Inspection on 15/01/07 for Alphin House

This inspection was carried out on 15th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Alphin House 01/02/06

Alphin House 21/06/05

Alphin House 06/01/05

Alphin House 12/05/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Alphin House Alphin House Mill Lane Alphington Exeter Devon EX2 8SG Lead Inspector Ms Rachel Fleet Unannounced Inspection 15th January 2007 8.55 X10015.doc Version 1.40 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 Alphin House DS0000028741.V315508.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 Older People. 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. Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alphin House Address Alphin House Mill Lane Alphington Exeter Devon EX2 8SG 01392 251728 01392 493461 kay.bainbridge@devon.gov.uk www.devon.gov.uk Devon County Council 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) Kay Bainbridge Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (8), Physical disability of places over 65 years of age (8) Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 2006 Brief Description of the Service: Alphin House is a purpose-built care home, owned by Devon County Council, the Local Authority. The home offers long-stay care for people over retirement age, admitted because of age-related needs or in some cases because of a physical disability. But there are also a small number of beds for intermediate care and short stay respite care, which can also be occupied by younger adults. Intermediate care is provided in partnership with and through the Primary Care Trust, for assessment or relevant care prior to an individual returning home or moving on to a rehabilitation facility as appropriate. The home cannot accommodate anyone with nursing needs other than those that the district nurses can meet. The home has level gardens, with a patio at the rear. The entrance foyer is used as the designated smoking area. Internally, there are three units: one on the ground floor and two on the first floor, each with its own lounge and dining room, bathroom and toilets. All bedrooms are for single occupancy only, and some have en suite facilities. Residents are encouraged to furnish and personalise their rooms. There is a large ground floor lounge/dining room, which is also used for activities. There are wide corridors and level access to all areas, with a passenger lift between floors. The main kitchen caters for the home, an adjoining day centre, and a Meals on Wheels service. The day centre is run as a separate service, which is not regulated by the Commission for Social Care Inspection (CSCI). The home is in a residential area of Alphington, approximately two miles from the centre of Exeter. A Post Office, shops and village hall are within walking distance. There is a regular bus service from the main road into Exeter City Centre. Weekly fees at the time of the inspection were £556.57. These did not include the costs of chiropody (£12-15, if not under a NHS chiropodist), hairdressing, toiletries, continence aids (unless eligible for free provision through the PCT Continence Service), newspapers/magazines, and transport other than to hospital appointments - which are all charged at cost price. Prospective Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 5 residents are advised to contact the home for up-to-date information on fees and any extras costs. Recent inspection reports, produced by CSCI about the home, are on the notice board in the entrance hall. Copies are also placed in a file of information in each bedroom. The manager will print copies for enquirers, or people are directed to CSCI’s website, where the reports can be found. Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over nine hours. Kay Bainbridge, the manager, had returned a CSCI pre-inspection questionnaire. Completed CSCI surveys or comment cards had been returned from seven residents (- ten were sent out, six being returned anonymously), six care staff (- twelve were sent out, four being returned anonymously), and three community-based healthcare professionals (- nine were sent out to health or social care professionals). The inspector met 14 of the 31 residents, both men and women, in sitting areas or their bedrooms. One said they did not wish to speak with the inspector, confirming they had no concerns or complaints about the home or their care. Two were not able to give their views fully because of physical or mental frailty. But most were able to answer questions or discuss the service they received. She also spoke with two visitors, a visiting healthcare professional, six care staff and a relief cook, as well as the manager. The inspection included ‘case-tracking’ of four residents; the group included people above and below retirement age, a new resident, someone admitted for intermediate care, people who had no or few visitors, someone who selfmedicated, people who had mental health disabilities, those with impaired sight, and someone with deteriorating health. This involved looking into their care in more detail by checking care records and other documentation relating to these residents (medication sheets, personal monies records, etc.), seeing their private accommodation, general observation of the care they received, and talking with staff about this. A tour of the home included the kitchen and laundry. Staff files and some records relating to health and safety – such as accident records - were seen. The inspector ended the visit by discussing her findings with the manager. Information gained from all these sources and from communication with the service since the last inspection is included in this report. The Commission has not received any complaints about the home since the last inspection. What the service does well: When asked what the home did well, or what they appreciated about it, one resident said, “It’s all pretty good.” Another said, “They do everything well.” Entries in the Compliments book, from residents being discharged, visitors, etc. included the food served and comments such as ‘No worries and no Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 7 upsets’, and ‘…being utterly spoilt and wonderfully cared for’. Two professionals were impressed by the responsiveness of staff. Care is taken to get full assessments of prospective residents’ needs, to ensure the home can care for them properly if they are admitted to the home. There is up-to-date information about residents’ needs, including those admitted for intermediate care. This, with multidisciplinary co-working and good catering arrangements, helps ensure residents’ various health and social needs and preferences are met. Residents also benefit from the clean, homely environment, with facilities that promote their wellbeing and independence. Excellent attention to health and safety matters promotes the welfare of everyone at the home. Appropriate numbers of staff, employed in a range of roles, helps to ensure residents’ various needs can be met. The care staff team has the basic knowledge and skills to ensure residents receive safe care. The manager has excellent levels of knowledge, skills and experience needed for the home to run well. Residents enjoy various fulfilling activities and regular contact with residents’ families, friends or the community around the home, thus benefiting from supportive and interesting relationships. Staff respect residents’ right to choice, privacy and control of their lives, promoting their dignity and personhood. Concerns and complaints are listened to and used to improve the service provided. An excellent variety of strategies are used to ensure the home is run in the best interests of residents – including consultation with residents and protecting them from harm through safeguarding practices, which include good recruitment, and systems that protect residents’ financial affairs. Staff comments on what the home does well included making people welcome, showing real care for residents and staff, consultation with residents, putting them first, good systems in place with good team working, activities provided, cleanliness, and the catering What has improved since the last inspection? What they could do better: Medications are handled adequately by the home, although advice is to be sought about one aspect, to ensure safe and correct systems are in place. There is training and support for staff, but some more regular updating would help ensure staff have knowledge and skills needed to care for certain residents. Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 8 Residents who were asked didn’t think there was anything that the home or staff could do better. Staff suggestions included quicker recruitment if any staff leave (- a laundry staff member having just left), more organization, use of uniforms so that residents respected them as staff/carers, and an extra washing machine. Some staff were sorry that the intermediate care beds are to be replaced by longstay beds, since the variety of care needs such residents had was interesting. 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. Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good attention to assessment of prospective residents’ needs, ensuring the home is able to meet their needs on admission to the home. Residents admitted for intermediate care have good support during their stay, which enables them to return home. EVIDENCE: A new resident said they had settled in well, and had written information about the home’s facilities, routines, etc. Four residents’ surveys said they also received enough information before moving in; one didn’t remember, one didn’t answer, and one said ‘No’. Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 11 Comprehensive detail about a new resident’s health and personal needs or preferences was seen in their care records. This had been obtained, before their admission, from a Social Services care manager, the previous carers, and health staff. Senior staff had taken appropriate action to clarify an aspect of care, noting some information previously provided was at odds with the situation found when the person was admitted. Care assistants said they were informed about new residents and their care needs before their admission. Most felt people were admitted appropriately, in the light of the service the home offers. But two staff said sometimes people were admitted with greater needs than usual or outside of their usual area of expertise, one saying this caused staff to feel overwhelmed. The manager confirmed there had been an unusual situation recently, which caused unforeseen demands on staff. She had involved other professionals, etc., to resolve the situation as quickly as possible, and to review systems to ensure pre-admission assessments were as robust as possible. A resident admitted for intermediate care was clear that they were encouraged to be as independent as possible at the home but got the support they needed, to achieve rehabilitation. They also spoke about the preparations for their return home, including a planned home visit. Their care notes showed support for this was coming from community-based physiotherapists and occupational therapists. The home has higher care staffing levels than is usual in residential homes, in order to provide the extra help such residents may need to return home as quickly as possible. Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good information about residents’ general care needs, informing staff how to meet their needs and preferences. Multidisciplinary working ensures residents receive good health care. There is adequate management of residents’ medication, although some practices supporting self-medication could be improved. There is good respect for residents’ privacy, with promotion of their dignity and rights. EVIDENCE: Three care plans seen for long-stay residents were set out clearly - with personal, health and social needs, residents’ usual routines as noted in preAlphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 13 admission assessments, goals for care, and monthly reviews. A resident spoken with had a copy of their recently updated care plan; staff said residents were involved at least yearly in full reviews of their care. Care information about a fourth resident - admitted for intermediate care - was not set out as clearly, with frequent updating of required support seen in daily records instead, as their rehabilitation progressed. Staff descriptions of current care for the residents corresponded with the four care records seen. They said they felt able to ask senior staff questions, or read care plans, if they were not sure about anything. Residents felt staff were observant regarding residents’ health, listening if a resident expressed a concern themselves, and getting advice from health professionals promptly. Residents’ surveys said they got the medical support they needed. Responses from healthcare professionals indicated satisfaction with care at the home, and that the home worked well with them. Records showed specialist care by community nurses was being organised, for a resident who was declining due to a medical condition. Specialist nurses had also been contacted about condition of a resident’s skin, and to ensure a resident received appropriate continence aids. The manager confirmed there is a visiting optician, but said one resident was assisted to go to the optician they went to prior to admission, as they wished. A staff member was heard to encourage a resident in a wheelchair, admitted for intermediate care, to walk a little distance with their help - promoting their mobility in readiness for going home. There are lockable facilities that enable safe storage of medication, should any residents wished to self-medicate. Risk assessments are carried out to ensure support is given as necessary for the individual, in such circumstances; these were seen for two residents, signed by them to confirm the arrangement. Although a self-medicating resident spoken with knew all about their medications, the inspector suggested the risk assessment checklist should also specifically include checking residents knew what each of their medications was taken for. Medication received into the home and disposed of was generally well recorded, although at present, there is no specific record of medication given to those who self-medicate. It was agreed that this would be included, with the resident signing to confirm receipt wherever possible. Advice is to be sought to ensure safest use of a compliance aid. No issues were noted with practical administration of medication during the inspection, a related requirement having been made at the last inspection. Residents felt staff ensured their privacy when bathing, etc. There are sockets in each bedroom for the home’s mobile payphone, should someone wish to make a phone call in private. Surveys from community-based health professionals said they could see residents in private. Shared toilets and bathrooms had locks. Staff were heard to be discrete in care-related conversations with residents, when in communal areas. Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ lives are enriched through good opportunities to take part in various activities, and to be part of a wider community. Good links are maintained with residents’ families, friends and the community around the home, so residents benefit from supportive and interesting relationships. There are good practices that promote residents’ choice and control in their lives where possible. There are good catering arrangements that meet residents’ tastes, as well as their social and health needs. EVIDENCE: During the inspection, a Bingo game and musical entertainment took place. Residents spoken with felt there was enough for them to do with their time, Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 15 one saying they looked on the notice board if they wanted to know what activities were planned. Five residents’ surveys said there was always or usually activities arranged that they could take part in; two were less positive, but without further explanation. When asked how Christmas had been, a resident said, “Very good – they put on lots of things for us”, with others agreeing. Residents confirmed church services are held regularly at the home. Care staff said they are each responsible for organising certain activities, and enjoyed spending this recreational time with residents, finding out more about them individually. Two visitors were happy with the care provided by the home for the people they visited, saying the home had no restrictions on visiting times. Two residents’ surveys said they already knew a lot about the home before they went to live there. The pre-inspection questionnaire said residents were taken to the shops, to pubs and Dartmoor. Information about the home says residents are also assisted to their previous local place of worship, if they wish it. A week of events relating to other countries was being planned, using the first-hand knowledge of staff or other people known to the home. When asked if they felt they were given enough choice in, or control of, their daily routine, one resident said of staff, “They fit in with me”. Another said, “They go along with you…they try to co-operate in any way” - giving an example of when they changed their usual routine once, with staff help, because they were expecting visitors. Most residents’ surveys said staff listened and acted on what they said (- one said, ‘More or less’). At lunchtime, a staff member asked if a resident wanted help to go to the dining room and, when the resident declined to go at that time, discussed with them when to return again. Residents were heard addressing staff by name, with conversations taking place between them on equal term. Bedrooms were personalised with family photos, ornaments, etc. The home does not act as appointee for any residents, leaving residents free to choose who helps them with their financial affairs. Residents spoken with were well informed about choices available for their next meal, and said the food was very good (- also reflected in residents’ surveys, with all but one saying they always liked the food). Some had chosen sandwiches rather than the hot meal options. Dietary likes/dislikes were seen on daily menu sheets completed by staff with residents, and special diets were listed in the kitchen. Weekly menus seen were balanced and varied; fresh fruit, vegetables, and homemade cakes were seen in the kitchen. The mealtime observed was organised but relaxed, with meals served to residents choosing to stay in their rooms or in various dining areas around the home. One staff member was heard encouraging a resident in an appropriate way, to eat a little more. Staff had taken action to address one complaint that meals were sometimes not hot enough; extra measures were discussed with the manager, to try to keep food hot during delivery to the resident and eating of the meal. Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good response to concerns and complaints raised, so that the service provided by the home is improved. There is a good range of safeguarding policies and practices in use, to try to protect residents from abuse. EVIDENCE: All residents spoken with said they felt able to speak to someone at the home if they had a concern or something was wrong about the care they received, and that action would be taken to address the problem. Residents’ surveys also reflected that they would speak to staff, with one also saying they would contact the provider. A relative said there was an open atmosphere; they were sure that the person they visited would either speak to them (- and they would speak to the manager) or to a member of staff about any problems or complaints. The home’s complaints procedure was in a file of information in each bedroom. The manager said it could be provided in alternative formats if necessary – audio versions if someone was blind, for example. Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 17 The Complaints and Compliments logs were seen. There were three of the former and 16 of the latter (- coming from relatives, residents and visiting professionals) made since the last inspection. A resident confirmed action had been taken to try to address complaints they had made, as seen in the log. They said they still felt able to raise any issues with staff. The Commission has not received any complaints about the home since the last inspection. Surveys from community-based professionals showed they felt the home took appropriate decisions when they could no longer manage the needs of a resident, protecting residents’ welfare. A resident who had personal spending money kept on their behalf by the home said they were satisfied with how their money was handled, and said they could ask to see relevant records if they wished. Staff knew they had a responsibility to report any abusive practice they were aware of; one correctly included ‘not giving residents choice’ as an example of abuse. Those spoken with had had relevant training in the last year from the manager – who herself has had specific training to enable her to train others on safeguarding. Staff knew whom they could speak to in their wider organisation or where to find their contact numbers (although not all knew whom they could contact outside of the organisation if necessary – knowledge which would strengthen existing systems). Action had been taken to address an allegation made since the last inspection. See also standards 29 and 35, which are relevant to safeguarding of residents. Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a good, well-maintained and homely environment. Systems are in place to promote good standards of hygiene, protecting residents’ wellbeing. EVIDENCE: The home looked well maintained, including the décor and soft furnishings. Residents who used walking frames said they got around without encountering difficulties (tripping hazards, uneven surfaces, etc.). They, and staff, said repairs were attended to quickly, staff saying equipment breakdowns rarely happened. The pre-inspection questionnaire showed routine maintenance (of Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 19 the lift, hoists, etc.) has been carried out. The building is wheelchairaccessible, including a shower facility; baths are adapted for people with physical disabilities. Staff said admission checklists included discussing with new residents how they wanted their room arranged. Residents were satisfied with the lighting and heating in bedrooms and lounges, including in the evenings. Handrails, grab rails in toilet areas, raised toilet seats and washbasin stools were seen, to promote independent mobility. Particular signs were seen to help some residents identify which was their room, most rooms being identified by a number rather than displaying the resident’s name. The home has pendant call bells, which some residents were wearing, enabling them to get staff help when not able to reach wall-fixed call systems. The home was free of malodours, with domestic staff seen during the morning cleaning around the home – rotas showing they are employed seven days a week, as the manager also confirmed. Residents said they were satisfied with standards of cleanliness, including shared bathrooms and toilets; satisfaction was also reflected in all the residents’ surveys. The laundry area was orderly despite there only being one washing machine and one tumble drier for laundry from over 30 residents; flooring has been replaced, improving safety and ease of keeping it properly clean. There was clear information on appropriate wash programmes for thoroughly cleaning items, including advice from the local infection control nurse specialist. Appropriate systems were seen being used to prevent cross-infection, with staff confirming they always had disposable gloves and aprons available to them, and specialist bags used for transporting soiled laundry. Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs continue to be met by good staff numbers and the skill mix, with some monitoring to ensure this. The staff as a team have good basic knowledge and skills to guide practice and ensure residents’ safety. Residents are protected by the home’s good recruitment policies and practices. Training and support for staff is adequate, but some updating would help ensure staff have knowledge and skills needed to care for certain residents. EVIDENCE: When the inspector arrived, there were seven care staff, one cook, three domestics (including someone on the first day of their induction), a laundry person, a clerk, a duty manager and the manager to support 31 residents. Residents spoken with felt staff responded sufficiently quickly to call bells, coming as soon as they could although they were sometimes very busy so were delayed; two felt this occurred more in the evenings. The manager Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 21 thought this might occur when popular evening TV programmes finished, with several residents then requesting help at the same time. Four residents’ surveys said staff were always available when needed, three saying ‘sometimes’ or ‘usually’; but all said they always received the care and support they needed. Staff felt there were usually enough staff on duty. But some added a number of residents had recently needed more care, increasing pressure on staff, although the situation was now improving. The home’s information includes that they will only accommodate five high dependency residents, to try to prevent such an issue. During the inspection, residents looked well cared for and content. Staff were occupied but did not appear rushed or unprofessional in any way, chatting with residents when they were with them, etc.; two residents who needed help with mobility said staff never hurried them. Three staff files were checked. They each included information required to find out if applicants were suitable to employ in the home, obtained before individuals actually began working there. This included relevant police checks and two positive references. Staff surveys indicated this was usual recruitment practice at the home. All three staff had care work qualifications or experience. The pre-inspection questionnaire showed much less use of agency care staff than at the last inspection, ensuring residents are usually looked after by carers who know them. When the inspector arrived, a new ancillary staff member was beginning their induction programme with the manager. Care staff confirmed they have supervision sessions, when they can discuss any training they feel they need, etc. Residents said they felt staff were sufficiently skilled and knew what help each resident needed. Two of three community-based professionals thought staff showed clear understanding of residents’ needs; a third said ‘Not always’. The pre-inspection questionnaire showed half of the care staff have a nationally recognised care qualification; three of four care assistants spoken with had the qualification or were working to gain it. This will ensure some initial skills and knowledge relevant to caring for those with conditions of old age. However, staff confirmed they had not had recent updates on impaired sight - which a number of current residents experience – or caring for people with mental health disabilities, for example. This was reflected in the pre-inspection questionnaire’s information on residents’ needs and staff training. It was noted during the inspection that certain items had not been left within reach of someone with very poor sight, so they would not have been able to locate them; conversation with the resident indicated they would have benefited from being enabled to use them. The home has training videotapes, which the manager thought would be helpful for staff updates, but she also agreed to look into other training possibilities. Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The manager has an excellent level of knowledge, skills and experience, which ensures the home is run well. There are an excellent variety of strategies to ensure the home is run in the best interests of the residents. Good practices used by the home protect residents’ financial affairs. There is excellent attention to health and safety matters, promoting the welfare of everyone at the home. Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager, Kay Bainbridge, has been in post for several years, and achieved the Registered Managers Award in 2004. Since the last inspection, she has undertaken regular updating - on Equality matters, infection control, and disciplinary procedures, for example. Residents felt the home was organised, and said they saw her regularly. Two said they could make a complaint to her, or see her if they wanted to know something. Two residents confirmed residents’ meetings were minuted, were informative, and that residents could contribute to these meetings. Several confirmed they had recently completed surveys from the home, about the service they received. The manager said these had been sent to another office for analysis; and, as in the past, the findings will be shared with residents in written form as well as at a residents’ meeting. Staff explained they also have monthly meetings around the same time as the residents, so that issues raised at the residents’ meeting can be discussed with staff if necessary. Action was taken after the last inspection to address the requirement made. (See also Standard 7, 8 & 14 for examples of how residents’ views are regularly sought or listened to, ensuring the service provided is in their best interest). Three residents’ personal monies records were checked. These were kept in the office, and were well ordered. Two signatures were recorded to verify each transaction recorded, with receipts also available. Residents’ cash balances are not kept individually so could not be checked in the time available. The manager confirmed all records are reconciled weekly with the cash total held, to verify the right amount of money is still available. (See also Standard 18.) Both residents and staff felt the home was a safe environment to live or work in, with staff explaining action they took to promote residents’ safety (checking bathwater temperature, for example, before residents used it). The manager confirmed a first aider is always on duty, the pre-inspection questionnaire naming staff who have undertaken certified first aid courses. One staff said when they had reported a problem, senior staff carried out a risk assessment in response. Safety-related improvements since the last inspection were seen (such as vision panels in some doors). Staff spoken with confirmed they had attended updates on topics such as food hygiene and safe handling. The fire log showed recommended fire safety checks had been carried out regularly; training records showing fire safety updates are taking place – the manager expecting all staff will have been updated within the recommended timescale. The kitchen area was clean and orderly, with cleaning rotas in place, and food storage temperatures kept at safe levels according to the records seen. Where checked, upstairs windows had restrictors in place, to reduce risk of falls. Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 4 Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 OP9 Good Practice Recommendations It is recommended that the registered manager seek advice from a pharmacist regarding medicine policies in the home & medicines dispensed for individuals, so that medicines are handled according to guidelines from the Royal Pharmaceutical Society. This is especially with regard to policies and practices that support residents to self-medicate, including safe use of compliance aids, record-keeping, etc. It is recommended that the registered manager ensure that there is a staff training & development programme that ensures staff meet the changing needs of residents. This is especially with regard to ensuring staff have knowledge and skills needed to care fully for current residents with impaired sight, mental health disabilities, etc. 2 OP30 Alphin House DS0000028741.V315508.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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