Care Home: Dalkeith.

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What the care home does well Service users thinking about moving into Dalkeith are told in writing about what it is like to live there. A member of staff will visit them before they move in to see what support they need and to make sure that the home is suitable. Dalkeith is friendly and relaxed. The manager runs it well and makes sure that service users are happy. Staff listen to what service users want and if they are unhappy, sort it out. They feel at home and enjoy living in a comfortable house. Service users are able to make up their own minds about what they do. They can be themselves and have lots of chances to meet other people, enjoy their hobbies and learn more skills. Service users are able to see their family and friends when they want. The meals in the home are good. Service users are given the support they need and staff are polite and friendly. This is written down in a care plan to make sure that staff are clear about how to help. Service users can get involved in their own care plans, which are kept safely by staff. Staff look after service users health, help them to see a doctor or specialist if they need to and look after their medication. There are enough staff to support service users when they need it. Staff understand service users, fit in with what they need and make sure they are looked after. What has improved since the last inspection? This is the first inspection since the home was registered with the Care Quality Commission in April 2009. What the care home could do better: To make sure that service users are safe, the home must test the gas system properly and give staff more training. It could be better for service users if the home looked at how clothes and hands are washed in the laundry, how service users money is looked after, how many staff are qualified and how repairs can be done more quickly. The Care Quality Commission has told the Fire and Recue Authority about the systems in the home for the prevention and detection of fire. Key inspection report Care homes for adults (18-65 years) Name: Address: Dalkeith. Dalkeith Maidstone Road Staplehurst Tonbridge Kent TN12 0RE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Helen Martin     Date: 1 2 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Dalkeith. Dalkeith Maidstone Road Staplehurst Tonbridge Kent TN12 0RE 01580892102 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Affinity Trust Name of registered manager (if applicable) Miss Sally Jane OSullivan Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: Five (5) The registered person may provide the following category/ies of service only: Care home only - PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the folowing category/ies: Learning Disability - LD Date of last inspection Brief description of the care home Dalkeith was established in the 1980s and converted to its present use to coincide with the closure of long stay hospitals in the area. The home was under the ownership and management of the West Kent and Medway Social Care Partnership Trust, who under Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 5 Brief description of the care home the National Plan for the Re Provisioning of NHS supported accommodation, transferred the service to the Affinity Trust and the premises to the housing association MCCH. Dalkeith has been registered with the Care Quality Commission since April 2009. Dalkeith is located in a rural area, the nearest village being Staplehurst. The home provides 24 hour care and purpose built accommodation for up to five adults with a learning disability. Accommodation and communal facilities are all at ground floor level. Prior to registration the facilities were refurbished and redecorated. There is a large enclosed garden including a patio and barbeque area with some off-road parking. Longer term plans include replacement and conversion of the existing premises to provide two new 2 person bungalows. Full details of the service provided and the fees charged are available from the Manager. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Dalkeith provides care and accommodation for up to five adults with a learning disability. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Dalkeith was registered with the Care Quality Commission in April 2009 and this is the first Key Unannounced Inspection undertaken since. A visit to the service took place on 12th October 2009, where two Support Workers and one Agency Worker were spoken with and time was spent with five service users. In addition the Manager was present for some of the time. Some judgements about the quality of the service provided were taken from observation and conversation. Some records and documents were looked at together with the premises and facilities of the home. Care Homes for Adults (18-65 years) Page 6 of 29 An Annual Quality Assurance Assessment, AQAA, has been received from the home and any other information received since the service was registered has been reviewed. All of the above have been included within this inspection process and some of the gathered evidence is mentioned in this report where appropriate. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users thinking about moving into Dalkeith are given written information about the service, which helps them make an informed choice. Before they move in, service users are assessed by the home to make sure that staff can meet their needs. Evidence: Written information about Dalkeith is available for service users who are thinking about moving in. There is a statement of purpose and service users guide about the service offered, which has not been amended since registration with the Care Quality Commission in April 2009. Service users have been living at Dalkeith for some time. Before they moved in, they were assessed to make sure that staff could meet their needs. Care plans for the support that service users need were developed from this. No new service users have moved in since the home was registered with the Care Quality Commission in April 2009. Care Homes for Adults (18-65 years) Page 10 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users who live in the home are supported to make choices and decisions about their lives. Their changing wishes and needs are reflected in care plans, which are stored in a confidential manner. Service users are safer because staff take action to reduce the risk of any harm occurring. Evidence: Individual plans of care for each service user are developed with the aim to identify the support required from staff to meet their personal, social and health care needs. Three care plans seen were in good detail, holistic in nature and reflected service users changing wishes, needs and goals. Information includes social and learning activities, family and friends, health and care needs. Care plans are clear and easy to follow, individual and up to date. Service users benefit from having care plans they can more easily understand and being involved in their care planning. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: Service users are supported by staff with any risks involved in being as independent as possible. Risks are assessed and recorded in service users care plans. Service users are safer, because staff take action to reduce the risk of any harm occurring. Service users are supported to make their own individual choices. Attention is given to support them to make decisions in all aspects of their life. Service users are able to choose how and where to spend their time and supported with domestic tasks. Handover meetings ensure the continuity of care between staff shifts making sure that service users daily needs and preferences are met. The confidentiality of service users personal information is maintained through the secure storage of records. Care Homes for Adults (18-65 years) Page 12 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users enjoy individual lifestyles and are able to choose from a variety of leisure activities; they benefit from opportunities for personal development. Contact between service users and their families and friends is encouraged and supported where possible. Service users enjoy a choice of food. Evidence: Service users are treated with respect and supported with their responsibilities. They are treated as individuals who have different interests and aspirations. Service users are able to choose from a variety of different activities and opportunities. The routines of the home and the number of staff on duty are flexible to accommodate this. Handover meetings ensure the continuity of care between staff shifts making sure that Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: service users daily needs and preferences are met. Staff support service users to enjoy a variety of activities. A vehicle is available, enabling service users to partake in the wider community, retaining their independence and accessing leisure facilities. Service users go for trips to the cinema, bowling or lunch out. Some enjoy keep fit, aromatherapy and hydrotherapy. Staff support service users to go shopping to buy items of their choice, such as books and magazines. Staff described how the home was in the process of arranging holidays for service users. Care plans record information about any individual religious belief. Service users are able to see their family and friends both inside and outside of the home when they wish. It was said that the recent staff recruitment drive would make it easier to support service users with activities in the future. The manager described how they are in the process of developing opportunities for service users to replace those lost when the home transferred from the NHS. Service users benefit from support towards independent living skills, such as in the kitchen and laundry and with domestic chores. One service user particularly enjoys making desserts. Some service users attend a horticultural project located next door to the home. Records are kept of the skills that service users have learnt. Service users can choose what they want to eat. They are supported to go shopping to choose their food. The home has a menu planner with pictures of meals to help people choose what they would like. Staff spoken with demonstrated a good understanding of individuals preferences. Records are kept of four weekly planned menus, with facility to include any alternative. Staff spoken with said that currently no service users were on a special diet. Care plans record any individual preferences or needs. Care Homes for Adults (18-65 years) Page 14 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from having their social and healthcare needs met in a way that they prefer. Service users are protected by the system for the administration of medication. Evidence: Dalkeith provides 24 hour care for up to five adults with a learning disability. Service users dignity and privacy are respected. Service users are asked about their wishes and needs, which are reflected in their care plans. Staff have an understanding of these and fit in with the preferred routines of each person. Handover meetings ensure the continuity of care between staff shifts making sure that service users daily needs and preferences are met. Service users are able to see social and health care professionals when they need to and staff support people to attend appointments, such as GP, dentist, optician and care manager. Service users have access to a range of multi disciplinary support, such as physiotherapy, hydrotherapy, speech and Language therapy as and when required. At the time of this inspection, one service user was supported to attend hospital. Staff Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: monitor service users nutrition and weight and any ongoing medical conditions. There are guidelines for any challenging behaviour, which is recorded. Service users are assisted with their mobility if necessary; one care plan showed good, clear photographic guidelines regarding individual moving and handling needs. Information regarding death and dying is recorded. Currently no service users manage their own medication and all benefit from support from staff to do so. Service users are protected by the systems in place within the home regarding the storage and administration of medication. All medication is stored securely and administration records are completed appropriately. There are good written guidelines available for staff about the administration of drugs prescribed on a when required basis. One service user uses homely remedies. Staff spoken with assured the inspector that use of these are agreed with the GP and that written confirmation would be sought immediately. The home is currently in the process of updating the signature list for those staff who are trained to administer medication. Care Homes for Adults (18-65 years) Page 16 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from their views being listened to, considered appropriately and action being taken. Service users would be better protected if improvements were made to the systems in place for managing their personal finances. Evidence: At the time of this visit service users were at ease and relaxed talking and spending time with staff who listen to their views and concerns. The home provides a written complaints procedure. Service users benefit from access to this in a format they can more easily understand. The home records any complaints received together with the outcomes. Written policies regarding the protection of vulnerable adults are available for staff, which include the procedures from the local authority. One member of staff described how the home took appropriate action regarding one service user, which occurred before the home was registered with the Care Quality Commission. The manager stated that the management of service users financial interests continued to be in the process of transfer from the NHS to the local authority and the current provider, Affinity Trust. The manager described how Affinity Trust was in liaison with the local authority, banks and family members with the aim to provide Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: individual accounts for each service user. The manager explained that until this is resolved and although not ideal, a temporary arrangement has been made for the home to give service users an allowance. Small amounts of cash are kept securely and individually. Handover meetings ensure continuity between staff shifts, when all cash, transaction records and receipts are checked. However, the current system in place within the organisation and the home did not make it possible to audit service users monies at the time of this visit. The Provider is strongly recommended to fulfil their stated intention: to complete the transfer of the management of service users financial interests; to open individual bank accounts for each service user in order to comply fully with current legislation. Care Homes for Adults (18-65 years) Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from living in a homely and comfortable environment, although their safety and quality of life would be enhanced by the timely completion of planned maintenance and a review of infection control procedures. Evidence: Dalkeith is located in a rural area, the nearest village being Staplehurst. The home provides purpose built accommodation. The building has a style and atmosphere suitable for current service users. They benefit from living in clean, tidy, comfortable and homely accommodation. The premises are suitable for service users current needs and attractively decorated. There is a large enclosed and secure garden, which includes a patio and barbeque area. Prior to registration the facilities were refurbished and redecorated. Currently there are some outstanding maintenance issues: a raised carpet strip, which could cause a potential trip hazard; the wet room shower doors are off their hinges, making this facility unusable and there are problems with external security lights. The home is aware of these issues and has requested that they be addressed. In order to reduce the potential risk to service users, the Provider is recommended to ensure that all necessary repairs are undertaken in a prompt and timely manner. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Longer term plans include replacement and conversion of the existing premises to provide two new 2 person units. Accommodation is all at ground floor level. Included are the communal dining room, living room and kitchen, a utility room, service users rooms, storage facilities and a staff office. Bedrooms are personalised according to each service users preference. Current communal facilities include two bathrooms with toilets and a wet room shower with a toilet, although the latter cannot be used currently as mentioned previously. In order to reduce the risk to one service user, one bathroom facility is kept locked, although this can be accessed at any time with staff support. Service users have unrestricted access to other bathroom and toilet facilities. Each bedroom has a sink; staff stated that ensuite facilities would be included in the planned new units. The home is accessible for wheelchairs and provides specialist equipment where necessary. There is an intercom system within the home, with the main panel in the staff office. It was said that, as there are only five service users, staff know their whereabouts and that a more comprehensive call system is not necessary. Service users can use the utility room and the kitchen with support from staff, both of which are domestic in nature. Staff described the procedure for the use of paper supplies, which was said to consider the risks of infection control and damage to property. It was said that one washing machine would be repaired shortly. This does not have a sluice cycle and there are no designated hand washing facilities in the utility room. The Provider is recommended to review infection control procedures, including the facilities for soiled laundry and hand washing in the utility room in liaison with the Environmental Health Officer. Care Homes for Adults (18-65 years) Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from the support of a committed and enthusiastic staff team who have a good understanding of their needs. Service users would be better protected by additional staff training and qualification. Evidence: A good rapport was observed between service users and staff. Staff spoken with were clear about their roles and responsibilities and communicate well with each other. Handover meetings ensure the continuity of care between staff shifts making sure that residents daily needs and preferences are met. There were enough staff on duty at the time of this visit to meet service users needs. There are usually three staff during the day with one awake at night. Staffing levels are flexible depending on service users needs and reflected in a written rota. There is a system in place for emergencies. Currently the home uses agency workers as there is some staff shortage. Wherever possible, the same agency workers are sought in order to provide continuity of care for service users and are not used for lone night duties. Agency workers on duty at the time of this visit knew service users needs and wishes well. The home is currently in the process of recruitment. It was said that the recent staff recruitment drive would make it easier to support service users with Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: activities in the future. The home has a procedure in place which aims to recruit suitable staff who can meet the needs of residents. The manager described this as including pre employment checks, such as references, identification and a criminal records bureau check. The manager explained that all current staff were recruited by the NHS before the home registered with the Care Quality Commission in April 2009. The manager stated that at the time of registration, the Affinity Trust undertook new criminal records bureau checks for all transferred staff. The home is currently in the process of recruitment and new staff are due to be employed shortly. The manager stated that they were in the process of reviewing all staff files. An induction programme is in place for all new staff. There is also ongoing training for all staff, which is designed to further develop and update their skills and meet the needs of service users. However, whilst some records show up to date courses undertaken, such as induction, medication, the safeguarding of vulnerable adults, the Mental Capacity Act and Deprivation of Liberty; others show courses undertaken some time ago with some entries blank, such as moving and handling and fire prevention. The manager stated that they are aware of gaps in staff training and that Affinity Trust has put a new system in place to address this, including a training coordinator for the home; all courses are now provided by external agencys. The manager assured the inspector that fire prevention and moving and handling training were a priority and would be undertaken soon. Staff spoken with described planned training. Staff must be provided with up to date training that meets the needs of service users. A requirement has been made. The manager stated that two members of staff had obtained a qualification in learning disability, whilst another had completed a National vocation Qualification at level 3. It was said that the organisation were in the process of reviewing this. It is strongly recommended that the Provider fulfil their stated intention to enable a minimum of 50 per cent of the staff team to obtain a National vocational Qualification. Staff spoken with said that the manager was very supportive and always available. Informal support takes place regularly and there is a system in place for formal recorded 1:1 supervision. The manager assured the inspector that there is a schedule in place, which will improve the frequency of formal supervision. Care Homes for Adults (18-65 years) Page 22 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Dalkeith is run by an experienced manager. Service users enjoy living in a relaxed atmosphere. Service users benefit from their views being sought about the service they receive. The home is monitored with the aim to protect service users from potential hazards, although this would be improved by the testing of the gas system as safe. The Care Quality Commission has contacted the Fire and Recue Authority about the systems in place within the home for the prevention and detection of fire. Evidence: Dalkeith was established in the 1980s and converted to its present use to coincide with the closure of long stay hospitals in the area. The home was under the ownership and management of the West Kent and Medway Social Care Partnership Trust, who under the National Plan for the Re Provisioning of NHS supported accommodation, transferred the service to TACT UK Ltd and the premises to the housing association Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: MCCH. Dalkeith has been registered with the Care Quality Commission since April 2009. The Registered Manager is experienced in the management and care of people with learning disabilities and has been working in the home since 2004. They have obtained a National Vocational Qualification at level 3 and various qualifications in health and social welfare. At the time of registration, the manager stated that they would complete the Registered Managers Award within one year. The Manager works at Dalkeith most days and stated that they also oversee another small home within the organisation, for which they are applying for registration also. There is an open and inclusive atmosphere in the home. At the time of this visit service users were at ease and relaxed talking and spending time with staff who listen to their views and concerns. Service users benefit from being asked about their wishes and needs. The organisation uses a quality assurance system, which includes questionnaires to gain opinions of the service from service users, their families, staff and health and social care professionals. These were sent out recently and examples were seen. Weekly audits are undertaken in the home. An Annual Quality Assurance Assessment has been returned to the Care Quality Commission and the organisation undertakes audits against Key Lines of Regulatory Assessment. The manager said that visits to the home from a representative of Affinity Trust as the Provider take place on a monthly basis. The home has developed Best Interest meetings to ensure that any actions or decisions taken on behalf of those service users without capacity to give informed consent are taken in their best interests. Some staff have undertaken training regarding the Mental Capacity Act and Deprivation of Liberty and more is planned. A number of records have been looked at as part of this inspection and these have been mentioned within this report where appropriate. Accidents and incidents are recorded appropriately. No dates regarding the regular testing and maintenance of systems and equipment within the home were provided within the homes Annual Quality Assurance Assessment. Some records and certificates were looked at during this visit. It was noted that the gas safety certificate was dated 25th September 2008. This means that the gas system and appliances within the home are now overdue for testing as safe, by a professional external contractor. A requirement has been made. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: The manager assured the inspector that portable electrical appliances were tested in April 2009. It was said that the Affinity Trust would be undertaking new checks shortly. The fire alarm was serviced in August 2009, although the system has not been tested regularly by the home. The manager stated that tests recommenced in September 2009, although these have not been written down as records show the last test as February 2009. It was said that although fire extinguishers had been serviced, the emergency lighting system had not yet been tested. Currently no fire drills take place within the home. Discussion took place regarding the procedures for leaving the building in the event of fire. Currently the front door has a keypad lock that does not release when the fire alarm sounds. There are chains on all external doors including fire exits; these are out of the reach of some service users. There is confusion about whether the chains should be used or not. The home has a fire risk assessment. The Care Quality Commission has contacted the Fire and Recue Authority about the systems in place within the home for the prevention and detection of fire. The premises and the accommodation are monitored and weekly audits are undertaken with the aim that potential hazards to the health and safety of residents can be identified and addressed. Service users are protected by the procedures in place for the use of cleaning chemicals. The kitchen is clean and tidy. One member of staff stated that a food probe had recently been purchased and assured the inspector that hot food temperatures would be regularly tested and recorded from now onwards. In order to reduce the risks of scalding, all hot water outlets have mixer valves fitted and temperatures are checked regularly. Radiators seen are of the type that provide low surface temperatures. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 35 18 The registered person shall 31/01/2010 ensure that the persons employed to work at the care home receive training appropriate to the work they are to perform. In order to protect service users: the Provider must provide staff with up to date training that enables them to meet service users needs. 2 42 13 The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. In order to protect service users, the Provider must ensure that the gas system and appliances within the home are safe. 10/12/2009 Care Homes for Adults (18-65 years) Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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