Inspection on 04/08/06 for 1 St Alphege Road

This inspection was carried out on 4th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but 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 17/07/07

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 Joseph Harris Unannounced Inspection 4th August 2006 09:30 1 St Alphege Road DS0000023757.V304891.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.V304891.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.V304891.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) 020 8780 9686 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.V304891.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th December 2005 Brief Description of the Service: 1 St Alphege Road is a 7 bedded home supporting people with enduring mental health problems. The service is owned and managed by United Response, which is a national charitable organisation specialising in the fields of mental health and learning disabilities. The house is on a residential road close to the centre of Dover, which has relatively good amenities and public transport links. The premises are set over 4 floors and provide adequate space throughout for service users. All of the bedrooms are single occupancy and there are number of well appointed communal lounges and spaces. There are attractive gardens surrounding the building that are reasonably well maintained. 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 current fees for the service at the time of the visit are £770.92. Information on the Home services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. The e-mail address of the home is dover.east@unitedresponse.org.uk 1 St Alphege Road DS0000023757.V304891.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on the 4th August 2006 and lasted for around 5.5 hours. During the course of the inspection discussions were held with the service manager, staff and service users. A tour of the premises was undertaken and a range of documentation and records were viewed relating to the running of the home, service users and staff amongst other things. What the service does well: What has improved since the last inspection? A new service manager has been appointed within the last 6 months, having previously worked as the Deputy Manager. He has managed to introduce some improved ways of working in a relatively short space of time. The staff team of reviewed and redeveloped the care and support plans, which now provide a very good level of information detailing the support to be provided to individual service users. This process has also applied to individual risk assessments. All previous requirements have been addressed, including efforts to improve the level of staff training and update recruitment files. The service manager has also re-established supervision systems providing staff with regular formal support. 1 St Alphege Road DS0000023757.V304891.R01.S.doc Version 5.2 Page 6 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. 1 St Alphege Road DS0000023757.V304891.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 1 St Alphege Road DS0000023757.V304891.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Service users are given information about the home prior to moving in. Individual needs and aspirations are assessed. The home can meet the individual needs of service users. Prospective service users have the opportunity to ‘test drive’ the home. Each individual is provided with a written contract. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A clear and accessible statement of purpose and service user guide has developed providing information about the service. Both documents contain all required and relevant information and are provided to service users and their representatives. Most of the service users are referred through care management/CPA processes and the most recent care plans, risk assessments and background information is obtained. All prospective service users have their needs, aspirations and suitability for the home adequately assessed using an assessment tool which addresses holistic needs. The prospective service user is invited to the home and is able to spend time on short visits ranging to overnight and longer stays allowing the service user to become acquainted with the home, staff and other residents and to determine the suitability of the service. There is a relatively experienced and enthusiastic staff team who are provided with suitable to training to enable them to meet the needs of the service users. The home also has established reasonable links with local community health services including the mental health services. 1 St Alphege Road DS0000023757.V304891.R01.S.doc Version 5.2 Page 9 The home provides each service user with a written contract detailing the terms and conditions of residency covering all required elements including fees. 1 St Alphege Road DS0000023757.V304891.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10. All service users have an individual plan of care and support. Staff enable residents to make decisions affecting their lives. Residents are encouraged to participate in the daily running of the home. Service users are supported to take responsible risks. Information is maintained in a confidential manner. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An individual plan is developed for all service users addressing needs and aspirations. The home has worked hard to improve these plans, which address all aspects of support in an informative and coherent manner. Three service user plans were examined at random and it was evident that sufficient information is provided to ensure that the assessed needs are adequately addressed and there is clear guidance for staff to meet those needs. The plans are regularly reviewed and updated as required. Residents are enabled to make decisions affecting their daily lives and are encouraged to participate in the day-to-day running of the home. If limitations or restrictions occur they are agreed and discussed with the multi-disciplinary 1 St Alphege Road DS0000023757.V304891.R01.S.doc Version 5.2 Page 11 team and service user. There is information available regarding advocacy services and resident meetings regularly take place. Service users are supported to manage their own finances and where an appointee is required they are independent of the service. Service users confirmed that they can take an active role in the running of the home including resident meetings, household chores, staff interviews and menu planning and preparation. The home has introduced a robust risk management process enabling residents to take responsible risks. Risk assessments are completed for all individuals providing adequate detail to enable staff and service users to minimise risks and are regularly reviewed. All information is maintained in a confidential manner. Records and documents are securely managed and staff have an awareness of confidentiality issues underpinned through induction and training. 1 St Alphege Road DS0000023757.V304891.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. There are opportunities for personal development and participation in meaningful activities. Service users can choose from a range of leisure activities and are supported to be part of the local community. The rights and responsibilities of individuals are recognised and visitors are welcomed into the home. A healthy, balanced diet is provided. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users have access and opportunities to take part in a range of activities, both recreational and therapeutic. Staff work with residents on an individual level assisting and supporting daily living skills. Service users have opportunities to attend external centres and resources including local colleges, the Community Mental Health Centre OT department and other groups. Many service users access the local town and facilities independently or with support as required. 1 St Alphege Road DS0000023757.V304891.R01.S.doc Version 5.2 Page 13 Visitors are welcomed into the home at all reasonable times and there is adequate space for people to meet in private should they wish to do so. Service users are enabled to maintain and establish relationships with others. Residents are consulted and participate in the process of planning, shopping and preparing menus. Records demonstrate that a healthy, balanced diet is provided. 1 St Alphege Road DS0000023757.V304891.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Service users receive appropriate levels of personal support in the manner of their choosing and healthcare needs are met. Medication processes are well managed and administered appropriately. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff ensure that those residents who need some assistance with personal support receive it in a manner that meets their preferences. Service user plans address personal care needs in good detail and staff demonstrated a clear understanding of individual needs. Residents confirmed that they are able to determine their own daily routines and are supported in this by the staff. Residents have access to all relevant healthcare professionals and are supported, where required, to attend appointments and consultations. Additional healthcare services such as chiropody and dentistry are offered on a regular basis. The home has established reasonably good links with the local community mental health team and other healthcare professionals. The home has well-established and maintained medication systems, although it was noted that administration records could be improved. Staff are given induction training regarding medication and attend additional external training before administering medications. Medication records were examined and were 1 St Alphege Road DS0000023757.V304891.R01.S.doc Version 5.2 Page 15 well kept and up to date, but the MAR sheets do not enable staff to sign for individual medications and this area should be addressed. Refer to recommendation 1. Storage facilities are adequate and suitably sited. Service users, where assessed, are supported to manage their own medication. 1 St Alphege Road DS0000023757.V304891.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. The home has an adequate complaints process in place. Service users are protected from forms of abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a clear and effective complaints process in place, which is accessible to residents, staff and visitors. A record of complaints is maintained and it was reported that no complaints have been received since the last inspection. Residents stated that they feel able to approach the staff and manager and said that they would know what to do if they had a complaint or concern. There are adequate policies and procedures in place relating to protection from forms of abuse and adult protection. Staff are given induction and formal training in this area and demonstrated a satisfactory understanding of issues surrounding abused and adult protection. There have been no adult protection concerns raised since the last inspection. The registered manager demonstrated a good understanding of his responsibilities under relevant legislation in this respect. 1 St Alphege Road DS0000023757.V304891.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. The premises are comfortable, homely and well-maintained. The home is clean and hygienic. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is well-maintained, clean, comfortable and homely. There is a good range of communal space including two lounges, one of which is a designated smoking area, a dining room and a conservatory. There is an attractive garden to the side and rear of the property. All of the bedrooms are single occupancy and meet relevant guidance in terms of size, furniture and fittings. There is a well appointed kitchen with adequate facilities and suitable laundry facilities. The home has a number of bathrooms and toilets throughout the building. The premises are bright, well-ventilated and furnished and decorated to a good standard. A semi-independent flat has been developed on the top floor, which is not currently in use. The home was clean and hygienic at the time of the inspection visit. It was reported that the home complies with relevant legislation including, fire, environmental health and water fixtures and fittings. Policies and procedures are in place to prevent the spread of infection. 1 St Alphege Road DS0000023757.V304891.R01.S.doc Version 5.2 Page 18 1 St Alphege Road DS0000023757.V304891.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. Staff have clear roles and responsibilities and undertake NVQ and additional training. There are adequate numbers of suitably experienced staff on duty at all times. Staff receive required mandatory training and other additional courses, although some updating is required. The home’s recruitment processes are satisfactory. Staff receive appropriate levels of support and regular supervision. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff receive a copy of the job description when appointed in post, which is reviewed as required. Staff stated that there is a good understanding of the roles and responsibilities of all involved in the running of the service. The manager effectively delegates duties and is supported by a recently newly appointed deputy manager. Service users stated that they have positive relationships with the staff team and feel well supported. The organisation promotes NVQ training and professional development for staff and over 50 of the team have achieved NVQ level 2 or above. All new staff are expected to undertake NVQ training. Through discussion with staff it was evident that good principles of care are understood and competency in all aspects of working within a care home setting. 1 St Alphege Road DS0000023757.V304891.R01.S.doc Version 5.2 Page 20 There are adequate numbers of staff on duty at all times. The manager is generally on duty throughout office hours. There is a minimum of 2 care staff on duty throughout the day and a staff member sleeping-in every night. The staffing levels are relatively flexible and additional staff are on duty in response to the needs of the home. The home provides mandatory training for all staff, although there were a few areas which required updating for a number of staff, which is being addressed. Other training courses are also provided including mental health awareness, adult protection and equal opportunities amongst others. Refer to recommendation 2. Three staff files were examined at random, which demonstrated that satisfactory recruitment processes are in place. All necessary checks are completed including CRB and POVA along with two written references, proof of identity and completed application forms as well as other relevant documentation. The manager has re-established a supervision structure and staff receive 1:1 formal supervision sessions at least every two months. Staff reported that they feel supported and there is a positive culture of peer and managerial support. 1 St Alphege Road DS0000023757.V304891.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. The service manager has a good level of experience, but needs to complete the registration process and complete the Registered Managers Award/NVQ 4. There are good quality assurance measures in place. The health, safety and welfare of service users is promoted. EVIDENCE: The service manager has now been confirmed in post for around 6 months. He has many years experience working within the field of mental health both as a support worker and, latterly, as a deputy manager at St Alphege Road. He has demonstrated since appointment positive management skills and has continued to develop the service and enable staff to take an active role in the running of the home. Service users commented that he is approachable and open. The manager should now progress through the registration process with the Commission and work towards achieving his NVQ 4/Registered Manager Award. Refer to requirement 1. The home and organisation has instituted robust quality assurance processes. The home is managed by United Response, which is a national charitable organisation and has a clear management structure with strong lines of 1 St Alphege Road DS0000023757.V304891.R01.S.doc Version 5.2 Page 22 accountability. The area manager visits the home at least on a monthly basis and completes Regulation 37 monitoring visits, which are made available to the Commission. There is clear evidence of service development including plans for a semi-independent flat and an outreach service. A programme of routine maintenance and refurbishment is planned on an annual basis. Systems are in place to get feedback from service users and stakeholders regarding the service through quality monitoring visits, satisfaction questionnaires and residents meetings. The home maintains clear and consistent health and safety records. Fire safety records were up to date and maintained as were the accident records. All routine maintenance checks were completed with records retained on file. Environmental risk assessments were also in place and are reviewed. Adequate systems are in place to ensure safe working practices. 1 St Alphege Road DS0000023757.V304891.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 3 2 3 3 3 4 3 5 3 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 3 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 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 2 X 2 X 3 X X 3 X 1 St Alphege Road DS0000023757.V304891.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 YA37 Regulation 8, 9 Requirement The service manager to progress through the registration process and work towards his NVQ 4/RMA. Timescale for action 01/12/06 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 YA20 YA35 Good Practice Recommendations To update medication administration records ensuring that all medication can be individually signed for by staff. To ensure all staff receive required mandatory training within the first 6 months of employment and periodical updates thereafter. 1 St Alphege Road DS0000023757.V304891.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 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.V304891.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. 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