CARE HOME ADULTS 18-65
Alpha House 28 Warlingham Road Thornton Heath Croydon Surrey CR7 7DE Lead Inspector
Lee Willis Key Unannounced Inspection 12th April 2006 10:45 Alpha House DS0000025749.V288221.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 Alpha House DS0000025749.V288221.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. Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Alpha House Address 28 Warlingham Road Thornton Heath Croydon Surrey CR7 7DE 020 8665 0092 NONE 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) Dr Edward Newton Osei Appah Mrs Helen Appah Ms Felicia Aseidua Appah Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A variation has been granted to allow one specified resident over the age of 65 to be accommodated. 2nd December 2005 Date of last inspection Brief Description of the Service: Alpha House is a privately run residential care home, which specialises in providing accommodation and personal support for up to three younger adults with a past or present experience of mental ill health. The homes registered manager, Felicia Appah, has been in operational day-to-day control for the past six years. This small mid-terrace house is located in a quiet residential street in Thornton Heath and is with five minutes walking distance of a wide variety of local shops, cafes, a library and park. The home is also close to a main line train station and numerous bus routes with good links to Croydon and central London. This two-storey house comprises of three single occupancy bedrooms and a staff sleep-in room/living quarters. All three of the service users bedrooms have en-suite toilet and wash hand basin facilities, and one a shower unit. There is a shared toilet and bath on the first floor. Communal areas include an open plan lounge/dining area, a separate kitchen, and small concrete yard at the rear. Both the service users currently residing at Alpha House have been supplied with a copy of the homes Statement of purpose, Service users guide and their terms and conditions of occupancy. These documents include information about the range of fees charged for services and facilities provided, although a copy of the homes complaints procedures and most recent CSCI inspection report need to be more conspicuously displayed and not just made available on request. Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over five hours from 10.45 on the morning of Wednesday 12th April 2006. The accumulated evidence used to inform this report came from a wide variety of sources, although the vast majority of information came from the people met during the site visit to the home, which included both the service users currently residing at Alpha House and the homes registered manager. Both service users were also encouraged to have their say about life at the home and were supported to fill in a satisfaction surveys with the inspector during the visit. The manager was also asked to complete a Pre-inspection and Equalities questionnaires. The remainder of the site visit was spent examining the homes records and touring the premises. The rest of the evidence was gathered at the pre-fieldwork stage and came from information the CSCI had received from the home in the past twelve months, as well as the homes two most recent inspection reports. No additional visits or complaints investigations have been carried out by the CSCI in respect of this service in this same period, although Regularly activity in the form of Warning letters for repeated non-compliance with the Care Homes Regulations (2001) have been issued in this time. What the service does well:
Alpha House is overall an adequate quality service that has more strengths than weaknesses which provides the service users with a safe environment in which to live, although there remains significant areas for improvement (See under the heading ‘what they could do better’). The home is generally viewed quite positively by the people who use the service and both residents met during the inspection said they liked living at Alpha House: Both service users agreed that one of the best things about living at Alpha House was always having the freedom to choose what you did when you wanted, such as getting up and going to bed, going out and having a bath and/or shower. The service users also said all three of the homes permanent staff team, which included the manager, were all very approachable and they knew they could speak to anyone of them if they were unhappy with something. The lives of the people who use the service are undoubtedly improved because they are supported by a relatively small group of trained staff who are familiar with their unique needs, strengths, and preferences. Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Eleven new Requirements have been identified in the main body of this report of which six remain outstanding from the homes previous inspection report. These Requirements cover a wide range of important areas of practice and will all need to be addressed in a timely fashion if the quality of this service is to improve.
Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 7 The homes Statement of purpose and guide both need to be revised to contain more detailed information about staff qualifications to enable prospective service users and their representatives to make informed decisions about whether or not to use this service. Service users care plans must be amended to contain far more detailed information about how staff are expected to deal with behaviours that challenge the service in a consistent and positive manner. Plans must also be reviewed at least once every six months and updated accordingly to reflect any agreed changes. People who experience mental ill health often lack self-motivation and it is therefore important the providers make more of a consorted effort to ascertain service users views about their social, leisure, and recreational interests and actively encourage them to find out about and participate in more meaningful activities in the local community. The homes complaints procedure needs to be more conspicuously displayed to ensure service users and their representatives know how to make complaints about the homes operation. People who use the service are still unable to take full advantage of the rear garden, which remains a much under utilised space because of the lack of adequate seating in this area. In the main the homes staff team are suitably competent to perform their duties, although as previously mentioned a number of gaps in training were identified at the pre-fieldwork stage. Sufficient numbers of staff still need to attend suitable courses in a number of core areas of practice, including fire safety, basic food hygiene, first aid, vulnerable adult protection, and equal opportunities. Furthermore, the manager is still not suitably qualified to run a residential care home and must achieve her NVQ Level 4 in management and care to meet National Minimum training targets. The homes arrangements for assuring quality through self-monitoring remain woefully inadequate and must be addressed as a matter of urgency. Without a system in place to ascertain the views of service users and other major stakeholders, including service users relatives and professional representatives, the home will be unable to effectively measure how successful or not it has been in achieving its stated aims and objectives. The providers have repeatedly failed to take appropriate action to resolve this on going issue and with a greater emphasis now placed on providers to continually monitor their own performance the CSCI is considering taking enforcement action to ensure compliance. 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.
Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 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 Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Using all the available evidence including a visit to the home the services performance in the outcome area ‘Choice of home’ is judged to be adequate because limited progress has been made by the manager to improve the homes Statement of purpose and guide. Consequently, prospective new service users and their representatives do not have all the information they need to make an informed choice about whether or not to live at Alpha House. EVIDENCE: Since the homes last inspection the homes oldest service user requested to transfer to another residential care home in the area, which was granted. Consequently, the home now has one vacancy and both the service users currently residing at Alpha House are under 65 years of age. The homes conditions of Registration will therefore need to be amended and the variation that allows one named service user who is over 65 to be accommodated their removed. As required in the homes last inspection report the manager has compiled a list of all her staff teams current qualifications. However, this information is currently hand written on a loose sheet of paper that the manager said she is waiting for staff at the providers’ other service (Mary’s Home) to electronically incorporate into Alpha Houses most up to date Statement of purpose and Service users guide. Furthermore, the Service users guide does not include a copy of the homes most recent CSCI inspection report or make reference to its
Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 10 availability from the home on request. Both service users met during the course of this visit said they had decided against keeping copies of the homes Statement of purpose, guide and their terms and conditions of occupancy in their bedrooms, and were happy for these documents to be held in filing cabinets in the lounge. However, none of the service users were aware that CSCI inspection reports existed or were available from the home on request. Evidence from the pre-fieldwork planning stage revealed that key Standard No#2 was met at the homes two previous inspections and it was therefore deemed unnecessary to reassess it again on this occasion. As required in the homes previous inspection report both the homes service users have now signed their terms and conditions of occupancy, along with the manager. Both contracts viewed set out the range of fees each service user is currently charged for services and facilities provided, as well as additional costs for services not covered by the basic price of their placement. Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Using all the available evidence including a visit to the home the services performance in the outcome area ‘Individual needs and choices’ is judged to be adequate because not all their care plans had been reviewed in the past six months or their views ascertained about all aspects of life in the home. Consequently, service users do not know their changing needs and personal goals will always be reflected in their care plans or feel confident they will be consulted about all aspects of life at Alpha House. EVIDENCE: Care Plans were available for both Service users and set out how the service intends to meet their current personal, social, and health care needs. Both service users care plans have been formally reviewed in the past twelve months and involved a number of relevant social and health care professionals. However, one service user plan has not been reviewed since July 2005 and is in urgent need of updating to reflect their changing needs. The service user stated that they are always invited to attend their annual care plan review with their Care Manager, father, and homes manager. Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 12 Since the homes last inspection the home has notified the CSCI without delay about the occurrence of several significant events involving both service users. It was therefore disappointing to note that despite the occurrence of these incidents and it being identified as a major shortfall in the homes previous inspection report care plans have still not been revised to include individualised procedures to enable staff deal more effectively with behaviours that challenge the service. Minutes of the homes last service users meetings revealed that it took place over four months ago. One service user said they found these meetings quite useful and would like them to be held on a more frequent basis. Both service users also said that they did not always feel they were consulted about all aspects of life in the home. Evidence gathered from a recent Regulation 37 sent to the CSCI and comments made by the manager confirmed that the home had responded promptly to an unexplained absence of a service user in line with the homes missing person’s procedures. However, no risk assessment had been carried out in response or action plan developed to minimise the likelihood of similar incidents reoccurring in the future. Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 & 17 Using all the available evidence including a visit to the home the services performance in the outcome area ‘Lifestyles’ is judged to be good because meals are nutritionally well balanced and provide daily variation and interest for the people living in the home. However, some service users are not being sufficiently encouraged to find out about and participate in meaningful activities in the local community. EVIDENCE: One service user said they likes to get up late each day and decide what to do after lunch. This often involves visiting the local shops or library service to borrow a book. In the evening and at the weekend they liked to visit their family and friends, many of whom live near by. They also acknowledged that they had been feeling ‘unwell’ recently, but said they would appreciate more support from the home in the future to find out about and participate in activities in and around the local area, which matched their own social interests. The service user’s daily records showed that they visited family and friends on regular basis, but had not been engaging in what could be described as any meaningful social/leisure activities in the wider community in recent months.
Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 14 The second service user said they were satisfied with the arrangements that the home had in place that enabled them to come and go as she pleased and to stay out over night at their friends. Key Standard No#16 was assessed as met at the homes previous inspection and was therefore not judged on this occasion. Both service users said they could always choose what and where they ate their meals, which were generally always tasty and in plentiful supply. When asked one service user said they could not remember what they had requested for lunch that day, but did recall being asked by the manager what they would like to have for today’s lunch yesterday afternoon. Lunch was prepared by the manager and was plated up at around 1pm. One service user chose to eat their his Salmon casserole, with boiled rice and green beans in their bedroom, whilst the other service user ate their lunch in the lounge. They said their mild beef curry dish was very tasty and was what she had ordered. Having been invited to join HA for lunch I was able to confirm that the beef curry was well presented, nutritionally well balanced, and very tasty. Neither of the meals served on the day matched the published menus, but the home appropriately maintains a record of all the food consumed by the service users on a daily basis, which was sufficiently detailed to enable anyone authorised to inspect these records to determine whether or not service users diets were suitably varied and nutritious. One service user said they did not eat red meat, which had been recorded in their care plan. Both service users said they were not practising Christians, although everyone spoken with said it was customary for staff to buy the service users chocolate eggs at Easter. The manager also said she planned to serve up hot cross buns this coming Good Friday and prepare a special dinner on Easter Sunday. Both service users said they were looking forward to Easter and would be spending a lot of it with their family and friends. Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21 Using all the available evidence the services performance in the outcome group ‘Personal and Healthcare support’ is judged to be good. The home has sufficiently robust arrangements in place to ensure the service users emotional health care needs are met, and where appropriate, service users are encouraged to retain as much control over their medication as reasonably practicable as a means of promoting their independent living skills. Finally, service users are confident their wishes regarding illness and death will be respected. EVIDENCE: The service user, who was lying in bed at the start of this inspection, said they always got up, went to bed, had a shower, and when out when they liked. Feedback was also received from the manager on this point who said there were no restrictions on what time service users could return home, although there was an expectation that both service users should notify staff if they were going to be late back or planned to stay out over night with family or friends. During the course of this inspection one service user popped out to the local shop on two separate occasions. They confirmed that they did not need to seek anyone’s permission to go out, although they would always let staff know where they were going.
Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 16 A service user stated that they regularly receives input from their Care Manager who they had an appointment to see that afternoon. During the course of the inspection the Care Manager telephoned to confirm the appointment to be held at a local Resource centre. Records revealed that service users continue to be in regular contact with the relevant social/health care professionals who are always involved in their annual care plan reviews. The manager said that none of the service users have been admitted to hospital in the past twelve months or been involved in any minor accidents. As required in the homes previous inspection report alternative methods of supporting one service user take their medication on time have been considered, and based on an assessment of their willingness and ability to do so, they now take greater control of their medication. This individual has a lockable space in their bedroom to securely store small dosages of their medication and an up to date record is maintained of their current medication regime. The manager said the new system had been working well and had given the service user far greater freedom to decide whether or not they wanted to stay out over night at their friends. It was also noted that no recording errors were evident on Medication Administration sheets sampled at random. As required in the homes previous report documentary evidence was available in both service users care plans regarding their wishes if they were taken seriously ill and/or passed away. Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Using all the available evidence the services performance in the outcome group ‘Concerns, complaints and Protection’ is judged to be adequate. On the whole the home has sufficiently robust arrangements in place to ensure service users views are listened to, although more detailed information about how service users and their representatives can make complaints needs to be more prominently displayed in the home. Furthermore, sufficient numbers of staff still need to receive suitable training in recognising, preventing and reporting vulnerable adult abuse to ensure the service users are protected from abuse, harm and neglect. EVIDENCE: During the course of the inspection the manager was observed interacting with both service users, and in particular with one in a very friendly and respectful manner. Felicia promptly and politely answered all the questions HA asked her during the visit. Both service users said they felt their views were always listened to by staff and knew they could always speak to the manager if they were unhappy with anything at the home. However, both service users said they did not know how to make a formal complaint about the homes operation because they had not been given a copy of the homes complaints procedures or had them explained to them. A copy of the homes complaints procedures is included in the Service users guide, which was available from a filing cabinet in the lounge on request. Both service users confirmed that they were happy for these guides to be kept in a filing cabinet in the lounge, which could be made available on request. As a consequence of these arrangements all the relevant parties, including the service users and manager, all agreed that an up to date copy of the homes complaints procedures should be more conspicuously displayed in the home and/or given to each of the service users. The homes
Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 18 complaints log revealed that no formal complaints or informal concerns had been made about the homes operation in the past twelve months. Evidence gathered from the CSCI’s database and comments made by the service users and manager revealed that no allegations of abuse had been made within the home in the past twelve months. The homes manager conceded that she had not made any arrangements to attend the Local Authorities vulnerable adult protection and preventing abuse training. None of the service users are capable of managing their own finances without staff support. During the inspection one service user requested some of their money to buy cigarettes, which was immediately granted by the manager. The home maintains an up to date records of all financial transactions involving service users money and the balances recorded on these sheets for the past four weeks matched the sums of money being held by the home on service users behalves. This money is currently kept in individually marked envelopes in a lockable filing cabinet. To improve security it is recommended separate cash boxes and used to store each service users money. Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 19 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, 26. 27, 28 & 30 Using all the available evidence, which included a site visit to the home, the services performance in the outcome group ‘Environment’ is judged to be good. On the whole bedrooms and communal areas are furnished and decorated to a reasonable standard ensuring the service users have a clean and safe environment in which to live. Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 20 EVIDENCE: Both service users met during a tour of the premises said the home was always kept fresh and clean by staff. The manager acknowledged that the lounge, which is the homes only communal area, could do with some more soft furnishings, such as a rug for the recently tiled floor and cushions for the armchairs. Having inspected radiators in both service users bedrooms and communal areas it was positively noted that as required in the homes last two reports the providers had fitted them all with accessible temperature controls that could be adjusted to suit individual preferences. One service user said their bedroom contained all the furniture they needed. The damaged chest of drawers in this bedroom will need to be repaired. While touring the home is was noted that as required in the homes previous inspection report a new fax machine was now available in the entrance hall. One service user said it would be nice to have some furniture in the garden so it could be enjoyed when the weather got warmer. The manager was aware that the timescale for adequate seating to be provided in the rear garden expired on 1st May 2006 and was confident the providers had made plans to rectify this on going matter. The soap dispenser in the first floor toilet/bathroom that had come away from the wall and the kitchen door handle, which fell off several times during the course of this inspection, both need to be made secure. The maximum temperature of hot water emanating from a tap attached to the first floor bath was found to be a safe 39 degrees Celsius after a run off of three minutes. The homes washing machine is kept in the kitchen and therefore laundry is taken through areas where food is stored and prepared. Nevertheless, separate hand washing facilities are prominently sited in this newly fitted kitchen and the new tiled flooring is readily cleanable. Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 21 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, 33, 34 & 35 Using all the available evidence the services performance in the outcome group ‘Staffing’ is judged to be adequate. On the whole service users are supported by sufficient numbers of reasonably competent staff, although more staff will need training in other core areas of practice to ensure all the service users individual needs are appropriately met. The homes arrangements for recruiting new staff are sufficiently robust to protect the service users from avoidable harm. EVIDENCE: As mentioned in previous chapters both service users said staff usually treated them well and could not recall any occasion when they had not listened to them. The manager was also observed taking her time to deal with one service users questions. Documentary evidence of staff training forwarded to the CSCI by the manager revealed that in keeping with Government training targets for care workers at least 50 of the homes current staff team had achieved an National Vocational Qualification in care - Level 2 or above. The manager said her only other member of staff was currently enrolled on an accredited NVQ course, which they planned to have completed by the end of the year (2006). These certificates of attendance also showed that although staff members, including the manager, had all received training in a number of key areas of practice
Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 22 relevant to the work they were expected to perform, which included supporting people with a past or present experience of mental ill health, there were nevertheless a number of training gaps noted. All staff need to attend fire safety and several others require first aid, basic food hygiene and equal opportunities training. The homes duty roster and staff files revealed that no new members of staff had been employed since the homes last inspection and nor had any changes been made to staffing levels, which remain adequate to meet the assessed needs of both the homes service users. On arrival the homes manager was on duty, which matched the homes duty roster for that day. The all female staff team which consists entirely of people who consider themselves to be black British, is only partially reflective of the ethnic and gender mix of the service users. The homes only other service user is a young white Caucasian male, and the manager said she would be mindful of this acute imbalance when she next recruits any new members of staff. The manager also said she will consider this when she encourages him to engage in more meaningful activities in the wider community. As mentioned in the previous paragraph more staff also need to receive equal opportunities training. Staff files contained up to date Criminal Records Bureau and Protection Of Vulnerable Adults register checks for both the homes permanent care workers. Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 23 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, 40 & 42 Using all the available evidence the services performance in the outcome group ‘Conduct and management of the home’ is judged to be poor. The registered manager is not suitably qualified to ensure the home is well run. The homes current arrangements for assuring quality are insufficiently robust to ensure the service users and other major stakeholders feel confident their views will underpin all the homes self monitoring. Not all the homes policies and procedures comply with current legislation and need to be amended to ensure service users rights and best interests are safeguarded. Finally, the homes basic food hygiene practices are not sufficiently robust to ensure the welfare of service users are protected. Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 24 EVIDENCE: The homes manager, who has been in operational day-to-day control of Alpha House since it opened over six years ago, has still not completed her National Vocational Qualification level 4 in Management and Care, although she is very confident that her last piece of course work will have been submitted for assessing by the end of April 2006. Documentary evidence was available on request to show that the manager had recently established some stakeholder surveys in order to ascertain people’s views about the quality of the service they received, although none of these have been carried out at the time of this inspection. This is an on going requirement and despite some progress being made by the manager to established satisfaction questionnaires the providers are reminded that in order for them to be able to effectively judge how successful or not they have been in achieving their stated aims and objectives the results of these surveys must first be compiled and then analysed. Similarly, documentary evidence was available on request to show that unannounced inspection visits had been carried out on a monthly basis since January 2006 by the deputy manager of the providers other care home in the area. Disappointingly, although this marked a significant improvement since the homes last inspection with regards the provider’s self-monitoring performance, the subsequent regulation 26 reports lack detail and are not being forwarded to the CSCI, contrary to the Care Homes Regulations (2001). The home has an equal opportunities policy document that has not been reviewed for over five years and which does not make reference to any antidiscrimination legislation, such as the Race Relations, Sex and Disability Discriminations Acts. The home also does not have procedures and codes of practice in place to deal with racial harassment occurring between service users; between staff; by staff; or by service users on staff. During a tour of the premises it was concerning to note that three items of food found in the fridge that had been taken out of there original packing, which included some corn beef, gravy and a block of cheese, had all been wrapped in unmarked clean film. This major shortfall was identified in the homes previous inspection report and the manager, who had some sticky labels to hand specifically for this purpose, is reminded that all items of food taken out of there original packaging must always be labelled and dated in accordance with basic food hygiene standards. During a tour of the premises the cupboard under the kitchen sink, which was being used to store a number of COSHH products, was noted to be unlocked, contrary to health and safety Regulations.
Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 25 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 1 2 X 3 X 4 X 5 3 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 3 25 X 26 2 27 3 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 X 1 2 X 1 3 Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 26 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 4(1)(c), Sch 1.2 3 & 5.1(d) Requirement Timescale for action 01/05/06 2. YA6 3. YA6 4. YA9 The homes Statement of purpose and service users guide both need to contain up to date information about the number, relevant qualifications and experience of all the homes staff team, including the managers, and include a copy or make reference to the availability of the homes most recent CSCI inspection report. Previous timescale for action of 1st February 2006 not met. 15(2) & Care plans must be reviewed 17(1)(a), Sch at least every six months and 3.1(b) updated accordingly to reflect changing needs. 13(4) & 15(1) Care plans must contain individualised procedures for supporting service users who have been assessed as likely to be verbally and/or physically aggressive. Previous timescale for action of 1st February 2006 not met. 13(4) & 15(1) Care plans must contain individualised procedures for responding to unexplained
DS0000025749.V288221.R01.S.doc 01/05/06 01/05/06 01/06/06 Alpha House Version 5.1 Page 27 5. YA13 16(2)(m) 6. YA22 22(5) 7. YA23 9(2)(b)(i) & 13(6) 8. 9. YA26 YA28 16(2)(c) 23(2)(c) 10. YA28 23(2)(o) 11. YA35 18(1) & 19, Sch 2.4 absences by service users who have a history of absconding. Consult DP (preferably at his next care plan review meeting) about his social, leisure and recreational interests, record them in his care plan, and make suitable arrangements to enable him to find out about and engage in local community based activities of his choosing. A written copy of the homes complaints procedure must be conspicuously displayed on the premises and/or given to each service user and to any person acting on their behalves. The manager must attend the Local Authorities vulnerable adult protection course and cascade this knowledge down to her staff team. Previous timescale for action of 1st April 2006 not met. Damaged chest of drawers in ground floor bedroom must be repaired. Damaged soap dispenser in the first floor bathroom and the loose handle attached to the kitchen door must both be repaired. The rear garden must be kept clean and provided with adequate seating for service users, their guests and staff to take full advantage of this previously under utilised space. Sufficient numbers of the homes staff team must be suitably trained in fire safety, basic food hygiene, first aid, and equal opportunities. Documentary evidence of this training must be available for inspection on request.
DS0000025749.V288221.R01.S.doc 01/06/06 01/05/06 01/07/06 01/05/06 01/05/06 01/05/06 01/08/06 Alpha House Version 5.1 Page 28 12. 13. YA37 YA39 9(2) 24(1) (2) 14. YA39 26(4) (5) 15. YA40 12(4) (5) 16. YA42 16(2)(j) 17. YA42 13(4) The registered manager must obtain an NVQ level 4 in management and care. A system for reviewing at appropriate intervals and improving the quality of care provided by the home must be implemented and service users, their representatives and the CSCI supplied with a report in respect of any review undertaken by the providers. Previous timescales for action of 1st June 2005 and April 2006 not met. Persons responsible for undertaking unannounced monthly inspections of the home must interview service users and staff; inspect the premises, the homes record of events and complaints log; and supply a copy of the subsequent report to the CSCI. Previous timescale for action of 1st January 2006 not met. The home must review its current equal opportunities policy and establish racial harassment procedures. All items of food taken out of their original packaging must be correctly labelled and dated in accordance with basic food hygiene Standards. Previous timescale for action of 1st January 2006 not met. All cleaning materials and other substances hazardous to health must be kept secure in a lockable space when they are not in use. 01/06/06 01/07/06 01/05/06 01/07/06 12/04/06 12/04/06 Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 29 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 YA1 Good Practice Recommendations A copy of the homes most up to date Statement of purpose, Service users guide, and CSCI Inspection report should be conspicuously displayed in the home at all times. Service user meetings should be held at least once every two months and the minutes recorded. Money held by the home on service users behalves should be individually stored in lockable cash boxes. The communal lounge should be supplied with more soft furnishings (e.g. a rug and cushions for armchairs). The manager should be mindful of the cultural and gender imbalance that currently exists between her staff team and the homes only white Caucasian male service user when she next recruits new members of staff or helps plan community-based activities. 2. 3. 4. 5. YA7 YA23 YA28 YA33 Alpha House DS0000025749.V288221.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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