Inspection on 12/09/05 for Alexandra House

This inspection was carried out on 12th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Alexandra House 31/03/08

Alexandra House 02/11/06

Alexandra House 06/01/06

Alexandra House 10/02/05

Alexandra House 08/07/04

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Townley Road, 2-3

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

CARE HOME ADULTS 18-65 Alexandra House 87 Alexandra Road Addiscombe Road Croydon CR0 6EZ Lead Inspector Margaret Lynes Unannounced 12 September 2005, 10:00 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 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 Stationary 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. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Alexandra House Address 87 Alexandra Road, Addiscombe, Croydon, Surrey, CR0 6EZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8656 2232 020 8656 2232 Mr James Emmanuel Kwabena Safo Care Home 5 Category(ies) of Mental disorder(5) registration, with number of places Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10/2/05 Brief Description of the Service: Alexandra House is a semi-detached building set in a residential area of Croydon and is indistinguishable form any other house in the street. It provides for a family type dwelling for its five service users who have a past or present mental illness. Each service user has their own bedroom, all of which are of an acceptable standard of décor and furnishing. The home is situated within easy reach of Croydon town centre, and near to bus routes and local amenities. The stated aim of the home is to provide a safe and suitable environment that is friendly and homely, and to base its service on a service users right to respect, dignity, independence and flexibility for choice rights and fulfilment. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, and was conducted over one day. During that time a number of records were examined, a tour was made of the home, and time was spent talking with service users and staff. The last inspection report contained 4 requirements. Of these two have been met. This visit resulted in a further 9 requirements being made. Six of these concern the premises, and while perhaps time-consuming should not be difficult to meet. In meeting them the home will improve the overall quality of the service being provided, and improve the well-being of the service users. What the service does well: What has improved since the last inspection? What they could do better: This report contains nine new requirements and two that have been carried over from the preceding inspection. The vast majority relate to the house which while functional is now in need of refurbishment (it is noted, as mentioned above, that some of this refurbishment has already started). None of these requirements should be difficult to meet, and in doing so the quality of the service being provided will be further enhanced. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 Page 6 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. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The Inspector was satisfied that adequate pre-admission assessments were being carried out. This means that service users and their relatives can be reassured that the home has taken into account their individual needs, and feels that it can meet them; and the staff in the home can be as familiar as possible with new service users, and have an understanding of what specific service they will need to provide. EVIDENCE: The file of the most recent admission was selected for examination and contained a satisfactory pre-admission assessment from the placing authority and this was supplemented with an in-house assessment. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 Page 9 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 standard(s) 6, 7 and 9 The service user plans seen adequately covered the health, personal and social care needs of the service users. This means that the staff team are aware of the differing needs of their residents, and know what specific care needs to be given. There was good evidence of the involvement of service users in planning their care. This means that service users are kept fully appraised of their assessed and changing needs and can feel that the plan is an accurate reflection of their personal goals. The service users spoken with all felt that they were enabled to make decisions about their lives, with as much input from staff as necessary. They also felt that they were enabled to take risks as part of an independent lifestyle. EVIDENCE: The files of all service users were examined. Each one contained a recently revised care plan, and these were supplemented by regular in-house reviews, a risk assessment, a personal profile, a medical history and a care plan evaluation. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 Page 10 Where service users were willing, they had signed their care plans, indicating that they were both aware of, and involved in the care planning process. Each service user received a monthly 1:1 session with their keyworker. These sessions were recorded and gave each resident a specific opportunity to contribute his or her ideas. All of the service users had, as mentioned above, a current risk assessment on file. Daily records are maintained for each resident – it would contribute to the overall professional appearance of the service if specific record sheets, rather than scraps of paper, were used for this recording. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 Page 11 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 standard(s) 12, 13, 15, 16 and 17 The Inspector was able to witness residents engaging in both pre-planned and ad-hoc activities, in-house and in the community. This means that the service users are given the opportunity to take part in appropriate activities, and be part of the local community. The level of contact with family and friends varies considerably. It was pleasing to note that each of the residents in Alexandra had some family contact, and this is supported and encouraged. The service users are offered a healthy diet, and all said that they enjoyed their meals. EVIDENCE: All but one of the service users is able to go out into the community unescorted. Two attend day centres regularly each week, while one work on a voluntary basis in a charity shop. Another participates in a number of classes at local colleges. Participation in in-house activities such as keep fit, board games and cooking is encouraged. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 Page 12 The staff (and all others who assisted in the process) are to be commended for enabling one resident to meet up with siblings whom she had not seen for many many years. All of the residents, to a greater or lesser degree, are in touch with family members and this contact is promoted. Each of the residents spoken with on this visit commented on the good quality of the food provided. All residents are encouraged to assist in the kitchen, and a number do help with some of the cooking. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 Page 13 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 standard(s) 18, 19 and 20 From observing the interaction between the staff and the service users, and having also talked to a number of service users, it was evident that they felt that they were being treated with respect and that they received personal support in the way that they preferred. Staff ensure that each resident is able to access community based health facilities as and when required. The medication administration records were examined and two gaps noted. Clearly this is unacceptable, as any mistakes made in giving out medication can have serious consequences for the service users. EVIDENCE: The service users spoken with were complimentary about all of the staff team. They felt that they were well looked after, but were also given the opportunity to be involved in their care and make decisions, including how they received personal support, for themselves. To the extent that community based health services are available for this client group, staff do all they can to enable the residents to access it. They are Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 Page 14 encouraged to make and attend their own medical appointments and the manager felt that the support from community based psychiatric services was actually quite good. The medication administration records for all service users were examined. Two unexplained gaps were noted. It was also noted that on occasion, while staff were entering the appropriate code on the records, they were not recording an explanation (as required) as to why medication was not given. These issues need to be rectified. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 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 standard(s) 22 and 23 Slight amendment is needed to the complaints procedure. The Inspector was not satisfied, therefore, that service users were made aware of the scope of the complaints process. This means that it is conceivable, albeit perhaps unlikely in this home, that service users will feel that their views/complaints are not fully listened to. It was surprising to find that there was no in-house protection of vulnerable adults procedure. This means that staff will not know what action to take in the event of possible abuse, thus placing service users at unnecessary risk. Service users financial interests are safeguarded through the recording systems in use in the home. EVIDENCE: No complaints have been made since the last inspection. Similarly, there have not been any adult protection concerns at the home. The majority of the staff team have attended in-house training in the protection of vulnerable adults. It was noted that the complaints procedure did not make it explicit that a complainant could contact the Commission directly if they so wished, and they did not have to exhaust the in-house procedure first. Appropriate amendments to the procedure are therefore needed. While there was a copy of the Local Authorities Protection of Vulnerable Adults procedure, it was surprising to find that the home did not have its own procedure to compliment this. This needs to be rectified. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 Page 16 The files relating to service users’ finances were being maintained in a satisfactory manner. All service users signed for monies received, and receipts were kept where money was spent on their behalf. It is recommended, however, that an appropriate receipt book is obtained so that residents are not give scraps of paper as a substitute. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 Page 17 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 standard(s) 24 and 30 While the home was comfortable, clean and generally safe, parts of it are now in need of refurbishment. For this reason, it was not felt that the environment provided was as well-maintained as it could be. This obviously means that the surroundings for residents are not as pleasant as they should be. EVIDENCE: A tour was made of the premises, parts of which are in the process of being repainted. These areas have not, therefore, been included in the list of requirements at the end of this report. The ongoing refurbishment work notwithstanding, there were other areas of the building identified as requiring attention, or where work is recommended. These are all outlined in the requirement/recommendation section of this report. At the time of the last inspection visit, it was noted that while the manager’s quality assurance audits of the premises indicated where remedial work was required, little was then done to rectify the issues identified. On this visit, a similar picture was presented. The proprietor must ensure that all necessary repairs/redecoration are carried out promptly. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 and 35 Following inspection of the files of the two newest staff members, the Inspector was satisfied that the recruitment processes in place were robust enough to both support and protect the service users. Staff have been enabled to attend a variety of training courses since the last inspection, however there has been nothing specific to this client group. This means that staff may not have sufficient knowledge to adequately meet the service users individual and joint needs. EVIDENCE: Each of the staff files contained all of the required documentation. In the case of the newest carer, the CRB disclosure had not yet been returned however a POVA 1st check had been carried out prior to the carer commencing work in the home. At the last inspection it was required that staff be provided with suitable training, commensurate to the type of service user being cared for. While training has been carried out in such areas as fire safety, medication, protection from abuse, food hygiene and health and safety, there has been no specific training in mental health issues. This needs to be rectified. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 The Inspector was satisfied that the home was being run with the best interests of the service users in mind, as a number of quality assurance checks were in place, and the records examined were being appropriately maintained. The Inspector felt that in the areas that were inspected on this visit (risk assessment/health and safety), the home was being maintained to an appropriate level of safety, thus ensuring that service users were not subject to unnecessary risk. EVIDENCE: Monthly (Regulation 26) visits are being carried out by a representative of the proprietor, and a report of each visit being produced. The manager conducts a number of quality assurance audits, including those of the fire and environmental health records; medication records; residents’ files and staff records. Surveys of service users; staff and stakeholders are periodically conducted – it would be good practice to publish those results within the Service User Guide. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 Page 20 Following the last inspection two requirements were made relating to this section – specifically to the need for a quality assurance system to be implemented, and for (health and safety) risk assessments to be more comprehensive. Both of these requirements have now been met. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x x 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Alexandra House Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 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 35 Regulation 18 Requirement The proprietors must ensure that the staff team are provided with training specific to meeting the needs of the service users. The previously set timescale has not been met. The manager/proprietors must ensure that where the quality assurance audits uncover areas that require attention, then the necessary work is carried out without undue delay. The previously set timescale has not been met. The manager must ensure that the medication administration records are accurately maintained at all times. The complaints procedure requires amending as outlined in this report. The manager must ensure that there is an appropriate in-house adult protection procedure in place, and staff familiarise themselves with it. The kitchen requires refurbishment, including a diffuser for the fluorescent light. A new carpet is required for dining room. G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Timescale for action 31/10/05 2. 39 24 31/10/05 3. 20 13 12/9/05 4. 5. 22 23 22 13 31/10/05 31/10/05 6. 7. 24 24 23 23 13/12/05 13/12/05 Page 23 Alexandra House Version 1.40 8. 9. 10. 11. 12. 24 24 24 24 23 23 23 23 A new door is required to the storage area on the ground floor. The bath requires reenamelling/repacement. The staff WC requires redecorating and a new floor covering laid. New light bulbs are required for the first floor hallway. 13/12/05 13/12/05 13/12/05 13/9/05 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. 3. 4. 5. 6. Refer to Standard 6 23 24 24 24 39 Good Practice Recommendations It would be good practice to ensure that there is a good supply of pre-printed daily record sheets. It would be good practice for a proper receipt book to be obtained. The lounge would benefit from redecoration. The bathroom/Wc would benefit from redecoration. It would be good for staff morale if the staff office could be refurbished/redecorated. It would be good practice to ensure that the results of service user surveys are publicised. Alexandra House G53 G53 S25810 alexandrahouse V249190 120905 stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 8th Floor, Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 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. 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