CARE HOME ADULTS 18-65
Alpine Lodge Alpine Road Torquay Devon TQ1 1RB Lead Inspector
Peter Wood Unannounced Inspection 28 July and 08 August 2006 13:00 Alpine Lodge DS0000018312.V303146.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 Alpine Lodge DS0000018312.V303146.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. Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Alpine Lodge Address Alpine Road Torquay Devon TQ1 1RB 01803 295514 01803 400214 agnes@alpinelodge-rch.co.uk 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) Alpine Lodge RCH Ltd Mrs Helen Agnes Rochester Care Home 23 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (23), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (23) Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 06/11/05 Brief Description of the Service: Alpine Lodge is registered for up to 23 young and older residents with mental health needs although the number of residents is effectively limited to the 21 single rooms. The one double room is used as a large single room. There are currently 18 residents. The large detached house is in a residential area of Torquay within walking distance of the town centre. It has two porta-cabins to the front of the house used as the managers office, staff office and accommodation for 3 staff. There is a small parking area, with gardens to the front of the building and a ramp leading to a patio area at the side. The house can be accessed to the front via shallow steps, with additional steps and stairs throughout the rest of the building which might pose a problem for residents who have mobility problems. The accommodation is laid out over three floors. Two flatlets with their own kitchen facilities are located in the basement, with other bedrooms on the ground and first floor. The ground floor also has a TV lounge, a games room, quiet room, dining room, kitchen and laundry room. There is one bathroom and three shower rooms and additional toilet facilities. CCTV is in operation in the kitchen, linen room, front entrance and office. Fees range between £450 and £900 dependent on the need of the individual resident. Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and undertaken over one and a half days in July and August 2006. The focus of this inspection was to inspect all key standards and to seek the views of residents, staff, relatives and professional visitors to the home, the latter mainly using comment cards, survey forms and follow-up telephone calls. The first day of the inspection coincided with an Open Lunch to which health professionals had been invited. Opportunity was taken to discuss with nurses who attended the barbeque and seek their views of the home. No staff returned the “Care Workers Survey” form. Two “Health and Social Care Professionals in Contact with the Care Home” returned a form with that title and a further two agreed to give their views during a follow-up telephone conversation. No “Relatives / Visitors Comment Cards were returned, but two relatives agreed to give their views during a follow-up telephone conversation. Considerable time was spent with the registered manager examining documentation, particularly that relating to client assessment and care planning, staffing and health and safety. Residents who were at the home were consulted, as were the staff on duty. A full tour of the public parts of the building was undertaken, and several residents were pleased to show their rooms. What the service does well:
This home aims to give their clients a good quality of life without too many restrictions, in a relaxed atmosphere. This home sees itself very much as part of the community of local professionals working together to improve the lives of people with mental health problems. The home works closely with the community mental health teams whose staff know the sort of client Alpine Lodge can help best. Several residents remain living successfully at this home after having to leave other homes. The home has an experienced staff team, many of whom have worked for many years at the home. Residents described staff as being very kind and caring. Residents described living at Alpine Lodge as “good” and “this is my home”. They were happy with the food and said they feel safe here, aware that the home provides a home for life if the client wishes that, or support to move on to more independent living if that is a realistic opportunity. A professional visitor from a community mental health team said the team could not manage without the resource of this home. Another described the manager as caring, competent and efficient, keeping her up-to-date with reports about her client and always present at CPA reviews. Relatives consulted were very grateful that the home was able to provide accommodation and support to their relative client. Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 7 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 Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. Assessments are made at the time of admission covering areas considered the most important, but not all the resident’s needs and aspirations are taken into account. EVIDENCE: Most referrals are from members of specialist mental health teams, sometimes using the Care Programme Approach and are therefore usually appropriate, made on the basis of professional assessment prior to admission. The home uses its own Referral Form as an assessment tool. This concentrates on the physical and mental health of the client omitting elements such as personal development, education, occupation, leisure needs, and overall goals. Including such elements would enable the assessments to be more comprehensive, from which more holistic care plans could be generated. Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. Care plans were completed, but these are generated from less than comprehensive assessments, limiting their scope. EVIDENCE: Each resident has a care plan, reviewed regularly. However, these are generated from less than comprehensive assessments. Although plans recorded how staff should work with most identified needs, missing elements were personal development, education, occupation, leisure needs, and overall goals and aspirations. Consequently it is difficult for staff to work with residents towards increasing skills and gaining independence. Daily records were being kept, but did not always reflect that care plans were being followed and that staff were systematically working towards residents’ goals and aspirations. Documentation should be improved to become a useful tool and a true system of assessment / planning / implementation recording. Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. The Home helps to support and maintain resident’s personal and family relationships, and their rights and responsibilities are recognised. More emphasis is required, however, on identifying and meeting resident’s holistic needs. EVIDENCE: Care plans did not detail resident’s personal development, educational, occupational and leisure needs. The Home provides a table-tennis table, computer, board games and tea and coffee-making facilities for residents. A daily timetable of activities indicates the paucity of activities undertaken by most residents most of the time. While some residents went out for a walk on the afternoon of an inspection day, most spend an inordinate amount of time in bed or watching television. Some residents enjoy music or have other individual interests. However, it is proving hard to encourage some residents to take part in any activities. Trips out have been organised which residents said they enjoyed. Friendships and family contact is encouraged. Staff demonstrated the respect they have towards the residents and encourage
Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 11 residents to show respect for the property and person of their fellow residents. Residents said they enjoyed the food. Lunch on a day of inspection consisted of sandwiches, crisps and drinks. The dining room could benefit from decoration and refurbishment, replacing the dated tables with integrated seating with modern furniture and separate chairs. Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. Residents are well supported with their physical and mental health needs met. Residents are able to administer and control their own medication, and medication administered by staff is done so safely. EVIDENCE: The assessments and care plans generated from them focus on the physical and mental health needs of the residents, which are well identified and met. Residents reported that they feel safe and well supported living at Alpine Lodge. They feel respected and are encouraged and enabled to have as much control over their lives as possible. This includes varying degrees of control over their own medication as they wish, are sufficiently confident, and following an appropriate risk assessment. A lockable facility is now provided for those residents who administer their own medication. The manager sees the home very much as part of the local circle of support for people with mental health problems, alongside (other) professionals such as GPs and particularly the team of various professionals in the community mental health teams. Residents reported that they received as much support as they wished and needed. Records and discussion with the manager confirm that residents’ physical and mental health needs are assessed and attended to appropriately,
Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 13 subject to the willingness of the resident to accept the medical and dental treatment they need. The home has appropriate policies and procedures in respect to the receipt, storage, administration and disposal of medication. The home has a proper medication cabinet and uses the blister pack monitored dosage system. This system allows nearly all medications the home uses to be within the system, reducing the number of separate packs of medications that need to be separately wrapped. This in turn reduces the likelihood of error. Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. Comments from residents, relatives or other visitors to the home are treated seriously. Residents are listened to and issues resolved promptly. Practices at Alpine Lodge protect residents from abuse, neglect and self-harm. EVIDENCE: Residents reported that Alpine Lodge is their home. A copy of the complaints procedure is available to all residents and visitors to the home and detailed in the home’s Statement of Purpose and Service User Guide. Although no complaints had been formally recorded, residents are confident through experience that their views are welcomed, encouraged, listened to and acted on. The home has policies and procedures to minimise the likelihood of abuse of residents in all its forms. The manager and staff have received training in issues relating to abuse and the protection of vulnerable adults and knew what constituted abuse and what to do if they came across an abusive situation. Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. Whilst considerable improvements have been made, there is still a long way to go before the home could be described as smart and homely, well furnished and decorated. EVIDENCE: Much time, effort and resources have been spent on improving the environment at Alpine Lodge, to keep it clean, safe and in a good state of repair. Improving the furniture, furnishings and decoration is, however, still a work in progress. A very pleasant decked area has been laid in the garden, and a summer house has just been erected, designed to entice residents out of the house during the excellent summer weather. A full time maintenance person is employed so repairs are carried out swiftly. Owing to their illnesses, many residents do not take as much pride in their appearance as they perhaps may have done when well. Sadly, the appearance of many residents and the environment in which they live reflect each other. Improving the environment may improve the value residents put on their appearance. Residents said they were happy with their bedrooms. Whilst some of those seen were well personalised and contained expensive items of equipment, much of the furniture and furnishings required renewal. The furniture in the lounge appears
Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 16 in poor condition while the tables with integrated seats in the dining room are not at all homely in character. The furnishings and decoration throughout the house suffer from the heavy smoking of many of the residents and staff. Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. Vulnerable residents are cared for by competent staff who are properly recruited to protect them. EVIDENCE: Residents are cared for by staff competent by experience if not by training to meet the needs of those currently living in the home. Staff training records including evidence of NVQ, First Aid, food hygiene and fire safety. Two staff members hold NVQ 3 in mental health. One staff member holds NVQ 2 in mental health and is in the midst of completing NVQ 3. One staff member is in the midst of NVQ 2. This level of qualification falls well short of the requirement that 50 of care staff have NVQ2 by December 2005. Staff files include evidence of references being obtained as well as CRB checks, terms and conditions, and job description. Residents described the staff as very kind and caring and confirmed they responded promptly to requests for assistance. Comments from staff reflected their confidence, care for the residents and loyalty to the home. Staff report that they work as a team and spend quality time with residents. Staff receive on-the-job monitoring by the “hands-on” manager, who undertakes an annual appraisal with them all. However, supervision, as described in the National Minimum Standards, does not yet take place. Good supervision can greatly enhance staff’s professional work.
Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. Alpine Lodge is a wellmanaged safe home run in the residents’ best interests. However, the Registered Manager must become appropriately qualified. EVIDENCE: Interviews with and comment cards from residents, relatives and professional visitors provide evidence of the good management of this home. Examination of documentation including resident’s care files, satisfaction questionnaire, policies, procedures, risk assessments, accident book, fire log, and health and safety literature confirm that residents’ health, safety and welfare are promoted and protected. Residents report they are happy living here. They value their private and communal rooms, the management style of the owners, and the food. They know they can come and go as they wish, have confidence in the owners and staff, and most enjoy living with their fellow residents. All residents consulted expressed appreciation for being able to live here.
Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 19 The Registered Manager and Registered Provider have developed a quality assurance system that includes an annual development plan that has been sent to the Commission. The Registered Provider also visits Alpine Lodge monthly and reports his findings to the Commission. The Registered Manager holds an NEBSM Cert (National Educational Board of Supervisory Management) and is also an NVQ Assessor and is in the midst of completing the Registered Managers Award and NVQ 4. These qualifications were originally required by the Commission to be obtained by the end of 2005, though the Commission no longer makes it a condition on her continued Registration. Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 20 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 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 3 x x x x Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 21 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 YA2 Regulation 14 Requirement Resident’s assessments must cover all areas of need including personal development, social, educational and leisure needs. Original deadline 09/03/06. 2. YA6 15 Resident’s care plans must reflect all areas of need, including personal development, social, educational and leisure needs. Daily recording must demonstrate the action taken by staff to meet these needs. Original deadline 09/03/06. 3. YA14 12 (1)(2)(3) Resident’s social, educational and leisure needs must be identified, recorded so staff and residents are working towards achieving goals. Original deadline 09/03/06. 4. YA13 12 (1)(2)(3) Resident’s social, educational and leisure needs must be identified, recorded so staff and
DS0000018312.V303146.R01.S.doc Timescale for action 08/11/06 08/11/06 08/11/06 08/11/06 Alpine Lodge Version 5.2 Page 22 residents are working towards achieving goals. Original deadline 09/03/06. 5. YA12 12 (1)(2)(3) Resident’s social, educational and leisure needs must be identified, recorded so staff and residents are working towards achieving goals. Original deadline 09/03/06. 6. YA24 16, 23 Furniture, furnishings and decoration must be renewed as their condition deteriorates so they remain fit for purpose. 50 of staff should have attain NVQ level 2 in care. Original deadline 31/12/05. 8. YA37 9 (2) (b) (i) The registered manager must be suitably qualified. Original deadline 31/12/05. 31/12/06 08/11/06 08/11/06 7. YA32 18 31/12/06 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 YA26 YA20 YA17 Good Practice Recommendations Lockable storage should be provided for all residents in their bedrooms for valuables and medication. Lockable storage should be provided for all residents in their bedrooms for valuables and medication. Freezer and fridge temperatures should be kept daily.
DS0000018312.V303146.R01.S.doc Version 5.2 Page 23 Alpine Lodge 4. 5. YA24 YA35 All windows, where there is a risk of someone falling, should have restricted opening. Staff should receive equal opportunities training including disability awareness. Staff should have individual training and development assessments and profiles. All staff should have done Induction and Foundation training. Staff should receive appropriate supervision on a regular basis. Comments made by stakeholders should be incorporated into the aims, objectives and targets in Alpine Lodge’s annual development plan. 6. 7. YA36 YA39 Alpine Lodge DS0000018312.V303146.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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