Inspection on 31/03/08 for Alexandra House

This inspection was carried out on 31st March 2008.

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

Alexandra House 02/11/06

Alexandra House 06/01/06

Alexandra House 12/09/05

Alexandra House 10/02/05

Alexandra House 08/07/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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 Croydon Surrey CR0 6EZ Lead Inspector Janet Pitt Key Unannounced Inspection 31st March 2008 13:35 Alexandra House DS0000025810.V362983.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 Alexandra House DS0000025810.V362983.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. Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra House Address 87 Alexandra Road Addiscombe Croydon Surrey CR0 6EZ 020 8656 2232 F/P 020 8656 2232 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr James Emmanuel Kwabena Safo Mrs Bernadette Joan Redmond Mrs Celia Ann Gurney Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One (1) place for a service user over the age of 65 can be accommodated 2nd November 2006 Date of last inspection Brief Description of the Service: Alexandra House is a semi-detached building set in a residential area of Croydon and is indistinguishable from any other house in the street. It provides a family type dwelling for the five people who live there. Each person 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 persons right to respect, dignity, independence and flexibility for choice rights and fulfilment. Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means people who use this service experience good quality outcomes. Two site visits were made on 31/3/08 and 8/4/08 that lasted a total of five hours. During the site visits the inspector was able to talk with the people who live in the home and some members of staff. A tour of the premises was undertaken and staff files relating to recruitment and training were examined. Care plans were also inspected. Surveys received from a member of staff, a relative and two people who live in the home were also used to inform this report. The home submitted an Annual Quality Assurance Assessment in September 2007 and this was also used to inform the report, as the evidence within the document was noted to be current and ongoing at the time of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 6 The home’s AQAA states that barriers to improvement are staffing numbers, as at present it is not always possible to escort people on visits to the community, some help is available from family and friends. The manager is looking at ways to facilitate community visits. Staff have concerns that their views are not always heard by the provider. 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. Alexandra House DS0000025810.V362983.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 Alexandra House DS0000025810.V362983.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 and 5 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People can be confident that their needs will be assessed prior to them moving into the home. People are involved in this process and receive a contract detailing what is included in the fee. EVIDENCE: People’s care plans were examined. Assessments are undertaken prior to and on admission to the home. The AQAA states that: ‘All clients sign a contract on admission and have a trial period of up to six weeks.’ Each person has an individual contract that details what is included in the fee, a copy is held in their personal file. These assessments detailed information as needed in the Standards and gave information on past medical history and current care needs, along with information on social needs. One survey respondent stated that they did not receive adequate information prior to moving into the home, but this was not elaborated upon. All the other Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 9 respondents considered that they had been given sufficient information to make a decision on whether to move into the home. Individuals or their representatives are involved in the assessment process and sign to indicate that they have been consulted. Alexandra House DS0000025810.V362983.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 and 9 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who live in the home are able to make choices and take risk as part of independent living. People are supported to develop and maintain independent living skills. EVIDENCE: Peoples care plans were examined during the site visits. The plans were seen to lead from assessments and included risk assessments. Religious needs and sexuality were addressed sensitively. If a person declined to discuss these areas, this was recorded. There was evidence within plans of people being able to maintain contact with significant others, such as family and friends. One person was able to maintain telephone contact with their sibling; another person had regular contact with their parent. Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 11 At present none of the people who live in the home wish to have an intimate relationship. The manager reported that when a person chooses to have a relationship this is supported by the home. Health needs of people were recorded in the care plans, for example. One person was diabetic and needed monitoring and visits from the district nurses had been detailed. People who live in the home are weighed monthly and encouraged to eat healthily to maintain an optimum body weight. Individualised risk assessments were in place. These covered areas such as accessing the community independently, topical creams, finances and managing medications. One person is able to collect their medications from the pharmacy or clinic. The manager said that there has been some concerns over one person who chooses to go to pubs in London with large amounts of cash on their person. The risk of being ‘mugged’ has been explained and care is taken to try and encourage the person not to take more cash than is needed. In the homes AQAA plans for improvement include planning meaningful education and training for people who live in the home and liaising with local police to come and chat to individuals about going out late at night and possible dangers they may face. The home considers that improvements have been made in personal lifestyle choices: ‘We have liaised more with social services, friends and advocates on how to meet clients needs.’ ‘People are encouraged to take calculated risks for day to day living.’ Care plans are routinely reviewed every six months, the form consists of tick boxes, but there is adequate space to detail any comments. One person chooses not to go out into the community, so health professionals visit them in the home. Another person chooses not to have contact with their family, but wishes to maintain contact with friends. This decision has been supported by the home. At the time of the site visits only one person chose to visit a day centre on a regular basis. Alexandra House DS0000025810.V362983.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 and 17 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who live in the home are able to access the community when they chose. They are encouraged to maintain relationships with their family, friends and other significant people. Mealtimes at the home are flexible and catered for people’s individual needs. EVIDENCE: During a conversation with three people who live in the home, all stated they could choose how they spend their day. One person was out at a day centre. Two people regularly visit local shops. One person visits Croydon and goes out with their family. We observed during people that live in the home all interacted well and were used to each other and presented themselves as a close unit. Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 13 A person who liked music and TV was seen in their room, their radio was on their preferred station and there was a personal TV to watch. People who live in the home are able to make snacks, meals and drinks when they chose. No one raised any concerns about the quality or quantity of food at Alexandra House. People at home on the day of the site visit chose to make themselves a sandwich for lunch, as they thought the manager was busy with the inspector and they did not wish to disturb her (the manager). On inspecting the food stores it was noted that there were sufficient quantities of fresh, dried and frozen food. The manager said the menu is flexible according to people’s wishes. The home’s AQAA states that: ‘All clients are encouraged to have regular contact with family and friends. All clients are given choice and independence at all times. Clients’ health and well being is cared for. Diet and well balanced meals are catered for, including cultural and religious needs.’ One survey respondent stated: ‘[The staff] never mind us phoning to ask how our relative is. They always have time to talk to us. When you visit your relative they always offer a cup of tea/coffee.’ Alexandra House DS0000025810.V362983.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 and 21 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who live in Alexandra House can be confident that emotional, physical and health needs will be met according to their wishes. End of life care is planned for appropriately in consultation with the person. EVIDENCE: Throughout the site visit good interactions were observed between staff and people who live in the home. The manager demonstrated awareness of differing needs of people during her interactions with people that live in the home. For example she was helping one person chose some clothing from a catalogue and was offering suggestions of what might be suitable. One person needed support with personal hygiene needs and would state that they had had a bath, but this is not always the case. Their care plans demonstrated steps staff needed to take to make sure hygiene needs were being met. Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 15 Each plan had a record of visit by other health professionals and there was appropriate health care support in place when needed e.g. psychiatrists. A person can chose to have same gender care. End of life care had been recorded and was available to view in a separate file. One person has chosen to end their days at the home and the staff recognise the need to make sure that their care plan is reviewed more often to ensure needs are met. Involvement from the Macmillan nurses has commenced, in order to build up a working relationship. Alexandra House DS0000025810.V362983.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 and 23 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People are protected from harm by the Safeguarding policies within the home. People are aware of how to make a complaint and are confident that their views will be heard and acted upon. EVIDENCE: The home’s complaint log showed that there had been no complaints since the previous inspection. CSCI have not received any. The AQAA indicated that: ‘All clients are fully aware of the procedure to make a complaint.’ This was evidenced during discussion with people who live in the home. All the people spoken with said they would know what to do if they had any concerns. The home has a Safeguarding Adults policy in place and this was noted to contain current information and referenced the host boroughs own policy. Staff training records evidenced that they have received training in Adult protection. People who live in the home are able to manage their own finances if they chose, one person does so. Another person has assistance from their family. Other people have access to their personal allowance via the home. Records were seen to be maintained and accurate. Receipts are kept of purchases and the person signs when they receive money. Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People live in a home that is safe and homely. Improvements have been made to making sure that redecoration and routine maintenance are carried out. EVIDENCE: People are able to live in a homely atmosphere. They are able to answer the door if they want and have keys to their rooms. The kitchen has been refurbished since the previous inspection. The dining room is the designated smoking area, but there is a comfortable lounge, which is non-smoking. Staff do not have to stay in dining area if they do not want to. If the weather is pleasant some people chose to smoke outside. The bathroom has been redecorated. The manager reported that staff support people in maintaining their rooms. Other people rooms are decorated to a good standard, there are matching homely effects i.e. bed covers and curtains. Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 18 The lounge has a new three-piece suite, there is a television and music facilities in this room. The lounge leads onto the garden that the home plans to improve during the summer months, so that people are able to sit outside in a safe environment. Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 19 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, 34 and 35 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People are protected from harm by good recruitment processes and checks carried out on staff. Training is given to staff to enable them to develop and maintain their skills. Staff must make sure that training given is put into practice, in order that people are supported by competent staff. EVIDENCE: People who live in the home can be confident that staff employed undergo a through recruitment procedure. Staff files examined had all the necessary information needed. It is recommended that the application form is reviewed and personal information such as number of children and marital status is not asked for. It is also recommended that information on any cautions is requested. Each staff files had a copy of the persons contract and a record of supervision. There were completed induction booklets on file and the training record detailed what courses of study the member of staff had undertaken. Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 20 Training given included: medications, safeguarding, health and safety. The AQAA indicates: ‘Training has been in progress since last inspection and staff continue to attend and improve their skills and knowledge which has improved clients well being.’ ‘All staff have or are in the process of completing NVQ in health and social care.’ This was evidenced when examining training records. Staff had recently had training in manual handling, but this has resulted in some not carrying out personal care for a person in the home. The manager is in the process of writing a risk assessment regarding this aspect of the person’s care. Staff must make sure they are aware of what constitutes manual handling and how to reduce risk. If a person is able to stand for short periods to enable personal care to be carried out, then this does not constitute manual handling. Risk of the person falling must be minimised, but cannot be ruled out. Some staff also have issues with carrying the Hoover upstairs. The manager reported that another Hoover was purchased, but had been broken. Staff need to make sure they put into practice correctly what they learn on manual handling courses, as each task could involve some moving of a load. The inspector discussed a person who wished to die in the home, the home will need to look at increasing staff levels when appropriate, to make sure this persons’ needs are met. There is good support from the hospice team. At the time of the site visit the staffing of the home was usually one person. There are concerns about the nightly rate of pay for people who undertake sleep-in duties and are only paid a flat rate, which does not covers the hours worked. This needs to be addressed to make sure that staff receive an appropriate allowance for night duty. An allowance should be made available for the waking hours of a sleep-in duty and the hours when the member of staff is sleeping. The manager is undertaking NVQ 4; study time is allocated during work hours for the attendance required at college. However, to enable the manager to develop in her role, it is recommended that this time be increased to a whole day, to support her with gaining this qualification. This will assist in developing the service provided by the home. Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 21 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 and 43 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People are supported by a manager who runs the home in their best interests. Quality assurance systems have been put in place. This allows regular review of the service provided. Staff need to be confident that the provider supports their work in the home. EVIDENCE: The manager is suitably qualified and experienced to run the home. She has registered with CSCI and is aware of the need to meet all Standards. The manager stated that she views Alexandra House as the peoples home and the staff are visitors. The manager is open and proactive in her interactions with people that live in the home. She was chatting with them and was knowledgeable about their Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 22 needs as individuals. The staff team have worked hard to meet the requirements set at the previous inspection. No health and safety issues were identified at the time of the site visit. The AQAA states that Regulation 26 visits are being done, these were available for inspection. The AQAA also stated that quality assurance within the home has improved ‘We have improved the quality assurance systems which has helped us to identify areas of improvement.’ Risk assessments on the safety of the home have been revised and maintained. This was evidenced during the site visits, when no issues relating to health and safety were identified. The homes AQAA was detailed and continued relevant information in relation to requirements made. It clearly demonstrated areas of weakness where improvement is needed and how this will be achieved. Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 23 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 X 4 X 5 3 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 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 X X 3 3 Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 24 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 YA32 Regulation 12 (1) (a) Requirement In order that needs are met appropriately and safely staff must make sure that training they receive is implemented correctly. This will make sure that people are supported and their needs are met. In order that staff can contribute to the running of the home, the provider must make sure that they are responsive to staff issues and ideas. This will encourage good working relationships. Timescale for action 30/12/08 2 YA38 12 (5) (a) 30/12/08 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 YA34 YA43 Good Practice Recommendations It is recommended that the application form is reviewed to comply with good practice guidance. It is recommended that the manager is given sufficient time to completed NVQ level 4. Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Alexandra House DS0000025810.V362983.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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