Care Home: Alexandra House

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Alexandra House 87 Alexandra Road Addiscombe Croydon Surrey CR0 6EZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janet Pitt     Date: 0 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Alexandra House 87 Alexandra Road Addiscombe Croydon Surrey CR0 6EZ 02086562232 F/P02086562232 alexandracarehome@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr James Emmanuel Kwabena Safo,Mrs Bernadette Joan Redmond care home 5 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 1 mental disorder, excluding learning disability or dementia Additional conditions: 5 One (1) place for a service user over the age of 65 can be accommodated Date of last inspection Brief description of the care home Alexandra House is a semi-detached building set in a residential area of Croydon and is indistinguishable from any other house in the street. It provides a family type dwelling for the five people who live there. Each person has their own bedroom, all of which are of an acceptable standard of decor and furnishing. The home is situated within easy reach of Croydon town centre, and near to bus routes and local amenities. The stated aim of the home is to provide a safe and suitable environment that is friendly and homely, and to base its service on a persons right to respect, dignity, independence and flexibility for choice rights and fulfilment. Care Homes for Adults (18-65 years) Page 4 of 25 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: two star good 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 service was judged as a two star service. This means that people who live in the home experience good quality outcomes. This unannounced inspection was undertaken by one inspector. A site visit was made which lasted a total of two hours. During the site visit people who live in the home were spoken with. A tour of the premises was undertaken and records relating to care and staffing were examined. Discussion was also held with the manager Care Homes for Adults (18-65 years) Page 5 of 25 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 6 of 25 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 7 of 25 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. People who chose to live in the home will be provided with sufficient information to allow them to make a decision on where they want to live. Assessments of need are carried out prior to admission and involve people and their representatives. Evidence: The homes AQAA indicates that a full assessment is requested from the placing authority. An assessment of need is also carried out by the home. THe AQAA states that this is achieved by using appropriate communications with the individual, social services, family, advocates or friends. All new people are able to stay for a trial period. On the site visit one person had recently moved in and arrangements were being made to make their stay permanent. We inspected assessments of need and found that these had been completed well. Relevant information from other professionals had been included in the document. A contract for the new admission was in place and detailed what is included in the fee. Care Homes for Adults (18-65 years) Page 8 of 25 Evidence: Surveys received from people who live in Alexandra House indicated that they thought they had received adequate information prior to moving in. Care Homes for Adults (18-65 years) Page 9 of 25 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. Individuals are able to make a choice about how they spend their time. Risk assessments make sure that people are not limited in what they chose to undertake. Support is given by staff and other people as necessary. Evidence: Alexandra Houses AQAA states that care plans are individual person centred plans based on the clients preferences. Attention is paid to promoting positive behaviour and abilities. Each person has a keyworker who is responsible for reviewing plans. We examined care plans and found that the document lead from needs assessments. Information on a persons past medical history, social interests and employment was contained in the plans. There was also information on any Safeguarding issues that had occurred prior to a person being admitted. A persons spiritual needs had been documented and whether they wished to practise their chosen faith. Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: Feedback received from a health professional stated that Care plans are relevant and set out well. Individuals plans were person centred and had evidence of involvement of the person or their representative. One survey respondent indicated that they are able to make choices about what they do. One individual said that they go to the local shops and another person assists the new person in familiarising them with the local area. We found risk assessments in place detailing this. Care Homes for Adults (18-65 years) Page 11 of 25 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. People who live at Alexandra house are able to continue with everyday activities and are encouraged to maintain their skills. The atmosphere of the home is person centred with the needs of individuals being the priority for staff. Evidence: Choice and Independence were main themes throughout the homes AQAA. We found that individuals are encouraged to visit the local community and farther afield within a risk assessed framework. One person enjoys travelling around London independently and visiting places that interest them. The manager reported that staff encourage individuals to seek employment or attend college courses if they want. Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: Mealtimes and menus are flexible. On the day of the site visit people had open access to the kitchen to make themselves or other people drinks and snacks. We were pleased when a person who lived in the home answered the door and greeted us. We had a good chat with two people who gave information on the latest happenings in the home. From this conversation we found out which members of staff had left, what areas had been decorated and how they spent their time amongst other things. Individuals also said when they had been visited by family and friends. One person has decided to make sure the home is secure, as they have had many years in employment where this was one of their duties. One staff survey comment was Since I began working I have learnt to treat people equally regardless of their background, race or ethnicity. The induction course helped me with these topics. Care Homes for Adults (18-65 years) Page 13 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their personal and health care needs will be routinely monitored. Changes to care plans are made if needed. People are protected from harm by the homes handling and administration of medications. End of life care is handled sensitively and people are able to make informed decisions. Evidence: At the site visit people were well presented in clothing of their choice. The manager reported that they work with individuals in support them to maintain their hygiene needs. The AQAA indicates that people are supported to attend outpatient appointments. There was evidence in plans of involved of attendance at hospital appointments. The document also stated that end of life care and death and dying were addressed on admission and at reviews. Evidence of this was found in the care plans. Some people had chosen to make specific wishes, such as being buried. Discussion was held around Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: the legality of relatives making decision for individuals. The manager stated that for one person she would contact a solicitor for advice. The person did not have English as a first language and the manager has knowledge of a solicitor who is able to speak the persons language. Staff consider that they have up to date information on people who live in the home, Care plans are updated on a monthly basis and if there are any changes before then, an emergency meeting is called for usually by the manager of the house. The majority of individuals who live at Alexandra House have been there for many years and said they are very happy. They have been able to achieve a degree of independence and security. The manager is aware of this and promotes this information at placement reviews. Medication is safely handled and administered. There were recent photographs of the person on the medication record and a record of staff signatures. The amount of each medication received by the home had been documented and there were no gaps in the administration record. Good instructions on when to give medication were in place and why it was needed. Medications were seen to be stored safely and securely. Care Homes for Adults (18-65 years) Page 15 of 25 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. People who live in Alexandra House are protected from harm by good Safeguarding procedures and making sure that staff are aware of what is needed to be done if there are any incidents. Individuals are able to raise concerns they have and can be confident that action will be taken if needed. Evidence: Surveys received from people who live in the home showed that they knew who to speak with if they were not happy and how to make a complaint. A staff member put on their survey that if they received a complaint they would Record the information, keep it confidential and follow through to see that their needs are met. The home complaints log showed there had been no concerns raised. We have not received any concerns or complaints about Alexandra House since the previous inspection. There have been no Safeguarding incidents reported. One staff survey respondent stated I have taken POVA training which has enabled me to understand how to communicate and the different types of abuse and how to react on discovering any type of abuse. Care Homes for Adults (18-65 years) Page 16 of 25 Evidence: The manager reported that some members of staff were on the waiting list for an update on Safeguarding training. She said she had recently attended and had obtained a copy of the local authorities revised procedures. During the site visit we observed a good rapport between staff and people that live in the home. Individuals were confident in expressing their needs. Care Homes for Adults (18-65 years) Page 17 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to suitable communal and private space. Work on the garden would extend the areas in which people can access safely. Evidence: People spoken with at the start of the site visit told us that one room had been redecorated and some shelving had been put up in the lobby. On looking around the home we found that individuals are able to personalise their rooms. The back garden still needs tidying and sorting out to enable people safe access outside. This item has been an issue on the homes own plans for improvement since 2004. This work needs to be done to make sure that everyone is able to enjoy being outside safely if they chose. The home was clean and tidy on the day of the site visit and survey respondents indicated that this was generally the case. Care Homes for Adults (18-65 years) Page 18 of 25 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. People are supported by staff who have been recruited safely and have the skills to undertake their role. Training is adequate, but improvement could be made in this area to make sure that all staff are developed to their full potential. Evidence: The AQAA states that recruitment is based on equal opportunities and staff have a training and development plan in place. Evidence from staff surveys confirmed this. One respondent stated CRB and POVA checks are done. employment is only offered after these checks have been carried out and the results are satisfactory. and Induction gave me an awareness of what I was doing. once I started work I was enrolled onto a level 2 NVQ in Care course which have completed. Examination of staff recruitment files demonstrated that all the required information was in place, for example POVA and Criminal Records Bureau checks. Evidence of identity and permissions to work was also available. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: The majority of training is provided in house for NVQs and mandatory training. Consideration should be given to accessing more external training to enable staff to be developed further. At present only medication training is provided externally. Care Homes for Adults (18-65 years) Page 20 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a manager who has the skills and experience to run the home. Quality monitoring has improved and there is evidence that all interested parties are involved in the process. Good health and safety monitoring systems are in place. This makes sure that risk is minimised. Evidence: Staff consider that they are supported in their role and are able to contribute to the running of the home. This was reflected in surveys received. One person said, as follows The manager is always ready to offer support to the staff as well as the clients to meet our everyday needs when I did my NVQ I got alot of support from work. The AQAA indicates that in the past twelve months they have improved the quality assurance system which has helped them identify areas for improvement. On the day of the site visit the manager reported that she was awaiting surveys the Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: home had sent out to be responded to. These were sent to stakeholders, staff and relatives as well as information from people that live in the home. Peoples monies are handled safely. Records show that one person has a solicitor who acts on their behalf and others are able to manage their own personal money. A requirement to make sure that responsible persons visits were undertaken and recorded has been met. Regulation 26 visits are carried out monthly and a report of each visit was available for inspection, issues identified had been actioned. The manager said that she has been given more study time to assist her in completing the Registered Managers Award. This has been beneficial. No issues with health and safety were identified during the site visit. the AQAA states that necessary health and safety checks are carried out and documented. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 23 of 25 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 24 It is recommended that the garden is made accessible so that individuals are able to spend time there safely in the summer. It is recommended that appropriate external training is accessed to assist in developing staff to their full potential. This will benefit people that live in the home as staff will be able to gain a greater understanding of varying needs. 2 35 Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 25 of 25 - 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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