Inspection on 15/09/06 for Dawnings

This inspection was carried out on 15th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Dawnings 20/12/05

Dawnings 15/04/05

Dawnings 09/11/04

Dawnings 30/06/04

Dawnings 16/01/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Dawnings 1 Vaga Crescent Ross-on-Wye Herefordshire HR9 7RQ Lead Inspector Martha Nethaway Unannounced Inspection 15th September 2006 10:00 Dawnings DS0000024712.V311884.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 Dawnings DS0000024712.V311884.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. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dawnings Address 1 Vaga Crescent Ross-on-Wye Herefordshire HR9 7RQ 01989 565101 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) www.mencap.org.uk Royal Mencap Society Mrs Melanie Keighley Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6) of places Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th December 2005 Brief Description of the Service: Dawnings is run by the Royal Mencap Society (Mencap), a registered charity. The property is owned and maintained by Dimensions Housing Association and they have a management agreement with Mencap. The home is registered to provide personal care for six adults (men and women) who require care due to learning disabilities. Dawning is a home to the service users for as long as it can meet their individual needs. The Dawnings is an extended modern house situated on a residential estate in the market town of Ross on Wye, about a mile from the town centre. There is a good range of local facilities and services nearby and the service users also have the use of a car. There are two single bedrooms located on the ground floor that can cater for the needs of older and/or less mobile service users. Four more single bedrooms are situated on the first floor. There is a range of communal rooms on the ground floor and a reasonably sized, enclosed garden to the rear of the house. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced visit and took place six hours. One inspector visited the home and discussions were held with the service users, the registered manager and deputy. Random selections of records were examined. What the service does well: What has improved since the last inspection? • • All of the previous recommendations were acted upon. A new three-piece suite was purchased and service users were involved in choosing this. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 7 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 Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions to the home are well managed and supported by a clear assessment process. EVIDENCE: The home has in place a clear admissions procedure that sets out the assessment process and a criterion to review the placement. Any prospective service user is encouraged to visit the home to gain an understanding of the day-to-day living and have an opportunity to meet the other member of the group. The home has had no new admissions since the last inspection visit. The registered manager explained that in practice the home was very dependent on the initial core assessment completed by the local authority. One file was examined and evidenced a comprehensive community care assessment. Royal Mencap expect the registered manager and the external line manager to work closely with the prospective service user, family, social worker and the Commissioning department. Information about the home is provided in a helpful format describing the ethos and principles of the home and includes the use of photographs. The registered manager considers all the service users currently living in the home to be suitably placed. She acknowledges that a couple of service users require intensive support and Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 9 meeting all the groups needs is given clear priority and value is placed on the diversity of the group. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning is well considered and involves services users, relatives and care professionals. Service users autonomy is recognised and protective strategies are in place to minimise risks. EVIDENCE: All service users have a written care plan. Information is available that covers areas of strengthens and assessed needs to help inform staff. The care plans are personalised to cover areas related to health including emotional and physical welfare, day-to-day living skills, educational and recreational interests and accessing community resources. The maintenance of independences is also considered. Each service user has a named keyworker who are responsible for preparing a monthly review report. Their role is considered crucial to developing Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 11 individuality and choice and truly considering involvement of the individual. Two of the plans sampled were varied and there was opportunity for considering progress that is linked to gaols being set and achieved. Royal Mencap provide a range of strategies to enable service users to have a voice and be heard. Priority is given to quality of life philosophy. Regular newsletters are provided in an accessible format. Care staff are monitoring and gathering the view of service users. Some of the service users have had involvement with the local advocacy service for specific support and representation. Service users expenditures are recorded in the case files. Royal Mencap have stringent auditing tools in place for collecting, moving and controlling cash. Risk assessments are available for individuals who take responsibility for managing their own money as they wish. Risk assessments are available and follow Royal Mencap’s procedures. There are clear guidelines to indicate how risks are both measured and minimised. The registered manager ensures that the staff team have a good understanding of the ways in which service users could be considered to be at risk and vulnerable. The home provides a comprehensive assessment tool that is being monitored and reviewed. To help promote good practice all staff have signed to acknowledge that they have read and understood the situations of risks. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are enabled to access the community on their terms. Retaining involvement with relatives is viewed positively. Service users are able to be involved with the day-to-day running of the home. Service users are fully engaged with menu planning and the preparation cooking of meals is encouraged. EVIDENCE: The majority of service users are accessing adult education and some attend the local day care service provision. One service user made favourable comments about his experience of his workplace and looked forward to this on a weekly basis. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 13 Individuals have a schedule that is designed specifically to match their needs. The development of skills and retaining independences are seen as key cornerstones. Service users are encouraged to participate in activities in the local community. Good attention is given to risk assessment to ensure safety with participation for example with banking, shopping and travelling. Staff have a good knowledge of the local community and the paper is delivered to help service users to be kept informed about local events. The majority of the service users retain contact with their relatives. Since the last inspection all contact by phone is now recorded in the care files. The home is able to accommodate visitors without impinging on the existing group. Service users are supported by their keyworker to keep their bedroom clean. Individuals are encouraged to participate with daily house tasks and staff actively supports this. Some service users only require prompting and minimal supervision. A couple of service users need more intensive supervision, support and guidance and this is clearly identified in their care plan. Service users plan out their weekly menus. Significant work has taken place to ensure that menu planning is presented to individuals at an accessible level. Digital photographs of prepared meals are used to assist with making choices. There is also a range of cookery books and staff have accessed the Internet to provide step by step guidelines for certain dishes. Where possible service users are encouraged to be involved with the preparation of meals and cooking. The registered manager did try to make contact with the local dietician but had limited success. Royal Mencap have now employed a dietician and the manager is in the process of establishing contact for advice and guidance around nutritional input and staff training with menu planning. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff support and enable individual’s autonomy to be valued. Staff monitor and review health care needs and links to health care professionals are well established. Good arrangements are in place for the safe handling of medications and staff are suitably trained. Consideration should be given to adopting a health care plan to provide a comprehensive overview of general health care needs and act as a early indicator of changing health needs. This will help to improve health care monitoring as needs become more complicated. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 15 EVIDENCE: The home has a comprehensive policy about providing personalised care and support. Staff are expected to fully comply with this guidance. As mentioned earlier all of the care plans consider how service users personalised needs should be met. Staff have broken down tasks for the service users to follow and adapt this to meeting the individual’s needs. The registered manager identified that the staff are sensitive to the needs of individual and will pace their support to match this. The care plans highlight the mornings, evening and nighttime routines. All of the service users are allocated a keyworker who are responsible for amending and reviewing the care plans. The care plans are considered to be working tool to help keep staff informed. Health care are discussed in the care plans. Records indicated that appointments are being attended to primary health professional including dentistry, optician and chiropodists. Some health care needs are changing and becoming more complicated but the manager is keeping this under close review. Discussions with the registered manger indicated that consideration should be given to introducing a health care document that could address the holistic health care needs. This could provide a platform to give a comprehensive overview of service users general health needs and as an indicator of changing health needs. The home has a clear policy in relation to medication. The home has in place the Boots pharmacy MAR system. Records are well organised and staff are complying with the expected standards of record keeping. The Boots pharmacist conducts a quarterly-unannounced visit to audit and check the practices in the home. The registered manager demonstrated that any follow action has been fully implemented. The home has now purchased a Bristol Maid cabinet and the staff have appreciated this as some service users medication regimes have increased. Staff have completed the safe control and handling medications. The registered manager keeps staff competences levels under review. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected by clear policies from all aspect of abuse. Staff are suitably trained and a high profile is given to protective practices adopted in the home. EVIDENCE: The provider has implemented a new complaints and compliments procedure in March 2006. This also includes an accessible format ‘I’m talking are you listening’ to enable all service users to be able to use the complaints process effectively. There is evidence that the complaints process is well advertised at both service users and stakeholder levels. The home has received no complaints since the last inspection visit. A log of complaints is maintained and records the nature of the complaint; investigation process and action take to resolve the issue. The protection of vulnerable adults policy is available and the corporate guidance is consistent with the local interagency policy. There are no live adult protection concerns. Discussions with staff indicated a good understanding of their role and area of responsibility if they witnessed an incident or have an incident reported to them. All staff receive training at the point of induction called ‘Protect and Respect’ and ‘Respond and Respect’. Royal Mencap intend to provide localised training that will be more specifically linked to the Herefordshire Vulnerable Adults Procedure. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 17 Records relating to financial recording keeping are comprehensive and follow the home’s procedures. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a home that is well maintained. The provider has in place a suitable policy to manage infection control. EVIDENCE: Dawnings is large detached property situation on the outskirts of Ross on Wye. It’s within accessible walking distance of the town and has access to rural public transport. The home is well maintained and pleasantly decorated. The Dimensions House Association intends to redecorate the communal areas and replace the kitchen units. This will upgrade and improve the home. Painting the exterior woodwork is also being planned by the housing association. The communal areas were found to be clean and tidy. A new three-piece suite has been recently purchased and service users were involved in choosing this. Dawnings has a policy in place for infection control. There was one outbreak of infection episode and the provider had informed the Commission and contacted the Public Health Agency. As a result the home has reviewed its protocol for managing bodily fluid connected to air borne infections. Likewise the home has Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 19 reviewed its management of clinical waste and now has an external contract set up for the collection and removal of waste. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 &35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment practices at the home are sound. The quality of the staff skill mix matches the needs of service users. Staff training is promoted and kept under review. EVIDENCE: The registered manager describes her staff as well motivated and resourceful. The provider ensures staff receive training to equip them to competently care for people with a disability. Staff are able to convey to the manager when extra resources or input needs to take place to fully meet individuals needs. There is a planned approach to care staff obtaining NVQ Level 2. Three staff are qualified to this level. The registered manager has proactively involved a local assessment centre that is able to deliver NVQ training. An assessor attends the home on a fortnightly basis to assess candidates work practices and course work. Two staff are undertaking NVQ training and four staff will be registered in October 2006. The recruitment records were examined and the system in place provides evidence of auditing. All the necessary checks were completed and available on Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 21 the files. The selection process includes the completion of an application form, attending an interview and a minimum of a six-months probationary period being completed. There is a planned approach to inducting staff. This is carried out over a sixweek period and includes staff being trained in core topic related to care, health and safety, fire safety and adult protection. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed effectively and a process is in place to measure the quality of the service. Consultation with stakeholders and service users are key component to evaluation of the care being delivered. Good arrangements are in place to maintain a safe environment. EVIDENCE: The registered manager is an experienced and suitably qualified at RMA level. She continues to update her knowledge base by attending internal and external management training. The staff team consider her approachable and able to lead the team. Good lines of communication exist and an open culture is encouraged. The staff team have a team development plan that is consistent with the provider’s operational objectives. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 23 The provider has a quality assurance system in place to monitor the performance of the home against the operation goals of Royal Mencap. The tool used to capture this information is now more sophisticated and directly related to the outcomes for meeting service users needs. It is too early to provide any commentary about the effects of the new quality assurance system. Consultation with service users, stakeholder and commissioning service is viewed essential to understand the quality of the service being provided. Questionnaires are used annually to help gauge this and feedback forms part of the overall development plan for the home. There are systems in place to monitor health and safety matters and Royal Mencap provide substantial procedures. Fire safety checks are being carried out and fire drills are taking place. All domestic installation checks were found to be within the timeframe for maintenance. Risk management and documentary assessments are in place. There was evidence that risks were being reviewed and updated. Service users safety and retaining independence were not unduly compromised. Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 24 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 3 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 X 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 3 X 3 X X 3 X Dawnings DS0000024712.V311884.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA19 Good Practice Recommendations Consideration should be given to adopting a health care plan to provide a comprehensive overview of general health care needs and act as a early indicator of changing health needs. This will help to improve health care monitoring as needs become more complicated. 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