Inspection on 27/01/08 for Alban House

This inspection was carried out on 27th January 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

Alban House 30/01/07

Alban House 15/11/05

Alban House 17/08/05

Alban House 26/01/05

Alban House 24/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Alban House 8/10 Apsley Terrace Highfield Road Ilfracombe Devon EX34 9JU     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: Joanne Walsh     Date: 2 7 0 1 2 0 0 9 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. that people have said are important to them: They reflect the things 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 Older People 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 Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 Older People Page 3 of 27 Information about the care home Name of care home: Address: Alban House 8/10 Apsley Terrace Highfield Road Ilfracombe Devon EX34 9JU 01271863217 NOFAX fran@albanhouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Frances Svenson,Mr David Svenson Name of registered manager (if applicable) Mrs Frances Svenson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: MD age range 40 years and over The total number of registered placements is 22 (twenty two) Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 27 care home 22 Over 65 22 22 22 0 22 0 Brief description of the care home 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 users pets where possible. Copies of previous inspection reports are available in the home. Fees charges can be obtained directly from the home. Care Homes for Older People Page 5 of 27 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place on a week day in January and lasted approximately 7 hours. During this time eight people who live at the home were asked for their views about living at Alban House, care practice was also observed. We also spoke with staff on duty and looked at some of the key documents. These include, assessments, plans of care, medication records, staff recruitment and training files. Prior to this inspection we sent surveys to a sample of people who live at the home, to staff and to health care professional who visit the home. Their views and comments from face to face interviews have been included throughout this report and have helped to inform the inspection process. Care Homes for Older People Page 6 of 27 The home was asked to complete an Annual Quality Assurance Assessment (AQAA), which provides us with information about how the providers maintain a safe environment, train staff and ensure the health and safety of the people who live at the home as well as their staff group. The information in the AQAA helps us to make judgments on the quality outcomes. 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 Older People Page 8 of 27 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 Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. New people are only admitted once an assessment has taken place to ensure that Alban House can meet assessed needs Evidence: The pre admission assessment information was looked at for the two newest people to the home. The registered manager will, where possible always try to visit the person in their own home or hospital and talk to them and/or their relatives and carers to establish the agreed needs and how staff will support these needs. The assessment ensures that good basic information is captured in respect of personal, health care and to a more limited point their social needs. This enables the home to make a decision about whether they can meet assessed needs and to plan for the care and support to be in place. One of the newer people to the home came to visit and assess for themselves Care Homes for Older People Page 11 of 27 Evidence: whether the home would be suitable. The home are aware that where individuals are funded, that the care management assessment and care plan need to be obtained as this forms part of their assessment information. Staff spoken to confirmed that they are given information about new people moving into the home, so that they can plan for their care and support. Care Homes for Older People Page 12 of 27 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Individuals personal and health care needs are well met. Evidence: Three peoples plans of care were looked at and discussed with the senior staff member and with care staff on duty. The home have been using a cardex system for planning care for just under a year. They adopted this in response to staff requests to have all individuals information in one place. Although they have found some benefit to this system, they have needed to add significant forms and details to it to ensure that they have covered all areas. This has included more detailed risk assessment forms to ensure that they have covered all risks identified with providing personal and health care to individuals with complex needs. The plans of care do detail what individuals needs are and how they will support these needs, but they are very task centered and could be improved by including more detail about individuals preferences and choices such as preferred daily routines, social history and any diverse needs. Care Homes for Older People Page 13 of 27 Evidence: Daily notes kept show that individuals have their health care needs well met. People spoken to also confirmed that they were supported to maintain good health. One person said The staff are very good, they make sure I get to all my doctors appointments, which I would forget or not be able to get to without them. Another person said that they had visits from the community nurse team and have been assisted to go to see their GP and hospital appointments. The staff team spoken to appear to have a good understanding of the needs of individuals who currently live at the home. The senior staff team ensure that if specialist advice and/or support is needed for a particular person, that make contact. The assistant manager gave an example of how they have made links with a specialist unit for people with a particular illness to ensure that they are providing the right support and to seek further advice on various aspects of the condition. Comment cards from two health care professions were received and they both gave positive views. One commented Alban House is a home where respect and dignity is afforded to every client; all of the time. Clients are encouraged to live the life they choose. I am very impressed by the dedication to meeting clients differing needs; and their ability to manage problems in a person centered, positive manner. Surveys received from people who live at the home also gave positive comments and most ticked always to the question do they get the support they need and the medical support they needed. During this inspection the medication system for storage and recording was checked. Medications are kept secure in a locked medication trolley that is kept in a locked room. They do not currently have anyone on controlled drugs but are aware of what they need to have in place should anyone be prescribed controlled drugs. The records relating to the administering of medications appears well recorded and accurate and only staff that have been trained in the safe handling and administration of drugs do the dispensing. Individuals who wish to self medicate can do so after a risk assessment has been completed. There are several people who have their own medications and the risk assessments for these are reviewed as part of the regular review of their plan of care. Care Homes for Older People Page 14 of 27 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. The routines of the home are flexible and individuals social needs are reasonably well met. Evidence: During this inspection individuals were observed being supported to get up and spend time where they chose. People spoken to said that they could choose when and what they did throughout the day. One visiting relative confirmed that visitors were made welcome throughout the day and that they could see their relative where they chose. The home does not have a list of daily activities, but has been trialling a weekly activity group with varying degrees of success. Some individuals enjoy going out and about in the local town and throughout the day people were coming and going in taxis. Staff do sometimes assist with transport and the home do try to facilitate outings during the warmer weather. The assistant manager spoke about how they ha worked hard to try to facility individuals who wished to go out for daily walks and to shopping trips. The home had a visit from Prince Edward who was looking at regeneration projects in Care Homes for Older People Page 15 of 27 Evidence: Ifracombe. Alban House received a grant to improve the garden and court Yard area. People spoken to and those who returned surveys said that activities were offered sometimes. No one said they would like more offered by way of activities. Some individuals may not be able to make their views known verbally and may benefit from more regular stimulation of planned activities. This is an area the home should further explore as part of their quality assurance and seeking the views of people who live at the home. People spoken to and those who returned surveys expressed satisfaction with the meals provided. Comments included yes the food is very good, I have no complaint, the cook is very good, we always get good food. The current menu plans do not give sufficient detail to be able to determine if individuals are receiving a balanced and nutritious diet. They need to include what vegetables, puddings and any alternatives offered for the main meal. The home also need to find a way of ensuring that individuals are aware of what the menu choices are. For the tea time meal, staff go around and ask individuals what they would like, but the lunchtime meal is not discussed with people in the same way. A menu broad, menu sheets or pictorial records of meals being offered should be considered so that individuals can be assisted to make choices. The home only has skimmed powdered milk available. People should be offered a choice and the home should check the nutritional value of the milk powder they are using. Care Homes for Older People Page 16 of 27 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Individuals views will be listened to and acted upon Evidence: The home has a stated complaints process and individuals spoken to said they were aware of who they could make their concerns known to. Since the last inspection there has only been one complaint received by CSCI and this was discussed with the provider who had already sent us the details of the issues and what actions had been taken. We are satisfied that they home dealt with the complaint issues fairly, promptly and appropriately. Staff spoken to were aware of what they should do if the suspect abuse and have regular training in the protection of vulnerable adults. Care Homes for Older People Page 17 of 27 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, 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. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and reasonably well maintained, but some improvements are needed to ensure the health safety and welfare of people who live at the home and staff who work there. Evidence: During this inspection all of the communal areas and most of the bedrooms were seen. Alban House is three old Victorian houses knocked into one, with a shaft lift through the middle to access all floors. The registered providers are working through a programme of refurbishment and some areas that have been updated are clearly more pleasant that others that appear tired and in need of refurbishment. Overall individuals bedrooms are well furnished personalized and decorated in a style that suits the individual. Not may of the home radiators have been covered, and although the registered provider has completed risk assessments for individuals in their own rooms, some of the new people have not been risk assessed, and they should also consider that individuals can enter other peoples bedrooms. To eliminate risks of burns from hot surfaces all radiators should be guarded or replaced with low surface ones. Some individuals smoke in their bedroom, this should be included in the homes fire risk assessment and these rooms should be clearly identified so that staff are aware that they are entering an area with potential health and safety issues. Care Homes for Older People Page 18 of 27 Evidence: The laminate flooring near the downstairs dinning area is lifting and was a trip hazard. This was painted out to the assistant manager who immediately secured it with duct tape as a temporary measure. She also found a temporary solution for a glass panel in one persons room hat linked to the medication room. This meant that light would come into the individuals room when staff went into get medications. This could be disruptive especially during the nighttime. They home have blocked it with cardboard for the time being. The assistant manager said they had not noticed this window before. The home should audit individuals rooms as part of their ongoing quality assurance. One person pointed out that their curtains were very thin and hanging off the rails. The assistant manager was aware of this issue and was in the process of getting more curtain hooks. Most of the bedrooms have star locks fitted. This is a universal lock that can be used with one simple key and can be locked from both inside and out. If an individual does not have a key however, they could be accidentally locked in by someone else who does. These locks should be removed. Ideally locks should be fitted that are easy for people to use, and can be opened quickly in an emergency, such as a master key system. Other locks on bedroom doors are all of an individual type, with the duplicate kept down in the staff basement room. Staff may not always be able to access people in an emergency quickly, with the current system they have. This should also be clearly identified in the homes fire risk assessment. The floor was uneven in several parts of the home and of particular concern was a large dip in the floor area near a fire exit. This should be repaired as a matter of urgency. Although soap dispensers are available in communal toilets there are no paper towels. Communal hand towels are available, which may compromise infection control. The home should provide paper towels for use in communal toilets. Care Homes for Older People Page 19 of 27 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and supported to do their job however improvements are needed in recruitment to ensure that safety of people who live at the home. Evidence: Staff spoken to and those who returned surveys said that they have good training opportunities and are given support to do their job effectively. This is backed by the supervision records and training records held at the home. The staff group are all offered regular opportunities to sit down and discuss their role and what training needs they have. The supervision records were of a very high standard. This enables the home to plan for key training throughout the year. Staff spoken to said that they have induction training and the records show this follows the Skills for Care guidelines. The staff group are fairly stable and have good relationships with the people who live at the home. This was evident in their interactions though out the day. People who live at the home have a high opinion of staff and the support the get. Comments included the staff are lovely, they really look after us, couldnt ask for better. The staffing levels are sufficient for the number and current needs of the people who Care Homes for Older People Page 20 of 27 Evidence: live at Alban House. There is normally four carers and a manager on during the morning, three carers for the afternoon, two on evenings with one waking night and one sleeping during the night time period. There is also a cleaner and a cook. Staff recruitment files seen showed that individuals did not have a POVA first check completed, this is a check to see if they are on a registered of people unsuitable to work with vulnerable people. The CRB check was completed after the start date, and one person only had one reference in their file. Care Homes for Older People Page 21 of 27 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 is well run and managed in the best interests of the people who live there. Evidence: The registered providers also have day to day responsibility of running the home. They are qualified and experienced. Staff and people who live at the home said that they could speak to the providers, that their approach was open and ideas were listened to. The home completed the AQAA on time and gave us good details about how they ensure a safe well maintained environment and what policies and procedures they have in place to keep individuals and their staff safe. Since the last inspection the home have ensured that the views of the people who live at the home are gathered via surveys, meetings and spending one to one time with individuals to make sure they are happy with their care and support. Care Homes for Older People Page 22 of 27 Evidence: The home have an audit trail for dealing with individuals finances, this was not checked on this occasion. Care Homes for Older People Page 23 of 27 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 Older People Page 24 of 27 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 15 17 Records should be kept of all 28/02/2009 food offered to people in the home This needs to be in sufficient detail to enable anyone inspecting these records to be able to form a view about whether people receive a nutritionally balanced diet. 2 19 13 All floors should be even and 28/02/2009 in good order To ensure that there are no trip hazards and individuals can move freely and safely around the building. 3 29 17 Staff should only be in post once relevant checks and references are in place To ensure that only individuals who are suitable to work with vulnerable people are employed 28/02/2009 Care Homes for Older People Page 25 of 27 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 15 Individuals should be offered a choice of milk not just skimmed, and the home should check the nutritional value of dried skimmed milk. Rooms that individuals smoke in should be clearly identified so that staff are aware of potential risks to their own health and safety. All risks to burns from hot surfaces should be removed, radiators should be guarded or replaced with low surface ones. Star key locks should be removed from bedrooms, ideally locks should be replaced by ones that can be easily accessed by staff in an emergency, with a master key. Paper towels should be provided in all communal toilets to help prevent the spread of infection. 2 19 3 19 4 19 5 26 Care Homes for Older People Page 26 of 27 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 © (2009) 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 Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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