Inspection on 01/10/08 for Alison House

This inspection was carried out on 1st October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alison House 21/04/09

Alison House 06/12/07

Alison House 14/05/07

Alison House 22/08/06

Alison House 13/09/05

Alison House 04/04/05

Alison House 20/09/04

Alison House 19/05/04

Similar services:

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Extracts from inspection reports are licensed from CQC, this page was updated on 16/12/2008.

CARE HOME ADULTS 18-65 Alison House 4 Hadleigh Road London N9 7BX Lead Inspector Jane Ray Unannounced Inspection 1st October 2008 2:00 Alison House DS0000010601.V372602.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 Alison House DS0000010601.V372602.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. Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alison House Address 4 Hadleigh Road London N9 7BX 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) 020 8805 3200 020 8211 8098 alison-house@hotmail.co.uk Mr Jessie Busenpeso Espino Mrs Angelina Linga Espino Mrs Angelina Linga Espino Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2007 Brief Description of the Service: Alison House is a family run business with the care staff coming exclusively from family members. The homes stated aims are to “provide high quality 24 hour residential care for you whilst supporting and maintaining your independence and supporting you so make your choices”. The home is situated in Edmonton, just off the main Hertford Road. A range of shops and amenities is nearby and there are good public transport links. The lounge-diner, one bedroom and a toilet, are located on the ground floor. There are two other bedrooms on the first floor, and a staff bedroom, which is also the office. There is another toilet and bathroom upstairs. There is a lean-to conservatory and a garden at the rear of the building. The fees for the service range from £350 to £400 per week. A copy of this report can be obtained direct from the provider or via the CSCI website (web address can be found at page two of this report. Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection took place on the 1 October 2008 and was unannounced. The inspection lasted for four hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to observe the support given to two of the three current residents. Both residents also spoke to the inspector about their experiences of living in the home. The inspector was also able to spend time talking to the manager who was the only person working. The inspector did a tour of the premises and also looked at a range of records including resident records, staff files and health and safety documentation. The home had provided the inspector with a self-assessment questionnaire (AQAA) prior to the inspection. Three surveys completed by residents were also received. What the service does well: The people living in the home benefit from a family run business, which means the same people have cared for them over a number of years. The two residents we spoke to were both very happy in the service and clearly felt it was their home. One resident said, “we are certainly looked after very properly, I am very happy here”. The three residents have lived together a number of years and clearly are very fond of each other. The home has good working links with health care professionals including the mental health service that enables the people living in the home to be supported with their healthcare issues. The people living in the home all feel able and comfortable to express their views on how the home is working and anything they need or want to happen. The home is maintained on an ongoing basis and provides a homely environment for the residents. The home is well located to enable the people living in the service to access local shops and other amenities. Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: This inspection has identified a number of shortcomings. Some of these have a direct impact on the quality of life for the residents and others could potentially affect their safety and welfare. There is a need to ensure all the residents have updated assessments so that staff and other care professionals have access to accurate information. Residents also need to be supported to contribute to the development of their care plan and staff need training so they can implement a system of person centred planning, so that the resident is able to achieve some selfdetermination in their lives. Where residents have issues that could potentially place them at risk, these must be recognised and risk assessments put into place with the involvement of the appropriate care professionals. Residents also need to be advised on the full range of opportunities in the local area and supported to access activities of their choice. Residents should also be supported to practice their religion where they have expressed a wish to do so. Healthy food choices must be made available to the residents and fresh rather than convenience food used. Support must be offered to enable residents to monitor their weight as regularly as is needed. Where residents are regularly using homely remedies this must be discussed and approved by the doctor. Staff must also have updated medication training so they can understand how to follow the medication procedures. The protection of residents must be improved by ensuring all staff have updated safeguarding training. The manager must also not use residents post office cards and pin numbers to draw money on their behalf when this can be achieved by the residents themselves with support. Where cash is held on behalf of a resident this must be reflected in the care plan and risk assessment and agreed with an appropriate care professional. Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 7 Staff skills need to be improved by ensuring at least half the team has completed or is studying towards an NVQ in care. The home must also offer an ongoing programme of training. Health and safety must be improved by ensuring all staff have completed fire safety, infection control, food hygiene and first aid training. Previous training must be refreshed. The manager needs to ensure her training is adequate and must ensure she has started an NVQ level 4 in management and care unless she has verified that previous qualifications are adequate. The quality of the service must be reviewed through seeking the views of residents, relatives, care professionals and other stakeholders. 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. Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 8 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 Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 9 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): Standards 1,2,3,4 and 5 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that their individual needs will be recognised and that the staff have the skills and ability to meet these needs. Information about the home could be in a more comprehensive and accessible format to tell new people moving to the service and other interested parties about the home. EVIDENCE: “We provide high quality 24-hour residential care for the residents whilst supporting and maintaning their independence and choosing their choices. And the level of care we give them should be concentrated around maintaining the best possible quality of life”. (Extract from the AQAA prepared by the home) The service has a combined statement of purpose and service user guide and this was inspected. The document does not include all of the information needed in a statement of purpose such as the organisation structure of the home, the number qualifications and experience of the staff, fire precautions Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 10 and emergency procedures. The document is not in a very accessible format for example including photos of the home and a clear layout. The document does include how the service will aim to address issues of equality and diversity. We looked at the assessments for the three current residents. All the residents have recent assessment information provided by an appropriate care professional as part of recent reviews. The home has also completed an assessment as part of each persons care plan. Some of this information is out of date, for example one residents assessment listed relatives who are now no longer alive. The assessments include details of each persons race, culture and religion. Since the last inspection there have been no changes in the residents living in the home. The service user guide includes details of how admissions would be handled in the home and says that potential residents would be offered visits as part of this process. The current needs of the people who live in the home were discussed with the manager. The three residents are all being supported appropriately in terms of their mental health. The manager has a good understanding of each person and how to support them when they are feeling anxious or distressed. The residents were observed to be very much at home and communicate when they wish to do so with the manager. Each resident has a contract in place between themselves and the home. These clearly state what the home will provide as part of the service. Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 11 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): Standards 6,7,8 and 9 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are not enabled to take part in a care planning process that is person centred. Their changing risk management needs are not reflected in their individual risk assessments. The residents do however make choices in their daily lives. EVIDENCE: “Staff here at Alison House are excellent with supporting all residents with their daily activities of living. If residents are self caring, staff are there to provide support and continue to encourage service users to become independent. The staff at Alison House are professional at all times, they treat all service users with respect and maintain the service users dignity with their Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 12 daily care”. (Extract from the AQAA prepared by the home) “I have not seen a care plan – what is that?” (Quote from a resident) We inspected care plans for the three people currently living in the service. These documents are very simple and list two or three goals for each person, such as improving their personal care, or developing more day activities. The care plans had been reviewed but there was no information on how the goals would be achieved or the progress in meeting the goals. There was also no evidence that the care plans were truly person centred and that the residents had been involved in their development. One resident said she did not know what a care plan was. The care plans had not been signed by the residents and when this was pointed out to the manager, she asked one resident to sign the care plan but did not explain to her what she was being asked to sign. The manager said she had not attended training on person centred planning provided by Enfield Social Services. The last review with a social worker had taken place for the three residents in June 2007. The manager said they had not yet been sent a date for the next review meeting and that she had not chased this up herself. We read the risk assessments for the same three people who live in the service. These were completed using a standard format. From discussions with the manager it was evident that residents did have recent areas of potential risk. One resident was having problems eating and was loosing weight and another was having difficulty sleeping at night. All areas of risk must be included in the risk assessments including details on how these are being addressed by the staff team. We observed the people living in the home and their interaction with the manager. It was positive to note that they felt very comfortable making decisions about what they wanted to do and able to ask the staff for support where this was needed. For example one resident asked the manager to help prepare a snack and felt very comfortable making choices about what she wanted to eat. There is a record of a monthly resident meeting that mainly discusses what outing they want to do when they go out socially once a month. It was however observed that in such a small home, the residents tend to tell the staff what they want on an individual basis. Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 13 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): Standards 11,12,13,14,15,16 and 17 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the homes are supported to develop their daily living skills and are also enabled to follow their own routine. The residents go out in the local community but could be supported to access a wider range of resources. The residents are eating mainly convenience food and this is not a healthy and nutritious diet. EVIDENCE: “Staff at Alison House are trained to support all residents and encouragement them to act an independent lifestyle and participate with daily tasks and activities”. (Extract from the AQAA prepared by the home) Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 14 “I used to go to the day centre but now I like to go swimming and shopping in Wood Green” (Quote from a resident) “I like shopping in the market at Edmonton it is really good” (Quote from a resident) The manager and residents talked about how they are developing their independent living skills. Everyone is encouraged to clean their room with support as needed. One person said she does the dusting and tidies up and the manager does the hovering. Two residents talked about how they make their breakfast and lunch and how the staff prepare their evening meal. The residents are all able to go out independently and use public transport. The residents spoken to both said they use their freedom pass on the buses and trains. One resident has a place at a day service, but the manager said she has recently chosen not to attend and goes out mainly with her family. One resident said she likes to be at home and goes out shopping or to the café. The other resident said she goes swimming and shopping. The manager said she also accesses the library. From discussions with the manager it was evident that she was not fully aware of all the local resources that could be accessed by the residents living in the home in terms of potential preparation for employment, social, health and leisure opportunities. The inspector felt the residents could potentially really benefit from being offered more choices in terms of activities. The residents have not been on holiday, but the manager explained that they go out once a month and the preferred activity is shopping and lunch out. The AQAA completed by the home said that two of the residents were Christian. One resident during the inspection said she was Jewish and was interested in her religion. The manager said they had looked at culturally appropriate activities in the past but she had not been interested. The resident said she would like to explore this again. Another resident said she did not particularly want to go to church One of the current residents has regular contact with her relatives and goes to visit them. Another resident occasionally visits her family. One resident talked about how she likes to go and see her boyfriend. Another resident talked about how she chats to all the neighbours when she sees them on the street. It was observed and from talking to residents it was evident that everyone has their own routine and that this is flexible and reflects their preferences. One resident said “some evenings I go to bed early and other evenings I go to bed Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 15 late”. One resident said how much she enjoyed watching TV in bed. The AQAA explained that the residents have their own keys to the front door and bedroom, but choose to leave their rooms unlocked. One resident when spoken to about food said she had eaten a biscuit and crisps for lunch and was going to have fish fingers and chips for supper. The record of what people had eaten showed that most evening meals consist of convenience food such as burgers, pizza, fish and chips. The manager said this reflected the choices of the residents but recognised it was not a healthy diet. One resident who is Chinese chooses to eat noodles and rice-based meals. There was some fresh fruit and vegetables in the home. The food in the fridge was appropriately stored. Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 16 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): Standards 18,19 and 20 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported in a manner that protects their privacy and dignity. Each person is supported to access professional healthcare input based on their individual needs. Whilst systems are in place to enable the residents receive the correct medication the use of homely remedies needs input from a healthcare professional. EVIDENCE: “The medication policy now contains guidance about self-medication and there is a system for recording the administration of medicines”. (Extract from the AQAA prepared by the home) “I choose my clothes and the manager sometimes comes with to help me” (Quote from a resident) Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 17 We observed during the inspection that the residents attend to their own personal care, but where some prompting is needed this takes place in a sensitive and encouraging manner. We also observed that the residents were all dressed in an appropriate manner. One of the residents wears make-up that is very bright and might benefit from some guidance from a beautician on applying her make-up. We looked at the healthcare records for the people living in the home. Everyone was registered with the GP and had regular health checks. Everyone had been encouraged to visit the dentist and optician. All the residents had input from the local mental health care professionals. The staff understand the importance of monitoring each persons mental health and contacting the care professionals if there are any issues to address. The records show that the residents have been supported to check their weight since August 2007. This was a matter of concern as one resident has issues with her weight. We looked at the medication procedure and staff training records. Two of the residents only have a prescribed depot injection and the home keeps a record of when they have attended an appointment for this. The third resident selfadministers her medication and this is approved in writing by her GP. During the inspection one of the residents talked about how she uses a homely remedy each night to help her to sleep. The manager when asked said that the use of this medication had not been discussed with the GP. The use of regular homely remedies should be discussed and agreed with the GP. The training records were inspected and the staff team had last received medication training in 2005 and would benefit from having this training refreshed. Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 18 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): Standards 22 and 23 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home have access to an appropriate complaints procedure and feel able to raise any concerns. Procedures on safeguarding vulnerable adults are in place but some staff have not received training or need the training refreshed. The current systems being used to access residents monies does not promote their independence. EVIDENCE: “Service users at Alison House Care Home are overall happy with service we provide. Service users are aware of the complaints procedure if a situation was to occur. All service users have expressed that Alison House care staff are very supportive with residents views and listens to them attentively”. (Extract from the AQAA prepared by the home) “Angie (the manager) gets my money from the post office and gives me my spending money” (Quote from a resident) We looked at the complaints procedure and this was easy to follow. The record of complaints was inspected. There have been no complaints since the Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 19 previous inspection. The surveys completed by the residents said they would know how to make a complaint. There have been no safeguarding vulnerable adult issues since the last inspection. Copies of the organisations procedures and social service procedures are available in the home. We looked at the staff training records and these show that all the staff apart from one received safeguarding vulnerable adult training in 2005. This would benefit from being updated so the manager and staff are aware of current practice. We talked to the manager about how they support the residents when they become distressed. She was able to describe how they know each person well and are able, to speak to them and help them relax. We spoke to the residents about how they manage their personal finances. One person explained how she manages her finances completely independently and has her own building society account. Another resident said she had a post office account and that the manager collects her money. The manager when asked said she had the card and pin number for two of the residents and collects their money. She said there was no reason why with support they could not do this for themselves. The manager also said she holds the monies for one resident and she signs when she takes her money. This is to help the resident budget. This arrangement is not recorded or agreed as part of a care plan or risk assessment. Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 20 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): Standards 24,28 and 30 were inspected. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living in the home benefit from a comfortable and homely environment, which is maintained on an ongoing basis. EVIDENCE: “The home is located in a quiet residential street which has a local park at the end of the road. We are also close to Edmonton Shopping Mall and market, cafes, lesiure centre, library and numerous restaurants and fastfood takeaways. Alison House provides a welcoming and a homely environement. Residents are encouraged to bring their own belongings and personal photos, encouraging a comfortable and a homely environment. Residents are provided with personal keys to lock their rooms”. (Extract from the AQAA prepared by Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 21 the home) The service consists of a terraced house. The home is clean, safe and comfortable. There are local shops available very close to the home and access to public transport. The home has three large single bedrooms. We looked at two bedrooms and they were adequately furnished with a double bed. Bathrooms and shower rooms are easily accessible from all the bedrooms. One resident said how much she enjoyed having a television in her room. The home has adequate communal space consisting of an open plan kitchen, dining area and lounge on the first floor. The home also has an enclosed garden. A designated smoking area is provided in the conservatory. It was observed that this room is very cold in the winter. The house was clean and tidy. Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 22 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): Standards 32,33,34,35 and 36 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents are supported by a small team of staff who have all worked in the service for a number of years. Additional training is needed to ensure the staff have the most current knowledge to enable them to work to a high standard. EVIDENCE: We checked the rota for the home and this showed that there is a team of five regular staff working at the home. Mr and Mrs Espino who are the registered providers carry out most of the care. Three other members of their family assist on a part-time basis. Two other relatives come to the home occasionally when Mrs Espino needs to pop out. There is one person on duty during the day and at night one-person sleeps in the home. There have been no staff changes for a number of years. Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 23 The manager explained that staff team meetings take place on a monthly basis and the records show that these are used to discuss progress with the residents. The staff training records were inspected for the manager and the four care staff. One of the staff had completed an NVQ in care level 2 and one is a qualified nurse. Another one of the care staff needs to complete the NVQ. We looked at the recruitment records for staff members. It was found that all the staff had all the necessary recruitment checks including references and ID, a POVA check and a CRB disclosure. Each member of staff had certificates to confirm the training they had received. It is positive that this training included good practice in mental health. No further training was booked even though there were some staff training needs. We looked at the supervision records. All the care staff had received regular two-monthly individual supervision. The format used for supervision is appropriate. Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 24 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): Standards 37,39 and 42 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. All residents benefit from a permanent manager who can provide a stable environment. Not all the staff have received health and safety training to ensure they can safeguard the people living in the home. The views of the residents have been sought as part of a system of quality assurance but this has not been extended to relatives and other stakeholders. EVIDENCE: “All appliances are routinely checked and recorded. Fire, gas and electrics are tested by qualified technician. All service users rights and best interests are Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 25 safe guarded by the record keeping policy”. (Extract from the AQAA prepared by the home) The service has a registered manager. The manager is a qualified nurse who has many years experience of caring for people with mental health needs. The manager has not completed an NVQ level 4 in management and care, although she does have a City and Guilds qualification. The manager said that she had not spoken to Skills for Care to see if her existing qualification is equivalent to an NVQ. The company has questionnaires to seek the views of residents, relatives and other care professionals as part of a quality improvement exercise. One completed questionnaire was seen in one of the residents case notes. There were no completed questionnaires from relatives or other care professionals. The manager acknowledged that these views needed to be sought. In terms of fire safety we looked at the fire safety risk assessment and emergency plan and this was complete. According to the AQAA the fire alarm and fire extinguishers had been serviced. The fire alarm records show the alarm is checked weekly but the last fire drill had taken place six months previously, which is not regularly enough. The training records show that none of the staff had received fire safety training. The AQAA showed that all the health and safety maintenance checks had taken place. The staff training records show that most staff had completed food hygiene training but this is now out of date. Only one member of staff had a certificate for first aid training. None of the staff had been trained in infection control. Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 26 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 2 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 x LIFESTYLES Standard No Score 11 3 12 2 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 2 x x 1 x Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4(1)(c) Requirement The registered person must provide a statement of purpose that includes all the necessary information so that this can be given to people who want to know about the service. The registered person must ensure each residents assessment is updated to reflect their current information and needs. The registered person must ensure that each person has a care plan that is person-centred and where the resident has been fully involved in its development. The registered person must ensure each resident has a risk assessment that covers all areas of potential risk. The registered person must ensure that they support the residents to explore different options for community based learning, skill development, sport and leisure in the local community. The registered person must ensure that healthy and nutritious food choices are DS0000010601.V372602.R01.S.doc Timescale for action 31/12/08 2. YA2 14(2) 31/12/08 3. YA6 15(1) 31/01/09 4. YA9 13(4) 31/12/08 5. YA12 16(2)(m) 31/12/08 6. YA17 16(2)(i) 31/12/08 Alison House Version 5.2 Page 28 offered at all times. 7. YA19 12(1) The registered person must support each resident to remain healthy by enabling them to monitor their weight. The registered person must ensure all staff have updated medication training so they can follow medication procedures. They must also obtain medical input on the use of homely remedies to ensure they are being taken safely. The registered person must ensure all the staff have updated training on safeguarding vulnerable adults. The registered person must ensure all the residents are supported to manage their own finances and where support is needed this is clearly reflected in their care plan and risk assessment. The registered person must ensure that 50 of the staff team have completed or are undertaking NVQ training. The registered person must ensure the service has an ongoing training programme that can include accessing training provided by social services. This is to ensure staff have access to training to ensure they perform their work to a high standard. The registered person must ensure the manager either starts an NVQ level 4 in care or management or obtains written confirmation that her existing qualification is an equivalent. This is to ensure she has the appropriate skills to carry out the management role. The registered person must ensure a quality assurance DS0000010601.V372602.R01.S.doc 31/10/08 8. YA20 13(2) 31/12/08 9. YA23 13(6) 31/12/08 10. YA23 20(3) 31/10/08 11. YA32 18(1)(c) 31/12/08 12. YA35 18(1)(c) 31/12/08 13. YA37 10(3) 31/12/08 14. YA39 24 31/12/08 Alison House Version 5.2 Page 29 15. YA42 23(4) 16. YA42 13(3)(4) exercise is completed that in addition to the residents seeks the views of the relatives, other care professionals and stakeholders. The registered person must ensure all the staff have completed fire safety training. They must also ensure fire drills are undertaken on a quarterly basis or more regularly if needed. The registered person must ensure all staff have completed or updated training in first aid, food hygiene and infection control. 31/12/08 31/01/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA1 YA6 YA12 YA18 Good Practice Recommendations The service user guide should be made available in an accessible format. The registered person should support each resident to have an annual review meeting and to invite their care manager as well as relatives and other care professionals. The registered person should support residents who want to find a way of practicing their religion or culture. The registered person should support the resident to have input from a beautician to provide advice on the application of make-up. Alison House DS0000010601.V372602.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. 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