Inspection on 23/11/06 for Alton House

This inspection was carried out on 23rd November 2006.

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 but made no statutory requirements on the home.

Other inspections for this house

Alton House 09/06/08

Alton House 05/11/07

Alton House 15/05/07

Alton House 09/01/06

Alton House 29/09/05

Alton House 26/01/05

Alton House 15/07/04

Alton House 01/03/04

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

CARE HOMES FOR OLDER PEOPLE Alton House 22 Sunrise Avenue Hornchurch Essex RM12 4YS Lead Inspector Joanna Moore Unannounced Inspection 23rd November 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alton House Address 22 Sunrise Avenue Hornchurch Essex RM12 4YS 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) 01708 451547 Mr Frank Barrs Mrs Patricia Lilian Barrs Mrs Patricia Lilian Barrs Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Alton House be registered to accommodate 19 older people of either sex, with the registration category of Old Age, not falling within any other category. 9th January 2006 Date of last inspection Brief Description of the Service: Alton House is a privately owned care home providing care and support to 19 older people. The home is owned by Mr and Mrs Barrs and is currently managed by Mrs Barrs. The home is situated in a quiet residential area of Hornchurch with access to local shops and transport links. The home is traditionally styled and in keeping with other properties in the area. It offers a warm, welcoming environment. Alton House DS0000027828.V321305.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 inspection carried out as part of the annual inspection program. The inspection was carried out between the hours of 930am and 4pm. The inspector met with residents, relatives, spoke informally with staff, met with the manager and deputy and toured the building. Information was also obtained from a pre-inspection questionnaire and staff training records supplied after the inspection. What the service does well: Staff in the home are friendly, caring and take time to sit and chat with the service users and their families. The things the home does well can best be summarised through comments made by service users and their families as follows: “staff do not “ fuss” over me but are on hand to provide the necessary level of support., They get the balance right” “they know I like Lilac so that’s what they got me”. “ they are very nice here they help me do all the bits I can’t”. “ The hairdresser came in a couple of days ago and did my hair a treat”. They do sit and chat with us and we do some sing-along and quizzes but I do get a bit bored sometimes”. “ care staff and office staff are approachable and friendly. If they can’t answer a question immediately they always get back to me quickly…. They keep me informed of any issues of concern. I feel that we made a good choice in this home” “I am always made welcome when I visit and I come nearly every day. Staff are friendly and helpful. “A” is so much better now than when at home, much calmer. I am pleased that we were able to find this place “The food is good. It’s mostly home cooked and nutritious. It always smells nice too. “B” has put on a bit of weight as she enjoys her meals here”. Alton House DS0000027828.V321305.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 Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 & 5. The home does not provide intermediate care. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users and their families were happy with the support they received from the home during the admission. However the home failed to meet the minimum standards 1 through to 5. Clear systems were in place to support those service users funded by the Local Authority but not for those selffunding. In order to meet the standards the home needs to organise itself to carry through the same processes for all prospective service users. EVIDENCE: As part of reviewing the above standards the care records of the two most recently admitted service users, one self-funding and one local Authority funded were reviewed and both service users and their relatives interviewed. A service users guide is available and displayed in the hallway however from discussion with two newly admitted service users and their families they were Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 10 not aware of this document and had not been provided with it upon moving in. This document which guides service users as to how the home operates, what they can expect, how fees will be paid and how any issues of concern should be raised. This document is must be made available to each and every person and their family prior to or in an emergency at the point of moving in. Those service users who are funded by the Local Authority have a clear contract for care, which outlines what they can expect from the home. A similar contract exists for self-funding service users however this had not been issued to the most recently admitted (three months) service user or their family. The Home must ensure that all information required upon admission is issued to service users and their families namely a service user guide and a contract of residence. Service users are offered the opportunity to visit the home before deciding to whether to move in. In reality however this does not often happen and relatives visit instead. Service users had all been assessed prior to their moving into the home. The home had obtained a copy of the Community Care assessments for service users who were funded by the Local Authority but had been unable to do this for self-funding clients. The deputy manager visits each prospective service user and a record of the assessments carried out is maintained. Trial stays so that the service user can “ test drive the home are standard practice for those people who are funded by the Local; Authority and a formal review of care takes place at the end of this period. Again this was different for the person who self funded, there was no evidence of a trial period or formal review of how the placement was working out. Similar issues have been raised in previous inspections. The registered person is required to keep service users care under review, it is strongly recommended that the home reviews its practices and ensure that those for self funding service users are brought in line with those for Local Authority funded people. The above comments relate directly to what the Commission for Social Care determines as best practice and specific questions asked by the inspector. Both families said they felt supported by the home and the staff in the admission process and if they had any questions that they were able to ask these. Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users healthcare needs are outlined in a care plan which is known to the staff and these needs are effectively met. Service users are treated in a way which is respectful and dignified. Service users are safeguarded by the homes medication procedures. EVIDENCE: One service user interviewed and whose care records were reviewed was a diabetic. The district nurse visited daily to provide medical support. This lady and her family were happy with the way her medical needs were supported. The care plan detailed the service users needs and District Nurses support. The cook was aware of the needs for diabetic diet and it was provided the service user and their family informed the inspector. All service users care files evidenced regular support from Gp and community health care teams. All service users have had the opportunity to have a flu jab. The chiropodist visits Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 12 the home every six weeks and the optician twice a year. Service users receive support from specialists such as the consultant psychiatrist as appropriate. Care plans have been developed and include information about people’s needs and life history giving care staff a wider knowledge of the persons background, which is particularly helpful. Care is reviewed monthly and recorded in the daily Cardex notes. Two of the three care plans did not have the service users photograph on them. It is a requirement that each service user care records include a recent photograph. Service users and their families said that the staff offered the appropriate level of support. One service user was very able to many things independently and advised that the “staff do not “ fuss” over me but are on hand to provide the necessary level of support., They get the balance right” The inspector sat and chatted with one lady and spoke to her about who had chosen her clothes which she said the staff had “but they know I like Lilac so that’s what they got me”. Staff had obviously taken great care in helping this lady dress and look very well presented. The dress and cardigan had been carefully selected to match, as had her broach. This lady also said “ they are very nice here they help me do all the bits I can’t”. On commenting that she looked so nice she said, “ The hairdresser came in a couple of days ago and did my hair a treat”. All the service users who required assistance dressing were similarly well presented. Service users and families said that staff worked in a way, which supported service users dignity and rights. Two service users medications were checked. The storage, administration and recording of medication was satisfactory. The home uses the monitored dosage system for most medication. Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported in maintaining contact with families and friends. Service users receive a wholesome balanced diet. A variety of in house activities are provided. EVIDENCE: Service users said that they thought the home was a good one with friendly staff. “They do sit and chat with us and we do some sing-along and quizzes but I do get a bit bored sometimes”. Relatives said “ care staff and office staff are approachable and friendly. If they can’t answer a question immediately they always get back to me quickly…. They keep me informed of any issues of concern. I feel that we made a good choice in this home” “I am always made welcome when I visit and I come nearly every day. Staff are friendly and helpful. “A” is so much better now than when at home, much calmer. I am pleased that we were able to find this place” Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 14 The menus within the home evidenced that a variety of nutritious home cooked food was served. On the day of the inspection it was a roast dinner, which was tasty. The cook was able to provide a diabetic diet for any diabetic or low sugar requirements. “The food is good. It’s mostly home cooked and nutritious. It always smells nice too. “B” has put on a bit of weight as she enjoys her meals here”. Routines do exist within the home such as the times meals are served but these can be varied according to the wishes of a service user if requested. Activities are provided within the home such as sing-along, quizzes and other games. Relatives in the homes quality assurance questionnaires made comments such as “a” enjoys the activities” “ Likes Alice’s sing-along” “ the home provides entertainment and music as well as exercises and at Christmas they have a party”. Other questionnaires and discussions with relatives showed that relatives are not always aware of the activities which are available and when they take place. It is recommended that the home prominently display information on planned daily activities and special events to keep service users and their families informed. The inspector was informed that every service user is provided with a Christmas dinner and a present on Christmas day if staying at the home. An entertainer was planned to come in over the Christmas period. Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are protected by clear complaints and adult protection policies. Service users and their families feel able to raise issues of concern. It is not clear how many staff have currently received adult protection training. EVIDENCE: The home has a copy of the local adult protection procedures as well as the homes own procedure. The deputy manager and manger are aware of the need to report any concerns to CSCI and the local authority adult protection co-ordinator and have familiarised themselves more fully with POVA since the previous inspection. It has been noted at previous inspection that the majority of staff have attended adult protection training however the home has not provided the inspector with information about the current number of staff who have received adult protection training and is required to do so. Staff when interviewed previously were clear as what constituted abuse and the need to report it to their manager immediately. A recent fall was investigated appropriately and the home liaised with the adult protection team. Where staff have been found to be at fault the accident investigation has been linked to the disciplinary procedure. Please also refer to staff recruitment for related comments. Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 16 The complaints policy was displayed in each bedroom. Service users and their families said they felt able to complain and that issues of concern would be raised with the deputy manager. Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 &26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from a home, which is pleasant and well maintained. The décor and furnishings are appropriate to the needs of the service users. The home is unable however to fully meet the standards until it is ascertained via an OT assessment what the service users needs in relation to adaptations and the provision of a second assisted bath. This is an ongoing recommendation. EVIDENCE: Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 18 Alton House is a generally well maintained and furnished home in a quiet rural area of Hornchurch. The shops are some distance away in central Hornchurch. Furniture provided was suitable for the client group. Each service user had their own bedroom most with either en-suite shower or bathrooms. All bedrooms viewed were decorated to a suitable standard and were furnished according to the users wishes. The hall and stairs carpet was looking “tired” and the proprietor advised that it was the homes intention to replace this within the next twelve months. The home was clean, odour free, warm and well ventilated. The Kitchen was clean. Temperatures were recorded in the outside freezers but it was not clear as to how those temperatures recorded were arrived at given that the thermometers were broken. The registered person is required to ensure that accurate recording of freezer temperatures occurs. The registered person is required to provide new thermometers for the outside freezers. The first aid box required blue plasters. Please refer to standard 38 fro further health and safety comments. At the previous three inspections the provision of a second assisted bathroom for the home has been recommended. At the three previous inspections it has also been recommended that an occupational therapy assessment of the home be carried out in order to ensure that appropriate adaptations are provided. Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff working in the home on a long-term basis are kind and in the words of service users and families good at providing care. The home however fails to evidence that all staff receive adequate training, evidence that enough staff are available at all times in accordance with the duty rota and fails to ensure robust recruitment practices, which may place service users at risk. EVIDENCE: Staff were deployed according to the rota in line with previously agreed staffing levels as follows: 7.30-9.30 am 2 Care staff and deputy manager 9am-3pm: 2 care staff and deputy/ manager 3pm- 7pm: 2 care staff 7pm- 11pm: 2 care staff 11pm-7am: 2 waking night staff. It was noted however that on the 20th and 21st November R Barrs was detailed on the rota both as cook and care duties at the same time. The inspector was advised that this did not happen and that J Mitchell covered the cooking duties however this could not be evidenced. The registered person is required to ensure that care staffing levels are maintained and that the rota is an accurate Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 20 record of the duties performed by staff. The accuracy of the staff duty rota is a repeated requirement from two previous inspections. Three service users were interviewed who said staff are very friendly, they take their time to sit and chat with service users and their families. Care was said to be offered at the appropriate level to each individual service user allowing people to remain as independent and able as long as possible. All the staff including the deputy manager were said to be approachable and helpful. Relatives said that both care and office based staff were friendly, kind and helpful. The deputy manager provided the inspector with a list of staff employed and the training they had undertaken. A variety of staff training has been provided including health and safety, dementia awareness, fire training, nutrition, adult protection, diabetes, medication, food hygiene, first aid, moving and handling, continence promotion. The training record provided however indicates that not all staff have attended basic mandatory courses which are relevant to their role for example 6/14 have attended health and safety, 9/13, first aid, 9/13 manual handling, 7/13 dementia awareness, 7/14 fire training. No evidence was provided for the number who had attended adult protection. The registered person is required to ensure that all staff attend these basic training sessions. This is a repeated requirement. The training record provided does not specify dates that training took place and this limits the usefulness of the training monitoring as will not identify when time limited courses such as first aid have expired and will therefore fail to prompt people to update training. The inspector is of the opinion that this is the same training record proved over a year ago and to which no changes have been made which indicates no new training has occurred and that new staff have not been included on this. It is required that dates be added to the training monitoring record to enable a fuller understanding of how often training is provided and updated for staff. This was a recommendation in previous inspection which due to these concerns has been upgraded to a requirement. The inspector was advised that the deputy manager has completed the registered managers award and is an approved NVQ assessor. The deputy manager in the training record provided states that five care staff have undertaken NVQ in care. In order to meet the national minimum standards more staff must undertake this training. This is a repeated recommendation. Staff recruitment was checked at the inspection by reviewing two new staff whom had been recruited. Shortfalls in the recruitment were noted as follows: these two new staff require photos to be placed on their files, one staff was noted to have commenced employment on 10th April but their Pova first check was not applied for until 5th may. The second individual had a CRB but this was from another employer and no Pova first check had been carried out. CRB checks are not portable from one employer to another. The registered person is required to ensure that a current photograph is held on each staff file and Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 21 that a CRB / Pova first check is in place prior to commencement of work at the home. Two references were in place for each recruited person however for one person there was not one from the current/ most recent employer. The inspector was advised that this is because the referee refuses to give references for staff despite them chasing the referee and that this is not a single occurrence in relation to this staff. The home should be able to evidence that it has tried to get the reference and followed this up. One of the newly recruited staff was said to have yet to start but was recorded on their file as starting on 25th October and was seen working in the home at the time of the inspection. The registered person must be clear as to what constitutes a start date for employment. It was not possible to evidence an induction for either of these staff. The home is required to evidence a full induction for all newly employed staff. The induction, which has been provided by the home to staff, previously is again as in previous inspections recommended to be further developed in line with the skills for care induction program. Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32,33,34,35, 36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home seeks to meet its service users needs and the manager and deputy are clearly familiar with service users needs however the significant number of ongoing repeated requirements and recommendations in additions to concerns around health and safety gives the inspector cause for concern. The management arrangements in the home need to be clear and the current manager/ proprietor must undertake management training or submit an application for a suitably qualified and experienced manager. EVIDENCE: Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 23 The home does not the deputy manager advised the inspector hold any pension or capital finances for service user only the petty cash floats provided by relatives. One service user and their relative informed the inspector that they were happy with the financial accounts. The home held a small amount of money for this person and they were shown receipts and the records of how it had been spent. Two service users financial records were checked. The records showed receipts for expenditure and the amount held tallied with the records. A staff supervision program could be evidenced as now being in place. Staff files viewed recorded three or four supervisions in the last year with an annual appraisal in addition. In order to meet the national minimum standards however supervisions should be held six times per year. The member of staff without the CRB in place should be supervised on weekly basis however there were no records of this happening. The registered person is required to supervise staff who did not have a valid CRB weekly and keep records of this. Staff supervision for the staff member who started in April could be evidenced for April, may and July with an appraisal held of their performance so far in May. The home advised that they had sent out service user surveys and some responses were viewed by the inspector. According to the pre inspection questionnaire Valid Gas (16.3.06) and electrical safety certificates (26.2.03) were in place and systems to monitor ongoing health and safety issues were used. A fire risk assessment was available. Health and safety risk assessments were recorded as last having been implemented/ reviewed in November 2006. Systems and records were in place to evidence regular checking and maintenance of fire prevention systems. On touring the building however the inspector found that the side fire exit from the laundry was blocked by the large clinical waste bin and a chair and it was not possible to exit the building or open the gate by this way. A second gate from the garden, which may need to be used as a means of escape, was chained shut meaning that although people could exit the building they could not exit the garden, which may not provide sufficient shelter in the case of a fire. The home confirmed in agreement with the inspector by fax later that day that these breeches of health and safety had been addressed otherwise a further visit and immediate requirement notices would have been served. It is of concern to the inspector that health and safety and fire checks had failed to note such obvious risks. The registered person is required to ensure that the building can be exited in line with fire requirements at all times. The manager and owner Mrs Patricia Barrs has been managing the home for many years. Mrs Barrs has no management training. At this inspection as in previous inspections Mrs Barrs has said that she does not intend to take on Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 24 management training. The significant number of recurring requirements from inspection to inspection in addition to new requirements gives the Commission concern as to the effectiveness of the current management arrangements. Ms Mitchell is referred to by staff, service users and relatives as the manager. It was noted that Ms Mitchell had signed documentation referring to herself as the manager. Mrs Barrs and Ms Mitchell were advised that this was unacceptable and that to do so may be committing an offence. The current management arrangements are not satisfactory and must be resolved. Mrs Barrs has stated that she intends to resign as manager and submit an application for the deputy manager Ms Mitchell to be registered. It is required that either Mrs Barrs secures a place on an appropriate management training course or that an application for a suitably experienced and qualified manager be submitted to the Commission by 31st January 2007. Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 2 2 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 3 3 3 3 3 1 STAFFING Standard No Score 27 2 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 3 3 3 2 X 1 Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 26 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 OP1 Regulation 5 Requirement It is required that the service user guide be issued to each service user and their representative prior to or within 48 hours of admission. It is required that a service user contract be issued to each service users or their representative prior to or within 48 hours of admission. It is required that the home keep the care of all service users under review particularly a formal review of the care for residents who have been recently admitted. It is required that each service user file have a photo of the service user. This is a repeated requirement previous timescale 01/03/06. The registered person is required to confirm the number of current staff who have received adult protection training. The registered person is required to ensure that all staff undertake adult protection training. This is a repeated requirement, DS0000027828.V321305.R01.S.doc Timescale for action 01/01/07 2 OP2 5 01/01/07 3 OP4 14 01/01/07 4 OP8 17 01/01/07 5 OP18 18 01/01/07 6 OP18 18 01/03/07 Alton House Version 5.2 Page 27 7 8 9 OP26 OP26 OP26 13 13 13 10 OP29 19 11 OP27 17 previous timescale 01/03/06 The registered person is required to provide new thermometers for the outside freezers. The registered person is required to ensure that accurate recording of freezer temperatures occurs. The first aid box needed further supplies of blue plasters. This is a repeated requirement, previous timescale 10/02/06 The registered person is required to ensure that a CRB or Pova first check is in place for every staff prior to commencing employment and that a current photograph is held on file. This is a twice repeated requirement Previous timescales given 24/10/05 and 10/02/06. The registered person is required to ensure that the rota is an accurate reflection of the duties performed by staff. This is a twice repeated requirement Previous timescales given 24/10/05 and 10/02/06. The registered person is required to ensure that care staffing levels are maintained. This is a repeated requirement Previous timescale given 10/02/06. The registered person is required to ensure that all staff attend training in health and safety, first aid, manual handling, dementia awareness, fire training and adult protection. This is a twice repeated requirement. Previous timescales given 1/12/05 and 01/03/06. It is required that dates be DS0000027828.V321305.R01.S.doc 01/01/07 01/01/07 01/01/07 01/01/07 01/01/07 12 OP27 18 01/01/07 13 OP30 18 01/03/07 14 OP30 18 01/03/07 Version 5.2 Page 28 Alton House 15 16 17 OP30 OP29 OP36 18 17 19 18 OP31 Care Standards Act 19 OP31 9 20 OP38 23 added to the training monitoring record to enable a fuller understanding of how often training is provided and updated for staff. The home is required to evidence a full induction for all newly employed staff. The registered person must be clear as to what constitutes a start date for employment. The registered person is required to supervise staff weekly who do not have a valid CRB and keep records of this. This is a repeated requirement. Previous timescale given 10/02/06. No one other than the registered manager must make statements to the effect that they are the manager or intentionally mislead people into believing that they are the manager of Alton House. It is required that Mrs Barrs undertake training in management and inform the commission of the date that she is enrolled to begin or that an application for the registration of a suitably qualified and experienced manager be submitted to the commission. This is a repeated requirement. Previous timescale given 1/03/06. The registered person is required to ensure that the building can be exited in line with fire requirements at all times. 01/02/07 01/01/07 01/01/07 01/01/07 31/01/07 20/12/06 Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP4 Good Practice Recommendations It is recommended that the home reviews its processes for the admission of self funding service users and brings them into line with those for Local Authority funded service users. It is strongly recommended that each service user have the opportunity of a trial stay of between one and three months. It is recommended that the home prominently display information on planned daily activities and special events to keep service users and their families informed. It is recommended that the home record in personnel files where it has not been possible top obtain a reference from the current or most recent employer and that this has been followed up, an alternative reference sought and a decision to employ despite this made on whatever grounds are relevant. In order to meet the national minimum standards more staff must undertake NVQ training. This is a repeated recommendation. The induction provided by the home is recommended to be further developed in line with the skills for care induction program. This is a repeated recommendation. In order to meet the national minimum standards supervisions should be held six times per year. This is a repeated recommendation. 2 3 4 OP5 OP12 OP29 5 OP30 6 OP30 7 OP36 Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Alton House DS0000027828.V321305.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!