Care Home: Alfrace

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What the care home does well Alfrace is situated in the countryside near Wigston. There is lots of space in the home and all service users have their own bedrooms. One service user told us, `I like my room. I like the television on the wall and I like having my own sink.` The home is clean and well-decorated. There is a big garden at the back. The home has a friendly atmosphere and everyone who lives there gets on well. All the service users said they were happy and liked the Owners. The service users lead active lives. They go to day centres and colleges. In the evening they play skittles, and go to pubs and clubs. They go on holiday with the Owners twice a year. Healthy food is served which the service users said they enjoyed. One said, `The food is very good.` What has improved since the last inspection? The Owners have bought four hens and a hen house. The service users help look after the hens and collect the eggs. What the care home could do better: The Owners need to write down more information about the service users on a day to day basis. This will show they are being cared for properly and leading full lives. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Alfrace Newton Lane Wigston Leicestershire LE18 3SH     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: Kim Cowley     Date: 0 4 0 6 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 29 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Alfrace Newton Lane Wigston Leicestershire LE18 3SH 01162883352 01162449013 residentialcare@alfracehouse.wanadoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Richard Morgan,Mrs Rita Morgan care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 No additional conditions of registration apply. Date of last inspection Brief description of the care home Alfrace is registered to provide care for six adults with learning disabilities. It is a small family-run home situated on the outskirts of Wigston, about four miles away from the City of Leicester and about a mile from the town of Wigston, in Leicestershire. The home is a large detached farmhouse, which has been upgraded and modernised. It is staffed by both of the Owners (one of whom is the Registered Manager) who also live on the premises. The accommodation consists of six ground floor single bedrooms, one with an en-suite facility, a large lounge/dining room and a smaller lounge with a television. The home has nearly one and half acres of gardens with a summerhouse, aviary, lawns, and a terrace. The Owners grow organic fruit and vegetables helped by the service users. The fees are 351 pounds per week per person. Further information about the home is available from the Owners. Care Homes for Adults (18-65 years) Page 4 of 29 Care Homes for Adults (18-65 years) Page 5 of 29 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: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was a key inspection that included a visit to the home and inspection planning. Prior to the visit, we (throughout the report the use of we indicates the Commission for Social Care Inspection) spent half a day reviewing information relating to the home. During the course of the inspection, which lasted four hours, we checked the key standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means we looked at the care provided to three of the people living at the home by meeting them; talking with the staff who Care Homes for Adults (18-65 years) Page 6 of 29 support their care; checking records relating to their health and welfare; and viewing their personal accommodation as well as communal living areas. Other issues relating to the running of the home, including health and safety and management issues, were examined. We also talked to the four service users who currently live in the home, the Owner Manager, Owner, and Administrator. 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.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 29 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 29 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. Quality in this outcome area is good. Service users have their needs assessed on admission to ensure the home is suitable for them. This judgement has been made using available evidence including a visit to this service. Standard 2 was inspected. Evidence: The service user group at Alfrace is small and established. The current service users were assessed by social services in conjunction with the Owner Manager prior to moving in. Appropriate records have been kept. There have been no admissions since the last inspection, However there is a set admissions procedure to be followed when necessary. The Owner Manager told us that service users who are interested in coming to the Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: home are invited to visit as often as they like and stay overnight if they wish. This will help them decide if the home is likely to be right for them. The assessment process helps to ensure the home is suitable for people who are considering living there. Care Homes for Adults (18-65 years) Page 11 of 29 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. Quality in this outcome area is good. Care plans help staff to identify and meet service users needs. Running records should be kept so staff can monitor service users progress. This judgement has been made using available evidence including a visit to this service. Standards 6, 7, and 9 were inspected. Evidence: The Owner Manager works from care plans produced by the social services department. These are detailed and contain all the necessary information about each persons care needs including risk assessments. They are reviewed annually by social services staff in conjunction with the service user, their representatives, and the Owner Manager. Between reviews diaries are kept for each service user. These are intended to record Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: any changes in their care needs or significant events in their lives. However these are mostly blank. This was discussed with the Owner Manager who said there were few entries because the service users were stable and their care needs remained the same. While this is understood, more information should be recorded. It is important to know what each service user has done over the course of the year, for example achievements, improvements, ups and downs, activities, incidents, etc. In consequence, some sort of running record should be so kept. This would enable the Owner Manager to demonstrate that service users are leading full lives and their care and other needs are being continually assessed and met. Since the last inspection the Owner Manager has worked with service users to prepare end of life plans. This was done informally and the Owner Manager told us that service users have chosen their favorite hymns, flowers, etc. Service users were happy to chat about the decisions theyd made and were positive about the whole exercise. Care Homes for Adults (18-65 years) Page 13 of 29 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. Quality in this outcome area is good. Daily living and social activities enable service users to lead full lives and grow in independence. This judgement has been made using available evidence including a visit to this service. Standards 12, 13, 15, 16, and 17 were inspected. Evidence: During the inspection the service users returned from their various day time activities. A hot meal was waiting for them and when theyd finished they sat together in one of the lounges to watch televsion. The atmosphere in the home was relaxed and peaceful. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: We joined the service users in the lounge and chatted to them about life in Alfrace. All said they were very happy and considered Alfrace to be their home. Their comments included I like everything here. I want to stay here forever. This feels like my own home. It feels like home because it is home. All the service users lead active lives which include attendance at day centres, community projects, and work placements. At evening and weekends they go shopping, play skittles, and visit pubs and clubs. They holiday with the Owners twice a year, having recently been to Ilfracombe. Service users are encouraged to help around the home, for example by setting the table, washing up, and helping to clean their rooms. They told us Ive taken over the watering of the garden and I do that every night. I help to wash up. I make hot drinks in my room. I get milk from the kitchen. I fill up the kettle. I dont have to ask for the milk. I just get what I want. Since the last inspection four hens and henhouse have been purchased for the home. Service users help look after the hens and collect the eggs. Everyone who lives in the home has contact with friends and relatives, and regular visits and/or phone calls. The emphasis in the home is on healthy eating. Only fresh ingredients are used, and some of these are grown or produced at Alfrace. Service users do have a fry-up every Saturday, but apart from that the food tends to be low-fat and high fibre. There are no set menus as meals are decided on a day to day basis with service users involved in choosing what to have. During the inspection dinner was served. This consisted of roast chicken, roast potatoes, fresh vegetables and gravy, with fresh fruit for pudding. All the service users we talked to said they liked the food. They made the following comments The food is very good. My favourite is the fry up on Saturday mornings. The food s good. I like pasta with tomato sauce. Care Homes for Adults (18-65 years) Page 15 of 29 Care Homes for Adults (18-65 years) Page 16 of 29 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. Quality in this outcome area is good. Service users have their personal and health care needs met in the way they want. This judgement has been made using available evidence including a visit to this service. Standards 18, 19 and 20 were inspected. Evidence: Everyone who lives at Alfrace is encouraged to be as healthy and fit as possible with a combination of a good diet and gentle exercise. For example, two service users who attend day centres where they are mostly sedentary, walk for half an hour every morning and evening (weather permitting) at Alrace to help ensure they remain fit. Care is provided in a sensitive and flexible manner. Care plans contain the basic information the Owners need to provide the right help and support. Service users can choose which one of the Owners assist them with their personal care. This gives them a choice as to whether to have a male or female carer. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: Local health care services are used, for example GPs, opticians, dentists, chiropodists, and well-person clinics. All service users have an annual health check either with their GP or privately. Basic records are kept to show that service users health care needs are being met. There is a procedure in place in case the home has to manage anyones medication, although at present this is not necessary. Care Homes for Adults (18-65 years) Page 18 of 29 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. Quality in this outcome area is good. The Owners know how to safeguard service users and help them express any concerns they might have. This judgement has been made using available evidence including a visit to this service. Standards 22 and 23 were inspected. Evidence: e talked to service users about what they would do if there was something at Alfrace they werent happy about. Without hesitation all said they would tell the Owners. Comments included Rita and Dick tell us to tell them if we re worried about something. If I was upset I would tell Rita. She would help me. If you re troubled about something you can talk to Rita and Dick. The homes statement of purpose includes the complaints policy and procedure. This is also displayed in the home.Service users also have the opportunity to raise any concerns they may have at their annual social services reviews. There have been no complaints made to the home or CQC since the last inspection. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: The Owner Manager said that minor niggles are dealt with as soon as a service user raises them. This is good practice as it prevent issues escalating and becoming a problem. We discussed safeguarding (protecting vulnerable adults form abuse) with the Owner Manager who was aware of her responsibilities in this area and the need to immediately report any corners to social services and CQC. Care Homes for Adults (18-65 years) Page 20 of 29 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. Quality in this outcome area is excellent. The home is comfortable, spacious, and decorated and maintained to a high standard. This judgement has been made using available evidence including a visit to this service. Standards 24 and 30 were inspected. Evidence: Alfrace is situated in a rural area overlooking open fields. The large (one and a half acres) secluded garden is a feature of the home. It is popular with the service users for walking, sitting, gardening. The home is spacious and light throughout. At its centre is a large open plan kitchen, dining area and lounge. There is also a separate lounge where service users can watch television in peace. The Owners have their own private accommodation on the first floor. All the service users bedrooms are on the ground floor and have ensuite facilities. Call bells have been installed in case they need to summon the Owners at night. The bedrooms we looked at were personalised and well-equipped. All had distinct sleeping Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: and seating areas, tea and coffee making facilities, and television sets. We talked to service users about the premises and they made the following comments I like my room. I like the television on the wall and I like having my own sink. I like living here because theres lots of room. I like the big garden. I really like books. Ive got some in my room. All areas are decorated and maintained to a high standard and the overall effect is homely and comfortable. Care Homes for Adults (18-65 years) Page 22 of 29 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. Quality in this outcome area is good. The Owners, who staff the home, provide good care and have warm and friendly relationships with the service users who live there. This judgement has been made using available evidence including a visit to the service. Standards 32, 34 and 35 were inspected. Evidence: The Owner and Owner Manager work at the home full time. They also live on the premises and are on call during the night. No other care staff are employed and the Owners told us that if they go on holiday they take the service users with them. Staff files are not kept as only the Owners provide care to the service users. They were CRB checked and assessed as fit (suitable to run and manage a care home) when they were registered by one of the CQCs predecessors. A family member provides administrative support to the Owners. She had the necessary checks carried out before starting work at the home. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: During the inspection we saw that the Owners got on very well with all the service users. Relationships were mutually respectful and there was much good natured banter. The Owners go on short courses to update their skills and make themselves aware of changes and improvements in the field of care. When we talked to the service users they all praised the Owners and told us how happy they were being cared for by them. One told us, Rita and Dick work extremely hard to look after us. It was evident that relationships in the home were warm, happy and secure. Care Homes for Adults (18-65 years) Page 24 of 29 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. Quality in this outcome area is good. The home is safe and well managed and service users are involved in the way it is run. This judgement has been made using available evidence including a visit to this service. Standards 37, 38, 39, and 42 were inspected. Evidence: Alfrace has a family atmosphere and relationships between the Owners and the service users are relaxed and informal. The Owners have run the home for many years, know the service users well, and are familiar with their likes and dislikes and preferred routines. However they also encourage them to try new things. For example they arranged for one service user, who wanted to drive a car, to have a go on a simulator at a driving school to give him an idea of what it would be like. All the service users told us how much they liked the Owners and how happy they were at Alfrace. One said, Rita and Dick are very good and nothings too much trouble Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: for them. The Owners told us they chat to service users every day about the home. They told us the best time for discussions tends to be in the evening, or over breakfast on a Saturday and Sunday morning when everyone tends to be relaxed. Service users are encouraged to make comments and suggestions about the home. Recently they heard about an open-top bus tour of Leicester and thought it sounded interesting. They told the Owners about the tour and are now booked to go on it. The Owners have developed a quality assurance questionnaire and this is currently being handed out to service users and their representative. Records showed that the Owners have taken the necessary steps to promote and protect the health, safety, and welfare of the services users. The premises are risk assessed every three months to help ensure they are safe for everyone at Alfrace. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 7 A running record should be kept of each service users achievements, improvements, ups and downs, activities, incidents, etc. This would enable the Owner Manager to demonstrate that they are leading full lives and their care and other needs are being continually assessed and met. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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 29 of 29 - 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!