Inspection on 18/04/08 for Dainton House

This inspection was carried out on 18th April 2008.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 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 17/02/09

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

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 David Halliwell Key Unannounced Inspection 16th April 2008 09:30 Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 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 www.cht.org.uk Community Housing and Therapy 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) Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 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. 9th November 2007 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.V361793.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the 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 1 day. 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 3 staff, the Deputy Manager and 4 residents at Dainton House. A completed AQAA was received. No enforcement activity has occurred since the last inspection in November 2007. Since the last full inspection the Manager has now moved on and the recruitment process has started for a new manager at Dainton House. That person once appointed will need to register with the Commission for Social Care Inspection. As a result of this inspection 7 areas requiring improvements have been identified, 4 requirements and 4 recommendations. This marks a significant reduction from the last inspection where 23 requirements / recommendations were made. It also reflects the positive progress that has been achieved by the Clinical Director, the Manager and her staff team since the last inspection. People who use the services at Dainton House said they like to be called residents. The Inspector 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. The Deputy Manager told the Inspector that the current cost of a placement at Dainton House is £875 per week. What the service does well: As noted in previous inspections this home provides an intensive, three year rehabilitation programme for service users. This support includes a range of group meetings, plus individual counselling sessions to help service users better understand their own mental health and social needs. Staff also provide practical support and guidance to help residents improve their daily living skills. Practical help is given within the context of a therapeutic community, so staff offer intensive support that aims to enable a more independent lifestyle for the residents. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? Positive progress has been achieved since the last inspection in November 2007 and the Clinical Director, the Manager, the staff group and the residents are to be commended for their hard work in gaining these improvements. The following specific areas of progress have been achieved: Information to do with community events and social activities is now made available for residents on notice boards. This should help encourage residents to be involved as much as possible in local activities. Policies and procedures to do with medication and the administration of medications have been completely reviewed and revised to ensure that staff practices in this area are safe. Medication records / MAR sheets are now being signed by staff after residents have been given their medication. Reasons are being provided if residents refuse or are not present to take their medication. MAR sheet records are accurate, so an exact account of residents receiving their medication can be found. Staff at Dainton House have been provided with specific training on the new policies and procedures to do with the safe handling of medications, again this should help protect residents and ensure that staff practices are safe. There is now clear guidance for each resident together with the MAR sheet records where PRN medication is being used. Staff have received POVA training and now know the policies and procedures to follow to do with safeguarding adults. Improvements have been made in the cleanliness, decorations, repairs and maintenance of the home and standards have therefore been raised. New procedures for dealing with the laundry have been drawn up and implemented. New floor coverings have been provided for the all the bathrooms, toilets and for the laundry room. In the main hall the area under the stairs is no longer being used as a storage place. Policies for infection control have been revised and staff training implemented. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 7 Hand washing facilities have been made available and usable for both staff and residents who are doing the laundry before entering the kitchen area. All staff files have been reviewed and are in good file order. They contain the information described in Standard 34. This should help ensure that the residents are protected by the home’s recruitment practices. Some progress has been achieved in developing a quality assurance system that enables a level of self-audit and monitoring that should inform improvements and development targets for the home. Recommendations made by Southern Water in a water and legionnaires test carried out on 13th July 2007 have now been met. 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: Appropriate provision is required for the storage of controlled drugs in the future i.e. there will need to be a lockable metal cupboard within the existing metal cabinet. The complaints procedure should be revised to 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. Details of how to contact the Commission for Social Care Inspection at stage 3 of the procedure should be included in that section and a copy of the complaints process should be posted on the notice board and given to each of the residents. 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. 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 Registered Person and for the Registered Manager. This must be renewed. 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. Bedroom no: 2 - the shower area needs a thorough clean. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 8 The toilet adjacent to the laundry has been fitted with a new floor. This has however risen and needs to be repaired as soon as possible. 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. The summary of this inspection report can be made available in other formats on request. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available 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 2 of the 11 resident’s files. Assessments of the resident’s needs had been undertaken for both of these residents and the needs assessments covered the essential areas of the person’s life including their religious and cultural needs. In addition there was also assessment and care planning information supplied by the referring agencies most usually hospital or community mental health teams. Care Programme Approach documentation was seen on the residents’ files that outlines the clinical team’s assessment of the resident’s needs and sets out care plan objectives for the residents and for the staff at Dainton House to follow. 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. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 11 It is noted that residents do sign their assessments and that they seem to be an integral part of the process and so should be able to express their comments and views about their needs as a part of the assessment. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 & 9. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. The individual service user plans seen by the Inspector on the residents’ files do reflect the assessed and changing needs and personal goals of the residents. 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 – 2 residents’ files were inspected and the Inspector spoke to 3 residents formally over the course of this inspection. The Deputy Manager informed the Inspector that once a prospective service user has taken up a place at Dainton House the clinical multi disciplinary care teams (MDTs) Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 13 continue to provide their support to the resident together with that of the therapeutic care team at Dainton House. The Deputy Manager also informed the Inspector that the Dainton House care team base the service user 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 Dainton House staff review the needs assessments and accordingly amend the care plans. A review of the individual care plans seen on the 2 residents files inspected included a good level of detail that evidences a comprehensive package of care is being delivered to the residents to meet their needs. The link between the Care Programme Approach (CPA) documentation and those needs assessments and Dainton House’s service user plans is also clear. The residents’ files that were inspected also included the information required under schedule 3 of the National Minimum Standards. All residents at Dainton House are allocated a key worker and they sign their care plans when in agreement with the content. Standard 7 – 3 residents interviewed by the Inspector 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 Deputy Manager told the Inspector 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 the Inspector that they attend the daily meetings and the community meetings together with staff. Minutes of the community meetings were shown to the Inspector. Standard 9 – The Deputy Manager informed the Inspector that risk assessments are undertaken for each resident to assist in their taking responsible risks. Inspection of the files confirmed that these risk assessments had been undertaken. 2 members of staff who were interviewed at this inspection confirmed that they are involved with their residents in completing these risk assessments in order to support residents to lead as independent a lifestyle as possible. The clinical care teams are also involved in these assessments appropriately. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection 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 Inspector was told by residents that care support staff do encourage the maintenance of their relationships with family and friends if they the residents express a wish to do so. The Deputy Manager told the Inspector that visitors to the home are encouraged and that they use the visitor’s book to sign in. The visitor’s book was seen in the hall was evidently in regular use. The Deputy Manager also said that residents are enabled to take part in appropriate activities by the staff. She showed the Inspector the notice board Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 15 in the hall that had a variety of information about local activities and events, all of which the residents are actively encouraged by staff to take a part in. Residents confirmed with the Inspector that they look at the information on the board and if there is something that interests them, often they will go and get involved. This means that residents are enabled to take part in appropriate activities in the community. Standard 13 - Interviews with residents demonstrated that they do attend local community events and that they enjoy doing so. Residents spoken to said they want to have an active community social life. Some residents told the Inspector that they like to go to the shops. 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. All residents living at Dainton House are registered to vote in elections and are supported by staff to do so if they wish. Standard 15 – Some of the residents interviewed by the Inspector said that they keep in regular contact with their families and friends. Staff were seen to encourage the residents to keep and maintain contacts with family and friends so that they benefit from having appropriate relationships. There is no visitor’s room in the house so residents tend to entertain people in their rooms. Standard 16 - Policies seen by the Inspector to be established within the unit ensure that service user’s 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. The Inspector observed staff to be interacting with residents in a friendly and respectful manner. The Deputy Manager explained to the Inspector that since the last inspection the daily cleaning group has been changed to the first morning group of the day. 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 Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 16 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 kitchen and 2 residents put together a shopping list and went shopping for food for a special “leaving do” lunch time meal that had been planned for one of the residents. The Deputy Manager told the Inspector 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 the Inspector spoke with said the meals are to their liking. No complaints about the food were received by the Commission. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19, & 20 were inspected at this inspection. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection 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 home’s policies and procedures for dealing with medicines. EVIDENCE: Standard 18 – Residents who were interviewed at this inspection confirmed with the Inspector 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 care staff who were also interviewed by the Inspector. 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 Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 18 how when drawing up the 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 - The Deputy Manager told the Inspector the residents are registered with dentists, opticians, chiropodists and community nurses in order to maintain their all round good health. Residents interviewed were able to confirm this. Information in their case files also evidences it by the recording of their contact with these services. It was confirmed that annual healthcare checks are routinely carried out by GPs. Standard 20 – At the last inspection in November 2007 4 requirements and 1 recommendation was made with respect to the policies and procedures that were being used at Dainton House at the time of that inspection. The Clinical Director and the Manager told the Inspector that they have now completely revised the policies and procedures to do with the safe administration and handling of medications for residents. The Clinical Director and the Manager explained to the Inspector that 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 that all the new policies and procedures have been drawn up with their assistance and support and that they are in line with national guidance. The Inspector was told that Boots now visit Dainton House on a six monthly basis, the last visit being on 10th March 2008. The report they submitted was positive about the new policies and procedures in place at Dainton House. At this inspection the Deputy Manager showed the Inspector the new policies and procedures. After a review it is clear that there are now appropriate policies for the control of medication that should ensure the protection of the residents. The Inspector reviewed the records for the administration of medication to residents (MAR sheets) and these were seen to be appropriately completed and in line with the home’s new policies and procedures. Photographs of the residents were attached to the MAR sheets, which helps to ensure that staff administer medications to the right resident. The Deputy Manager showed the Inspector newly drawn up 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 resident’s GPs were involved in this process and the information was placed together with a medication profile for each resident. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 19 The Inspector did a spot audit check on the stock control system and this proved satisfactory with the levels of medications being as stated on the control sheets. A check on the storage facilities for the medication was seen to be appropriate. The Deputy Manager told the Inspector 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 Deputy Manager told the Inspector 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 were interviewed by the Inspector 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. All the residents’ files inspected contained appointment information for dentists, opticians, chiropodists, weight charts and individual homely remedies. All the previous requirements and the recommendation made at the last inspection to do with medication have now been met. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 were inspected at this inspection. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection 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 Deputy Manager informed the Inspector 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. 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. This is a requirement. It is also recommended that a copy of the complaints process be posted on the notice board and a copy given to each of the residents. Standard 23 – The Deputy Manager advised the Inspector that the policy for the Protection of Vulnerable Adults is in place and is aligned with the Royal Borough of Kingston’s own procedure. She said that since the last inspection all the staff team have been provided with training and guidance about what actions they need to take if the need arises. This training was provided in 2007 Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 21 and on inspection of 4 of the 7 staffing files there was evidence in certificated form that all 7 staff members had attended the L.B.Kingston’s POVA training. The Manager is reminded that all Dainton House’s 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. The Inspector saw the policy in the Unit’s 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 Deputy Manager told the Inspector that no allegations of abuse had been made at the home since the last inspection. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 were inspected at this inspection. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users at Dainton House are able to live in a homely, comfortable and safe environment. The home is also clean and hygienic and well looked after by staff. EVIDENCE: Standard 24 – At the last inspection in November 2007 a tour of the premises was undertaken. The Inspection revealed a number of areas in the home that were in need of urgent repairs and maintenance as they were evidently well below an acceptable standard. 8 requirements or recommendations were made to do with the environment at Dainton House as a result of that inspection. All areas of the home were inspected and problems and issues arose to do with cleanliness and hygene and maintenance and repairs that were needed in the home. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 23 Following this the Clinical Director and the Manager met with the Inspector and provided assurances that the cleaning programme would be reviewed; professional deep cleaning would be carried out where it was needed; and the process for ensuring repairs and maintenance are carried out effectively would be reviewed and revised. At this inspection the Inspector was shown around the home by the Deputy Manager and all the areas were inspected. It was soon evident that more effective cleaning measures had been implemented and especially in the communal kitchen and bathroom areas. The Deputy Manager told the Inspector that a professional cleaning firm had been employed following the last inspection to “deep clean” the kitchen and that all the needs identified in the last inspection report had since been addressed. The Deputy Manager also told the Inspector that arrangements have been agreed with the Clinical Director that a professional deep clean can be carried out if the need arises. The results of the inspection of the premises were as follows: 1. The kitchen was now in a much improved state of cleanliness. At the time of this inspection the residents were in the process of cleaning the kitchen as part of the daily morning cleaning group. The Deputy Manager advised the Inspector that a member of staff monitors the cleaning work done by residents and where necessary will ensure that where standards of cleanliness have not been met they are addressed by the group on the next day. The measures now in place should help to ensure the residents’ health will be protected. 2. At the last inspection food in the fridge was opened but had not been labelled. This was still the case at this inspection. The Deputy Manager showed the Inspector the labels that 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 Manager is reminded 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. 3. Inspection of the laundry room demonstrated an improvement in the washing and cleaning procedures that have now been updated. The Deputy Manager told the Inspector that a new policy on cleanliness has been drawn up; notices have been prominently placed to ensure that laundry and soiled washing is not carried through the kitchen into the laundry room. It was explained to the Inspector that each resident has also now been provided with 2 blue laundry bags that are to be used to carry their laundry to and from the laundry room and that this must be through the passageway and not via the kitchen. The Deputy Manager said that staff actively monitor and enforce this practice with residents. This is good as it should help prevent and reduce the possibility of cross infection between the laundry and the food. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 24 4. The floor covering of the laundry room has now been renewed with a sealed floor which should be easy to keep clean and should help prevent potential health hazards to the residents. 5. In the main hall the area under the stairs was being used as a storage place. This presented a potential fire hazard. The area has now been cleared. 6. The bathrooms and the toilets on all 3 floors were inspected and the areas of concern raised at the last inspection have since been addressed and are now in much better condition. 7. Bedrooms 2, 5, 7 and 8 were inspected. They were in a good state of repair and looked clean and bright. 8. The repairs required in Bedroom 2 at the last inspection have now been completed. However the shower area was still grubby and needed cleaning. The maintenance man told the Inspector that he is due to steam clean this area next week. 9. The floor covering in the “white bathroom” has been replaced and the room was in good decorative condition. 10. The shower tap in the “blue bathroom” was broken and has since been replaced so that the shower can be used by residents. 11. The toilet adjacent to the laundry has been fitted with a new floor. This has however risen and needs to be repaired as soon as possible. The Inspector was assured by the Deputy Manager that this will be addressed next week. The Inspector also met with the maintenance / handyman who was present at the time of the inspection. He explained that he attends to the home’s maintenance and repair issues and is usually at Dainton House at least once a week and sometimes more often when required. The Deputy Manager explained that a member of the staff group now co-ordinates maintenance and repair issues. Problems are identified in a number of ways, by way of visual checks and from the monthly health and safety maintenance checks, as well as by residents. These problems are reported to Alan, the home’s handyman and he ensures repairs are carried out as required either by himself or by authorised contractors. For instance all the home’s new floors that have been laid in the bathrooms and in the laundry were done by a contractor, whereas room decorations are carried out by Alan. This new process now in place has meant that the necessary work of maintenance and repair is addressed in a timely and appropriate way and residents can live in a safe and comfortable home. Standard 30 – The Deputy Manager showed the Inspector the home’s new infection control procedure, which seems comprehensive and to be effective in practice. The Inspector was told that all staff had recently in March 2008 also received training for infection control. Certificated evidence confirmed this as did staff who the Inspector spoke to over the course of this inspection. At the time of this inspection the home was clean and hygienic. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 25 Staff interviewed confirmed that they are issued with appropriate clothing and equipment for them to carry out their work appropriately The laundry facilities in the home are appropriate for the residents who are living in the home. The Inspector was informed by the Deputy Manager that laundry is not now taken through any areas where food is being prepared. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 & 36 were inspected at this inspection. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection 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 Deputy Manager informed the Inspector 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 the Inspector on the 4 staff files inspected. Staff interviewed also confirmed that they had completed an induction programme covering these areas. The Deputy Manager explained that there are 2 student social workers currently working at Dainton Lodge. She said that they had both been CRB checked and had received induction training. This was confirmed by one student to whom the Inspector spoke over the course of this inspection. She told the Inspector that she had found the induction process very useful in Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 27 helping her to understand her role. She said, “I was asked to go through the induction checklist of the home’s policies and procedures and to do a resume of the residents who I key work. This was really useful in helping me to understand how best to offer support and in understanding the needs of some of the residents living at Dainton House. The staff here have been very supportive and I have enjoyed my placement here.” Residents interviewed told the Inspector that staff are approachable and the Inspector saw staff taking time to deal with resident’s questions. Standard 34 – The Deputy Manager told the Inspector 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 by the Inspector on the staffing files. At the last inspection not all the documentary evidence required under Standard 34 was seen to be held on the staff files reviewed and a recommendation was made that all staff files be reviewed and action taken to ensure that they are in good file order and containing the necessary information as described in Standard 34. This recommendation was made to help to ensure that the residents are protected by the home’s recruitment practices. A review of 4 of the staffing files at this inspection evidenced that this recommendation has since been met. 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 now 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 Deputy Manager informed the Inspector that a structured induction programme is offered to all new staff. At this inspection 3 staff were interviewed and they confirmed that they had attended this induction training. The Inspector 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. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 28 Training records were examined by the Inspector and evidence was seen of staff having completing 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. A very useful training matrix has been developed by the Manager that provides an excellent tool for management and staff to see at glance what training has been received and by which staff. Where the gaps are and therefore what training needs exist for each member of the staff team. Staff who were interviewed said that they had been on training courses covering key 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 Deputy Manager informed the Inspector that staff do receive regular supervision from either the Manager or the Deputy Manager. She said that supervision is undertaken at least once a month and sometimes more often. Records are kept on the staff files and were seen by the Inspector at this inspection. The 3 staff who were interviewed confirmed the frequency of their supervision sessions and the areas of discussion in supervision that included key work with residents, group work issues, the work rota, annual appraisals and training needs. This means that residents should benefit from well supported and supervised staff. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 29 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39, & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they will benefit from a well run home. When a quality assurance system is implemented stakeholders will be able to 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 – The Clinical Director for Dainton House told the Inspector that the Manager who had been working in this role since July 2007 has now left and has moved on to another role within the CHT organisation. The Deputy Manager has been filling this role together with the Manager in recent weeks. The interviews for a new Manager are being held next week and it should not be too long before another manager is in post. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 30 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 Registered Person and for the Registered Manager. This will need to be renewed once the new Manager is in place. This is a requirement. Standard 39 – At the last inspection a requirement was made that a quality assurance system be put in place at Dainton House that enables a level of self audit and monitoring that may inform improvements and development targets for the home. This requirement was made so as to enable the key stakeholders to be confident that their views underpin all self monitoring, review and development at Dainton House. The Manager had told the Inspector that there was no quality assurance tool / process in place at Dainton House that specifically monitors all the service areas. Although there are several independent methods already in place to monitor some areas (such as the daily hazard analysis of critical control points; the health and safety checklist that identifies potential risk areas in the home) they need to be expanded and co-ordinated. Some discussion was had with the Manager at the last inspection as to what elements could be used to inform the process, some suggestions included were: • Questionnaires for residents, relatives and referring professionals seeking their feedback on different aspects of the service. For instance residents might be asked for their views on the environment within the home, the effectiveness of the care support they receive etc. Professionals who have referred people to Dainton House could be asked about the effectiveness of the service in meeting the Care Programme Approach care plan objectives. Relatives and families could also be asked for their views on different elements of the service and how their relative is being served by it. • A review of any complaints made. • A review of any accidents that have occurred. • Issues raised by residents at community meetings. • Issues raised by staff at staff meetings. • Commission for Social Care Regulatory inspection report feedback. A summary and analysis of the key points arising from the above would then be needed that could then be used to inform an annual development plan for the home. Different areas or themes could be targeted on an annual basis that over a longer period would inform all the key areas of service provision. At this inspection the Deputy Manager told the Inspector that some progress has been made with implementing a quality assurance tool. Feedback questionnaires have been devised and sent out in March 2008 to residents, Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 31 relatives and referring professionals seeking their feedback on different aspects of the services provided at Dainton House. The feedback questionnaires and those that had been completed and returned were shown to the Inspector. No analysis has yet been undertaken but this is planned as is an analysis of the other areas outlined above. The Inspector suggested to the Deputy Manager that once the analysis has been finished a report be compiled that outlines the key findings. Also that the results are fed back to the stakeholders of Dainton House and to those parties who participated in the surveys. The requirement will remain in place until the planned work has been completed and the standard met. Standard 42 – The Inspector was 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 Deputy Manager informed the Inspector that all staff receive training in fire safety, first aid, food hygiene, and infection control. This was supported by staff interviewed that confirmed that they had received training in these areas. Up to date and satisfactory pass certificates were seen by the Inspector for: Boiler & Gas – 18th February 2008 Fire alarms – November 2007 Emergency lighting – November 2007 Fire equipment – 18th July 2007 A water and legionnaires test was carried out on 13th July 2007; this resulted in 13 recommendations being made by Southern Water for required actions by Dainton House in order to bring their water supply up to date. At the last inspection a requirement was made because the recommendations had not been met and the timescales set by those inspectors had passed. The Deputy Manager showed the Inspector (at this inspection) evidence that this work has since been carried out as required and as outlined by Southern Water. The requirement has therefore now been met. Records were seen by the Inspector that confirmed regular tests had been carried out for the: Fire alarm - weekly Fire extinguishers - weekly Emergency lighting – 6 monthly last on 29.6.07 Fridge and freezer temperatures records were checked and records indicate that they came within the acceptable ranges. Accident records were checked – the Deputy Manager explained that there is a new system now in place to record any incidents or accidents that should arise at Dainton House in the future. This had been recommended at recent health and safety training. The new recording system ensures that all the appropriate information is recorded and timescales and outcomes monitored. This is a very Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 32 new process that has only just been implemented, nothing had yet been recorded on it. Fridge and freezer temperature records were checked – no problems noted. Hot water temperatures were checked. However records seen by the Inspector indicate that the temperatures recorded are outside the prescribed limits. Since this could cause hot water burns to unwary residents the Deputy Manager was asked to ensure that this problem is rectified immediately and that temperature controls are 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. This is a requirement. It is important that where records are taken as they are at Dainton House for the hot water temperatures a monitoring and review process is put in place by the Manager to ensure that appropriate action is taken when necessary. At the time of this inspection no fire doors were seen to be wedged open and the building appeared to be secure. The Deputy Manager showed the Inspector a recently completed (December 2007) risk assessment for the building and for the communal areas. This is welcomed as it should assist in the prevention of accidents and will inform the maintenance programme for the building. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 2 X Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA22 Regulation 22 Requirement Timescale for action 01/05/08 2. YA37 9 3. YA39 24 4. YA41 17 The complaints procedure 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 for 01/09/08 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 01/12/08 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 01/05/08 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 DS0000013383.V361793.R01.S.doc Version 5.2 Dainton House Page 35 period of one month. 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. 2. 3. 4. Refer to Standard YA24 YA24 YA22 YA24 Good Practice Recommendations Bedroom no:2 - the shower area needs a thorough clean. The toilet adjacent to the laundry has been fitted with a new floor. This has however risen and needs to be repaired as soon as possible. A copy of the complaints process should be posted on the notice board and given to each of the residents. All food in the fridge once opened must be labelled on the same day as to when it was opened and the expiry date given. This is to avoid potential health hazards. Dainton House DS0000013383.V361793.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 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 © 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.V361793.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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