CARE HOME ADULTS 18-65
Alness Lodge 50 Alness Road Whalley Range Manchester M16 8HW Lead Inspector
Steve OConnor Unannounced 02 June 2005 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 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 Stationary 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. Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Alness Lodge Address 50 Alness Road Whalley Range Manchester M16 8HW 0161 226 4313 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Mohan Ramsumair Mrs Peggy Ramsumair CRH Care home PC Care home only 10 Mental disorder 10 Category(ies) of MD registration, with number of places Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21 September 2004 Brief Description of the Service: Alness Lodge is a residential care home providing 24-hour personal care and accommodation for 10 persons with mental health problems. The home is situated in the Whalley Range area of Manchester, close to local amenities and public transport routes. It is sited on a residential street and was originally a purpose built home for older people. It has a small car park to the front and a garden at the rear. Bedroom accommodation is on the ground and first floors. All the bedrooms are single with hand washbasins. The home is unable to offer a service to people with restricted mobility due to the layout and lack of access around the building.Communal space is provided on the ground floor with a large lounge that leads through to a conservatory and a dining room. The kitchen and laundry facilities are also situated on the ground floor. The philosophy of the home focuses on maintaining independence and rehabilitation. The manager stated that it is their aim to build on people’s skills and enable people to participate in the day-to-day running of the home. Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over the 2nd and 3rd of June 2005. During the inspection time was spent sitting and talking with the people who lived at the home, with staff on duty and the registered manager. In addition people’s files, records and other relevant documentation were examined. As this inspection only looked at a limited number of standards the report should be read together with the previous and any future reports to gain a full picture of how the home is meeting the needs of the people living there. At the last inspection the home needed to work on several areas to make sure it met the National Minimum Standards (NMS). Most of this work has been completed but some areas had not yet been completed. Those requirements have been included again in the report. What the service does well:
The home offers accommodation and support to people with long-term mental health problems. It offers a safe, secure and comfortable environment and support to people who would not be able to cope on their own. The home has provided the physical and emotional support, along with other specialist mental health services, that has meant that people have not needed further hospital treatment for their mental health. All the people spoken to say that they were happy with the home and the support they received from staff and management. Comments from a person’s mother also showed that they were ‘happy with the service’ their daughter received. Staff showed that they had a good understanding of the needs of the people they support and were clear about their roles in supporting people to stay as independent as possible and to make the home a safe place for them. The importance of communication and working with people was stressed and how being able to give comfort and reassurance reduces the impact of people’s mental health. The relationships between people and staff appeared friendly and relaxed with time spent together talking, joking, singing or joining in activities. Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 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. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 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 standard(s) 2 and 4 People’s needs and goals had been identified and generally had the opportunity to experience the home before deciding to live there. EVIDENCE: The purchasing authority had provided the home with a Care Programme Approach (CPA) assessment and care plan for each person coming to live at the home. Pre-admission assessments from other relevant health and behavioural assessments were also available from healthcare providers. In addition, the home undertook it’s own in-house assessment. From this an individual care plan was developed. The standard of the assessments provided by the purchasing authority was at times vague and did not contain important information the home required to identify and support people’s needs. Since the last inspection, the home had admitted two new people. The manager described the process of introductions to the home in that people had the opportunity to visit the home, meet other people and staff and have overnight stays before deciding to come to live. There was no record kept of these introductions and it was recommended that the home maintain a record of people’s introduction to the home. Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 Page 9 At the time of inspection another person was being introduced to the home. Although the person was able to visit the home they were not able to have any overnight stays due to a lack of funding from the purchasing authority. This issue will be raised with the CSCI. Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 The home had identified risks areas in people’s lives and provided the support to allow them to remain as independent as possible. Generally the home had assessed people’s needs and goals. However, support around people’s personal finances was not identified. EVIDENCE: The purchasing authorities had provided the home with a care plan for each person setting out, in general terms, the support they needed. These care plans were reviewed on an annual basis through the Care Programme Approach (CPA) multi-disciplinary review process. The home had introduced a new care planning document that set out people’s needs for support and described how the home would support those needs. The manager would review the care plan on a regular basis and change the plan as required. The need to record in the care plan the support offered to people to manage their personal finances was discussed with the manager as this was an issue that had been raised in the last two inspections. A care plan must record how a person’s needs are going to be supported by the home. If the home supports a
Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 Page 11 person, in any way, to manage their personal finances then this must be recorded in the person’s care plan. This requirement was reiterated. The new care plan format had improved the scope of the risk assessments and the guidance to staff to minimise those risks. This action met the previous requirement issued at the last inspection. Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 and 16. People were offered opportunities to take part in valued and meaningful activities both within the home and the community. The home’s daily routine was relaxed and informal and people are supported to maintain relationships with their families. EVIDENCE: A number of people have a structured programme of events and activities that they participate in provided by the local mental health service such as dropins, a women’s centre and other specialist leisure and education services. Several people are independent in the community and will use the local community facilities when they want to. In the home people have access to television, videos, music, reading, craft activities and games. The home is supporting several people to go on holiday in July. Other people require support to access the community and the home try to offer people time to go for walks and take part in household tasks such as shopping.
Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 Page 13 The issue of people not having the motivation or choosing not to take part in the opportunities offered by the home was discussed with the manager. Being able to show that the home was continually trying to offer valued and meaningful activities even when the person declined was discussed and it was recommended that the home record the opportunities for social and leisure activities offered to people. The routine of the home was relaxed and informal with no strict times set for activities such as meals, personal care or visitors. People would take part in household activities according to their abilities and the state of their health. Family and friends were encouraged to visit and maintain contact and relationships with people. Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 Page 14 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 standard(s) 18, 19 and 20 The home provides the support required for people to maintain their personal and general and specific healthcare needs. The medication procedures and systems were not being implemented sufficiently to ensure that people are fully protected. EVIDENCE: Most people require prompting and encouragement to maintain their own personal care. Where additional support was required this was recorded in the person’s care plan. Any risks associated with moving and handling had been identified. These actions met the previous requirements issued at the last inspection. The home supported people to attend regular appointments with general and specialist healthcare providers. People’s mental health was monitored on an ongoing basis where this was required. The home had supported most of the staff to complete a distance learning ‘Safe Handling of Medication’ course. Only the two most recent staff were still to complete the course. Some people required medication to be given ‘as required’ (PRN). The last inspection had made a requirement that the home must develop clear and detailed guidance for the administering of PRN
Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 Page 15 medication. Although the administering of PRN medication was being recorded the development of clear guidance had not yet been completed and so was reiterated in the report. The medication administration policy, procedures and systems was inspected and found to be clear and detailed. However, staff had not signed that mornings administering of medication at the time it was given. This was raised with the manager who spoke to the relevant staff member to remind them of the medication procedure. The home must ensure that all staff responsible for the administering of medication follows the set procedures for recording. Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 Page 16 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 standard(s) 22 The home encourages and supports people to raise their concerns and worries in their individual way and has the policies, procedures and systems in place to protect people from abuse and harm. EVIDENCE: The Complaint Policy set out the process and the timescales involved in making a formal complaint. The contact details of the Commission for Social Care Inspection were included. The policy was available to people and was seen attached to the notice board in the dining room. The complaints log was seen and no complaints had been made since the last inspection. People spoken to were able to explain that if they had any concerns or worries then they were able to speak to the staff and manager to help resolve them. Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 The home was comfortable and well maintained and had the facilities and systems in place to keep the home clean and safe. EVIDENCE: The home was clean, well maintained and decorated and had a homely atmosphere. The previous requirement to repair a shower room had been completed. Staff carried out the majority of the daily cleaning of the home with people undertaking a number of domestic tasks. There was a no smoking policy in the house and people can only smoke in the garden. The kitchen contained clear instructions on the use of colour coded food preparation boards and the boards were seen. The laundry room contained a domestic washing machine and a tumble dryer that was sufficient to meet people’s needs. Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 and 35 People are supported by sufficient staff to meet their day-to-day needs. The home’s systems for the recruitment of staff does not fully protect people and the home’s training programme does not fully show that staff have been appropriately trainied. EVIDENCE: The staff team had one outstanding support worker vacancy that was being covered by the remaining staff team. Staff showed through their interaction with people and through discussions with the inspector that they had the values and understood the emotional needs of people with mental health problems. The staff files and Criminal Record Bureau (CRB) certificates were seen. A CRB certificate for a member of staff was over 12 months old when employed and had not been renewed. The home must ensure that new CRB checks are made for all new staff employed and that a system is developed for the renewing of existing CRB checks. A sample of staff references was seen. An example was found where a staff member had provided reference details of a previous employer but the home had not sought that reference. The home must ensure that all staff have suitable references before offering employment.
Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 Page 19 Documentation relating to a staff member being able to work in the United Kingdom (UK) was seen. The documentation was unclear whether it was still valid and the conditions of working set by the Home Office were not being met in relation to the number of hours the staff member was allowed to work. During the inspection the required documentation was presented that clarified the situation. The home must ensure that it has all the necessary documentation relating to staff’s eligibility to work in the UK and that it is aware of all conditions of working set by the relevant authority. The home’s induction programme ran for four days in new employee’s first week. The subject areas included the aims and values of the service, an introduction to people’s needs, the main operational policies and procedures and some basic information around health and safety. The staff would then follow a training programme based on the TOPPS Induction modules before going onto take a NVQ level 2/3. The home stated that it provided training around the nature of mental health and how it impacts on people. However, through discussions with a member of staff they were not able to show that they had this knowledge. The home must ensure that staff have an understanding of mental health and how it impacts on the people they support. The issue of First Aid training was discussed and how to meet the Health and Safety Executive’s (HSE) recommendations. It was recommended that the home discuss with their training provider whether the First Aid training provided meets the HSC recommendations. Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed during this inspection. EVIDENCE: Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score x x x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score x x 3 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Alness Lodge Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 14 Requirement The support, if any, that people require to manage all or part of their personal finances and spending must be assessed and recorded in the Care Plan.(The timescale of the 30th November 2004 was not met). Evidence that this has been included in the care plans must be provided to the CSCI. Clear and detailed guidance must be developed for each service user prescribed with PRN medication. (The timescale of the 30th October 2004 was not met). Evidence of the guidance must be provided to the CSCI. Staff responsible for the administering of medication must follow the set procedures for recording. CRB checks must be obtained for all new staff employed and that a system is developed for the renewing of existing CRB checks. All the necessary documentation relating to staff’s eligibility to work in the UK must be available and the home is aware of all conditions of working set by the relevant authority.
F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Timescale for action 15th July 2005 2. 20 13 15th July 2005 3. 20 13 15th July 2005 15th July 2005 15th July 2005 4. 34 19 5. 34 19 Alness Lodge Version 1.30 Page 23 6. 35 18 7. 34 19 All staff must have an understanding of mental health and how it impacts on the people they support.Evidence of the training provided must be sent to the CSCI. Suitable references must be gained for all staff before offering employment. 1st September 2005 15th July 2005 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. Refer to Standard 4 12,13,14 35 Good Practice Recommendations It is recommended that the home maintain a record of people’s introduction to the home. It is recommended that the home record the opportunities offered for social and leisure activities to people. It is recommended that the home discuss with their training provider whether the First Aid training provided meets the HSE recommendations. Alness Lodge F55 F05 s21600 alness lodge v230826 020605 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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