Care Home: Albany House

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What the care home does well People living in the home are given written information regarding all of the care and services provided in the home, which helps them to understand the support they can expect. New residents are fully assessed before moving in and have well written care plans in place which also include using pictures to help residents understand them. They are supported to make decisions affecting their day-to-day life and risk assessments in place help them to be more independent. Good food is provided and the residents help to buy it and to cook it People living in the home receive appropriate support from health care professionals, and the staff know how to help them and provide good safe Albany House DS0000071411.V376354.R01.S.doc Version 5.2 personal care support. Residents said that they are happy at the home, the staff are nice and very helpful, and that there are lots of activities and outings which they like. They also say the food is good. The home is clean, bright comfortable and with good furniture and has a range of interesting pictures which residents have chosen. Resident`s bedrooms are nicely decorated in a manner they like. Staff say that there is very good team morale and a good atmosphere in the home and they work with residents in a very calm, sensitive and confident manner which helps residents to feel comfortable and relaxed. Recruitment procedures are good and help safeguard residents from harm. What has improved since the last inspection? Care plans are now in place for all residents and are well written with good use of pictures and Person Centred Planning has begun for all residents. Medication is now well managed and staff have had the necessary training. Incidents and accidents are now reported properly to the Care Quality Commission and action is being taken to support residents and staff where necessary. The fire alarm system is now being regularly checked to better protect residents and staff. What the care home could do better: Information about the full cost of the service, what support is provided and the rooms they occupy must be given to residents in writing so they can understand their rights and obligations. The home should see if they can improve the transport for one resident so that they are easily able to go out in the community. Residents who take medication must be assessed about their ability and wishes to take responsibility for their own medication so that where possible they can have better understanding and be more independent.Albany HouseDS0000071411.V376354.R01.S.docVersion 5.2The induction and training for staff must be improved regarding protection of residents, mental health support, learning disability support, and in how to help residents when they become angry or challenging. When recruiting new staff two managers or staff must be involved in the interview process to ensure fairness and the best choice of staff for the home. Key inspection report CARE HOME ADULTS 18-65 Albany House 75 Southwood Road New Eltham London SE9 3QE Lead Inspector Sean Healy Key Unannounced Inspection 8th July 2009 09:00 Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Albany House Address 75 Southwood Road New Eltham London SE9 3QE 020 8850 1659 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) Precious Homes Ltd Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission are within the following category: 2. Learning disability - Code LD The maximum number of service users who may be accommodated is: 6 15th July 2008 Date of last inspection Brief Description of the Service: Albany House is a detached property that can accommodate up to six people who have been assessed as having a learning disability. Accommodation is spread over three floors. There are two large rooms on the ground floor which are used for dining and recreational space. There is also a large kitchen, laundry room and the office is also situated on the ground floor. All bedrooms have en-suite facilities and there are additional bathrooms and toilets. There is a garden to the rear of the property with a seating area. The home is situated in a residential area close to local amenities, bus and train links to London. There is parking to the front of the building for a limited number of cars. The home now has four female residents with two vacancies Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means that the people who use this service experience Adequate quality outcomes. This inspection site visit took place over one day on the 8th July 2009 and ended on 13th July 2009 following receipt of information requested. The inspection was unannounced, and was facilitated by the Acting Manager. The registered manager’s post is currently vacant. Three residents were observed being helped by staff and there was good communication between residents and staff. Two residents planning files were examined, two residents gave their views on how the home was run. Two support staff were interviewed and two staff files were examined to see recruitment and supervision and training records. The inspection included examination of records and policies and procedures, a tour of the building and discussion with the area manager for the provider about staff training needs. All of the requirements made at the previous inspection had now been met. This shows a good commitment to making improvements to the home and the care provided. Residents seem to be very happy at this home, and the atmosphere was relaxed and friendly. The manager and staff involved Residents and spoke with them regularly. What the service does well: People living in the home are given written information regarding all of the care and services provided in the home, which helps them to understand the support they can expect. New residents are fully assessed before moving in and have well written care plans in place which also include using pictures to help residents understand them. They are supported to make decisions affecting their day-to-day life and risk assessments in place help them to be more independent. Good food is provided and the residents help to buy it and to cook it People living in the home receive appropriate support from health care professionals, and the staff know how to help them and provide good safe Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 6 personal care support. Residents said that they are happy at the home, the staff are nice and very helpful, and that there are lots of activities and outings which they like. They also say the food is good. The home is clean, bright comfortable and with good furniture and has a range of interesting pictures which residents have chosen. Resident’s bedrooms are nicely decorated in a manner they like. Staff say that there is very good team morale and a good atmosphere in the home and they work with residents in a very calm, sensitive and confident manner which helps residents to feel comfortable and relaxed. Recruitment procedures are good and help safeguard residents from harm. What has improved since the last inspection? What they could do better: Information about the full cost of the service, what support is provided and the rooms they occupy must be given to residents in writing so they can understand their rights and obligations. The home should see if they can improve the transport for one resident so that they are easily able to go out in the community. Residents who take medication must be assessed about their ability and wishes to take responsibility for their own medication so that where possible they can have better understanding and be more independent. Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 7 The induction and training for staff must be improved regarding protection of residents, mental health support, learning disability support, and in how to help residents when they become angry or challenging. When recruiting new staff two managers or staff must be involved in the interview process to ensure fairness and the best choice of staff for the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 8 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 Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2 and 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents do have all the information to make a choice about where they live. Care needs assessments are in place for residents, and the home has been responsible in requesting information from social services when needed. Residents need to be given up to date contracts/statements of terms and conditions including charges made and who is responsible for payment. EVIDENCE: The home provides good information for current and prospective residents, which clearly show services to be offered, and a range of information about staff experiencing training, the provider organisation, and how residents can complain should they need to. Staff qualifications and the details of the Care Quality Commission are now included are also included in the Statement of Purpose thus meeting a requirement from the last inspection. All of the residents have been complete care needs assessments on file. All care and support needs are clearly recorded in detail covering all areas of health, and social care needs, and these are reviewed twice a year by the Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 10 home. All residents have had full involvement from social services with support from relevant mental health professionals in their placement at the home. Care support needs primarily are learning disabilities with some significant mental health support needs. These are fully included in assessments. The home does not as yet provide residents with individual contracts or statements of terms and conditions. The home must provide each resident with one of these including charges made for care/support, food transport, accommodation and any other charges stating who pays these charges. All of the areas listed in the Care Homes Regulations Standard 5 should also be included. (Refer to Requirement YA5) Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessed and changing needs are fully reflected in all residents care plans and they are supported by staff to make decisions about their lives. Risk assessments are in place to protect residents and understood by staff. EVIDENCE: Since the last inspection the manager has improved the system for care planning, which is now very detailed and reflects individual residents support needs very well. These plans have since been fully completed for all residents and there is a range of information about health and social care needs, including a very effective cross referencing when risk is identified in any activity. Care plans are now good and include a Person Centred plan for each resident including a broad range of pictures to enable them to understand their own plans. Care plans are regularly reviewed at least every 6 months. Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 12 When tasks are to be carried out with the residents with support from staff, detailed guidance on how to provide the support is available in writing for staff to follow. Care plans include the use of pictures when carrying out tasks so that residents can more easily understand them. This is a very positive improvement in care planning for residents in this home, and staff say that they find the new system very helpful and beneficial for residents. Residents commented that the staff are really good and help them to go out on activities and ask them about the best way to help them. Residents in the home are fully able to walk and go about independently. There are some high level mental health and learning disability support needs which can challenge staff and management. Appropriate health care professionals are fully involved in providing support and there are a range of well written risk assessments in place, which describe how to reduce risk to residents and staff. These are reviewed regularly, at least every 6 months. A “traffic light” system is used to highlight risks which need to be reviewed earlier. The staff and manager say that at the moment these risk assessments are working well and that they are confident in managing risk. However there is a need for all of the staff to undergo more specialist training in the management of challenging behaviour, mental health and in safeguarding adults so that their ideas can be more fully reflected in care plans and risk assessments. (Refer to Standard 35 of this report) Risk assessments include: Mental Health, epilepsy, testing boundaries, verbal and physical aggression and throwing objects. Discussion with staff and the manager reflected the importance of maintaining good levels of activities for some residents in particular to ensure that they have a stimulating life and to help reduce the likelihood of challenging situations arising. To help monitor levels of participation in activities it is recommended that the home consider developing easy to complete recording sheets for monitoring levels of opportunity and take up in activities individual to each resident. The manager felt that this would be useful. (Refer to Recommendation YA6) Care plans show a good level of involvement from health care professionals such as mental health and psychology, and from the mental health support team. (Refer to Standard 19) There is consistent involvement from the GP for all resident’s, and dental and foot care support is also provided. There are detailed plans showing staff how to support residents in personal care. There was a requirement made at the last inspection for the home to ensure that the care plan for a newly admitted resident is put in place and this has now been done. Recommendations made to ensure that care plans for all new residents be done at the time they move in, and for the daily record sheets to be made larger so that there is sufficient space to write in, have both now been met. Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 13 Residents are supported to be as independent as possible in day to day living and one resident who does not have family involvement has an advocate who visits every one to two weeks and who takes part in the care planning process on this residents behalf. There is also a teacher from a school attended by one resident who also helps in care planning for her with her permission. All other residents have family involvement. Resident’s finances are managed either by themselves, social services or by resident’s families. None are managed by the home. One residents finances are held by social services in the Isle of Wight but she does not receive regular updates about money received, spent or balances. It is recommended that the home ask her about her wishes to have this information and then if appropriate request it in writing. (Refer to Recommendation YA7) Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 14 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): This is what people staying in this care home experience: Standards 12,13,15,16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to take part in age/peer and culturally appropriate activities, They are part of their local community, and are supported to have relationships. Resident’s rights are respected, and good meals are provided. EVIDENCE: The home now has four female residents three of whom moved in since March 2009. One moved in during June 2009 and as yet is settling in and developing some outside activities. This resident needs to develop some consistent daytime activities and this is stated as an objective in her care plan. The manager felt that social services need to be involved in replacing structured day service activities and said that this will be raised at her next review. It is recommended that this happen as it was felt to be important by the staff and manager. (Refer to Recommendations YA12) Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 15 The majority of residents do have good opportunities for taking part in activities both in and outside of the home. These include: embroidering, movement and dance, attending church, shopping, attending day centres, and one resident attends school and has gained a place at college full time doing arts and crafts, cooking and speech and language. This is a significant achievement on her part and she said she was very happy with the support she receives from the staff to do this. Two residents interviewed said that they were very happy with the activities and support provided by the home. Discussion with the staff and manager reflected a need to improve transport arrangements for one resident to enable them to consistently help her to attend activities. Making progress on this is viewed as very important by all who took part in the inspection interviews and it is recommended that the registered provider help the home to try to do this. (Refer to Recommendation YA12) The home supports residents to keep up family relationships and the home has now got consistent involvement from citizen’s advocacy for residents who don’t have family available, and residents now have opportunities to have more frequent contact with friends they have met at day activities. Feedback from residents in response to the inspection surveys and discussion during the inspection showed they felt that staff are very caring and seem to genuinely enjoy their jobs, they organise many activities and their commitment shows in the residents care. Food is bought from local shops and there was a good supply of fresh fruit and vegetables in the kitchen. The menu was varied and nutritious and the food eaten by each resident was recorded in their daily diary. The manager described how as part of the move in assessment staff had got to know what residents liked and residents commented that they enjoyed their food. Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Respectful and sensitive support is provided for Residents regarding personal care, health and emotional needs. Residents are supported with their medication but are not fully supported to be as independent as they can be regarding medication. EVIDENCE: There was a requirement made at the last inspection for the home to information about resident’s medication as recorded on their medication sheet tally with that shown on the written information on the medication itself. Inspection of the medication showed that this has now been done and this requirement is met. I looked at two residents care plans which showed that they have well written personal care plans and each also has a Health Action Plan outlining their individual health care needs. The resident’s primary care needs are around Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 17 their learning disability support needs and there are also mental health support needs of significance for one resident. Challenging needs support also is a feature of the health care needs provided for. Overall the home has good detailed information written into residents care plans about each individual resident’s health care needs and there is full involvement from a range of health care professionals in providing the support needed. All are registered with a GP and there is involvement from Psychology, psychiatry, with support provided by Bexley NHS care trust in the management of challenging behaviour. Adequate mental health support is also provided for by the mental health team for residents who need it. However staff need to have more in depth training regarding the provision of mental health support in order to fully provide for residents needs in this area. (Refer to Requirement Standard 35) Medication is well managed and stored and stored safely in a locked cabinet. Good written records are kept about the receipt and return of medication and recording of medication given by staff is consistently good. The manager does weekly checks and reports she is very happy with the staff recording of medication. The manager said that all staff have had administration training and only trained staff can give medication. Two residents are on prescribed medication and one of these is totally self medicating while the home totally manages the medication for the other resident. Neither of these residents have had a medication self assessment recorded on their files. The home must carry out such an assessment in line with the provider’s medication policy and record it on each residents file/care plan. (Refer to Requirement YA20) Staff are generally new at the home with need for more in depth training in understanding the benefits and side effects of medication which would give them a good grounding in monitoring the effectiveness of medication prescribed for mental health or behavioural management. It is recommended that the home provider such training specific to the needs of the residents who live at the home at a team level. (Refer to Requirement YA35) Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who bring concerns to the attention of the provider can be assured that action will be taken to address their complaints. Comprehensive safeguarding adults procedures are in place but all staff are not yet adequately trained in these procedures. EVIDENCE: The home has a complaints policy which has been updated in 2009. No complaints have been received by the home and two staff interviewed were clear about their responsibilities in recording and reporting complaints received. Two residents said they understood how to make a complaint if they needed to, and said they were happy to speak with staff and the manager about any concerns. The home has an up to date safeguarding adult’s policy which reflects a responsible approach to protecting residents form harm. There was one safeguarding allegation reported to social services since the last inspection and Greenwich social services after investigation felt this to be unfounded. The attitude of staff and the manager with regard to protecting residents from abuse and harm is very good in spite of sometimes challenging circumstances at work. However although it is the case that some staff have had safeguarding training briefly included in their induction, the majority of the Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 19 staff have been appointed over the past 12 months and hardly any had received substantial training in the providers and local authorities safeguarding adults policy and procedures. The registered provider must ensure that all staff have this have this training as soon as possible. (Refer to Requirements YA35) Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,26 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is homely, comfortable and safe and is kept very clean and well maintained. Toilet and bathrooms are designed to meet resident’s needs and specialist equipment is provided. EVIDENCE: Accommodation is spread over three floors and bedrooms have en-suite facilities. There are additional bathrooms and toilets. There are two large rooms on the ground floor which are used for dining and recreational space. There is a large kitchen, laundry room and office. There is a garden to the rear of the property with a seating area. The house is light, bright and airy and the rooms are appropriately furnished for the purpose. Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 21 The home offers a homely comfortable and safe environment suited to the needs of the residents. Bedrooms are personalized and look fresh, clean and well decorated. Residents interviewed said they like their rooms and feel comfortable in the home. There are adequate toilets and bathrooms providing sufficient privacy, and there is a choice of communal areas which are spacious and decorated very nicely. The home is clean and hygienic and free from unwanted odours. The manager does a weekly report on all house repair and renewals needs and also regarding health and safety. She said that any repair needs are quickly actioned by the provider and the homes current state reflected this. The door frame to the office needs to be repaired and the manager said that this is in hand. There is a fire risk assessment in place which is up to date and the home has an adequate fire alarm system which is checked at least annually under contract. Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,33 34 and 35 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are qualified and there are enough of them to ensure they meet the needs of residents effectively. Residents are now protected by the homes recruitment practices but staff have not been adequately trained to ensure that residents individual and joint needs are met. EVIDENCE: There is a total of 9 care staff posts allocated to the home plus the registered manager. Currently there are six female staff and one male staff employed with one full time and one part time vacancy. There was a requirement made at the last inspection to ensure that the homes duty roster was accurate and reflected the numbers of staff on duty. This has now been done and there are now a minimum of two staff always on duty, with the manager working in addition to this number five days a week. There are 3 staff on duty at peak times for personal care and in the evenings for social activities. Night support is provided by a night waking staff supported by a sleepover staff at weekends to facilitate visits by a prospective resident. This level of support would seem Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 23 to be adequate for the support needed by residents as staff said that they feel they can do their job at these levels. Four of the current seven full time staff employed have an NVQ qualification which meets the requirement for this home. Other staff are scheduled to go on the NVQ course. This is a good achievement given the relatively recent formation of this team. The files of two members of staff were examined in relation to recruitment and training. There was evidence that Precious Homes operate an appropriate recruitment procedure. Records in relation to recruitment indicated that staff had been required to provide proof of identity, POVA/CRB checks had been completed and two references provided. The application form also requires staff to complete a health declaration form. Staff had been provided with a job description. Overall recruitment information is very well managed and presented in a clear and easy to read manner. However on a number of occasions it has been suggested that the interview process of staff only involved one interviewer. It is recommended in the interests of fairness and best practice that the registered provider always has at least two interviewers at interview. (Refer to Recommendation YA34) A copy of the skills for care induction programme was seen. The home provides induction in line with skills for care requirements, and two staff files examined showed a clear record of induction which was dated and signed. However it would seem given the high level of support needed regarding mental health, learning disability, challenging behaviour and medication, it is to be strongly recommended that the normal induction programme is quickly followed by more substantial induction in the areas of mental health, learning disability, challenging behaviour medication and safeguarding appropriate to the support needs of the residents. (Refer to Recommendation YA32) Examination of two staff employment files and discussion with the two staff, the manager and the provider’s business manager, showed a need to include more substantial training in the homes training prospectus for all care staff and the manager in the following areas. (Refer also to Standards 18, 20 and 23 of this report): Mental health specific to residents support needs, De escalation of challenging behaviour and breakaway techniques, safeguarding adults, and medication benefits and side affects related to residents support needs. This must be provided soon after induction of new staff and must be provided for all of the current staff. (Refer to Requirement YA35) Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 24 Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do now benefit from a well run home and they are consulted by the management and staff regarding their views. The health and safety of residents are now protected by the homes practices. EVIDENCE: There have been two managers since the home was registered in February 2008. At present a manager from another service managed by Precious Homes is over seeing the day-to-day running of the home. The provider’s business manager stated they are continuing to try and recruit to the post. The current acting has an NVQ 4 qualification, RMA and community mental health Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 26 qualification and has been in post since October 2008. There is also a team leader post and senior support worker post which are being actively recruited to. The manager demonstrated a good knowledge of the care standards for this home during the inspection and said she has been previously registered with CSCI as manager for another home. There is a responsible individual for the provider organisation who visits the home monthly and to whom the manager is responsible. The manager said she has completed an application form to register with CQC but this has not yet been submitted to CQC. The provider organisation must submit an application to CQC for the registration of a manager as soon as possible. (Refer to Requirement YA37) The registered provider should recruit to the post of team leader or senior support worker as soon as possible. (Refer to Recommendation YA37) The provider has a Quality assurance system in place which includes an annual quality audit and service user surveys. This is to be checked more thoroughly at the next inspection. The current manager submitted a very well completed Annual Quality Audit Assessment prior to this inspection and has written objectives for the homes development including the environment and staff development. There were 2 health and safety requirements made at the last inspection regarding the reporting of events which adversely affect residents and to ensure routine fire system checks be carried out. Both of these were met. Health and safety within the home is well managed, and all residents have appropriate risk assessments in place for their protection. There is good clear documentation in place regarding health and safety, fire safety, food hygiene, staff training, and electrical and gas certification. All of this documentation is up-to-date. There were no health and safety incidents or concerns raised by residents or staff. The five year electrical certificate for the home is up to date. Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 27 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 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 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 2 X 3 X X 3 X Version 5.2 Page 28 Albany House DS0000071411.V376354.R01.S.doc 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 YA5 Regulation 5 Requirement The registered provider must ensure that all residents are in possession of a costed contract or statements of terms and conditions, which have been signed and dated as outlined in Standard 5 of the Care Homes Regulations 2000. This is to ensure that they are fully informed of their rights and support arrangements. The registered provider and manager must ensure that the residents who take prescribed medication be assessed regarding their abilities and wishes to take charge of their own medication. This is to promote their understanding of medication and to promote independence The registered provider and manager must ensure that all new care staff receive suitable training regarding mental health, medication, safeguarding and management of challenging behaviour as part of the homes induction programme. This is to DS0000071411.V376354.R01.S.doc Timescale for action 30/10/09 2 YA20 13 30/10/09 3 YA32 18(1)C (i) 30/10/09 Albany House Version 5.2 Page 29 4 YA35 18(1)C (i) 5 YA37 8 protect staff and residents from risk or abuse The registered provider and manager must ensure that all of the current care staff receive adequate training regarding mental health, medication, safeguarding and management of challenging behaviour as soon as possible in order to protect staff and residents from risk or abuse The registered provider must ensure that an application for registration of a registered manager is submitted to the Care Quality Commission in order to ensure consistent and stable management is provided. 30/09/10 30/10/09 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 YA6 Good Practice Recommendations The registered provider and manager should consider developing easy to complete recording sheets for monitoring levels of opportunity and take up in activities for individual residents. The registered provider and manager should consider whether using mood charts for recording indicators of mental health would be beneficial to staff in monitoring changes in mental health for those who need it The registered provider and manager should determine the views of one resident regarding her wishes re details of finances held on her behalf by social services as discussed in this report Standard7, and act according to her wishes The registered provider and manager should explore options for improving transport arrangements for one resident as discussed in this report under Standard12 The registered provider and manager should raise the issue of day care provision for one resident at their next care review as discussed in this report under Standard12 DS0000071411.V376354.R01.S.doc Version 5.2 Page 30 2 YA6 3 YA7 4 5 YA12 YA12 Albany House 6 YA37 The registered provider and manager should appoint to the team leader or senior care worker posts in order to provide more robust management and supervision arrangements in the home. Albany House DS0000071411.V376354.R01.S.doc Version 5.2 Page 31 Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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