Care Home: Dawnings

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What the care home does well It is homely and friendly at Dawnings and people living there seem to be very settled and to get on well with staff. Their relatives are pleased with their care and one says "I am totally satisfied with Xs general wellbeing and happiness". Each person living at the home has a care plan they are involved in making. Plans show all their needs, skills, likes & dislikes and any possible risks. They help staff know how best to support them and how to keep them safe. People living at the home make choices in their daily lives and routines. Staff enable them to go out in the community, take part in activities they enjoy (and that could develop their life skills) and to keep in touch with their families. Staff make sure that all the personal and health care needs of people who live at the home are met. They also manage their medicines safely on their behalf. Dawnings is an ordinary, family house and so helps people living there fit in with the local community. It offers them a secure, well-kept and comfortable home and is in a good place near the shops and facilities of Ross-on-Wye town.Staff receive training so they know how to keep the home and people living there safe and understand their special needs. Necessary checks are taken up to help to make sure that new staff are suitable to care for vulnerable adults. The home is well run and provides good individualised care for the people who live there. The quality of the service is checked regularly and plans are made to keep on improving it as people living there wish and/or for their benefit. What has improved since the last inspection? Each person living at the home is having a Health Action Plan set up for them. These plans should better ensure all their health needs are met and they are involved in managing their own health care as much as possible. Some decoration has been done and new furniture bought to make the house look nicer and be more comfortable for the people living there. More staff are working towards achieving a qualification in care. This should enhance their skills and knowledge and so benefit people living at the home. What the care home could do better: The home needs to continue to develop "person centred" care planning. This means more personal goals of people living at the home would be identified so they could be supported to achieve them and develop their life & social skills. It will be good when staff use more pictures and other ways to help people living at the home make their views known, so they can make more choices. The home plans to involve people living at the home more in the selection of new staff. This will give them grater choice about who supports them. CARE HOME ADULTS 18-65 Dawnings 1 Vaga Crescent Ross-on-Wye Herefordshire HR9 7RQ Lead Inspector Christina Lavelle Key Unannounced Inspection 23 November 2007 14:00 rd Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dawnings Address 1 Vaga Crescent Ross-on-Wye Herefordshire HR9 7RQ 01989 565101 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.mencap.org Royal Mencap Society Mrs Melanie Keighley Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6) of places Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: NA Date of last inspection 15th September 2006 Brief Description of the Service: Dawnings is operated by the Royal Mencap Society (Mencap), which is also a registered charity and one of the largest providers of services for people with learning disabilities in the United Kingdom. Mencap’s mission statement for its service users is “To fulfil our ambitions, experience lots of things and make our mark in the world”. The registered manager for the home is Mrs Mel Keighley. The home provides accommodation and personal care on a long-term basis for six adults who need care due to learning disabilities. People living there should have a moderate learning disability and not use severe challenging behaviours. The property is owned and maintained by Dimensions Housing Association and is leased to Mencap. Dawnings is an extended modern house on a residential estate in the market town of Ross on Wye, about a mile from the town centre. There is a good range of local facilities and services nearby and people living there have the use of a car. Two single bedrooms are on the ground floor and so are more suitable for the needs of older and/or less mobile people. Four single bedrooms are situated on the first floor and all the bedrooms have wash hand basins, although none have en-suite facilities. The home has a lounge, dining room, conservatory, one bathroom and two shower rooms that everyone shares. There is a reasonably sized, enclosed garden to the rear of the house. Information about the service is provided in a statement of purpose document and a service users’ guide. The guide is available in a user-friendly format. The fee for the service is as agreed between Mencap and service users’ funding authorities and is dependant on their assessed individual needs. The actual fee level should be specified in each person’s contract, with the signed agreement of relevant parties. People living at the home are also expected to pay for such as their clothes & toiletries, luxury items, college and specialist course fees, the cost of their holiday accommodation and £25.00 a month towards transport. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a key inspection of the service provided by Dawnings. This means all the Standards that can be most important to adults living in care homes are assessed. The first visit was made without anyone at the home being told beforehand. Time was spent talking to staff on duty and some people living there. It is difficult to obtain the views of everyone living at the home directly due to their disabilities. During the second visit the way the home is run and any changes made since the last inspection were discussed with the manager. Surveys were left at the home for support staff and three people living there asking what they think of the service. Nine surveys were sent to their families and health/social care professionals involved with their care. Feedback from eight surveys returned is mentioned in this report. An AQAA (Annual Quality Assurance Assessment) had been completed before these visits. This asks managers to say what they feel their home does well & could do better, what has improved in the last year and about their plans to improve the service. It has information about people living there, staff and other aspects of the home. Various records kept by the home were checked and the house looked around. All information received by the Commission in respect of Dawnings since the last inspection is also considered, such as events affecting people living there. What the service does well: It is homely and friendly at Dawnings and people living there seem to be very settled and to get on well with staff. Their relatives are pleased with their care and one says “I am totally satisfied with Xs general wellbeing and happiness”. Each person living at the home has a care plan they are involved in making. Plans show all their needs, skills, likes & dislikes and any possible risks. They help staff know how best to support them and how to keep them safe. People living at the home make choices in their daily lives and routines. Staff enable them to go out in the community, take part in activities they enjoy (and that could develop their life skills) and to keep in touch with their families. Staff make sure that all the personal and health care needs of people who live at the home are met. They also manage their medicines safely on their behalf. Dawnings is an ordinary, family house and so helps people living there fit in with the local community. It offers them a secure, well-kept and comfortable home and is in a good place near the shops and facilities of Ross-on-Wye town. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 6 Staff receive training so they know how to keep the home and people living there safe and understand their special needs. Necessary checks are taken up to help to make sure that new staff are suitable to care for vulnerable adults. The home is well run and provides good individualised care for the people who live there. The quality of the service is checked regularly and plans are made to keep on improving it as people living there wish and/or for their benefit. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. Thorough assessment procedures are in place, which should help to ensure the home could suitably meet the needs and goals of people wishing to live there. EVIDENCE: Required information documents about the home are provided, which include a statement of purpose and a service user guide. The guide is called “A Promise to You” and includes pictures and simple language so it should be easier for people with learning disabilities to understand. Mencap also has a policy and procedures clearly setting out its assessment, admission and review processes. Although no one has moved to Dawnings since 2005 the procedures the home would follow should any referrals be made were discussed with the manager. Mencap receive referrals first; including a copy of a comprehensive community care assessment undertaken by prospective service users’ funding authorities. The home manager and Mencap’s service manager then work closely with the potential service user, their family and social worker to check that their needs and wishes could be suitably met. They would then give them information about the home (which two people living at the home confirmed in surveys). Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 9 Introductory visits to the home would be arranged next, including for a meal and overnight stays. This is to give them the opportunity to meet the people already living there and staff. A three-month trial stay would then be agreed, with a meeting held at the end of this period with all those involved when the suitability of the placement is reviewed. Daily reports are completed by staff to show how successful the visits and trial stay had been and as far as possible people living at the home would be asked their views of the new person and their interactions would also be observed. It is good that compatibility with the current group would always be considered and staff feedback is also sought. When all involved agree the home would suitably meet the need and goals of a new person a contract and terms & conditions of residence are agreed between Mencap’s service manager and the person’s funding authority. Their contract must reflect the weekly fee, (which is based on their individual needs) and this fee and any additional charges must be clearly indicated in their contract. Dawnings DS0000024712.V351591.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 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. People living at the home all have a plan showing their current needs and how to meet them. Plans include their preferences and risk assessments to reduce safety risks, but should focus more on their personal goals to better reflect what they wish to achieve and develop their independent life and social skills. EVIDENCE: Care records kept by staff for people who are living at the home were sampled. Each person has an up to date plan showing their care needs and any support they need to meet them. The home is implementing an appropriately more person centred (PC) approach to care planning. This aims to involve individuals in planning their own care and making choices to the extent they are capable. The plan format being used by the home includes a brief history with pictures and details of family contacts etc. It also has a needs and skills assessment, written in the first person, covering “What I can do” and “Need some, or a lot, of help with” in all relevant areas such as communication, bathing, dressing, Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 11 continence, eating, cooking, cleaning & laundry, shopping, travelling and finances. There is also an assessment of their social & emotional skills and behaviours as well as information in relation to each person’s activities, personal space & possessions and their preferred daily routines. Plans are drawn up with individuals whenever possible and through consulting significant other people (e.g. family) and a formal annual care review meeting is held when their relatives etc. are invited. keyworkers are allocated to each person living at the home from the staff team who give more personal support. Their role includes care planning and reviews and they make monthly progress reports of events, health etc and update plans to reflect changes. Keyworkers complete a pre-review questionnaire detailing any changes and showing what their allocated people have done, new activities etc and also reflect their views. It will be good however when care planning focuses more on personal goals, with actions and timescales specified to meet goals identified. Reviews should then show if they are achieved, with outcomes and benefits to each person (or not). This is one of the manager’s improvement plans as well as setting up life books to provide more information about their background and things in their lives that are important to them. Part of the PC process is facilitating effective communication and staff have introduced pictures to help people living at the home choose their meals. The manager recognises this too needs developing and plans to utilise more symbols and pictures around the home to promote choices and is seeking relevant staff training. Individual communication plans and objects of reference are other techniques that could be considered. Risk assessments are carried out primarily relating to minimising safety risks (such as when accessing the community, going out in the car, showering, fire safety and managing finances) with detailed generic checklists completed. Some people also have individual behavioural management plans that guide staff about how to deal with their challenging behaviours. Risk management should also however be directly linked to their PC plans and focus more on promoting a more independent lifestyle and developing life skills. Regarding issues of equality and diversity the home’s philosophy and practice clearly focuses on individuals’ needs. This includes physical & emotional needs and in respect of supporting people with age appropriate activities & religious beliefs e.g. attend church. Mencap’s induction programme for new staff covers values and respect and there are policies on Diversity and Equal Opportunities. Although some limitations to individual’s choice and freedom are specified in their plans (e.g. money managed by staff and not to leave the home without support) these have been signed just by the manager. In line with the Mental Capacity (MC) Act the home should be aware of the process of setting up best interest groups when a person is unable to make informed choices so decisions are made by all appropriate others. The manager and deputy will be receiving instruction on the MC Act and should ensure consent issues are reconsidered. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. People living at the home are supported to take part in activities they enjoy, to mix in the community and maintain links with their families. Staff respect their individuality and they are able to make choices in their daily lives and routines. The home provides food people like, whilst healthier options are promoted. EVIDENCE: Plans of people living at the home shows how they like to spend their time; activities they regularly participate in (and any they have tried) and outings and holidays they would enjoy. Activities should also be linked more however to their interests and any assessed social and developmental needs. This may result in specific goals and there should be evidence that action is being taken to meet and achieve their goals, which is reviewed along with the outcomes. Staff confirm that people living at the home are enabled to lead interesting and active lives (if they want to) and go out in the community as much as possible. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 13 Some people attend day services and are involved in a recycling project and/or college. One person goes to their college independently using public transport. Most belong to a club for people with learning disabilities, which has a varied programme of social activities, and staff also support them to use mainstream facilities and services e.g. shops, pubs & cafes. Some people are therefore well known and integrated within the local community. Efforts are made to arrange activities and outings flexibly to suit individuals and staff seek new and varied activities e.g. they now use a snozelen sensory centre. It is good that the manager plans to set up a more structured weekly timetable for those people who do not attend day services or take part in other regular activities. People living at the home are encouraged to be involved in day-to-day issues and to make choices about their own routines and lifestyles. Meetings are also held monthly, facilitated by staff, when they try to involve everyone to discuss such as menus, décor and holidays. Staff confirm that individual daily routines are flexible and some people were seen to get up when they wanted to, stay in their bedrooms and go out if they wished. Staff also encourage them to be as involved as they can be in household tasks, which is limited for some people and could just be observing or unloading the dishwasher. It is clear that staff respect the rights of individuals and recognise that Dawnings is their home. Mencap has recently developed a Family Charter, which has been distributed to relatives who are actively involved in the lives of people using their services. This outlines the way they should work with families in their best interests and directs them to share information and insights to help meet their individual needs. People living at this home are supported by staff to maintain links with their family and develop friendships and they are made welcome in the home. Two relatives who completed surveys say the home always keeps in touch and keeps them up to date. Whilst no one has an advocate, the home has used an advocacy service for specific issues and the manager is aware of its value. Regarding food provided by the home weekly menus are drawn up and pictures are now being used to help people living there choose one main meal each. Staff know individual likes & dislikes and any special dietary needs and plan to try to broaden their knowledge of food and choices. Menus include a variety of mostly traditional meals whilst healthy eating is promoted through home made dishes using fresh ingredients and vegetables. Food stocks were checked and to include plenty of fresh fruit, yoghurts, skimmed milk, cereals with fibre etc. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. People living at the home are supported to meet all their personal and health are needs and staff ensure that necessary health care input is obtained. Their medicines are also managed safely in the home on their behalf by trained staff. EVIDENCE: People living at the home have their personal care needs assessed with any support needed detailed in their plans. They also have a personal care checklist showing support received and for keyworkers to complete in respect of their clothes etc. They were all seen to be well presented and suitably dressed and are supported by their keyworkers to choose and shop for their own clothes. Care records include information about specific and general health issues and any special requirements in relation to such as diet and equipment. Staff are also setting up Health Action Plan (HAPs) for everyone, as is recommended by the Department of Health for people with learning disabilities. The HAP is a detailed booklet that covers relevant health care areas and includes promoting a healthy lifestyle. The manager says HAPs will also be used to support people to be more aware of their health needs and feel good about themselves. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 15 Records are kept of all visits, input sought and/or treatment received from a range of health care professionals & specialists and keyworkers arrange routine health check ups and escort people to attend appointments. Physical checks are also made by staff when necessary, such as weight, with records kept. Regarding medication the home has a clear policy & procedures to ensure they are obtained; kept and administered safely. Whilst staff manage medicines on behalf of everyone currently living at the home they consider how to support them to self-administer through risk assessment. Everyone has a medication pen picture showing medicines they are prescribed, the reason for this and any possible side effects. Staff receive relevant training as part of their induction and those designated to administer attend an accredited course on the care of medicines. New staff shadow trained staff whilst they are administering etc. and then have to be observed themself until they deemed suitably competent to administer. The home uses a monitored dosage system, which is regularly checked by a pharmacist from the company providing it and regular audits are also carried out by the home. It is confirmed there is suitably secure medicines storage and that administration records are being maintained appropriately. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. The home has processes that enable people living at the home to express their views and concerns and ensure they are dealt with appropriately. Systems are also in place to manage complaints and promote their welfare and protection. EVIDENCE: The home has a complaints procedure available in a user-friendly format. This is displayed in the home and everyone has a copy and/or it has been explained to them. People living in the home and their relatives confirm they know about this procedure and feel any concerns would be dealt with properly. A stamped & addressed postcard to Mencap is also provided and can be sent to bring issues directly to their attention. Staff receive training from Mencap in respect of complaints and the manager states in the AQAA that the home aims to encourage people to express their views in meetings & reviews and keyworkers are very receptive to issues that may affect their well-being. There were no complaints made to the Commission about the home since the last inspection. Staff receive training about their responsibility to protect people living in the home from abuse and/or neglect. Policies & processes also link in with local Protection of Vulnerable procedures and there is a new flowchart displayed in the home about reporting any incidence or suspicion of abuse (in addition to a whistle blowing policy). Assessments are carried out in relation to the finances of people living at the home and records kept of all transactions when staff need to manage their money to ensure it is used appropriately and accounted. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 17 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. The accommodation suitably meets the needs of people living there and offers them a comfortable, safe and well-kept home. Appropriate arrangements are in place to promote good hygiene and to keep the house safe, tidy and fresh. EVIDENCE: Dawnings is a modern, detached house situated on a residential estate about a mile away from Ross-on Wye centre. Town is within walking distance for some people living at the home and it is accessible to public transport. The house is well maintained and upgrading is ongoing (some new furniture had been bought and areas redecorated since the last inspection). Dimensions Housing Association owns the property and the manager reports they work constructively with Mencap to keep improving it. All areas visited were found to be clean, tidy and fresh and one health care professional confirms the view that Dawnings “provides a comfortable, safe and homely environment for service users”. The stained carpeting in the hallway and lounge due to spilled Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 18 drinks somewhat detracts from the overall impression and it is good that plans are being considered to provide more suitable alternative floor covering soon. The two ground floor bedrooms meet the needs of those living there who are older and have mobility difficulties and bedrooms seen are well personalised. A comprehensive infection control policy is in place and suitable arrangements are made for the disposal of soiled waste. Staff take overall responsibility for cleaning and all have received instruction relating to infection control as part of their induction and food hygiene training is also arranged. The home provides staff with protective gloves and aprons. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. People living at the home are supported by sufficient staff who receive relevant training and are supervised. Staff skills and knowledge will be enhanced when more of them achieve a care qualification. Thorough recruitment procedures help to ensure suitable staff work at the home, to protect people living there. EVIDENCE: Staffing levels are maintained appropriately to meet the personal care needs of people living at the home. Although there have been vacancies and shortages during the last year contracted staff have covered the home without need to use agency staff. This apparently at times affected their flexibility and time to accompany people to go out when they wish. However a recruitment drive is ongoing and there is now only one vacancy, which a relief worker is covering. There should be ten support workers employed at the home plus the manager, deputy manager and two relief staff. Two support staff at least are always deployed between 8am & 10pm (plus the manager and/or deputy weekdays) and one person works waking nights with another on call. There is a mix of male and female staff, which is good as only one women is living at the home. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 20 Mencap provides robust policies & procedures for the selection and recruitment of staff. Records of two staff were checked and confirmed that a police (CRB) check and two written references were taken up (one from their last employer) and these checks must be satisfactory before new staff are allowed to start working with people at the home. Copies of relevant documents are held and an application form completed, including a full employment history (with any gaps explored) and a statement of applicants health. The manager is advised however than whenever possible a more creditable second reference should be obtained i.e. from a professional relationship rather than a colleague. It is good the home plans to involve people living at the home more in staff selection. New staff undertake a 6 month probationary period before their employment is confirmed. During the first 3 months they complete Mencap’s comprehensive induction & foundation programme, which has recently been revised to provide underpinning knowledge for NVQ (National Vocational Qualification) at level 2. A new staff member described how two days were also spent with the manager going through policies & procedures and then working alongside other support staff to get to know everyone; the home’s routines and read care records etc. Staff say they feel their induction covered everything they needed very well. During induction staff also start to undertake training in the mandatory health & safety training areas and care related topics such as Respect & Values and protection. They move onto NVQ and more specific training relevant to people with learning disabilities such as autism awareness and positive approaches to managing challenging behaviours. There is a staff team training matrix and individual training records are kept to ensure they all complete the necessary training and so regular updates can be arranged. Currently only two support staff have achieved an NVQ but another eight are working towards it, which is good as the Standards specify at least half the team should be qualified. It is confirmed staff receive regular individual supervision, with records kept, when they have the opportunity to discuss such as their keyworker role, staff issues, training, areas of responsibility and any other issues they wish to raise. Each staff member also has an annual appraisal performance review. Team meetings are held regularly when staff have the opportunity to discuss any issues openly and most feel that ways of passing information usually work well and that management are approachable and open to suggestions. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 21 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 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. People living at Dawnings receive good individualised care at a well run home. The quality of the service is monitored and reviewed so it continually develops, as they want and/or on their behalf. Policies, procedures & working practices help to protect the people who live and work at the home. EVIDENCE: The registered manager of this service (Mel Keighley) is suitably experienced and qualified, having achieved an NVQ level 4 qualification in social care & management. Mrs Keighley has also completed training in all relevant health & safety topics and management areas and has a development portfolio to make sure there is a continuous update of her skills and knowledge. The home has a deputy manager and some responsibilities are delegated to her and other staff. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 22 This key inspection confirms the staff team are committed to providing a good quality and individualised service for people living at the home. The home and staff team are also well supported by Mencap. Being an established national organisation they offer specialist and expert resources in relation to areas such as training, human resources, service user involvement, quality & best practice and finances. Their services are also kept informed about changes in practice guidelines and legislation and policies & procedure are regularly updated. On a personal level the manager also feels well supported and has the opportunity to attend home managers’ meetings held for peer support and updates etc. Mencap operate a formal system to monitor, review and assure service quality. This includes the required monthly visits from an external manager when all aspects of services are checked and/or audited periodically and a plan is made to continually improve the service, with actions and timescales specified. An annual service review is also completed (the last one at Dawnings was March this year). The views of people living at the home must also be reflected in development plans and so satisfaction surveys had been sent to them and all relevant stakeholders. All information obtained from these surveys is analysed as part of the quality assurance process. Mencap is currently reviewing how they seek and gain feedback and moving towards a more flexible process for facilitating and recording their views, which will be positive especially in view of the limited communication of some people living at this home. Regarding health & safety staff training is arranged in all the mandatory areas including fire safety, first aid, food, hygiene and moving & handling. The following was also confirmed from information in the AQAA:• • • • Electrical circuits are regularly checked and PAT tests carried out. The fire safety system and equipment are checked & tested as required. The heating system & gas appliances are serviced regularly. COSHH risk assessments are in place. There were no safety hazards identified during these visits and overall it is evident that due attention is paid to maintaining safety in the home and to minimise any risks and so protect the people living there. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NA STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered persons meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Care planning in the home should continue to develop so that plans focus more on the personal goals of people living at the home. Plans would then better reflect what they wish to achieve and/or help to develop their independent life and social skills. Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Dawnings DS0000024712.V351591.R01.S.doc Version 5.2 Page 26 - 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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