Inspection on 20/06/06 for Alison House

This inspection was carried out on 20th June 2006.

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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alison House 23/07/07

Alison House 23/01/07

Alison House 15/03/06

Alison House 11/10/05

Alison House 09/02/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Alison House 16a Croxley Road London W9 3HL Lead Inspector Ann Gavin Unannounced Inspection 20th June 2006 09:45 Alison House DS0000055306.V291896.R01.S.doc Version 5.1 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 DS0000055306.V291896.R01.S.doc Version 5.1 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 DS0000055306.V291896.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Alison House Address 16a Croxley Road London W9 3HL 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 8960 0990 www.wspld.org Westminster Primary Care Trust Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Bedroom A6, which measures 8.7 square meters, must not be used to accommodate service users who are wheelchair users. 15th March 2006 Date of last inspection Brief Description of the Service: Alison House is a care home for up to six clients, of either gender, with learning disabilities providing short-term and respite care. There are currently thirty clients that have been assessed to receive respite care. There is one bed allocated for an emergency placement. It is operated by the Westminster Primary Care Trust, who lease the building from the Westminster Society for people with disabilities and was registered on 7th December 2004. The facility is located in the Maida Vale area and is within easy access of local shops, other amenities and transport links. It provides ground floor accommodation and there are six single bedrooms available. A condition of registration is that one bedroom that measures 8.7 square metres is not allocated to a wheelchair user. Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection on 20th July 2006 from 9.45 to 5pm was announced to the managers the week before, as the inspector had not met the managers on any previous inspection. However due to unforeseen circumstances the manager was unable to be present. The deputy manager changed their arrangements in order to be present throughout the day. The inspection confirmed the amount of work the responsible individual, managers and the staff have done to comply with the requirements and to put plans in place to address any outstanding requirements. Twelve requirements and one recommendation made. There were noticeable improvements to the planning and recording of care plans and to risk assessments but still some work needs to be completed to ensure that all staff work to the same standard and to person centred care. A major concern was that no permanent staff members had completed Criminal Record Bureau checks. Since the inspection and following further discussions with the responsible individual the following action has been agreed. 1.All staff (without CRB) have POVA first checks and apply for CRB disclosure. 2.The staff rota is revised so that all shifts for the next 4 weeks have a shift leader who has a CRB Disclosure. 3.That staff who have not had a CRB check will not work unsupervised. What the service does well: What has improved since the last inspection? The majority of the requirements have been met and much work has gone into creating continuity and consistency of care. The environment is much improved, more homely and welcoming. The staff are becoming more a part of the process of change to person centred care. Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 6 The responsible individual has carried out regular meetings, monitoring and spot checks of the service. 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. Alison House DS0000055306.V291896.R01.S.doc Version 5.1 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 Alison House DS0000055306.V291896.R01.S.doc Version 5.1 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): 1,2 The outcome for this area was adequate. All service users have an assessment before entering Alison House. The standard of the assessments varied. All assessments need to become detailed and personalised. The statement of purpose has been updated. EVIDENCE: The care of four service users was tracked as part of this inspection. All had an assessment of their needs. Two of the assessments were sketchy and used generalised terms lacking a person centred approach. For example ‘ X is ambulant’ The other two assessments were clear detailed and person centred. They had excellent profiles of the service users giving a good vision of the service users needs and aspirations. The manager needs to continue to work with the team to produce consistent and person centred assessments. The updated Statement of purpose has been sent to the Commission Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 The outcome for this area is adequate. All the service users care plans seen had an updated care plan and risk assessments. As with the assessments the standard varied from good to poor. The risk assessments need to follow through with clear actions any risks identified. All service users should have a photograph. The excellent profiles of service users could be used for all service users EVIDENCE: Two care plans and their risk assessments gave a good profile of the service users. Each aspect of their daily life was described with the persons likes dislikes and the level of support required to achieve them. They contained clear guidelines on supporting the person on arrival to make sure they received the help and care they like. These guidelines also covered moving and handling and transport. These two care plans showed the date of the reviews and evidence of the partnership with other professionals in planning care. The accompanying risk assessments were detailed with guidelines and action plans for identified risks. One person requires specific medical intervention if Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 10 they show certain symptoms and this was well documented with a step by step action plan. It was clear that these plans had been devised involving the service users. The other two care plans and risk assessments had a completely different style. They were not person centred and neither gave an idea of the personal likes and dislikes of the person nor the way they wish to be supported. There was no personal profile. The care plan was generic with no real indication of what type of support the person wished. The care plan reviews were not clear. The risk assessments were poor, incomplete and with no action plan or follow through of issues identified. One person had a good assessment by another professional who gave specific guidelines to follow. These were not reflected in the care plan. The care plan did not demonstrate the service users involvement in planning their care. All care plans and risk assessments need to be person centred involving the service user. . Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.15.16.17 The outcome for this area is good. The service users leisure activities and links to the local community are now in place in the care plans. There is a new three week rolling menu which has been devised with service users and input from the dietetic department. EVIDENCE: Three service users were in Alison house during the inspection. Observing the support offered it was clear that they had a good rapport with staff. The deputy manager said how there has been more focus on activities making sure that service users have a range to choose from. Alison House now buy Time Out each week for up to date local events. The activity book reflected this with the Brazilian festival at the beginning of June and more descriptions of all the activities. One service user was observed being supported to prepare a meal. One care plan spoke of a love of trains and this person was watching a train video and expressing their delight. Another service user is creating a photo album of them taking part in various activities. Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 12 The pre inspection questionnaire gave a list of activities and links with the Croxley project and Gateway clubs. The staff said that they enjoyed a good relationship with these services. The deputy manager and staff spoke of the good contact with service users families. Alison House have been working closely with the dietetic department to look at the nutritional needs of service users and planning balanced healthy and appetising menus. A vegetarian choice is always on the menu. Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 13 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): 18,19,20 The outcome for this area is good. Each service users health needs are include in their care plan. The medication procedures have been revised and a new protocol is awaiting ratification form the PCT. Regular audits and spot checks are carried out. EVIDENCE: Each of the service users has a health plan as part of their care plans. One person who has seizures had a detail action plan on how best to support them. People who required extra support for drinking or need their liquid intake monitored had a ‘drinking programme’ The medication system has been completely revised since the last inspection. There were no drugs retained in the medication cupboard as service users now bring in and take home their medication. The records were clear with no gaps in recording. The deputy manager and the responsible person both do medication audits and spot checks and the standard of administrating medication has vastly improved. The deputy manager has produced a new protocol and procedure for safe handling storage and administration of medication. This is to be used in Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 14 conjunction with the Westminster Primary care Trust (PCT) medicine management policy. It is currently being ratified by the PCT though it is agreed that Alison House work to it in agreement with the PCT and pharmacy. Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The outcome for this area is poor. Only the new members of staff have completed Criminal Record Bureau Checks (CRB) checks. The complaint book was not available, as the Manager had taken it home to complete a complaint investigation. The outcome of the investigation must be forwarded to the Commission. Alison House have completed their policy on the protection of vulnerable adults. EVIDENCE: Discussing with the deputy manager and looking at staff records it became clear that only new members of staff have completed their CRB checks. The existing staff have not been checked though the manager had just been sent the CRB disclosure forms. This must be addressed immediately. The staff spoken with were aware of the policy on protecting service users and the completed policy has been sent to the Commission. There were three complaints noted on the pre inspection questionnaire completed by the manager. The complaint book was not available, as the Manager had taken it home to complete a complaint investigation. The deputy manager said that the manager was just finalising their findings and the outcome should be very soon. This needs to be forwarded to the Commission. The complaint book should be available in the home at all times. Alison house have sent out questionnaires to service users and their families as part of their individual service agreement (ISA) Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27,30 The outcome for this area is adequate. Most of Alison house has been redecorated and looks much cleaner brighter and more homely. The staff are in the process of putting up more pictures The bathrooms still need urgent attention to create a more welcoming and restful environment. EVIDENCE: A tour of Alison House highlighted the difference achieved from re-decoration. The whole appearance is brighter less clinical and more homely. The staff have taken away the notice board from the dinning room/sitting room. There are new dining room chairs and a new painting, which was just waiting to be hung by the works department. The managers and staff have produced an action plan for re-decoration and redesign of Alison House. This is aimed at creating an ever more ‘homely’ and service user focused environment. The majority of tasks have been undertaken and staff have been allocated specific tasks to action. There are plans to replace the sound and vision centre and to create a sensory stimulation area. Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 17 Alison House are awaiting an occupational therapist assessment of the kitchen worktops for them to be made height adjustable. The funding has been agreed for the redesign and work will be carried out once the assessment is complete The bathrooms areas need urgent attention. There is no natural light or ventilation and both bathrooms need redecorating. The showers are in need of attention as they are stained and worn they need making good or replacing. The cupboard containing the control of substances harmful to health (COSHH ) was seen. The assessments were up to date and in place. They are currently handwritten and it is recommended that they be typed so as to read and update easily. The laundry has now been fitted with appropriate ventilation, which was installed in May 2006. Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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): 32,34,35 The outcome for this area is poor. The staff on duty were clear about their role. The key working system is developing. A Training needs assessment and yearly appraisal must be carried out for each member of staff. Staff records must contain key contact and other key information. All staff must have CRB checks and not work unsupervised until they are in place. EVIDENCE: The deputy manager and three members of staff were spoken with during the inspection. There is stability in the staff group many of whom have been in place for some years. Westminster Primary Care Trust are responsible for all recruitment. The shift patterns are 8-3.30 early 2.30 –10pm late 9.30 to 8.15 am waking night and 10pm – 8 am sleep in cover. The deputy manager says that there are 3 staff members per shift and 1 waking and one sleeping staff at night. Bank and agency staff cover the vacancies. Three staff records were looked at. The manager has recently sent the staff records to Human Resources and so there was very little information left .The appropriate staff records must be kept in Alison House. Reviewing staff records showed that none of the permanent staff had CRB checks. Staff without CRB checks must not work unsupervised. Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 19 All staff require a training needs assessment and yearly appraisal. The pre inspection questionnaire stated that staff had carried out mandatory training. Three staff are starting NVQ level 3 as soon as possible. Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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): 37,39,42 The outcome for this area is adequate. The manager must register with the Commission. The monthly monitoring visits have been completed regularly and a copy sent to the Commission. EVIDENCE: The deputy manager was present throughout the inspection. The responsible person was present for the feedback. The manager still needs to complete their application to be registered with the Commission. There has been much work by the managers and the staff to comply with the requirements. The staff team are more involved in the process and there are regular staff meetings The monthly monitoring visits have been carried out regularly with copies sent to the Commission. Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 21 The responsible person is carrying out spot checks on all aspects of the home and a questionnaire has gone to all service users and families to receive feed back from them about the service. The fire drills and weekly checks were up to date. The deputy manager has carried out a fire assessment on the fire exit for bedroom 6. Alison House will make sure the London Fire Brigade are in agreement with it. Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 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 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 23 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 YA1 Regulation 3(4) Requirement The organisation must apply to be registered as a home providing nursing care and for a variation in numbers from 6 to 5 beds as agreed in December 2005. Immediate requirement Timescale for action 03/07/06 2 3 4 5 6. YA6 YA6 YA9 YA22 YA24 15 17 13 22 23 All care plans need to be planned 30/09/06 with the service user. Every service user must have a photograph on their care plan All risk assessments must have an action plan for risk identified The complaint book should remain in the home at all times. The kitchen worktops must be made height adjustable so that clients in wheelchairs can use them if they wish Repeat requirement The bathrooms must be redecorated and the showers and baths replaced or made good A Training needs assessment and yearly appraisal must be carried out for each member of staff DS0000055306.V291896.R01.S.doc 31/07/06 30/09/06 31/07/06 31/12/06 7 YA27 23 31/10/06 8 YA32 19 30/09/06 Alison House Version 5.1 Page 24 9 YA32 17 Staff records must contain contact details and other key information. The provider must make sure that all staff have CRB checks and that no staff without CRB checks works unsupervised. The Manager must complete an application for registration with the Commission Immediate requirement The fire assessment of the fire exit in room 6 will be verified by the London fire brigade 31/07/06 10. YA32 19 31/07/06 11 YA37 8 03/07/06 12 YA42 23 31/08/06 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 YA30 Good Practice Recommendations The COSHH assessments are currently handwritten and it is recommended that they be typed to help both read and update easily. Alison House DS0000055306.V291896.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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