Inspection on 20/02/07 for Alyson House

This inspection was carried out on 20th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alyson House 20/11/08

Alyson House 15/11/05

Alyson House 21/06/05

Alyson House 09/11/04

Alyson House 03/06/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Alyson House 11 Cobham Road Westcliff On Sea Essex SS0 8EG Lead Inspector Diane Roberts Unannounced Inspection 20th February 2007 09:30 Alyson House DS0000015416.V333658.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 Alyson House DS0000015416.V333658.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. Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alyson House Address 11 Cobham Road Westcliff On Sea Essex SS0 8EG 01702 345566 01702 345566 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) Mr Eric Tang Mrs May Ying Tang Mrs May Ying Tang Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2005 Brief Description of the Service: Alyson House is large detached property, which was adapted and upgraded for its current use seven years ago. Some original features of the property have been maintained. The home is decorated and equipped to a high standard. The property is situated close to Southend seafront and close to local amenities. There are good public transport links nearby. Alyson House is registered to provide care for eight service users who have a learning disability. Service users living at the home are mostly over fifty years of age with two residents over 65 years of age. Accommodation for service users is provided on two floors, accessible by a shaft lift. The home provides all single bedrooms, all but one of these have an en-suite facility. Service users are encouraged to use community and day care facilities. The home has a paved garden area and some parking is available to the front of the building. The home has their own website at www.alysonhouse.co.uk. A service users guide is available and the current rates are - £600.00 to £800.00 per week. Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over five hours and was carried out as part of the annual inspection programme for this home. The registered proprietors/ manager were available throughout the inspection. The home currently has two empty beds but referrals are currently being followed up. The inspection focused upon all of the key standards. A partial tour of the premises was undertaken. Evidence was also taken from the Pre Inspection Questionnaire completed by the home and submitted to the CSCI. Some of the residents were out of the home on the day of the inspection. It was possible to meet residents and staff and speak to a representative from Mencap, who knows the home well. Residents, relatives, visitors and staff have completed feedback sheets. Comments from these were taken into account when writing the report. What the service does well: What has improved since the last inspection? What they could do better: Whilst the management team provide a good level of training overall, fire safety training could be better. The process of reviewing care plans should be dated and planned for. Evidence of consultation with residents could be developed further. Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 6 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. Alyson House DS0000015416.V333658.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 Alyson House DS0000015416.V333658.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are individually assessed prior to admission to ensure that their needs will be met. EVIDENCE: There have been no new admissions to the home since the last inspection. The manager has updated the pre admission assessment forms since the last inspection and the content was seen to be sound and covered all the required areas. As the manager is introducing person centred care planning into the home it is recommended that this document be reviewed with this in mind, so it links in. The assessment may benefit from including more personal preferences and identifying strengths and abilities and personal goals for the future. Prospective residents come to the home for visits, often several times, depending on the resident, as there is no fixed policy. From records and discussion it is clear that the admission is very resident orientated. The proprietors see Alyson House as a home for life and would look continue to care for their residents after the age of 65 if they could continue to meet their needs. Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 9 Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 10 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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good care planning system in place that is developing positively and increasingly towards a person centred approach. EVIDENCE: The home has a detailed care planning system in place, which gives a comprehensive picture of the resident and their personal/care needs and wishes. The manager is in the process of introducing person centred care planning into the home and this is developing well. Care plans evidence that the team at the home are very resident led and that their wishes and preferences are taken into account. The team records a good personal family and social history and obviously know the residents well in relation to this and how it may affect their daily lives. Throughout the care plan there is evidence that residents personal preferences and choices are known and acknowledged by the staff team and these relate to a wide range Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 11 of daily life including, washing, dressing, hobbies/spending time in the home, type of people and social situations the resident prefers etc. Risk assessments were seen to be in place for all the appropriate needs as identified in the assessment process. Where needed, specific behaviours are monitored and records show that staff are clear as to the reasons why people may behave in a certain way. This helps to ensue that resident’s care is appropriate and individual. Dates are needed on many of the records in order to evidence a thorough review process. It was also noted that after placement reviews, the care plans had not always been updated and this needs to improve. This was discussed with the manager. Whilst it is clear from the level of information in the care plan, that the resident has been consulted, actually signing or written evidence is not available – ways to increase this were discussed with the manager. Records show that the manager communicates with relatives, where required, on a regular basis so that they are kept up to date with how the resident is. Placement reviews are held and records show that family and key people are invited. Reviews were seen to be very positive and indicated how the resident had improved their abilities since being at the home. Both residents and relatives who commented were very positive about the home and the services offered. Detailed daily notes kept on residents and how they have spent their time etc. These showed activities in house, escorts to external activities and general mood and behaviour and the involvement and level of input with persona care. The level of recording is good. Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 12 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 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a range of appropriate activities; both within the home and the local community and residents are encouraged to develop their independent living skills. EVIDENCE: Care plans evidence that residents undertake a wide range of social and developmental activities. These are resident led and the amount/type depends on the age and abilities of the resident. Some residents in the home are elderly and are restricted in the amount they are able to do. Records show that residents attend local day centres, attend local churches, go to evening clubs, the pub and other community facilities. At the current time none of the residents attend college or take part in paid employment and the manager states that this is due to resident ability, choice and the courses/work offered. Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 13 In house, residents take part in daily living tasks and are encouraged to develop skills and independence in these areas. Some residents take part in cooking and baking and the kitchen has a good relaxed homely atmosphere in which to promote this. Residents enjoy listening to music, watching the tv and films and many have their own hobbies which are evident in their rooms. Records show that a reflexologist visits some residents at the home. Food provided at the home was seen, from records to be nutritionally sound and varied. The manager reports that menus have been put in place with residents input. There are very good picture menus available, which manager has been implementing and all the resident’s use and she plans to extend these further. A healthy diet is promoted including fruit smoothies for breakfast and the menu shows that choice is available. Only fresh vegetables are used. Residents also like to eat out at local restaurants and bring home fish and chips. Packed lunches are provided for those attending day centres and residents preferences for these and other meals are available for staff to refer to. Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 14 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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ personal and healthcare needs are being managed effectively with their choices being taken into account. EVIDENCE: The care planning system records residents daily routines which are flexible and do change if required or based on residents choice. Within the routine residents personal choices and preferences are evident and these include choices regarding the provision of personal care. Records within the care planning system evidence that resident’s health needs are attended to in a proactive way and the appropriate referrals are made. Records indicated that a detailed approach is taken with regard, to example, the cleaning of residents’ teeth to promote good gum health. Records showed evidence that residents were keeping hospital appointments and that the staff team were following up on any advice or guidance given. Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 15 Records show that where appropriate residents’ weights are being monitored consistently and that any issues are referred to the local dietetic service and advice is put into practice. Medication systems at the home were inspected and found to be maintained in good order. Either the residents GP or the local learning disability consultant carries out reviews. A medication policy is in place but this was just available on the manager’s computer. It is recommended that a printed copy is available for staff and that a review of the policy is undertaken in relation to the retention of medication and dealing with medication for residents spending time away from the home. A clear homely remedies policy is in place. Good stock control and returns were noted. Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 16 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has systems in place, which ensure that residents’ views are listened to and acted upon. The home has systems in place, which help to ensure to ensure that residents are protected from abuse. EVIDENCE: The manager has a complaints procedure in place, which is clear and meets the required standards. This is available to residents in the Service Users Guide and is explained to them by staff. The procedure is not currently displayed in the home, but relatives who commented said that they were aware of how to raise any concerns. Records show that residents have raised 2 concerns since the last inspection. These had been dealt with promptly and with the residents’ interests put first. Where required the manager had taken action to ensure matters were dealt appropriately. One related to personal care and other to meal provision. It is clear that residents feel comfortable to raise concerns. The manager should review the complaints procedure in relation to format, as it may be more suitable to consider other methods of communication such makaton or a pictorial format. The manager has a comprehensive adult protection policy and procedures in place, which includes local guidance and information from placing authorities. Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 17 Training records submitted show that the majority of staff have been trained in adult protection and staff feedback forms confirmed this along with the staff feeling competent to deal with any concerns relating to this subject. Advocacy services are available, although no residents are accessing these at the current time. In the past the manager reports that advocates have been used. The home has also used local Mencap services for residents and it was possible to speak to one of their representatives who visited a resident regularly at the home until recently. They spoke very positively about the home, saying that they were made welcome, the staff were very good and they felt that the residents needs were being met. They also felt that the team at the home communicated well with them about any issues. Records show that relatives felt that residents were better at raising their views since being at this home and that is made them feel more reassured. Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 18 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good quality accommodation, which is homely, clean and safe. EVIDENCE: A partial tour of the home was undertaken. Standards of furnishings and décor were seen to be very good. New bedroom furniture was being delivered on the day of the inspection for one room. The home was very clean and no odours were noted. The bedrooms seen were of a good size, bright, airy and the residents had personalised them. Where appropriate, communication systems were being use to help residents with their daily living skills/activities. The home has a small hard standing area to the rear of the house, which during the summer months is brightened with planted pots and furniture. The Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 19 home is situated close to the seafront and gardens and the residents are encouraged to visit this area. An up to date fire risk assessment was seen to be in place and all other fire safety related documentation was in good order. Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 20 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 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels and skill mix were appropriate to meet the needs of the current residents. The manager has generally sound recruitment process in place but needs to tighten up some aspects. A good level of staff training is provided by the management team which helps staff to provide a knowledge based care service. EVIDENCE: The home has a stable group of staff and no agency staff are used at the current time. The manager provides three staff during the day and 2 at night, one of which is asleep. The manager reviews these levels in relation to resident dependency and in relation to activities or events that residents’ may be attending. Both proprietors have a very hands on approach in the home, working a range of shifts. The manager has recently completed a workforce and development plan. Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 21 Staff recruitment procedures were inspected and staff files reviewed at random. An employment checklist in place, all the required checks and documentation were seen to be in place, including POVA first and CRB. It was noted from dates on the records that the manager needs to be prompt when applying for POVA first/CRB checks, although staff are shadowed until results are received. The management team are very proactive with regards to staff training and ensure that staff have both statutory training such as health and safety and additional training, which would positively affect outcomes for residents. For example, records show that staff have been trained on managing epilepsy, basic makaton, and a range of general care related subjects that relate to both the care of people with a learning disability and the elderly. Training records submitted showed that only 75 of staff had up to date fire safety training in place. This shortfall should be addressed. Whilst some of the staff have NVQ qualifications, the majority of the staff are currently undertaking them. This should help the team to reach the 50 standard during 2007. It was noted that booking forms had been sent off for places on continence promotion courses, risk management and epilepsy. An induction programme linked to Skill for Care is available for new staff starting work at the home. Records show that some staff are currently completing this. Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 22 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 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and this is reflected in positive outcomes for residents in relation to health and safety and consultation. EVIDENCE: The proprietors/manager have a very hands on approach in the home. From discussion it is clear that they are committed to providing a good level of service and facilities for their residents. Records show that they regularly review business and recording systems in the home and have a proactive approach to staff training and development. The management team have a quality assurance system in place primarily based on satisfaction questionnaires. Questionnaires were last sent out in Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 23 July 2006 and from records, the response rate was seen to be good. Overall, residents, staff and visitors/relatives were happy with the facilities and services at the home. From the records submitted, it is clear that residents are comfortable to raise any concerns but the manager needs to develop her action plans, following results, to evidence that issues, lower scores or comments have been addressed. Development of the quality assurance programme was discussed with the manager with regard to internal audit of their business and recording systems etc. The manager says that at the current time she does not hold residents meetings due to their abilities to take part in a group discussion. However more thought should be given to evidencing, where possible, residents input into the running of the home and their choices and opinions on events and developments. This may be done on an individual basis as with the satisfaction questionnaires. The management team have a health and safety policy in place. A health and safety audit of the premises was undertaken in July 2006 and this was seen to be comprehensive. Consideration should be given to developing safe working practice risk assessments. Accident records were inspected. There is a very low incident of accidents as staff ratio is quite high and records shows that issues with mobility have been addressed proactively. Training records for staff show that all staff have received first aid training. A high number of staff have also received training in health and safety and fire safety. Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 24 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 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 Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 25 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 YA6 Regulation 15 Requirement The registered person must keep the care plan under review and where possible involve residents with their care plan. The registered person must make arrangements for person working at the home to receive suitable training in fire prevention. Timescale for action 30/04/07 2. YA35 23 (4) d 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA2 YA20 YA22 YA39 Good Practice Recommendations The registered person should review the pre-admission assessment so that it links into the person centred care planning system. The registered person should review the medication policy/procedure and make it available to staff. The registered person should give consideration to providing alternative formats for the complaints procedure. The registered person should further develop the quality assurance system in relation to resident consultation and action plans. DS0000015416.V333658.R01.S.doc Version 5.2 Page 26 Alyson House Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Alyson House DS0000015416.V333658.R01.S.doc Version 5.2 Page 27 - 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!