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Care Home: Alexandra House

  • 202 High Street Honiton Devon EX14 1AJ
  • Tel: 0140444528
  • Fax: 01404549429

Alexandra House is situated in the main high street of Honiton and is owned by Readlee Care Homes Ltd. and managed by Mrs Joanna Read. The company also own The Coach House, which is the next door but one property to Alexandra House. Alexandra House is a mid-sized terraced property fronting on to the road, with a small garden to the rear. The facilities and design of the home mean that it would not be suitable for anyone with physical disabilities. The home is registered to provide personal care with accommodation for up to two people with mental health needs. At the time of the inspection two people were living at the home. Fees for people living at the home vary according to their needs but are in the region of £2000 per week and include most activities and some phone calls. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at <<http://www.oft.gov.uk>>. Copies of CSCI inspection reports are available from the office, with a copy also being displayed in the lounge.Alexandra HouseDS0000073152.V375001.R01.S.docVersion 5.2

  • Latitude: 50.79700088501
    Longitude: -3.1960000991821
  • Manager: Mrs Joanne Read
  • Price p/w: £2000
  • UK
  • Total Capacity: 2
  • Type: Care home only
  • Provider: Readlee Limited
  • Ownership: Private
  • Care Home ID: 18950
Residents Needs:
mental health, excluding learning disability or dementia

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Alexandra House.

Key inspection report CARE HOME ADULTS 18-65 Alexandra House 202 High Street Honiton Devon EX14 1AJ Lead Inspector Michelle Oliver Key Unannounced Inspection 30th April 2009 09:30 Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra House Address 202 High Street Honiton Devon EX14 1AJ 01404 44528 01404549429 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) Readlee Limited Mrs Joanne Read Care Home 2 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2) of places Alexandra House DS0000073152.V375001.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 either gender whose primary care needs on admission to the home are within the following category: 2. Mental Disorder (Code MD) The maximum number of service users who can be accommodated is 2 Date of last inspection 5th December 2007 Brief Description of the Service: Alexandra House is situated in the main high street of Honiton and is owned by Readlee Care Homes Ltd. and managed by Mrs Joanna Read. The company also own The Coach House, which is the next door but one property to Alexandra House. Alexandra House is a mid-sized terraced property fronting on to the road, with a small garden to the rear. The facilities and design of the home mean that it would not be suitable for anyone with physical disabilities. The home is registered to provide personal care with accommodation for up to two people with mental health needs. At the time of the inspection two people were living at the home. Fees for people living at the home vary according to their needs but are in the region of £2000 per week and include most activities and some phone calls. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . Copies of CSCI inspection reports are available from the office, with a copy also being displayed in the lounge. Alexandra House DS0000073152.V375001.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 that people who use this service experience good quality outcomes. This inspection was undertaken by one inspector over the course of 8 hours on one day. During this time we spoke with people living at the home and staff. We also spent time observing the care and attention given to people by staff. To help us understand the experiences of people living at this home we looked closely at the care planned and delivered to 2 people. Both people living at the home were spoken with during our visit to hear about their experience of living there. We also spoke to staff including one of the directors, head of care, deputy manager and occupational therapist. A tour of the premises was made and we inspected a number of records including assessments, care plans and records relating to medication, recruitment and health and safety. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk. Copies of the inspection report are available from the office. What the service does well: There is a good admission process that ensures people thinking of moving into the home have all the information they need with which to make a decision. The home provides people with an individual package of care that ensures they are encouraged to reach their full potential. An excellent range of activities and opportunities are on offer and driven by the individual so that they can live fulfilled lives. People living at the home are supported and encouraged to gain independent social skills and staff work well with other health care professionals to achieve this aim. People are encouraged to plan realistic goals and supported to meet them. There is a clear and simple complaints procedure so that people know how to raise any concerns, and a ‘niggles book’ has been introduced to help with this. The home provides a safe, comfortable, relaxed and friendly home for three vulnerable people who have mental health issues. There is a comfortable Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 6 homely atmosphere and people are encouraged to personalise the home as much as possible. The rights and choices of people living at the home are respected and independence is encouraged. All staff spoken to during this visit told us they enjoy working there and feel well supported by the staff team. They are encouraged to undertake regular training to enable them to meet the needs of people living at Alexandra House and motivated to put people living at the home first in all areas. What has improved since the last inspection? What they could do better: A record is not kept in the home of pre admission assessments of individuals’ health and social care needs. Details of people’s health care needs and how these are managed are not recorded in individual care plans. The homes Complaints Procedure does not include up to date information relating to how people may contact the Care Quality Commission if they wish. People living at the home are not being consistently supported and protected by the home’s recruitment policy. [This relates to results of Police checks not being available prior to 2 staff being employed and no proof of identity being available for another.] Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 7 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Alexandra House DS0000073152.V375001.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 Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of moving into the home would be assured that their care needs can be met. EVIDENCE: The home has good admission process that ensures people have sufficient information to enable them to make an informed choice about moving into Alexandra House. The manager told us that each person who is referred to come and live at Alexandra House undergoes an assessment of need and a detailed risk assessment. The home also ensures it receives comprehensive assessments from health care professional who have been involved in the care of the people who are referred to the service. This is to enable the home to determine if the needs of Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 10 the individual can be met by the environment and by the staff of Alexandra House. Referrals made to the home are considered by one of the providers and the Head of Care, who will discuss the information provided, and decide whether the placement is suitable. Issues considered include whether the person would be compatible with the people who may already living at the Alexandra House, whether staff are trained and competent in dealing with the individuals’ health and social care needs and whether the environment is suitable. We were told that staff would visit the person in hospital, which is usually where people are referred from, and get input from other people involved in the persons care. This will include the person, their care manager, other medical staff such as consultants, staff who have been involved in their care and treatment and family and friends. The person is then invited to visit the home. This process depends on the individual, but they can visit as often as they wish. We looked at the files of both people living at the home, which included comprehensive records of multidisciplinary health care professionals’ reviews of the assessment and admission process. However, there were no records of the information gathered when people visited the home. Both of the people living at the home told us they had visited before deciding to move in and confirmed that this was sufficient to enable them to make the decision as to whether to move in. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear care planning system in place, which provides information needed by staff to enable them to satisfactorily meet the day to day needs people living at Alexandra House. Peoples’ choice is sought and acted upon whenever possible. EVIDENCE: The home had completed a comprehensive weekly routine that set how the individual’s initial aims were to be met. This included activities and outings and work towards independence and was drawn up with the individual. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 12 The home accommodates people who have been identified as exhibiting behaviour that challenges the system and who may be at risk of harm to themselves or others. Comprehensive risk assessments are therefore drawn up and control measures put in place, based on any such risks that have been identified. Daily records have been kept for the individual and contained some good recordings, but generally did not relate to specific areas of need. A diary is also kept for staff handovers. This contained information personal to individuals and was not consistent with the guidelines of the Data Protection Act or the Freedom of Information Act. This is because no-one can look at their personal information without also having access to the personal information of others. The unregistered manager said that this would be addressed along with the introduction of a new format for care plans. The AQAA (Annual Quality Assurance Assessment) submitted shortly before the visit indicates that in order to improve the service the home intends to introduce new care plans and simplified daily programme sheets so that everyone can understand them. All people living at The Alexandra House have individual plans of care. These provide comprehensive information about health and social care needs and how they can be best met. Care plans show that progress is monitored and that changes are made accordingly. Plans are written, and reviewed, in conjunction with other health care professionals and plans are agreed by the person concerned, if they wish, and the Head of Care. This means that people are included in how they choose to have their care provided and how they will be supported and encouraged to meet assessed needs. This was confirmed when we looked at individual plans of care. Care plans are detailed and set out details of all aspects of people’s personal and social support needs and the day-to-day action that needs to be taken by staff in order to ensure the care plans are followed. Great emphasis is placed on agreement with the person whose care is being planned to make sure that goals are what they want and steps to meet them are achievable. We spoke to both of the people living at Alexandra House, one of whom told us that they had not been involved in drawing up or reviews of their care plans. We spoke to both people currently living at Alexandra House one of whom confirmed that they had been included in the drawing up of their plans, in regular reviews, told us what their care plans contained and confirmed that they felt comfortable and supported in raising any matters that they did not agree with. Another person told us that they were not included in the care planning or review process. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 13 The service operates a key worker system, which means that each person living at Alexandra House has a member of staff allocated to them, who can communicate with the person and provide support and encouragement to meet individual goals. This is done with the involvement of the person. We saw detailed information relating to how people’s independence and confidence had been increased in a well planned and monitored way. This included educational and vocational as well as leisure activities. For example one person is undertaking a distance learning course and is being encouraged and supported to meet their individual goals, which include cooking. The person told us they would also like to undertake a First Aid course, which would work well with the distance learning training. They had spoken to the occupational therapist employed at the home but as yet nothing had been planned. We did not see any reference to this goal in the persons care plan. When we spoke to the occupational therapist they told us that this would be recorded and steps were being taken to access a local course. Although care plans were detailed and person centred they did not include details of health problems that some people had or how these would be managed or prevented. For example one person is prescribed medication for controlling asthma, but no plan for management of this condition has been compiled. We spoke to the person who is prescribed medication for this, who told us that they “used to have asthma” but no longer has problems. We discussed this with the occupational therapist employed at the home and the head of care. The occupational therapist told us that they are currently working to improve the quality of detail included in care plans. We were shown a recently compiled care plan that included clear, comprehensive details of the assessed needs of a person and how the goals would be worked towards and reviewed. Since the last inspection an individual daily record has been maintained for each person living at the home. The information included is comprehensive and clearly shows whether progress has been made during any one day towards meeting individuals’ aims or goals, good descriptions of behavioural issues and the day’s events. The home accommodates people who have been identified as exhibiting behaviour that challenges the system and who may be at risk of extreme self harm. Comprehensive risk assessments are therefore drawn up and control measures put in place, based on any such risks that have been identified through the care plan. People we spoke to were aware of any restrictions placed upon them and understand why they are there. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 14 There is a rota at the home for jobs that need to be done as well as shopping and cooking. All residents take a turn with these jobs as well as being responsible for keeping their own rooms clean and tidy. One person told us they didn’t agree with the rota system and would prefer to undertake chores on a daily basis as they arose. This had been detailed in their care plan and their chosen system was being monitored to make sure the system was fair and that other people were in agreement. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 & 17. People using the service experience excellent 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 can be confident that they will be supported to make choices about their lifestyles through using the local community, taking part in appropriate activities and maintaining relationships with families and friends. They are provided with choices of well balanced meals are treated respectfully and consulted in all decisions about their lives. EVIDENCE: We spoke to both people living at the home during this inspection who confirmed that staff treat them in a kind and caring way. People living at Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 16 Alexandra House confirmed that staff respect their privacy and only enter their bedrooms with their consent and when they are there. They also confirmed they have keys to their rooms and they can lock the doors when they choose. During the inspection we saw staff treating people respectfully, offering choices and being supportive. People living at Alexandra House may sometimes present behaviour that challenges the service, and restrictions may be placed on their access to the community during these times. However, generally people are encouraged to be independent and are helped to overcome their particular behavioural problems. The home is working hard to encourage people to be as independent as possible, for example some people living at the home are able to use the local facilities and public transport independently now. Care plan goals and risk assessments reflect this work. One person told us that sometimes they do not feel supported by staff at the home. We discussed this with them and staff. We were told, and saw written information, which indicated that relationships between both people living in close proximity to each other were complex. We saw detailed information relating to strategies for coping, encouraging and supporting both people to develop social skills, independence and confidence. Transport is available, provided by Readlee Ltd. All staff over the age of 25, who has a current driving license, is insured to drive either of the 2 cars. We were told that it is hoped that another people carrier will be bought so that people living at Alexandra House and those living in another service owned by Readlee Ltd will be able to go out together if they wish. We saw photographs of a people from Alexandra house and the Coach House enjoying an evening out together. We spoke to both people living at Alexandra House who were happy to tell us about some of the activities they take part in and enjoy. These included both leisure and educational activities. One person told us they enjoy dog walking, cooking and is currently undertaking a distance learning course, which they are enjoying. They told us they would like to undertake First Aid training and had discussed this with staff. We did not see any evidence of this aim in the persons’ care plan. We were told that this was due to be included when plans were reviewed. One person told us they were interested in sport, including football. They told us they enjoy going to watch Exeter play at home. They also look after the Alexandra House resident cat and kittens. They take particular interest, enjoyment and responsibility for feeding and caring for them. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 17 People living at Alexandra House are encouraged and supported to maintain close contact with the families if they wish and are able to make a free phone call to their families every evening if they wish. We spoke to staff that showed a good understanding of peoples’ needs and were able to describe good practice in relation to maintaining their privacy and dignity and ensuring that despite complex behaviour relationships are promoted and respected. The home employ an occupational therapists to promote independence for the people living at the home, and to support and encourage them to find new and interesting activities for them to participate in. Activities which meet individual interests are sought and all of those we spoke to told us how staff would try to sort out any activities they wanted to take part in. Mrs Joanna Reed, Company Director, told us she was very happy to pay for any courses or activities that interested people living at Alexandra House. Healthy eating is encouraged at the home and people living there are helped to choose healthy alternatives although personal choice is supported. People take it in turns to shop and cook for the evening meal. Both people living at the home told us that they were able to choose what they wanted to eat and when they wanted to eat. One person told us they don’t always like the style of food cooked by their fellow resident but this was simply a matter of choice. The home always encourages people to eat healthily. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from their dignity and privacy being fully respected. Improvement in care planning will ensure that peoples’ health needs are closely monitored. Medication is generally well managed at the home. EVIDENCE: The aim of the service provided at Alexandra House is to increase the daily living, emotional and social skills of the people living there in order that they may at some time live independently. The home accommodates people who may have severe mental health issues and lack emotional stability. Staff said that they see their role as supporting people and enabling them to work towards the independence they want. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 19 Neither of the two people currently living at the home receives any physical personal care, but staff are on hand to prompt and guide if needed. People are encouraged and supported to make and attend appointments with health care professionals such as doctors, consultants, dentists and opticians. Records are kept of all appointments people attend also information about any treatment or dates of follow up appointments. Care files show that all individuals have regular contact with psychologists and psychiatrists who monitor their emotional wellbeing. Medicines are generally well managed and are stored securely in a locked room in a locked cabinet. Since the last inspection the majority of medicines are supplied to the service in individual blister packs supplied by a local pharmacy and some continue to be dispensed in bottles. The service has a “homely remedy” policy, which may be given for the treatment of minor ailments such as headaches. The policy lists medicines that have not been prescribed but which can be bought from pharmacists “over the counter”. There are some risks that prescribed medicines may interact with medicines bought over the counter. The manager told us that the service has consulted with a doctor for advice about the chosen remedies and we were told that a doctor would be consulted if symptoms persisted. Staff at the home have undertaken training in the administration of medication and the Head of Care assesses their competencies regularly to ensure they continue to understand safe practices. This reduces the risk of any mistakes being made in relation to medication procedures. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Alexandra House know they can raise any issues or complaints at the home, and have been given information to enable them to know the system to be followed. Improvement is needed in recording issues or complaints raised to ensure that people can be confident that they will be listened to and complaints will be dealt with appropriately. There are good systems in place to ensure people are protected from abuse and the risk of harm. EVIDENCE: The home has a clear complaints procedure, which is displayed around the home, on notice boards, in individuals’ bedrooms and also each person is given a copy when they move into the home. The complaints procedure gives information of how people can make a complaint to the home or to the Commission if they wish. Timescales for looking into issues and feeding back to the person concerned is also included. The procedure needs to be amended to show the correct details of the Commission. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 21 The home also has a ‘niggles book’ where anyone can write any issues they may have. Alexandra House is run as a family home and all staff regularly meet with people when any concerns can be highlighted and discussed. Staff told us they would also recognise any problems with either of the two people currently living at the home as they knew them well. Both people living at the home told us they know how to make a complaint and would feel comfortable doing so if they were unhappy about anything. If they were unhappy they would speak to their key worker or any other member of staff. One person living at the home has made a complaint to the Head of Care since the last inspection and has also contacted the Commission. No details of the issues raised or of how the issues had been dealt with had recorded; although we were told the issues had been dealt with. The person who made the complaint was not fully satisfied with the outcome of the investigation. Another issue had been recorded in a persons care plan with details of assurances given to the person that the problem, which related to the gender of staff being in the house throughout the night, would not happen again except in extreme circumstance, when the person would be told of it in advance. The person told us the issue had re occurred but they had not been told about the situation and they were “extremely upset” by the incident. All staff at the home have received training relating to POVA (Protection Of Vulnerable Adults) issues. Staff spoken to during this inspection gave us good examples of what they would consider being poor practice or abuse and said they would not hesitate to report any concerns to the Head of Care or one of the Directors of Readlee Ltd. People living at Alexandra House are at high risk of self harm and risk assessments have been undertaken, and are in place to minimise these risks. All staff spoken to during this inspection were aware of these and discussed with strategies undertaken to ensure they are followed. Peoples finances are managed well. People said they had their own bank accounts where benefits are paid and a standing order is set up to pay their contribution towards the homes fees. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Alexandra House provides safe, comfortable, clean and homely accommodation and environment for people living and working there. EVIDENCE: The home is a large terraced house on the main road into Honiton. It has a large spacious lounge/diner as well as a large kitchen/diner, which has been refitted since the last inspection and had an updated fire detection system installed. There is also a pleasant rear garden area. All communal areas are well maintained and comfortably furnished with contemporary furniture and fittings. Neither bedroom is on the ground floor, making the home unsuitable for anyone with mobility difficulties. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 23 The home was clean and hygienic throughout. People are responsible for keeping their own rooms clean and there is a rota for general household tasks. A bathroom on the first floor has been refurbished since the last inspection, making bathing/showering a more pleasant experience for those living at the home. The laundry is sited on the first floor and has to be walked through in order to reach the bathroom. The laundry was well equipped and had an impervious floor covering to minimise the risk of cross infection. People living at the home are encouraged to treat it as their home and take responsibility for their own rooms. All communal areas are well maintained and comfortably furnished with contemporary furniture and fittings and there were lots of pictures and photographs of those who live and work at the home, giving it an ordinary domestic feel. Several people commented that they liked the way the environment was so relaxed and homely. A hall carpet has been replaced since the last inspection and a new central heating system has been installed. We were told there are plans to redecorate the hall, stairway and landing soon. Individuals are encouraged to personalise their rooms and are able to choose their own colour schemes and furnishings and fittings. We did not look at any bedrooms during this inspection but all people we spoke to told us they were very happy with their rooms. Individuals are responsible for keeping their own rooms clean and there is a rota for general household tasks. The home was clean, fresh and hygienic throughout at the time of this inspection. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Alexandra House benefit from being cared for and supported by staff that are well trained, caring and experienced. Not all staff have been recruited following a robust recruitment procedure. EVIDENCE: The service aims to have at least two members of care staff on duty at all times throughout the day and night. Both directors, the head of care and an occupational therapist are also on duty and available in any of the three homes owned by Readlee Ltd, all of which are in Honiton within walking distance of each other. The homes are also supported by a secretary and a part time office administrator. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 25 People living at Alexandra House confirmed that there was usually enough staff available to enable them to do what they chose. If there were not then arrangements would be made to make extra staff available. At the time of this inspection one carer was on duty supported by an occupational therapist. We were told that usually there would be another member of staff on duty but they were attending training, which was being held over 2 days. Joanna Read and the head of care were also available throughout the day. The head of care was also available throughout the day. All staff are encouraged to undertake NVQ training after they have completed a 3 months probationary period. Information received prior to this inspection told us “all staff have or are working towards NVQ2 and encouragement is given to NVQ 3 and above”. Readlee Ltd had a good response to a recent recruitment drive and has employed a number of staff since the last inspection to work at all services owned by the Company. The service has a robust policy and procedure to be followed when employing staff but we saw evidence that this had not been complied with consistently when we looked at 3 of the 4 employment files looked at during this inspection. For example, one person had been employed before a police check had been applied for, another was employed before the result of a police check had been received and although we were told that proof of identity would have been seen by the interviewers at the time of interview, a copy of this was not available in the file at the time of this inspection. The manager told us they would “ never employ someone without checking their identification”.We were told that staff had not worked alone before the result of police checks had been received. Not complying with the services’ employment procedure and policy puts people, who use the service, at risk of being cared for by staff who have not been employed using a robust recruitment procedure. We were told that currently 6 recently employed staff are undertaking induction training. Training is comprehensive covering topics including medication, protection of vulnerable adults, food hygiene, infection control, health and safety, Mental Capacity Act and communication and also includes an assessment of what staff have learned from the training. The induction training programme meets good practice guidelines. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a well managed, safe home where their views and wishes are listened to and they are included in the running of the home. EVIDENCE: Mr & Mrs Read, Directors of Readlee Ltd are experienced social workers, have several years experience in residential care and Mr.Richard Read is registered as the manager of Alexandra House. A deputy manager of the company has Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 27 recently been recruited and a head of care and an occupational therapist are also employed and all work between the 3 services owned by the Company. We were told that relatives, and visitors, of people living at the Alexandra House have recently been asked to complete a Quality Assurance survey so that the level of satisfaction with services delivered could be assessed. However, a report, which would be made available to interested parties, has not yet been produced. There are regular meetings for those living in the home and records show that they are offered as much choice as possible about how they lead their lives, within the confines of interpersonal relationships and individual choice. A questionnaire was completed by the manager prior to the site visit, which provided information about the people living in the home, staff, and fees and indicates whether necessary policies are in place. The information helps the Commission prepare for the inspection. Information provided by Alexandra House prior to this inspection, indicates that the service complies with health and safety legislation in relation to maintenance of equipment, storage of hazardous substances, health and safety checks and risk assessments. All windows above ground floor level are fitted with restrictors, in order to minimise the risk of falling from these windows. No radiators have been fitted with covers, but risk assessments, which have been undertaken, indicated that covers were not needed at this time. We were told the service is operated in an “open door” management style encouraging people living and working there to speak openly without fear of being judged or in any way victimised. Confidentiality is respected and if a person wishes to speak privately they can do so at any time to whoever they wish to speak to. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 28 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 X 2 3 3 X 4 X 5 X 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 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 2 X X 3 X Version 5.2 Page 29 Alexandra House DS0000073152.V375001.R01.S.doc 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 YA34 Regulation 19[1][b] Requirement Before a person is employed to work at the Care home unless the information specified in 1-7 of Schedule 2. [This relates to 2 people being employed prior to the results of a Police check being received and no evidence of proof of identity available in the recruitment file of another] Timescale for action 28/05/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA2 YA6 YA22 Good Practice Recommendations Pre admission assessments of health and social care needs should be recorded and kept in the care home. Details of people’s health care needs and how these are managed should be recorded in individual care plans. A record should be kept of all issues raised or complaints made by people living at the home, details of any investigation, action taken and outcome and this record should be checked at least 3 monthly. DS0000073152.V375001.R01.S.doc Version 5.2 Page 30 Alexandra House Care Quality Commission South West Region PO Box 1251 Newcastle upon Tyne NE99 5AN National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Alexandra House DS0000073152.V375001.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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Alexandra House 30/04/09

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