Inspection on 06/05/08 for Alstone House

This inspection was carried out on 6th May 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Alstone House 145a Alstone Lane Cheltenham Gloucestershire GL51 8HX Lead Inspector Mr Adam Parker Key Unannounced Inspection 6th May 2008 09:40 Alstone House DS0000071169.V361460.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 Alstone House DS0000071169.V361460.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. Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alstone House Address 145a Alstone Lane Cheltenham Gloucestershire GL51 8HX 01453 766441 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) Kentwood Ltd Mrs Joanna Moralee Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 5. Date of last inspection This is the first inspection of a new service. Brief Description of the Service: This service has been commissioned by Gloucestershire County Council to provide care for people with learning disability and dementia. Alstone House is a converted bungalow set in a residential area on the outskirts of Cheltenham. The environment of the home has been thoughtfully designed for the needs of people with dementia. The home comprises of five bedrooms with en suite facilities, a lounge, dining room and two conservatories with kitchen and separate laundry. Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means that the people who use this service experience good quality outcomes. The home was visited once, on a Tuesday in May 2008. We did not tell the home that there would be a visit. We did not use surveys in this inspection. Although an Annual Quality Assurance Assessment (AQAA) document was requested from the home, it was agreed that this would not be completed due to the home only admitting the first person in late March 2008. During the visits various records were looked at including examples of care plans, healthcare notes, risk assessments, daily records, medication charts, training information and staffing files. Discussion took place with the manager and members of staff. General observation of life in the home took place, including some mealtimes. All of the people living in the home were met and one was spoken to gain their views of the home. This home was also considered as part of a Commission for Social Care Inspection’s Thematic Probe inspection into safeguarding vulnerable adults. Up to date information about fee levels was not obtained during this visit. What the service does well: What has improved since the last inspection? Not applicable, the service is classed as new. Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Alstone House DS0000071169.V361460.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 Alstone House DS0000071169.V361460.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who may use the service are assessed as to how their needs would be met, how they would benefit and the suitability of the home before they move in. EVIDENCE: The care files for the two people using the service at the time of the inspection were examined. Information had been obtained from funding authorities and from previous placements. It was reported that with one person a previous placement had been unwilling to supply much information, however the home had pursued this and had obtained some information from a member of staff who had worked with the person. In addition a ‘proposal for residential care’ document summarised the person’s care and support needs, how the service would meet these and how the person would benefit form living in the home. This also took into account such factors as staff training and location of the home with the view that this would be a ‘ home for life.’ Alstone House DS0000071169.V361460.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A person-centred approach to care planning with comprehensive risk assessment, gives staff clear information on how people can be supported to live their lives. EVIDENCE: Documents relating to the care and support of people who use the service were looked at. These files were very detailed and contained specific information in the form of plans about people’s routines at different times of the day. A physical intervention protocol known as a ‘calm protocol’ had been completed by the registered manager who is a physical intervention instructor. This included information on any factors that may affect the person’s behaviour both at home and in the community. Support plans used a ‘person-centred’ approach as though the person themselves was speaking. Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 10 Care and support plans showed where people would need help in decision making and how staff would provide this. One example was where a person would need help with shopping, buying and choosing appropriate clothing. Risk assessments were completed for a number of identified risks such as eating and drinking, bathing and using a cooker. The assessments were robust and gave evidence of a comprehensive approach to keeping people safe from harm without undue restrictions and in the interests of maintaining some independence. Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 11 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to take part in appropriate activities inside and outside of the home, maintain relationships and have some links with the local community. EVIDENCE: One person was sewing and listening to music in one of the conservatories, which is an interest that they have carried on for many years. There was evidence of people going out for walks with staff, going shopping and attending a day centre. A monthly summary report for each person recorded the activities they have taken part in. The religion for both of the people living in the home was Church of England and it had been noted that they would like to attend church. The home has two vehicles to transport people including a specially adapted minibus. In addition use has been made of public transport such as buses. Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 12 Care plans showed that people were being supported to maintain relationships with family and friends, such as going out with friends on a regular basis and visits from relatives. The registered manager reported that people using the service could have keys to their rooms if they wished. This would be risk assessed and staff had keys that could be used to access any locked rooms in an emergency. It was also reported that mail for people would be given to them unopened and only opened by staff at their request. People using the service have unrestricted access to the garden of the home and were observed taking walks outside with staff. A baffle lock on the front gate prevents any immediate unaccompanied access to the car park and the road beyond in the interests of people’s safety. The main meal in the home is offered in the evening with the menu chosen through discussion on weekly basis by the people who use the service. This was confirmed by one person using the service. The menu is posted on a notice board in the kitchen. An individual record is kept of the meals eaten by each person throughout the day. It was reported that residents prepare some drinks and snacks with staff preparing the majority of meals. Support plans included food allergies and food likes and dislikes. Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 13 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Despite the need for an improvement in some aspects of medication administration and recording, people who use the service have their health needs met and receive good personal care and support. EVIDENCE: Personal care and support needs for people are recorded in specific plans that are written in a person centred way and take into account individual preferences as well as needs. A daily record is made of the person’s day detailing support given, activities and meals eaten. One person’s plan addressed gender issues of staff giving support both in terms of personal care and how this would help them to complete household tasks such as cleaning their room. There was evidence of people’s health care needs being met by liaison with General Practitioners (GP) over referrals to speech and language therapists. Also people had had podiatry treatment and a hearing test and were to attend hospital appointments, one person had recently been reviewed by a Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 14 psychiatrist from the local learning disabilities service. A record of weight for each person had also been kept. The arrangements for medication storage, administration and recording were checked. Medication was stored securely and storage temperatures had been recorded and were being kept at correct levels. Two bottles of eye drops were kept in the refrigerator in the kitchen. The containers had been dated on opening as an indication of expiry dates. Examination of the Medication Administration Record (MAR) charts showed that although the recording of administration was taking place for medication in tablet form there were some examples of where topical creams and in one case eye drops had not been recorded and gaps were left on the chart. These were pointed out to the registered manager during the inspection visit. One of the people using the service was taking a tablet from a container that had been prepared the night before by staff who had removed the tablet from its original container. In the interests of safe administration medication must be given from the original containers that it is supplied in. It is accepted that in this case the home were carrying on a practice ‘inherited’ from the home that the person was living in before coming to Alstone House. This had been done in the interests of settling the person into a new environment. In addition the registered manager had already identified that the practice needed review and this was to be discussed at a forthcoming meeting. The practice had also been subject to a risk assessment. Handwritten entries in medication administration sheets should at all times be signed and dated by the staff member making the entry and checked and signed by a second staff member. This ensures that there is a checking system for safe administration. Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 15 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in places that enable complaints and concerns to be raised by people using the service or on their behalf. Training is given to staff to safeguard people from possible harm or abuse. EVIDENCE: The home’s complaints procedure was displayed on a notice board in one of the corridors both in standard written form and in an easy read form for people who use the service to access. Consideration was being given to explaining the complaints procedure to people on an individual basis. The home had only recently opened and there had been no complaints. Apart from one member of staff who had recently started work in the home, all care staff had undertaken the ‘Alerters’ training provided by the local authority in safeguarding adults from abuse. When spoken to they were able to recall aspects of this training and how issues of abuse would be reported. In addition training had been provided to staff in dealing with challenging behaviour. The policy on preventing abuse was looked at and needed updating in some areas where references to the Commission had been made. All references to the NCSC need to be replaced with CSCI and local contact details need to be amended. The policy included referring incidents to the local authority adult protection unit and the police should the need arise. Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 16 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 & 30 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service have the benefit of living in a carefully designed environment suitable to their needs that also promotes their independence. EVIDENCE: The home has been adapted for its purpose with thought being given as to how the environment will meet the needs of people who use the service. The colour scheme was chosen with people with dementia in mind with doorways being painted in a distinctive colour from walls and doors or walls at end of corridors being painted in strong colours to encourage people to turn into nearby doorways. Toilets seats were black in contrast to the white cisterns, which helps people with dementia to recognise and use them. Carpets throughout are muted and plain. Light fittings were flush to the ceiling and did not cast shadows onto the floor. Grounds around the home were still under Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 17 development in places although provided people with a circular walk around and inside the home marked out in coloured paving and floor surfaces. The home was very clean and free from offensive odours. The laundry which is be used by people who use the service with the support of staff was in good order with hand-washing facilities provided and readily cleanable wall and floor surfaces. There are two access doors to the laundry one from the kitchen and the other from the hallway that allows washing to be taken directly into the laundry and so avoiding any infection control risks by taking this through the kitchen. Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 18 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment and selection procedures are robust ensuring that people using the service are safeguarded. Staff have access to a training programme that will equip them to meet the specific needs of people using the service. EVIDENCE: Staff in the home have undertaken training relevant to the needs of service users in previous care homes prior to working at Alstone House. New staff had completed Physical intervention training and learning disability training. At the time of the inspection there was one member of staff with an NVQ level two, another with a level three. Another staff member was undertaking a level two NVQ and the remaining three were due to start in September. A number of staff recruitment files were examined these showed robust recruitment checks had been made with all the required information and documentation obtained to protect people who use the service. Staff applying for jobs in the home had criminal records checks and had provided two references. Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 19 Staff have also undergone induction training based on the standards of the British Institute for Learning Disabilities (BILD). Staff progress through the various stages of the induction with their knowledge checked through questioning. At the time of the inspection all staff were undergoing induction with one having finished. Two staff members were spoken to and they commented positively about working in the home and the training they had received. Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 20 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is well managed with the start of a variety of quality assurance audits and safety checks to ensure that the home is run in the best interests of people who use the service. EVIDENCE: The registered manager has previously worked in both health and social services including management positions and as a support worker with the registered provider in another service. She became Deputy Manager at another care home in 2006 before taking up the current position at Alstone House. She has started the registered managers award and has a qualification equivalent to NVQ level 4 in social care practice. In addition she has recently Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 21 completed training in dementia care and is planning to undertake training in ‘aggression and wandering in dementia’. Quality assurance checks had been started in the home with a monthly manager’s audit completed by the registered manager and visits and reports completed by the registered provider in line with regulation 26. Other audits are planned around medication, complaints, recruitment and the care and support of service user. Due to the inspection taking place soon after the first people were admitted to the home it is appreciated that quality assurance systems will not have had time to fully develop. Staff working in the home have received training in relevant safe working practices in the areas of fire safety, moving and handling, health and safety, first aid, basic food hygiene and infection control. The home was registered in November 2007 following conversion of the premises. Some annual safety and maintenance checks were not yet due. Monitoring and recording of hot water temperatures was taking place daily or when a person used a bath or shower. There was some further work to be completed around any possible risk from Legionella and portable electrical appliance testing had not yet taken place. A fire risk assessment completed when the home was first registered was due for review and this was confirmed by the registered provider as being planned for late May 2008. Weekly fire safety checks were in place with records kept. Cleaning materials were safely stored away and it was reported that relevant data sheets were on order. Staff have completed training in Control of Substances Hazardous to Health (COSHH). Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 22 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 3 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 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP20 Regulation 13(2) Requirement In order to ensure safe practice all medication must be administered directly from the containers that it is supplied in. Timescale for action 30/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP20 OP20 Good Practice Recommendations All medication administration or omission should be recorded accurately with particular attention given to creams and eye drops. All handwritten entries in medication administration records should be signed and dated by the staff member making the entry and checked and signed by a second staff member. The abuse policy should be updated to include the new contact details for the Commission and to remove references to the NCSC. 3 OP23 Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Alstone House DS0000071169.V361460.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!