Inspection on 23/01/07 for Alison House

This inspection was carried out on 23rd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 10 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 20/06/06

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 and Tony Lawrence Unannounced Inspection 23rd January 2007 11:30 Alison House DS0000055306.V322164.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 DS0000055306.V322164.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 DS0000055306.V322164.R01.S.doc Version 5.2 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 5 Category(ies) of Learning disability (5) registration, with number of places Alison House DS0000055306.V322164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A nurse must be on duty at any time that a service user assessed as having nursing care needs is staying in Alison House. 20th June 2006 Date of last inspection Brief Description of the Service: Alison House is a care home for up to five 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.V322164.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection on 23rd January 2007 from 11.30 to 5pm and was announced to the managers the day before, as the inspectors had not met the managers on any previous inspection. There have been major changes and improvements since the last inspection and the hard work and commitment of the management team was evident. The majority of the requirements were met. There were 5 questionnaires returned form relatives and 4 returned from health and social care professionals. These were all very positive and their comments are included within the report. The managers, staff and service users were welcoming to the inspector’s. What the service does well: What has improved since the last inspection? What they could do better: There is a need to make sure that every service user has been involved in creating a good clear and informative plan of their care and support needs. That the management of any risk to service users are well assessed and managed. The fire sign need to be replaced and the fridge temperatures maintained at a safe level. The privacy of service users must be maintained by covering the viewing panels on their bedroom doors. Alison House DS0000055306.V322164.R01.S.doc Version 5.2 Page 6 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 DS0000055306.V322164.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alison House DS0000055306.V322164.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good statement of purpose and the service users guide. EVIDENCE: The service users guide has been updated. It is well planned with good use of photographs and pictures making it easy to read and accessible. The statement of purpose has also been updated and is currently being changed to reflect the newly appointed deputy manager. Service users are assessed prior to coming into the service. The manager spoke of the information they insist on having prior to accepting a service user for respite. Alison House DS0000055306.V322164.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The manager staff have been working to review care plans and have teaching sessions planned to support this. All care plans need to be modelled on the best care plan seen which was drawn up with the person using the service reflecting how they wish to be supported. EVIDENCE: ‘I was not happy with the care provided to my relative twelve months ago, but I feel that recently standards of care have improved’ (relative) Three care plans were looked at which showed that there is a marked difference in the level and quality of service users care plans. The best was very good focusing on the person and how they would want to be supported. ‘ I am able to understand most things so if you explain what you are doing we will get along fine’ Alison House DS0000055306.V322164.R01.S.doc Version 5.2 Page 10 This was the first line written under communication. The plan was clearly written involving the person and expressed their thoughts and hopes about what they wanted to gain from respite at Alison House. There was a full assessment of this persons needs, a care plan which was reviewed, good daily records and a contract. This care plan could be used as a model for other staff. The only area it needed to be worked on was risk assessments to ensure that there was a risk assessment completed for the use of cot sides. All service users must have up to date risk assessments The second care plan was adequate, it was dated May 2006 and had been reviewed and the plan updated by hand. The care plan does need to be updated and finalised. The plan did include activities cooking clothing laundry and housework. The daily notes were brief and mainly focused on personal care with some mention of activities. It would need more focus on the person reflecting their experience of respite care at Alison House. The remaining care plan seen was generally poor with no care plan or risk assessment. There had been an audit of the file in March 06 by the responsible individual and the gaps identified but the information remains unavailable on file. This person is on transition but the staff need to know how this person wants to be supported, how they like to spend their time and if they need any extra support to enable them to carry out activities. The daily notes were there but were mainly looking at the person’s physical care. The guidelines for staff as to transferring the person from their chair to bed and their nighttime needs were good. The manager spoke of the move towards ever more joint working building on the relationships built and being sure that service users are more involved in planning their care. The managers and staff are increasing the work they do with the local day services staff are going to the day car service s to see how service users spend their day to help create a complimentary service. The manager has arranged regular teaching sessions, one session a fortnight on person centred care with the lead trainer form Westminster Social Services. Alison House DS0000055306.V322164.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Alison House is increasing their links into the community using more local resources to make sure that the people who use the service can take full advantage of the social and leisure facilities. EVIDENCE: There were two service users in Alison House with two more planned to come later that day. Service users were observed relating well with the staff and the activities they were doing were reflected in their care plans. One person spent much of the time with one member of staff and was happily colouring puzzles an activity that they enjoy. Another service user had been out with a support worker and was happily engaged in conversation and planning the rest of the day. There were videos and DVD in the lounge area with a good selection of games and crafts enjoyed by the service users. Alison House DS0000055306.V322164.R01.S.doc Version 5.2 Page 12 Part of the development plans of the service is to develop a recourse bank of low cost and accessible activity opportunities in London and beyond. Also there are plans to gather information about transport details of what is available. The manager included a three week menu which had a choice of vegetarian dishes. These menus have been designed with the help of a dietician and include appetising and nutritious meals. Once the kitchen is redesigned service users will be able to be more involved in the preparation of meals Alison House DS0000055306.V322164.R01.S.doc Version 5.2 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. 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 quality of the information about supporting peoples health needs was variable. All information needs to be of the very good standard shown in one care plan. EVIDENCE: ‘General service delivery seems to have improved since filling vacant post – still some improvement to be made to reach standards of excellence. I would prefer to work more closely with Alison house and am trying to work towards this – e.g. with their clinical governance.’ (Health professional) ‘Day Services at Westminster have a very positive relationship with Alison House. Our teams have jointly worked with service users undertaking joint reviews that have been person centred and led to provision that people really want. We have also been supported by Alison House on outings and holidays for people attending both services’ (Day Service Manager) One of the planned objectives for Alison House this year is to clarify each persons assessed nursing needs and to complete medication competency assessment for all support staff. It is planned this will be completed by March this year. Alison House DS0000055306.V322164.R01.S.doc Version 5.2 Page 14 The care plans seen reflected what has been said throughout the report that there is, as yet, a lack of consistency in creating with people good plans to support their care. Two care plans were very good in outlining people’s health and personal care needs. One care plan had no information at all which is unacceptable. The manager and deputy manager are aware of the discrepancies and are working with staff to help create consistently good and informative care plans for every each person who uses the service. Alison House DS0000055306.V322164.R01.S.doc Version 5.2 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. 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. Alison House has a clear system for complaints and compliments. They have developed their own policy for the protection of vulnerable adults. EVIDENCE: ‘I have felt that respite should be an extension of your home, in the past it has not always been that way but it is now. Staff are very friendly and feel if you have a problem you can talk to them about it before you make a complaint’ (Relative) The manager spoke of how complaints and compliments were now addressed and recorded. The complaints book seen had clear details of both the complaint and the action taken. The complaints investigation mentioned in the last report has now been concluded. The Commission was kept informed of the progress and outcome. There had been a POVA (Protection of Vulnerable Adults) strategy meeting over an incident between two service users. The manager spoke of the risk assessments undertaken and the actions they followed to ensure the safety of all the service users. The manager showed they had a clear understanding of the service users that would benefit from respite at Alison House as well as those who’s needs cannot be met by the service. All support staff have completed the LDAF unit on the ‘protection from abuse’ Alison House DS0000055306.V322164.R01.S.doc Version 5.2 Page 16 All the staff now have CRB (Criminal Record Bureau) checks. However the practise of the PCT, who are responsible for arranging the CRB checks is that they only apply on the first day of employment meaning that staff are needed to be supervised until their checks come through which could be as long as two months. In a care setting this does have implications for staffing levels so as to ensure that service users are always protected. Alison House DS0000055306.V322164.R01.S.doc Version 5.2 Page 17 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. Alison House is becoming more welcoming and homely. The completion of the bathrooms and kitchens will enhance the whole environment. There is a need for carpet in the lounge and for arrangements to be made to cover the viewing panels on the bedrooms to ensure service users privacy. EVIDENCE: Alison House entrance is now more welcoming. There is a large display board with all the staff pictures on. It appears more ordered and organised and also more homely with pictures and evidence of DVD’s and games for relaxing. The lounge now has a soft play area in the corner that is still being developed. The paintings are now up and the addition of a carpet would greatly enhance the whole warmth of the room. The manager is aware of the need for more domestic furniture within the home. Alison House DS0000055306.V322164.R01.S.doc Version 5.2 Page 18 Walking around the home highlighted the need to both cover the viewing panels on the service users bedroom doors and make the doors are lockable to ensure privacy. There is also a need to add more domestic and homely lighting in the service users rooms. The deputy manager went through the plans they have been developing with an occupational therapist and a specialist firm for both the bathroom and kitchen. The kitchen refurbishment will mean that service users will be able to use the facilities, as there will be height adjustable surfaces. The plans have been made and the deputy manager requires a further quote before the work can begin. It is planned that it should be completed within the next few months. The bathrooms need a considerable amount of work and they have drawn up two plans with the same group of specialists. These are being considered and work should also be completed within a few months. It is clear that a great deal of work has gone into creating these plans and considering the best outcome for service users. The home was clean and fresh. Alison House DS0000055306.V322164.R01.S.doc Version 5.2 Page 19 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): 32,34,35,36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Alison House is now fully staffed. There is regular staff supervision with supervision contracts. The managers have a clear vision for training and staff appraisals. EVIDENCE: ‘…The staff I worked with have been insightful and attentive with good team working.’ (Health and social care professional) Discussions were held with the manager and deputy manager and four staff records were looked at. The managers were clear on the roles and responsibilities of the staff and are working on clarity of roles with staff to ensure good practise. There was evidence of the work carried out by the manager to ensure that the staff files and records were updated and relevant. The staff files were clear, well presented with easily accessible information. All held evidence of CRB Alison House DS0000055306.V322164.R01.S.doc Version 5.2 Page 20 checks, supervision contracts and recent supervision notes along with a training and development profile. The manager has been completing all supervision, as the deputy was a temporary post. Now that the deputy has been confirmed in post they will share the supervision of all staff between them. Alison House use agency staff and the manager plans to include them in the supervision programme. The manager and deputy are aware of the need to promote staff training and are doing so with clear plans for all staff. All staff will attend a PCT course on appraisal and personnel development planning. The manager is currently completing annual appraisals on all staff and plans to carry out a workforce development plan. The manager also has in place a plan for staff to complete the LDAF (Learning Disability Award Framework) and NVQ training. The staff meeting every Wednesday afternoon includes training. They are about to begin a series on person centred planning with a trainer from the Westminster Social Services. Alison House DS0000055306.V322164.R01.S.doc Version 5.2 Page 21 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): 37,38,39,42,43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Alison House is led by a good management team of manager and recently appointed deputy manager. There are clear plans to develop the service. EVIDENCE: ‘ In my view everything is going on nicely, I am very satisfied with the ways things are going – it couldn’t be better’ (relative) ‘..The staff team at Alison House are helpful, professional and caring in their work – I have worked alongside Alison House for a number of years and the past year has shown a really positive way forward in our relationship as providers. The management team are strong and making changes that will lead to people receiving a service that is forward thinking and in line with modernisation agenda’ (Day Services Manager) Alison House DS0000055306.V322164.R01.S.doc Version 5.2 Page 22 The manager has a number of years experience in day care and is person centred in their approach. They are aware of current developments both nationally and by CSCI. The objectives of Alison House for 2006/2007 were planned using the national minimum standards. They are completing an NVQ level 4 and are in the final stages of being registered as manager with the Commission, the process was delayed due to a period of sickness. The managers have clear plans to develop the service together with the service users and staff. The plans state the involvement of service users in all aspects of the home. The newly appointed deputy manager has worked at Alison house as a temporary agency deputy. They are a trained nurse and have been very instrumental in bringing ahead the kitchen and bathroom refurbishments and working on clinical governance. Both managers spoke of the support and encouragement received from the responsible individual. There has been a complete building and fire risk assessment carried out in October 2006. The London fire brigade visited the home. The fire exit signs were not present in one part of the building as they had been removed when the home was being redecorated they must be replaced. The fridge temperatures were showing as too high this must be addressed and the appropriate temperatures maintained for food safety. The COSHH (Control of substances hazardous to health) assessments have been reviewed and all substances have an assessment. The staff are planning to continue work on them to make sure that they are easily available and clear. The managers encourage feedback from service users and their families and the responses received from Commission questionnaires were all positive. In October 2006 the managers produced a clear informative report giving an overview of what has happened within Alison House with service users and staff and outlining the plans for developing the service. The report welcomed feedback and demonstrated the inclusiveness of the service. Alison House DS0000055306.V322164.R01.S.doc Version 5.2 Page 23 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 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 3 2 X X 2 3 Alison House DS0000055306.V322164.R01.S.doc Version 5.2 Page 24 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. 2. Standard YA6 YA9 Regulation 15 13 Requirement All care plans need to be person centred and reflect the way the person wants to be supported. All service users must have an up to date risk assessments with an action plan for risk identified The kitchen worktops must be made height adjustable so that clients in wheelchairs can use them if they wish The lounge requires a carpet to help create a more homely environment Arrangements must be made to cover the viewing panels in the bedroom doors and make sure they are the doors are lockable to ensure privacy. There should be additional lighting in the bedrooms to create a more homely atmosphere. The bathrooms must be redecorated and the showers and baths replaced or made good The Manager must complete an DS0000055306.V322164.R01.S.doc Timescale for action 31/05/07 31/05/07 3. YA24 23 31/05/07 4. 5. YA24 YA26 23 23 31/05/07 31/05/07 6. YA26 23 31/05/07 7. YA27 23 31/05/07 8. YA37 8 31/03/07 Page 25 Alison House Version 5.2 application for registration with the Commission 9 10 YA42 YA42 23 16 The fire exit signs must be replaced. Fridge temperatures must be maintained at the appropriate level 10/02/07 10/02/07 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. 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