Inspection on 02/10/06 for New Dawn

This inspection was carried out on 2nd October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

New Dawn 27/10/08

New Dawn 31/10/07

New Dawn 29/11/05

New Dawn 09/05/05

New Dawn 18/01/05

New Dawn 10/05/04

Similar services:

Coopers Mill Ltd

Pocklington House

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 New Dawn Dog Lane Horsford Norwich Norfolk NR10 3DH Lead Inspector Mrs Dorothy Binns Unannounced Inspection 2nd October 2006 10:00 New Dawn DS0000027338.V314652.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 New Dawn DS0000027338.V314652.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. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service New Dawn Address Dog Lane Horsford Norwich Norfolk NR10 3DH 01603 891533 01603 890840 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.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) Mrs Suzanne Goodacre Care Home 20 Category(ies) of Learning disability (20), Physical disability (20), registration, with number Sensory impairment (20) of places New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Twenty (20) people with a Learning Disability who may also have a Physical Disability and/or a Sensory Impairment may be accommodated. The total number should not exceed 20. 29th November 2005 Date of last inspection Brief Description of the Service: New Dawn is a care home providing personal care and accommodation for 20 Younger Adults with severe learning difficulties. A skill centre is located adjacent to the home and is attended by most service users. The home is owned by Care Management Group, whose head office is located in Wimbledon, London. The home is located in the village of Horsford, approximately 8 miles from Norwich. Local facilities, including shops, pubs and a post office are within walking distance. The home is a single storey building with purpose built extensions. Most of the rooms are single and are made individual to the service user. Communal spaces are spacious and comfortable. Level access is available to the enclosed gardens and recreation area. Ample parking space is available to the front of the building. Fees for the service are based on an assessment of need and range between £661.19 to £1682.80 per week. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection of the home lasting eight hours. During the visit the progress of the home was discussed with the registered manager and records and policies were examined. Three staff were spoken to in private and two others were seen as they went about their work. The service users who have severe disabilities were not able to speak to the inspector but were observed as they spent their time in the home. A tour was also made of the building. Surveys were sent out by the Commission to the service users for their views about the home but were not returned as the service users are unable to comment. Three medical professionals responded to the Commission’s survey. The report also reflects any information received by the Commission since the last inspection. The inspection concentrated on the key national minimum standards for care homes for younger adults. Overall this is a good home for service users who though extremely dependent on staff are well protected and cared for with dignity and kindness. There are currently staffing vacancies which need to be filled as they are affecting the quality of the social care normally provided. What the service does well: Service users are assessed in detail before coming to the home to ensure that they can be properly supported in the home and staff know what they need. The records are well kept and monitor how the service users are doing. The accounts showing how the home looks after the service users’ money are also properly in place. These are good safeguards for the service users. Staff are compassionate and act as good advocates for the service users. They want them to have a good quality of life. They speak up for the service users and have a sense of responsibility for them. The health needs of the service users are well monitored with access to a range of community services. Staff are also well schooled in the individual care needed for each service user and the equipment needed to help them. The home has done well in providing outside training to nearly all staff on protecting adults from abuse. While in house training is always helpful, to hear other agencies speak and meet people from other homes is always very effective and the home has done well to provide this essential training. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 6 The provision of short training courses for staff and the induction training gives a good basis for staff practice ensuring service users are supported by an effective staff. What has improved since the last inspection? What they could do better: The home is usually proactive in organising activities and outings for the service users and staff see their job as helping them to enjoy the community. This is currently stalling because of staffing problems with the number of outings reduced. More regular outings should be organised. The training being given by experienced staff on how to use peg feeds should be checked with the dietician to ensure appropriate training is being provided. The staffing should be increased to deal with the multiple needs of the service users and to fulfil the normal rota for this home. Gaps must be filled when sickness or holidays intrude. Staff need more encouragement and support to study for a national care qualification. Staff need the chance to meet with a supervisor on a one to one basis. This has been started but needs to be more regular. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 7 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. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 8 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 New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 9 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 The quality of this outcome area is good. Full and detailed information about each service user is collected to make sure they are well supported in the home. EVIDENCE: Three care plans were chosen at random for examination. Each contained a full assessment of each service user covering all areas of their needs and abilities. Medical, physical and behavioural problems were highlighted. Skills interests, family contacts and recreational activities were all mentioned. All this information led to guidance for staff on how best to support the service user. New Dawn DS0000027338.V314652.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 and 9 The quality of this outcome area is good. Information about the individual service user’s needs and choices and information to help staff support them in their decisions, were detailed in the care records. Service users were also supported to take risks as part of an independent lifestyle. Records about how their finances were looked after were complete and satisfactory. EVIDENCE: Three care records were inspected and had details showing how the assessment information led to a plan of care. Each file gave details on how a service user was to be supported, what special assistance they would need, how they communicated and what they liked doing. There were protocols on meals, and instructions on aspects of health. Daily recordings by staff showed what actions they took to support the service users and the plans were reviewed usually on a monthly basis though some gaps were identified. Some reviews were also repetitive and not saying enough. There is a key worker system and they are involved in reviewing the care but to make the system more effective the home may want to review the frequency and quality of the reports. It may be better to have reviews less frequently but of a better quality. A recommendation has been made to review the system. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 11 Service users are able to make some decisions and one staff demonstrated how she asked them what they wanted to wear for instance. Staff said they knew when service users did not like something by their demeanour or vocal communication. They are very dependent on staff however. In terms of their money, all need assistance but the information from the manager shows that family deal with their money whenever possible. Otherwise most service users have their own bank accounts into which their benefits are paid. Two files sampled showed the bank statements giving evidence of benefits being paid in, then a record of cash withdrawn and looked after on a service users behalf. A running total was shown accounting for how the money was spent and how much was left. Cash held was checked against the record. Another file showed money deposited by the family and how the staff assisted the service user to look after his money and buy what he required. Overall these financial records were satisfactory. Staff do have to initiate the buying of clothes and paying for outings but the inspector was satisfied that this is all done in the interests of the service users. For such dependent service users, there are clearly risks attached to their health, mobility and vulnerability. The home’s files showed that areas of risk such as choking, burning in the bath, travelling outside were all considered. Precautions and actions which staff needed to take to make the service user safe were all detailed giving staff good guidance. New Dawn DS0000027338.V314652.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 and 17 The quality of this outcome area is adequate. Although the service users are respected and well cared for by staff, there is criticism about the current lack of activities and outings. These assume greater importance with service users who are so severely disabled that they are restricted in both mobility and communication as most cannot amuse themselves. There is a good emphasis placed on ensuring service users enjoy their food and good contacts with families. However the need for further stimulation is clear. EVIDENCE: Service users are unable to work because of the severity of their disabilities though two service users are attending an adult training centre. The remaining service users have time at the skills centre, a separate day centre in the grounds of the home. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 13 Service users need support to go outside into the community and the activities provided by the home and organised by the skill centre are reported to include outings to local facilities, visits to shops and pubs and outings to local beauty spots. However the activities record and the views of staff reflect fewer activities in recent months. One service user’s record showed only one outside visit to swimming recently, another two showed they had been on holiday but otherwise had not been taken outside the home. Another had only one visit to a picnic. Staff said that outings are programmed but that it is difficult to fulfil because of lack of staffing. As only six service users can walk, it does mean that the ratio of staff to service users has to be high both inside and outside the home. Recently staffing has been lower than required and activities have suffered as a result. The skills centre staff have also had to come into the home for part of their shift to fulfil staffing requirements within the home, taking them away from a full day at the centre which concentrates on stimulation and skills. Staff interviewed by the inspector were keen to support the social care of the service users and gave examples of what they would like to do. Previously they had had time to take service users horse riding and swimming. As a key worker, one described how she would link and support a service user with an interest that he had and would like to provide more evening activities. Transport is provided by the home with two minibuses and a 7 seater car but these are not in use as often as they could be because of staffing difficulties. There was clearly an understanding from the staff that more stimulation was required but a frustration about the ratio of staff to these very physically dependent service users. Many service users are immobile and are made comfortable by staff on cushions or special chairs. They are not able to speak so many indoor activities are not within their grasp. Staff were seen to make them comfortable and to talk to them in the home. The atmosphere was relaxed. However in order to provide some variety in activity and for stimulation and better integration, it is essential that service users are supported more frequently to go out. A requirement has been made. The files showed that service users had regular contact with the family wherever possible. Visits to family were recorded and one sample record showed regular family contact was part of the action plan for that particular service user. The home encourages families to stay in touch. Although service users are extremely dependent on staff and there are communication challenges, the impression from observing staff is that service users are respected and that staff do speak up on their behalf. Staff interacted well with the service users and knew what they liked. They could tell from body language whether someone was tired or distressed. Service users do need staff to make decisions for them however and care plans could be more detailed in showing how service users communicate and what they like (see the good example on food below). See recommendations. However the philosophy of the home and the practice of the staff was respectful of the service users. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 14 The menus for the home were available and showed a varied menu and a choice of food. The home has a four weekly rotating menu. However several service users have soft diets and two require peg feeds. Up to ten service users require staff assistance or prompts with feeding. A catering file showed detailed instructions on how individual service users were to be assisted and the equipment required. Details included whether they needed a plate guard, could use a normal chair or spoon and whether they used a gastronomic tube. One file showed full instructions on how to feed a service user following an assessment by a nutritionist. This was very good practice, ensuring that service users individual needs were met and staff fully instructed. Because of the demands on staff at mealtimes, consideration is being given to having two sittings to ensure that service users are satisfactorily catered for. On the day of the visit, the food looked appetising and wholesome and service users appeared to be enjoying it. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 15 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 and 20 The quality of this outcome area is good. Service users’ health and personal care needs are well monitored to ensure they receive appropriate and speedy assistance. Service users are unable to look after their own medication but are protected by the policies and procedures of the home. EVIDENCE: All the service users require assistance with personal care and most need to be moved and supported by staff. Their care files show details of the assistance they need and equipment has been provided in the form of hoists, special beds and tracking to ensure they are well supported. The occupational therapist has been involved with the home. There is a choice of male and female staff and the home’s code of practice is that male carers will not assist a female service user on their own. Staff confirmed that bathing and personal care is carried out in private and service users have their own clothes. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 16 Details of each service user’s health needs are recorded in their files and there was a list of medical contacts. Specific instructions from a dietician were in evidence in one file (and seen again in the catering file already mentioned) and a behaviour chart to monitor behaviours was seen in another. Medical appointments for wheelchair assessment, for physiotherapy and chiropody were all noted and there was evidence of contact with a continence advisor, a community nurse and learning disability social workers. Staff monitored weight, sleep and mood to keep an eye on general wellbeing. Specific interventions were also noted, for example “stretches completed” in line with a physiotherapy recommendation. Care plans have been provided by the GP where rectal diazepam may be required (seen in the files) and staff are trained annually. Two GPs responded to the Commission’s survey and said they were satisfied with the overall care provided in the home. Two service users were fed by peg feeds and training had been handed down by experienced staff. However the dietician should be training staff to ensure the correct methods are used. A recommendation is made. The records for the administration of medication were satisfactorily completed and the record tallied with the medication stored. A monitored dosage system is used where the pharmacist pre packs the medication. Record is kept of tablets returned to the pharmacist and all medication is kept in a locked cupboard in a locked room. An incident in the last twelve months where medication was not correctly ordered has meant a tightening up of procedures with named staff who check the medication. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 17 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 and 23 The quality of this outcome area is good. Service users are supported by staff who protect them and will speak up on their behalf. Policies and the training of staff also give good protection to service users. EVIDENCE: The complaints procedure is in the service users guide given to each service user and is also posted on the wall in reception (down at the moment due to renovations) in pictorial form. The manager says that relatives also have a copy. A record of complaints is kept though none had been received. None have reached the Commission either. As the service users are not able to communicate effectively and would find it hard to make a complaint, it is essential that staff understand the need to protect them and keep them safe from abuse. The home has done well on this. Not only are the policies and procedures in place alerting staff to any suspicion of abuse and linking those procedures into local multi agency protocols, but nearly all the staff have been on an outside course on adult protection which has given them a better understanding of the current thinking on this topic. Staff spoken to in private all felt that service users were well protected in this home and that respect of the service users was paramount. New Dawn DS0000027338.V314652.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 and 30 The quality of this outcome area is good. The home has excellent facilities for the service users with good adaptations and equipment. It is bright and comfortable with single bedrooms made individual and homely. Some work is still going on to upgrade the building but this is almost complete. EVIDENCE: A tour was made of the building and there have been considerable renovations since the last inspection when requirements were made for improvements to the facilities . Bathrooms have been completely redecorated and equipped with adapted baths, tracking devices and shower tables to enable staff to help those who are not mobile. One spa bath has been installed, and another room is a wet room with special chair for the service user who is not mobile and half doors giving protection to staff. Three bathrooms are now fully operative and there is also an en suite bathroom for two service users. This offers much more choice to the service users and enables staff to be more flexible in the timing of baths because of the increased resources. These renovations had been a requirement of the last inspection and have now been fully met. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 19 Work has also taken place in the dining room and conservatory with new floors and furniture. Temporary heating has been replaced and all radiators are now covered to prevent burning, both requirements of the last inspection. The bedrooms, all singles, are also extremely attractive and have been made not only homely and bright and comfortable but also have a host of adapted beds, hoists and appropriate equipment to cater for the needs of the service users. In addition, the lounge areas are being renovated alongside changes to the office area with the creation of two new single bedrooms which when complete will give all twenty service users single accommodation. Overall communal space is extensive and has been made open plan to cater for wheelchair access. These improvements are transforming the home and making it into a very good facility for the service users. The home also has a separate laundry facility with two industrial washing machines with sluice facilities and high temperature washes. There are also two tumble driers, one of which is new. The home has to deal with soiled laundry and clinical waste facilities are in place. Staff are instructed on infection control and are issued with disposable gloves and aprons. The home has no offensive odours and is clean and hygienic. New Dawn DS0000027338.V314652.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): 32,33 34,35 and 36 The quality of this outcome area is adequate. Whilst the home is providing induction training and other one off courses for staff and recruitment procedures are good, there are insufficient staff on duty and this is affecting the quality of care provided. Supervision needs to be more methodical and the NVQ training should be promoted. EVIDENCE: Training files showed that staff are provided with training to increase their knowledge of the client group and several of the staff have worked in the home for a long time and know the service users well. New staff felt that the staff were respectful of the service users and knew about their disabilities. Staff are also graded with always a senior on duty to lead the shift and a manager or deputy also on site. This gives good support. Studying for the NVQ is being encouraged though only five staff have qualified. Five others are studying for it. With 29 staff this is only 17 of care staff qualified which is below the standard. A requirement has been made. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 21 The rota for the week of the inspection shows that six staff are normally on duty throughout the day. This is normally considered a good staffing ratio to cater for the extensive needs of the service users, some of which are commissioned to have one to one care. From the information provided by the home fourteen out of eighteen service users use a wheelchair and need help or supervision with their meals. Staff have to help with bathing for all service users. This is a very dependent group and staffing has to be sufficient to meet the needs of the service users. There have however been shortages of staff and although the home is currently recruiting and hopes to have more staff in the near future, the staffing is not currently adequate. It is also noted that the staffing situation was very similar at the last inspection when staffing was only met by staff doing extra long shifts. Recruitment was also expected then to resolve the problem but apparently there continue to be difficulties. The rota showed that on morning shifts between 7 to 2.30 there were only 4 staff on two of the days helped by the day centre staff who came in early to help between 7 and 9 only. On Friday there was projected to be only three staff on duty with the two day centre staff on duty till 9am. The afternoon shifts were better with six staff on most of the time. On Sunday only one cook would be on duty so care staff would have to make the breakfast or tea depending on her hours. Staff spoken to at the inspection said that there were only four staff on duty the previous Sunday and no cook and it had been extremely difficult. They had to prepare the meals and all the particular dietary requirements for the service users as well as carry out the usual care tasks. Several service users need assistance to eat meals on a one to one basis with staff sitting with them. One service user has to be fed in his own room because of feeding difficulties, identified by the dietician and one staff has to be free to do that. With fewer staff this is extremely difficult. From a previous section in this report, it has been noted that outings and activities are curtailed because of staffing limitations. This is not satisfactory. A requirement has been made to have better staffing in the home. If this means recruiting agency staff to fill the gaps whilst recruitment continues then the home will need to consider this because currently the staffing is not satisfactory. Three staff files were examined and were found to contain all checks and references prior to the person starting work. They are only confirmed in post after a satisfactory police check has been made. Staff are subject to a probationary period and are issued with a code of conduct and a job description. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 22 Induction training for new staff was in evidence in the staff files with a checklist of what was covered. A workbook was reported to be completed by staff though there were none in evidence as staff keep them at home. New staff also shadow experienced staff for several days to get to know the service users. Each of the staff files showed the training done by staff and an overall training plan was seen showing what staff had done and when updates were due. Training certificates were seen on epilepsy, communication and disciplining staff as well as basic compulsory training and quite a lot of training had been offered during 2006. What was noticed that staff often travelled to London for training and sometimes this meant a delay in when new staff were trained in moving and handling. Four staff were currently without the training and although they were due to receive it in October (booking seen) they had already been employed for two months. With this client group where most of the clients are not able to walk and need to be hoisted and moved, it is essential that staff receive moving and handling training as soon as possible after they start. A trainer on the staff group would make more sense for this home where staff should not operate without such training. A requirement and a recommendation has been made. A system for staff to receive one to one supervision has been started but is not totally off the ground. Evidence was seen that staff had received some sessions, some only one and others more but with long gaps. However the manager stated that she has allocated the work and seniors have received training to deal with this aspect of their job. Two staff seen confirmed they did receive one to one supervision with a senior. So the system is started but a more methodical approach is required in order for the home to meet the standard. See requirements. Staff do attend handover meetings at the start of their shift and have access to a senior support worker whilst on duty. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 23 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 and 42 The quality of this outcome area is good. Although there is still work to be done to fine tune the quality monitoring systems, overall the management and organisation is effective and the home is well run. The manager is committed to ensuring a good life for the service users and has systems in place to promote that. EVIDENCE: The manager is experienced in the care sector and has completed her NVQ4. She is currently studying for her registered managers award. She has overall responsibility for the running of the home but is supported by the deputy regional operations manager who is also on site. A hierarchy of management and particular departments are available at the organisation’s head office in London where budgets are controlled. Quality monitoring systems were in evidence with a wealth of material produced at a national level to help each home monitor whether aims were being met. Service users questionnaires were in place though may be of limited use in this home because of the multiple needs of the service users. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 24 Next of kin and staff questionnaires were in place however as was a manager questionnaire about how the home was functioning. All of this showed the home had systems in place to monitor how it operated though these were quite complicated. Work needs to continue however as there was not enough analysis of the questionnaires to see what people thought nor was the home critical enough of itself. The next stage is to see where it does not meet its own standards (and these could be clearer and measurable) and produce an improvement plan for work in the future. However a lot of work has gone into achieving a quality assurance programme and the home accepts that this is still ongoing. In terms of health and safety, a full file of policies and procedures were in evidence outlining how the organisation would keep the service users and staff safe. Staff training files outlined the compulsory training in moving and handling, fire safety, food hygiene. Certificates for electrical testing and fire safety were in evidence and the records showed that regular drills were carried out as well as monitoring of fire systems. Water temperatures were tested for safety. Risk assessments were seen for the building and accidents were reported correctly. Overall the home is taking appropriate actions to promote the health and safety of service users and staff. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 25 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 4 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 1 33 1 34 3 35 3 36 2 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 2 14 x 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 2 x x 3 x New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA13 Regulation 16(2)(m) Requirement The registered person must make arrangements to enable service users to engage in local, social and community activities. The registered person must ensure that staff receive training appropriate to their work. In this instance more staff should be supported to study for their NVQ. The registered person must ensure that the number of staff on duty is sufficient for the health and welfare of the service users. The registered person must make arrangements to provide a safe system for moving and handling service users. In this instance, new staff should be provided with moving and handling training as soon as they start work. The registered person must ensure that staff are appropriately supervised. Timescale for action 30/11/06 2. YA32 18(1)(c) 31/01/07 3. YA33 18(1)(a) 31/10/06 4. YA35 13(5) 31/10/06 5 YA36 18(2) 30/11/06 New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4 Refer to Standard YA6 YA13 YA19 YA35 Good Practice Recommendations It is recommended that the manager review the quality of the reviews of care. It is recommended that care plans have more details about what interests the service users have and how they communicate so staff are clear. It is recommended that staff have training from a dietician on peg feeds and this is documented in their staff records. It is recommended that moving and handling training is provided locally to avoid any delay. New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI New Dawn DS0000027338.V314652.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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