Inspection on 09/11/07 for Dainton House

This inspection was carried out on 9th November 2007.

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 17 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 18/04/08

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 9th November 2007 9:30am Dainton House DS0000013383.V345591.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.V345591.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.V345591.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 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Community Housing and Therapy Laura Liverotti Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Dainton House DS0000013383.V345591.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. 26th April 2006 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. The fees for this care home range from £750 to £900 per week. Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit over 1 day undertaken by the Inspector responsible for Dainton House. 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 staff and service users. Informal interviews were conducted with other service users as a part of the inspection of the home. The Manager explained that there have been a number of changes in personnel at Dainton House since the last inspection. She said that there are 4 new staff and 5 new residents. The Manager now in place said she took over this role on 16th July 2007; she is in the process of applying for registration as a Manager at Dainton House with the Commission for Social Care Inspection. A new Registration Certificate will need to be issued as the current certificate names the wrong person as the Registered Manager. 17 requirements were made as a result of this inspection and 5 recommendations. It is recognised that these requirements and recommendations arise in 2 main areas of the inspection, environment and medication practices. The Inspector found the residents and staff helpful and they are to be thanked for the assistance that they gave him over the course of this inspection visit. What the service does well: What has improved since the last inspection? What they could do better: Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 6 The following areas were identified at this inspection that requires improvements and either appears in the report as a requirement or a recommendation. They are as follows: 1. Information to do with community events and social activities was not seen to be available on notice boards or coffee tables and it is recommended that this should be addressed as it may help encourage residents to be involved as much as possible in local activities. 2. Policies and procedures to do with medication and the administration of medications need to be reviewed to ensure that staff practices in this area are safe (Requirement). 3. Medication records / MAR sheets must be signed by staff (authorised to administer medication) after residents have been given their medication and that reasons are provided if residents refuse or are not present to take their medication (Requirement). 4. The Manager must ensure that there are no gaps in the MAR sheet records so that the individual residents’ pattern of medication administration is known and is accurate. Where residents refuse to get up in the mornings to take their medication staff should discuss this problem with the prescribing doctor in order to find a satisfactory solution (Requirement). 5. The Agency needs to ensure that specific training is devised around the policies and procedures for this unit to do with the safe handling of medications and that all staff who administer medication receive this training (Requirement). 6. The Manager ensures clear guidance for each resident is made available with the MAR sheet records where PRN medication is being used. (Recommendation) 7. The Manager must ensure that those staff who have not done so, enrol on POVA training in the near future. Certificated evidence will be required to be seen (Requirement). 8. The Inspection revealed a number of areas of the home that are in need of urgent repairs and maintenance as they were evidently well below an acceptable standard at the time of this inspection. 9. Clearly much more effective cleaning measures are also required that involve deeper cleaning of the communal kitchen and bathroom areas and a minimum standard of cleanliness especially in these areas should be aimed at, at all times. The Manager will therefore need to review the existing regimes in these areas to ensure that this is achieved (Requirement). Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 7 10. The kitchen should receive a “deep and professional clean” and measures be put in place to ensure the residents health will be protected (Requirement). 11. Food in the fridge should be labelled with the date of opening (Recommendation). 12. Procedures for dealing with the laundry must be drawn up and then implemented to ensure that when ever /if soiled laundry has to be taken through the kitchen they prevent and reduce the possibility of cross infection between the laundry and the food (Requirement). 13. The floor covering of the laundry room has lifted behind the washing machine. This means that there could be ingress of water under the floor presenting a potential health hazard to the residents. The Manager must ensure that a new floor covering is put in place that seals the whole area of the laundry room (requirement). 14. In the main hall the area under the stairs is being used as a storage place. This presents a potential fire hazard and the area should be cleared to avoid this (requirement). 15. The bathrooms and the toilets were inspected and were generally in poor decorative condition. Some taps were broken and tiles were missing around the sink in the top floor bathroom. The seal around the plinth of the sink in this bathroom had also given way and it was clear that water is ingressing below the sink. The floor in this bathroom is also not sealed and this means that water may again ingress below the covering. It is a requirement that all these repairs should be addressed as soon as possible to prevent a possible health hazard to residents. 16. Bedroom 2 - It is a requirement that the identified repairs are carried out swiftly and effectively as the existing condition of the ensuite bathroom does not meet the required standards and is clearly causing distress to the resident concerned. 17. Policies for infection control should be revised and specific reference needs to be included to cover laundry being taken through the kitchen area and to ensure that the risk of cross infection is minimised as much as possible (Requirement). 18. Training on the infection control policies and procedures is required that covers all staff and residents and ensures that the procedures are followed (Requirement). Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 8 19. Hand washing facilities need to be kept available and usable for both staff and residents who are doing the laundry before entering the kitchen area (Recommendation). 20. 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 should help ensure that the residents are protected by the home’s recruitment practices (requirement). 21. The Manager either draw up training files for each member of staff or a single training file that identifies what training that individual has achieved and when; what their training needs are that need to be met and evidence of the training courses attended. This is important so that the Manager has an accurate overview of what staff have covered in skills training and where the gaps are so that they may be addressed effectively (Recommendation). 22. A quality assurance system should 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 (Requirement). 23. A water and legionnaires test was carried out on 13th July 2007; this resulted in 13 recommendations being made by that company for required actions by Dainton House in order to bring their water supply up to date. It is a requirement that these recommendations are met as soon as possible as already timescales set by those inspectors has passed. 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.V345591.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.V345591.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): Standard 2 - 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 - The Inspector reviewed 5 of the 11 residents files, 4 of these files were for recent admissions of residents to the home and since the last inspection in April 2006. Assessments of the resident’s needs had been undertaken for each new person admitted to Dainton House and these needs assessments covered most of the essential areas of a 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 documentation was seen on all 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 support staff at Dainton House to follow. This helps to ensure that staff at Dainton House have all the available information about a prospective resident at an early stage of the process and are enabled to make a fully informed decision about whether and how best a residents needs could be met. Dainton House DS0000013383.V345591.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.V345591.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 does 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: Standards 6 – 5 service user files were inspected and the Inspector spoke to 3 residents formally over the course of this inspection. The 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) continue to Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 13 provide their support to the resident together with that of the therapeutic care team at Dainton House. The 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 5 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 CPA documentation and those needs assessments and Dainton House’s service user plans is also clear. The residents’ files that were inspected also included most of 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. Support 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 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 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. Care support staff also 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.V345591.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 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 front entrance porch was evidently in regular use. The Manager also said that residents are enabled to take part in appropriate activities by the care staff, although when the Inspector Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 15 looked at the files there was no evidence to show how a person’s cultural needs had been assessed and considered in care planning terms. This needs to be addressed. One resident told the Inspector that she had recently signed up to a range of different activities with the helpful assistance of her key worker. This includes a number of college courses targeted not only to help her with future employment prospects but also for her enjoyment. This resident told the Inspector that she is working part time at some stables with horses and is soon to start part time work at a charity shop. All of these experiences should help with this resident’s ability to move on towards independence more successfully. Other residents also spoke of plans to take part in outside activities that should equally help with their transition to independence that is each resident’s aim in this home. Standard 13 - Interviews with residents demonstrated that they do attend local community events and that they enjoy doing so. All the residents spoken to said they want to have an active community social life. Information was not seen to be available on notice boards or coffee tables and it is recommended that this should be addressed as it may help encourage residents to be involved as much as possible in local activities. 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 are not facilities such as a visitor’s room in the house that can be used by visitors who wish to see their relatives in the house, so residents tend to entertain people in their bedrooms. 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 Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 16 on their doors before entering. The Inspector observed staff to be interacting with residents in a friendly and respectful manner. 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. Tere 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. The Manager informed the Inspector that this is part of the therapeutic regime and is partly designed to expand the residents independence skills in these areas. Residents said the meals are to their liking. No complaints about the food were received by the Commission. The kitchen itself was not in good order on this occasion and specific reference to this is made under Standard 24. Dainton House DS0000013383.V345591.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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they will receive personal support in the way that they prefer and require and that their physical and emotional needs will be met. Service users cannot rely on the home providing a well managed service with regards to medication. EVIDENCE: Standard 18 – The Manager explained to the Inspector that residents are expected to be up and about each morning by 9.30am so that they are able to participate in their rehabilitative care packages and this includes their need to take their medications at 9.30 each morning. The residents interviewed at this inspection said that they do choose when to go to bed, when to have a bath, what they wish to wear and what activities they do during the day. Some said that they have allocated housework chores on specific days of the week. Residents do not have a choice of their allocated key worker however the Manager said that they have a chance to discuss any issues they may have or which arise subsequent to the allocation of their key workers. Residents did not Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 18 raise any concerns with the Inspector about their key workers in fact their comments reflected a positive view of key work support. Residents at Dainton Lodge 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 informed the Inspector that all residents are supported to keep well through accessing appropriate healthcare and associated mental health care support. All residents are signed up with local GP surgeries and some are registered with local dentists. The Manager told the Inspector that annual health checks take place at the GP surgeries and residents attend there. The Manager said that whether or not a resident uses the dentist is left up to the resident’s own decision but staff will encourage residents to use this service if required. Residents who spoke with the Inspector said that they go to see their GPs as and when necessary. Standard 20 - The Manager told the Inspector that all the permanent staff administer medication to the residents and that staff have received training to do with the safe handling of medicines. Staff when interviewed said that they had received medication training. The Manager informed the Inspector that 2 residents self-administer their medication. At the start of this inspection at 09:50am when the Inspector entered the office the medication cabinet was seen to be open and unlocked. The Inspector pointed this out to the member of staff who said that it was open because residents were receiving their morning medications. No residents were at that moment present in the office to receive their medications nor did any residents come to the office for 5 – 10 minutes. The Inspector said that the medication cabinet should always remain locked except at the point when medication was actually being given to residents. The potential dangers of leaving the medication cabinet open were pointed out to that member of staff and later to the Manager. Policies and procedures to do with medication and the administration of medications need to be reviewed to ensure that staff practices in this area are safe. This is a requirement. Later an inspection of the medication records MAR sheets was undertaken together with the Manager. Several unexplained gaps for a number of residents were found where staff signatures were missing or where reasons why the medication was not taken or had not been received had not been written down. The Inspector asked the Manager about this and she explained that residents may not have been present in the home to take their medication. The Inspector explained that whatever the circumstances some explanation should always be recorded on the MAR sheets. It is therefore a Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 19 requirement that medication records / MAR sheets are signed by staff authorised to administer medication, after residents have been given their medication and that reasons are provided if residents refuse or are not present to take their medication. The Manager must ensure that there are no gaps in these records in future so that the individual residents’ pattern of medication administration is known and is accurate. Where residents refuse to get up in the mornings to take their medication staff should discuss this problem with the prescribing doctor in order to find a satisfactory solution. The Agency needs to ensure that specific training is now devised around the policies and procedures for this unit to do with the safe handling of medications and that all staff who administer medication receive this training. A requirement. As part of this inspection a check on the stock of medication held in the home was carried out and records kept were inspected and seen to be satisfactory. An appropriate medication cabinet was seen in the office bolted to the wall however provision will need to be made in future for “controlled drugs” as described to the Manager. Some residents receive PRN medication and it is recommended now that the Manager ensures clear guidance for each resident is made available with the MAR sheet records where PRN medication is being used. This information should be readily accessible for staff and residents alike when PRN medication is needed. The guidance should set out clear individual information. It could include when or when not to take the PRN medication, what the potential side effects are and this should be done in conjunction with the resident’s GP. . Dainton House DS0000013383.V345591.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. 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 now be assured that their views are listened and acted on. Also that that they will be protected from abuse within the home. EVIDENCE: Standard 22 – The Manager informed the Inspector that a record is kept of any complaints received by the unit. This record was inspected showing that there have been no complaints made since the last inspection. The Manager confirmed this. Standard 23 – The 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 most of the staff team have been provided with training and guidance about what actions they need to take if the need arises. On inspection of 3 of the 9 staffing files there was evidence in certificated form that 2 of these 3 staff members had attended the L.B.Kingston’s POVA training. It is important that all Dainton House’s staff team receive this training at least once every 2 or 3 years. It is therefore recommended that the Manager ensure that those staff who have not done so, enrol on POVA training in the near future. Certificated evidence will be required to be seen. This will help ensure that all staff are up to date with the policies and procedures and other issues to do with the protection of vulnerable adults at Dainton House. Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 21 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 Manager told the Inspector that no allegations of abuse had been made at the home since the last inspection. Dainton House DS0000013383.V345591.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 and 30. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Given the conditions seen at the time of this inspection service users may not be assured that they can live in a safe and comfortable house. Areas of this house were not clean or hygienic at the time of this inspection. EVIDENCE: Standard 24 – A member of the staff group explained to the Inspector that residents are responsible for the cleaning of all areas of the home and that each day there is a cleaning group made up of residents and some staff who undertake the cleaning together. The intention is to enable residents to gain the skills and ability to do household chores as part of their rehabilitation programme. An inspection of the premises was undertaken of the home together with a member of the therapeutic staff team and then later with the Manager. Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 23 Communal areas such as the kitchen, lounge, hall, stairs, bathrooms and toilets were inspected as were 5 of the 11 resident’s bedrooms. The Inspection revealed a number of areas of the home that are in need of urgent repairs and maintenance as they were evidently well below an acceptable standard at the time of this inspection. Clearly much more effective cleaning measures are also required that involve deeper cleaning of the communal kitchen and bathroom areas and a minimum standard of cleanliness especially in these areas should be aimed at, at all times. The Manager will therefore need to review the existing regimes in these areas to ensure that this is achieved. This is a requirement. The results of the inspection of the premises were as follows: 1. The kitchen was in a very poor state of cleanliness. Leftover food from past meals, dirty cups and plates, cluttered the work surfaces which were also greasy. The floor was greasy and had food spilt over it. Walking across the floor was sticky and slippery. In the gaps between the kitchen equipment (such as the fridge / freezer) and the kitchen walls particles of food had accumulated over a period of time and had not been cleaned up. Large amounts of fluff and other debris was also in evidence. In the pantry a light bulb was missing and so it was hard to see the contents of the cupboard. It is a requirement that the kitchen receives a “deep and professional clean” and that measures are put in place to ensure the residents health will be protected. 2. Food in the fridge was opened but had not been labelled and upon closer inspection there were pots of coleslaw that were evidently old (out of date) and inedible. 3. Adjacent to the kitchen area is the laundry room and on inspection there were several soiled articles of clothing in the sink that had clearly been carried through the kitchen thus presenting a possible health hazard. This was later pointed out to the Manager who said immediate measures would be taken to ensure that soiled washing is not carried through the kitchen into the laundry room. It is a requirement that procedures are drawn up and then implemented to ensure that when ever /if soiled laundry has to be taken through the kitchen they prevent and reduce the possibility of cross infection between the laundry and the food. 4. The floor covering of the laundry room has lifted behind the washing machine. This means that there could be ingress of water under the floor presenting a potential health hazard to the residents. The Manager must ensure that a new floor covering is put in place that seals the whole area of the laundry room. A requirement. 5. In the main hall the area under the stairs is being used as a storage place. This presents a potential fire hazard and the area should be cleared to avoid this. A requirement. Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 24 6. The Manager told the Inspector that the blue carpet on the stairs and landings is new and was laid in the summer. Unfortunately the colour of the carpet seems to show every particle of dirt and at the time of this inspection it was covered in leaves and general debris from outside evidently carried in on people’s shoes. The effect of this was that it looked as if it had not been cleaned for a long time. A front door mat may help reduce the amount of outside debris being brought into the home. The Manager told the Inspector that this carpet is hoovered each day. 7. The bathrooms and the toilets were inspected and were generally in poor decorative condition. Some taps were broken and tiles were missing around the sink in the top floor bathroom. The seal around the plinth of the sink in this bathroom had also given way and it was clear that water is ingressing below the sink. The floor in this bathroom is also not sealed and this means that water may again ingress below the covering. It is a requirement that all these repairs should be addressed as soon as possible to prevent a possible health hazard to residents. 8. Bedrooms 1, 2, 3, 8 and 10 were inspected. Bedroom 1 was in a good state of repair and looked clean and bright. 9. Bedroom 2 however was in a poor condition. The resident was present at the time of the inspection and he complained about several things in the room that the Inspector also found to be in need of repair and maintenance. In the “ensuite shower room and toilet” tiles were missing from the walls, other tiles were loose and unstable. Part of the wall also seems to be missing. The cistern cover was cracked and broken and water was continually leaking from the base of the cistern into a drain in the centre of this room. The light bulb in the main room was broken and consequently the room appeared to be dark and dingy. The toilet roll holder was also missing although the screw fixings for it were evident on the wall. With regards to the leak and the broken cistern the Manager explained to the Inspector that a plumber had been called several times to make repairs but still this has not been completed successfully. The Manager also said that the maintenance man that is employed by the home is making repairs to the tiles and to the wall. This was confirmed by the maintenance man to the Inspector. It is a requirement and it is essential that these repairs are carried out swiftly and effectively as the existing condition of this bathroom does not meet the required standards and is clearly causing distress to the resident concerned. 10. Bedroom 3 was seen and inspected, the decorations need renewing as they look “tired”. 11. It was evident to the Inspector that at the time of this Inspection some residents had been smoking in their bedrooms, the air smelt strongly of tobacco smoke and ashtrays were evident in a number of the bedrooms. When this was mentioned to the Manager she said that residents had been asked many times not to smoke in their bedrooms. Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 25 12. The floor covering in the “white bathroom” has lifted and this needs to be sealed so as to ensure the floor is impermeable to water. 13. The shower tap in the “blue bathroom” is broken and needs to be replaced so that the shower can be used by residents. Standard 30 – The home does have some information to do with infection control however as indicated above the procedures need to be reviewed and revised. Specific reference needs to be included to cover laundry being taken through the kitchen area and to ensure that the risk of cross infection is minimised as much as possible. Training is required that covers all staff and residents and ensures that the procedures are followed. Hand washing facilities need to be kept available and usable for both staff and residents who are doing the laundry before entering the kitchen area. Dainton House DS0000013383.V345591.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. Quality in this outcome area is good. This judgement has been made using available 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 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 3 staff files inspected. Staff interviewed also confirmed that they had completed an induction programme covering these areas. Residents interviewed told the Inspector that staff are approachable and the Inspector saw staff taking time to deal with resident’s questions. The Manager explained that there are 2 student social workers currently working at Dainton Lodge. She said that they had both been CRB checked. Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 27 Standard 34 - There is in place an appropriate recruitment policy. 3 staff files were inspected. Generally the files were in reasonable loose leaf order but this could be improved if the information was set out under sections in a ring binder for instance. Inspection of 3 out of the 9 staff files showed that most of the information required under the Standard 34 was held on these files and in evidence. However some information was not on the files. For example on 2 staff files there was not a copy of the work contract, nor an application form or job description for their posts at Dainton House. A recommendation is made therefore 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 should help ensure that the residents are protected by the home’s recruitment practices. Staff interviewed did confirm that have a contract of employment and that they understand their terms and conditions as well as their roles and responsibilities within the home, however a copy should be available for reference in the unit. Standard 35 - The Manager informed the Inspector that a structured induction programme is offered to new staff. At this inspection 2 new staff were interviewed and they confirmed that they had attended this induction training. The Manager informed the Inspector that the Agency does provide a good comprehensive training programme for staff that includes all the necessary areas of training to support staff in carrying out their roles effectively and efficiently. Staff who were interviewed said that they had been or were booked onto training courses covering key areas such courses as the Protection of Vulnerable Adults, 1st aid, food hygene, fire safety, health and safety and infection control. It is recommended that the Manager either draw up training files for each member of staff or a single training file that identifies what training that individual has achieved and when; what their training needs are that need to be met and evidence of the training courses attended. This is important so that the Manager has an accurate overview of what staff have covered in skills training and where the gaps are so that they may be addressed effectively. Standard 36 – The Manager informed the Inspector that staff do receive regular supervision from either the Manager or the Deputy Manager. She said Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 28 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. Dainton House DS0000013383.V345591.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 stake holders 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 new Manager at Dainton House said that she has been working in this role since July 2007 and is therefore relatively new to the work of Manager. Standard 39 – The Manager told the Inspector that at present there is no quality assurance tool / process in place at Dainton House that specifically Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 30 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. This needs to be addressed so that service users and other stakeholders can be confident that their views underpin the self monitoring and development of this home. Some discussion was had with the Manager 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 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 provison. It is a requirement that a quality assurance system is 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 should enable the key stakeholders to be confident that their views underpin all self monitoring, review and development at Dainton House. 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 Manager informed the Inspector that all staff receive training in moving and handling, 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 – 18.10.07 Fire alarms – 26.10.07 Fire equipment – 18.7.07 Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 31 A water and legionnaires test was carried out on 13th July 2007, this resulted in 13 recommendations being made by that company for required actions by Dainton House in order to bring their water supply up to date. It is a requirement that these recommendations are met as soon as possible as already timescales set by those inspectors has passed. 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 – none had been noted. Hot water temperatures were also checked and records indicated that they also came within the acceptable range. At the time of this inspection no fire doors were seen to be wedged open and the building appeared to be secure. The Manager showed the Inspector a recently completed (3.10.07) 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. The Manager informed the Inspector that there is planned a new mains electrical installation within the home and that an estimate is now being gained for this work to be carried out in the near future. Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 32 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 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 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 1 X 3 X 2 X 2 X X Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 33 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 YA20 Regulation 13 Requirement Policies and procedures to do with medication and the administration of medications need to be reviewed to ensure that staff practices in this area are safe. Medication records / MAR sheets must be signed by staff (authorised to administer medication) after residents have been given their medication and that reasons are provided if residents refuse or are not present to take their medication. The Manager must ensure that there are no gaps in the MAR sheet records so that the individual residents’ pattern of medication administration is known and is accurate. Where residents refuse to get up in the mornings to take their medication staff should discuss this problem with the prescribing doctor in order to find a satisfactory solution (Requirement). DS0000013383.V345591.R01.S.doc Timescale for action 20/12/07 2. YA20 13 01/12/07 3. YA20 13 01/12/07 Dainton House Version 5.2 Page 34 4. YA20 13 5. YA23 13 6. YA24 23 7. YA24 23 8. YA24 23 9. YA30 13 The Agency needs to ensure that specific training is devised around the policies and procedures for this unit to do with the safe handling of medications and that all staff who administer medication receive this training. The Manager must ensure that those staff who have not done so, enrol on POVA training in the near future. Certificated evidence will be required to be seen. Previous timescale not met. Clearly much more effective cleaning measures are also required that involve deeper cleaning of the communal kitchen and bathroom areas and a minimum standard of cleanliness especially in these areas should be aimed at, at all times. The Manager will therefore need to review the existing regimes in these areas to ensure that this is achieved. The kitchen should receive a “deep and professional clean” and measures be put in place to ensure the residents health will be protected. Procedures for dealing with the laundry must be drawn up and then implemented to ensure that when ever /if soiled laundry has to be taken through the kitchen they prevent and reduce the possibility of cross infection between the laundry and the food. The floor covering of the laundry room has lifted behind the washing machine. This means that there could DS0000013383.V345591.R01.S.doc 20/12/07 31/03/08 01/12/07 01/12/07 01/12/07 01/01/09 Dainton House Version 5.2 Page 35 10. YA24 23 11. YA24 23 12. YA24 23 13. YA30 13 be ingress of water under the floor presenting a potential health hazard to the residents. The Manager must ensure that a new floor covering is put in place that seals the whole area of the laundry room. In the main hall the area under the stairs is being used as a storage place. This presents a potential fire hazard and the area should be cleared to avoid this. The bathrooms and the toilets were inspected and were generally in poor decorative condition. Some taps were broken and tiles were missing around the sink in the top floor bathroom. The seal around the plinth of the sink in this bathroom had also given way and it was clear that water is ingressing below the sink. The floor in this bathroom is also not sealed and this means that water may again ingress below the covering. It is a requirement that all these repairs should be addressed as soon as possible to prevent a possible health hazard to residents. Bedroom 2 - It is a requirement that the identified repairs are carried out swiftly and effectively as the existing condition of the ensuite bathroom does not meet the required standards and is clearly causing distress to the resident concerned. Policies for infection control should be revised and specific reference needs to be included to cover laundry DS0000013383.V345591.R01.S.doc 01/12/07 01/02/08 01/12/07 01/12/07 Dainton House Version 5.2 Page 36 14. YA30 13 15. YA39 24 16. YA41 17 17. YA34 1917 being taken through the kitchen area and to ensure that the risk of cross infection is minimised as much as possible. Training on the infection control policies and procedures is required that covers all staff and residents and ensures that the procedures are followed . A quality assurance system should 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. A water and legionnaires test was carried out on 13th July 2007; this resulted in 13 recommendations being made by that company for required actions by Dainton House in order to bring their water supply up to date. It is a requirement that these recommendations are met as soon as possible as already timescales set by those inspectors has passed. 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 should help ensure that the residents are protected by the home’s recruitment practices. 01/02/08 01/02/08 01/12/08 01/01/08 Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 37 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 YA24 YA13 Good Practice Recommendations Food in the fridge should be labelled with the date of opening. Information to do with community events and social activities was not seen to be available on notice boards or coffee tables and it is recommended that this should be addressed as it may help encourage residents to be involved as much as possible in local activities. The Manager ensures clear guidance for each resident is made available with the MAR sheet records where PRN medication is being used. Hand washing facilities need to be kept available and usable for both staff and residents who are doing the laundry before entering the kitchen area. The Manager either draw up training files for each member of staff or a single training file that identifies what training that individual has achieved and when; what their training needs are that need to be met and evidence of the training courses attended. This is important so that the Manager has an accurate overview of what staff have covered in skills training and where the gaps are so that they may be addressed effectively. 3. 4. 5. YA20 YA30 YA35 Dainton House DS0000013383.V345591.R01.S.doc Version 5.2 Page 38 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.V345591.R01.S.doc Version 5.2 Page 39 - 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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