Inspection on 17/07/07 for 1 St Alphege Road

This inspection was carried out on 17th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 St Alphege Road 23/10/08

1 St Alphege Road 27/06/08

1 St Alphege Road 04/08/06

1 St Alphege Road 20/12/05

1 St Alphege Road 05/09/05

1 St Alphege Road 13/12/04

1 St Alphege Road 01/09/04

1 St Alphege Road 20/01/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 1 St Alphege Road Dover Kent CT16 2PU Lead Inspector Wendy Mills Key Unannounced Inspection 17th July 2007 09:30 1 St Alphege Road DS0000023757.V345917.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 1 St Alphege Road DS0000023757.V345917.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. 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 St Alphege Road Address Dover Kent CT16 2PU 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) 01304 225252 None United Response Post Vacant Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: 1 St Alphege Road is a residential care home providing care and support for up to seven people with enduring mental health problems. The service is owned and managed by United Response. This is a national charitable organisation specialising in the fields of mental health and learning disabilities. The home is situated on a residential road close to the centre of Dover. There are good local amenities and public transport links. The accommodation is arranged over four floors. There are well-appointed and comfortable communal areas. There is a lounge, dining room and conservatory. All of the bedrooms are for single occupancy only. Outside there are attractive and well-maintained gardens surrounding the building. Service users are encouraged and supported to work towards a more independent lifestyle with staff facilitating the choices and decision-making of the residents. The e-mail address of the home is dover.east@unitedresponse.org.uk The current weekly fees for this service are £800 for each service user. 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key visit formed part of the inspection process by the Commission for Social Care Inspection (CSCI) in accordance with the Care Standards Act 2000. This report takes information gathered since the last inspection. The sources of this information include feedback from staff at the home, visiting health and social care professionals, relatives and the home itself. On the day of this visit there were five service users living in the home. During this visit, it was possible to speak, in depth, with the manager, deputy manger, shift leader and support workers. The views of visiting health care professionals were sought. Time was spent with residents, interacting with them, and directly and indirectly observing the way in which they interacted with staff. Due to the communication difficulties of some of the residents, it was not possible to reliably elicit their views but it was possible to make an assessment of their comfort, choices they make and the quality of their daily life within the home. Documentation, including, care plans, staff files and health and safety records were examined and a tour of each part of the home was made. Direct and indirect observations were made throughout the visit. The home has made good progress in meeting the recommendations placed at the last inspection. One requirement remains unmet. This was for the manager to apply for registration with the Commission for Social care inspection. However, it is good to note that the manager is currently in the process of completing his application form for this. All comments received about the home were very positive. The residents, staff, deputy manager and manager are all thanked for the welcome they gave and for their assistance throughout this visit. Although the legal term for those living in the home is, “service users”, they said that they would like to be refereed to as “residents “ throughout this report. They felt that this term was more appropriate, friendly and homely. The term, “residents” has therefore been used, in the body of this report, to describe the service users. 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The records of medicines coming into the home, and those being returned, have improved. This was a recommendation made at the last inspection. It has now been met. Some redecoration of rooms and communal areas has taken place. The home is clean and well decorated. Staff now receive statutory training within six months of starting work at the home. 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 7 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. 1 St Alphege Road DS0000023757.V345917.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 1 St Alphege Road DS0000023757.V345917.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. Appropriate pre-admission assessments are made. This ensures that only those residents who are suited to the home and whose needs can be met are admitted to the home. EVIDENCE: Examination of documentation confirmed that appropriate pre-admission assessments are made prior to a prospective resident being offered a place at the home. Currently there are two vacancies. A prospective resident was due to make an overnight trial stay the weekend following this visit. The other residents were aware of this, said that they knew all about it. They were looking forward to meeting the prospective resident and seeing how they get on. There are sound admissions and assessment policies and procedures in place. 1 St Alphege Road DS0000023757.V345917.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, 8 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to make informed decisions about their lives and to take appropriate risks. They are involved as much as possible in the running of the home. This promotes independence and self esteem. EVIDENCE: The residents spoken to were aware of their care plans and are involved in any changes made to them. They take part in their reviews and are involved as much as possible in the running of the home. Most actively participate in the planning of meals, shopping and preparation of meals. Some do their laundry with support from staff. The home is now involving residents in the recruitment process. One resident sat on the interview panel when the most recent staff member was recruited. 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 11 Risk assessments are in place and residents are supported to be as independent as possible. Some go out on their own to take part in various activities in the community such as church services and Tai Chi. Residents said that they felt they could gain some independence whilst living in the home at the same time as feeling safe and supported. They said that the staff help them make decisions and explain any risks that might be involved in an activity in which they may wish to take part. Direct and indirect observation confirmed that staff interact well with the residents and give appropriate prompts and explanations. 1 St Alphege Road DS0000023757.V345917.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): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are supported to live interesting and fulfilling lives and to maximise their independence. EVIDENCE: The care plan of each resident was examined. All contained information about individual wishes, likes and dislikes. Whilst the care plans meet the National Minimum Standards, better recording of the goals and aspirations of the residents and clearer monitoring of progress could improve them further. Each resident takes part in leisure activities of their choice. The activities are varied, some enjoy arts and crafts such as pottery, whilst others enjoy more physical activities such as walking and Tai Chi. Residents go to concerts, enjoy music in their rooms, some are good at using computers and some like to go on shopping trips, particularly for clothes. 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 13 Staffing levels are such that staff are able to support the residents in their activities. Some residents are able to take part in some activities without the support of staff. Where possible, the residents are encouraged to walk or use public transport, however, the home does have it’s own car and this is used when necessary. Some of the residents talked about their families and the ways in which they keep contact with them. They said that visitors are made welcome to the home and that they can have guests for a meal if they wish. The home manages nutrition well. Healthy eating is encouraged and special diets are provided if necessary. Staff give appropriate support to those residents who need psychological support with eating. Direct and indirect observation confirmed that this support is given in a very sensitive and discrete way. The manager said that there is a good budget for food and that the residents help plan menus, help with food shopping and help prepare meals. Three residents were observed to be busy in the kitchen at lunchtime on the day of this visit. 1 St Alphege Road DS0000023757.V345917.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 a visit to this service. The home promotes the health and well-being of the residents and encourages them to take responsibility for their own healthcare. EVIDENCE: Care plans show that appropriate health and social care appointments are made on behalf of the residents. The home works to ensure these appointments are kept. Some residents require more support than others support to attend appointments. Some of the residents showed good insight into their health care needs. They were all in good health on the day of this visit. Those spoken to were in good spirits and expressed very positive feelings. Staff were observed to give very gentle and discrete support when necessary. Some residents require occasional hands-on personal care and staff give this with great respect for the privacy and dignity of the individual. 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 15 Each resident is assigned a “collator”. The role of the collator is similar to that of a key worker. The collator is responsible for ensuring health and social care appointments are made and kept, ensuring that care reviews take place and that appropriate contacts are made with visiting health and social care professionals. Since the last inspection the staff at the home have worked hard to gain more understanding about the causes of challenging behaviour. Direct and indirect observation showed that they are very good at giving emotional support to the residents and at understanding the triggers for anxiety. The staff work hard to diffuse tensions and allay anxieties. On the day of this visit, even though the process of inspection can create tension in the home, there was a very calm and inclusive environment. Since the last inspection the home has improved the way it records the ordering, storage and disposal of medicines. These records are particularly important as some of the residents self medicate. These records now meet the required standard. The residents who self medicate are given the appropriate reminders about medication. They said that they speak to staff if they have any concerns about the medicines that they are taking. 1 St Alphege Road DS0000023757.V345917.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 a visit to this service. There are sound policies and procedures for the handling of concerns and complaints, and for the protection of vulnerable adults. The views of the residents are listened to and acted upon and the home makes every effort to protect the residents from harm. EVIDENCE: Those residents spoken to say that they know how to complain if necessary. However, they said that they had no need to complain. They love living in the home and that they don’t want to move. One said, “The staff are very helpful and kind, if I have any worries I can talk to the staff.” Staff said that they are encouraged to advocate on behalf of the residents and would always be prepared to speak up on their behalf. They said that there is good teamwork in the home and that any day-to-day concerns are dealt with as they arise. There are regular residents meetings where residents can express their views. The home tries to involve all the residents in decision making about the home. 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 17 There is evidence on the staff files to show that staff have undertaken training in the protection of vulnerable adults (POVA). Staff are aware of these policies and procedures and said that they would have no hesitation in reporting concerns to the manager. 1 St Alphege Road DS0000023757.V345917.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 & 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 welcoming, clean and pleasant. This gives the residents a relaxed and homely environment in which to live. EVIDENCE: A tour of the home was made. Some bedrooms were viewed with the permission, and in the company of, the resident of that room. All areas of the home are clean and well decorated. Residents have been able to choose colour schemes and personalise their own rooms. There is plenty of communal space. There is a comfortable lounge, a pleasant dining room and a conservatory. The kitchen is large but homely and residents enjoy spending time here preparing meals. Outside there are gardens that surround the premises. These are divided into three small sections and provide two pleasant areas with seating and shade and one area with a small, but very productive, vegetable garden. 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 19 The gardens are well maintained and staff support the residents to take part in growing some of the vegetables for the home. The staff and residents are commended for the way they tend these gardens and use the produce. Since the last inspection temperature control valves have been fitted on the hot water taps. The water temperatures to all the bathrooms and wash-hand basins in the bedrooms are now at a safe level. Automatic closure fixtures have also been fitted to doors throughout the home. 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a stable and well-trained staff team. Staff morale is very good and recruitment practices are sound. This means that a skilled and well-motivated staff team supports the residents. EVIDENCE: Examination of staff files showed good evidence of appropriate training. Staff have undertaken both statutory and specialist training. Some have already achieved the National Vocational Qualification (NVQ) at level II or above. Some are currently undertaking this course. Staff praised the company for the support it gives to staff who want to achieve recognised qualifications such as the National Vocational Qualifications. 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 21 Recruitment practice is good. Inspection of staff files showed that all staff have been checked with the Criminal Records Bureau (CRB) and at least two references have obtained before a job is offered at the home. Residents are involved in the recruitment process. They are able to meet candidates informally. Recently, one of the residents has joined the manager and company representatives on the interview panel. Very positive feedback was given in respect of his involvement in this process. There is a good range of age, gender and skill mix amongst the staff. This reflects the age, cultural and gender mix of the residents. Conversation with staff members showed that they are knowledgeable about best care practice and the individual needs of the residents. Staff said that there are enough staff rostered each shift to meet the needs of the residents. The residents said that the staff are, “very good”. One said, “They understand us. Some here are quite ill and need a lot of support and the staff give it They also know when to leave us alone”. Another talked about the way the staff helped them with day-to-day problems. Staff were observed to give any help needed with patience and kindness. 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 22 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 a visit to this service. The views of the residents and their supporters are listened to and acted upon. This means that the home is run in the best interests of the residents. EVIDENCE: The manager of the home demonstrates a good understanding of best care practice and the individual needs of the residents. He is very open and honest. He was both helpful and informative during the course of this visit. Both staff and residents said that the home is well managed and that there is good communication within the home. They praised the company and the 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 23 manager of the home for the way they listened to their opinions and supported them. The manager has several years experience in the care of people with mental health problems both as a support worker and a deputy manager. It is clear that he understands the needs of residents and staff and has commanded their respect. However, there was a requirement placed at the last inspection for the manager to apply for registration with the CSCI and the registered providers have a responsibility to ensure that this regulation is met. The manager is now in the process of making an application for registration with the CSCI. The company must take responsibility for ensuring this application progresses in a timely way. Although the responsible individual visits the home on a regular basis, there has been a failure to ensure that the requirement placed at the last inspection has been met. This implies a deficit in the quality assurance mechanisms. There are sound systems to ensure that the general health and safety requirements of the home are met. 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 24 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 X 34 4 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 4 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 3 X 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA37 Regulation 8, 9 Requirement The application for the manager to register with the CSCI in accordance with the Care Standards Act 2000 to be progressed. This requirement is carried forward from the previous inspection with and extended action date. Timescale for action 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA37 YA41 Good Practice Recommendations The manager to continue to work to achieve the NVQ level IV The organisation of documentation should be improved to ensure there are no loose papers that could be mislaid or lost, as this would compromise confidentiality. 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 1 St Alphege Road DS0000023757.V345917.R01.S.doc Version 5.2 Page 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!