CARE HOME ADULTS 18-65
Albany House 16/18 Albany Road Stratford On Avon Warwickshire CV37 6PG Lead Inspector
Catherine Mundy Unannounced Inspection 26th January 2006 12:45 Albany House DS0000004382.V280340.R01.S.doc Version 5.1 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 Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Albany House Address 16/18 Albany Road Stratford On Avon Warwickshire CV37 6PG 01789 261191 01789 296359 albanyhouse@rethink.org 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) Rethink Mrs Mary Ullah Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. In addition to undertaking the corporate induction programme, a structured induction programme specific to the role and responsibilities of the Registered Manager be completed within 3 months of registration. A programme of monthly (minimum) supervision meetings by senior manager be put into place. Supervision meetings should be structured to encompass all aspects of the manager`s role and responsibilities as well as specific issues arising within the home. Successful completion of National Vocational Qualification in Management within 12 months. 28th September 2005 2. 3. Date of last inspection Brief Description of the Service: Albany House is a Home owned by Rethink (previously The National Schizophrenia Fellowship). It is an 8-bedded nursing home for people with mental health needs. It is situated within walking distance of Stratford town centre and local parks. The home aims to provide a supportive residence in which 8 people with enduring mental health needs can have a sense of belonging, be treated with respect and exercise choice in their daily lives. Each individual is encouraged to participate in activities suited to their own needs and wishes, to access local resources and facilities and to manage social and familial relationships beyond the home. Through the long term development of trust between residents and staff, the fostering of hope and focus on the strengths, the home endeavours to enable people to approach their potential and to achieve some recovery in the quality of their lives. Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second inspection of this service in the 2005/06 inspection year. This inspection focuses upon the key standards that were not inspected at the last inspection and upon the progress made towards meeting the requirements made at that time. This report should be read along side that written following the previous inspection of this home that took place on 29th September 2005. This inspection took place on 26th January 2006 between 12.45pm and 4pm and concluded on 1st February 2006 between 3.55pm and 5.05 pm. Both visits to the home were unannounced. Sue Houldey, (Regulation Manager with the Commission for Social Care Inspection) was also present on the second day of the inspection. The inspection included a tour of the communal areas of the home and four residents bedrooms, discussions with residents, staff and the acting manager and examination of care plans and other relevant documents. In addition the home has completed a pre-inspection questionnaire, feedback cards have been received from four residents and one relative. The comments made have been included in the body of this report. Since the time of the last inspection the homes manager has transferred, temporarily to another home within the organisation. The deputy manager has taken responsibility for the home in the absence of the manager. What the service does well:
Feedback received from relatives in comment cards indicates that the residents relatives are satisfied with the overall care that is provided by the home. All four cards received states that the relatives have not had cause to make a complaint. One card states ‘the care received has consistently improved’. The feedback cards indicate that the relatives are welcome to visit the home at any time and are able to see their relative in private if they wish. They state that the residents relatives are kept informed of important matters and are consulted if the resident is not able to make decisions relating to the care that they receive. Four comment cards were received from residents. All four indicated that they feel well cared for and that they like the meals provided. Three residents indicated that they thought that the staff treat them well. The residents are supported to make decisions regarding their everyday lives, with additional support available to residents to enable them to make more complex decisions if required.
Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 6 The residents are able to maintain links with their families and friends, either by having visitors to the home or in visiting others. The residents are also able to use the telephone and are supported, if required, with letter writing. The staff demonstrated an understanding of their roles and responsibilities throughout this inspection. Records confirm that they have received appropriate training. During the inspection the residents were treated with respect and sensitivity. What has improved since the last inspection? What they could do better:
The care plans examined did not contain enough detail to indicate how the residents needs are to be met, records relating to the care plans also do not contain enough detail to indicate whether the resident health has improved, remained stable or deteriorated. The residents stated that on the whole they enjoy the meals provided in the home, however they said that if they don’t like a particular meal they are not given an alternative. The staff were unsure about this but were not able to prove that the choices of the residents are respected as the home does not keep records of the meals that are consumed by the residents. The meals are planned seasonally, with the residents. The staff said that on occasions it is not possible to provide the planned meal. The staff said residents are informed of the changes to the menu when they are written on the board, displayed in the dining room. There is no indication that the residents are consulted about this. Residents indicated in the comment cards received, that the home does not provide suitable activities. The staffing ratios in the home reduce the residents opportunities to participate in independence promoting activities and pursue leisure activities. The requirement, made at previous inspections, to provide sufficient staffing ratios in the home in order to meet residents rehabilitation needs, social and leisure needs, remains outstanding. It was noted at the last inspection that the home is registered to take people who have a Mental Disorder, excluding those with dementia and a learning disability. The home must apply for a variation to their registration to allow them to continue to provide a service to those residents who have also have a diagnosis of learning disability. Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 7 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. Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): x EVIDENCE: The standards within this section were not assessed on this occasion. Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 7 The residents care plans and related records provide insufficient information to demonstrate that the residents health care needs are met or to indicate whether the residents health has improved or deteriorated. The residents are supported to make informed decisions about their everyday lives in a sensitive way. EVIDENCE: Following discussions with one of the residents, this residents care plan file was selected for case tracking. This file included an assessment of need, which referred to individual care plans to address the needs identified. Records are maintained of the progress made towards meeting these needs. The care plan identified that the resident has health care needs, but did not provide sufficient detail to identify how these manifest or how they are to be met. Records relating to this plan had been completed three times in a seven month period. The review notes dated 1/2/06, provides the consultant psychiatrist with information that is not recorded in the residents care plan notes. Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 11 A recovery plan and records of individual meeting between the residents and their key worker were also available. These did not refer to the needs identified in the residents care plan. The care plan examined did not detail any restrictions imposed upon the resident, or any agreement between the resident, home and other professionals involved, that the restrictions in place had therapeutic benefit. Discussions with staff and residents and observations during the inspection, confirmed that the residents are able to make decisions regarding their every day lives. The staff demonstrated in discussion that appropriate action would be taken to support the residents to make an informed choice about more difficult issues. The home facilitates regular residents meetings to assist the residents to make joint decisions regarding the running of the home. Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 and 17 The home offers the residents a varied diet, that although on the whole they enjoy, does not always reflect the residents preferences. The residents are supported to maintain family links and friendships. The provision of additional staffing will enable the home to support all of the residents to participate fully with rehabilitation, occupation and to develop their independence. EVIDENCE: Standards 12, 13 and 16 were assessed and met in part, at the last inspection of this home. The requirement made in relation to these standards, has been made at the three previous inspections of the home and remains outstanding. The home was required to provide sufficient staffing to enable the residents to have an increased opportunity to participate in rehabilitation, independence promoting activities and to access leisure opportunities. Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 13 Feedback from residents in the four comment cards received, states that three residents do not feel that the home provides suitable activities. One resident indicated that the home provide suitable activities some of the time. The manager stated that since the last inspection the staffing ratios have not been increased. In addition the manager and staff also believe that, in the near future, the home will no longer have its own transport. The expressed their concerns that this would lead to a decrease in the frequency of leisure opportunities available to the residents. Discussions with the staff and residents confirmed that the residents are supported to maintain links with their families and friends, if they wish. If required the home provides support with writing letters, using the telephone and also provide transport. Feedback received from relatives states that they are welcome to visit the home at any time and are able, if they wish to visit their relative in private. The residents confirmed that on the whole they enjoy the meals that are provided by the home. The menu plans examined reflected that the residents are provided with a varied and balanced diet. The menus plans cover a fourweek period, these are changed seasonally and are planned with the residents at the residents meetings. The staff stated that on occasions when changes need to be made to the planned menu the residents are informed of the alteration on the dry wipe board situated in the dining room. Feedback received from the residents indicated that they are not always provided with an alternative meal if they do not like or wish to have the meal that is planned. The home was not able to produce records that indicate when alternative meals are provided. Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): x EVIDENCE: The standards within this section were not inspected on this occasion. Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): x EVIDENCE: The standards within this section were not inspected on this occasion. Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The standard of the environment is good providing a clean, comfortable and homely place to live, this is compromised by some of the décor. EVIDENCE: A tour of the communal areas of the home confirmed that the residents continue to be provided with a safe, comfortable and homely place to live. Communal space includes a large kitchen, lounge/diner and conservatory. The residents are also able to spend quiet time in the ground floor office, which is furnished with two sofas and a coffee table. The home has three bathrooms, one on the ground floor and two on the first floor. The residents each have their own bedrooms. Four of which were seen. These have been decorated and furnished to reflect the residents personalities and preferences. Décor in the hallways, landing and stairways is tired and requires redecoration. The manager advised that there is a plan in place to replace the flooring in the dining area of the home and redecorate the ground floor bathroom. New flooring is also required in this room. A recommendation was made at the previous inspection to ensure regular replacement of the flooring in one residents bedroom is included in the homes
Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 17 maintenance and renewals programme. The manager is not certain if this has been actioned. Laundry facilities are appropriate to the needs of the home. The staff confirmed that the procedures in place to attend to the residents laundry are acceptable. Soiled items can be washed at appropriate temperatures and sluicing facilities are also available. Most of the cleaning materials are stored in a lockable cupboard, to which the staff have access. Some cleaning materials were found in an unlocked cupboard in the kitchen. The staff rectified this during the inspection. Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 35 Despite the ability of the staff to perform their roles within the home the current staffing ratios restrict their ability to effectively support the residents. EVIDENCE: Since the time of the last inspection the homes manager has transferred to another home within the organisation. The deputy manager has taken responsibility for the home in the absence of the manager. Staffing ratios within the home allow for two staff members to be on duty for each shift, one of which is a registered nurse. The staffing rotas provided confirmed that on some occasions an additional staff member is allocated to work during the day. This is usually the community mental health support worker who is responsible for administration or the acting manager. A requirement, made at the previous three inspections of this home, to provide sufficient staffing in order to meet the residents rehabilitation needs, develop their independence and provide increased social and leisure opportunities remains outstanding. Five staff members were spoken with during the inspection, including the acting manager. Each demonstrated an understanding of their roles and responsibilities within the home. The interactions between the staff and residents confirmed that the residents are supported sensitively
Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 19 Training records relating to three staff members were examined, these related to the acting manager, a registered nurse and a community mental health assistant. These provided evidence that the staff team are provided with training that is relevant to their roles. Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 The residents can not yet be confident that their views underpin the future development of the home. EVIDENCE: It was noted at the time of the last inspection that the organisation had commenced a review of the quality of the service that is provided in the home, which included the views of the residents, their relatives/representatives and the staff. This work was planned to be completed and presented to the organisations board in November 2005. The manager stated during this inspection that she was unsure as to whether this had taken place. The outcome of the review had not been made available to the home. Evidence that the views of the residents, their relatives and other stakeholders had been sought was also not available. The home is visited by a representative of the organisation, as required under Regulation 26 of the Care Homes Regulations 2001. Copies of the reports made following these visits are now provided to the Commission.
Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 x 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 x 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x x x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x x x x x 2 x x x 2 Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Sch 3 3(m) Requirement Timescale for action 31/03/06 2 YA6 14(2)a 15(2)a Sch3 3m 3 YA6 15 4 YA12YA13YA16YA33 12(1)b 16(2)m,n 18(1)a The provider must ensure that the residents care plans are completed in sufficient detail to enable the residents identified needs to be met. The provider must 10/03/06 ensure that records are kept in sufficient detail to enable accurate assessment and review of the residents health needs to be made. The provider must 31/03/06 ensure that any restrictions imposed by the home are detailed in the residents plans of care and agreed by the resident and other professionals involved in their care. The provider must 31/03/06 ensure sufficient staffing is provided to enable the residents to have an increased opportunity to participate in rehabilitation,
Version 5.1 Page 23 Albany House DS0000004382.V280340.R01.S.doc independence promoting activities and to access leisure opportunities. This requirement has been made at the previous three inspections of this home. 5 YA17 Sch 4.13 The provider must ensure that records detailing the meals consumed by the residents are completed and retained within the home. The hallways, stairs and landing are to be redecorated. The provider must ensure that the outcome of the recent quality monitoring is available in the home. A copy of the report made is to be provided to the commission as part of the action plan to the report. The home must apply for a variation to registration to allow placements in the home for residents who have a dual diagnosis of mental health and learning disability. This requirement was made at the previous inspection and remains outstanding. 10/03/06 6 7 YA24 YA39 23(2)(d) 24 21(2) 31/03/06 10/03/06 8 YA43 12 10/03/06 Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA24 YA24 Good Practice Recommendations The provider should continue with the plan in place to replace the flooring in the dining room and decorate the ground floor bathroom. Regular replacement of the flooring to one resident’s bedroom should be included in the homes maintenance and renewals programme. Albany House DS0000004382.V280340.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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