Care Home: Alexandra Homes (Bristol) Ltd

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What the care home does well The home`s Statement of Purpose provides the required information about the home` the facilities staffing arrangements` admission procedure and aims and objectives of the home so that individuals can make an informed choice about the suitability of the home. The residents can be assured that the staff team complete detailed care plans about the care they would like to receive. The residents can be assured that the staff team will encourage them to take appropriate risks. The residents can be confident that there is a wide range of activities for them to take part in. Residents benefit from a well run home with good transparent systems in place to monitor the service. The excellent quality assurance systems ensure that residents and their supporters views are sought acted on, and are involved in the development of the home. Residents can be assured that records are kept to safeguard the residents best interests. Residents are protected by safe working practices. However the testing of fire alarms could be more frequent to ensure the residents safety. What has improved since the last inspection? Since the last inspection there have been improvement made to residents contracts and the staff team have reviewed the menu planning in the house. The residents have also benefited from a robust quality assurance plan for the house that means that there is continual development of the service. What the care home could do better: Whilst there has been some review of the residents contracts there should be another review of their contents. The resident still need to know more information about additional costs that they may pay. The residents would benefit further from having menus which detail; the alternative meals in place. The residents would benefit from staff members receiving additional training from outside agencies. Key inspection report Care homes for adults (18-65 years) Name: Address: Alexandra Homes (Bristol) Ltd 250 Wells Road Knowle Bristol BS4 2PN     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jacqueline Sullivan     Date: 1 3 0 4 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 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 Homes for Adults (18-65 years) 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Alexandra Homes (Bristol) Ltd 250 Wells Road Knowle Bristol BS4 2PN 01179778423 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): alexandra.homes@btconnect.com Alexandra Homes (Bristol) Ltd Name of registered manager (if applicable) John Dennis Duggan Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: May accommodate adults aged 18 - 45 with Learning difficulties. The home may not admit residents at a rate more than there are communal or en-suite bathroom/shower facilities available (based on no more than three residents per communcal bathroom). Date of last inspection Brief description of the care home Alexandra Homes opened in May 2004. The home caters for adults, aged 18 -45, with Aspergers syndrome, who require additional time and high staff support in order to learn ways for dealing with their condition and to live in an independent setting. There are sixteen registered places, at present twelve people are in residence. There are communal facilities, which are shared by all, including a dining area; two lounges; a kitchenette; and a patio garden. The home is set over three Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 0 16 16 Brief description of the care home floors and is accessible by stairs and a lift. The house is residential in style and is in keeping with the neighbouring properties. The home is close to the local shopping centre and major public transport routes to the centre of Bristol. Alexandra Homes has its own transport for residents. The home holds copies of all inspection reports and has an available Statement of Purpose and Service User Guide. Alexandra Homes has a website which can be accessed to find out more information about the service as a whole at www.aspergercare.co.uk The home calculates their fees on a weekly basis. As of 27th April 2007, the range of fees is from #1,500 to #3,000 per week. Additional charges apply to transport costs, which is calculated against the residents? Disability Living Allowance, if applicable. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection that took place over two days. The inspector saw all the communal areas in the home, and two of the residents showed her their bedrooms. She also looked at a number of records, including:the homes Statement of Purpose and Service User Guide, some other residents care records, residents work timetables and leisure activities,staff recruitment and training and records of the homes own health and safety checks. We spoke with three residents, staff members on duty and members of the management team. Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Adults (18-65 years) Page 7 of 26 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. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 homes Statement of Purpose provides the required information about the home the facilities staffing arrangements admission procedure and aims and objectives of the home so that individuals can make an informed choice about the suitability of the home. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. Evidence: The homes Statement of Purpose provides the required information about the home. It has recently been reviewed in order to meet the new regulations. The service user guide has also been updated. Information in the surveys received from people that use the service confirmed that the residents have the necessary information prior to moving into the home. There is Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: also a newsletter which is produced by the residents which is given to new residents so they can get a more personilised view of what it is like to live there. The manager said We have lots of budding journalists here. The quality of this document is high and also includes lots of pictures,articles, film and activity reviews. The assessment process seen on the residents files was detailed and comprehensive. These assessments included input from the person themselves, their relatives, health professionals and other carers where appropriate. Information seen on residents files, information in the surveys and discussions with the manager confirmed that people visit the home prior to admission in order to assure themselves that they wish to live there. At the last inspection a requirement had been made that the contracts contain more detailed information about extra costs. We looked at the file that contained peoples contracts and saw that, although they had been reviewed since the last inspection, they still need additional information about how people will pay for some use of the mini bus. As there has been additional work since the last inspection this requirement is now a recommendation. Care Homes for Adults (18-65 years) Page 11 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this 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 residents can be assured that the staff team complete detailed care plans about the care they would like to receive. The residents can be assured that the staff team will encourage them to take appropriate risks. Evidence: We looked at the care plans for three residents and saw that they contained sufficient detail as to inform the staff team how best to care for each person. Each plan had appropriate risk assessments and these are kept in the office and in peoples rooms. At the last inspection we stated that the risk assessments were not reviewed frequently. At this inspection we saw that all residents either had new risk assessments or the old assessments had been reviewed in April or March of this year. Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: We saw that four people of the sixteen living in the house, also had medication assessments about their ability to self medicate. The manager said that this was in order to comply with the new standards. Care Homes for Adults (18-65 years) Page 13 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this 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 residents can be confident that there is a wide range of activities for them to take part in. Evidence: There is a wide range of activities available for people living in the house. two people are undertaking a foundation course for a degree, another has just finished a hair and beauty courses at a local college. The manager said that they use the rooms of the local pub for events and the residents can play pool or attend discos there. one person goes horse riding and others use facilities in the city. these include seeing bands and going to the theater. There are three mini buses available for people. larger camping holidays are also available. for people. We spoke to staff members who told us that they have a separate flat which they use as an activity room for people in the house. Information in the residents files, the surveys we received, discussions with residents Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: and with staff members confirmed that contact with family and friends is positive and encouraged . There is a monthly summary of contact and the staff team plan to have a summer BBQ for friends and relatives. The residents care plans detail how each person spends their day. These include time for chores and college. Those residents who choose to attend church are encouraged to do so. The biggest change since the last inspection has been the addition of two cooks there is a daily menu available for residents.The manager said that it is difficult for sixteen people to agree on what to eat, therefore people are encouraged to develop their own menu and meals as pet of their care package or they can choose to eat the communal meal. We read in one persons file that they one person has specific needs in relation to the presentation of the food that is eaten. Some residents raised concerns about the food in the surveys and in the minutes of their meetings. It was clear the staff team have tried to address this and we saw minutes of a meeting where these assures were discussed. the manager intends to have the menus in the dining room. We recommend that the alternative ,meal that is available to people is written on the menu and this placed so it can be easily read. the manager told us that people mostly ask the cooks and a resident confirmed this. Care Homes for Adults (18-65 years) Page 15 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from staff supporting their personal needs in a way they prefer and require. Residents can be assured that their healthcare and emotional needs will be met Residents are protected by a robust medication system. Residents can be assured that their family and friends will handle their wishes at the time of death. Evidence: The inspector spoke with one of the senior support workers about the medication process. The medication is kept in a locked cupboard on the ground floor. No residents self administer their medication. There are no controlled drugs kept on the premises. Some residents are do not take any medication. Only the senior support workers administer the medication after training with the homes pharmacy. Staff also attend a course at a local college to ensure that they have a more in depth knowledge of the medication such as what it is for, and the possible side effects. This training is Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: refreshed annually. There is a robust procedure in place for reporting errors which the senior explained. When residents go away, staff sign over the medication to the person who is looking after the resident. There are records of the medication coming in and out of the home ensuring there is a current stock list of what is held in the home. The senior said that their pharmacy is very helpful and they can fax them urgent orders and ring for any advice if need be. Homely remedies such as paracetamol, and medication which is administered as and when necessary is recorded on the back of the Medication Administration Record sheets. Care Homes for Adults (18-65 years) Page 17 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 residents would be even further assured that the staff team are trained to protect them if additional training were in place. Evidence: We looked at the complaints book and saw that complaints are recorded and action is taken by the staff team to resolves these. the information in the book serves as a prompt and more detailed information is kept in another file. Residents that we spoke with felt that they could complain if they wished to do so and that they were confident that the staff team would resolve any issues for them. One person asked for some information to be shared with the manager and this was completed. There is a wide variety of training for staff available most of which is in house and had CDs and work books. Ther is firther discussion about this in furtherr parts of this reports. We spoke with the manager about the additional use of outside courses ,particually in relation to those on safegurding. We were shown a program of courses that staf attends. In relation to safeguarding we recommend that there is evidence that the staff team attend additional safeguarding training other than the CDs to further develop good practise. We spoke with a staff member who was not completely clear about safeguarding proceedures. Care Homes for Adults (18-65 years) Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents live in a homely,clean safe environment. Evidence: The house is two houses that are joined. The manager told us it was once a hotel. There are two spacious lounges, a large kitchen,residents bedrooms, staff sleeping in rooms and office. These are arranged over two floors. The majority of residents have ensuite bathrooms. We were shown some residents bedrooms and these were of a good standard. they were well furnished and comfortable. one person told us I chose the colour of my room. This person had personalised bedding which looked really homely. In the court yard there are two self contained flats which are well presented and serve as more independent living for people. All bathrooms were clean and hygienic. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this 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 residents can be assured that a competent, will supported staff team will look after their needs. however additional evidence of the training completed by the staff team should be available. Evidence: since the last inspection the managerial staffing structure has changed. Mr Duggan is responsible for Alexandra House is assisted by the general manager . There is also a counselor/programme manager. there are two team managers,two assistant team managers and two team leaders. The staff team is large with twenty two support workers and two part time cooks to assist the residents. There are two teams that work shifts and meet together once a week to ensure continuity. As noted at the last inspection, the home uses a training package called BVS which comes in the form of a DVD. It was advised that the home looks into resourcing external training to further enhance statutory training. At this inspection we noted that the majority of training remains via the DVD. The certificates seen on staff files are signed by the registered person who the manager stated is a qualified trainer. we discussed with the manager how they could evidence that the staff had understood the course and reached the required standard as the evidence is kept elsewhere. We remain of the view that the input of external courses would enhance learning Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: opportunities for the staff team . A recommendation has been made about this issue. The staff members who were spoken with were very positive about the staff team and stated that they felt supported. this was confirmed further in the surveys received by the Commission. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well run home with good transparent systems in place to monitor the service. The excellent quality assurance systems ensure that residents and their supporters views are sought acted on, and are involved in the development of the home. Residents can be assured that records are kept to safeguard the residents best interests. Residents are protected by safe working practices. However the testing of fire alarms could be more frequent to ensure the residents safety. Evidence: The registered manager is Mr John Duggan, As stated in the last report, he has a wealth of experience working in social care and in a managing role and has a number of qualifications suitable for managing the home such as a Post Graduate Certificate in Management and a Diploma in Social Work. Since the last inspection the management Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: structure has changed there is now an assistant manage, two team leaders Staff spoke positively about the management, with comments such as I can go to them if I need help. They went out of their way to make sure I got on a course that I wanted. The home has an external fire safety contractor to deal with any issues and to annually check the home. The last visit was in this year. There were no concerns raised. Fire drills are regular. But attention must be given to the weekly tests for the fire alarm. This was brought to the attention of the manager.The lift was serviced and passed in March 2007. The emergency call system is tested monthly. The home tests for Legionella disease and was passed in March 2007. The Employers Liability Insurance certificate is in date and on display in the hallway. We saw the improvement plan for 2009 to 2010. which includes staff training eg mental awareness training , building and environment plans eg th installation of a staff shower refurbishments of bedrooms and lounges and the development of administration and general care practices such as to developing post admission feedback from social workers. The manager had a good system in place to ensure each element was completed and staff members spoken to stated they felt they had input into the development of the home. Residents spoken with also stated that they were able to have their say about elements of how the house is run such as activities and holidays. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 5 5(1b) The Registered Person must 30/06/2007 ensure that each resident has a contract to reflect current fees and extra costs. The Registered Person must 30/06/2007 ensure that residents have a healthy, nutritional and balanced diet with a choice of meals. 2 17 16(2)(i) Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 4 17 22 32 The contracts are revised to include more information about the cost to resident when using the mini bus. There is evidence that residents can have a choice of food on the menu There is evidence that all staff members attend external training in safeguarding There is evidence that staff members receive additional external training and the evidence that staff members have completed their training is kept at the home. Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: 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. 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