Care Home: Alliston House

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What the care home does well It was apparent that the residents and staff have developed good relationships. Staff were observed to be treating residents with kindness, understanding and respect. They were very responsive to people`s needs and went out of their way to provide people with choices. They continue to demonstrate a good working knowledge of the residents and their individual needs. The menus offer a wide choice of meals, and on both days of the inspection residents could choose from a wide variety of meals, which included a vegetarian option and a choice of several desserts. Culturally appropriate food is also available for those residents who are from a minority ethnic community and special diets catered for. Additionally, cleanliness in the kitchen was of a particularly high standard. Good progress is being made with providing a range of information in pictorial format for the benefit of residents who are living with dementia. The "life story" books that have recently been created with residents are of a very good standard. Signage around the home is of a good standard to aid the orientation of those residents living with dementia. The management and the staff demonstrated a good understanding and awareness of equality and diversity issues around religion, culture, sexuality, disability and gender. What has improved since the last inspection? CARE HOMES FOR OLDER PEOPLE Alliston House Alliston House Church Hill Road Walthamstow London E17 9RX Lead Inspector Caroline Mitchell Unannounced Inspection 10:00 22 July & 7 August 2008 nd th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alliston House Address Alliston House Church Hill Road Walthamstow London E17 9RX 020 8520 4984 020 8520 6266 deirdre.mosley@walthamforest.gov.uk 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) London Borough of Waltham Forest Deirdre Catherine Mosley Care Home 43 Category(ies) of Dementia (43), Old age, not falling within any registration, with number other category (43) of places Alliston House DS0000034835.V365196.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: PC Care home only to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 43) Dementia - Code DE of the following age range: over 55 years (maximum number of places: 43) The maximum number of service users who can be accommodated is: 43 25th June 2007 2. Date of last inspection Brief Description of the Service: Alliston House is registered as a care home for up to 43 people of either sex over the age of 65 who are frail elderly or who have a diagnosis of dementia. The home is owned and operated by the London Borough of Waltham Forest and is situated in a quiet residential area of Walthamstow. The care home is situated on 3 levels and there are 5 units, Warner and Disraeli on the ground floor, Atlee and McEntee on the first floor and Morris on the top floor. Each unit is self-contained with its’ own kitchenette, lounge and dining area. All bedrooms are single with a washbasin and toilets and bathrooms are communal. There is a lift to all of the floors, and the home is wheelchair accessible. There is an enclosed rear garden, which has seating for the residents, and there is car parking to the front of the home. The home is situated near to some local shops, and is accessible by public transport. The fees are in accordance with the Local Authority’s charging policy following a financial assessment and range from £566 to £623 per week. A copy of the statement of purpose was available at the home in the reception area, and a copy can be obtained on request from the manager. Following “Inspecting for Better Lives” the provider must make information available about the service, including inspection reports, to the people who use the services and other stakeholders. Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key unannounced inspection undertaken over 2 days, on 22nd July and 7th August 2008. The manager was available throughout the inspection process, and the responsible individual came to hear the feedback towards the end of the inspection. During the 2 visits the inspector was able to speak to many residents, visiting relatives and friends, and several staff members. A sample of residents’ files were looked at, together with the medication administration records (MAR), staff rotas, training schedules, activity programmes, maintenance records, accident records, menus, complaints records, staff recruitment processes and files. The organisation had returned the Annual Quality Assurance Assessment (AQAA) and this was used as part of the inspection. The AQAA is a self-assessment completed by the home, that focuses on how well outcomes are being met for people living there the service. It also gave us some numerical information about the service. What the service does well: It was apparent that the residents and staff have developed good relationships. Staff were observed to be treating residents with kindness, understanding and respect. They were very responsive to people’s needs and went out of their way to provide people with choices. They continue to demonstrate a good working knowledge of the residents and their individual needs. The menus offer a wide choice of meals, and on both days of the inspection residents could choose from a wide variety of meals, which included a vegetarian option and a choice of several desserts. Culturally appropriate food is also available for those residents who are from a minority ethnic community and special diets catered for. Additionally, cleanliness in the kitchen was of a particularly high standard. Good progress is being made with providing a range of information in pictorial format for the benefit of residents who are living with dementia. The “life story” books that have recently been created with residents are of a very good standard. Signage around the home is of a good standard to aid the orientation of those residents living with dementia. The management and the staff demonstrated a good understanding and awareness of equality and diversity issues around religion, culture, sexuality, disability and gender. Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them and the care home that includes how much they will pay and what the home provides for the money. EVIDENCE: At the last inspection the registered provider was required to make sure that information is available to prospective and current residents in formats, which will enable them to make decisions on where to live. This is particularly Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 9 relevant to prospective and current residents living with dementia, or who have a sight impairment or other bars to reading. At this inspection we found that the statement of purpose is available in Braille, an audiotape version and is available in a number of languages, on request. It is specific to the individual home and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by a service user’s guide. The management team has worked hard to make sure that the guide is accessible for people with dementia. It has been written in a thoughtful way, is in large print, clear language and supported by pictures. It give clear details what the prospective residents can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff, how to make a complaint, recent CSCI inspection findings and contains comments and experiences of residents living at the home. All residents are given a copy of the guide. Although the statement of purpose mentions equality of opportunity, we found that there was room for improvement in that it didn’t specifically mention peoples’ sexuality. The manager was very responsive and addressed this issue at the time of the inspection and we saw the revised written version. She also made arrangements for the statement of purpose that is in other formats, such as Braille and audiotape to be updated to include this information. We looked at the written records for 3 residents and these showed that admissions are not made to the home until a full needs assessment has been undertaken. The assessment is conducted professionally and sensitively and involves the individual and their family or representative, where appropriate. Copies of the assessments that had been undertaken through care management were also included in peoples’ records. Each person had been provided with a contract between themselves and the local authority, and this included the fees payable, what they cover, the accommodation to be provided and details of the care and services to be provided by the home. The manager told us that she always likes prospective residents to come for the day, or a least a visit and a cup of tea so that they are given the opportunity to spend time in the home before moving in. Each person had a contract, setting out what they could expect from the home and the costs, on their file. Although there was evidence that that manager had been working on this, some had not been signed by residents or their representatives. A requirement is made about this. Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. EVIDENCE: Staff understand the importance of residents being supported to take control of their own lives. During the inspection we saw many instances where people were encouraged by staff to make their own decisions and choices. We looked at the written records for 3 people and each person had a care plan. These were person centred, written in plain language, were easy to understand and looked at all areas of the person’s life. They included reference to equality and diversity and address any needs identified in a person centred way. They recorded any relevant equality and diversity needs for the residents, such as religion, diet, disability, ethnicity and language. At the last inspection the Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 11 registered provider was required to make sure that all residents have a care plan which reflects the new format agreed by the organisation, and that daily record reflect these and the desired outcomes. At this inspection we found that the new format had been introduced and that the needs of residents were being monitored, recorded, reviewed and updated. The care plans recorded the preferred communication style of each person. Staff have skills and ability to support and encourage residents to be involved in the ongoing development of their plan. Staff make the process interesting and use a variety of ways to help individuals make a worthwhile contribution. For instance a “life story” book has been developed for each person, recording things that they recalled about their lives and illustrating these with pictures. This gives residents the opportunity to tell their story, who they are and where they come from, what they like and what they don’t like. Some of these were of a very high standard, particularly where peoples’ relatives had been involved and had provided lots of photographs. Additionally, a key worker system allows staff to work on a one-to-one basis and contribute to the care plan for the person. The care plans we saw included a range of information that is important to people. They also included information about peoples’ health. They had been kept up to date. Reviews focused on asking what has worked for the person, where there are progress, achievements, concerns and identified action points. Each care plan included a comprehensive risk assessment, which had been reviewed regularly. The management of risk was positive in addressing safety issues while aiming for improved outcomes for people. Where there were limitations placed on people, the decisions had been made with the agreement of the person or their representative and were accurately recorded. While there were good quality risk assessments in place regarding each of the areas that were relevant to each person, we found that there was room for further information in the risk assessments about preventing people from having falls. A recommendation is made about including guidance for staff about checking that peoples’ foot wear was in good condition, to reduce the risks for people. The care plans included details of peoples’ personal care needs to make sure that people receive personal care using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. These placed a lot of emphasis on where staff should offer people opportunities to make choices, such as in the areas of bathing, personal care, personal appearance, clothing and times for getting up and going to bed. Each person we spoke to said things that indicated that staff respect peoples’ privacy and dignity and listen and responds to peoples’ choices and decisions about who delivers their personal care. People said they are supported and helped to be as independent as possible and staff listen and take account of what is important to them. Necessary equipment to aid mobility is available in Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 12 the home, and where necessary referrals are made to an occupational therapist. Personal healthcare needs including specialist health, nursing and dietary requirements were clearly recorded in each person’s plan. They gave a good overview of their health needs and act as an indicator of change in health requirements and showed that residents have access to healthcare and remedial services. Staff make sure that those who are fit and well enough are encouraged to be independent, have regular appointments and visit local health care services. The health care needs of residents unable to leave the home are managed by visits from local health care services. At the last inspection the registered provider was required to make sure that the home has effective equipment to weigh residents, that weights are appropriately monitored to make sure that any increases or decreases are noted, with necessary advice/referrals being requested. At this inspection we found that new scales had been bought and records were improved. We noted that systems were in place to identify those residents who are at risk of developing pressures sores, and appropriate advice and intervention is sought and was recorded in the care plans. We looked at how medication is received, kept, administered and recorded. The home has an efficient medication policy supported by procedures and practice guidance. Medication records were fully completed, contained required entries, and were signed by appropriate staff. Regular management checks were being undertaken. The home was not administering any controlled drugs at the time of the inspection, although it had the appropriate storage facilities and record keeping systems in place for when this is needed. All of the MAR sheets were in good order and all staff involved in the administration of medication had undertaken certificated training. The home’s policy states that 2members of staff must undertake the administration of medication and both members sign the MAR sheets accordingly. The manager is making good progress with the introduction of end of life plans for all of the residents, and this is being done with the involvement of the local National Health Service end of life co-ordinator. From discussions with the manager and her staff, it was evident that if people wished to remain in the home, arrangements are put in place to enable family and friends to stay and help with their care. The manager was clear that support would be given to staff during this process. Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 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. They are as independent as they can be, and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. EVIDENCE: In discussion the manager came across as having a strong commitment to enabling residents to maintain their skills, including social, emotional, communication, and daily living skills. People who use the service have the opportunity to develop and maintain important personal and family relationships. The staff practices promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices. Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 14 The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. At the last inspection the registered provider was required to continue to develop the activities within and outside of the home so that all residents are given daily opportunities for stimulation through leisure and recreational activities, which suit their needs. This is particularly important for residents living with dementia or other cognitive impairments or other disabilities. At this inspection we found that this had been addressed. There was evidence that residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. We visited the units at various times throughout the 2 days of the inspection and saw some residents engaged in either individual or small group activities on the majority of the units. Staff were observed interacting well with residents, laughing and joking with them. We also saw lots of photographs of the larger group activities that people had been involved in since the last inspection. These included the Christmas party, and other Christmas entertainment, a trips to the seaside, residents choosing new furniture for the home, a trip to a museum, a 102nd birthday party, Easter lunch, various entertainers visiting the home, the gardening club and a trip to Greenwich Park. These are kept in albums so that staff can sit and talk to residents about the activities, using them as aids to their memory. The team have been doing some work with the dementia support team from Waltham Forest and staff had also had 3 days of dementia training. Residents were given the opportunity to go out in a mini bus, to local cafes and centres on a regular basis. 1 resident was on holiday in Ireland at the time of the inspection. All of the units have an orientation board and this is changed daily with the help of some of the residents to show things like the day and date, the season, the weather and the next meal. It was evident from looking at the residents’ files and talking to residents and relatives that they felt that their religious needs were being met. Various clergy visit the home to either take a service or to talk to residents. The manager told us that to help with reminiscence work, a display of pictures of old Walthamstow had been put up last year and we were very impressed by the “life story” books previously mentioned. The home has also recently bought a number of music CDs. The residents were encouraged to choose the ones they wanted and we noticed that these were playing in some of the units when we visited and that staff often asked the residents if the music was OK and if they wanted the volume changed. We also noted that staff were wearing name badges with their names printed clearly and in large print and that this was helpful for some residents. We stayed for lunch on both days of the inspection. This was so that we could sample the food being provided to residents and we sat and talked with a Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 15 different group of residents on each day. The food was of a very good standard. We sampled 1 of the puddings offered to people with diabetes and this was very pleasant. Everyone we spoke to said that they were always very happy with the standard of the food. The compliments included, “There is a very good cook.” And “The food is always very good indeed.” There was a well-presented photographic menu, designed to help the residents with dementia to make choices. On the days that we stayed for lunch the menu was varied with a number of choices, including a vegetarian option. It included a variety of dishes. The meals were balanced and nutritious and catered for the varying cultural and dietary needs of the residents. We noted that the care staff were very responsive to residents at mealtimes, offering lots of choices and checking people were happy with their meals. They were also very sensitive to the needs of those residents who find it difficult to eat and gave assistance with feeding at the pace of the resident, helping them in a way that would make them feel comfortable and unhurried. Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. EVIDENCE: All of the residents we spoke to told us that they were happy felt safe and well supported by the home. They said they would complain to the manager if they were not happy and were sure that they would be listened to. The relatives and friends we spoke to also praised the home and the staff and were all aware of how to complain if they were not happy with anything. 1 resident was moving out of the home, with the help of their relatives. The relatives were very keen to make sure that we knew that this was not due to any problems with the home, but that they had moved house and wanted their relative be nearer, so that they could visit more often. They were very complimentary about all that Alliston House had done for their relative. 1 resident enjoys a daily newspaper, and this is facilitated by the home. They told us that when they complained that it had arrived late, the manager responded immediately and made sure it was there at breakfast time. The service had a clear complaints procedure. There was also an easy read version for residents, which was clearly written, easy to understand and was displayed on each of the units. It is available on request in a number of Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 17 formats (including other languages, large print, audio etc) to help anyone living at, or involved with, the service to complain or make suggestions for improvement. Residents also have access to the London Borough of Waltham Forest’s Social Services complaints procedure, which they can use in parallel with the home’s complaints procedure. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. Unless there are exceptional circumstances the service responds within the agreed timescale. At the time of this inspection there were no formal complaints. The policies and procedures for safeguarding adults were available and gave clear specific guidance to those using them. Staff had received training in safeguarding adults, and the staff we spoke to showed a good understanding of the need to make sure that vulnerable people are protected from all forms of abuse. Other training around dealing with physical and verbal aggression is also made available to staff as necessary. The manager was very aware of the need to involve external agencies when necessary, and a copy of the local authority’s safeguarding adults procedures were available in the home. There were no outstanding safeguarding adults matters at the time of the inspection. There was evidence that alternatives to restraint are always looked for. We noted that equipment that could be used to restrain individuals such as keypads, recliner chairs and wheelchair belts were not being used to restrain people unnecessarily. Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 23, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People stay in a safe and well-maintained home that is homely, clean, 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. EVIDENCE: A tour of the premises was undertaken and the home was found to be clean and hygienic with no offensive odours. Staff were observed practising safe infection control processes through the use of protective clothing and hand washing. The lay out and design of the home allows for small clusters of people to live together in a less institutional environment. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 19 At the last inspection the registered provider was required to make sure that the premises are maintained in a good state of repair, decoration and furnishings, both internally and externally at all times. This was to make sure that residents live in a safe, comfortable and pleasant home. Since the last inspection a lot of redecoration has been done and lots of new furniture has been bought, so that the home is now more comfortable and provides a physical environment that is appropriate to the specific needs of the people who live there. The addition of new cushion covers, tablecloths and fresh flowers have served to make it a more a pleasant place for people to live. The sensory area in the rear garden is progressing nicely. As some of the residents smoke, at the last inspection the registered provider was also required to ensure compliance with the Smoke-free Regulations 2007. This was to make sure the health and welfare of residents and staff. At this inspection we found that this issue had been addressed. Residents are encouraged to personalise their bedrooms and some people had brought in small items of furniture, pictures and ornaments. Call alarms were available in all bedrooms and these were seen to be in reach of residents. However, there are many residents who may not be able to use these call alarms because of a physical or cognitive impairment, so some people had pressure alarm mats by the side of their beds. Each person’s room had their name on the door in large print and a picture of their choice. The home provides specialist aids and equipment to meet peoples’ needs. The bathrooms and toilets are fitted with appropriate aids and adaptations and are in sufficient numbers and of good quality. The toilets were clearly identified with pictures on the doors and the toilet seats were of a contrasting colour to help people with dementia or visual impairment to identify and use them. The kitchen was inspected and found to be well maintained and particularly clean. The home is to be congratulated for the very high standards in this area. The laundry was also visited and again this was found to be clean and tidy with all of the equipment in good working order. Staff spoken to were aware of the COSHH regulations, and necessary materials were appropriately stored. Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have safe and appropriate support as there are enough competent 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. EVIDENCE: The managers recognise the benefits of a skilled, trained workforce and encourage staff to attend training. The manager showed us the library that she has started building up for staff, and which already has a range of relevant books on good practice in areas that are relevant to the needs of the people in the home. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. The residents we spoke to said that they had confidence in the staff working with them. Although more than 50 of the staff have achieved NVQ level 2 in care the home continues to work on this, so that eventually all staff employed at the home will have achieved NVQ level 2 as a minimum. Managers have attended training in the new common induction standards introduced by Skills for Care. Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 21 The rota we looked at showed that there are consistently enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. On the day of the inspection staffing levels were adequate to meet the needs of the reduced number of residents. However, as the home begins to admit new residents it is recommended that staffing levels remain under review. We noted that with an increased number of residents living with dementia, staff have been provided with the necessary training, and that staff numbers were sufficient to ensure that these residents continue to enjoy a quality of life which maintains their skills and motivation. Some staff have been relocated from another home run by Waltham Forest social service department and this has meant that there is less need for temporary or agency staff to be called upon to provide cover. We saw the staff training record for the home. This helps with monitoring and planning for training needs. It showed that staff do regularly receive relevant training that is focussed on delivering improved outcomes for residents. The home puts a high level of importance on training and staff report that they are encouraged and supported to do the relevant training. There were some training needs identified and we saw evidence that training had been booked to meet these. A recommendation is made for the manager to continue with the progress made in this area. At the last inspection the registered provider was required to make sure that staff undertake training in the implementation and implications of the Mental Capacity Act 2005. This was to make sure that all care delivered at the home is in accordance with the wishes of each resident who has capacity to give such instructions and choices, and arrangements made for those residents who do not have capacity. At this inspection we found that good progress had been made with this. The manager has completed this training and has shared this with the staff team in house. The remaining staff team had also been booked to attend the formal training in September 2008. As the home is run by Waltham Forest Social Services Department it benefits from a recruitment procedure that clearly defines the process to be followed. Although the main staff files are maintained within the local authority’s personnel department, there is a record kept at the home for all staff members which gives details of the criminal records bureau disclosure number, references and other personal information. The Commission has previously agreed this arrangement. Through looking at the staff records, and talking to staff and management, we found that staff are receiving 1:1 supervision through individual, group supervision and direct observation. Staff meetings take place regularly. Staff told us they find supervision helpful, with a focus on improving outcomes for people using the service. Notes and action points are taken of meetings and sessions, and progress is regularly reviewed. Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have confidence in the care home because it is led and managed appropriately. People have the appropriate support to control their money and choose how they spend it. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and makes sure their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. EVIDENCE: Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 23 At the last inspection the manager was very new to the home, and a requirement was made for her to submit an application for registration to the Commission for Social Care Inspection. The manager has done this. She has the required qualifications and experience and is competent to run the home. There evidence that she is proactive in identifying areas for improvement, taking action to address these and good at motivating the staff team to work with her. During the inspection she came across as very committed and responsive and was very keen to address any areas identified for improvement during the inspection. She works to provide an increased quality of life for residents with a strong focus on equality and diversity issues and promoting human rights, especially in the areas of dignity, respect and fairness. There is also a focus on person centred thinking in the team, which was evident in the staffs’ day-to-day practice. The AQAA that the home sent to the Commission contains clear, relevant information that is supported by a wide range of evidence. The AQAA lets us know about changes the home have made and where they still need to make improvements. It shows clearly how they are going to do this. The data section of the AQAA is accurately and fully completed. The service has sound policies and procedures, which the manager effectively reviews and updates, in line with current thinking and practice. The manager makes sure staff follow the policies and procedures of the home and those of the parent organisation. We saw lots of instances of the team positively translating policy into practice. Management processes make sure that staff receive feedback on their work. The home works to a clear health and safety policy. Staff showed awareness of the policies and had received training. Regular random checks take place to make sure that the home is safe. The home has a consistent record of meeting relevant health and safety requirements and legislation, and closely monitoring its own practice. Practice and guidance in the home reflects the parent organisation’s health and safety policies and best practice. There was also evidence of organisational monitoring by Waltham Forest Council. Records were of a good standard and routinely completed. There were clear quality assurance and monitoring processes in place to make sure efficient running of the home, monitoring the performance and practice of the home. We saw lots of instances where the residents and their representatives had been consulted to gather information about their satisfaction with the home. Many improvements and changes have been introduced in the home since the manager came into post and all of the residents, relatives and friends we spoke to spoke very highly of her. She actively promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The manager’s practice, skills, and knowledge, is based on continuous development, gained through training and enthusiasm for the role. Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 24 People are supported to manage their own money where possible. Where this is not possible there is a clear reason why. At the last inspection the registered provider was required to make alternative arrangement for the management and control of the main finances for 12 residents whose finances were being managed by the manager as agent. As mentioned, the manager has undertaken training regarding the Mental Capacity Act and this has helped her in undertaking to make changes in the arrangements around how people are supported with their finances. She has talked to peoples’ relatives and arranged for them to take over this responsibility or to pass this on to the Court of Protection. The home keeps small amounts of money for most of the residents’ day-to-day expenses and there is a proper recording process in place to protect peoples’ best interests. We saw clear records of 1 resident’s expenditure. Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 2 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 3 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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 OP2 Regulation 5 Requirement The registered persons must ensure that all residents or their representatives have signed up to the contract/statement of terms and conditions between them and the home to indicate that they understand the terms of their stay. Timescale for action 31/01/09 Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that risk assessments about preventing falls includes more guidance for staff about checking that peoples’ foot wear (particularly their slippers) is in good condition. This is to help reduce the risk of residents tripping and falling. It is recommended that, as the home begins to admit new residents, staffing levels remain under review. This is to make sure that sufficient staff are employed at all times, to ensure that all of the needs of the residents are met. It is recommended that the manager continue with the progress made in working with the training schedule that is in place for the home, so that all staff receive all of the necessary training. 2. OP27 3. OP30 Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alliston House DS0000034835.V365196.R01.S.doc Version 5.2 Page 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. 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