Inspection on 31/10/07 for New Dawn

This inspection was carried out on 31st October 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 16 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 02/10/06

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 Judith Last Unannounced Inspection 31st October 2007 10:00 New Dawn DS0000027338.V354019.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.V354019.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.V354019.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 893537 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) Position vacant Care Home 20 Category(ies) of Learning disability (20), Physical disability (20), registration, with number Sensory impairment (20) of places New Dawn DS0000027338.V354019.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 Sensory Impairment may be accommodated. The total number should not exceed 20. 2nd October 2006 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. Care Management Group, whose head office is located in Wimbledon, owns the home. 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 areas 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. However, there is no up to date information in the service user’s guide as the law requires, about amounts and arrangements for paying these. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We spent 9 hours at the home. There was another person there to help with the inspection for three hours. We spoke to five staff members between us, looked at records and spoke to five of the people living there although only two of them could talk to us. Because most of the people living at the home found it difficult to talk to us, we needed to look and listen to what was going on. The manager also sent us some information before we visited, saying how he thought the home was doing and we took that into account. Care homes are judged against outcome groups that assess how well outcomes for people using the service are achieved. We have rules to follow that show us, from what we find, how well the home is doing. Overall the service is adequate at this time. The previous manager left earlier in the year and the new manager has not had a lot of time to make sure that things are happening as well as they could, but has been working on this. We expect that the home will get better over time and the manager already has some ideas about how it could improve. What the service does well: People’s needs are assessed properly before they come to the home. This means that they can be reasonably confident staff will know how to support them properly. Staff work hard to help support people. They help people maintain a good standard of personal care so that they are clean and comfortable. They also provide help to people to eat their food, in a way that respects their dignity. They sit next to the people they are helping and keep good eye contact so that they can encourage people with their meals. They try to provide opportunities for people to join in activities, but this is compromised by staffing levels at this time. Staff also have access to good training opportunities. They are aware of the vulnerability of those they care for, what they should do if they have concerns and how important they are in speaking up for people who cannot do this for themselves. Staff say that the new manager is someone they can go to with concerns or queries. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 6 Recruitment practices help to protect people living at the home from unsuitable staff being employed to work with them. The home is kept clean and people have their own belongings in their rooms. This means that each bedroom is different. What has improved since the last inspection? What they could do better: We have made 15 requirements from this inspection. Requirements are the things the service needs to do by law. Four of these are outstanding from the last time we visited. We know that the acting manager has had a lot to do as he has not been at the home for very long, and the last manager left earlier in the year. However, these things still need to happen. We still have concerns about staffing levels and how this affects people living at the home and the opportunities there are to spend time with individuals. At this inspection as well as the last one, staffing needs to be increased so that people’s needs can be properly met and people can engage in a greater variety of activities. Some people need extra supervision to keep them and others safe, and this does not always happen. This might be because of staffing levels. Although the number of staff with qualifications has increased, this still does not meet the minimum standard and so this requirement has been repeated as well. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 7 Staff are still not being properly supervised. There was one thing that the manager had to make sure happened immediately. This was because one person who had been working at the home for two days did not properly know what was supposed to happen if there was a fire. This means that the staff member, colleagues or people living at the home could be at risk in an emergency. There are some other things to do with people’s care plans and whether staff are following properly what the plans set out as necessary, because this does not show up in all the records. Records are often poorly organised and do not follow good record keeping practices. This means people may be at risk of not having their needs fully understood and met. There are some concerns about the way medication is managed and recorded, that the manager needs to look into. If these are not addressed people are at risk of not having the treatment they need at the right time, or potentially at risk from overdose or mistakes. The full range of things that need to improve are set out in the report and people who are interested can get this information from the manager, or copies of the report from the Commission. 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. New Dawn DS0000027338.V354019.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.V354019.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvement is needed in the information available to service users’ representatives, (given the cognitive abilities of people living at the home), so they can make a more informed choice about using the service. However, the process of assessment and the level of detail these contain mean that people who did decide to use the service could be confident their needs and aspirations had been taken into account. EVIDENCE: The service users’ guide does not set out the arrangements for fees as required by amended regulations. This needs to be included so that service users’ representatives would understand the arrangements for charging – and, as set out by the Office of Fair Trading, in the interests of fairness and transparency for those purchasing the service. Care plans seen contained full assessments of people’s abilities, strengths and needs. Health problems are included as are issues to do with behaviour, mobility and cultural or religious background and preferences. New Dawn DS0000027338.V354019.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This represents a decline in standards since the last inspection. However, there have been management changes recently and some staffing issues that may have impacted on this area. While some records are well organised, others are haphazard, out of date, disorganised and without recognition of how aspects of the care planning process need to link together in order to provide a full picture of how to meet people’s current needs. This and a lack of consistent evidence in daily records makes it difficult to be sure that people’s needs are being properly and safely met. EVIDENCE: The manager’s self-assessment of performance in this area refers to the heading of “needs and choices”, but not to the individual standards. This New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 11 means it does not properly show how the service considers they meet the key standards. There are good underpinning assessments of people’s support needs covering the areas set out in standards. However, although some care plans based on these are well structured and laid out in numbered sections for staff to follow, others are not well organised. In some cases items have been added without reference to other issues. For example one review report from August 2007 makes no reference to the implementation or effectiveness of a physiotherapy programme that another part of the plan says is needed. Documents are frequently undated and unsigned to show who is accountable for their completion. Daily diaries contain gaps between entries predominantly only a line, but this allows for insertion of entries that were not made contemporaneously. These issues are not good recording practice. A recommendation has been made. Old documentation, needed for occasional reference and not archived, is stored in a cupboard off the lounge that is not locked. See recommendation. Care plans provide for recording of people’s psychological and mental health needs and communication skills. These show insight into how non-verbal communication for each person shows content, discomfort or distress. This is good practice. One person, had been admitted for rehabilitation following a fracture, had no reference in an individual action plan to the goal to promote, encourage and recover mobility and there was no update as recovery progressed. There were instructions in the care plan that the person was not to put weight on their leg, but it was clear that the person is now being encouraged to mobilise with a frame – at odds with the care plan instructions. See requirement. Risk assessments are carried out and cover a wide range of issues. However, they are added to with apparently little thought to the purpose they serve or whether they could be combined in anyway. This increases the likelihood that staff will not wholly be aware of or follow them. For example, one person had 37 separate risk assessments. There were 3 separate risk assessments to do with running in the house, running and hitting obstructions and for bumping into people while running. There is the instruction have 1:1 cover from staff with half hourly turns, and “no exceptions”. We saw that the person was not supervised to this level, so the person or others would be exposed to unnecessary risk, or the assessment is out of date. See requirement. Risk assessments for two people regarding swimming were checked. These were poor in identifying the full range of risk and did not mention that either New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 12 person was epileptic. One person affected had had four seizures recorded in October, but no mention of epilepsy on the risk assessment. Documentation showing that all the risk assessments were reviewed and “correct” was dated in July 2007. See requirement as above. There are documents in care plans showing that people are not able to manage their own money. These set out the clear procedure for checking the records and balances held on the premises. They also set out accountability for this, and provide for the regional operations manager, who carries out visits to check the quality of the service, to check a sample of these records at each visit. This is good practice. Staff spoken to understand the needs of people living at the home, but records do not wholly support that care delivered is as set out as necessary in the care plan. See also following section and health and personal care section. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 13 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): 12, 13, 15, 16 and 17 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the service users are respected and well cared for by staff, we could not conclude that social and recreational needs for all people living at the home are met. It is possible that records do not do justice to practice. 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 and there is heavy reliance on the television to occupy or stimulate people. The need for further stimulation is clear. There is a good emphasis placed on ensuring service users enjoy their food and good contacts with families. Additional methods of communication could be explored to improve the options available to people in attempting to make decisions about their daily lives and what they would like to do New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 14 EVIDENCE: People’s cognitive abilities make it difficult to discuss the kinds of activities that they do. There are opportunities for people to attend the in house “Acorn” centre and their interests are set out in care plans. People’s cognitive abilities mean that employment opportunities would not be open to them. There are two service users from other ethnic backgrounds than the majority of service users and all of the staff. The manager’s information about equality and diversity in the self-assessment did not reflect this. Care plans recognise this for one person in relation to encouraging access to different foods and music, but daily records of care delivered do not show that this happens. A report from a visit made by the regional manager on behalf of the registered providers reflected that more could be done to meet the cultural needs of people. See recommendations. There were entries in some people’s records to show that people went out shopping, riding or swimming, or to the cinema and that people have had the opportunity to go on holidays. We also saw some people making hats for Halloween. However, records of care delivered do not support that people are always encouraged with the variety of activities their care plans say they are interested in. We were concerned that most interactions we observed were directed towards people who had more communication skills and were able to respond. During the afternoon we saw that people were grouped around the television although one person was positioned in such a way as to be unable to see it easily. Records of care delivered repeatedly show that people have “relaxed in front of the television”, sometimes in the lounge and sometimes on their beds. At one point we saw three staff engaged in other activities around the area, but no one engaging positively with people who were positioned in the lounge. One person was left approximately 30 minutes without staff attention when they had removed and torn an item of clothing. We cannot conclude from the records of daily activities that the requirement made at the last inspection is wholly met, particularly in relation to those who have more profound needs. See outstanding requirement. Records show that people are encouraged to keep in contact with families and make or receive visits regularly. There are also lists in people’s files of important dates such as the birthdays of family members, so that keyworkers can help them to send cards or letters. This standard has been consistently New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 15 met since 2003 and we saw no evidence of deterioration. It was not explored further. One person has recently completed training as a communication coordinator and the service acknowledges that this is an area that needs to develop. At present it is difficult for people to make meaningful choices for example about what they might like to eat or to choose individual activities. See recommendations. At present there is a daily set menu with no choices, and there are no pictures to help people. Staff rely on their knowledge of what people like and their body language rather than being able to offer positive choices. The main meal we saw contained an accompaniment in tomato sauce, (spaghetti), but that a similar accompaniment was also repeated at teatime. The levels of staffing in the kitchen are not as good as previously and we were concerned that this meant it was difficult for the remaining person to provide choices. See recommendations. However, one review report in a care plan did reflect the opportunities offered to a person to sample small amounts of food of different types (they are limited in this due to tube feeding), and also items with different smells. We did see that staff who were helping people to eat sat with them and talked to them to encourage them with their meal. Some people had a buffet lunch in the Acorn centre for their Halloween party, but others were not involved and ate in the main home. People do not go shopping for food. Dieticians have expressed concerns since the last inspection about nutrition of some of the more vulnerable people living at the home. Records show they have been involved where there have been concerns about people’s weight and nutrition, and correspondence in one plan we saw showed that there had been some success in using nutritional supplements to keep someone well and prevent unwanted weight loss. We saw that food intake is monitored where there are concerns, with records showing whether people have eaten well or refused meals. This is good practice. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 16 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): 18, 19 and 20 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have a good understanding of people’s personal care needs and support them with this, although records in this regard and with reference to health care could be more specific. Medication practices need to be improved to show that people are not at risk. EVIDENCE: One person told us that staff chose what they wore, but they would like to do this themselves. (This may be linked to reported lack of staff time to spend with people while carrying out tasks such as personal care). Comment is made elsewhere about the need to increase opportunities to make active choices rather than relying on what staff know about someone’s likes and dislikes. Records show that personal care for people is delivered, although this is not always specific. For example one person is noted as needing application of cocoa butter and also to have their hair washed and braided each week. Care records make only one reference to special creams and no indication of attention to hair care, although it was clear from the person’s appearance that this was attended to. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 17 The deputy manager says that people can choose when they want to have a bath or shower, but given the lack of communication skills or other aids to this, we are not sure how people would be able to communicate that to staff spontaneously. Staff told us that people could choose when to get up, although for those who are physically dependent upon staff this would need to be when staff are available. They told us that people living at the home were expected to be in bed by 11pm. Case records show that people have good contact with other health care professionals. They also make reference to how people would express or show their distress or upset, therefore reflecting emotional needs. Care plans are not explicit about pressure area risks or the preventative measures that should be taken, even though a significant proportion of service users are in wheelchairs and physically disabled. See recommendation. Staff told us they did not have training in this area, but understood the kinds of things they would be expected to report about the condition of people’s skins. Neither are they explicit about goals to minimise the risk of contractures potentially arising from people’s physical disabilities. One care plan referred to the need for staff to follow a physiotherapy programme for the person on a daily basis. This was dated in November 2006 with specified goals and devised by the specialist attached to the relevant community learning disabilities team. There was no update showing that the programme was no longer needed, and no indication in daily records that it was delivered as identified as necessary by the care plan itself. See requirement. We were told the company’s physiotherapist had been in and reassessed people recently but that individual programmes had not yet been developed and implemented in all cases. There were further concerns about a care plan not being kept up to date in relation to one person who had a fracture. There are sample signatures of staff who are authorised to administer medication so that these can be matched to entries. This is good practice. Where medicines were prescribed in amounts that might be varied (e.g. one or two tablets when needed) the records on the medication administration record (MAR) charts did not show how much had actually been given. See requirements. One person had two such medicines that were supposed to be given in corresponding amounts according to the deputy manager. This did not show New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 18 on prescribing instructions on the medication chart. The chart itself had been written on in such a way as to appear that the instruction for “two” had been crossed through, looking like only one of the two blistered tablets was to be given. There was a separate envelope for medication to be returned to the pharmacy when only one of the two tablets blistered had been given. There were four tablets in the envelope and 10 doses signed as given. This suggests that on six occasions two tablets had been given. The deputy manager thought the prescription had changed a couple of months previously, but this was not borne out by mar charts or blister packs. Later information given to us was that it was a variable dose and the handwritten annotation was intended to underline the instruction “or two”. This was not clear and there was no additional information on the sheet. See requirement. Phenobarbitol tablets are prescribed for one person. Records showed that 28 tablets of 30mg strength had been received on 26/10/07, ready to start the cycle on 28th. Two tablets had been given based on the MAR chart, but there were four missing from the packet, (foil wrapped). This indicates the person may have been given too much of this medication. There was no separate envelope for any surplus that had been removed from the foil by mistake. See requirement and recommendation. The 60mg tablets of the same medication for the same person, did match the administration record. The 8am dose of Furosemide 40mg (two tablets to be given every morning) was unsigned and uncoded for the morning of 30th October. See requirement. Phenobarbitol tablets are kept in a separate lockable tin on the advice of the pharmacist who has said although it is not a controlled drug it should be double locked due to the potential for abuse. The separate lockable tin is within the medicine trolley, but the key is left in it thereby negating the double locking system. See recommendation. Senior staff authorised to give medicines have their own separate keys to access medicine supplies (with the exception of the tin where the key is left in). There is a duplicate set available for emergencies held in the office and only accessible to the manager or the deputy. We asked one person about their training and they said that they shadowed people who were responsible, then were supervised until they felt confident, and a competency assessment was carried out. See recommendation. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 19 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): 22 and 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff make efforts to support people and are aware of the vulnerability of those in their care. EVIDENCE: These standards have consistently been met and so we did not check them in detail. In practice staff would need to advocate on behalf of service users, because of their cognitive and communication difficulties. There are also other agencies involved with people who could make any concerns known. Care plans set out any signs of distress or discomfort that people might show so that this could be explored. A member of staff told us that every month people can “moan” at a meeting and that this will be taken to an end of year meeting for review. Again, people would need to rely on staff or other people who are important in their lives, to advocate and raise issues on their behalf. The organisation has a good history of training staff in the awareness of adult protection issues. They also have a good record of referring any concerns under appropriate procedures and of taking prompt action to protect people should there be any concerns. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 20 There are issues relating to how people are protected if risk assessments are not followed, (for example the vulnerability of people with brittle bones and osteoporosis where one person is not receiving the supervision that the risk assessment identifies as necessary). Requirement has been made elsewhere in the report about following these. Staff were clear about their obligations to report abuse. A staff member recognised that sometimes things could come across as aggressive in the way residents were spoken to and we heard one member of staff issuing a firm and loud instruction to a resident to come for their dinner. Another staff member followed this up later, but was more encouraging. See recommendations. The company that owns the home provides regular training in the “Dignified Management of Conflict” so that staff have an awareness of how to deal with difficult behaviour in a manner that respects the people they work with. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 21 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): 24, 27 and 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs met in a comfortable and clean environment, with suitable adaptations to meet their needs. EVIDENCE: Décor and furnishings were in reasonable condition. There is some wear and tear from minor scrapes to paintwork off wheelchairs, and the carpet on the front reception lounge was stained in places. However, overall it was safely maintained. There is level access throughout the home. The manager says that there has been input from an architect to look at the possibility of dividing the home to create two smaller units. This would be a welcome development as it would help create a more homely environment and allow for increased consideration of the compatibility of people and areas of staff expertise. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 22 The ramp to the adjacent activities centre is steep meaning that people who were recovering mobility or who had mobility problems would find it difficult to access independently. It was also lacking in some stability, which might mean people did not feel sure and confident of using it without support. See recommendation. We heard running water to the rear of the home outside one of the bathrooms where an overflow was running. This was rectified during the course of the inspection, but it is clear from a risk assessment on someone’s file that this may be a recurrent problem that may need more radical attention. The hot water tap to the same bathroom was difficult to turn off and had been left trickling so that supplies of hot water could potentially be affected. See recommendation. There are aids to assist with mobility including mobile hoists and track hoists in bathrooms. Baths are adapted for people with physical disabilities and people can bath or shower. One of the bathrooms has a spa/Jacuzzi bath. Privacy bolts are fitted in all cases. There are not enough bath thermometers for each bathroom to have one for monitoring and checking bath temperatures. Thermostatic valves are fitted to bath/showers, but in one case there is a notice saying this is not working. The deputy manager says it has been reported for repair. See requirement. Shared en-suite bathrooms have been created. Two bedrooms each share two adapted bathrooms, with privacy locks each side of the interlocking doors. (People would need staff assistance to use the facility and so could expect that staff would act on their behalf to make sure their privacy was respected when using these bathrooms.) There were no unpleasant smells. We saw ample supplies of protective aprons and gloves in bathroom/shower facilities. 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. The home has to deal with soiled laundry and clinical waste facilities are in place. There is infection control guidance for staff. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 23 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): 32, 33, 34, 35 and 36 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We acknowledge that the management of the home changed earlier this year and there would be some need to prioritise the new manager’s work. However, under these outcomes we can see no substantial difference in outcomes from the last inspection, despite the requirements that were made under regulations. EVIDENCE: Staff say that the company offers good training and records show there are a variety of relevant short courses on offer. (The training matrix on the staff office area off the lounge is not up to date. This means that an easily visible source of information is not as helpful as it might be.) However, only one fifth of staff, (based on the manager’s self assessment), have National Vocational Qualifications. Although improved from 17 at the last inspection, this is still below standards. The assessment gave no indication of the number of staff who are currently working towards this. See outstanding requirement. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 24 Staff are stretched at the moment. Two staff are unavailable, one person had to go home after the start of the shift, and one person is needed to provide support to a service user in hospital. Staff say that there is sometimes not a lot of time to spend with people. Examples were given of finding it difficult to spend time making bath time enjoyable, and of not having sufficient time to properly encourage communication with those for whom this was a difficult and slower process. One person requires 2:1 support when out of the home, and the risk assessment says the person should have 1:1 support when in the home. This means that, if followed, the evening of our visit would have left three people to support 16 other people, many of who need two staff to attend to their care because their physical disabilities mean they need help from two staff for mobility/hoisting etc. A notice in the staff office regarding shifts shows that for the 12 days from 7th to 18th November inclusive, overtime is needed on 30 shifts. Between 6th November and 30th November, 19 waking night shifts need to be covered. This means that staff volunteering to do extra are working long shifts in order to sustain adequate cover on the duty roster. Similar concerns were expressed at the last inspection. There is also a reduction in catering input at present. We are not able to conclude that the requirement made at the last inspection has been met. See outstanding requirement. The abilities of service users means that it takes time to encourage whatever level of participation, skills or abilities people have. The service has one person trained as a communication coordinator who has recently finished the training. There is another who is due to undertake this training early next year. The person says it is difficult to find the time on shift to develop things further. Staff recruitment files were checked. These show that appropriate checks are undertaken before staff are appointed to their posts. However, one of the three was missing an up to date photograph. The file for one person starting during the course of this year recorded that the company’s induction into policies and procedures had an end date of October. It was not completed. Protection of vulnerable adults and health and safety were not covered for example. One person completing Skills for Care induction had their certification signed by the deputy manager and not by the registered manager, even though that person was in post at the time. At the last inspection, moving and handling training was required for people as soon as they start work, given the need for physical assistance that many people living at the home have. One new person had moving and handling listed as completed one week after they started, but there was no certificate confirming this. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 25 Supervision does not take place with the frequency and content set out in standards. One person told us this happened about every three months. Minimum standards required six times yearly. We checked records of supervision dates for 8 people. One person starting in July had their first supervision in August and no evidence of any since. One person had no supervision between January and July this year recorded. One person has had only three supervisions since October 2006 and another had no supervision between January and September this year. The requirement made at the last inspection has not been met. See outstanding requirement. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 26 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): 37, 39 and 42 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The acting manager has relatively recently assumed this role and is making progress towards achieving the qualifications he needs. There are efforts to monitor the quality of the service and to promote health and welfare of those living there, but shortfalls in the instruction to staff about how they should do this in emergencies. EVIDENCE: The home is without a registered manager at present who can take legal responsibility for the operation of the home. The acting manager has indicated his intention of completing the registration process in order to properly operate the home. He has a training place to complete the qualifications set out in National Minimum Standards as necessary to support competent management. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 27 The manager’s self assessment of service quality sent to us, needs to make closer reference to the standards and “rules” within each section so it can be more robust and reliable. The manager needs to be sure that the evidence claimed is robust enough to support the quality of outcomes claimed, (for example claiming supporting evidence in supervision records is inappropriate when there are shortfalls in the process and staff are not receiving supervision to national minimum standards). Quality assurance surveys are carried out regularly, but it is difficult to obtain the views of the service users themselves in many cases. Efforts are made to gather views from other stakeholders including relatives and staff and to see what could happen to improve things. The regional operations manager visits regularly and looks at the quality of the service. Reports cover a range of issues and allow for recording of discussions with staff and people living at the home, as well as observation. Recently these have started looking at the same “outcome” groups as we look at. We checked a sample of records associated with health and safety. These showed that maintenance checks were carried out regularly. Health and safety issues are checked also during the monthly visits by the regional manager, as well as by audits from the management team. However, we were concerned that a staff member transferred from another establishment had not been properly inducted into the fire procedures in the home and we left an immediate requirement that new staff receive this information promptly on arrival. See immediate requirement. Risk assessments in relation to how people would be evacuated from the home could take into account other possible methods of moving people (for example using bedclothes if people were in bed, to move people who were nearest an outbreak if it were safe to do so, rather than lifting) and also the time of day which would impact on what staff could actually do. This would include whether staff should actually make any attempt to move the individual concerned or ensure that those who cannot move themselves are placed behind fire doors and the fire brigade informed on arrival. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 28 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 2 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 2 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 3 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 3 x x 2 x New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 29 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 YA1 Regulation 5 Requirement People who live at the home or who are thinking about moving there, must have the information the law says they need. This is so they or their representatives can make an informed choice about moving into the home. It is also so they can be sure of the arrangements for charges or increases in these. Care plans must be up to date and reflect the current support needs of each person. They must be updated as needs change. This is they clearly set out what staff need to do now in order to properly meet people’s needs. Timescale for action 31/01/08 2. YA6 YA19 15 31/12/07 3. YA9 13(4) Care plans must set out risks to 31/12/07 people posed by their behaviour or participation in activities. Staff must follow the instructions given for keeping these risks to a minimum. If they do not, then people living at the home may be exposed to unnecessary or avoidable risk. New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 30 4. YA13 16(2)(m) Outstanding requirement The registered person must make arrangements to enable service users to engage in local, social and community activities. Timescale of 30/11/06 made at the last inspection has not been met. 31/01/08 5. YA19 13(1) Where other health care 31/12/07 professionals have said particular treatment plans need to be implemented (for example, physiotherapy), there must be evidence that this is properly delivered. This is so people’s health is promoted and their health care needs are met. Where medicines are given in variable amounts, the record must show the actual dosage given. This is so there are accurate records available to demonstrate safekeeping and safe administration of those medicines. People who use the service must have records of prescribed medicines with indicated prescribed doses at all times. Changes to prescribed doses must be safely and accurately documented. This is to help make sure people receive the right dose of medicines and help to protect them from error. 31/12/07 6. YA20 13(2) 7. YA20 13(2)&(4) 31/12/07 8. YA20 13(2)&(4) Medicines must be administered strictly in the dosages prescribed as necessary and records of receipt, administration and disposal must confirm this. This is so the management team 14/12/07 New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 31 can be sure people have had the medication they are prescribed in the right dosages needed to keep them well. 9. YA20 17 & Schedule 3 There must be accurate records 14/12/07 of administration of medicines or codes indicating the reason why the medicine has not been given. This is so records are accurate and show that medicines have been administered as prescribed and considered necessary for people’s health. 10. YA27 13(4) The faulty thermostatic valve in the bathroom must be repaired. This is to minimise risks of accidental scalding. 11. YA27 13(4) Thermometers for testing hot water temperatures must be provided in all bathrooms. This is to help minimise the risk of accident and to ensure that staff are easily able to objectively check water temperatures are both comfortable and safe. Outstanding requirement 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. Timescale of 31/01/07 has not been met. Outstanding requirement The numbers of care and ancillary staff on duty must be sufficient to meet people’s needs properly and to allow for the promotion of their health and welfare. 14/12/07 31/12/07 12. YA32 18(1)(c) 30/04/08 13. YA33 18(1)(a) 31/01/08 New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 32 14. YA36 18(2) Timescale of 31/10/06 has not been met. Outstanding requirement Staff must be supervised with the agenda and frequency set out in national minimum standards. This is so staff receive adequate supervision and support to ensure they understand and can fulfil their roles properly, can support people in line with the home’s philosophy and so that any initial problems with staff performance can be addressed. Timescale of 30/11/06 has not been met. 31/01/08 15. YA42 23(4)(d) and (e) Immediate requirement issued All staff must be properly inducted in emergency procedures in the event of fire, including people seconded to the home from elsewhere in the company. This needs to be within four hours of arrival. For one person you were required to do this by 10.30am on the date shown. This is so staff understand what is expected of them and can respond properly in an emergency to help protect people living at the home. 01/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. New Dawn Refer to Good Practice Recommendations DS0000027338.V354019.R01.S.doc Version 5.2 Page 33 1. Standard YA6 The manager should review the quality of the reports staff make for reviews of care. This is so the manager can be confident that these represent a full picture of the person’s needs and progress and do not overlook important aspects of their care. Records should be dated and signed in all cases. This is so the management team can be confident information is up to date, regularly reviewed and shows who is accountable for accuracy. Lines should not be left between entries in daily notes. This is to ensure that all entries are made contemporaneously and cannot be added to or tampered with at a later date. Records not in current use but needed for occasional reference, should be secured. This is to protect the confidentiality of people using the service. There should be a review of all documentation associated with risks to avoid repetition or duplication and increase how comprehensive these are. If there are lots of separate pieces of paper that are not linked, crossreferenced or otherwise clear, staff may not be able to remember all the concerns they set out and may inadvertently place people at risk. Records of care delivered need to match what the care plan says is necessary. This is so there is evidence that the care delivered is the support people should have to meet their social, recreational, religious and cultural needs. Alternative methods of communication should be explored to encourage people to make active choices for example about what they want to do and to eat. Choice should be offered on the daily menu (see also above) so that people are able to make decisions about what they would like to eat. Care plans should reflect vulnerability to pressure area problems and the equipment, techniques and observations that are necessary to prevent them. This is to show that measures are in place to promote people’s health and welfare in respect of tissue viability. DS0000027338.V354019.R01.S.doc Version 5.2 Page 34 2. YA6 3. YA6 4. YA6 5. YA9 8. YA6 YA12 7. YA14 YA16 YA17 YA17 8. 9. YA19 New Dawn 10. YA20 Consideration should be given to obtaining storage that complies with regulations and guidance issued by the Royal Pharmaceutical Society for controlled drugs, or medication that may potentially be abused. This is to increase security and minimise risk. The management team should investigate any anomalies identified in medication administration and take any remedial action necessary. This is so systems provide for adequate monitoring that staff continue to be competent to carry out medicine administration safely. Keys to the second lockable tin should not be left in the lock thereby negating the effectiveness of having a separate and lockable storage system. This is to increase security and minimise risk. In house competency assessments of medication should be followed up with formal training for staff. This is to help protect people from errors and to make sure they receive the treatment they need safely. Staff should be aware of the manner in which they speak to people living at the home. This is so their interactions are less likely to be perceived as overly firm and show a balance of clarity of expression with respect for people’s dignity and self-determination. The ramp to the adjacent day service should be reinforced to increase stability or preferably replaced to provide a less steep gradient. This is so people feel secure when using it and if they are able, can use it independently with confidence. The problems with the overflow to the rear of the home should be thoroughly investigated to make sure intermittent problems are addressed in the interests of maintaining standards outside the building and minimising distress or risk to people who might walk round it. 11. YA20 12. YA20 13. YA20 14. YA23 15. YA24 16. YA27 New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 New Dawn DS0000027338.V354019.R01.S.doc Version 5.2 Page 36 - 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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