CARE HOMES FOR OLDER PEOPLE
Alban House 8/10 Apsley Terrace Highfield Road Ilfracombe Devon EX34 9JU Lead Inspector
Susan Taylor Unannounced Inspection 15th November 2005 11:00 X10015.doc Version 1.40 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 Alban House DS0000022139.V253070.R01.S.doc Version 5.0 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 Older People. 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. Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Alban House Address 8/10 Apsley Terrace Highfield Road Ilfracombe Devon EX34 9JU 01271 863217 NO FAX fran@albanhouse.co.uk 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) Mr David Svenson Mrs Frances Svenson Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Mental registration, with number disorder, excluding learning disability or of places dementia (21), Mental Disorder, excluding learning disability or dementia - over 65 years of age (21), Old age, not falling within any other category (21) Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. MD age range 40 years and over The total number of registered placements is 21 (twenty one) Date of last inspection 17th August 2005 Brief Description of the Service: Alban House provides accommodation and varying degrees of care and support for 21 service users over the age of 40 years. The home promotes independence, choice and respect. The property is situated in the residential area of the coastal town of Ilfracombe. It is close to the facilities of the town centre and is easily accessed to all areas by local transport. The accommodation is provided on four levels and is unusual in that it is a large terraced house, which was formerly three separate houses converted to make one. The home is in the process of being updated and completely refurbished by the owners. There are a variety of private rooms and communal areas. All of the bedrooms are single, some with ensuite facilities. A shaft lift provides access to all areas. The home has accommodated service user’s pets where possible. Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took three hours over one day. The purpose was to follow up a recommendation made at the last inspection, and key standards management of medication, covering lifestyle, complaints and protection and management issues. The inspector looked at records, policies and procedures. A tour of the building took place. Nine residents gave their views of the home to the inspector. Three staff and the registered persons were interviewed. The people living at Alban House told the inspector at the last inspection that they preferred to be referred to as ‘residents’. Therefore, this term is used throughout the report. What the service does well: What has improved since the last inspection?
Staff who had not undergone training to protect residents from abuse have done so since the last inspection. Alban House DS0000022139.V253070.R01.S.doc Version 5.0 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. Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 The handling of medication in the home is well managed to provide the best outcomes for the residents. EVIDENCE: All staff administering medication have a good level of knowledge of the system in use. All medication is taken to the residents for administration to take place and it is recorded immediately after administration. There are risk assessments in place for all residents looking after any of their medicines and secure storage space are provided. Hand written entries made on the Medication Administration Record (MAR) charts are only signed by one person and dated. There is a record of ordering of medicines and all receipts of medicines into the home are recorded. No medicine requiring refrigeration was present and information about its storage if needed was discussed Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The personal input from the registered persons ensures that there are varied and interesting activities to suit individual resident’s expectations, preferences and capacities at Alban House. There are few restrictions, which help residents feel completely at home and free to do whatever they like. Families and friends are considered an important part of residents lives and are encouraged to visit. Meals are varied, appetising and provide residents with plenty of choice. EVIDENCE: The inspector observed residents involved in various activities during the day that included handicrafts, reading or going out to the pub. One person said that they had enjoyed being taken to see a show at the local theatre the previous week. Another resident told the inspector that the owners had recently driven them and a friend to Cardiff to go to a concert there. Staff told the inspector that as key workers they were encouraged to find out what interests people had and tried to fulfil their wishes. Several residents verified that they regularly went to church, pubs, clubs and adult education classes. Resident’s comments about the home were very positive and included: “If I don’t like what’s on offer I can have anything I like [re menus]”. “There’s no
Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 11 rules really, only one is that we must not smoke in the bedrooms”. “I’ve been on lots of trips to South Devon – Paignton Zoo and the Plymouth aquarium” Staff and residents told the inspector that visitors were welcome. One person said, “You greet people as you would in your own home”. The inspector observed lunch being served. Alternatives were offered for all courses of the meal. Positive comments were made to the inspector about the lunch such as “This is lovely” and “I really enjoyed my lunch”. The record of meals provided demonstrated that meals are varied, and alternatives are offered at every sitting. A resident showed the inspector where food supplies are stored and said “We can help ourselves if we get hungry, none of this is locked off to us”. The inspector saw that food supplies were plentiful. Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 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 Policies, procedures and training to protect residents from abuse are evident at this home. EVIDENCE: Standard 18 was not fully inspected. At the last inspection, it was recommended that all staff should receive training about adult protection matters. The inspector read the training file, which demonstrated that staff had covered adult protection issues whilst doing NVQ’s. For those staff who had not commenced NVQ’s, adult protection training had been provided since the last inspection. Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35, 38 Quality assurance systems are in place that enables residents to contribute towards the continual improvement of the home. Resident’s financial interests are safeguarded by accurate record keeping, policies and procedures. The health and safety of residents, staff and visitors is promoted over and above what is required by law. EVIDENCE: The inspector observed that residents were actively encouraged to give their opinions about life at the home. One resident told the inspector “they are always asking us for suggestions about how things can be improved”. Three staff verified that they regularly had team meetings to discuss practice, training and development issues. The Commission received a copy of the annual quality assurance report that had been circulated to residents and families also. From this, the home had set out a development plan that reflects the aims and outcomes for residents.
Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 16 Two records relating the management of resident’s money were inspected. Balances had been kept that showed a running total of money available. Receipts corresponded with records kept. The entries did not have two signatures denoting withdrawals. This is recommended. Health and Safety records inspected demonstrated that the registered persons prioritise this issue and their input to minimising risks is over and above what is required by law. A monthly check of the premises and equipment had been done by one of the registered persons. Risk assessments had been completed and were regularly reviewed. Actions taken to minimise risks were clearly documented. The electrical system had been inspected and a compliance certificate was seen. Engineer’s reports showed that regular maintenance had been carried out on the lift and other equipment in the home. Manual handling training had been provided for staff during 2004/5, and certificates were seen on four personnel files. Fire training had been provided for all staff in 2005. Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 x x 4 Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 18 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. Standard Regulation Requirement Timescale for action 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 OP9 Good Practice Recommendations It is recommended that when an entry is hand written onto the Medicines Administration Record chart that this is signed and dated by the person making the entry and it is then checked and countersigned by a second person. Two people should also sign the record of receipt. Ensure that balance sheets have two signatures denoting when residents make withdrawals of money. 2 OP35 Alban House DS0000022139.V253070.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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