Inspection on 05/11/07 for Alton House

This inspection was carried out on 5th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Alton House 09/06/08

Alton House 15/05/07

Alton House 23/11/06

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 Harbinder Ghir Unannounced Inspection 9:55 5 & 6th November 2007 th 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.V354154.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.V354154.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 altonhouse@btconnect.com Mr Frank Barrs Mrs Patricia Lilian Barrs Jacqueline Ann Mitchell Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Alton House DS0000027828.V354154.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. 15th May 2007 Date of last inspection Brief Description of the Service: Alton House is a privately owned care home registered to provide care and support to 19 older people. 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. The property has two separate lounges and 19 single bedrooms, 17 of which have en-suite facilities. As informed by the current registered manager of the home, the ranges of fees charged by the service are from £416 to £460 per week. Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the 2nd key unannounced inspection for the service since the 15th May 2007 the last inspection, undertaken by Regulation Inspector Harbinder Ghir. The inspection took place on the 5thth and 6th November 2007, the registered manager was available throughout the second day of the inspection. The proprietor used consultant advisors in an attempt to meet the requirements made at the last inspection. During the inspection the inspector was able to talk to the residents residing at the home, staff and relatives who were visiting during the inspection As part of the inspection the inspector toured the home, read records of people who use the service and examined documents in relation to the management of the home. At the end of the inspection the inspector was able to provide feedback to the manager. A completed Annual Quality Assurance Assessment by the registered manager was received by the Commission for Social Care Inspection prior to the inspection. The inspector would like to thank everyone involved in the inspection process. What the service does well: What has improved since the last inspection? At the last key inspection 21 requirements were made in the following areas; pre-admission assessments; the availability of the service user guide; residents or their representatives signing the contract; reviewing of residents’ mental health needs; medication practices; recording of residents’ wishes in Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 6 the event of death, health and safety, staff training; infection control; reviewing of staffing levels; recruitment practices; registration of a suitably qualified manager. At this inspection 20 of these requirements had been complied with. I was pleased to see that these requirements had been complied with at this inspection, and that there is evidence of some improvement since the last inspection. However, one requirement has not been met within its timescale and will be repeated at this 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. The summary of this inspection report can be made available in other formats on request. Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 7 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.V354154.R01.S.doc Version 5.2 Page 8 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, 6 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Pre-admission assessments are completed by the service, but these need to be completed more comprehensively to ensure the needs of prospective residents are met. Not all residents are issued with a written contract or statement of terms and conditions, to ensure they are in agreement with the services provided by the home. Trial visits are offered to all prospective residents and families and representatives can also visit the home, to ensure they have information on the services and facilities provided by the service. The service does not provide intermediate care. EVIDENCE: Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 9 The Service User Guide is now placed in all residents’ bedrooms. The document has been devised in text format but also includes photographs of staff at the home, residents and entertainment, which has taken place. However, the document does not include details of the qualifications of the registered manager or the staff at the home. The document refers to the service providing End of Life Care; holding regular relative and client meetings and that residents are given assistance to meet their religious needs. The complaints procedure refers to the home as Abbey Care. This is an inaccurate reflection of the services currently provided at the home as no evidence during the inspection was found of the above events taking place, which will be discussed in more detail throughout the report. The Statement of Purpose has also been updated by the service provider. However, the document does not include the details of Mr Frank Barrs who is also the registered provider of the home, or the number and relevant qualifications and experiences of the staff working at the home. The document makes reference to 50 of the staff team achieving their NVQ qualification, again making reference to providing the above services such as End of Life Care, holding regular client meeting and meeting religious needs. The document states “Arrangements will be made with the pastor of their choice for volunteers to escort them to services.” The findings during the inspection does not find evidence that the information provided in both documents is an accurate reflection of the service. It is Requirement 1 that both documents are amended to provide the correct information required by the Care Homes Regulations and that the information content is a true reflection of the actual services provided by the home. This is Requirement 1. The service has introduced a new pre-admission assessment form, which has not yet been used. The new format is comprehensive and allows the assessor to include more information on the assessment taking place. Three preadmission assessments were closely examined for residents that have been admitted since the last inspection on the 15th May 2007. Pre-admission assessments are taking place but the information on the assessment is very basic and does not provide in-depth information on the needs of prospective residents. Limited information was recorded which was not personalised to the individual or included information on the concerns and anxieties of the prospective resident or their families. The assessments viewed contained ‘yes’ and ‘no’ answers and did not further elaborate in detail on the needs identified. It is Requirement 2 that comprehensive pre-admission assessments are completed for all residents, to ensure adequate information is obtained on the needs of residents. On the admissions viewed the service had obtained care management assessments and care plans from local authorities and health services for residents who were funded by the local authority before they were admitted to the home. Pre-admission assessments were also completed for self-funding residents. Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 10 The contract of statement of terms and conditions was requested to be inspected for the three residents that had been recently admitted. Only one signed contract was viewed, the remaining two contracts had not been issued. All residents must be issued with a contract of statement of terms and conditions within 48 hours of admittance and must be signed by the resident or their family or representative and the home to ensure all parties are in agreement to the services to be provided. This will be stated as Requirement 3. Trial visits are offered to all prospective residents and their relatives and representatives are also invited to visit the home. A relative spoken to stated “I visited the home on my mothers behalf and was provided with the necessary information.” Residents are offered the opportunity to move in on a trial basis to ensure they are happy with care and facilities provided by the service. Residents and relatives spoken generally spoke positively about the care provided at the home. One relative stated, “The staff and the manager are nice and they are helpful, they always keep me updated.” A resident spoken to informed “The staff are very friendly.” Another relative spoken to informed “Most staff are caring, they always contact me if need be.” Alton House DS0000027828.V354154.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, 11 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are set out in individual care plans. Care plans are detailed, but need to ensure all the information in the document is consistently implemented in the day-to-day care of residents and is correct to ensure the needs of residents can be met effectively. Residents receive personal support and care in the way they prefer and require. Risk assessments must be completed in detail to ensure all risk areas are identified and minimised, to ensure the safety of staff and residents. Medication practices always ensure the safety of people who use the service. The ageing, illness and death of service users are handled with respect and as the individual would wish. Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 12 EVIDENCE: The service has introduced a new care plan format, which is easy to follow and understand, covering the physical, mental, emotional, dietary, medical and communication needs of residents. It was good to see that care plans identified personal preferences of what times residents wanted to go to bed and get up and their likes and dislikes of foods. However, on the close examination of four care plans, it was disappointing to find inconsistent information throughout the documents. One resident’s care management assessment completed by the funding local authority stated, “X eats well but requires prompting as his intake can be poor. The nutritional screening assessment completed by Alton House also identified that X has a “poor intake, managing less than half of his meals.” On viewing the daily care plan devised by the home, the information recorded under diet stated, “X has a good appetite.” Monthly weight checks had also not been completed for the resident even though there were clear identified concerns with the resident’s nutrition intake. For another resident their pre-admission assessment recorded that they had a history of falls. But on viewing the personal resident risk assessment, the information stated there was no history of falls, but on viewing the falls risk assessment the information stated “special assistance is required”. For another resident the deputy manager of the home stated that Y sleeps in her chair at night in her room and needs encouragement to go to bed. On viewing the resident’s care plans; these needs and concerns had not been identified. Information regarding the personal care needs of residents was also not recorded in detail, for example whether one required shaving, the assistance of one or two carers. It is Requirement 4 that residents’ health, personal and social care needs are accurately set out in detail in their care plan to ensure staff are provided with the correct information to meet the needs of residents. Risk assessments viewed were completed covering manual handling, mental health, physical health and pressure sores. However, although risks were identified posed to residents, very little information could be found in regards to how these risks were to be managed and minimised by the service. Daily case recording evidenced that one resident since being admitted to the home had become aggressive and abusive to towards staff. A risk assessment had not been completed to inform staff of how the service was to manage the risks posed to them and other residents at the home. It is imperative that risk assessments are completed comprehensively and are updated with the changing needs of residents to ensure their safety. This will be stated as Requirement 5. All care plans viewed contained information on the wishes of residents in the event of death and the contact details of relatives and representatives where appropriate. The service is planning to introduce the end of life tools to further Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 13 identify the wishes is residents. The scheme focuses on agreed practices to support people when they are terminally ill or who are at the end of their life. The main premise of this is to involve the resident and establish their needs and wishes and to ensure these are met by the service. The deputy manager has completed the training and the registered manager is to commence hers. There was evidence that the health needs of residents are monitored and appropriate action and intervention is taken. Health records indicated other health professionals such as the district nurse, optical, dental and chiropody services saw residents. Various healthcare professionals were also seen to visit residents throughout the time of the inspection. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication administration records (MAR) were closely examined. Medication records are fully completed, contained required entries, and are signed by appropriate staff. An audit trail of two medications was checked against the medication administration record, which was found to be in order. The home uses the blister pack system to administer medication to its residents. The accident and incident book was reviewed. Accidents were recorded in full and regulation 37 forms were completed and sent to the Commission for Social Care Inspection promptly where appropriate. However, residents were not checked after their accident and follow up sheets were not completed for residents to ensure there were no further health associated risks posed to them. The requirement in relation to the above findings will be stated as Requirement 6. The registered manager did inform and showed the inspector a new form which they had devised and were going to use to record follow up checks for any future incidents. Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Limited social activities are arranged at the home and do not meet the needs of people who use the service. The meals in the home do offer variety and choice, but further reviews need to take place to ensure all residents are happy with the meals they are provided, to ensure their needs are being met. EVIDENCE: The service’s Statement of Purpose states “Clients coming into Alton House will be actively encouraged to continue with any hobbies or interests that they had before admission to the home. Any client, who wished to continue going to clubs or other outside activities, will have arrangements for transport made for them.” There was very little evidence found at the inspection to demonstrate this. For one resident who on their life history as part of the pre-admission assessment process stated that they like to listen to talking tapes, is a church goer and likes music. On viewing their care plan under social activities, no Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 15 social activities had been identified. There was no evidence in the daily case recording notes that her religious needs had been met by the home arranging for her to go church or a church service being provided at the home. The home did have an activities programme displayed in text format in the front foyer of the home, which consisted of activities such as puzzles, music, exercise, cards, dominos and bingo. The service also has an activities profile for each resident and lists the activities they have participated in which included the indoor activities listed on the timetable. However, on speaking to residents and relatives they all commented negatively on the number and range of activities offered at the home. One resident stated, “There are not much activities done here, staff really don’t come round and ask if people if they want to go out.” Another relative spoken to stated, “I visit up to three times a week and I have never seen them do a sing along here. They don’t go out much here or even sit in the garden.” Another resident spoken to informed, “We never go out, we haven’t got enough staff.” Residents who have family go out, as their relatives take them out.” Another relative spoken to about activities stated, “They don’t do anything here, the residents just sit there all day, they definitely need to do more for residents.” Residents were observed to be sleeping in their chairs on and off throughout the day of the inspection due to a lack of social interaction and stimulation within the home. The records further evidenced that no outdoor activities were provided at the home. The service must review its activities programme within the home and consult residents about their social interests, and make arrangements to enable them to engage in local, social and community activities of their choice. This will be stated as Requirement 7. The menu was seen which consisted of a choice of two hot meals at lunch and at teatime and variety of snacks and drinks throughout the day. There was plenty of fresh and frozen food available. Records were seen of residents’ choices of meals for each day that they had chosen when consulted with by the cook, who was seen in the morning of the inspection going round to each resident informing them of the choices available. On speaking to the cook she was able to demonstrate her knowledge of those residents requiring special diets, for example diabetic and pureed diets. The inspector joined residents at lunchtime and talked about the meals provided at the home with residents. Condiments were placed at each table and drinks were available throughout the mealtime. Three residents spoken to all commented negatively on the meals provided at the home. The menu choice on the day was beef stew with dumplings and vegetables and the alternative was sausages with vegetables. One resident stated, “I don’t like the meals here. Another resident stated, “I’ve had better meals.” Another resident who had chosen the alternative of sausages and vegetables stated that he wasn’t going to eat his food as he found it “too chewy.” He also commented that he didn’t want to ask for an alternative. Another resident was seen picking the meat off her plate and putting it aside as she stated that the meat was too Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 16 hard. The service must ensure the dietary needs of all residents are reviewed and are met to ensure that residents’ dietary needs are catered. This is Requirement 8. Further improvements to the formats of menus and the activities programme would also benefit residents. These were displayed in a very small font and text format, which were not appropriate to the communication needs of residents, as some residents within the home are partially sighted. A relative spoken to stated, “My mother always looks for a board for the menu as this is what they did at the last home she was in, that would be something the home should definitely provide here.” It is Recommendation 1 that the activity timetable and the menu is displayed in the home where it is accessible and suitable to the communication needs of all residents living at the home. Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 17 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 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users cannot always be assured their views are listened to and acted on. However, the service needs to broaden its way of recording complaints to include concerns to ensure any dissatisfaction is recorded and acted upon regardless of source. Staff have received up to date training in safeguarding adults, which ensures the protection of residents. EVIDENCE: The complaints procedure is clear and easy to follow. Timescales within which a complaint would be investigated were stated on the complaints procedure and included the contact details for the Commission for Social Care Inspection. A complaints logbook is kept by the home, which was viewed. There were no recent written formal complaints logged. The Commission for Social Care Inspection has not been informed of any complaints. However, evidence was not seen of verbal concerns recorded by the service or how they are actioned. On speaking to a resident at the home, he informed that he has verbally told staff that he cannot watch TV in his room as he does not have an aerial and also does not have an armchair to sit on. On tracking these concerns no Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 18 evidence was found that they had been recorded or actioned. It is Requirement 9 that all concerns about the care of service users, regardless of source or how they are made, are recorded and responded to. Since the last inspection staff have attend POVA training and safeguarding adult policies are comprehensively covered in the induction programme. The service has comprehensive safeguarding adults procedures and protocols in place. The service has obtained safeguarding adult protection procedures devised by The London Borough of Havering. Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 19 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 People using the service receive adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable environment but further improvement to the décor of the home would enhance residents living environment. EVIDENCE: The inspector undertook a tour of the building, which identified that the general environment of the home was looking tired and dull. The home overall would benefit from a programme to improve the decoration of the building, which has been devised by the service. Residents’ bedrooms were seen, which were comfortable with adequate furnishings and were also personalised by residents with personal family photos and furniture. However, on speaking to one resident he informed that he has “not been provided with an armchair in his room” which really concerned him. On speaking to the manager of the Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 20 home she had acknowledged that the service had not yet done anything about it. It is Requirement 10 that adequate furniture in rooms occupied but residents is provided where in need and necessary. All rooms were lockable and can be overridden by staff in an emergency. The service has improved its signage throughout the home. All toilets are clearly labelled and residents bedrooms are now have a door number and picture of the resident displayed on their bedroom door. On touring the kitchen, fridge and freezer temperatures were taken daily. However food was not correctly labelled with date of opening and foods were not stored in airtight containers. Food temperatures were also not taken before it was served. Residents on the arrival of their food at lunchtime complained that the food was too hot. Staff were also telling residents to be careful as it “was hot.” A requirement in relation to the findings will be stated as Requirement 11. Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 21 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 People using the service receive adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The numbers of staff on duty does not always meet residents’ needs. Recruitment practices are robust to ensure residents are in safe hands at all times. Adequate staff training is provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. EVIDENCE: At the last inspection a requirement was made that the registered person reviews it staffing complement to ensure there are adequate numbers of staff on duty to meet the needs of residents. Although the staffing complement has been reviewed and evidence was seen of the service advertising for an afternoon cook at the local employment centre, no increases in staff levels have been provided during peak hours. There are currently two care members of staff on duty during the mornings, afternoon and two waking night staff. There is a cook on site working from 7.30am to 1pm who cooks breakfast and lunch. The two carers on duty in the afternoon have responsibility for preparing tea and to complete further cleaning duties in the kitchen. This leaves one Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 22 member of staff on duty to care for 18 residents, which is not sufficient. During the inspection members of staff were observed to be rushing around throughout the day and were clearly unable to meet the needs of all residents. The low staffing levels have also had a direct impact on the limited number of social activities provided at the home as residents spoken to all commented negatively about their opportunities to go and get involved in the community. They felt there were not enough staff on duty to support them to go out. There requirement made at the last inspection in relation to staffing levels will be repeated as Requirement 12 at this inspection. On viewing the staff rota it did not include the full names of staff on duty and the manager was also on the rota but was actually on annual leave. It is Recommendation 2 that the staff rota is an accurate reflection of the members of staff on duty to ensure the protection of residents. Since the last inspection the service has been very proactive in organising training for its staff team. Evidence seen of staff certificates and a training programme for the coming months included training provided in Manual Handling, Dementia, First Aid, Food Hygiene, Fire Safety, Safeguarding Adults, Health and Safety, Infection Control, Medication and Nutrition. The deputy manager has completed her training in the End of Life Care and the registered manager is in the process of commencing this training. The service has introduced a new induction programme for all new staff, which is comprehensive. The staff team do not meet a ratio of 50 of NVQ qualified staff but the service has enrolled two further members of staff on the course since the last inspection. The service is commended for it positive action to meet the requirement from the last inspection set in regards to providing training to its staff team to ensure they are equipped with the skills and competences to meet the needs of people who use the service. Three staff files were closely examined, which were all in good order. References and Criminals Records Bureau checks had been obtained for all three members of staff. Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 People using the service receive adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users can be confident that the staff team who care for them benefit from regular supervision. Service users’ financial interests are safeguarded. The systems for service user consultation have been introduced, to ensure residents’ views are acted on. The health and safety of staff and residents is promoted by the home’s policies and procedures. EVIDENCE: Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 24 Since the last inspection the service has recruited its deputy manager as the homes manager who has registered with the Commission for Social Care Inspection. She has completed a City and Guilds qualification in Advanced Management Care and is also in the process of achieving her Registered Managers Award. Through discussion and observation it was evident that the manager has the qualities and experience necessary to manage the home. The Commission for Social Care Inspection received a completed Annual Quality Assurance Assessment completed the registered manager. However, the detail and content of the information provided was not an adequate reflection of the service provided at the home. The service has now devised quality assurance surveys for residents and relatives and any stakeholders in contact with the home. These surveys are in the process of being sent out and completed with residents. The standard will be fully tested at the next inspection to see how the results have been collated and compiled and how any dissatisfactions with the service have been actioned. The home does not currently hold residents meetings, which would be a good opportunity for residents to express their views on the running of the home. The manager informed that they are in process of organising residents’ and relatives meetings. A recommendation was made at the last inspection, which will be repeated at this inspection. This will be stated as Recommendation 3. Services users’ records of finances were viewed and the inspector tracked the amount of money the service held for three service users. All amounts were accounted correctly and were in order. Staff supervision records evidenced that staff were supervised at least six times a year. However, on viewing the records sufficient supervision notes were not recorded to reflect the training needs they have, any concerns they may have or any practice issues that needed to be addressed, although new supervision and performance indicators are being developed for staff, which the inspector saw evidence of. It is Recommendation 4 that supervision records are taken in sufficient details to reflect that staff are competent to meet the needs of people who use the service. Health and Safety records were inspected. All documentation was in order and appropriately completed. Fire drills were completed regularly. Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 25 Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 26 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 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 3 3 3 3 2 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 2 x 3 Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 27 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 4, 5 Schedule 1 Requirement The registered persons must ensure that the Statement of Purpose and the Service User Guide are amended to provide the correct information required by the Care Homes Regulations and that the information content is a true reflection of the actual services provided by the home. The registered persons must ensure that comprehensive preadmission assessments are completed for all residents, to ensure adequate information is obtained on the needs of residents. Timescale for action 31/03/08 2 OP3 14 31/03/08 3 OP2 Schedule 3, 5 The registered persons must ensure that all residents must be issued with a contract of statement of terms and conditions within 48 hours of admittance and must be signed by the resident or their family or representative and the home to ensure all parties are in agreement to the services to be DS0000027828.V354154.R01.S.doc 31/12/07 Alton House Version 5.2 Page 28 4 OP7 15 provided. The registered persons must ensure that residents’ health, personal and social care needs are accurately set out in detail in their care plan to ensure staff are provided with the correct information to meet the needs of residents. The registered persons must ensure that risk assessments are completed comprehensively and are updated with the changing needs of residents to ensure their safety. 31/01/08 5 OP8 13 4 (b) (c) 30/01/08 6 OP7 OP8 12 17 13 7 OP12 OP13 OP14 16 (m) 8. OP15 16 (i) 9 OP16 22 (3) (4) The registered persons must demonstrate that following an accident in the home, residents are checked after their accident and follow up sheets are completed to ensure there were no further health associated risks posed to them. The registered persons must review its activities programme within the home and consult residents about their social interests, and make arrangements to enable them to engage in local, social and community activities of their choice. The registered persons must ensure the dietary needs of all residents are reviewed and are met to ensure that residents’ dietary needs are catered for. The registered persons must ensure that all concerns about the care of service users, regardless of source or how they are made, are recorded and responded to. DS0000027828.V354154.R01.S.doc 31/01/08 31/01/08 31/03/08 31/12/07 Alton House Version 5.2 Page 29 10 OP24 16 ( c) 11 OP26 The registered persons must 31/01/08 ensure that adequate furniture in rooms occupied by residents is provided where in need and necessary. 13 (4) ( c) The registered persons must 31/12/07 ensure unnecessary risks to the health and safety of service users are identified and so far a possible eliminate. 18 The registered person must 31/12/07 review its staffing complement to ensure there are adequate staffing numbers to meet the needs of residents. Repeated Requirement. Timescale of 31/08/07 12 OP27 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 OP24 Good Practice Recommendations It is recommended that the activity timetable and the menu are displayed in the home where it is accessible and suitable to the communication needs of all residents living at the home. It is recommended that the staff rota is an accurate reflection of the members of staff on duty to ensure the protection of residents. It is recommended that the service consider holding residents meetings, which would be a good opportunity for residents to express their views on the running of the home. It is recommended that supervision records are taken in sufficient details to reflect that staff are competent to meet the needs of people who use the service. 2 OP27 3 OP33 4 OP36 Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 30 Alton House DS0000027828.V354154.R01.S.doc Version 5.2 Page 31 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.V354154.R01.S.doc Version 5.2 Page 32 - 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!