Inspection on 19/04/05 for Dainton House

This inspection was carried out on 19th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Dainton House 01/12/09

Dainton House 17/02/09

Dainton House 18/04/08

Dainton House 09/11/07

Dainton House 26/04/06

Dainton House 13/08/05

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 08/07/2008.

CARE HOME ADULTS 18-65 Name Dainton House 1a Upper Brighton Road Surbiton Surrey, KT6 6LQ Lead Inspector Michael Williams Announced 19th April 2005 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 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 Stationary 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. Name Version 1.10 Page 3 SERVICE INFORMATION Name of service Dainton House Address 1A upper Brighton Road, Surbiton, Surrey, KT6 6LQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8390 0545 020 8390 0545 Community Housing and Therapy Laura Liverotti Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia of places Name Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 19/04/05 Brief Description of the Service: Dainton house is a large, detached period house. It is situated on a busy main road in a residential area of Surbiton. The house is within easy 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 thereutic groups and meetings aimed at equipping service users to move on to more supportive accommodation where that is possible. The estimated length of stay is three years for their programme of rehabilitation. Name Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is an established mental health service providing an intensive, time limited programme of rehabilitation. The service users are therefore expected to participate fully in the regime of meetings, groups, individual support and life skills such as shopping, cooking and money management. Those service users who chose to assist in the inspection spoke favourable about the home, the helpful staff, the meals and the general environment. The inspector found the staff very professional and thoughtful in their approach to their work. The environment was not to as high a standard as might be expected for a registered care home but this is due, in part, to the expectation that service users will manage the domestic work. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Name Version 1.10 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Name Version 1.10 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3 Service users do have their needs assessed at the point of admission but a requirement is made to ensure this initial information is filed clearly and methodically in the service users’ case files so that their needs are clearly known from the outset and can be referred to at a later stage to assess progress and change. EVIDENCE: Detailed case files are in place for all service users and within these files is documentation about the assessment, care planning and risk assessments of each of them. This is a therapeutic community and the care plans are a little unusual but the format suites the home’s therapeutic approach. The service users were aware of the purpose of their admission to the home, preparation for independence and a better understanding of their mental health and how they can manage their special needs in future. Name Version 1.10 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 Not all risks known prior to admission are translated into risk assessment and action plans after admission. EVIDENCE: Despite evidence that in some instances risk assessments were not in place they were for many predictable circumstances where services users were being supported in taking appropriate risks. Service users are involved in the initial decision making about their admission and then are involved in the review process at this point they are fully involved in decision making about the care and support to be provided by the home. Service users are also involved in the day to day running of the home including shopping, cooking and cleaning responsibilities. Name Version 1.10 Page 9 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16, 17 Service users are assisted by staff to regain their social skill both within the home with domestic and social activities as well as involvement within the community setting. EVIDENCE: Service users explained how they spend their day and this includes a lot of inhouse meetings and domestic activities; service users also make use of the community for leisure pursuits, learning and employment or voluntary work. Service users are supported in maintaining personal and social contacts. No breaches of service users rights was noted or commented upon by service users during the inspection. The service users themselves organise the meals and so a consensus of opinion is sought about meals; the service prepared a nice buffet on the day of inspection and this communal meals at single large refectory table; again this is aimed at helping service users regain social skills. Through the General Practitioner service a dietician is periodically consulted about balanced meals for service users. Name Version 1.10 Page 10 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 The physical, emotional and health care needs of service users are met. The procedures and policies for the administration of medication ensure the safety of service users. EVIDENCE: The case files of service users record their health care needs and this includes details about specialist mental health services provided under the ‘care programme approach’ (aftercare). Staff support service users in controlling their own medication when this is appropriate otherwise the staff administer medication as prescribed by the doctors. As noted on the day of inspection many service users are capable of asking for medical advice if they feel unwell. Name Version 1.10 Page 11 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 Staff training in respect of the protection of service users from abuse and a complaints procedure ensures the safety of the service users. EVIDENCE: No complaints were made during the course of the inspection. One complaint has been recorded since the previous inspection and this was from a neighbour (about the home’s garden) and the home’s manager dealt this with. Service users have ample opportunity to comment and give feedback on the service provided and it is noted that a member of staff will be undertaking a specific programme of consultation as part of her own studies and this will provide information about the service users’ views on Dainton House. Name Version 1.10 Page 12 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 27, 30 Whilst the premises are homely and domestic in scale not all areas were thoroughly clean. Areas of the home need to be redecorated and refurbished with attention to ensuring that the hot water supply is available throughout the home. EVIDENCE: During the inspection of the home it was noted that it is a homely place with pleasant décor and original features of an old family home. The bedrooms in most instances are large enough for the service users (who usually stay only three years). One rooms is just 10 square metres but is acceptable as an ‘existing’, rather than newly registered, care home. As the service users clean the home with the support of staff not all areas are thoroughly clean, including the kitchen, communal areas, bathrooms and toilets. The manager states that self help is an important aspect of the home’s rehabilitation programme so a system of thorough cleaning is needed that ensures proper hygiene standards as well as maintaining the ethos of the organisation. A cover is needed for the strip light in the kitchen. It is suggested that each service user is given a laundry basket (instead of black plastic bag) so they can hold their laundry until the small laundry-room is free for them to use. The garden would benefit from greater attention. Unsafe and unsuitable locks were seen in various locations throughout the home. Name Version 1.10 Page 13 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35 Sound recruitment practices and the investment into staff training and support ensures that service users are protected and their care needs meet. EVIDENCE: Many of the staff in this home are graduates in psychology and most have continued higher education in other therapeutic based training courses including the home’s “dialogical therapy” approach. Recruitment practices seem sound; staff files contain the documentation required by regulation including police checks, health and identity checks, qualification checks, references and interviews and so forth. Ongoing training and support is provided by the company. Each service user is allocated a key-worker (a nominated member of the care staff) and the service stated how helpful they find the staff team. Name Version 1.10 Page 14 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 42 Service users’ contribution is vital to the whole ethos and style of the therapeutic community in this generally well run home. In respect of health and safety, a review door locking mechanisms needs to be undertaken throughout the home. Poor standards of hygiene also compromise the well being of service users and there is a need for clarity in respect of drug misuse is also a matter of safety. EVIDENCE: This is a well established care home providing a specialist service to people with mental health problems. There is an emphasis on group and individual meetings. The manager and staff are clearly well motivated and bring a range of experience and academic qualifications to their role. The manager is registered with the CSCI and is therefore assessed as competent to run this type of care home and she does with the support a small housing charity. In respect of safety and well being of service users, a requirement is made in respect of the misuse of drugs and alcohol and another in respect of door locking mechanisms, some of which are not suitable for this type of service. Name Version 1.10 Page 15 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x 2 x x 2 Standard No 11 12 13 14 15 Name 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 x 3 x Version 1.10 Page 16 16 17 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x 1 x Name Version 1.10 Page 17 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 12(1)(a) Requirement Assessments: Assessment of service users must be more clearly defined in the case files to ensure information gathered is being acted upon. Risk Assessments: risks identfied prior to admission, and subsequently, must be recorded in the service care plans. Risks: The home must make clear its position regarding the misuse of drugs that are not presribed and are illegal to use, sell or allowed to be used. Furniture, fittings and redecoration: The home must produce a three plan of action to replace or refurbish those parts of the home requiring improvement. Hot water supplies: The home must ensure an adequate supply of hot water to baths, showers and sinks. Staff facilities: The home must provide adequate facilities for staff including an adequate office and storage for staff personal possessions. Kitchen and hygiene: The kitchen and all other areas of the Version 1.10 Timescale for action 31/7/05 2. 9 13(4)(b) 31/7/05 3. 3 13(4) 31/7/05 4. 24 16(2)(c) 31/7/05 5. 24 23(2)(j) 31/7/05 6. 23 23(3) 30/12/05 7. 30 16(2)(g) 31/7/05 Name Page 18 home msut be maintained to an adequate state of cleanliness. 8. 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. Refer to Standard 40 40 Good Practice Recommendations Mental Health Law: It is recommended that the home acquires an up to guide on the Mental Health Act. National Minimum Standards: it is recommended that the home acquires an up to date edition (currently 2nd Edition) of the NMS includes the revised Regulations and Schedules. Laundry: for the diginity of service users and efficient running of the laundry service it is recommended that each service user is given a suitable closed container to hold their laundry until the (very small) laundry-room is free for them to use. Laundry should not be carried through the kitchen nor left in the dinig room. Garden: It is recommended that the garden is properly maintained to ensure it provides an agreeable space for service users. 3. 30 4. 28 Name Version 1.10 Page 19 Commission for Social Care Inspection CSCI 8th Floor Grosvenor House 125 High Street, Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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