Inspection on 02/12/05 for Alpha House

This inspection was carried out on 2nd December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alpha House 22/05/07

Alpha House 12/04/06

Alpha House 20/04/05

Alpha House 18/01/05

Alpha House 22/04/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Alpha House 28 Warlingham Road Thornton Heath Croydon Surrey CR7 7DE Lead Inspector Lee Willis Unannounced Inspection 10:45 2 December 2005 nd Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 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.V256606.R01.S.doc Version 5.0 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.V256606.R01.S.doc Version 5.0 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.V256606.R01.S.doc Version 5.0 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. 20th April 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 (i.e. aged 18 to 65) with past or present mental ill health. Mrs Felicia Appah, the proprieotrs Sister-in-law, remains in operational day-to-day control of the home, where she has been the registrered manager for nearly six years. This small terrace house is located in a quiet residential street in the centre of Thornton Heath and is well placed for accessing local amenities, which includes a vareity of shops, cafes, a park and library. The house is also within five minutes walk of numerious bus stops and a local railway station with excellent links to Croydon, central London and the surrounding areas. Built over two storeys this compact midrow terrace still comprises of three single occuapancy bedrooms, a communal lounge/dinning area, and a separate kitchen, which was recently refurbished. All three of the service users bedrooms have also been redecorated and fitted with en-suite toilet and wash hand basin facilities. An ensuite shower facility has also been installed in the one bedroom located on the ground floor. There is another bedroom on the top floor which is the living quarters for the one member of staff who works nights at the home. At the rear of the property is a small enclosed concrete yard, which is surrounded by flower beds. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and began at 10.45 on the morning of Friday 2nd December 2005. It took three and a third hours to complete. Since the homes last inspection was carried out in April 2005 the Commission has not received any comment cards in respect of this service. The majority of this inspection was spent talking to the homes manager and a couple of the service users who were both at home at the time of this visit. The rest of this inspection was spent examining the homes records and touring the premises. No additional visits or complaints investigations have been carried out by the CSCI in respect of this service in the past eight months. What the service does well: The atmosphere in the home was very relaxed on arrival with two of the homes service users occupying themselves in their bedrooms. The manager was in the kitchen preparing lunch for them both. The one service user who was not at home had being staying over night with her boyfriend as arranged. As a converted terrace house the communal spaces and the bedrooms are all domestic in scale, which gives the place a homely feel. Both service users met said one of the best things about living at Alpha House was having the freedom to choose what you did and when you did it. One service user went onto to say that having you own single occupancy bedroom, which now has en-suite facilities, meant you could spend as much time as you liked in your own company. Staff records revealed that the homes current staff team has not changed at all in the past twelve months, ensuring the service users receive continuity of care from a relatively small group of experienced support workers who are familiar with their unique needs, wishes and preferences. Both service users met said they got on extremely well with all three of the homes permanent staff team, which includes the manager. One service user spoken with at length said he felt confident that he could talk to any one of them about any problems or concerns he may have. Finally, a lot of positive comments were also received about the quality and choice of the meals served. That day’s lunchtime meal of battered fish and assorted vegetables appeared to be nutritionally well balanced and well prepared. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Progress has clearly been made by the home to improve the quality of the service is provides in the past twelve months, although the positive comments made overleaf notwithstanding, the homes manager acknowledges that there is still a great deal of room for improvement. Some of the core areas of practice that could be improve upon are listed below: Firstly, medication administration sheets must be appropriately maintained by staff and under no circumstances should dashes (-) be used to denote a service user was absent at the time their prescribed medication should have be administered. A risk assessment which sets out in detail what action should be taken by staff in such an event also needs to be drawn up in conjunction with all the relevant professionals. Service users wishes regarding dying and death, although ascertained, have still not been recorded in their care plans. Staff must ensure that the balances entered on service users financial audit sheets always matches the amounts held by the home. The rear garden still needs to be supplied with some patio furniture for service users and their guests to enjoy this much under utilised space. The home needs a facsimile machine to enable the manager to communicate more effectively with the proprietors and professional agencies, such as the CSCI and mental health teams. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 Page 7 Service users are still unable to individually control the temperature of their bedrooms and provision must be made for them to access the heating control on their covered radiators. As previously mentioned, although it was positively noted that the vast majority of staff training requirements identified in the homes two previous reports have now been met, although very little documentary evidence to proof this was available on request. Certificates of staff attendance of these courses must be forwarded to the Commission as soon as practicable. The manager also needs to up date her training and complete her NVQ level 4 in management and care, as well as a vulnerable adult protection course. Finally, the proprietors have failed to carry out unannounced inspections of the home at regular intervals in the past twelve months or introduce a professionally recognised quality assurance system contrary to National Minimum Standards. 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.V256606.R01.S.doc Version 5.0 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.V256606.R01.S.doc Version 5.0 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 Significant progress has been made by the manager to improve the homes Statement of purpose and guide to ensure prospective new service users and their representatives are supplied with all the information they need to know to make an informed decision about whether or not to move in. Nevertheless, further amendments are still needed to ensure the homes Statement of purpose and guide meet this Standard. Furthermore, one service users contracts still needs to be signed as proof that all the interested parties understand and agree to the terms and conditions of occupancy. EVIDENCE: Since the homes last inspection the manager has amended its Statement of purpose and service users guide, which now both contain the vast majority of information required by the Care Homes Regulations (2001). However, these documents will also need to include more detailed information about the number, relevant qualifications and experience of the other two members of staff who also work at the home on a regular basis and either include or make reference to the fact that the homes most recent CSCI inspection report is available from the home on request. The home currently has no vacancies and consequently has not received any new referrals in the past twelve months. One service user met, who happens to be the homes most recent admission said he had been living at Alpha House Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 Page 10 for well over a year and gets on extremely well with the other two service users who had both lived there for sometime. As required in the homes two previous inspection reports both the homes longest standing service users have now been provided with written and costed contracts, which set out their individual terms and conditions of occupancy. The manager is reminded that one contract still need to be signed by the service user and/or their representatives as evidence that they understand and agree to its contents. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 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 Care plans are assessed at regular intervals and updated accordingly reflect changing needs, thus enabling staff to plan for and meet individual service users unique needs, wishes and preferences. EVIDENCE: It was positively noted that the two care plans sampled at random had both been reviewed in the past six months and updated accordingly to reflect changing needs. One review meeting, which took place in July 2005, had included the service user, their community mental health practitioner and the homes manager. It was apparent from the minutes of this meeting that this particular service users designated mental health practitioner continues to play a very proactive role in their ‘clients’ life and regular meets with them, in accordance with the Care Programme Approach (CPA) for meeting the needs of people with mental ill health after discharge from hospital. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 16 & 17 Progress has been made by the home in the past year to ensure service users have the opportunity, at least, to engage in a number of organised social and leisure activities both at home and in the wider community, while ensuring their rights to choose not to participate are respected. Meals are nutritionally well balanced and provide daily variation and interest for the people living in the home. EVIDENCE: Having arrived mid morning the two service users who were at home were both relaxing in their bedrooms. One was having a cigarette and listening to the radio while the other was reading a magazine. The manager said that the homes only female service user had stayed overnight at her boyfriends and was due back that afternoon. Activity records revealed that an activities coordinator visits the home on a weekly basis to run music and exercise classes. The sessions are popular with one service user who said he liked exercising to country and western style music. He also said he liked to go on some of the day trips organised by staff at the proprietors other home in the area. This summer he said he had been to Brighton for the day. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 Page 13 It was positively noted that staff record when service users decline to join a particular activity. The other service user spoken with at length said he preferred not to engage in most of the homes organised activities, as he liked going out in the evening and at weekends to see family and friends. He also went onto say he was a big Arsenal fan and sometimes went to matches with his dad. This individual also has a computer in his bedroom, which he said he liked to play games on. Finally, this individual said one of the best things about living at Alpha House was having the freedom to spend time alone in the privacy of his own bedroom without staff continually ‘hassling’ him to join in activities he did not want too. Both service users met they had been provided with a key to their bedroom and the front door. The manager was observed knocking on one service users bedroom door and politely asking their permission to enter before doing so. Both service users met said staff always knocked on their bedroom doors before entering. During the course of this inspection the manager was observed cooking lunch for the two service users who were at home. Both service users were aware that fish was being prepared for lunch and said they had been consulted about the weekly menus, which they helped plan. One service user said the food at Alpha House was always ‘excellent’ and he felt confident that if he did not fancy eating a meal from the published menu he could request an alternative dish. That morning’s lunchtime meal of battered fish and assorted vegetables appeared to be well cooked and nutritionally balanced. It was noted that service users had a choice of yogurt or fruit for dessert. Service users met said the kitchen door was never locked and that they could always help themselves to hot drinks and snacks, as they wanted. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 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 the following standard(s): 18, 19, 20 & 21 Suitable arrangements are in place to ensure that service users psychology health care needs are identified, planned for and met. The homes arrangements for the safe handling of medication received and administered are in the main sufficient to protect the service user from avoidable harm, although a more thorough assessment of the risks associated with one service user being absent when medication is administered needs to be established. Service users wishes regarding what arrangements they want to be put in place in the event of their death has now been ascertained, although this information has still not been recorded in their care plans. Staff need to have access to this information to enable them to handle the ageing, illness and death of a service user, as the individual would wish. EVIDENCE: Both service users met, one of whom had clearly just got up, said they could get up and go to bed when they liked. It was evident from care plans sampled at random that service user continue to receive regular input from mental health care professionals as and when required, which includes support provided by community psychiatric nurses. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 Page 15 The homes accident book revealed that none of the service users had been admitted to accident and emergency in the past eight months and only one significant incident had occurred. It was positively noted that the staff member involved had contacted the police and notified the CSCI without delay as soon as the incident had occurred. This matter was appropriately dealt with at the time and the service user involved apologised to staff and police for their behaviour. No further action was taken. The home continues to use a professionally recognised monitored dosage system and records are kept of all medicines administered and those returned to the dispensing pharmacist. As required in the homes previous inspection report a procedure for the safe disposal of ‘unwanted’ medication has been established and all three of the homes staff team, including the manager, have now attended an accredited safe handling of medication in a residential care setting course. It was noted that staff had failed to sign a medication administration sheet having received a new batch of medication and had also used a ‘dash’ (-) to denote the same service user had been unavailable to take their prescribed medication at certain times. It was evident from the individuals daily diary notes and their MAR sheets that this was a regular occurrence and the manager has agreed to establish a more detailed risk assessment in conjunction with the individual CPN, which makes it more explicit what action must be taken by staff when this individual is absent without. Despite progress being made at the homes last inspection to establish a template to record service users wishes regarding terminal illness and death, they remain largely incomplete. The manager was adamant that this matter had been raised with all three of the service users, with most declining to comment, but does not explain why the outcome of these discussions was not recorded once again. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 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 the following standard(s): 22 & 23 Suitable arrangements are in place to ensure complaints and/or concerns made about the home’s operation are taken seriously and acted upon. Care plans need to contain more detailed risk assessments regarding how staff should prevent and deal with aggression and financial balance sheets kept up to date to ensure service users are protected, so far as reasonable practicable, from avoidable harm or abuse. EVIDENCE: The home has not received any formal complaints about its operation in the past six months and both service users met were confident that they could talk to staff about any concerns they had. In the past twelve months no allegations of abuse have been made within the home. In response to the occurrence of one significant incident in the home since its last inspection the manager has agreed to include more specific guidance for staff to follow when dealing with service users aggressive behaviours which sometimes challenge the service. None of the service users are capable of managing their own finances without a degree of staff support. The home maintains records of all the financial transactions that take place between service users and staff, and by the home on service users behalves. Two financial record sheets sampled at random revealed that staff sign and date all incoming and outgoing payments. However, the two most recent balances recorded on these sheets did not match the amount of money held by the home on the service users behalves. The first purse checked was £1 short and the second was 50p over. Eventually the manager was able to account for these discrepancies after carrying out a Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 Page 17 quick audit. The manager is reminded that financial records should be continually updated to reflect money held by the home for safekeeping. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 & 30 Significant improvements to the physical environment of the home have been made to the property in the past twelve months to ensure the service users live in a more homely and comfortable environment. However, service users ability to control the heating in their bedrooms remains unnecessarily restricted and must be addressed as a matter of urgency. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 Page 19 EVIDENCE: There have been no significant changes made to the interior of the home since its last inspection when work on fitting their new kitchen and en-suite facilities in the bedrooms had just been completed. An officer representing the local Environmental Health department last visited the home in April’05 and made no requirements, although they did recommend the home purchases a probe to check whether or not meat has been thoroughly cooked. As required in the homes previous report multi-coloured chopping boards have now been purchased for the recently refurbished kitchen. As recommended in the homes previous CSCI report no garden furniture has been purchased for the rear patio. The manager said she has raised the matter with the owners who have agreed to purchase a table and some chairs by next summer. The home is also still without a facsimile machine which adversely affects the managers ability to communicate not only with other professional agencies such as the CSCI and mental health resource centres, but also the proprietors. As part of a tour of the premises two bedrooms were viewed with the service users permissions. Both rooms were decorated to a ‘reasonable’ standard and as previously mentioned, had both been recently fitted with new ensuite toilet and washing facilities in the past year. However, it was disappointing to note that despite it being identified as a shortfall in the homes two previous inspection reports no action has been taken to adjust the radiator covers in these rooms to enable service users to individually control the temperature of their bedrooms. The timescale for action will be extended for a third and final time and if no progress is made to address the shortfall within the renegotiated timeframe then the Commission will have no option but to consider taking enforcement action. The maximum temperature of hot water emanating from a tap attached to the first floor bath was found to be a safe 40 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, and the new kitchen flooring is impermeable and readily cleanable. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 The home ensures that sufficient numbers of suitably competent staff are on duty at all times to meet the health and welfare needs of the service users. Significant progress has been made with regards staff training in the past six months, although documentary evidence of attendance of these training courses still needs to be obtained to enable the CSCI to determine whether or not staff are suitably qualified to carry out their duties. EVIDENCE: The manager stated one member of her current staff has now successfully completed a National Vocational Qualification in care (Level 2) and that the other member has now enrolled on an accredited NVQ course, which they have now started. Consequently, exactly 50 of the homes staff team have now achieved this award in accordance with Government training targets for care workers. There have been no changes to staffing levels since the homes last inspection, which appear adequate to meet the assessed needs of the service users. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 Page 21 In the past twelve months the home continues to experience extremely low levels of staff turnover. During this period no members of staff have left and consequently the manager has not needed to recruit any new members of staff. The manager was aware of her responsibilities with regard good recruitment practices and her legal obligation in respect of criminal records and protection of vulnerable adults register checks. The manager said that all the staff training shortfalls, which in some cases had been highlighted in the homes two previous inspection reports, have now all been addressed, with all three members of staff now suitably trained in fire safety, first aid, and working with adults with a past or present mental ill health. Both care staff have also attended a vulnerable adult protection course, although the manager still needs to receive this training in this core area of practice. However, despite reassurances from the manager that all these training requirements have now been met, it was disappointing to note that no documentary evidence by way of certificates of attendance were available from the home on request. The manager explained that these certificates were held on file at the proprietors other care establishment. Felicia Appah is reminded once again that it is essential that all training certificates are kept in the home where the staff actually work to enable anyone who is ‘authorised’ to inspect them to determine whether or not the homes staff team are suitably qualified to carry out their duties. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 & 43 The current manager has no professionally recognised mental health or management qualifications and therefore the service users and staff team would all benefit from Felicia Appah completing her NVQ level 4 in management and care training as soon as reasonable practicable. No progress has been made by the home with regards implementing an effective quality assurance system or undertaking Regulation 26 visits at regular intervals. Consequently, the proprietors and manager are still unable to measure how successful or not the home has been at achieving its stated aims and objectives. Overall, the homes health and safety arrangement are suitably robust to protect the service users and staff from avoidable harm, although food taken out of its original packaging needs to be correctly labelled and dated and employers’ liability insurance renewed on an annual basis to minimise identified risks. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 Page 23 EVIDENCE: The current manager has been in operational day-to-day control of Alpha House since it opened nearly six years ago. The manager has still not obtained her National Vocational Qualification level 4 in Management and Care, despite reassurances at the last inspection that she would have achieved this award by July 2005. The manager is clearly not on course to have achieved the aforementioned award by the end of 2005, contrary to the Governments timescales for action, and as Felicia Appah does not currently hold any professional recognised qualifications, this former recommendation has now been made a requirement. . It was disappointing to note that as required in the homes previous inspection report and despite reassurances from the manager that an accredited quality assurance system would be introduced by the summer of 2005, no progress on this particular issue has been achieved. The manager is reminded that it is essential that the home introduces an effective quality assurance system, which uses an objective, consistently obtained and verifiable method, that is based on service users and other stake holder’s views about the service. Without this the proprietors and manager will be unable to effectively measure how successful or not they have been in achieving the homes stated aims and objectives. This process of self-monitoring must be continuous and the results of service users/stakeholder surveys/questionnaires must be published and made available to all interested parties, including service users, their representatives and the CSCI. The timescale for the home to take action and meet this outstanding requirement will be extended for a second time and must be addressed by 1st April 2006. Furthermore, the CSCI has not received many regulation 26 reports in respect of this service in the past twelve months. Representatives of the registered owners on a monthly basis should be undertaking these unannounced selfmonitoring visits and the subsequent reports forwarded to the Commission, as part of an effective quality assurance programme to ensure the home meets National minimum standards. An officer from the London Fire and Emergency Planning Authority visited the home earlier in the year and it was positively noted hat the vast majority of the requirement made in the subsequent report have been met in full by the home, which includes installing a fire alarm system, emergency lighting and fire resistant doors. Both the lounge and kitchen doors when tested closed automatically into their frames forming effective barriers against the rapid spread of fire and smoke. The manager also carried a fire risk assessment of the entire building in September 2005 and is aware that this must be reviewed on an annul basis. During the course of this inspection the manager tested the new alarm system, which was clearly audible throughout the entire house. The Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 Page 24 homes fire records revealed that the new alarm system is being tested on a weekly basis and fire drills continue to be carried out at regular intervals. Overall, the food kept in the fridge was correctly stored, although it was noted that some cheese and corn beef taken out of their original packaging, although appropriately wrapped in clean film, these products had not been correctly labelled and dated, contrary to basic food hygiene regulations. The homes current employers liability insurance certificate is conspicuously displayed in the front hallway, but is currently out of date having expired in May 2005. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 X X 2 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X 1 3 X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 1 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Alpha House Score 3 3 2 1 Standard No 37 38 39 40 41 42 43 Score 2 X 1 X X 2 2 DS0000025749.V256606.R01.S.doc Version 5.0 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 Requirement Timescale for action 01/02/06 2 YA5 3 YA20 4 YA20 4(1)(c)Sch1.3 The homes Statement of &5.1.d purpose and guide needs to be amended to include information about the number, relevant qualifications and experience of the other two members of staff who also work at the home along with the manager and must also include or make reference to the availability of the homes most recent CSCI inspection report. 5(1)(c) Service users, their 01/02/06 representative(s) and the homes manager, must sign and date written terms and conditions of occupancy. 13(2) Under no circumstances must 01/01/06 dashes (-) be entered on medication administration sheets to denote a service user was unavailable to take their medication. 13(2) (4) A risk assessment must be 01/02/06 undertaken by the manager in conjunction with the service users mental health practitioner which specifies exactly what action must be DS0000025749.V256606.R01.S.doc Version 5.0 Alpha House Page 27 5 YA21 6 YA23 7 YA23 8 YA24 9 YA24 10 YA26 11 YA35 taken by staff in respect of their medication if they the individual in question is absent from the home. 12(2),(3) (4) Service user’s wishes with regard arangements to be put in place if they are taken seriously ill, or pass away, must be recorded in their care plans. Previous timescales for action of 30th October 2004 & 1st June 2005 not met in full. 13(4) Details of any risk assessment and management strategy relating to a service user in respect of how staff should deal with aggression must be included in their care plan. 17(2), Sch Balances recorded on service 4.9 users individual financial sheets must be continually updated to accurately reflect the amounts of money kept by the home on their behalves. 23(2)(o) The rear garden must be supplied with some patio furnture to enable servcie users, their guests and styaff to take full advanetge of this this previously under utilised space. Recommended in the homes last three inspection reports, but not considered. 16(1)(a)(ii) For the purpose of managing the home appropriate facilities for communication by facsimile transmission (i.e. Fax machine) must be provided. 12(2) & Service users must be able to 23(2)(p) access the temperature controls on their radiators to ensure they are able to adjust the heating in their bedrooms. Previous timescales for action of 1st September 2004 and 1st June 2005 not met. 19, Sch 2.4 Documentary evidence of all DS0000025749.V256606.R01.S.doc 01/02/06 01/02/06 01/01/06 01/05/06 01/04/06 01/02/06 01/01/06 Page 28 Alpha House Version 5.0 12 13 YA37 YA37 9(2)(b)(i) & 13(6) 9(2) 14 YA39 12(3) & 24(1,2 & 3) 15 YA39 26(1 to 5) 16 YA42 16(2)(j) 17 YA43 25(2)(e) the training courses attended by staff must be kept in the home and be available for inspection on request. Copies of all the training undertaken by the manager and her staff team in the past twelve months must be forwarded to the Commission. Previous timescales for action identified in the homes two previous inspection reports not met. The registered manager must attend a vulnerable adult protection-training course. The registered manager must obtain an NVQ level 4 in management and care. Previoulsy recommedated timeasacle for action of 01/01/06 will not be met. An effective quality assurance system must be introduced and the results of any service user/stakeholders holder surveys/questionnaires undertaken published. Previous timescale for action of 1st June 2005 not met. The registered owners who are not in operational day-today charge of Alpha House must ensure unannounced visits of the home are carried out on a monthly basis and a report of their findings is forwarded to the Commission and the homes manager. Items of food taken out of their original packaging must always be correctly labelled and dated in cornice with basic food hygiene regulations. The homes employers liability insurance certificate has expired and must be reviewed as a matter of urgency. DS0000025749.V256606.R01.S.doc 01/04/06 01/06/06 01/04/06 01/01/06 01/01/06 15/01/06 Alpha House Version 5.0 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 YA24 Good Practice Recommendations As recommended by the homes environmental health officer at their last visit the manager should consider purchasing a meat probe for checking how thoroughly it has been cooked. Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 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 © 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 Alpha House DS0000025749.V256606.R01.S.doc Version 5.0 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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