Care Home: Albion House

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What the care home does well The service has a staff team that offers stability and expertise to people using the service; a number of qualified staff are present on the team. People achieve positive outcomes while receiving the service, staff understand the difficulties experienced by people using this service and work alongside to encourage and motivate them. The following are a sample of peoples comments we received, " I have had stability in my life, prior to this admission two years ago I experienced long hospital stays with little progress and frequent relapses", " This is a homely supportive place to live, I feel I am making slow but steady progress". The home supports people using the service to balance and manage risks appropriately in relation to supporting individual capacity and choice. The service works closely with mental health services; it makes referrals when necessary and responds appropriately by implementing recommendations made by mental health professionals. A regular monthly surgery is held by the psychiatrist at the home which enables individuals easy access to consultation. The home has a good record of supporting safely people to manage prescribed medication. It promotes and encourages compliance with prescribed medication, it supports individuals to develop the capacity to self medicate. . What has improved since the last inspection? The home has made positive efforts to improve the service. It has responded to the areas of shortfalls found during the previous inspection and addressed the concerns. The home has completed a refurbishment programme since the February 2008 key inspection. The home now provides a pleasant and homely environment that people find comfortable and beneficial for a period of successful rehabilitation. The pre admission protocols are much improved. Full and comprehensive pre admission assessments are completed for all applicants before a decision is made to offer a person a place at the home. People living at the home are protected. Recruitment procedures have improved and are now more robust, new staff are fully vetted before they begin work at the home. Record keeping is improving and now up to date. A training matrix is maintained to identify and track all the training and development undertaken. Care planning has adopted a more person centred approach which places people using the service at the forefront. The service has introduced new care planning format that focuses on individual aims and objectives. In order to support individuals achieve aims and objectives the home recognises the need to promote personnel development opportunities in order to contribute to rehabilitation programme. The service now employs an activities coordinator/therapist with a key role in developing activities and opportunities so that people may engage in appropriate stimulation. People living at the home already feel more motivated. The quality assurance system is now underway; it consults with people in the home and reflects that the home is operating in the best interests of those using the service. CARE HOME ADULTS 18-65 Albion House 8-12 Albion Way Lewisham London SE13 6BT Lead Inspector Mary Magee Key Unannounced Inspection 28 th August &17 September 2008 09:30 th Albion House DS0000025602.V368661.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 Albion House DS0000025602.V368661.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. Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Albion House Address 8-12 Albion Way Lewisham London SE13 6BT 020 8318 3366 020 8318 5443 smazwikwe@msn.com 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) Prime Care Choice Ltd Shepherd Mazwikwe Care Home 23 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (23) of places Albion House DS0000025602.V368661.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 to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 23 7th March 2008 Date of last inspection Brief Description of the Service: Albion House is a registered care home for 23 adults with mental health problems. It is registered with Prime Care Choice Ltd as the registered provider. The building is located close to Lewisham shopping centre and public transport routes. The home is on three floors, with ample internal communal space and a pleasant back garden. Albion House aims to provide a rehabilitative and therapeutic environment where people experiencing mental health related issues can develop their skills to re-integrate back into the community through a programme of daily activities and support. Fees range from £975 to £1500. Albion House DS0000025602.V368661.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 2 star. This means the people who use this service experience good quality outcomes. We carried out this unannounced key inspection over two days. We observed the care and support given to people using the service; they together with relatives present spoke of their experiences. Case tracking was used to evaluate the service and the outcomes this achieves for people in the home. We sought the views of families, staff and relevant mental health professionals through written surveys and telephone discussions. We are grateful for the contributions from everyone who responded to written surveys and expressed their views to us. A document called an ‘Annual Quality Assurance Assessment’ (AQAA) was completed by the Registered Manager and returned in advance of the inspection. This document informs us at CSCI on how the service is addressing the National Minimum Standards along with other factual information about the care home. All of this information is used to inform judgements and to compile this report. The registered manager and support staff on duty facilitated both inspection visits; they were helpful and courteous throughout the process. What the service does well: The service has a staff team that offers stability and expertise to people using the service; a number of qualified staff are present on the team. People achieve positive outcomes while receiving the service, staff understand the difficulties experienced by people using this service and work alongside to encourage and motivate them. The following are a sample of peoples comments we received, “ I have had stability in my life, prior to this admission two years ago I experienced long hospital stays with little progress and frequent relapses”, “ This is a homely supportive place to live, I feel I am making slow but steady progress”. The home supports people using the service to balance and manage risks appropriately in relation to supporting individual capacity and choice. The service works closely with mental health services; it makes referrals when necessary and responds appropriately by implementing recommendations made by mental health professionals. A regular monthly surgery is held by the psychiatrist at the home which enables individuals easy access to consultation. Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 6 The home has a good record of supporting safely people to manage prescribed medication. It promotes and encourages compliance with prescribed medication, it supports individuals to develop the capacity to self medicate. . What has improved since the last inspection? What they could do better: The service has now compiled an up to date record of staff training and is aware of the shortcomings in this department. The service needs to respond to the individual training needs of staff, and invest in more staff training and development. Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 7 Staff are not receiving supervision as frequently as required, focus must be placed on providing staff with regular and consistent supervision. 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. Albion House DS0000025602.V368661.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 Albion House DS0000025602.V368661.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1235 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The home has introduced much improved admission protocols and actively demonstrates that it adheres to these. Admissions are not made to the home until full needs assessment has been undertaken The assessment is conducted professionally and sensitively and involves the individual and their family or representative, where appropriate. Important information and personal history is sought from mental health professionals to inform and develop the risk assessment. Needs assessment records form the basis of the development of care and support plans. EVIDENCE: We received a copy of the revised Statement of Purpose, this was updated recently. A new guide to the services was presented. According to a newly admitted resident this guide was provided to him prior to admission. It is unclear if all residents have information on the service, particularly those that have lived at the home for some time. It is recommended that a review take place of information supplied to those living at the home. Copies of contracts agreed with people using the services are held on individual files. Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 10 We looked at the admission process for a person that recently moved to live at the home. Admission took place after a full needs assessment was undertaken. The assessment gave us evidence that it was conducted professionally and sensitively and involved the individual. Important information and personal history was sought from mental health professionals, this includes psychiatrist’s report, CPA review. This procedure was consistent with admission procedures observed for other new admissions. Albion House DS0000025602.V368661.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 9 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Care planning arrangements continue to improve with the introduction of a much more person centred approach. Staff have a good awareness of individuals’ needs and the need to promote independence. People are supported to lead as independent a lifestyle as possible with due consideration given to managing risks in accordance with assessments. An inclusive environment is promoted with people invited to give their views and participate in aspects of life at the home. EVIDENCE: Case tracking was used to evaluate the care planning arrangements. We examined the written care plans for three of the people using the service. A new format for written care planning was introduced in recent months; a person centred approach is now taken. Much progress has been achieved with these newly developed care plans. We received confirmation at the end of the inspection that these are now in use for all that live at the home. Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 12 Care and support plans are well organised and comprehensive. Staff report that all the required information is now recorded and available in the care plans; they also find the new format is easy to follow. The plans are based on assessments completed by staff, also informing these plans are contributions from other mental health professionals. Care plans are more person centred and staff find that this approach is more beneficial for individuals using the service. Plans contain details of personal objectives, and action needed to support the individual to achieve these objectives, risks and the support plans to manage any identified risks associated with conditions and behaviours. As the new format was introduced staff used this as an opportunity to review all care plans and risk assessments. The manager spoke of future plans for reviewing the care plans every three months, CPA reviews take place every six months. Written daily records were viewed, these record individual’s progress and their state of well being. Individuals are allocated key workers, with key working sessions taking place frequently. Records are made of these and used to inform reviews and future plans. People living at the home are supported and encouraged to lead independent lifestyles with consideration given to risks associated with developing these skills. Some individuals are involved in cooking meals at the home. The staff team recognise individual capacities and the potential for development. There is evidence of multidisciplinary teamwork. CPA meetings take place. In the event of changes to individual’s state of well-being this is identified and discussed with CHMHT. We received very positive feedback from care coordinators that we consulted in the MHT. They find that the staff team work closely with all mental health professionals to achieve the best outcome for people using the service. We looked at staff support and monitoring arrangements. Staff are good at recognising any changes to the state of individual mental health conditions and taking appropriate action. We had contact with two relatives who are confident in the service. Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 13 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): 11 12 13 15 16 17 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The home recognises the importance of providing for the social needs of people living at the home. It has introduced a programme of stimulating activities that reflect and provides for individual need and choices. People find that this facility promotes self worth and esteem. A wide variety of meals is provided that residents find enjoyable. EVIDENCE: The home has operated for a number of years with not much change. As a result of changes to senior management some of the shortfalls in the service were recognised. Management recognised the need for more effort and progress in enabling and supporting residents to lead a more fulfilling lifestyles. It now employs an activities coordinator/therapist to coordinate and promote more social stimulation. We saw the activity development planner now under development. To prepare this the home first sought the views of the residents, considered the individual care plans and assessments and considered their varied Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 14 interests. A mental health professional said that he is pleased that more emphasis is placed on occupational therapy, as in the past the findings are that this was an area that needed attention. We found that staff actively seek information on available community resources to enable people to access education and work, including supported employment, and paid employment where they have the capacity. There are links with local mental health voluntary service, this offers advocacy as well as volunteer service. The premises are well located close to the main shopping area and leisure facilities as well as to good public transport facilities. A number of people using the service attend college outside, some have voluntary work. Staff confirmed that arrangements are in place for one of the newly admitted residents to attend college in October. The service actively supports people to be independent and involved in all areas of daily living in the home. This includes where appropriate, taking responsibility for shopping, planning and cooking meals, and meal preparation. Staff acknowledge the difficulties encountered in motivating people as some have chosen not to participate in any pursuit in the past. Staff have a good insight into the barriers experienced and have the ability to continue with encouraging individuals rather than placing undue pressure on individuals. We discussed with the activities coordinator the progress so far. Individual choices are respected and often individuals are reluctant to engage at first, but there are signs of progress and that people are participating in more activities. We spoke to two care coordinators from the CMHT, they said “One of the strengths of this service is the patience displayed by staff in working alongside individuals; they know that the pace is most important otherwise individuals will not engage”. Routines are very flexible and residents can make choices in major areas of their life. We heard from care coordinators other areas where progress is acknowledged. Often people admitted to the home had not maintained good communication with relatives. We heard of numerous occasions where this was addressed and where residents receive support in contacting relatives and building and developing much improved relationships. Mealtimes are flexible. During the inspection individuals absent when lunch was served had a lunch prepared and served on their return. According to all five residents spoken to, the home is flexible and adapts the routines to fit in with individual lifestyles. People using the service find that their wishes are respected and that they receive visits from family and friends. We had contact with two relatives, they find that they are made welcome at the home. Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 15 A telephone is supplied in a booth off the lounge area; it offers privacy and the opportunity for people to stay in touch with relatives and friends. There are certain restrictions in place for visitors accessing individual bedrooms. This is in accordance with agreed care plans. It is implemented to avoid placing an individual living at the home at risk, for example if it is deemed that there is a risk of using illegal substances. As a result not all visitors are allowed access to bedrooms. Responses from people living in the home confirm that people are satisfied with the food served, the following are a sample of replies from individuals, “we get good meals which I appreciate”,” I can always be sure that a good meal will be served”, “It tastes like home cooking”. Menus are developed with the people using the service. They are planned to reflect individual tastes with people arranging and attending meetings regularly so that they can choose meals that reflect their preferences and dietary needs. According to menu planners culture appropriate dishes are served too. Menus for a period of a month were viewed; these demonstrated that the meals are varied. Albion House DS0000025602.V368661.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 20 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. People living at this home receive the appropriate support that enables them manage their healthcare. They are enabled to develop more independent living skills. The staff team are responsive and respond appropriately to issues that arise. The home has established good working relationships with the CMHT which in turn contributes to better outcomes for each individual. Medicine procedures are robust and seek to promote individuals to comply with prescribed medication. EVIDENCE: We looked at the provision made to promote health care. The care plans describe the support that service users need with personal care, currently all are self caring in relation to personnel care. All of the people living at the home are registered on a CPA and see a psychiatrist and a social worker and/or a community psychiatric nurse. Regular monthly meetings with the psychiatrist are held at the home. Six monthly CPA meetings take place. Records of the outcomes of these consultations are held with care notes. The emotional and physical well being of individuals is closely monitored. Staff are good at recognising warning signs or triggers that indicate Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 17 a relapse is imminent. When staff have concerns they promptly seek assistance and refer to the mental health team. The staff team benefit from members of staff that have a wealth of experience. Relatives spoke of the expertise displayed by staff in responding to mental health concerns, relatives of a person using the service said “we have confidence in the ability of staff to manage appropriately situations should there be deterioration in condition”. The findings are that staff follow recommendations made. We received very positive feedback from care coordinators on the success of the home in meeting individual needs. The following report received “We have a good working relationship with the manager and staff, they listen to our recommendations, as a result some very successful outcomes are achieved by people living at the home” Good health care is promoted with individuals supported to take responsibility for managing their own healthcare. The ways that individuals are currently supported include regular weight monitoring, recording appointments for blood tests, dentists, chiropodists and optician. There are some inconsistencies in how records of health care are maintained. Key working sessions were not always maintained consistently up to date; recent records show that there have been some improvements recently. A recommendation is made. The medication systems at the home were examined. While case tracking we examined the medication procedures. These indicated that medication is appropriately stored, administered and recorded at the home. The home has a good record in this area, care coordinators we spoke to told of the success achieved with a number of people. According to care coordinators individuals that prior to admission had struggled with non compliance of medication were successfully supported with taking the necessary prescribed medication. Two of the people currently living at the home were assessed as suitable to self medicate. Recently for one of these individuals issues were identified by staff promptly that show non compliance with prescribed medication. As a result the medication prescribed is now administered by staff. The risk management of those self medicating was viewed. Staff are good at supporting people to self medicate, however there are no lockable cabinets in bedrooms since new furniture was purchased. A recommendation is made. Albion House DS0000025602.V368661.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Practices at the home ensure that individuals are protected from abuse. The environment promoted is open and inclusive where people’s views really matter. Complaints are addressed and responded to appropriately. EVIDENCE: The home is good at responding to individual complaints. All complaints made and the actions taken in response to them are fully recorded. The home learns from complaints in order to improve its service. The home management team welcomes the views of those using the service. We found that individuals feel free to express their views; they have regular residents’ meetings to facilitate forum discussions. Residents find that the home has benefited from changes to staffing personnel. Residents find the management approach to be open and inclusive; people feel that their views matter. A log is maintained of all complaints raised. The majority of these relate to minor issues raised during the refurbishment programme. It is evident that all of the issues raised were addressed satisfactorily. Relatives too find that their concerns are addressed satisfactorily. The home has an open culture where individuals feel safe and supported to share any concerns in relation to their protection and safety. Policies and procedures regarding safeguarding adults are available to staff and give them clear guidance about what action should be taken. Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 19 We looked at staff records, for a large number of staff they are up to date on training in safeguarding procedures. A copy of the local authority safeguarding procedures is on display in the office. We spoke to four members of staff. In discussions they demonstrate that they have a good knowledge of safeguarding procedures. They have a good awareness of the needs of the user group, they also demonstrate their knowledge of the potential of the user group to be exposed to neglect as a result of their vulnerability. At the previous key inspection a requirement was stated regarding safeguarding training for the staff team, some staff had not received safeguarding training for some time. The home had sourced training for staff and this was booked for September. It was cancelled at the last minute by the external trainer. It is rebooked for November 2008.The requirement remains with an extended timescale for achievement, CSCI to be notified when this requirement is complied with. Albion House DS0000025602.V368661.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 25 27 28 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People find that that the premises are a good place to enable successful rehabilitation. The premises benefits from a recent complete refurbishment. It is clean and safe; it is attractively presented and offers a homely and comfortable environment. Single and shared communal areas are spacious and furnished pleasantly. EVIDENCE: On day one of the inspection we found that work was in progress in refurbishing of the premises. A significant investment was made in overhauling the premises. When we returned to the home some two weeks later the works were completed. Both the exterior and interior of the building are attractively presented. The premises are light and airy throughout. Bathrooms and toilets have been fitted with new equipment. New furniture has also been supplied to communal areas. The lounge and dining area appear very attractive. All the flooring has been replaced. New carpets are fitted throughout, with wooden floors supplied on the dining room floor. Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 21 Bedrooms provided people find are more comfortable since the redecoration programme; new beds too are now supplied in all bedrooms. We viewed just three bedrooms with the permission of the occupants. The standard of hygiene has improved. Environmental health gave the home a satisfactory report when the kitchen area was inspected. We found that on both visits that the premises are maintained to a good standard of hygiene. A large budget is allocated for this. Two domestic staff is employed daily and maintains the premises to this standard. Albion House DS0000025602.V368661.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32 33 34 35 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People using the service find that staff working with them are knowledgeable and experienced. A high percentage of the staff team are trained and qualified. Staff need to receive more regular supervision and support to ensure that performance is guided and supported. The home needs to invest in a staff training and development programme so that staff are achieving their full potential. EVIDENCE: The staff team has experienced a number of changes to personnel. Despite this it has managed to overcome these obstacles to development. We looked at recruitment procedures for three new members of staff. These are now satisfactory. All staff are fully vetted before they start work at the home. The staff team benefits from having a high number of staff with NVQ Level 3 or equivalent, this is to be commended. It has engaged a number of qualified nursing staff too with further qualified nurse working as bank staff. According to care coordinators from MHT staff employed are good at supporting the client group and this they demonstrate consistently. Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 23 During the visit we had discussions with a number of staff. We are confident that staff are interested in their role and keen to enable people living there to achieve positive outcomes. Good dialogue was observed between staff and those using the service. The home has not always kept up to date records of training. The manager has prepared a matrix of staff training; we acknowledge that some mandatory training is booked too to respond to the gaps identified. The home has in the past not demonstrated too much investment in staff training and development. Qualified nursing staff are not all receiving sufficient opportunities for personnel development, some have qualified some time ago and have not kept their skills up to date. The induction training is not in line with Skills for Care Induction programme. A requirement is stated in relation to developing a full training and development package that meets the training needs of the staff team and the needs of the service. According to staff regular staff meetings take place, people find these useful. One to one supervision is provided but this often inconsistent and is not regular. We have no confirmation that staff (senior) providing supervision received appropriate training for this role. A requirement is stated. Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 24 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 41 42 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Changes to senior management have resulted in raised standards in the service. People at the home that include residents and staff benefit from having a registered manager that gives clear leadership and that fosters an open and inclusive environment. People enjoy living in premises that are safe and well maintained. EVIDENCE: The registered manager aims for high standards. He has introduced some changes to the home which has contributed to improvements in the quality of the service. The quality of the service is continuing to improve. The registered manager is professional in his approach and uses his experience and skills to gives a good clinical lead to staff. We found that people in the home have developed further confidence in the service since he became manager; relatives also find that he is knowledgeable and takes a Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 25 keen interest in the welfare of people using the service. He also demonstrates his concern that discharges are conducted in the best interest of the person leaving the home. Since he took up post six months ago he has developed excellent working relationships with fellow mental health professionals. The registered person conducts monthly Regulation 26 unannounced visits to review the welfare of residents and the running of the home. Copies of the reports were retained within the home and had been sent to CSCI to evidence the provider’s monitoring of the service. The quality assurance process continues to be developed and is ongoing. The people using the service are fully involved in consultations to inform the process. An annual development plan had been produced and reflected aims and outcomes for residents. Records indicated that all gas, fire and electrical systems and equipment in the home are serviced and inspected appropriately and that all internal checks are conducted at appropriate intervals. The home employs a maintenance person that deals with immediate repairs and organises maintenance contracts. According to records fire drills and evacuation procedures are undertaken regularly An environmental health inspection was conducted in the recent past. As a result of all the changes to the environment it is recommended that consultation takes place again with fire prevention officer on the fire risk assessment. Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 4 x 5 3 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 3 26 x 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 2 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 3 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 3 x 3 x 3 x x 3 x Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 27 Yes 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 YA23 Regulation 13 (6) Requirement The registered person must ensure that all the staff team receive up to date training on Safeguarding Vulnerable Adults. (Unmet in timescale of 30/05/08 rescheduled for November 2008) A staff training and development programme needs to be introduced, this to include induction/foundation for new staff, also training and development for qualified and non qualified nursing staff Staff must receive regular and consistent supervision; supervisees need to be trained and competent in this. Timescale for action 30/11/08 2 YA35 18 (1) c 30/11/08 3 YA36 18 (2) 30/11/08 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 YA19 Good Practice Recommendations All records relating to the promotion of health including DS0000025602.V368661.R01.S.doc Version 5.2 Page 28 Albion House key working sessions should be kept up to date 2 3 YA20 YA42 Lockable storage cabinets should be provided to individuals for storage of prescribed medication. It is recommended that following the refurbishment programme the fire authority is consulted on the current fire risk assessment and evacuation procedures for the premises Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Albion House DS0000025602.V368661.R01.S.doc Version 5.2 Page 30 - 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. 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