Care Home: The Daltons

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What the care home does well Each person who lives at the home has had their needs assessed to make sure the home can give them the care and support they need. Information is available to help people make an informed choice about the service before they decide to use it. All of the people have care plans which give information to staff about how to support them and meet their needs.The staff at the home treat the people as individuals and support them to live the life they choose as much as possible, so they will have new experiences and know that their opinions are valued. People who live at the home experience a variety of activities. This gives them choice, as well as building their self-esteem and confidence. The home is clean, warm and pleasantly furnished so the people who use the service have a comfortable place to live. The home has procedures for staff for the administration and recording of medication. This is to make sure the people who live at the home receive their medication when they need it and at the correct times. The home has procedures for dealing with complaints so any disputes are settled quickly so good relationships are maintained. The home has adult protection policies and procedures for the staff to follow. So the people are safeguarded against abuse and kept as safe as possible. The staff are supervised and trained so they know how to provide the people who live at the home with good care. Quality assurance systems are in place but are still being developed. This will help the service to shape the quality of the service and ensure it is run in their best interests. What has improved since the last inspection? This is a new service. CARE HOME ADULTS 18-65 The Daltons Dalton le Dale Seaham Co Durham SR7 8QT Lead Inspector Hilary Stewart Key Unannounced Inspection 13th August 2008 10:00 The Daltons DS0000071520.V370060.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 The Daltons DS0000071520.V370060.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. The Daltons DS0000071520.V370060.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Daltons Address Dalton le Dale Seaham Co Durham SR7 8QT 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) Young Foundations Ltd Melanie Leigh Stuart Care Home 5 Category(ies) of Learning disability (5) registration, with number of places The Daltons DS0000071520.V370060.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: 2. Learning Disability - Code LD, maximum number of places 5 The maximum number of service users who can be accommodated is:5 Date of last inspection New service Brief Description of the Service: The Daltons was a care home for children and was previously registered with the Commission for Social care Inspection. However, the people using the service have attained the age of 16 years plus. This has necessitated a new registration in order for the home to be registered as a care home for young adults. Young Foundations Limited is an established care provider to adults and children and is part of the Castlebeck group of companies. The Daltons is a 5 bedroom detached property located in Dalton Le Dale Seaham Co Durham. The home is close to local amenities although it is located in a valley area. There are two bedrooms on the ground floor and three to the 1st floor. There are no en-suite facilities but sufficient bathing and showering rooms are available. There is a small, raised garden to the rear of the home and large car parking area with private drive at the front. The home charges £3750.00p per week. The Daltons DS0000071520.V370060.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Before the visit: We looked at: • Information we have received since the home was registered. • How the service dealt with any complaints, concerns and safeguarding issues. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service and the staff. The Visit: An unannounced visit was made on 13th August 2008. During the visit we: • • • • • • • Talked with the staff and the manager. Observed and talked to the people who live at the home. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked to see if the staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building to make sure it was clean, safe & comfortable, Looked at information from the surveys that had been returned, We told the manager what we found. What the service does well: Each person who lives at the home has had their needs assessed to make sure the home can give them the care and support they need. Information is available to help people make an informed choice about the service before they decide to use it. All of the people have care plans which give information to staff about how to support them and meet their needs. The Daltons DS0000071520.V370060.R01.S.doc Version 5.2 Page 6 The staff at the home treat the people as individuals and support them to live the life they choose as much as possible, so they will have new experiences and know that their opinions are valued. People who live at the home experience a variety of activities. This gives them choice, as well as building their self-esteem and confidence. The home is clean, warm and pleasantly furnished so the people who use the service have a comfortable place to live. The home has procedures for staff for the administration and recording of medication. This is to make sure the people who live at the home receive their medication when they need it and at the correct times. The home has procedures for dealing with complaints so any disputes are settled quickly so good relationships are maintained. The home has adult protection policies and procedures for the staff to follow. So the people are safeguarded against abuse and kept as safe as possible. The staff are supervised and trained so they know how to provide the people who live at the home with good care. Quality assurance systems are in place but are still being developed. This will help the service to shape the quality of the service and ensure it is run in their best interests. What has improved since the last inspection? What they could do better: More detailed risk assessments which show why some peoples choices and independence have been limited would make sure that peoples rights are protected and at the same time staff are able to keep the people who use the service as safe as possible. When recruiting staff, any gaps in a person’s work history should be explored and the information recorded as well as any issues that may indicate a person is unsuitable. This would demonstrate that the agency have made sure that they only employ suitable people to work as support workers and therefore safeguard the people who use the service. The Daltons DS0000071520.V370060.R01.S.doc Version 5.2 Page 7 If the home repaired the bathroom and improved ventilation in the other bathroom this would make the home a more pleasant place for the people to live. 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. The Daltons DS0000071520.V370060.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 The Daltons DS0000071520.V370060.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): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Comprehensive assessments are carried out before people receive the service, so plans can be made to make sure they get the care and support they need. EVIDENCE: The manager said that the people who live at the home have had their needs assessed before and after they move in. A person can only move into the home if they are certain that their needs can be met there. The manager said that if a person decides to move into the home they can visit before they move in permanently, so they can be gradually introduced to the other people who live there. Some people said that they had visited before they moved into the home one person said that they hadn’t. The Daltons DS0000071520.V370060.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 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service get the personal support they require and at the same time staff make sure that their privacy, dignity and independence is respected. They are supported to become more independent but at the same time staff look at the risks to keep them as safe as possible. Records did not show why some people’s choices had been limited. EVIDENCE: All of the people who live at the home have an individual care plan. The manager said that staff try to involve the people in writing them up. The manager and staff said that they consult the people at the home as much as possible but they need to provide more support to people who do not use speech to communicate. Each plan includes information about what care each person needs such as their social relationships, their independence and what type of support they need. The plans were easy to read and contained enough detail. One described The Daltons DS0000071520.V370060.R01.S.doc Version 5.2 Page 11 very clearly how to meet the needs of one person and how staff should support them when they attend college. Some risk assessments were general and about the home as well as each person having individual ones. Records showed that the risk assessments were reviewed and up to date. Some risks had not been assessed. One person did not manage their own money but the reasons for this were not recorded in their care plan. None of the people at the home mange their own medication but again the risk assessment and the reason for this decision was not recorded either. The manager said that they are in the process of updating the care plans from being for children from when the home was registered as a children’s home to an adult format. The Daltons DS0000071520.V370060.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): 12,13,15,16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People at the home are supported by staff who value them, while maintaining links with their families and friends. This means they can have new experiences and interests and do not become isolated. EVIDENCE: Staff said that people are given choices as much as possible. All of the people have individual activities and some were out during the visit. Daily records show that activities take place with each person. The daily routines within the home are structured around the people who live there. Sufficient staff were on duty to support the people to take part in activities individually. The activities are based upon what the people like to do. Most had purposeful placements during the day; one person is a volunteer in a charity shop another is at college. Activities outside of the home included playing badminton, going to the cinema and going out for meals. Records showed that people go out most days. The manager and staff said that they support the The Daltons DS0000071520.V370060.R01.S.doc Version 5.2 Page 13 people to try new things and they have a good variety of activities for them to take part in. The activities are planned individually as some may cause some people anxiety. Staff said that they try to think of new activities for people to try. Staff said that the people are involved in domestic routines as much as they can. One person was about to go out shopping during the visit. They work with the people to support them to improve their independence. One young person said “ the staff help you with your washing if you need them to”, another said, “ yes” when asked if the staff helped them cook their own meals. Staff said that they respect the people’s privacy and they are aware of their rights. They were observed knocking on people’s bedrooms doors prior to entering. The people at the home looked relaxed and comfortable with the staff. Staff were observed explaining to the people what they were doing and asking them what they would like to do that day. The manager said that the meals served at the home are the choice of the people who live there. People have a choice of meals and the food served is written down so staff can make sure the people have a varied diet. Meals served at the time of visit looked appetising and nutritious. The people can have a meal different from what is on the menu if they choose. They let the people try new foods to see if they like them and they can use the kitchen at any reasonable time to make drinks and snacks. The manager said that they get an adequate amount of money to buy food for the home. The people at the home are supported to keep in contact with their families and friends. They are encouraged to visit them as much as they want. One young person said, “ I talk to my mum”. Records showed that the people have regular contact with their family and friends. The Daltons DS0000071520.V370060.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 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People have personal support when they need it so they can be as independent as possible. Healthcare needs are met, which ensures that people stay healthy. The risk had not been assessed to see if people could look after their own medication. EVIDENCE: The care plans identify the personal support that each person needs with everyday tasks. One person needs help with their personal hygiene and relevant details were in their care plan. Records showed and the manager said that each person has a health care plan. All of the people parents, social workers, doctors and looked after nurse receive a copy of their health care plans on a monthly basis or as and when changes are made. All of the people in the home also receive yearly health care checks. Specialist support is available from psychologist/psychiatric services when required. Records are in use to monitor the administration of prescribed medicines. They were up to date and had been signed by staff when they have administered The Daltons DS0000071520.V370060.R01.S.doc Version 5.2 Page 15 medication to people. Staff who are authorised to administer medicines are listed in the file and there is a copy of their signature. The manager said that staff have received in the safe administration of medication. They do not administer medication unless they have completed this training. Staff said that they had been trained and could describe the procedures that are followed in the home. Each person at the home had an individual medication plan. They did not contain a risk assessment or an explanation about why they don’t control their own medication. The manager said they intend to carry them out in the near future. The Daltons DS0000071520.V370060.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 and 23 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. A satisfactory complaints procedure is in place. This means that complaints should be dealt with effectively so people know that their comments are taken seriously. Satisfactory protection procedures are in place to protect the people at the home from risk of harm. EVIDENCE: The manager said that the home has an open culture that allows all of the people to express their views and concerns in a safe and understanding environment. They said that they welcome complaints and suggestions from people and use them positively so they can learn from them. Policies and procedures are in place that describes how the home responds to complaints. The manager said and records showed that the home had not had any complaints since the last inspection. All of the people receive a copy of the complaints procedure when they move into the home. There is a version in pictures that is easier for people to understand. Complaints forms are displayed in bookcases around the home and there is a suggestion box for people to use. All of the people spoken to said that they knew how to make a complaint one person said “ I have never had too make a complaint”. They complaints forms were still in the format for children the manager said that they are in the process of updating them. The Daltons DS0000071520.V370060.R01.S.doc Version 5.2 Page 17 All staff are fully trained in adult and child protection and senior staff members have recently attended a POCA course. The service has policies and procedures on safeguarding adults to inform staff what to do if they think a person at the home could be suffering from abuse. There is a copy of the Local Authority safeguarding adult’s procedures in the office. Staff and the manager could describe what actions they would take to safeguard the people who live at the home from potential abuse. The manager, staff and records showed that staff had received training in safeguarding adults. One person when asked if they felt safe at the home said “yes the staff are nice”. The Daltons DS0000071520.V370060.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is comfortable, warm and clean so the people have a pleasant place to live. Although some repairs are needed EVIDENCE: The home is comfortable, warm and clean so the people have a pleasant place to live. Although some repairs are needed The Daltons DS0000071520.V370060.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): 32,34 and 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff have opportunities for training so they know how to give the people who live at the home good care and meet their needs. Sufficient numbers of staff are in post to meet their diverse needs. The home has recruitment procedures in place, which help to prevent risk of harm to the people who live there. Some gaps in staff members work history had not been thoroughly explored. EVIDENCE: Staff said that they receive training, which helps them with their work. The manager said that all staff have a personal development plan, which makes sure they get the training and support they need. The staff said and records showed that they all have mandatory training such as first aid; food hygiene and safeguarding adults training. The manager said that five staff have vocational qualifications and seven are working towards one. Sufficient staff were on duty at the time of the visit. Staff said and records showed that sufficient staff had been on duty in the home the previous week. The Daltons DS0000071520.V370060.R01.S.doc Version 5.2 Page 20 The manager said that all staff have been CRB (Criminal Records Bureau) checked at an enhanced level to make sure they are suitable people to work at the home. All staff go through a recruitment process and they cannot not start to work at the home until this is completed. They are interviewed and are only successful when they have two satisfactory references. Copies of staff records showed that checks had been carried out. Some records showed gaps in staff ‘s work history that had not been explored during the recruitment process. Records did not show that issues highlighted during the recruitment process had been explored. The Daltons DS0000071520.V370060.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 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The opinions of the people who live at the home are sought about how the home is run so they know their views are valued and are used to improve the service. Quality assurance systems are in place but are still being developed for an adult service. This will help the service to shape the quality of the service and ensure it is run in their best interests. EVIDENCE: The manager said that the people who live at the home and their families are asked their views about the running of the home as much as possible. Staff said and records showed that the people have meetings with their key workers. One young person said “ the staff do listen to you” and another said “ I can talk to the staff they are nice to you”. The Daltons DS0000071520.V370060.R01.S.doc Version 5.2 Page 22 Safety checks have been carried out on the equipment in the home; such as testing electrical equipment and the servicing the central heating boiler. Fire safety risk assessments had been completed. The fire logbook showed that fire drills and fire instruction take place but fire instruction was not as regular as it should be. Staff said that they have fire drills and instruction. Records showed that regular training is provided for staff in fire safety and first aid. The Daltons DS0000071520.V370060.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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X The Daltons DS0000071520.V370060.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA7 Regulation 17 Requirement Timescale for action 30/11/08 2. YA20 17 3. YA24 23 4. YA34 19 Any limits on people managing their own finances must be risk assessed and the reasons for any decisions made recorded in their care plan. The manager must risk assess 30/11/08 and record the reasons why people do not control and administer their own medication. The toilet floor and cabinets in 30/11/08 the downstairs bathroom must be repaired as well as the toilet seat in the upstairs bathroom. Any issues highlighted during the 30/11/08 recruitment process that could indicate a person is unsuitable, must be followed up and recorded. Gaps in candidates work history must be explored and a record kept on their file. This will ensure that service users are protected by the employment of well-checked staff. The Daltons DS0000071520.V370060.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Daltons DS0000071520.V370060.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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