Inspection on 12/06/07 for Alder House

This inspection was carried out on 12th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alder House 02/02/06

Alder House 19/08/05

Alder House 17/02/05

Alder House 24/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Alder House Alder Way New Earswick York North Yorkshire YO32 4TH Lead Inspector Donna Burnett Key Unannounced Inspection 12th June 2007 01:30p Alder House DS0000015788.V335084.R01.S.doc Version 5.2 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 Alder House DS0000015788.V335084.R01.S.doc Version 5.2 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. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alder House Address Alder Way New Earswick York North Yorkshire YO32 4TH 01904 750453 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) Joseph Rowntree Housing Trust Mr David Charles Crampton Care Home 10 Category(ies) of Physical disability (10), Physical disability over registration, with number 65 years of age (5) of places Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The number of service users over 65 should not exceed 5 at any one time. The category (PD(E)) is only for use by current service users who have reached 65 and above whose needs can still be met by the home. Date of last inspection 2nd February 2006 Brief Description of the Service: Alder House is a purpose built single storey care home jointly managed by the Joseph Rowntree Housing Trust and the York and District Cerebral Palsy Society. It provides long- term accommodation with personal care and a respite service for to up to ten people with physical disabilities. The home is situated in New Earswick, a village owned and managed by The Joseph Rowntree Housing Trust, and is within easy walking distance of all of its facilities, which include shops, a post office, a library and a church. A regular bus service operates between the village and the city centre of York. The standard fees charged by the home range from £326.69 to £1,106.85 per week. Toiletries, taxi’s and activities outside of the home are not included in the fees. This information was provided by the registered manager on 6th March 2007. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Four hours were spent preparing for the inspection and gathering information about the service, including what had been happening at the home since the last inspection. A Pre Inspection Questionnaire asking for information about the home was sent to the manager before the visit and information from this was used to help plan the inspection. Surveys were sent to people living in the home, and their relatives. Their comments and feedback about the service are included in the main body of the report. All of the key standards were looked at during the inspection to try and find out what it was like to live at the home. The inspection lasted four hours and was timed for mid afternoon to allow time to speak with the staff prior to people returning to the home following their usual daily activities. The inspector spoke with people living in the home and observed their interaction with staff. Time was also spent speaking with staff on duty, looking at care plans and other records. What the service does well: What has improved since the last inspection? What they could do better: The home would benefit from some redecoration in order to provide a more pleasant environment for the people living in the home. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 6 A reassessment should be carried out to establish whether or not the current systems in place for monitoring someone’s well-being are the most effective and un-intrusive. Staff files should be available for inspection by The Commission for Social Care Inspection at all times so that we can check if people using the service are being adequately protected by the recruitment practices. People should not be deployed to work at the home until all necessary police checks have been carried out, and their suitability to work with vulnerable people has been confirmed. 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. The summary of this inspection report can be made available in other formats on request. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 & 3. People who use the service experience good quality outcomes in this area. They know what to expect from the service and can be confident that their needs will be met. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People who live in the home are happy and like living there. People who are thinking about coming to live at the home are given the information that they need to be able to make an informed choice. The home offers a respite care service, which allows carers to have a break, and also provides an opportunity for people to try out the service before they move into the home. People’s needs are assessed before they move into the home so that care workers can be told about any specific needs they might have and know what help and support to provide. Care workers often have a very good understanding of the needs of people new to the home as most people will have had short stays previously. Consideration is given to the social and emotional needs of people as well as their physical well-being. This is all taken into account when planning how the service can meet the needs of the individual people living in the home. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 9 People who live in the home have recently been consulted with about possible future changes to the service. They have been asked to consider where they might like to live, and how they would like to be supported, in order for their needs to be best met. License agreements explain to the people who live in the home, how much they have to pay and the terms and conditions of living in the home. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. People who use the service experience excellent quality outcomes in this area. They are supported and encouraged to make their own decisions about how they live their lives. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People who live in the home are provided with the care and support that they need and which is detailed in individually written care plans. The plans are reviewed as changes happen so that the information in them is always correct. However, the plans which were looked at had not been signed by either the people they related to or one of their representatives. It was not clear therefore whether the plans had been drawn up with the involvement of the people they related to or not, or that permission had been obtained to provide support in a certain way. For people with eyesight problems, the care plans can be made available in larger print. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 11 Everyone who lives in the home has a key worker who takes a special interest in them and makes sure that they have got everything that they need. Everybody who was consulted with felt suitably involved in making decisions in the home. Regular meetings provide a good opportunity for people to influence and have their say about how the service is run. Advocacy services are available to help people living in the home make important decisions about their lives. People who live in the home are encouraged and supported to maintain independent living skills skill such as looking after their own finances. Risks to people living in the home are identified and steps taken to minimise the risks without restricting independence. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. People who use the service experience good quality outcomes in this area. They are supported to live meaningful lives and have good access to a wide range of both social and therapeutic activities. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People who live in the home are supported to pursue leisure activities, further education and voluntary work. Opportunities are sometimes restricted however when either staffing levels, or the routines of the home, do not allow care workers to be out of the building. People are encouraged to pursue interests outside of the home environment although social events and activities within the home are also arranged. Relatives who returned surveys commented on the ‘genuine commitment to supporting and enabling people to do the things they want to do’. They spoke of the home and the people living in it as being ‘part of the community’ and of the hard work done to ‘sustain relationships with families and friends’. A Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 13 family member who returned a survey confirmed that their relative made contact on a daily basis (by telephone). Another family member commented on the staff taking time to take people out, but felt that ‘some of the stimulation and opportunities for outings’ had decreased of late due to staff shortages. Everyone who returned a survey said that they were treated well and that on the whole, their privacy was respected. One particular person has a monitor in the bedroom so that they can alert care staff if in distress. However, this could be invasive to their privacy, is not reliable, and a more suitable alternative needs to be considered. Individual bedrooms can be locked for privacy. Sensors on external doors alert care staff when someone is either entering or leaving the building so that they know who is on the premises at any given time. The home is not restrictive and the people who live in it have free access to all of the communal areas such as the laundry, kitchen, gardens and bathrooms. They can come and go as they wish. People who live in the home are asked not to use the kitchen in the late afternoon for their own safety. The cook is at this time often handling pans of boiling water and hot food, and the environment could be hazardous. People who live in the home say that they like the food. They are consulted with about what they would like to eat and specific dietary needs are catered for. Snacks and drinks are available throughout the day and there is a good supply of food. Work surfaces and a sink are at a suitable height for people using wheelchairs. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. People who use the service experience good quality outcomes in this area. They get the health and social care support that they need. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Everyone who was consulted with said that they felt well cared for. Care is specific to the needs of each person and takes into account preferences and individual choice. Specialist equipment and aids are available for people who are assessed as needing them. Some people need special attention to certain aspects of their personal care. This is documented and reviewed regularly so that care workers know what to do to make sure that dignity is maintained. When there are concerns that people’s care needs are not being properly met, it is documented and steps are taken to try and address the shortfalls. People who live in the home are supported to access a variety of health and social care professionals when required. This makes sure that they get all the help and support they are entitled to. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 15 Medication is supplied in blister packs and labelled for the sole use of the individual people living in the home. The system is safe and there is little chance of medication errors occurring. Care workers are trained to administer medication and are then supervised to make sure that their practice is safe. Should anyone living at the home wish to, and be able to, self medicate, there are safe storage facilities in individual bedrooms to allow this to happen. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. People who use the service experience good quality outcomes in this area. People who live in the home feel safe and are able to say if they are unhappy about anything. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People who live in the home say that they feel safe and know who to speak to if they are unhappy. There are opportunities to talk to either someone from the home or the Trust about any concerns or worries they might have. Meetings are also used to discuss any issues and either the registered manager or responsible individual are usually available to talk to. Relatives say that they would know how to make a complaint if they needed to. One person commented that ‘there is usually an overall improvement’ whenever they express concern about anything, but feel that it is not often ‘sustained’. Records are kept of complaints but not when concerns are raised. It is not therefore possible to find out what concerns have been raised, nor how they were dealt with. The Commission for Social Care Inspection passed one complaint to the provider to investigate following the last inspection. It had not been recorded in the complaints book but was discussed with the responsible individual following the inspection and seemed to have been dealt with satisfactorily. Care workers are taught about adult protection issues during their induction training. They are aware of the whistle blowing policy and know to speak up about poor practice, or if they suspect someone of being harmed. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 17 Records are kept of money held on behalf of the people living in the home and a random check found them to be in order. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 & 30. People who use the service experience good quality outcomes in this area. People live in a safe, homely environment. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Alder House provides a relaxed atmosphere. It is very much people’s own home. Bedrooms are individualised with personal belongings. The building is on one level and is accessible throughout for people who use wheelchairs. Space is limited however and there is just one communal room, which doubles up as a dining room and lounge. Visitors can either be seen in this area or in individual’s bedrooms. There is no other space for people to ‘get away from’ one another. Corridors are starting to look worn and would benefit from redecoration in order to keep the environment pleasant for people living in the home. The home complies with fire and health & safety regulations to make sure that it is a safe place in which to live. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 19 Care staff work hard to keep the home clean and tidy for the people who live there. Domestic staff are not employed. People who live in the home are able to summon help in a variety of ways. Some people use call bells whilst others who are less able use large buttons or pendants, which can be activated much more easily. One person summons assistance using a radio monitor. However, it could be intrusive to privacy and cannot be relied on as the sole method of attracting attention. Professional advice should be sought to determine whether or not there is a more suitable way for care staff to be summoned, if required. Laundry facilities are suitable for the people who live in the home to use. If people are able and willing, they can be supported to maintain independence and look after their own laundry. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35. People who use the service experience adequate quality outcomes in this area. People who live in the home are not being sufficiently safeguarded and protected by The Trust’s recruitment practices. However, the staff team are skilled and provide a good standard of care. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People who live in the home have the benefit of being supported by highly skilled, well-trained care workers who are warm and welcoming. A relative who returned a survey described the care staff as ‘very helpful at all times’. Another person commented on the ‘very good relationship’ between people living in the home and the care workers. Some staff are described as being ‘really skilled’, ‘committed’ and ‘tuned in to’ the needs of the people they care for and support. There is always a senior care worker on duty to make sure that the home runs smoothly. Domestic staff are not employed. In order to keep up with the cleaning and domestic chores, some people who live in the home are unable to get out as often as they would like to as the care staff are sometimes too busy to accompany them. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 21 Recruitment files were not available to be looked at but the responsible individual was able to provide some of the information required. For one of the members of staff it appeared that police checks had only recently been carried out despite having worked for The Trust for several years. Whilst assurances were given that induction and ongoing training were being provided, due to the lack of recorded evidence it was not possible to check if all of the necessary pre employment checks had been carried out in order to safeguard and protect the people living at the home. Information supplied prior to the inspection showed that a number of staff had started working at the home before having been checked with the Criminal Records Bureau. Shortfalls with the recruitment process were also identified at the last inspection and people living in the home are potentially being put at risk because of this. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. People who use the service experience good quality outcomes in this area. The home is managed well and people who live in the home have a say about how the service is run. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: A relative who retuned a survey described Alder House as a ‘good care home’ and the registered manager of the home as ‘excellent’. People find him approachable. The manager was unavailable during the inspection but the person left in charge was clearly able to take charge of the home in his absence. People living in the home were asked to help with the interviews for the present manager so that they had a choice about who ran the home. A relative who returned a survey commented that the home had ‘always been good’ at keeping in contact with family members and ‘willing to talk at length, Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 23 if necessary’. However, some anxiety was expressed about future plans for the service and one family member spoke about feeling ‘kept in the dark’. The organisation carries out a quality assurance survey of all of its services annually and reports its findings to the people who use them. Regular meetings with people living at the home allow the opportunity for people to have their say about how the home is run and ‘ensures that people’s voices are heard’. People who live in the home were told about the forthcoming inspection and one person volunteered to help with the distribution, collection and return of surveys. Practices within the home itself are safe and do not pose unnecessary risk to the people living in the home. Safety checks are carried out to make sure that people are kept free from risk of harm. Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 24 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 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 4 33 2 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 4 X 3 X X 3 X Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 YA34 Regulation 17 Schedule 4 19 Schedule 2 Requirement Records of people employed to work at the home must be available for inspection at all times. People must not be deployed to work in the home until all satisfactory police checks have been carried out and clearance given. Timescale for action 19/09/07 2. YA34 19/07/07 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 YA6YA16 Good Practice Recommendations Permission should be obtained for the use of radio monitors. Use of such monitors should be incorporated into the service plan so that it is clear to all care staff, when and how the monitors should be used. In order to maintain privacy and dignity, it is recommended that an assessment be carried out by a specialist therapist to ascertain whether or not the radio monitor could be replaced with a more suitable aid or piece DS0000015788.V335084.R01.S.doc Version 5.2 Page 26 2. YA16 YA29 Alder House 3. YA22 of equipment. It is recommended that a record be kept of all concerns raised about the service to show that what people have to say is taken seriously and that actions are taken to address any shortfalls with the service. The Trust should consider employing domestic staff so that care staff can concentrate on the needs of the people living in the home rather than having to spend time cleaning and doing the laundry. 2. YA13 YA33 Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 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 © 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 Alder House DS0000015788.V335084.R01.S.doc Version 5.2 Page 28 - 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. 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