CARE HOME ADULTS 18-65
Alfred Minto House Care Home 26-28 Zulu Road New Basford Nottingham NG7 7DR Lead Inspector
Stephen Benson Key Unannounced Inspection 20th July 2006 09:30 Alfred Minto House Care Home DS0000002228.V303152.R02.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 Alfred Minto House Care Home DS0000002228.V303152.R02.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. Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Alfred Minto House Care Home Address 26-28 Zulu Road New Basford Nottingham NG7 7DR 0115 978 3826 0115 978 0717 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) Turning Point Limited Mrs Dianne Field Ms Gaye Flounders Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th January 2006 Brief Description of the Service: Alfred Minto House is located in a residential area close to a range of public amenities and good public transport links. It is a specialist mental health service for men that aims to assist people make the transition from hospital and secure care, to more independent accommodation in the community. It is a non-secure facility with close monitoring and supervision. The home offers nine places comprising of eight single rooms and one self-contained flat, with communal facilities including two lounges (one non-smoking), a kitchen/dining area; and a laundry room. There is a back garden for residents’ use. The manager said on 20th July 2006 that the fees for the service range from £870 - £1120 per week depending on dependency needs Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first visit to the home since 1st April 2006 by The Commission for Social Care Inspection. The inspection lasted for 5 hours and the main method of inspection used was called case tracking which involved selecting 3 residents and tracking the care they receive through the checking of their records an discussing their care with staff. The residents were either not available or chose not to discuss their care. Two residents were spoken with, others in the home chose not to speak with the inspector and additional records were seen. A discussion was had with staff on duty and care practices were observed. The premises were not inspected in detail but various areas of the home were visited as part of the inspection. What the service does well:
The home has a comprehensive admissions procedure which includes an application form being submitted and the prospective resident being assessed by staff from the home. Following the assessment a report is prepared and the staff team discuss the suitability of the resident. When an admission is accepted the person then has to go through an induction into the home. A resident said he had been visited in hospital prior to moving into the home. The evidence shows that residents are fully assessed before moving to the home. Care plans are prepared by the worker allocated to work with each resident and these are discussed on a regular basis with residents at their arranged meetings. Care plans are prepared in line with the multi disciplinary team and take into account any restrictions/requirements set where residents have been conditionally discharged from hospital or are under licence from the Home Office. Residents said they look at their care plans with staff weekly. The evidence shows that residents care plans have details of residents’ needs and any restrictions. Residents are able to make choices where they are assessed as being able to do so. Any restrictions placed on residents are detailed in their care plans. Residents said they are able to do most things and staff will remind them if needed. The evidence shows that residents make the decision about their lives that they are able to. Residents are encouraged to take part in education or employment where they can and one resident was said to be doing well at a college in a nearby town. Other residents are encouraged to find things of interest to them. One resident said he had completed on course and was looking for another. The evidence shows that residents are taking part in appropriate activities.
Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 6 Residents are responsible for their own daily routines, including shopping and cooking their meals. Residents said that they decide how they spend their time and can prepare meals when they want. The evidence shows that residents maintain as much responsibility as they are able for their lives. There are good arrangements in place to meet the mental health needs of residents and staff work closely with other professionals involved with residents. Residents said they regularly go to the local hospital for support with their healthcare. Some residents self medicate and others are supported to take their medication. The evidence shows that residents receive appropriate healthcare support. Residents make use of the homes complaints procedure when needed and receive encouragement to do so. Records are kept of any complaint made and the action taken. The evidence shows that residents’ views are listened to and acted upon. Staff are expected to take part in the training programme provided by the registered companywhich includes a comprehensive induction. There is further training provided from the home. Staff praised the training available to them and residents said that staff seem to be able to do their jobs. The evidence shows that residents’ needs are met by appropriately trained staff. There are two registered managers employed who share the management of the home. Staff felt the home is well run. The evidence shows that residents benefit from a home that is well run. 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. Alfred Minto House Care Home DS0000002228.V303152.R02.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 Alfred Minto House Care Home DS0000002228.V303152.R02.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 at least once during a 12 month period. 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. New residents are assessed prior to admission. EVIDENCE: The manager said that following an enquiry a referral pack is sent out which includes an application form, which must be completed and all supporting information must be provided. Prospective residents are able to visit to see the home during the application process and an assessment is arranged to take place. An assessment of a prospective resident was being undertaken by 2 staff the morning of the inspection, one of the staff said that this had been the first assessment he had been involved in and had accompanied an experienced member of staff as part of his development. Staff said that they had used a pro forma to assess the resident and a report will be prepared and discussed in a team meeting as to the suitability of the resident. The manager showed a report that had been prepared for another prospective resident. All new residents are required to go through an induction to the home and a care plan is prepared to cover the admission period, which can be tailored to best suit the resident. Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 9 One resident said that he had been visited in hospital by staff before coming to the home and already knew a lot about it through friends that have been there but still came for introductory visits first. Alfred Minto House Care Home DS0000002228.V303152.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans show residents assessed and changing needs or their personal goals. Residents make decisions about their lives with assistance as needed. Residents who are able are supported to take risks as part of an independent lifestyle. EVIDENCE: The manager said that each resident’s named worker prepares the care plan and these are discussed with the residents at primary worker meetings, which usually occur weekly. Plans are reviewed as and when needed but no longer than three months. The plans are very much “live” documents and staff refer to them regularly as it tells them what has been agreed. Staff confirmed the same arrangements and said that care plans are prepared in line with the multi disciplinary team and take into account any restrictions/requirements set
Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 11 where residents have been discharged from hospital with certain conditions set as to what they have to do or have rules set by the Home Office. Residents are also able to create their own care plans if they wish to make certain arrangements for example about having contact or not having contact with a family member. Plans seen were regularly reviewed and updated and signed by residents and daily notes are made. Residents said that they have weekly meetings to look at their care plans and are checked that they are clean from drugs. The manager said that due to identified risks, including at times the residents’ vulnerability, their inability to cope or manage and the need for people with personality disorders to have clear boundaries, choices are restricted in some areas, but where it is assessed as being suitable residents are expected to do so. A record is made of any restriction placed on residents and there is information available in the home about advocacy services, which is included in the induction for residents. Residents said that they are able to decide most things and staff will tell you if there is something you are meant to be doing. Staff said that risk assessments are prepared for all residents by the multi disciplinary teams and take into account previous triggers and known offending behaviour. Any requests made by residents which staff feel raises any concerns are discussed in staff meetings and if felt necessary referred to the multi disciplinary team where decisions are made. Alfred Minto House Care Home DS0000002228.V303152.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to take part in age, peer and culturally appropriate activities. Residents are part of the local community. Residents are able to maintain family relationships. Residents rights are respected and responsibilities recognised in their daily lives. Residents are responsible for their own diet. EVIDENCE: The manager said that one resident is attending college full time in another town and is getting good results. Other residents are involved in voluntary
Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 13 work and attending a variety of courses. In addition residents have sessions with other healthcare professionals based at The Wells Road Centre, where mental health services are based. The manager said some residents need to be encouraged to take part in meaningful activities but care has to be taken not to hound them. Staff said that they try to get residents to have meaningful activities and time is spent initially during the induction helping residents to get to know the area and what is available. Use is made of local colleges and sporting activities and a resident due to move into the home soon has arranged his own programme. Residents have been spending time planting herbs and growing tomatoes in the garden area. There were weekly programmes seen in files that showed residents taking part in community activities and accessing mental health services. One resident said that he had completed a course and staff were helping him access a new one. Another resident spoke of spending time on the internet looking for accommodation so that he could move on, as he felt he had completed his recovery programme and was now stagnating. He was extremely frustrated at the lack of opportunity he had to get a property despite being assessed as a high priority. There was a recent trip to a theme park and notices were seen advertising a walk in Derbyshire. There are not any residents who have to be escorted when they leave the house at present but staff said that there have been occasions where this is required. Records showed that family contact is addressed and the manager said that in some cases there are complex relationships and establishing or maintaining contact is part of they multi disciplinary planning and that support is provided as required. Residents are supported to develop personal relationships. Staff said that residents are able to determine their own daily routine and do so; including what time they get up, go to bed and when they prepare their meals. Residents were seen having decided how they spent their time either in the home or going out. Residents said that they decide how they spend their day but staff will remind them of any commitments they have. Residents are responsible for their own meals and each one has their own locking cupboard and fridge. Residents ability to plan, purchase and cook meals is assessed as part of the induction programme and if any support indeed this is identified and included within the care plan. Staff said that they sometimes organise and activity of a house meal where residents can learn new cooking skills and try differing foods, and that curry nights are particularly popular. Residents said that they buy food from a local corner shop or use the local supermarket and although they usually prepare meals for themselves they sometimes club together in small groups and cook a meal. Residents said they can prepare food whenever they wish to.
Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 14 Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 15 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 the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents do not receive personal support. Residents physical, mental and emotional health needs are met. Residents are expected to take responsibility for administering their own medication. EVIDENCE: Residents are expected to be responsible for their own personal care and the manager said that if a resident needed any assistance this would be accessed through other community services. Residents mental health care is coordinated through the local mental health services based at The Wells Road Centre or if placed by another authority their mental health service. There were information posters displayed around the home highlighting ways of taking care of your mental health. All residents enrol with one of the local doctor surgeries. The manager said that residents are encouraged to have heath checks. Staff said that all staff have completed first aid training and that residents are able to talk about any health concerns
Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 16 with anyone they feel comfortable to do so with. Residents said they regularly go to The Wells Road Centre for healthcare reasons. Staff said that there are some residents who self medicate and there are spot checks carried out to ensure that they are taking their medication properly and staff observe for signs that indicate medication is not being taken. Other residents have their medication looked after by staff who do not administer it, they observe residents administering it themselves, which informs them when they feel a resident is ready to take responsibility for their own medication. Residents were observed going to the office to collect their medication and residents said they collect it from the office. Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 17 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 the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents views are encouraged, listened to and acted upon. Staff know how to protect residents from abuse, neglect and self harm. EVIDENCE: The home has a complaints procedure and a complaints log is maintained which showed that residents make use of this procedure. The log included details where residents had made contact with the responsible individual over an issue and where the manager had written to a resident encouraging a resident to make use of the procedure, although this was not done. The manager said that residents are encouraged to use the procedure in a constructive manner where they identify what outcome they are looking for. Staff said that residents are provided with information about the complaints procedure in the induction pack and that they actively encourage residents to use the procedure in an appropriate way. Residents said they did not have any complaints. The manager said that staff have received training on the adult protection procedures and that there have not been any allegations or incidents of abuse. Details of the Adult Protection Procedures are not included in the residents’ induction and the manager said that she intends to include these. Staff confirmed that they had received training on the Adult Protection Procedures and also on self-harm. Alfred Minto House Care Home DS0000002228.V303152.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable and safe environment. The home is clean and hygienic. EVIDENCE: There have been a number of repairs carried out which were set as requirements at the last inspection. Minutes of residents meetings showed that residents raise maintenance issues and these are attended to. Minutes also showed residents involvement in planting flowers and herbs in the garden. Residents said that staff will undertake minor maintenance. Staff felt that a security system in the office would be of benefit in case they need assistance when working alone with a resident. A cleaner works in the home 5 days a week cleaning communal areas. Residents are responsible for their own personal areas. The home was of an acceptable standard of cleanliness at the inspection. The manager said there have been some difficulties about the cleanliness of cooking equipment raised by residents and wanting to return to a system where everyone had their own
Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 19 individual pans. Staff have had training on infection control and the manager said that she will include information about this in the residents induction. Alfred Minto House Care Home DS0000002228.V303152.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by competent and qualified staff. Residents are supported by the home’s recruitment policies and practices. Residents individual and joint needs are met by appropriately trained staff. EVIDENCE: Staffing levels vary depending upon the commitments to be carried out during the day, but there is always a minimum of 2 staff on the premises. There are two staff on call overnight who are available if needed. The manager said that all new staff are required to complete an application form, attend an interview and provide 2 satisfactory references and Criminal Records Bureau check. The manager said that she will explore the idea of involving residents in part of the recruitment process. One of the staff files seen did not have references in but these were later located by the manager. A member of staff said that he was originally working in the home as a relief and had then followed the recruitment process when applying for a permanent position.
Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 21 All new staff attend the Turning Point induction and participate in the training programme. In addition local arrangements are made for staff to complete all mandatory training. A recently appointed member of staff said that the training has been excellent and training on drugs and alcohol awareness has been arranged. Residents said that staff seem to know what they are doing. Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 22 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a well run home. Residents believe their views are taken into account in the running of the home. The health, safety and welfare of residents are promoted and protected EVIDENCE: The manager, Gaye Flounders, has recently gone job share as she is involved in a new project with the registered company, Turning Point. A previous team leader, Diane Field, has recently been approved as a registered manager by the Commission for Social Care Inspection as the job share partner. Both managers are in the process of undertaking National Vocational Qualification level 4 and have a number of years experience. Staff felt that the home is well managed and any poor practice is challenged.
Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 23 The home provides details on advocacy services and there are regular residents meetings. The home is working through a quality assurance system, which seeks the views of residents. The manager said all the required health and safety checks and tests are carried out and the fire log was seen completed up to date. Staff aid that the fire alarm was tested the previous day and that they have keys to all residents fridges to carry out temperature tests. Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 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 4 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 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 25 No 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. Standard Regulation Requirement Timescale for action 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 YA19 Good Practice Recommendations The registered person should consider whether a security alarm is needed in the office Alfred Minto House Care Home DS0000002228.V303152.R02.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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