Inspection on 23/09/08 for 25 Alexandra Road

This inspection was carried out on 23rd September 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

25 Alexandra Road 06/10/06

25 Alexandra Road 28/09/05

25 Alexandra Road 19/04/05

25 Alexandra Road 07/12/04

25 Alexandra Road 21/07/04

25 Alexandra Road 06/05/03

25 Alexandra Road 06/05/03

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Extracts from inspection reports are licensed from CQC, this page was updated on 30/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 25 Alexandra Road 25 Alexandra Road St Leonards-on-sea East Sussex TN37 6LD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rebecca Shewan     Date: 2 3 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: 25 Alexandra Road 25 Alexandra Road St Leonards-on-sea East Sussex TN37 6LD 01424720749 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) East View Housing Management Ltd Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated will be three (3) The service users accommodated will be aged over eighteen (18) and under sixty-five (65) years on admission. Date of last inspection Brief description of the care home 25 Alexandra Road is a three storey terraced Victorian house in a residential area of St Leonards 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. 3 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place during the morning and afternoon of the 23rd September 2008. Incident reports, and the home’s Annual Quality Assurance Assessment (AQAA), held by the Commission for Social Care Inspection, were read before the inspection. The inspection of the home took five hours. A tour of the whole home was undertaken and the Appointed Manager was spoken with. Records such as care plans, staff files and medication records were also viewed. Three service users were accommodated at the home at the time of the inspection. The current range of fees charged by the home are from 709.76 GBP to 1006.07 GBP per week. There are additonal charges made for fuelling the minibus and this amount is varied dependent on individual use of this service. Care Homes for Adults (18-65 years) Page 5 of 26 Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 7 of 26 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate processes in place for assessing potential new service users, with services being offered to only those service users whose needs can be met. Evidence: East View Housing have a Senior Management Team who conduct all pre- admission assessments. Records inspected showed that Pre admission assessments had been carried out on all service users. Copies of care management assessments from placing authorities had also been obtained, where these exist. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service user care plans are comprehensive in detail and are suitable for meeting service users needs. Service users are encouraged to have control over their lives and to exercise choice and be independent in their decision-making. Risk assessments are satisfactory and encourage service user independence. Evidence: Care plans were viewed and it was noted that these were comprehensive, detailed in content and covered all aspects of service user’s needs and allows the assessor to gain a good overview of individuals medical, social and personal care needs. Care plans are devised and reviewed with service users involvement. There is a key worker system in place, so that each service user has a designated care worker to discuss care plan issues with. Care plans viewed reflected service users wishes and detailed how the home assist service users to make decisions about their lives and are designed around meeting the Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: service users physical/medical needs, as well as personal aspirations and goals that are within the service users limitations. Care plans are stored in a three ring binder format at the present time, this is currently being reviewed and the implementation of a Life Plan for every service user will be completed within the next few months. The life plan system is a concise document that contains all the relevant data for the individual service user and allows this information to be stored in one user friendly format. Records of accounts of service users monies were found to be well maintained. Service users, where able, are encouraged to maintain their own finances, whilst assistance is give to those who request it. Safes have been fitted to all service users bedrooms, ino rder to provide them with a secure place to store items that are important to them. Service users are encouraged to participate in the day to day running of the home. Each service user is aware of their structured activity and chores programme and staff assist service users, where necessary, to conduct their activities/chores/rest periods/skills learning at the agreed specified time. Suitable risk assessments were noted to be in place. The need to balance rights against health and safety is kept under constant review. Behavioural charts are also maintained and any limitations that behaviours may have on an individual service user are recorded and actioned. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users participate in an activities programme that is rewarding and stimulating. Service users individual programmes are varied and provide ample opportunities for personal development. The home provides good social, cultural and recreational facilities, including specialist diets to service users, with service user’s choice and wishes being respected. Evidence: Each of the service users has a programme of the activities that they participate in. Service users are encouraged to attend college courses/night classes. The home has the resources to access courses in: Cookery, employability courses, design and craft and IT, which are provided by Hastings College. Activities that service users participate in include: attendance to Reilly house (Day Centre operated by EVH) where they can attend sessions in Health and Beauty, trampolining, swimming, cookery, art and Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: Crafts, Drama, Music, Sports, Reporter Group, Ivyland Farm allotment and photography. External activities such as shopping, Social Clubs for: Bowling, Pool, Swimming and the gym are also available. Service users are encouraged to attend the cinema, Frimley Disco, Drama Groups and the theatre and other community related events. Programmes are designed to keep service users active through the day but there is ample leisure time in the evenings and weekends. At the present time there are no service users in active employment. Though access to resources to gain employment are in place and these are currently being utilised by service users who reside at the home. Service users are able to access the local community as part of their programme and as part of their leisure time. Service users religious wishes are observed and arrangements can be made to encourage service users to attend places of worship. The home believes in promoting an equal and diverse culture among staff and service users. Contact with family and friends is positively encouraged with visitors being able to attend the home at any time and in accordance with the service users wishes. Service users have access to all areas of the home to ensure that they have freedom of movement. Though this does not apply to the staff office/sleep in room. Permission to this area is sought prior to entry. Staff were observed knocking service users bedroom doors prior to entering. Service users are called by their preferred choice of address. Household chores/tasks are conducted by service users, with or without assistance. Such tasks are appropriately assessed and agreed in the service users individual care plan. The home’s menus are devised on a four weekly basis. All meals are home cooked with an alternative option available for each mealtime. Changes to menus can be made at service users request. Where able, service users are positively encouraged to cook their own meals or assist staff. Mealtimes can be varied upon request and service users guests are also welcome to have meals at the home. Medical, therapeutic or religious diets are provided as needed. Drinks and snacks are available at all times. Food shopping is conducted on a weekly basis and each service is encouraged to attend such shopping sessions. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are offered a good provision of health care and personal support by the home. Medication procedures ensure that all necessary precautions are taken to ensure errors do not occur and that medications are stored and administered safely. Evidence: Personal support that is offered is given in such a way as to promote and protect service users privacy and dignity, whilst promoting their independence. From the records sampled and from discussions with staff, it was evidenced that the health needs of service users are well met with evidence of good multi disciplinary working taking place. The Appointed Manager said that service users could be registered with a GP of their own choice or with one from the local surgery. Service users are encouraged to attend the GP surgery were able and home visits are conducted when necessary. Service users also have to the Community Psychiatric Nurse, Community Learning Disability Team, Diabetic nurse, Psychologist, Psychiatrist, Chiropodist, Dentist, Occupational Therapist, Physiotherapist and Optician. Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: The home has good procedures in place for the monitoring and recording of all drugs administered and those entering and leaving the home. The stores for medication were viewed and these were found to be maintained in a clean and orderly manner. The current stores for medication are being removed, as each service user has been supplied with a secure medication cabinet, which has been fitted in their individual bedrooms. There were no Controlled Drugs being held by the home at the time of the inspection. There is homely remedies procedure in place. Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a robust and efficient complaints procedure, whilst the homes procedures, processes should protect service users in the event of an allegation of abuse. In order to further protect service users, staff are required to receive up to date training in Safeguarding Vulnerable Adults. Evidence: The home has an established complaints procedure in place. There is a need for this to be amended in order to reflect that the CSCI can be contacted at any stage during a complaint. Therefore a Recommendation has been made. There have been no complaints received either by the home or the CSCI in the last twelve months. Both CRB and Protection of Vulnerable Adult (POVA) checks are carried out on all new staff. Staff have attended not training in the Protection of Vulnerable adults within the last twelve months. This was evident from the staff files that were viewed. Therefore a Requirement has been made. There has been one Safeguarding Alert raised in the last twelve months, which is currently being investigated. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides accommodation for service users that is appropriate, well equipped, safe, hygienic and odour free, whilst infection control procedures are adhered to at all times. Evidence: The location and layout of the home are suitable for its stated purpose. The home is well maintained and all areas of the home, including the garden, are accessible to service users. The home has an ongoing plan of refurbishment in place. The home has an infection control policy in place. The home was clean and odour free throughout. There is a daily cleaning schedule in place. Care Homes for Adults (18-65 years) Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a staff team that have the necessary skills and experience to the meet the needs of current service users. Staff are appropriately supported to conduct their jobs effectively. Evidence: There is a clearly defined staff team and service users are aware of staff roles and responsibilities. A competent staff team meets the service users needs. There is a staff rota in place, which details staff designations and hours of working. The home has a permanent staff team of one full time care worker. All other staff hours are covered by care staff from other homes within the EVH company or by agency staff. Therefore the previous inspection requirement that that the Responsible Individual and the manager must ensure there is sufficient numbers of staff employed within the home to support residents at all times, and have the skills to ensure residents needs and aspirations are met has been actioned. Staff recruitment files were viewed and it was evidenced that these files did not contain all items required under the Care Homes Regulations 2001. Items such as proof of identity and a recent photograph were observed to be missing. Therefore a Requirement has been made. The home has an Equal Opportunities policy in place and Care Homes for Adults (18-65 years) Page 19 of 26 Evidence: is an equal opportunities employer. Individual staff training files were viewed and it was evident that staff training in Induction, Health & Safety, Food Hygiene, Protection of Vulnerable Adults, Fire Safety and Medication. Additional Training is also provided in LDAF (Learning and Disability Awards Framework) subjects and NVQ. The staff induction-training package was viewed and this was found to be comprehensive in content. Staff records viewed confirmed that staff are regularly supervised, both formally and informally. Care Homes for Adults (18-65 years) Page 20 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is good, with evidence of consideration being given to resident’s choice and opinion, whilst the health, safety and welfare of service users and staff is protected at all times. Evidence: The Appointed Manager is in her first week of post, having been promoted from the role of Deputy Manager. The Appointed Manager is currently in the process of obtaining her CRB check, in order to make application to become the homes Registered Manager. She has NVQ levels 3 and 4 and has obtained the Registered Managers Award in Health and Social Care. The Appointed Manager has also conducted training in Team Leading, Management Skills, Staff Motivation, the Mental Capacity Act, Deprivation and Liberties and Conflict Management. EVH has suitable Quality Assurance procedures in place. A recent service user survey has been conducted, the results of which are yet to be correlated and published. The appointed Manager states that Regulation 26 Providers visits are conducted, however Care Homes for Adults (18-65 years) Page 21 of 26 Evidence: the reports for such visits were not on file. Therefore a Requirement has been made. Staff meetings are held two monthly and on an as required basis, minutes of which are maintained. Service user meetings have not been held since December 2007. The Appointed Manager has plans in place to recommence such meeting once she is established in her role. The homes AQAA was completed and returned to the CSCI in a timely manner. The home’s maintenance files were viewed and it was evident that fire drills, fire alarm testing and fire equipment checks, health & safety checks and water checks had been carried out. There were no health & safety issues noted at the time of this inspection. Care Homes for Adults (18-65 years) Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 18 That all staff receive training 23/12/2008 in Safeguarding Vulnerable Adults. In that staff have not received Safeguarding training in the last twelve months. 2 34 19 That all staff recruitment files are updated to include all items specified by this regulation and the associated schedules. In that staff files do not currently include proof of identity and recent photographs. 23/11/2008 3 39 26 That a copy of the 23/11/2008 Regulation 26 Provider Visit, is suppl;ied to the Appointed Manager and kept within the home. In that Regulation 26 visit reports were not available for inspection, providing insufficient evidence to Care Homes for Adults (18-65 years) Page 24 of 26 confirm that such visits are conducted. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 22 That the homes Complaint procedure is amended to reflect that, in the event of a complaint the CSCI can be contacted at any time. Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!