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Inspection on 22/08/07 for Alphonsus House

Also see our care home review for Alphonsus House for more information

This inspection was carried out on 22nd August 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users said that they enjoyed living at the home, they said "I love the staff and I love music". "I like being a service user here, I go out all the time". Service users are given the opportunity to talk with staff about what they like about the home, their lives and the things that they are not so happy with during "residents meetings". Each of the homes has their own meeting. Staff work with service users to ensure that they receive the healthcare they need. They have regular access to their doctor, dentist and optician.

What has improved since the last inspection?

The home is in the process of introducing Person Centred Care Planning (PCCP) for each of its service users. This means that the home has begun to plan the care for its service users based upon their individual needs and wishes. One service user said "I enjoyed helping the staff to do it". As a result of the person centred planning process staff and service users have reviewed "night time care", it was pleasing to find that service users are no longer being routinely checked on an hourly basis, as was the case in the last inspection. The home environment has been improved with the provision of new carpeting, and the decorating of some service users bedrooms. The dining room in house 85 has also been refurbished. More staff have been enrolled to complete their National Vocational qualification (NVQ). Staff have also undertaken training in infection control this builds upon their existing knowledge and skills and protects service users from the risks of cross infection.

What the care home could do better:

Terms and conditions of residency for service users need to be reviewed so that the rights and responsibilities of both the service user and the registered provider are clear. The process of person centred care planning needs to continue for all service users. This will ensure that service users are receiving individual care that is based upon their own needs and wishes. There is still no evidence that service users have been reimbursed the monies owed to them by the home following an adult protection meeting in 2006. This must be addressed promptly. There have been some improvements to the environment with bedrooms and living areas being redecorated. The programme of refurbishment and redecoration needs to continue to make sure that the home is a pleasant and comfortable place for service users to live. The home needs to give consideration to the way service users access the building. At present most visitors and service users access all of the homes from number 81. If service users are to be encouraged to think of houses 83 and 85 as their own separate home then service users should be able to access them directly. Staff continue to work long hours, this must be addressed so that service users are not being cared for by overtired staff. There is currently no registered manager for the home. The visiting manager has said that a new manager has been recruited but is unable to commence duty until all required security checks are completed. Service users were uncertain about what is happening they said "we have a new manager but we don`t know how long for", "when is the new manager coming, it will be nice to be settled" The home has now employed a maintenance worker who is responsible for all the safety checks in the home. Records of these checks are improving as aresult but the home must still ensure that all staff have regular fire training and fire drills with records kept. This will ensure that service users welfare is promoted at all times and staff will know what to do in case of an outbreak of fire.

CARE HOME ADULTS 18-65 Alphonsus House 81 - 85 Vicarage Road Oldbury West Midlands B71 1AH Lead Inspector Mandy Beck Unannounced Inspection 22 and 23 August 2007 09:00 nd rd Alphonsus House DS0000004837.V330093.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 Alphonsus House DS0000004837.V330093.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. Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alphonsus House Address 81 - 85 Vicarage Road Oldbury West Midlands B71 1AH 0121 544 6311 0121 544 6311 alphonsus.house@craegmoor.co.uk for AQAA www.craegmoor.co.uk Parkcare Homes Ltd 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) vacant Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Four service users identified in the variation report dated 17 August 2005 may be accommodated at the home in the category PD. This will remain until the identified service users placements are terminated at which time the category will revert to LD only. Four service users identified in the variation report dated 17 August 2005 may be accommodated at the home in the category LD(E). This will remain until such time that the service users placements are terminated at which time the category will revert back to LD only. One service user identified in the variation report dated 17 August 2005 may be accommodated at the home in the category SI. This will remain until such time that the identified service users placement is terminated at which time the category will revert back to LD only. 12th December 2006 2. 3. Date of last inspection Brief Description of the Service: Alphonsus House is owned by Craegmoor Healthcare and is registered to provide care for 18 adults with a learning disability. The home consists of three adjoining Victorian properties with external access between the houses via the rear garden. Each house is self contained with it’s own facilities with the exception of a communal laundry between houses 83 and 85. The home is situated on a busy main road between Oldbury and Langley. It is close to local shops, pubs and other public amenities. There are good public transport links to nearby towns of Dudley, Oldbury and Birmingham. There is a small driveway at the front of house 81 with space for one car. Car parking is on the main road outside the three properties. The home has 16 single bedrooms situated on the first and ground floors. Access to the first floor is by stairs only there are no passenger lifts in this home. Each property contains a dining room and a lounge. There are three domestic style bathrooms and toilet. Each house has it’s own dedicated staff team although staff may work in all three houses to cover absences if required. Fees for this home range from £358.97 to £1,388.50 per week. This fee does not include the cost of toiletries, the full cost of a holiday and service users spending money. Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit to the home carried out over two days by one inspector. A variety of methods have been used to reach the judgements in this report. The home has given us information about the service they provide in their Annual Quality Assurance Assessment (AQAA) we have included some of this information in the report. Service user files were also looked at in depth as part of our case tracking process. This process allows to make decisions about whether the service is meeting the needs of service users. Staff files were examined to ensure that the home continues to recruit staff members safely and that all appropriate security checks have been completed. Some of the service users have also completed a service user questionnaire we sent to them. Other service users were spoken with during the course of the inspection. Some of there comments have been included in this report. The inspector would like to thank everyone at Alphonsus House for their hospitality throughout the inspection. What the service does well: What has improved since the last inspection? The home is in the process of introducing Person Centred Care Planning (PCCP) for each of its service users. This means that the home has begun to plan the care for its service users based upon their individual needs and wishes. One service user said “I enjoyed helping the staff to do it”. As a result of the person centred planning process staff and service users have reviewed “night time care”, it was pleasing to find that service users are no Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 6 longer being routinely checked on an hourly basis, as was the case in the last inspection. The home environment has been improved with the provision of new carpeting, and the decorating of some service users bedrooms. The dining room in house 85 has also been refurbished. More staff have been enrolled to complete their National Vocational qualification (NVQ). Staff have also undertaken training in infection control this builds upon their existing knowledge and skills and protects service users from the risks of cross infection. What they could do better: Terms and conditions of residency for service users need to be reviewed so that the rights and responsibilities of both the service user and the registered provider are clear. The process of person centred care planning needs to continue for all service users. This will ensure that service users are receiving individual care that is based upon their own needs and wishes. There is still no evidence that service users have been reimbursed the monies owed to them by the home following an adult protection meeting in 2006. This must be addressed promptly. There have been some improvements to the environment with bedrooms and living areas being redecorated. The programme of refurbishment and redecoration needs to continue to make sure that the home is a pleasant and comfortable place for service users to live. The home needs to give consideration to the way service users access the building. At present most visitors and service users access all of the homes from number 81. If service users are to be encouraged to think of houses 83 and 85 as their own separate home then service users should be able to access them directly. Staff continue to work long hours, this must be addressed so that service users are not being cared for by overtired staff. There is currently no registered manager for the home. The visiting manager has said that a new manager has been recruited but is unable to commence duty until all required security checks are completed. Service users were uncertain about what is happening they said “we have a new manager but we don’t know how long for”, “when is the new manager coming, it will be nice to be settled” The home has now employed a maintenance worker who is responsible for all the safety checks in the home. Records of these checks are improving as a Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 7 result but the home must still ensure that all staff have regular fire training and fire drills with records kept. This will ensure that service users welfare is promoted at all times and staff will know what to do in case of an outbreak of fire. 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. Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 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 Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,5 Quality in this outcome area is adequate Service users can feel confident that their needs will be assessed. More work is needed to ensure that service users are clear of their rights and responsibilities before they agree to move in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to the home since the last inspection. The service user files we looked at contained assessments for each service user. The home is in the process of introducing new person centred care planning which helps streamline the assessment process. What this has meant for existing service users is each one is in the process of having all of their needs reassessed. Two of the files we looked at also showed how the staff had involved the service users in this process. Service users commented “I have a plan, they (the staff) helped me to do it, I told them I want to go out more”. At the last inspection we said that the staff needed to have more training in specialist subjects such as Autism, epilepsy and behaviour that challenges. It was disappointing to find that of the staff files we looked at none of the staff has recently completed any training in these areas. The visiting manager said that the priority has been to make sure that staff have had training in other health and safety areas first. Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 10 We also looked at the terms and conditions of residency for service users. We found that the document is unclear in places and does not clearly show the rights and responsibilities of the registered provider (Craegmoor) to the service users. There were one or two areas that were bought to the visiting manager’s attention. The terms and conditions state that service users are responsible for arranging their own insurance if their belongings amount to more than £1000, another clause states that it is the service user who is responsible for updating their own inventory of belongings. The visiting manager said that she would very much doubt if most of the service users who lived at Alphonsus house would understand this or be able to act upon it. It is recommended that the terms and conditions be reviewed for all service users and unfair terms and conditions be removed. Alphonsus House DS0000004837.V330093.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): 6,7,9 Quality in this outcome area is adequate. The people who live at this home are generally supported to make decisions for themselves although improvements are needed in the care planning processes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we looked at service user plans we found that new systems for recording information were in place. The home has begun using a Person Centred Care Planning (PCCP) system. Staff are currently in the process of working with service users to complete their PCCP’s. One staff member said “xxx has a new person centred care plan in place he feels that this new care plan is a good idea and is better than the old one as it in more details he enjoyed participating and putting it together”. Service users said “I am proud of my plan and that I am working with the staff to do it”. The home has provided no formal training for staff to follow when completing the new plans with service users. The visiting manager said that in her experience staff have found it better to get on with completing the paperwork Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 12 with service users and for them to address problems or questions as they arise. Staff do talk to service users when planning how to manage their money. This is clearly recorded in the service user plan. There is a dedicated form that specifically looks at service users money, it shows how the staff will assist the service user to have access to their money at any time. However not all of the content was clear. One entry on the new form states “the risk of me losing, misplacing, or having money taken from me is”, staff then have a choice of high, medium or low but it isn’t clear how staff would reach a decision as there is no guidance on what is considered to be a high, medium or low risk. The home manages personal allowances for some service users, who know how to collect the money they need from the office. The visiting manager said that service users have access to their money through appointeeship and where needed service users have their own advocates to act on their behalf. It was pleasing to see that an advocate visited the home during the inspection for this very reason. The home also has details of advocacy groups and contact information displayed in the hallway of number 81. it is recommended that these details be made available in both number 83 and 85. Risk assessments were in place and mirrored the content of care plans for service users in most cases. One plan and risk assessment looked specifically at safety whilst out in the community. It tells staff that the service user should “carry his mobile phone, that he can use the green cross code and that he can access the community independently”. However, this printed care plan was dated 24/11/06 and indicates that it should be reviewed on a monthly basis, it is not signed by staff or service user. The risk assessment that accompanies this care plan has been signed by the service user but has not been reviewed since 03/04/07. When talking to the service user and staff both were very clear about the content of the plan. The service user said “I always have my phone it has numbers in to help me”. The visiting manager said that it was likely that other risk assessments and care plans were out of date and would need to be reviewed but she was confident that the new PCCP process would address this once every service user has been reassessed. Alphonsus House DS0000004837.V330093.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): 12,13,15,16,17 Quality in this outcome area is adequate. People who use this service are given the opportunity to take part in activities both within the home and the community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At present none of the service users have a job but they do have the opportunity to go to day centres and attend local colleges. One service user said that he was looking forward to going to college to learn more about computers. Individual activity plans are included in the new paperwork, only one of them was completed on this occasion. Another service user had no activity plan at all in their plan. The home keeps records of activities that service users take part in, staff complete an activity sheet that is stored with the service user plan. Activities recently undertaken included visits to Stratford upon Avon, bowling, lunch out at the local pub and swimming lessons. Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 14 The home needs to concentrate on developing activities for those service users who cannot access the community as freely as others. This will give all service users the opportunity to take part in activities. When we visited last time we asked staff to help service users plan more activities over the weekend for service users to take part in. Although there is evidence that there are more activities taking place during the week there is still limited activity at weekends. We spoke to service users who said “I tidy my room and listen to music on Saturdays”, “we have been buying DVD’s so we can watch them at weekends”. Craegmoor’s Clinical Governance report dated July 2007 identified that staff need help to plan activities and coping mechanisms for complex behaviour problems support to be given through the clinical governance team and visiting home manager. This has yet to be put in place. We also noticed that there were no drivers available at the weekend to take service users out if they chose to go out. The visiting manager said that two new drivers have been employed, they work Monday to Friday, they do this because she is encouraging more service users to go out during the week. She also told us that staff have helped all of the service users apply for their own free travel passes to enable them to access public transport. It is hoped that this will further build service users confidence and independence out in the community. We were also informed that there are staff at the home who are capable of driving the minibus at the weekend if the situation arose. Some of the service users have recently been on a short break to Alton Towers. Other service users have not yet had break/holiday away from the home. When we visited last time we recommended that service users who are unable to go to hotels for their holidays should have time away in other settings and that this should be above what is arranged for everyone else. The visiting manager said that service users are expected to pay for their own holidays but the home will cover the cost of the staffing and meals for service users once they are there. Service users will also need to supply their own spending money. Menus have been updated since our last visit and service users are now offered two choices for evening meal. We looked at two service users files, it was pleasing to see that the home have written down each service users likes and dislikes when looking at food and drink. One service user said that they liked Pizza, another said, T bone steak. When we asked service users if these items had been added to the menu, they said “pizza is on the menu”, “I have had steak but you wont get it every day it costs to much”. All of the lunches on the menu consist of assorted sandwiches but service users did say that they do get a choice of filling. Staff said that most of the service users take money to day centres for lunch or take a packed lunch. Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 15 Each service user is now going to be screened for their risk of malnutrition, the home has begun to use the Malnutrition Universal Screening Tool (MUST). It was pleasing to see that one service user has been referred for specialist assistance because of their increased risk. This service users care plan had also been updated to reflect the recommendations of the dietician. For example “full fat milk and milkshakes, high fat foods, eat plenty of meals and snacks, give me 3 weetabix in the morning, puddings, I don’t want to eat a lot of food at once so offer me more an hour later”. Staff were also aware of the changes to diet for this service user. Another service user told us that they are hoping to leave the home and to go into independent living. As part of this plan they are to be assisted in the kitchen with meal preparation, however on the day of inspection the staff had forgotten to do this. The visiting manager said that she would remind staff so that this did not happen again. Alphonsus House DS0000004837.V330093.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): 18,19,20 Quality in this outcome area is adequate. People who use this service have access to healthcare both within the home and the community. Medication practices are much improved and are now protecting service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some of the health care plans we looked at were detailed. For instance, care instructions in one plan for management of a service users epilepsy said “please remove my helmet but do not move me unless I am in immediate danger, when my seizure finishes I will cry and then sleep put me on my side curled up stay with me for about 20 minutes”. Another example said “Mobility I need two staff to move me safely, I use a wheelchair”. There are areas that could be improved with more detail, such as one statement “blind in one eye” it would obviously be more helpful for staff to record in which eye the service user had lost their sight. Care plans did not always include service users preferences of gender of care staff when they receive personal care, however this would prove difficult as the home have indicated in their AQAA document that they have no male staff Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 17 currently working in the home. This should be addressed by the home so that service users can have a choice. The visiting manager said that since we last visited nighttime care plans have been reviewed and service users are no longer routinely “checked” on an hourly basis throughout the night but as and when service users indicate. Staff also confirmed that this happens, it was also reflected in care plans for service users. Service users are being assessed for their risk of developing pressure sores and where risks are identified advice and assistance is sought from the district nursing service. One service user was assessed as being at high risk of developing pressure sores, it was pleasing to find that the home had obtained pressure relieving equipment for their bed and chair and taken advice from the district nursing service. Moving and handling risk assessments were also seen to have been completed. Generally they were satisfactory but one did need to be updated to reflect a change in care for one service user and the use of a hoist. Service users have regular access to their doctor and other community services. All service users have regular check – ups with the dentist, optician and other specialist accordance with their needs. There is a recurring requirement identified in the last two inspections about reviewing a policy on ageing and illness which advocates staff discussing the benefits of will making with service users. No policy could be found during this inspection, the visiting manager said that it had probably been taken out of circulation, she was not aware of any policy currently in use for ageing and illness for any Craegmoor home. the requirement has been removed. Medication practices in the home have improved significantly and there are now good systems in place to ensure that service users are protected. Staff have received training from the dispensing pharmacist. Craegmoor have now introduced a competency assessment for all staff who administer medication to ensure that they are safe practitioners and are not placing service users at risk with poor practice. The medication policy has been amended to guide staff when the need for “secondary” dispensing occurs. Previously staff have been taking service users medication out of their blister packs and putting them into a medidispenser for service users to take away with them when they go on leave. This no longer happens, service users are given their own blister packs to take with them on leave, or if there is enough notice arrangements can be made with the pharmacist for them to dispense medication in separate containers. There are good arrangements for the ordering, receipt and safe storage of medication. There are some minor issues that need to be addressed. For Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 18 instance staff need to record on the Medication Administration Record (MAR) sheet if a service users has an allergy, this had not been completed in all cases. No one living at the home is currently managing his or her own medication. It is recommended that service users are reassessed and attempts are made by the home to support people to develop skills in this areas based upon their individual capabilities. Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 19 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): 22,23 Quality in this outcome area is adequate. People who live in this home will have their views listened to and acted upon but improvements could be made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy has not been reviewed since the last inspection, areas for improvement recommended at our last visit still need to be given consideration, such as the provision of a complaints policy in picture format or in large print. Service users do attend regular meetings where they are encouraged to offer their views about how the home is run. Service users are not routinely asked if they have any concerns or complaints during these meetings though. It was recommended during the last inspection that this be added to the agenda, this recommendation will remain. There has been no Adult Protection issues or referrals since we last visited the service. One issue remains outstanding; it appears that the monies that are owed to service users, as a result of a previous Vulnerable Adults meeting have still not been paid to them. The visiting manager was able to check service users account as far back as January this year but was unable to find any evidence that service users had been reimbursed. She has agreed to look into this matter further to ensure that service users receive what is owed to them. Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 20 The personal finances and records of some service users were seen. All were appropriate. Inventories of personal belongings are maintained for each service user. However we found that a clause in the terms and conditions of residency implies that service users are responsible for updating their own inventories and for arranging their own insurance for their property if it is worth more than £1000. This needs to be reviewed, as the visiting manager pointed out that most if not all of the service user currently living at the home would be unable to do this for themselves. Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 21 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): 24,29,30 Quality in this outcome area is adequate. The home continues to need a lot of refurbishment and redecoration to make it a suitable environment for service users to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was pleasing to see that there have been some improvements to the home since our last visit. Most of the service users have now had their bedrooms redecorated. Some of the rooms were seen and were pleasantly decorated and reflected service users likes and dislikes. Rooms were personalised with their own belongings and were all kept clean and tidy. Some of the duvets and pillows were seen to be very thin and lumpy, this was raised during the last visit but does not seem to have been addressed. In house 85 there have been a number of improvements, service users bedrooms have been decorated, flooring has been replaced and the dining room was in the process of being completely refurbished following a recent flood. Service users have been consulted about the decoration and the colour Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 22 schemes, it was noted however that there does seem to be a lot of yellow and lilac rooms throughout the home. In house 83 it was also pleasing to see that rooms had been decorated and the visiting manager said that there were plans to replace flooring and furniture for service users in the near future. Both house 83 and 85 have their own front doors, however none of the service users enter their home this way. Access to the all of the homes is through house 81. This means that those service users who live in house 81 are being constantly disturbed by visitors, and other service users walking through their home to get the other houses. It was also observed during the inspection that if no staff are available to answer the door in house 81 visitors will ring the doorbell until someone in the other houses hears them. This is not ideal and does not always offer a relaxing environment for service users and should be reviewed. There is no designated smoking room in any of the houses, at present service users have to sit outside under the shelter of a gazebo if they wish to smoke. There are some adaptations and equipment available for service users. One service user has recently been reassessed for a new wheelchair with extra head support. Another service user has appropriate pressure relieving equipment for their needs. The home now has a hoist in 85 for use with one service user, there were no records of maintenance for this hoist, the visiting manger explained that it was on loan from another home. The records must be obtained before the hoist is used to ensure that it is safe for use. Staff will also need to be trained in its use to make sure that they are competent to use the hoist when it is needed. There are two laundry’s one in house 81 and a shared laundry for 83 and 85. There were some improvements noted such as gloves and aprons and liquid soap being available for staff use to reduce the risks of cross infection to service users. Mops continue to be stored head down in buckets and are not being washed in line with current best practice. The walls of the laundry under house 85 are peeling and plaster has fallen of the walls, this must be addressed it has been outstanding since the last inspection. Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 23 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): 32,34,35,36 Quality in this outcome area is adequate. People who live in this home are supported by staff who are working excessive hours to meet service users needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff files we looked at to make sure that the home continues to recruit people in way that safeguards service users. There has been no change in the recruitment process since the last inspection this means that some files continue to lack the information required. This still needs to be addressed. It was pleasing to see that all of the staff files seen had a PoVA and Criminal Records Bureau (CRB) disclosures were completed. New workers who have begun working at the home did not have records in their files of any induction they have completed. No new staff were available to talk to in order confirm that they had received an induction. This must be improved, new workers must be given an induction and be supported during this time. It is recommended that the home keeps records of all aspects of the induction for new staff. Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 24 Staffing levels remain consistent however the amount of hours that staff are working remains high and is a concern. The visiting manager said that she was aware that staff are perhaps working too many shifts and in order to address this she has begun recruiting more staff. It is hoped that two new workers will start working at the home very shortly. This will mean that staff will no longer have to work excessive hours to ensure that all the shifts are covered. The staff rota covers all three of the houses and another registered home in the Craegmoor group. There are no designated care workers for each house at present this means that service users do not know who will be providing their care from day to day. It was also noted that the home does not employ any male care staff to assist service users. More recently staffing levels have been reduced during the night. The home now staffs house 85 with two carers, 83 and 81 both have one carer each during the night to address service users needs. The home must keep this arrangement under review and increase the number of staff on duty at night if service users needs require it. Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 25 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): 37,39,42 Quality in this outcome area is adequate. The home has no registered manager but interim arrangements have ensured that service users health and safety is being promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is no registered manager for this home at the present time. The home is being supervised by a visiting manager from another Craegmoor home nearby. She informed us that a new manager has been recruited for the home is it is hoped that she will commence employment soon. There has been no change in the quality assurance systems since the last time we visited the home. There are audits that address the environment, infection control and medication and more recently health and safety. The home still Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 26 need to provide and action plan that shows how it will address the issues raised as a result of these audits. Further improvements are still needed for the home to feel confident that they are finding out the views of their service users. It must be able to demonstrate how service users are involved in this process. It is not productive for the home to provide written questionnaires if the majority of service users cannot complete them. It is positive that service users do have regular meetings where they are encouraged to discuss things that are happening in their day to day lives. The home has systems in place to identify when staff need mandatory training and updates. The home does this by training workers themselves or through an outside agency who will deliver training for them. It was apparent when looking through staff files that there are potential gaps in the knowledge and skill base of staff because they have not attended training. This could place service users at risk as staff may be practising care that is not in line with current best practise. The home must make greater efforts to ensure that all of the staff working there have the appropriate knowledge and skills in relation to health and safety, first aid, food hygiene and fire safety, to keep service users safe. As in previous inspections maintenance records were spot checked and records were generally in order. The addition of a new maintenance worker has also improved this process. There are now records of regular fire checks being undertaken, this includes lighting and alarms. We did not however find any record of staff having undertaken any fire drills, although there were some records that staff have received training but not all of them. This will need to be addressed by the home promptly so that staff and service users know what to do in the event of a fire. Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 27 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 X 2 2 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 x 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 x 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 1 X 2 X X 2 X Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 28 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 15(1) Requirement Service users needs must be included in their care plans so that there is a record of how their needs are going to be met by the home. Service users plans must be kept under regular review so that they reflect changes in care needs An audit of monies paid to service users must be undertaken in relation on monies agreed to be paid in an adult protection investigation. Any remaining monies owned must be paid directly in to service users accounts (including the service user who has now left the home). (previous timescale of 01/01/07 not met) Timescale for action 01/11/07 2 YA23 13(6) 01/10/07 3 YA33 18 The registered manager must 01/10/07 ensure that staff have adequate rest periods between shifts. That staff do not exceed the 69 hours a week working hours indicated in the homes own risk assessment. Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 29 Staffing must be calculated using a recognised staffing tool, based upon the assessed dependency levels of each service user. The hours must be compared to the hour’s provided/budgeted for. The outcome must be provided in writing to the CSCI with an action plan to meet any discrepancy identified between the two figures - part met. (Previous timescale of January 2006 not met) 4 YA34 19 Recruitment documentation must be available for all staff to ensure that they are being recruited safely and service users are being protected. (previous timescale of October 2005 not met) The registered manager must further develop the quality assurance system to include feedback from stakeholders in the community. Service users must complete their questionnaire with independent advocates. The manager must develop ways of involving all service users in the quality review process The provider shall formulate an appropriate system for reviewing at appropriate intervals and improving the quality of care at the care home based upon consultation with service users and their representatives. There must be an action plan published once the results of Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 30 01/10/07 5 YA39 24 01/12/07 the service users surveys are completed. (previous timescale of 01/03/07 not met) 6 YA2 14(1)(a) The registered person must ensure that sufficient staff are trained to the level of skills required to assess the needs of this client group and maintain current good practice. (Previous timescale of June 2006 not met) Service users and staff must take part in regular fire drills to ensure that they know what to do in the event of a fire. The home should keep records of each drill. 01/12/07 7 YA42 13(3) 01/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA3 YA2 YA5 Good Practice Recommendations Greater numbers of staff should receive training in specialist areas such as epilepsy and autism to ensure that they have a good understanding of service users needs. It is recommended that staff have training in the Mental Capacity Act 2005 to ensure that they understand their role in supporting service users. Contracts and terms and conditions are reviewed, and unfair terms and conditions are removed. If service users are unable to understand the contents then the home should take steps to involve people who can help them or to provide terms and conditions in a format they can understand Staff should receive further guidance relating to the compilation of key worker meetings in order that they read as an overview of events from each month Staff should be given guidance on how to complete the DS0000004837.V330093.R01.S.doc Version 5.2 Page 31 4 5 YA6 YA6 Alphonsus House 6 7 8 9 10 11 12 YA13 YA13 YA17 YA20 YA22 YA23 YA39 13 14 YA40 YA42 new Person Centred Care Planning system to avoid misunderstandings occurring. Service users who are more dependent upon staff to meet their needs must be supported to participate in activities both in and outside of the home. All service users regardless of needs should be given the opportunity to have a holiday away from the home. Service users who are able to should be supported to plan and prepare their own meals. Service users should be reassessed in relation to selfmedicating and be given appropriate support to do so. Service users must be able to participate in the complaints system in the home. staff must be able to support service users to do this. That a monitoring system be introduced for adult protection. The quality assurance system should be further developed to ensure that service user involvement is recorded and the home can demonstrate that they are acting upon service users wishes and views about how they would like the home to be run and managed. Policies and procedures should be regularly reviewed to ensure that they reflect changes in legislation and protect service users. Greater numbers of staff must have training in COSHH, fire safety, first aid and infection control to ensure that service users health and safety is protected. Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Halesowen Local Office West Point Mucklow Trading Estate Mucklow Hill Halesowen B62 8DA 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 Alphonsus House DS0000004837.V330093.R01.S.doc Version 5.2 Page 33 - 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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