Inspection on 14/05/07 for Alison House

This inspection was carried out on 14th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 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 01/10/08

Alison House 06/12/07

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 08/07/2008.

CARE HOME ADULTS 18-65 Alison House 4 Hadleigh Road London N9 7BX Lead Inspector Tom McKervey Key Unannounced Inspection 14th & 30th May 2007 10:00 Alison House DS0000010601.V335433.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.V335433.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.V335433.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 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.V335433.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One specific service user who is over 65 years of age and has mental health needs may remain accommodated in the home. The home must advise the registering authority at such times as the specific service user vacates the home. 22nd August 2006 Date of last inspection Brief Description of the Service: Alison House is a family run business; the care staff coming exclusively from family members. The homes stated aims are to provide care and support for three adults who have ongoing mental health problems. 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 bathroom with toilet, are located on the ground floor. Two other bedrooms and a staff bedroom are on the first floor. The home also has 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. Alison House DS0000010601.V335433.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two separate days, because the proprietor/manager was abroad when I visited on the first day. In total, the inspection was completed in a period of three hours. The inspection was carried out as part of the Commission’s inspection programme and to check compliance with the key standards. On the first day, a member of staff and two residents were present during the inspection, and on the second day, the same two residents were present. I was able to speak to the residents about their experiences of living in the home. The inspection process included a discussion with the manager on my second visit regarding the home’s registration certificate, which will be changed to comply with new guidance from the registration authority. An inspection of the premises took place and I also examined residents’ files and other documents relating to the running of the home. What the service does well: The people who live in the home say they are well cared for and their needs are being met. The home provides a comfortable, homely environment and enables and encourages the residents to live as independently as possible. The residents are consulted about their views of the service and they feel part of the proprietors’ family. The residents are supported to access a wide range of community facilities and they can have friends to stay overnight in the home. The manager ensures that residents attend regular appointments with the Community Mental Health Team. There are good care plans in place, and care is taken to ensure that residents attend their health appointments. Staff have been trained in the care of people with mental health needs and to detect and prevent abuse. Alison House DS0000010601.V335433.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Alison House DS0000010601.V335433.R01.S.doc Version 5.2 Page 7 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.V335433.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.V335433.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): 2&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home say they like living there, and the professional services involved agree that the home continues to meet the residents’ needs. EVIDENCE: At the time of the inspection, no new service users had been admitted to the home. All three residents, who are women, have lived in the home for a number of years. One person is over the age of sixty-five, but she is able to access all areas of the home, including stairs, without difficulty. The people who live in the home told me that they liked living there and the manager and staff were very attentive to their needs. The three residents attend appointments with their consultant psychiatrist at least six-monthly to monitor their progress and to ensure that their needs are being met by the service. Alison House DS0000010601.V335433.R01.S.doc Version 5.2 Page 10 Care managers from the local authority carry out annual reviews of the residents’ care, which confirm that their needs are being met. Alison House DS0000010601.V335433.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): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ care plans set appropriate goals and are supported by the Community Mental Health Team. The care plans support residents to be as independent as possible. There is a good system in place for consultation with the residents about how they wish to live in the home. EVIDENCE: On the first day when I visited, the member of staff was unable to locate care plans or any other documents. This was a serious matter that I have addressed under the “Conduct and Management” standards. Alison House DS0000010601.V335433.R01.S.doc Version 5.2 Page 12 I was able to sample two care plans at my next visit. The care plans showed that the residents’ needs had been assessed, including mental and physical health and personal care, and there was written guidance about meeting needs. Regular reviews of the plans had been carried out including any changes in the residents’ needs. The objectives reflected the aims of the service for residents to be as independent as possible. Regular meetings are held with residents to decide on activities in the home, and they said that their suggestions were acted on. This was documented in the minutes of the meetings. Both residents who I spoke to stated that they are encouraged to live as independently as possible and had their own front door and bedroom keys. They said they could stay out as late as they liked, but for safety reasons, were asked to let the manager know their whereabouts. The residents described several areas of choice, including bedtimes, going out when they wished and in one resident’s case, not to attend a day centre. The care plans also contained risk assessments relating to activities within the home and in the community. Residents also accompany the manager to the supermarket where they can choose what they want to eat. Alison House DS0000010601.V335433.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): 12, 13, 15 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are well integrated with the community and they enjoy their independent lifestyles. However, a particular area where a resident has exercised choice has not been assessed to minimise risk to the resident. A record is not made of all visitors to the home. This poses a potential risk if there is a fire for example, and visitors are not identified. The residents are encouraged and supported to develop and maintain contacts with friends and relations. The people who live in the home say they are satisfied with their meals. EVIDENCE: Alison House DS0000010601.V335433.R01.S.doc Version 5.2 Page 14 One of the residents told me that she occasionally attends a Psychiatric Rehabilitation Day Centre, going by public transport. This day centre provides work-based activities and training in social skills. This person also regularly visits her family. One resident prefers not to attend a day centre, but has chosen to go out each day to a local café where she meets people in the same age group. During this inspection, she went out shopping. All the residents have bus passes, which they said they use frequently to visit friends and relatives. However, the only visits recorded in the visitors book were by “official” visitors and a requirement is made that all visitors sign when they come to the home. This is necessary for health and safety reasons. One resident said that she keeps in contact with her relations by phone. The people living in the home told me that they are encouraged to live as independently as possible and they have their own front door and bedroom keys. They also said that the staff respect their privacy and always knock their door before being invited to enter. A resident has a boyfriend who sometimes stays overnight as a matter of choice. This is regarded by the manager as quite appropriate. However, there was no record of consent and this issue had not been risk-assessed to ensure the protection of the resident. This person’s visits were not recorded in the visitors’ book. A requirement is made about this matter. The residents said that they enjoyed the meals that are provided and once a month they all go out with the staff to a restaurant. There was a menu available and the meals that were actually taken by the residents were recorded on it. This was a requirement at the last inspection. Alison House DS0000010601.V335433.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical and emotional healthcare needs of service users are generally well met with the support of the local G.P and community mental health teams. The residents are supported by the staff to provide their own personal care. There is no evidence that self-medication is being carried out safely, which could put a resident at risk. EVIDENCE: The residents are all able to provide for their own personal care but occasionally need prompting by staff. Alison House DS0000010601.V335433.R01.S.doc Version 5.2 Page 16 All three residents are registered with a local G.P, and have regular CPA, (Care Programme Approach) reviews by the Consultant Psychiatrist. There were individual residents’ books containing records of hospital and G.P appointments, as well as other healthcare professionals. Following the last inspection, the medication procedure now includes reference to residents self-medicating. One resident is self-medicating but although the manager is satisfied that the resident is capable of this, this practice has not been authorised by the G.P or psychiatrist. Also, this person’s medication was not stored securely in her room. Requirements are made to address these issues. Two residents receive medication by injection, which is administered at a nearby clinic. A record is kept of the residents’ weight each month. Alison House DS0000010601.V335433.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are happy with the service provided and know how to complain if necessary. The staff have attended training in the protection of residents from possible harm or abuse. EVIDENCE: The manager stated that no complaints had been made by residents since the last inspection, and I noted that none were recorded in the complaints book. In discussion with the residents, I was satisfied that they were happy living in the home and that if they had any concerns, they knew how to complain and that they were confident the manager would address this seriously. All the staff had attended training in adult protection procedures last year. Alison House DS0000010601.V335433.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents live in a homely and comfortable environment and they like the accommodation provided. The home is generally well maintained, but some minor repairs are necessary for the comfort of the residents. The home is clean and tidy, but hygiene could be improved by providing disposable hand towels in the bathroom. EVIDENCE: I carried out an inspection of the premises, which including visiting two bedrooms with the residents’ permission. Alison House DS0000010601.V335433.R01.S.doc Version 5.2 Page 19 The environment was homely and welcoming and the residents said that they were pleased with their accommodation. The lounge and dining room furniture was attractive and comfortable. The plaster on the wall of the conservatory was damp and flaking and a requirement is made to repair this area. The bedrooms were clean and attractively presented, and there were personal effects such as televisions, photographs and ornaments. New bedside lockers had been purchased since the last inspection. Each resident has a key to their bedroom, but choose not to lock their doors. There were no disposable hand towels in the upstairs bathroom; only a communal towel, which could cause cross infection. A requirement is made about this issue. Otherwise, the home was clean and tidy and there were no offensive odours. Alison House DS0000010601.V335433.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient staff available to meet residents’ needs but the staff rota does not properly reflect staffs’ duties. Staff have attended training appropriate to the needs of residents. The staff are not being given supervision, which could lead to their performance not being monitored nor their training and development needs being identified. EVIDENCE: No new staff had been recruited since the last inspection. All of the staff are members of the proprietors’ family or are related to her. Alison House DS0000010601.V335433.R01.S.doc Version 5.2 Page 21 There is always one member of staff on duty. This is satisfactory since the residents are usually out for most of the day. There is a sleep-in member of staff at night. However, the rota was not accurate or kept up to date. For example, the manager works full-time but she was not identified on the rota as being on duty at the time of the inspection and the sleep-in person was not identified for night duty. A requirement is made to address this issue. The people who live in the home said the staff were very able and competent to support and care for them. The manager told me that no formal supervision for staff had taken place since the last inspection. Supervision is an important tool for monitoring performance and supporting staff in their roles as carers. A requirement is made for supervision to be carried out at least six times a year. Alison House DS0000010601.V335433.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is no system in place for ensuring that the service is properly managed when the manager is away. This could lead to the residents’ needs not being met and pose a risk to their health and safety. Record keeping is poor, which could cause important information about the residents’ welfare being lost. The people who live in the home are consulted about their views of the service. EVIDENCE: Alison House DS0000010601.V335433.R01.S.doc Version 5.2 Page 23 The manager is a qualified nurse and she has many years of experience of caring for people with mental health needs. On the first day of this inspection, the manager was away on leave. I was very concerned to find that, in her absence, the member of staff on duty, who is also the joint proprietor, was unable to provide any documents or records pertaining to the residents or the running of the home. This included care plans and daily records of the residents’ activities. It is important that all staff are aware of the whereabouts of these and the other important documents, especially in the absence of the manager. The majority of the required documents were available to me on the second day when the manager was present. However, there were no residents’ daily progress records available between the last inspection and the 14th of May 07. The manager was unable to locate these, which is a serious concern, as these records must be kept for at least three years as evidence in the event of a serious incident affecting a resident. There was evidence that the service users had been consulted about their views of the service. I saw minutes of meetings that were held monthly between the staff and the residents, and they had also completed a questionnaire, which showed a high level of satisfaction. I noted that there were certificates of safety for gas, electric, fire and the emergency light systems. The fire alarms were tested weekly and the home has a current certificate of insurance. However, the portable appliances had not been tested in the past year and I was concerned to find on the first day of the inspection that there were eggs in the fridge that were several days out of date. The member of staff was asked to dispose of these immediately. Requirements are made to address these issues. Alison House DS0000010601.V335433.R01.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 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 X 35 3 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 2 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 1 X 3 X X 2 X Alison House DS0000010601.V335433.R01.S.doc Version 5.2 Page 25 Yes 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 YA15 Regulation 17(2) Sch 4 Timescale for action All visitors to the home must 30/06/07 sign the visitors’ book. This requirement is restated from the last inspection. The previous timescale was 31/10/06 2. YA15 13(4(a)(b) A risk assessment must be 30/06/07 carried out and written consent must be obtained for a visitor who stays overnight in the home. 13(2) Authorisation must be obtained 31/07/07 from a resident’s medical officer for them to administer their own medicines. The damaged plaster in the 31/08/07 conservatory must be repaired. Disposable hand towels must be 30/06/07 provided in the bathroom to prevent infection. Rotas identifying staffs’ actual 30/06/07 shifts, must be correctly maintained. Formal staff supervision must 31/07/07 DS0000010601.V335433.R01.S.doc Version 5.2 Page 26 Requirement 3. YA20 4. 5. YA24 YA30 23(2)(b) 13(3) 6. YA33 17(2) Sch 4(7) 18(2) 7. YA36 Alison House take place at least six times a year. 8. YA37 9(1) The manager must ensure that 30/06/07 there is a delegation of tasks, so that the home is efficiently run in her absence. All staff must be made aware of 30/06/07 where important documents are kept so that residents’ welfare and safety are maintained. All residents’ progress notes 30/06/07 must be securely stored and be available for inspection. The portable appliances in the 31/07/07 home must be tested to ensure residents and staff are not at risk. 9. YA37 17(4) 10. YA41 17(2)(3) 11. YA42 13(4)(c) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Alison House DS0000010601.V335433.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alison House DS0000010601.V335433.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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