the information displayed about the Registered Person and for the Registered Manager. This must be renewed once the new Manager is in place. The quality assurance process that has been started must be completed as it enables a level of self audit and monitoring that may inform improvements and development targets for the home. Hot water temperatures must be maintained within the prescribed limits; temperature controls must be put in place to ensure correct water temperatures are maintained within the acceptable range. All hot 01/12/2008 2 37 9 3 39 24 4 41 17 01/05/2008 Care Homes for Adults (18-65 years) Page 33 of 38 water outlets / taps should be checked over the period of one month. Care Homes for Adults (18-65 years) Page 34 of 38 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 20 13 It is required that a record is 01/04/2009 always completed at the time the medication is prescribed to be given. In cases where a resident arrives later to receive their medication the actual time that they take their medication should be recorded on the MAR sheets. In order to meet the NMS. 2 20 13 It is required that the 01/04/2009 Manager ensures an effective stock control system is implemented that ensures correct levels of medication are recorded in and out of the home and that secondary checks are put in place that monitor the effectiveness of the systems in place. In order to meet the NMS. 3 20 13 It is required that photographs of each of the residents must be attached 01/04/2009 Care Homes for Adults (18-65 years) Page 35 of 38 to their respective MAR sheets as this helps to ensure that staff administer medications to the right resident. In order to meet the NMS. 4 23 13 It is required that those staff 01/07/2009 who have not received specific POVA training do so within the new timescale. Evidence in certificated form will be required for those staff members who attend the next training in this important area of work. In order to meet the NMS. 5 24 13 Hot water temperatures must be recorded for each hot water outlet over a month; together with a system to be implemented where remedial action is taken when temperatures are over the prescribed range. In order to meet the NMS. 01/04/2009 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 6 It is recommended that a formal review is recorded at least once every 6 months in the residents file. This is so as to ensure that care plans remain appropriate to the needs of the resident. Risk assessments should be regularly reviewed so as to assist residents to lead as independent a lifestyle as possible. The clinical care teams should be involved in 2 9 Care Homes for Adults (18-65 years) Page 36 of 38 these assessments appropriately. 3 24 It is strongly recommended that all food once opened should be labelled on the same day as to when it was opened and what the expiry date is. This is to avoid potential health hazards. It is recommended that supervision records should be improved by being more detailed to include all the issues discussed and that any agreed actions are included in the records. Records should include discussions to do with specific residents issues and the key working process, monthly reports on progress being made by residents and key workers with care plan objectives as well as staff training needs. The Registration Certificate needs renewing given there is now a new Manager. Water Legionnaires testing last carried out in 2007 is now due again. Emergency lighting needs to be tested by contractors and checks must be certificated. 4 36 5 6 7 37 42 42 Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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