Inspection on 22/05/07 for Alpha House

This inspection was carried out on 22nd May 2007.

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

Other inspections for this house

Alpha House 12/04/06

Alpha House 02/12/05

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 Key Unannounced Inspection 22nd May 2007 10:30 Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 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.V341072.R01.S.doc Version 5.2 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. 12th April 2006 Date of last inspection Brief Description of the Service: Alpha House is a privately run residential home that provides personal support and accommodation for up to three 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 of the service for the past seven years. This small mid-terrace house is located in a quiet residential street in Thornton Heath and is within easy walking distance of a wide variety of local shops, cafes, pubs, a public lending library, and large park. The home is also very close to a main line train station and numerous bus routes with good links to Croydon and central London. This two-storey property comprises of three single occupancy bedrooms and a staff sleep-in room/living quarters. All three bedrooms have en-suite toilets and wash hand basin facilities. One bedroom has its own en-suite shower unit. There is a shared toilet and bath on the first floor. All the communal space is concentrated on the ground floor and comprises of a main lounge/dining area, a galley style kitchen, and patio garden at the rear. All the service users have been supplied with up dated versions of the homes Statement of purpose, Service users guide and their terms and conditions of occupancy. The homes current scale of charges ranges from £400 to £500 per week. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. From all the available evidence gathered during the inspection process the Commission for Social Care Inspection (CSCI) has judged the service as having some strengths, but also areas of particular weakness that need to be improved. Nonetheless, most Key standards are almost met and we judge the service to be a safe one, in that potential risks to residents tend to be recognised and managed by the home. This unannounced site visit was carried out on a Tuesday between 10.30am and 2.00pm. During the course of this three and a half hour inspection two people who currently live at Alpha House were met, along with the homes manager and only other permanent member of staff. The two residents met were selected for ‘case tracking’. The remainder of this site visit was spent examining the homes records and touring the premises. As part of the inspection process I also supported the two residents met to complete ‘have your say’ comment cards to ascertain their views about the home. What the service does well: Most of the written and verbal feedback received from residents about the quality of the service provided was relevantly complimentary. As part of the homes new quality assurance monitoring systems service users are asked to complete satisfaction surveys. One service user wrote, “Alpha House was the ‘best’ home they had ever been in”. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 6 The two service users informally interviewed during the course of the site visit both mentioned that one of the ‘best things’ about living at Alpha House was having the freedom to do what you wanted each day, such as getting up, going to bed, or going out, for instance. The two service users met also told us that staff tended to treat them well. Service users also benefit from the fact that as a relatively small home it only needs two permanent members of staff to run it, which coupled with the fact that the service continues to experience extremely low rates of staff turnover, means the two women staff team are very familiar with each of the residents unique needs, routines and likes/dislikes. It was positively noted on arrival that the homes manager was busy preparing all manner of Afro-Caribbean food in the kitchen in order to cater for the specific tastes of the homes one British Afro-Caribbean service user. It was clear from this individuals comments that they enjoyed Caribbean style cuisine and appreciated the managers efforts. Up to date records of all the main meals consumed by service users is appropriately maintained by staff are revealed that people who live at Alpha House have every opportunity to enjoy a varied and interesting diet. What has improved since the last inspection? Since the homes last inspection improvements have been made regarding arrangements for consulting service users about their leisure interests, although strategies to ensure people are actively encouraged and supported to participate in social activities of their choice, both at home and in the wider community, need further improvement. Information being recorded in daily diaries about the activities service users participate in each day is now kept in greater detail. The homes arrangements for ensuring service users can express their views about the standard of care they receive has significantly improved in the past year. Since the last inspection a copy of the homes complaints procedure has been pinned to the notice board in the lounge and service users are asked to complete satisfaction questionnaires about the standard of care they feel they receive. Furthermore, as part of the homes new systems for assuring quality, unannounced inspections by a senior representative of the providers are now being conducted on a more frequent basis. The two service users spoken with told us they liked what the owners had done to the rear garden and had begun to use it more now that the weather was getting better. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 7 What they could do better: Much of the verbal feedback received from a number of mental health professionals spoken with about the home told us that although they considered Alpha house to be a ‘safe’ place for the ‘clients to live they also felt the staff lacked the necessary expertise to deliver much in the way of professionally recognised mental health treatment and rehabilitation programmes. Furthermore, the service does not have a particularly good record of addressing all the requirements identified by the Commission. It was therefore disappointing to note that nearly half the requirements identified at the homes last inspection, many of which had been carried over from the previous visit, remained outstanding. Each person who lives at Alpha House has a care plan, but the practice of involving people who use the service in their development and review remains variable. Plans include basic information necessary to deliver the residents care, but are not particularly detailed in respect of identifying people’s goals or the actual support they will require to achieve them. Consequently, these plans are not person centred enough and staff should receive additional training to rectify this on going issue. The providers do seem to recognise the importance of staff training, although it was disappointing to note that the manager has still not achieved her National Vocation Qualification Level 4 in both management and care, which all residential home managers must acquire. This training shortfall has been in the homes previous three inspection reports. Furthermore, both the homes permanent members of staff have yet to refresh their basic first aid training, which expired some time ago. The providers are reminded that repeated failure to address these on going training matters will result in the Commission considering taking enforcement action to ensure future compliance. The manager told us that she has still not revised the homes equal opportunities policy or introduced a racial harassment procedure, despite this being identified in the homes previous two inspection reports. This lack of progress made to keep these policies up to date seems to suggest the homes manager does not understand or regard reviewing procedures as an importance part of her duties. Reviewing policies is a core management tool and the timescale for this outstanding requirement to be addressed is extended for a third and final time. Failure to address this matter within the new timescale for action will also result in the Commission considering taking enforcement action. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 8 New requirements identified at the time of this inspection are as follows: The manager must seek greater input from a qualified occupational therapist regarding the risks associated with supporting a service user in and out of the bath and act upon their advice. During a tour of the kitchen it was noted that a number of items of food had perished and had not been disposed of immediately contrary to basic food hygiene standards. Due to the serious nature of this environmental breach an Immediate Requirement Notice was served during the visit and the offending items disposed of at the time. Contrary to the Care Homes Regulations (2001) and good fire safety guidance the manager has failed to keep an up to date record of every fire practice conducted in the home. Finally, it is recommended that the providers should give serious consideration to establishing a time specific rolling programme to redecorate the living room and entrance hall. The Commission feels the décor in both these areas has seen better days and that the service users would benefit from the homes communal areas being upgraded. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 9 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.V341072.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): No.1 Quality in this outcome area is good. This judgement has been made using all the available evidence both during and before the inspection visit to this service. People who use this service have good information about the home in order to make an informed decision about whether the service is right for them. EVIDENCE: A copy of the Service users guide was looked at. A person who lived at the home told us they had been given a copy of the guide and it was positively noted that a version was pinned to a notice board in the lounge. The phrase ‘Rest’ home should be removed from both the service users guide and Statement of purpose. The outcome for key Standard No. 2 was not looked at on this occasion because the last full inspection of the service confirmed a suitable process was in place to assess prospective service users needs prior to their admission. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): No’s 6 & 7 Quality in this outcome area is adequate. This judgement has been made using all the available evidence both during and before the inspection visit to this service. Although improving, the variable practice regarding the homes approach to care planning means that the services users cannot be sure that they will receive the necessary support to enable them to achieve their personal goals. Suitable arrangements are in place to ensure the people who use the service have their views listened too and are consulted about decisions in the home that affect their lives. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 12 EVIDENCE: The individual care plans for the two people selected for case tracking were both examined and it was noted that neither of these documents contained any information about what these people wanted to achieve by living at Alpha House (i.e. what their personal goals and aspirations for the future were). Furthermore, these plans lacked any real detail regarding the actual support these individuals required to achieve their personal goals and aspirations, despite this being identified as a major shortfall at the homes last inspection. Two mental health care professionals representing the placing authorities for two of the people currently living at Alpha House told us over the telephone that they were also concerned about the homes whole approach to care planning. Both mental health professionals spoken with said they felt their ‘clients’ care plans developed by the home did not accurately reflect what these individuals capacities were and what support they actually required to realise their goals. The manager told us that each of the residents played a central role in drawing up their care plans. However, one service user spoken with at length during the course of this visit said they had not had much input in drawing up their care plan and were certainly not aware of having any care plan objectives. The home needs to introduce a far more person centred approach to care planning and staff should receive additional training in this important area of practice. On a positive note plans viewed did contain very detailed information about each of the service users unique personal, social and health care needs, and what their leisure interests and food preferences were. The manager was also able to accurately describe the plans for the two service users whose care was being case tracked. This knowledge means that service users can be confident that staff at least understand their care needs. Informal interviews with two service users confirmed that they do feel listened to and are consulted about major decisions that affect their life’s. Residents told us that they regular attend their own meetings. Documentary evidence in the form of minutes were produced on request that revealed the last residents meetings had been held in March 2007. During the course of this inspection the manager was observed taking her time to deal with a service users requests for money and advice. The outcome for key Standard No. 9 was not looked at on this occasion because the last full inspection of the service confirmed a suitable process was in place for assessing and managing identified risks. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): No’s 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using all the available evidence both during and before the inspection visit to this service. A limited range of activities within the home and lack of information about community based events means some of the service users are not being encouraged to lead as fulfilling and interesting social life’s as they might. Specific dietary needs and cultural tastes are well catered for, providing daily variation, choice, and interest for the people who use the service. However, during a tour of the kitchen it was noted that a number of fresh food items had perished and had not been disposed of in a timely manner contrary to basic food hygiene standards. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 14 EVIDENCE: One service user spoken with told us they are able to do as they please each day. The manager confirmed that the one service user who was out at the time of this visit lead a very active social life. Records inspected revealed this particular individual attends a local day centre on a regular basis and in the past month has visited a local funfair, been shopping in Croydon on numerous occasions, enjoyed two day trips with a local social club, and visited their relatives home. The manager said residents are consulted about what recreational activities they would like to pursue, which is recorded in their care plans. However, records revealed that some people who use the service are not getting out much and may be experiencing isolation because of a lack of friends and community contact. The manager told us that she is always exploring and encouraging all the people who use the service to lead more fulfilling lifestyles, but conceded that progress has been limited in this area because not all the service users are willing to join in with many community based activities. Nonetheless, the Commission feels the manager should make more of a concerted effort to gather a lot more information about community based activities and events and try much harder to make individual arrangements for people to attend them. One service user spoken with at length said they had asked the manager to have Internet access installed in their bedroom, but had yet to receive a response. The manager told us that she had concerns about how the resource would be funded and other risks associated with possible inappropriate use. The manager was reminded that limiting a individual’s freedom of choice in this way without the matter being first discussed with them or their representatives constituted extremely poor practice. All the risks associated with installing Internet access in the home need to be thoroughly assessed and agreement reached with all the relevant parties before a decision on this matter is taken. The manager told us that one service user has very strong family ties and regularly stays overnight at their relative’s home. The home continues to operate an open visitors policy. Staff maintain a visitors book that all guests must sign and date on entering and leaving the premises. One service user said they had been provided with a door key to their bedroom, and during a tour of the premises it was noted that the occupant of the ground floor room had chosen to lock their bedroom from within. One service user met said staff always give them their mail unopened. The manager told us that one service user enjoys doing their own food shopping and helping staff prepare some of their meals. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 15 The home does not maintain any planned menus but does keep a daily record of all the food consumed by service users at mealtimes. The record showed that in the past month all the service users had eaten a wide variety of what appeared to be nutritionally well-balanced meals that reflected people’s diverse ethnic tastes and preferences. For example, on arrival it was positively noted that the manager was frying plantain and fish for one service users lunch who told us they were very fond of Afro-Caribbean style cuisine. This service user was met during the visit and told us they liked most of the meals the staff prepared for them and were particularly fond of the managers savoury rice and peas dish. The record of food provided also revealed that service users rarely choose to eat the same type of meal as their peers. All the positive comments made above about the quality of the meals provided, it was nevertheless very disappointing to note two bags of potatoes and onions found on a work surface in the kitchen had perished sometime ago and were clearly no longer ‘fit’ for consumption. The manager told us that she had planned to dispose of these items the previous day, but had forgotten all about them. The managers explanation was considered to be rather ‘lame’ as these items were clearly more than 24 hours past their use by date, although we our confident that the manager would not have used any of these items to prepare a meal. Consequently, an Immediate Requirement Notice was served and the offending items of food disposed of at the time of the visit. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): No’s 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using all the available evidence both during and before the inspection visit to this service. In the main sufficiently robust arrangements are in place to ensure the people who live at the home receive personal support in the way they prefer and require. However, greater input from health care professionals regarding service users who require assistance with their personal hygiene is required to ensure their physical needs are recognised and met. Service users who choose to are actively encouraged and supported to retain a degree of control over their medication and are protected by the homes policies and procedures for dealing with medicines. EVIDENCE: Care plans include health care requirements and the homes managers told us that if they felt a service users needed to see a doctor or any other health care professional staff would always arrange this without delay. One care plan being case tracked indicated the individual required assistance in the bath, physical support getting in and out. It was therefore surprising to note that this mobility Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 17 need had not been assessed by a qualified occupational therapist suitable aids/adaptations made to the environment (e.g. grab rails in the bathroom). Staff maintain detailed records of all the accidents and incidents involving service users in the home. The record showed that none had occurred since the home was last inspected the manager was fully aware that she was legally obliged to notify the Commission without delay about any ‘significant’ incidents or events that occur in the home. No recording errors were noted on medication administration sheets sampled at random. All the medication held by the home on service users behalves is securely stored away in a locked cupboard in the lounge. One service user chooses to self administer their medication and a risk assessment detailing the management strategies used by the home to discreetly monitor this practice was produced by the manager on request. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): No’s 22 & 23 Quality in this outcome area is good. This judgement has been made using all the available evidence both during and before the inspection visit to this service. The homes arrangements for dealing with complaints and allegations of abuse are sufficiently robust and understood by staff to ensure people who use the service feel listened to and safe. EVIDENCE: A copy of the homes complaints procedure is included in the service user guide and specifies who deals with them and how long a complainant can realistically expect to wait for a response (i.e. within 28 days). The manager confirmed that no complaints or allegations of abuse had been made about the homes operation in the past twelve months. Both the service users met said they would normally talk to the homes manager first about any concerns they might have. The manager demonstrated a relatively good understanding of the action she would need to take if an allegation was made within the home. Care plans being case tracked contained specific guidance to help staff minimise the occurrence, as well as deal with, incidents of challenging behaviour. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): No’s 24, 26, 27 & 28 Quality in this outcome area is good. This judgement has been made using all the available evidence both during and before the inspection visit to this service. The décor, furnishings, and fittings in the home and of ‘reasonable’ quality, which means the service users, live in a safe, and relatively homely, and comfortable environment. EVIDENCE: No significant environmental changes have been made to the home since it was last inspected, although the lounge has a new coffee table and armchair. Some of the paving slabs in the garden have also recently been painted white to create a chequered effect. During the course of this inspection one service user was observed having several cigarettes and their lunch in the garden. This individual told us they spent a lot more time in the garden now they had some furniture to sit on and flowers to look at. The manager said arrangements to have the old coffee table in the rear garden removed and for Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 20 the damaged gatepost in the front garden to be repaired had already been made. One service user spoken with at length said they spent most of their day in their bedroom, as they preferred to spend as much time in their own company as possible. The individual also told us that their bedroom met most of their needs, although because none of the windows opened the room could become rather ‘stuffy’ in the summer. The manager has agreed to unseal all the windows that were accidentally painted shut, or supply the room with a fan. The temperature of the hot water emanating from the homes first floor bath was found to be a safe 39 degrees Celsius, when tested at 12.15am. The manager told us that the en-suite shower facility located in one of the service users bedrooms has also been fitted with a suitable thermostatic mixer valve that prevents the temperature of hot water exceeding 43 degrees Celsius. The manager confirmed that the lounge and hallway have not been redecorated for a number of years and conceded that the wallpaper in both these communal areas had begun to look rather dated and worn. The owner should consider establishing a rolling programme to redecorate both the lounge and entrance hall. The manager has agreed to purchase lampshades for ceiling lights on the first floor landing and the ground floor bedroom. Progress on this matter will be assessed at the homes next inspection. The outcome for key Standard No. 30 was not looked at on this occasion because the last full inspection of the service confirmed suitable arrangements were in place for controlling infection. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): No’s 32, 33, & 35 Quality in this outcome area is adequate. This judgement has been made using all the available evidence both during and before the inspection visit to this service. Overall, sufficient numbers of suitably competent and experienced staff are employed on a daily basis to ensure service users basic needs are met. However, staff will also need to attend refreshers courses in a number of core areas of practice to ensure their basic knowledge and skills remain up to date. EVIDENCE: Documentary evidence was made available on request to show that the homes only permanent support worker has achieved a National Vocational Qualification (Level 2 or above) in care. On arrival the homes manager was on duty. She told us that at least one member of staff was always on duty in the home during the day and at night. The duty roster for the week revealed the manager normally works across the day, Monday to Friday, with the other permanent member of staff covering weekends and sleep-ins. The manager told us current staffing levels are adequate to meet service users assessed needs. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 22 The outcome for key Standard No. 34 was not looked at on this occasion because the last full inspection of the service confirmed sufficiently robust arrangements were in place for assessing the suitability of prospective new members of staff. The manager told us that the service continues to experience extremely low rates of staff turn over. Consequently, no new members of staff have been recruited in the past 12 months. The two service users met said they were generally satisfied with the care they received from the manager and the other two members of staff, who were always on hand to offer them advice and support. During the course of this visit the manager was observed respectively and sensitively advising a service user about budgeting their finances. It was evident from the number of qualifications obtained by both the manager and her only other permanent member of staff that the service recognises the importance of training, and tries to deliver a programme that meets National Minimum Standards. Certificates of attendance were made available on request to show staff had received up to date training in fire safety, basic food hygiene, medication, equal opportunities, and mental health in later life. However, the service does not seem to be able to recognise when additional training is needed, or always be in a position to provide it. E.g. Both the manager and other permanent member of staff still need to up date their first aid training, despite this being identified as a major shortfall in the homes last inspection report. The staff teams basic food hygiene training expires at the end of the year (2008) and the manager was reminded that suitable arrangements would need to be made to refresh their core skills. Progress on this matter will be assessed at the homes next inspection. Furthermore, the staff teams lack of person centred care planning training also severely restricts the ability if the service to deliver person centred support. It is therefore strongly recommended that all staff, including the manager receive additional training in person centre care planning. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): No’s 37, 39, 40 & 42 Quality in this outcome area is adequate. This judgement has been made using all the available evidence both during and before the inspection visit to this service. The homes manager is not suitably qualified to run a residential care home and will need to complete the relevant NVQ 4 training course in order to obtain the necessary management skills. The newly introduced quality assurance system appears to be sufficiently robust to ensure service users and their representative’s views about the standard of care provided will underpin the homes development. However, not all the homes policies and procedures are being reviewed or kept up to date and the manager must improve her perform regards this core management tool. The homes health and safety arrangements are in the main sufficiently robust to safeguard the health and welfare of service users, their guests, and staff. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 24 Some gaps were found in the recording of fire drills conducted in the home, which the manager must ensure are kept up to date in future. EVIDENCE: The homes manager has been in operational day-to-day control of Alpha House since it opened in 2000. The manager is still not suitably qualified to run a care home, only has basic management skills, and no previous experience of running a residential care home before this one. The timescale for the manager to complete her NVQ level 4 training in both management and care has been extended for a third and final time. Failure to address this on going training matter by the end of the year (2008) will result in the Commission considering taking enforcement action to ensure compliance. Documentary evidence was produced on request to show that the deputy manager of another care home in the area, which is also owned by the same providers, visits Alpha House on a monthly basis. Since Christmas 2006 this individual has carried out three unannounced inspections of the home and produced three subsequent reports regarding their visits. The homes manager was able to produce a number of satisfaction questionnaires that service users had been encouraged to complete in order to ascertain their views about the standard of care they received at Alpha House. One service wrote that Alpha House, “was the ‘best’ home they had ever been in”. The manager told us that she has still not revised the homes equal opportunities policy or introduced a racial harassment procedure, despite this being identified as a major issue in the homes two previous inspection reports. The lack of progress made to keep these policies up to date seems to suggest the homes manager does not understand or regard reviewing procedures as an importance part of her duties. Reviewing policies is a core management tool and the timescale for this outstanding requirement to be addressed is extended for a third and final time. Failure to address this matter within the new timescale for action will result in the Commission considering taking enforcement action to ensure compliance. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 25 The homes fire records revealed that the fire alarm system continues to be tested on a weekly basis. The home has undertaken a fire risk assessment of the building, which is kept under review and updated accordingly. It was also clear from the minutes of the last residents meeting that the home ensures all the persons who live at Alpha House are aware of the fire evacuation procedures. However, contrary to the Care Homes Regulations (2001) the manager has failed to keep an up to date record of every fire practice conducted in the home, which should contain specific details of all the people involved, how long it took, and if any problems were noted. The manager is reminded that the London, Fire, and Emergency Planning Authority LFEPA recommends these drills be undertaken at least once every six months. Up to date Certificates of worthiness were in place to show that suitably qualified engineers had checked the homes fire alarm system, fire extinguishers, portable electrical appliances, and water heating, in the past twelve months. Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 2 27 3 28 2 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X X X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X 3 1 X 2 X Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 YA6 Regulation 12(2) (3) & 15(1) Requirement Timescale for action 01/09/07 2. YA14 12(3) & 17(1)(a), Sch 3.3(q) 3. YA17 16(2)(i) The home must introduce a far more person centred approach to developing care plans that service users are actively involved in drawing up. Care plans need to contain more detailed information about each service users personal goals, treatment and rehabilitation programmes, and the actual support they require to achieve their goals. Previous timescale for action of 1st March 2007 not met. A thorough risk assessment 01/07/07 involving all the relevant professionals must be carried out with regards one service users request to have internet access and a record of any limitations agreed with all the interested parties included in their care plan. All items of fresh food that have 22/05/07 perished and are no longer ‘fit’ for consumption must be disposed of immediately. Immediate Requirement Notice served at time of this DS0000025749.V341072.R01.S.doc Version 5.2 Alpha House Page 28 4. YA19 13(4) & 14(1) 23(2)(a) 5. 6. YA26 YA28 23(2)(p) 23(2)(o) 7. YA35 13(4), 18(1) & 19, Sch 2.4 8. YA37 9(2) 9. YA40 12(4) (5) 10. YA42 17(2), Sch 4.14 inspection and matter resolved. The physical needs of the service user who requires assistance in the bath must be assessed by a suitably qualified occupational therapist and any recommendations made in the subsequent report implemented. The home must ensure all the bedrooms occupied by service users are suitably ventilated. The rear garden must be cleared of all unwanted rubbish and the damaged front gatepost repaired. Both the manager and the homes only other member of staff must up date their first aid training. Documentary evidence of this training must be made available for inspection on request. Previous timescale for action of 1st March 2007 not met. The registered manager must obtain an NVQ level 4 in management and care. Previous timescales for action of 1st June 2006 & 1st July 2007 not met. The home must review its current equal opportunities policy and establish racial harassment procedures. Previous timescales for action of 1st July 2006 and 1st March 2007 not met. The manager must maintain an up to date record of every fire practice/drill conducted in the home. 01/08/07 01/07/07 01/07/07 01/08/07 01/01/08 01/07/07 22/05/07 Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 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. 2. Refer to Standard YA1 YA14 Good Practice Recommendations The manager should consider removing the word ‘Rest home’ from its Statement of purpose and Guide. Where possible staff should gather more information about what community based activities and events are available locally and make more of a concerted effort to make individual arrangements for people to attend them. The manager should establish a time specific rolling programmes to redecorate the homes communal lounge and hallway. The homes entire staff team should receive training in person centred care planning. 3. 4. YA28 YA35 Alpha House DS0000025749.V341072.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V341072.R01.S.doc Version 5.2 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. 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