Inspection on 03/08/05 for St Albans House

This inspection was carried out on 3rd August 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Albans House 24/09/08

St Albans House 18/09/06

St Albans House 06/12/05

St Albans House 06/12/04

St Albans House 18/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St. Albans House 12-13 The Grove, Deal Kent CT14 9TL Lead Inspector Joseph Harris Unannounced 03/08/2005 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 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. St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St Albans House Address 12-13 The Grove, Deal, Kent CT14 9TL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01304 374243 Deal Old Peoples Housing Society Limited Deborah Kim Harris Registered Care Home 19 Category(ies) of Old Age registration, with number of places St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 06/12/04 Brief Description of the Service: St Albans House is a 19 bedded residential home for older people. The service is set in a quiet residential area of Deal. Deal is a seaside town, which benefits from good amenities and public transport links. The town centre is approximately 1/2 mile from St Albans House. The home is set over three floors and comprises of spacious communal areas including lounges, a large dining room and a galley conservatory. All bedrooms are single occupancy and are well equipped and thoughtfully decorated. There a large gardens and car parking to the rear and side of the home. The home is owned by a charitable Housing Trust. St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 3rd August 2005 and lasted for approximately 5 hours. During the course of the inspection discussions took place with the Registered Manager, staff, service users and relatives. A variety of records and documentation were viewed including care plans, medication records, health and safety information, policies and procedures and staff records. A tour of the premises also took place. There is only 1 recommendation arising from the visit regarding additional information in risk assessments relating to the use of cot-sides. There was positive feedback from residents, relatives and staff about the home. Records were up to date and the home is well equipped, comfortable and homely. What the service does well: What has improved since the last inspection? St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 6 There have been some improvements since the last inspection and all previous requirements and recommendations have been actioned. The home now receives adequate CRB and POVA checks prior to any staff working unsupervised. Some improvements have been made to the environment and further upkeep is planned over the coming months dependant on funding. The home has also introduced an appeals process within the complaints procedure should any complainant be unsatisfied with the outcome of any internal investigations. 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. St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4. Service user’s needs are assessed prior to admission and they know that the service will be able to meet their needs. EVIDENCE: The home ensures that, prior to admission, adequate levels of information regarding the needs and wishes of each prospective service user is acquired. The home receives joint assessments and background information for service users referred through care management processes. Those privately referred are assessed by the home addressing holistic needs. The assessments form the basis of the care plan and risk assessments following admission into the home. The needs of all service users admitted to the home are catered for, including specialist needs. The home liaises with community healthcare professionals, where a need is identified, for advice, support and intervention as required. The needs of those with minority interests are considered and met where necessary. Staff are provided with the training and support to deliver effective care. St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10. Service users’ health and support needs are clearly set out in plans of care. Healthcare needs are met. Medication procedures are well maintained. Service users are treated with respect and dignity. EVIDENCE: Individual plans were viewed for two service users at random. The plans set out in sufficient detail the needs and aspirations of residents. Assessment tools are used to inform the care plans and a good level of detail is included in the plans. Guidelines are clearly set out to ensure that staff provide informed and consistent support. The plans are reviewed on a regular basis and changing needs are monitored with any alterations in the provision of care reflected. The plans are regularly reviewed and kept up to date. The home has a good risk assessment processes with clear management plans. Some additional risk assessments should be considered however, particularly where cot-sides are in use. Refer to recommendation 1. The healthcare needs of service users are monitored and addressed. It was reported that the home has developed positive relationships with local GPs and District Nurses who provide good levels of support. There is clear documentation demonstrating that health issues are identified and acted upon with advice from professionals. Pressure area care is planned appropriately St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 10 with advice as required. Service users are encouraged to remain physically active and have regular opportunities for exercise. All residents are registered with local GPs and receive input as needed. All complimentary healthcare needs are available such as chiropody and dentistry, etc. The medication records and storage facilities were assessed and are largely satisfactory. The registered manager identified the need for some additional work on storage facilities, such as a medicine fridge and plans are in place to address these issues. The home has adequate policies and procedures relating to medication and records were well maintained and up to date. Medicines were kept in an organised and systematic fashion and staff administering are provided with appropriate training. Service users are treated with respect and dignity by the staff in the home. One resident said that “all the staff are excellent here” and “we are all well cared for”. Personal care is provided in a sensitive and thoughtful manner with the needs of the individual as the primary concern. Residents are encouraged to be as autonomous as possible retaining independence and choice. There are no double rooms in the home. St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 14. Service users can maintain existing relationships with friends and family and are enabled to exercise choice and control over their lives. EVIDENCE: The home has a flexible and open approach to visiting times within reasonable boundaries. The registered manager was able to demonstrate where restrictions may apply to maintain the safety and health of residents, staff and visitors. An appeals process where restrictions have been applied has recently been established. Discussions were held with a number of relatives present who all provided positive feedback about the service as a whole. There is sufficient space to enable residents to meet visitors in private and comfortable surroundings. The staff and registered manager liaise well with relatives and significant others and have developed positive relationships. Service users, relatives and/or their representatives retain financial control of all personal accounts. The home does provide a safe keeping facility and maintains a good standard of record keeping. Information is provided by the home about external agencies and professional support as required. Residents are encouraged to bring their personal belongings with them and bedrooms showed evidence of this. The home also has an open access policy to confidential records in accordance with the Data Protection Act 1998. St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. The home has a clear and accessible complaints process and ensures that service users are protected from abuse. EVIDENCE: The home has a clear, comprehensive and accessible complaints procedure addressing all necessary issues. The registered manager aims to address any concerns or complaints in an informal manner in the first instance, but should this be unsatisfactory then there are formal processes to follow with an appeals process should this be required. A copy of the complaints procedure is displayed in the home and accessible. A record of complaints is maintained. The home has clear policies and procedures in place aimed at protecting service users from potential abuse and mistreatment. Systems are in place to record and document any incidence of abuse should it occur and procedures for reporting such incidents are also in place. The registered manager is aware of legislation and responsibilities regarding the Protection Of Vulnerable Adults. Staff are provided with guidance and training relating to adult protection and demonstrated good levels of awareness. Policies and procedures regarding service users finances are clear and adhered to. St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 24 and 26. The home is safe and well maintained with comfortable indoor and outdoor communal facilities. There are sufficient and adequately equipped lavatories and washing facilities. Resident’s rooms are well equipped, comfortable and homely. The home is clean and hygienic. EVIDENCE: A tour of the premises was undertaken and the home was found to be clean, hygienic and free from offensive odours. The environment was comfortable and well maintained offering a good range of communal space both indoors and outside. The registered manager stated that there are plans for improvements to the home, which have been costed, but due to the charitable nature of the organisation are dependent on funding. The home benefits from a good range of communal space including a large lounge and a galley-style conservatory. There is a large and accessible garden to the rear of the home, which is well maintained and attractive. There is an adequate number of toilets and washing facilities throughout the home and accessible to service users. There is the necessary equipment to ensure that service user needs can be met. All St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 14 bedrooms viewed were comfortable, well equipped and homely. Residents are able to bring personal possessions into the home with them and the service provides all additional furniture specific to the needs of the individual. The home is maintained to a good standard of cleanliness. Laundry and kitchen facilities are adequate for the needs of the home. The building meets the requirements of the fire and environmental health departments. Policies and procedures are in place for the control of infection and staff are provided with guidance on this topic through the induction process and additional training. St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29. There are sufficient numbers of staff on duty at all times and the home’s recruitment procedures are satisfactory. EVIDENCE: There is a minimum of two staff on duty at all times of the day and night with additional staff throughout the day. The registered manager is on duty generally during office and hours and a senior staff member is present at all times. The duty rota was up to date and accurately reflected the number of staff on duty at the time of the visit. A number of staff personnel files were viewed at random, which contained all relevant information including CRB checks, two written references and proof of identification. Staff do not commence unsupervised work prior to the home receiving satisfactory checks including POVA clearance. St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35 and 38. The registered manager is suitably qualified and experienced and has developed a positive ethos within the service. The home is run in the best interests of the residents. There is an adequate staff supervision system in place. The health, safety and welfare requirements of the home are ensured. EVIDENCE: The registered manager has been in post for a number of years and has suitable levels of qualification and experience including her NVQ level 4 and Registered Managers Award. She continues to participate in additional training to maintain her skills. There are clear lines of accountability within the home and she demonstrates good leadership skills. Furthermore staff commented that they feel supported and included in the running of the home. Staff, service users and relatives spoke of the friendly and positive atmosphere in the home generated by the staff team and the management of the service. St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 17 There are quality assurance systems in place. A representative of the Housing Society visits the home on a monthly basis and prepares a written report covering staff and service user views, maintenance issues and record keeping. Policies and procedures and other documentation relating to the service is regularly reviewed and an annual development plan is in place. The health, safety and welfare issues of the home are adequately addressed. Staff receive induction and mandatory training within appropriate time frames. Documentation was examined relating to health and safety and was maintained adequately with all necessary checks and routine maintenance completed. Environmental risk assessments are in place and the fire and accident books are up to date. St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 3 3 x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x 3 x x 3 St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 19 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 Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations To ensure risk assessments are developed where cot-sides are in use. St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 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 St. Albans House H56-H05 S23276 St Albans House V242141 030805 Stage 4.doc Version 1.40 Page 21 - 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. 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