Inspection on 02/04/07 for Alexandra Road Crisis Unit

This inspection was carried out on 2nd April 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alexandra Road Crisis Unit 24/03/09

Alexandra Road Crisis Unit 18/08/06

Alexandra Road Crisis Unit 31/10/05

Alexandra Road Crisis Unit 02/06/05

Alexandra Road Crisis Unit 03/02/05

Alexandra Road Crisis Unit 24/06/04

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 Road Crisis Unit 32 Alexandra Road Hornsey London N8 0PP Lead Inspector Peter Illes Key Unannounced Inspection 2nd April 2007 09:15 Alexandra Road Crisis Unit DS0000035135.V333046.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 Road Crisis Unit DS0000035135.V333046.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 Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra Road Crisis Unit Address 32 Alexandra Road Hornsey London N8 0PP 020 8365 7287 020 8888 9829 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) London Borough of Haringey Yvonne Biasio Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th August 2006 Brief Description of the Service: The Alexandra Road Crisis Unit is owned and run by London Borough of Haringey. The unit is unique in the borough as it only provides short-term emergency and respite services for up to eight people with mental health problems. Stays are typically from three days up to two weeks and may be an alternative to hospital admission. The unit is a three storey converted and extended domestic premises situated in a quiet residential street between Wood Green and Turnpike Lane. There are eight single rooms, several bathrooms and shower rooms, a choice of two lounges, a staffed kitchen, a separate dining room with facilities to make drinks and snacks, an attractive conservatory that is used as an alternative place to relax and to do artwork and a private garden. Referrals to the unit come via the statutory and non-statutory mental health services. However, the unit cost of an individual episode of respite care could not be ascertained at this inspection. The deputy manager stated that information about the unit, including information from CSCI inspection reports, was shared with stakeholders. In addition the home keeps a copy of the latest CSCI report on the service user’s notice board in the unit. The unit has several aims: to provide good quality individualised support that is strengths and needs led; to facilitate personal development; to assist service users in development of alternative crisis responses and to foster appropriate coping strategies in order to return to their appropriate environment. Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. At the last key inspection on 18th August 2006 twelve requirements were made to improve the quality of support to service users. On 5th January 2007 an additional random inspection was made to the home by the lead inspector to check on compliance with these requirements. Of the twelve requirements checked on 5th January 2007 eleven had been satisfactorily complied with leaving one that had not, which was restated with an extended timescale. All of the original twelve requirements made at the last key inspection on 18th August 2006 are referred to in the relevant sections of this report. This unannounced key inspection took approximately seven hours with the deputy manager, Ms Megan Laird, being present or available throughout. There were eight service users accommodated and no vacancies at the time of the inspection. The inspection included: meeting and talking to three service users, two of them briefly and one of them independently, the other service users were informed that an inspection was taking place but chose not to talk to the inspector on this occasion; detailed discussion with the deputy manager and independent discussion with two care staff. The inspector had also received a pre-inspection questionnaire since the last inspection. Further information was obtained from a tour of the premises and documentation kept at the home. What the service does well: The unit continues to provide specialist and sensitive short-term care and support for service users that are in crisis, which is highly valued by service users. Records of service user’s needs and how they are to be helped to meet these continue to be up to date, of high quality and reflect the specialist shortterm nature of the work. Joint working with others from outside the home, including mental health and social care professionals enhances the service offered. This is especially relevant with regard to ensuring the frequent admissions to and discharges from the unit take place with the minimum of stress to service users. Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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 Road Crisis Unit DS0000035135.V333046.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 Road Crisis Unit DS0000035135.V333046.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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The unit gathers current and detailed information regarding service users needs before every short stay admission and also agrees a discharge plan at that stage. This assists the unit in effectively addressing service users needs and maximising the benefit they receive from their short stay. EVIDENCE: Four service user files were inspected at random. Each showed a detailed assessment process, including a risk assessment process. The assessment information was multi-disciplinary and current. The assessment information showed the individual service user’s assessed needs immediately prior to that person’s admission. Input into this assessment process was seen from relevant health and social care professionals, staff at the unit and from the service user themselves. The inspector was informed that significant efforts were made by the unit to establish the service users current needs at the point of admission to ensure those needs could be effectively addressed. Information recorded included: presenting issues, psychiatric history, physical health needs, medication, aim of the referral and post discharge plan. The assessment process also includes establishing their needs in realtion to equality and diversity. There was clear evidence that the service user had been consulted on their assessed needs and staff and a service user spoken to independently confirmed this. Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users needs and aspirations are clearly set out in their care plans including outcomes that are planned to have been achieved by the end of the stay. Service users are supported to make as many decisions as possible for themselves to retain and maximise their independence. They are also supported to take responsible risks to assist keep them safe during their short stay at the unit. EVIDENCE: The care plans inspected for four service users were detailed, linked to the comprehensive assessment information available and contained clear short term goals with guidance for staff on how to address these. Evidence was seen that service users were actively involved in the development of their care plan. The unit operates a key worker system and evidence was seen on service user files of key worker sessions. These primarily related to objectives set out in the service users care plan. Evidence was seen that the care plans were actively reviewed and developed through the placement, in some cases daily, with the Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 10 service user’s involvement and with the input of health and social care professionals as required. Staff and a service user spoken to independently confirmed this. The service user files inspected contained a signed copy of a client agreement form that specified what they could expect from staff and what staff would expect from them. This contained some restrictions on service users while staying at the unit such as the prohibition of alcohol and illegal drugs. The inspector was informed that a tariff of consequences had been established if these house rules were not complied with. These consequences included a verbal reminder of the rules, a warning letter given to the service user or, in extreme circumstances where the situation could not be resolved, the termination of the placement. The files also included a form to specify whether the service user gave consent to information about them being shared. This included information regarding emergency situations and whether this could be shared with relatives or other carers outside of the unit. There are a range of ways the unit engages with service users including a daily coffee morning meeting and a community meeting with service users and staff held on a Monday evening. Service users accommodated are encouraged to manage their own finances and to retain as much independence as they can throughout their stay. The service user files inspected contained detailed risk management plans that had been agreed and signed by the service user. These were based on a range of relevant information primarily obtained from risk assessments. Risk assessments are undertaken by external health and/ or social care professionals when a referral is made to the unit. In-house risk assessments are completed by staff immediately prior to admission and this information is in turn shared with relevant health and social care professionals. The inspector was informed that admissions are not made until there was an agreed risk assessment with relevant stakeholders. The plans seen showed identified potential risks and gave clear guidance to staff in assisting to minimise these. These risk management plans had been reviewed at the same intervals as the care plans. Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can choose to participate, or not, in a range of appropriate activities both within the unit and within the community depending on their assessed needs. Contact with friends and relatives is supported subject to the service user wishes and the privacy needs of other service users. Service users are treated with respect and their rights and responsibilities are clearly stated with any limitations agreed with them. They also enjoy balanced and healthy meals that meet their needs and preferences. EVIDENCE: The unit only provides short-term care and support for service users and because of this activities are subject to individual negotiation during their stay. Service users can be supported to maintain employment, education or other activities if this is appropriate. It can also be agreed that service users stays are orientated toward providing them with a break from the pressures of living in the community and their usual activities. Evidence to support this was seen in service users care plans. The unit offers a range of activities for service Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 12 users, the majority of which are therapeutic in nature and appropriate to support service users that are experiencing some form of crisis at the time of their admission. Activities on offer include yoga, massage and a visualisation group run by staff in addition to a daily coffee meeting and weekly community meetings. The unit also runs its own library of books and videos that service users can borrow on request. The deputy managers stated that board games such as “scrabble” were popular with some service users and where appropriate such activities were helpful to promote service user interaction without the direct intervention of staff. Since the last key inspection the unit has installed two personal computers with Internet access for service users. These have proved very popular with service users. The inspector was informed that service users often use them to gain further understanding of their own mental health needs. The inspector was also informed that the computers are fitted with filters to prevent access to illegal or undesirable websites. The deputy manager stated that the unit was working on initiatives to the service provided for service users from ethnic minority communities. This had included promoting black history month at the end of 2006 with staff bringing in DVD’s of prominent black people, running quiz nights and promoting ethnic meals during that period. She also went on to say that the unit was receiving increasing referrals from the Turkish community and were looking to encourage and consolidate this. Service users are supported to access the local community, or not, if that is appropriate to meeting their assessed needs. Individual service users were able to leave and return to the unit on their own during the inspection. Where service users go out on their own they are required to inform staff when they intend to return and also to contact the unit if they are being significantly delayed from returning at the specified time. There was evidence that service users are informed of this requirement when they are admitted to the unit. Service users continue to be encouraged to maintain links with family and friends on terms that they can cope with. Where it is agreed with the service user the staff also support service users to maintain their privacy during their stay. The deputy manager informed the inspector that visitors are welcome between 9am and 11pm and that children can visit by arrangement although for the benefit of other service users they need to be accompanied during the visit. The inspector was also informed that visitors were required to abide by the unit’s house rules when at the unit, e.g. regarding the prohibition of alcohol and illegal drugs. The unit has a weekly menu that is discussed at the weekly community meeting and this showed a range of healthful meals. The deputy manager stated that she was working with the cook to develop healthy food options further. A service user told the inspector that they liked the “properly cooked” food at the unit, which they felt was much better than the meals they prepared Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 13 themselves at home. At the time of the inspection the unit’s permanent cook was on leave and an agency cook was covering this post. None of the service user’s required any special diet at the time although the inspector was informed that there was always a vegetarian option available for those that preferred this. The deputy manager stated that culturally appropriate meals such, as Ha-Al or Kosher meals, could be supplied when needed. The kitchen was satisfactorily clean and tidy although a little tired looking, it is due to be refurbished later in 2007. At the last key inspection a requirement was made that food stored in the freezer must be properly labelled. This was seen to have been complied with at the subsequent random inspection and food storage was satisfactory at this inspection. It was noted that the temperature of the food was tested and recorded when it was served although it was not clear to the inspector from the record seen which temperature record related to which food. A good practice recommendation is made regarding this. Alexandra Road Crisis Unit DS0000035135.V333046.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive appropriate personal support in accordance with their needs and preferences. They are supported to remain as independent as possible in addressing their mental and physical healthcare needs and are supported by community based health professionals as required regarding this. Service users are also generally well supported with their medication although an identified improvement is needed to ensure that service users and staff remain fully protected in this area. EVIDENCE: The deputy manager confirmed that the majority of service users who use the unit are generally independent with regard to their personal care. Where any personal care needs are identified these are reflected in the individual’s care plan. There were some issues relating to supporting service users with their personal care seen in care plans inspected. However, these were primarily related to supporting the individuals mental health needs to enable them to manage their personal care. The unit is not accessible to service users that have significant mobility needs as all the bedroom are on the first and second floors that can only be accessed by stairs. Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 15 The deputy manager confirmed that staff support service users with any ongoing health care needs where they are identified in their care plans. The acting manager confirmed that health care professionals who are involved with service users in the community would normally deal with any ongoing health issues. Because of the short-term nature of stays, service users keep their own GP’s. There was clear evidence from documentation in the home and from staff spoken to of mental health professionals input into monitoring and promoting service user’s mental and emotional health needs. This is done in partnership with the unit’s support staff while service users are accommodated in the unit. The medication needs were looked at for the four service users whose files were inspected. Two of these were administering their own medication and this was clearly shown on their medication profile. The two other service users were being assisted with their medication by staff while at the unit. The records for these were generally satisfactory although an identified record sheet for one service user needed amending to correspond with that person’s medication profile. A requirement is made regarding this. Two requirements were made regarding safe administration of medication at the last key inspection and evidence seen that they had been complied with at the subsequent random inspection. These were in relation to recording on an individual’s medication administration record and to staff training regarding safe administration of medication. Alexandra Road Crisis Unit DS0000035135.V333046.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to express any concerns and complaints and have these appropriately dealt with by the unit. Service users are also protected by an up to date adult protection policy and procedures that they and staff are aware of. EVIDENCE: The unit has a satisfactory complaints procedure that also included reference to L. B. of Haringey’s overall complaints procedure if a complainant was not happy with the response they receive from the unit. A copy of this was seen in information packs for new service users that are given to them when they are admitted to the unit. The unit had dealt with three complaints since the last key inspection. The records of these were sampled and showed evidence that the complaints had been dealt with satisfactorily. The service user spoken to stated that staff took any issues they raised seriously. At the last key inspection a requirement was made that the unit’s adult protection policy and procedure was reviewed to ensure it covered all the requirements of the local authority adult protection procedure and that staff were made aware of the revised procedure. Evidence was seen at the subsequent random inspection that the adult protection policy had been reviewed and revised in October 2006. The manager stated at the time that this had been completed in liaison with L.B. of Haringey’s adult protection coordinator. Evidence was also seen at that time that the manager had undertaken refresher training in adult protection and that a rolling programme Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 17 of adult protection training was in place for staff. Evidence was seen that staff had been made aware of the revised policy and how it should be implemented, including at a staff meeting in November 2006. At this inspection the adult protection policy remained satisfactory and evidence was seen that a summary of the L.B. of Haringey’s policy was given to service users as part of the information pack given to them at the time of admission. At the last key inspection a requirement was made that all allegations or disclosures of abuse must be reported to the Commission without delay. The manager stated at that time that there had been no allegations or disclosures of abuse since the last key inspection. It was noted that the revised adult protection policy clearly stated that any such allegation or disclosure must be reported to the Commission without delay and the relevant contact details were clearly included in the policy. The deputy manager stated that no allegations or disclosures of abuse had been made to the home since the last key inspection. Evidence was also seen that staff receive training/ refresher training in adult protection. Alexandra Road Crisis Unit DS0000035135.V333046.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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy their short stays in premises that are comfortable, well decorated and generally well maintained. The accommodation meets their short-term needs although an identified area of maintenance still needs attention and would enhance service users quality of life. The unit was clean and tidy throughout creating a pleasant environment for both those that live and work at the home. EVIDENCE: The unit is a three storey converted and extended domestic premises situated in a quiet residential street between Wood Green and Turnpike Lane. There are eight single rooms, several bathrooms and shower rooms, a choice of two lounges, a staffed kitchen, a separate dining room with facilities to make drinks and snacks, an attractive conservatory that is used as an alternative place to relax and to do artwork and a private garden. The deputy manager stated that a significant range of refurbishment and redecoration work had been agreed for the unit for 2007. A costed estimate was seen that included Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 19 refurbishment of the kitchen, utility room and cleaners cupboards. The deputy manager was hopeful that this work would commence in May or June 2007. At the last key inspection a requirement was made that the wooden steps were repaired that lead from decking that allows access from the conservatory to the garden. This work had not been completed at the subsequent random inspection although the manager stated that contractors had been commissioned to undertake the repairs but that the contractors had subsequently delayed the start date for the work. The manager stated at the time that she was confident that this work would now be undertaken by the end of January 2007 and the requirement was restated. The inspector noted that the steps had still not been repaired at this inspection. The deputy manager stated that the repairs were now to be included in the wider refurbishment work that was planned for the unit. The inspector was disappointed that despite a requirement being made at both the last key inspection and subsequent random inspection this work is still outstanding. The inspector was informed during the inspection that service users could not access the garden from the main lounge/ conservatory and this was problematic when they were upset, particularly for service users that smoked. The inspector now expects this repair to be dealt with as a priority so that service users can freely access the garden from the conservatory during the summer. This requirement is restated for the second time. Continued failure to comply with requirements may lead to the Commission considering enforcement action. The home was clean and tidy throughout during the inspection. The home has suitable laundry facilities and infection control procedures. The inspector was informed that service users are encouraged and supported to carry out their own laundry. Alexandra Road Crisis Unit DS0000035135.V333046.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient numbers of staff, who access a range of appropriate qualification and training opportunities, are deployed to effectively address service users needs. Service users are also protected by the unit’s staff recruitment procedure although an identified improvement is needed in this area. . EVIDENCE: The unit has a rolling programme for staff to complete national vocational qualification (NVQ) level 3 in promoting independence and evidence was seen that this is planned to continue in 2007/ 2008. The staff rota inspected showed a minimum of three staff members on duty for the majority of the weekday morning and afternoon shifts with two staff members on duty for the remainder. There are also two staff on some shifts during the weekends and three staff on others. One waking and one sleeping in staff are on duty during the night. The inspector was informed that this was satisfactory and that the unit controls when admissions were made to the unit to assist ensure that satisfactory resources were available to meet service user’s needs. The inspector was also informed however that working in the unit could be stressful when it was full. Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 21 At the last key inspection a requirement was restated that the home keeps copies of the required documentation for each member of staff employed to evidence the use of a robust recruitment procedure. The required documents were to include the following: a copy of each staff member’s proof of identity including a recent photograph, two written references including a last employer reference, employment history and evidence that the person had a current criminal record bureau clearance and protection of vulnerable adults clearance. At the subsequent random inspection this requirement was met. Staff files were inspected at random and all included the required documentation and also included evidence of entitlement to work in the U.K. where appropriate. It was clear to the inspector that the manager had undertaken significant work to ensure that copies of all the relevant recruitment documentation were obtained from L.B. of Haringey’s human resources department to be kept at the unit. At this inspection the files of three staff members that had been recently recruited were inspected. Two of these contained all the required documentation to assist evidence a robust recruitment procedure. The file of the third person contained the majority of the required documentation but only contained one reference. The staff member had worked at the unit as an agency worker prior to being recruited to a permanent post. The inspector was informed that the unit’s advice from L.B. of Haringey’s human resource department was that one reference would suffice, as the unit knew the member of staff. However, the one reference on file was from the unit manager and the Care Homes Regulations 2001 specify that two references be obtained for new staff. A new requirement is made regarding this. Despite this the inspector was pleased to see that a considerable improvement had been made to the documentation kept at the home to evidence a robust recruitment procedure being implemented. At the last key inspection a requirement was restated that all staff that administer medication had current training in safe administration of medication. At the subsequent random inspection records showed that all relevant staff had completed training or refresher training in the safe administration of medication. At the last key inspection a requirement was made that all staff received foundation training to Skills for Care specification, within six months of their appointment. At the subsequent random inspection records were seen to evidence that this was being complied with. Evidence was seen of a range of foundation training courses that staff had attended since the last key inspection and evidence of further courses, including refresher training where required, that staff were enrolled on for early 2007. These training courses included: infection control, safe administration of medication, adult protection, exploring diversity, food hygiene and first aid. Staff spoken to who had Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 22 recently been appointed confirmed that they had received formal induction training and were able to access training courses in core subjects. At this inspection a satisfactory draft training plan for 2007/ 08 was seen. The deputy manager was clear that all staff would receive the required training outlined in the national minimum standards and more specialist training to assist meet the needs of the service users who are supported by the unit. Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 23 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and staff benefit from the home being effectively managed by the registered manager and deputy manager. Service users views are sought after each stay to assist monitor and improve the quality of the service provided. Effective health and safety procedures contribute to protecting service users, staff and visitors to the home although these need reviewing with regard to fire safety. EVIDENCE: Following a requirement made at the last key inspection the inspector was pleased to note that the manager of the unit is now registered as such with the Commission. The deputy manager, who was on duty during this inspection, was friendly and helpful and was knowledgeable about the needs of service users with a mental health diagnosis. She was also knowledgeable about the Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 24 range of management issues that needed dealing with in a specialist mental health unit. Staff and service users spoken to told the inspector that they felt the unit was well managed. Staff informed the inspector that staff morale was high because of this. The unit continues to monitor the quality of the service it provides in an appropriate manner for a short stay crisis unit. Every service user is invited to fill out an evaluation form at the end of their short stay and copies of these were sampled and found to be satisfactory. The responses from these forms are evaluated on a regular basis and contribute to the unit’s overall aims and objectives that the inspector was informed were being developed for 2007/ 2008. An external manager visits the unit regularly on an unannounced basis and records of these visits were seen in the unit and copies are sent to the Commission. At the last key inspection requirements were made regarding testing of portable appliances, checking an identified power socket to ensure it was not overloaded, ensuring quarterly fire drills were undertaken and that the unit’s current third party and employer liability insurance certificate was displayed. The inspector was pleased to see that all these requirements had been complied with at the subsequent random inspection. At this inspection the majority of the health and safety documentation inspected was satisfactory. However, new fire regulations (Regulatory Reform -Fire Safety- Order 2005) have come into force from October 2006 and place increased responsibilities on owners and managers of registered care homes. A requirement is made that the home produces a current fire risk assessment, reviews its existing fire plan in the light of the new fire regulations and consults with the fire officer as part of this process. Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 25 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 4 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 3 23 3 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 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 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 2 X 3 X 3 X X 2 X Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 YA20 Regulation 13(2) Requirement The registered persons must ensure that the medication profile and medication administration record for an identified service user are accurate and correspond, for an identified service user. The registered persons must ensure that the wooden steps leading from the conservatory to the garden are repaired (previous timescales of 30/09/06 & 28/02/07 not met). Timescale for action 30/04/07 2. YA24 23(2) 31/07/07 3. YA34 19(1) 4. YA42 23(4) The registered persons must 30/04/07 ensure that copies of two references are kept at the unit for all staff recruited to work at the unit. The registered persons must 30/04/07 ensure that a current fire risk assessment is produced for the home, the existing fire plan is reviewed in the light of new fire regulations and that the fire officer is consulted as part of this process. Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 27 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 YA17 Good Practice Recommendations The unit should keep a clearer record of the temperatures of cooked food that is served in the unit to identify which ingredients the record refers to. Alexandra Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Road Crisis Unit DS0000035135.V333046.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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