CARE HOME ADULTS 18-65
ALFRED HOUSE 29-31 Horne Street Bury Lancs BL9 9BW Lead Inspector
Sue Evans Unannounced 31 August 2005
st 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. ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Alfred House Residential Care Home Address 29-31 Horne Street Bury Lancs BL9 9BW 0161 764 2442 0161 764 2442 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) Mrs Margaret Ann Partridge Mrs Margaret Ann Partridge CRH PC Care Home Only 8 Category(ies) of MD Mental Disorder - 8 registration, with number of places ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th February 2005 Brief Description of the Service: Alfred House is a small, privately owned care home that provides support for up to 8 adults with mental health needs. The home consists of 2 adjoining terraced properties that have been adapted to form 1 house. The house is situated just outside Bury town centre, close to bus routes, shops, and other local amenities. The house is similar to other properties in the area and it is not distinguishable as a care home. It has a no smoking lounge, a smoking lounge, a dining room, a kitchen, and a laundry room. All bedrooms are single. Outside there is a garden at the front and a paved area at the back, with garden furniture, where people can sit out. The owner is also the manager. She is a qualified mental health nurse with many years experience in supporting people with mental health needs. ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 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 took 5½ hours. More than half of this time was spent talking to 3 residents, 2 staff members, and the manager. The inspector also looked at some parts of the building and examined some key records. What the service does well: What has improved since the last inspection?
The home has introduced a key worker system whereby each resident has a nominated staff member who helps to ensure that certain things are done regularly, for example room cleaning. The aim is to improve upon the standard of personal support given to residents.
ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 6 The commitment to NVQ training continues. The manager has completed NVQ level 4 in management. Two staff members also have NVQ 4 in management as well as their NVQ level 3. In order to further their development, and promote creativity, the manager has given them specific tasks to do that will help the service to develop and improve, ultimately benefiting both the staff members and the residents. 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. ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 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 ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 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 Pre-admission visits, and the inclusion of residents in agreeing what they need support with, enables all parties to reach a decision as to whether the home will be able to meet a person’s needs. EVIDENCE: The personal files of 3 residents’ were looked at. They contained copies of initial assessments carried out by the manager before a resident came to live in the home. Records and discussion indicated that the manager visited prospective residents in their own homes or hospital to assess whether the home could meet their needs. There was evidence in 2 of the files that initial assessment information had also been obtained from the care manager who had made the original referral. The 3rd file contained only the home’s assessment. The resident had been living at the home for approximately 10 years, having gone there in an emergency. The manager could not recall having received a care management assessment. She was aware however that now, when a resident is referred by Social Services, the person who makes the referral must provide the home with their own written assessment. Residents who were spoken with during the inspection, knew about their assessments and care plans and said that they attended meetings to review them. Residents said that before they came to live in the home they had been
ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 9 asked about their likes and dislikes, and what kind of things they felt they needed help with. ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 Residents know about their care plans, and their opinions are taken into account, when agreeing them. The home encourages residents to be as independent as possible, helping them to keep any risks to their health and welfare to a minimum. EVIDENCE: Staff members were asked about the needs of three of the residents. They were consistent in their descriptions of how they supported them, and this matched with the information given by the residents, and recorded in care plans. Care plans were clearly written and included each resident’s own opinion. Records showed that potential risks had been assessed, and balanced against the resident’s right to choice and independence. There was evidence to show that care plans and risk assessments were kept under review and updated regularly. Annual reviews were arranged, under the Care Programme Approach (CPA), by Social Services. However, in some files it was difficult to locate the most recent CPA review notes. The manager said that the home did not always receive a copy. The home was asked to make
ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 11 sure copies of CPA minutes were obtained following reviews, and kept in personal files. She was also asked to re-organise the files to make it easier to find information quickly. Residents knew about their written records, and knew that they could look at them if they wanted to. Residents were pleased with the support provided. One said, “Staff do a good job. Excellent”. Another said, “Staff are brilliant. They look after me well”. Since the last inspection a key worker system had been developed whereby each resident had a nominated staff member who would take responsibility for ensuring that certain things were done, for example room cleaning and bedding changes. The aim was to improve upon the standard of personal support given to residents. ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 and 16 Residents choose how they spend their time, and take part in activities that they enjoy doing. They participate in the community, with staff support if needed, enabling them to lead fulfilling lifestyles. Practices in the home respect residents’ rights to privacy, dignity, independence and choice, subject to any agreed restrictions. EVIDENCE: It was clear that residents were encouraged to participate in fulfilling activities, with staff support as necessary. Staff rotas were flexible to accommodate those people who needed support with community activities. However, not all residents were keen to take up offers of outings. One person said that staff regularly offered cinema outings but he preferred to watch films at home. On the day of the inspection, three residents had gone out to START, a local art group. ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 13 Some residents had recently attended a learning open day at the Parsons Lane Centre. This had resulted in two of them signing up for courses on computers, beauty, literacy, and photography. (Last year, residents were enrolled on courses such as food hygiene and literacy). One person had a part time job. Another was on the list for Bury Employment Support Team, with a view to eventually finding a job. Residents and staff gave examples of the community facilities that were used, such as public transport, local parks, churches, restaurants, cafes, library, shops and health centres. The home had organised 2 swimming groups, and residents and staff had started going swimming at the local leisure centre. The home had a pet dog which some residents liked to take for a walk. Residents said that they kept in contact with family and friends. One resident said that his friend was coming to Alfred House for tea later that day. He said that he also met this person outside the home. Others talked about the contact that they had with their families. This was done by making and receiving visits, and by telephone or letter. At the time of the inspection, one resident had gone to visit her family for a few days. The manager said that, if necessary, the home provided a staff escort to enable people to visit their families. Discussions, and examination of care plans, showed that residents were given support and information to help them make appropriate decisions about their relationships. Residents said that they could choose how they spent their time. One said, “You’ve got choices, staff don’t make you do things”. Any restrictions on choice and freedom, to safeguard the welfare of the individual, were agreed and recorded (for example restrictions on alcohol to reduce risks of alcohol abuse). Residents gave examples of how staff members encouraged and helped them to do things for themselves, for example cooking, washing up, and some household tasks. Residents were satisfied that their privacy was respected, for example nobody entered their bedrooms without knocking. Locks were fitted to bedroom doors, and residents could have a key. Mail was given to them unopened and there was a portable telephone so that calls could be taken in private. It was observed that staff members and residents spoke with each other in a natural, friendly manner. Residents said that staff treated them with respect. ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 Any changes in health needs are dealt with in liaison with the appropriate specialist health services. EVIDENCE: Discussions with residents and staff indicated that residents used community healthcare services such as dentists and GPs. Residents said that a staff member accompanied them to appointments. Records showed that the home requested assistance from specialist health workers, for example Community Psychiatric Services, or social workers, if necessary. The manager and staff were clearly aware of the physical and emotional needs of the residents. ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 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 The systems in place for making complaints, and the approachability of the manager, mean that residents feel comfortable about airing their views, and are confident that they will be listened to. Staff members have the skills and knowledge to respond properly to any suspicion or allegation of abuse. EVIDENCE: The home had a written complaints procedure. Residents said that, if they had any concerns, they would speak to the manager, or a staff member. They said that they were confident that any complaints or concerns would be properly dealt with. During the inspection, residents had no hesitation in approaching the manager or staff if they wished to discuss something. Discussions with staff members showed that they understood their responsibilities in respect of reporting suspected abuse. They were able to give examples of what signs might arouse suspicion. A staff member said that training in adult protection had been done “in house” and that it had also been covered during NVQ level 3 training (which most staff had completed). The inspector was therefore satisfied that the outcome for this standard was being met. Nevertheless, the manager was advised to contact the Social Services Department to check whether any courses in protection were available. ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 28 and 30 Alfred House provides a safe, clean, homely, environment for residents, suited to their lifestyles. However, the smoking lounge needs improving to ensure that satisfactory standards are maintained. EVIDENCE: The home is situated in a residential area of Bury, just outside the town centre. It is close to bus routes, local shops, and other local amenities. The home consists of two adjoining terraced houses that have been adapted to form one house. The house is similar to other properties in the area and it is not distinguishable as a care home. Only the communal areas of the home were inspected this time. The home has two lounges, one of which is the designated smoking area, and a dining room, giving residents some choice about where they spend their time. There is also a domestic style kitchen, two bathrooms, and a laundry room. Outside there is a garden at the front, and a paved area at the back where people can sit out.
ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 17 The home had a comfortable, homely atmosphere. The pet dog added to the homeliness. Residents were pleased with the home and felt it had been a good choice. Most areas were nicely furnished and decorated. However, there was a need to improve the smoking lounge. The manager had already identified this and she said that improvements were planned. The manager was also planning to make improvements to the bathrooms. She was asked to provide the CSCI with a written improvement schedule, giving the areas identified for improvement, and the expected timescales for completion of the work. The areas that were looked at were clean. There were no obvious health and safety hazards. Liquid soap and paper towels were provided for hand washing. ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 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) 32 , 34 and 35 The home is clearly committed to ongoing staff training in order to equip the team with the knowledge and skills that they need to meet the needs of the residents. Pre-employment checks are carried out in order to protect residents but there is a need for staff to provide photographs, and medical declarations to confirm that they are fit to carry out their duties. EVIDENCE: From observations and discussions, and reading written information, it was evident that the staff team understood the needs of the residents and had the skills and knowledge to meet those needs. The level of commitment to staff training in NVQ was impressive. All staff members except the most recent recruit were trained to at least NVQ level 3. The recent recruit is expected to be enrolled onto NVQ 3 in due course. In addition to NVQ 3, two staff members had also completed the NVQ level 4 in management, and they are now getting involved in development work within the home. The manager had also done NVQ level4 in management. One part time staff member was doing a degree in social work.
ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 19 Staff members gave examples of some of the ongoing training that was provided, including first aid, moving and handling, and food hygiene. Most had done sign language to specifically improve communication with one of the residents. Staff training certificates were not looked at this time. They will be looked at during the next inspection. Staff recruitment records, in respect of a recent recruit, were looked at. They contained most of the necessary records, including employment history, CRB (Criminal Records Bureau) disclosure, evidence of the checking of the POVA (Protection of Vulnerable Adults) list, and 2 written references. In order to fully meet the regulations, the manager was asked to obtain a photograph of the staff member, and a declaration from her that she is physically and mentally fit to carry out her duties. ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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) 38 and 42 Residents benefit from the open management approach of the home and they are able to openly express their wishes and opinions. The health and safety of service users and staff are promoted by means of regular maintenance and safety checks. EVIDENCE: It was clear, from observations and discussions, that the manager encouraged an open, inclusive atmosphere within the home. Staff members and residents said that the manager was very approachable. One staff member said that the manager was “easy to talk to” and she described Alfred House as “ a very open house”. During the inspection it was observed that residents and staff had no hesitation in approaching the manager if they needed to speak to her. The manager had encouraged creativity within the team by allocating developmental tasks to team members.
ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 21 Several safety records were checked. These included gas soundness, portable electric appliance tests, electrical installation, servicing of fire alarms and emergency lighting, and servicing of fire extinguishers. Records showed that the home had done a fire risk assessment, and a workplace risk assessment. Examination of the fire book showed that fire alarms, means of escape, emergency lighting, and fire fighting equipment were tested at the required intervals. ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 22 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 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 4 x 4 3 x Standard No 31 32 33 34 35 36 Score x 4 x 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
ALFRED HOUSE Score x 3 x x Standard No 37 38 39 40 41 42 43 Score x 4 x x x 3 x F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 23 N/A 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 24 Regulation 16, 23 Requirement The registered manager needs to provide the CSCI, by the date in the end column, with a maintenance schedule that includes the proposed timescales for improving the smoking lounge. The registered person must ensure that staff recruitment records include a recent photograph and a declaration, signed by the staff member, that they are physically and mentally fit to undertake their duties. Timescale for action 31 October 2005 2. 34 19 31 October 2005 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 6 23 Good Practice Recommendations The manager is advised to re-organise service users personal files so that information can be located quickly. Copies of CPA reviews should be kept in personal files. The manager is advised to look at options for staff training courses in adult protectin. ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Turton Suite, Paragon Business Park Chorley New Road Horwich Bolton, BL6 6HG 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. Extracts may not be used or reproduced without the express permission of CSCI ALFRED HOUSE F56 F06 S8420 Alfred House V215533 310805 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
