CARE HOME ADULTS 18-65
25 Alexandra Road St Leonards-on-Sea East Sussex TN37 6LD Lead Inspector
Jeanette Denereaz Unannounced 19 April 2005 16:00 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 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 Stationary 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. 25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service 25 Alexandra Road Address St Leonards-on-Sea East Sussex TN37 6LD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01424 720749 East View Housing Management Ltd Vacant Care Home 3 Category(ies) of Learning disability (LD) 3 registration, with number of places 25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of residents to be accommodated will be three (3) 2. The people accommodated will be aged over eighteen (18) and under sixtyfive (65) years on admission Date of last inspection 7 December 2004 Brief Description of the Service: 25 Alexandra Road is a three storey terraced Victorian house in a residential area of St Leonard’s on sea. It benefits from a small patio garden to the rear of the property that is accessed only through the kitchen. The home is conveniently situated a short distance from local amenities, including public transport and shops. The home is part of the East View Housing Organisation (EVH) and three male service users with learning disabilities are in residence. 25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1st 2005 to March 31st 2006. The visit lasted from 16:00 until 19.00. The home has three service users, who wish to be referred to as residents in this report The visit was spent talking directly with all residents privately and collectively; and the team leader who is managing the home in the absent of a registered manager. Some judgements about quality of life and choices were taken from direct conversation with service users and observation followed by discussion with the team leader and evidencing records held at the home. A tour of the premises was undertaken. What the service does well: What has improved since the last inspection?
Since the last inspection the home now has benefited from a more stable staff team. The team leader Ms Tina Meehan has now been post for 4 months, and she will be making application to become the registered manager. The home has reviewed the security of residents’ money and money that was taken has been replaced. There is a new cupboard with good security locking and the office door is now locked when not being used. The home recognised and responsed appropriately to the issues of residents staying out late and other attention seeking behaviours, following risks assessments procedures are in place. The resident spoke to the Inspector and openly expressed the seriousness of his actions of staying out late, and seemed willing to be guided and supported by the staff.
25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 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. 25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 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 standard(s) 2,3 & 5 Service users are given all the information they need to be able to make an informed decision to live at 25 Alexandra Road The home has a homely environment, and residents are very relaxed and confident within the home. EVIDENCE: There has not been a new resident to the home since the last inspection, however, the home has a comprehensive policy and procedures in place for prospective residents. The home is part of the East View Housing organisation and has detailed policies and procedures in place for prospective residents. The team leader is fully aware of the procedures and detailed the process for a new resident, including the pre-assessment of needs, visits to the home and meeting the other residents. All residents living in the home have copies of their contract, statement of purpose and ‘service users’ guide. The purpose for these documents has been explained to the residents. 25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 Page 9 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 standard(s) 6,7,8,9 & 10 All residents are treated with genuine respect and dignity by support staff. Individual health and social care needs are well supported. EVIDENCE: The home was found to meeting the assessed and changing needs of the residents. There have been difficult times since the last inspection, with a resident challenging the support regarding his personal safety and his respect for other residents’ belongings. The home has appropriately response to the challenge and procedures have been put into place to protect and support all residents to continue to have independent lifestyles. All residents were interviewed and they expressed their satisfaction with the support they received from the staff. One service user recognised he had a difficult time, but felt supported by the staff. He explained in detail to the inspector the routine for him returning home from visiting friends, this was also detailed in his care plan with other detailed protocols for his safety, well being and the well being of others. The home has reviewed the security of money held in the home, and this was inspected and found to be adequate and documents were now in a locked cabinet.
25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 Page 10 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 standard(s) 12,13,14,15,16 & 17 Residents are encouraged to make choices about all aspects of their daily lives, through a range of activities in the home and local area. EVIDENCE: It was evident during this inspection was this is a very busy home. Residents are very involved in the running of the home, and have busy social lives in the community. The residents are able to make a range of choices about their lives, and consideration is given to their views about the routines in the home including shopping and menus. They all help with the cooking of the meals and the cleaning of the home in general. Records showed a set pattern of preferred meals over the week. The residents spoke openly about the their lives at 25 Alexandra Road and living in Hastings. They have local knowledge about the community and enjoy a variety of social activities. All this information was recorded in their care plans. One resident expressed his dissatisfaction with his day service, the team leader was fully aware of this situation and enquiries and referrals were in place for him to have employment in a horticultural setting which is his wish.
25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 Page 11 Residents are support to maintain family links and friendships. Two residents have frequent contact with their family, and one resident has a girlfriend who he frequently visits. He was staying out late, but now has a detailed risk assessment and procedure in place for returning home at night and he seemed to fully understand the reasons for this procedure. He explained to the Inspector that the staff and his girlfriend’s mum worry about his safety being out late at night. He has been returning home within the agreed times. This situation is continuously monitored by the home. On the evening of the inspection the previous manager had called in to see the residents, they spent time in the garden, having a cup of tea and discussing the day. 25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 Page 12 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 standard(s) 19 & 20 Service users are treated with genuine respect and dignity by support staff. Individual health and social care needs are well supported. EVIDENCE: Through discussion with individuals and sharing of care plans, it is clear that residents are given full support and encouragement is given to maintain personal contact with the Learning Disability Community team (CLDT) Psychiatrist and consultants as well as chiropodist and GP to maintain good standards of health and well being. A resident shared his recent experience of taking paracetamol without staff knowledge. The home acted promptly, and the resident was taken to hospital, the incident was recorded and all regulation bodies were informed. Following this serious incident the home needs to review the medication policy on self administer of medication and include the risk of residents buying drugs from pharmacies and other shop outlets. All risk assessments and reviewed documentation to be sent to the CSCI. 25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 Page 13 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 standard(s) 22 & 23 Residents feel confident raise concerns to complain, as they know they will be listened too and action taken to resolve them. Protection from abuse is promoted through staff training and understanding of the support and actions they may need to take. EVIDENCE: Residents stated that they knew who to talk to if they had a concern or wished to make a compliant, this included support staff, The Responsible Individuals, and the Inspector. Copies of the complaint procedure are available in the home. 25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 Page 14 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 standard(s) 24,25,26,27,28 & 30 Service users live in a warm, nicely decorated and clean home. However, in the small back garden the ground around the patio area is uneven and residents are finding it difficult to use this area. EVIDENCE: The home is well presented, homely and clean. Residents talked about and undertook daily chores and cleaning during this inspection. The team leader was seen to be supportive giving guidance and physical assistance where needed at a pace the service users could manage safely. Ongoing issues remain regarding the paved area of garden are still outstanding from the last inspection and there are areas of repair and decoration to the hallway still to be done. It was noted that new sofas have been purchased for the lounge. 25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33 & 35 Service users benefit from the support of competent and skilled support staff, resulting in good morale and enthusiasm to improve their whole quality of life. EVIDENCE: The home now has a stable staff team, with one staff member working between two homes in Alexandra Road. The resident showed signs of stress at the last inspection, but they were very settled and all said they really liked having Tina (Team Leader) working at the home. Comments made were “Tina is wonderful”; “She is a good laugh”. The home had benefited from the influence of a ‘woman’s touch’ especially for one resident who had brighten up emotionally and physically over the last few months, he assured the Inspector that he was happy now and that he really liked Tina being at the home. 25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,40 & 42 Residents personal preferences, support and care needs are encouraged through the team leader’s open leadership and the promotion of a safe home and working environment. EVIDENCE: The team leader has worked with this service user group for over two years at other EVH establishments and is currently working towards her NVQ 4 and then the Registered Managers Award. She will be making application to become the manager of 25 Alexandra Road, and make application to the CSCI to be the registered manager. The residents felt the team leader is very approachable, unfortunately the view of staff member were not sought at this inspection, as the team leader was the only member of staff on duty. However, supervision records were inspected and were found to open, frank and informative, giving the impression of a cohesive staff team. The team leader demonstrated through discussion a very clear understanding of the current needs of residents. Monitoring health and safety in the home is
25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 Page 17 to a good standard, with weekly health and safety checks taking place, and equipment serviced as required to maintain a safe home and facilities. Risk assessments are completed for individuals and staff activities in the home and care duties. 25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x 4 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 2 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
25 Alexandra Road Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x 2 x H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 Page 19 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 20 Regulation 13(2) see Schedule 3(3)(i) Requirement Timescale for action 1/06/05 2. 24 13(4(a) 3. 28 23(2)(o) It is required that with reference to the resident buying proprietary drugs that a risk management framework is put into place to safe guide the misuse of this medication. This risk assessment to be sent to the CSCI. It is required that the entrance 1/08/05 hallway and skirting is repaired and decorated to keep the home well maintained. It is required that the outside 1/07/05 backgarden patio area is levelled and becomes a usable space for service users. 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. Refer to Standard Good Practice Recommendations 25 Alexandra Road H59-H10 S21320 25 Alexandra Road V219164 190405 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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