Care Home: Alphonsus House

Similar services:

• Polesworth Group Friary Road
• Polesworth Group Pooley Heights
• Polesworth Group 32 Station Road
• Polesworth Group 70 Long Street
• Breme
• Polesworth Group 64 Long Street
• Polesworth Group 68 Long Street
• 10 Whitfield Avenue

What the care home does well The home is well run and people are provided with a clean, comfortable and safe environment in which to live. Bedrooms are decorated and furnished to their personal taste and their right to privacy is respected. Care is provided by a stable, competent and trained staff team who meet people`s needs in accordance with their individual plans. There are suitable arrangements in place to support people to live the lifestyle they choose, maintain relationships with family and friends and access community-based services. People are encouraged to express their views and there are systems in place to protect them from harm or abuse. Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 What has improved since the last inspection? The service has continued with its plans to improve the environment for people who live here and a designated smoking area has been identified in the garden. The service has reviewed its process for assessing people`s needs and arranging for people to visit the home before moving in. Health care records have been updated to ensure people`s needs are being appropriately met. Picture menus have been produced for people who find it hard to communicate to choose what they would like to eat and support is being provided for people to plan and prepare their own meals. The service has carried out risk assessments and, where applicable, people are supported to administer their own medication. Accidents are monitored for trends and action taken to reduce the risk of similar incidents occurring. Suitable arrangements have been made for covering staff absences to ensure people`s needs continue to be met appropriately. What the care home could do better: Although care plans are regularly reviewed by the service arrangements should be made for these to be reviewed at least once every six months with the individual and people who are significant in their lives to ensure the plans continue to meet their needs and preferences. Decisions made on a person`s behalf should be clearly recorded and regularly monitored to ensure these are made in their best interests. The service should seek advice for people who experience difficulty in taking their medication with the prescribing healthcare professional. A system should be produced for senior staff to report to the manager on the practice of newly appointed staff they are working. Fire risk assessments should be reviewed at least once every year to ensure the safety of people in the home continues to be protected. An annual develop plan should be produced for people to be fully confident that their views underpin the service`s self-monitoring and review of its own performance as part of its quality assurance system.Alphonsus HouseDS0000004837.V377172.R01.S.docVersion 5.2 Key inspection report CARE HOME ADULTS 18-65 Alphonsus House 81 - 85 Vicarage Road Oldbury West Midlands B71 1AH Lead Inspector Linda Elsaleh Key Unannounced Inspection 30th & 31st July 2009 10:00 Alphonsus House DS0000004837.V377172.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. Alphonsus House DS0000004837.V377172.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 Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alphonsus House Address 81 - 85 Vicarage Road Oldbury West Midlands B71 1AH 0121 544 6311 0121 544 6311 alphonsus.house@craegmoor.co.uk for AQAA www.craegmoor.co.uk Parkcare Homes Ltd 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) Clare Louise Booth Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Alphonsus House DS0000004837.V377172.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 the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) 18 The maximum number of service users who can be accommodated is: 18 18th August 2008 Date of last inspection Brief Description of the Service: Alphonsus House is owned by Craegmoor Healthcare and is registered to provide care for 18 adults with a learning disability. The home consists of three adjoining victorian properties with external access between the houses via the rear garden. Each house is self contained with its own facilities with the exception of a communal laundry between houses 83 and 85. The home is situated on a busy main road between Oldbury and Langley. It is close to local shops, pubs and other public amenities. There are good public transport links to nearby towns of Dudley, Oldbury and Birmingham. There is a small driveway at the front of house 81 for off-road parking. Bedrooms are situated on the first and ground floors. Access to the first floor is by stairs only there are no passenger lifts in this home. Each property contains a dining room and a lounge. There are three domestic style bathrooms and toilet. Each house has its own dedicated staff team although staff may work in all three houses to cover absences if required. The provider/manager should be contacted for update information about the fee charged for this service. Alphonsus House DS0000004837.V377172.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 the people who use this service experience good quality outcomes. We looked at information we have received about the service since our last visit and sent surveys to people who live in the home, their relatives and health and social care professionals asking them to tell us what they think about the home. We received responses from 10 per cent of the people we surveyed. Comments were generally positive about the service and have been included in this report. The service is required to complete an Annual Quality Assurance Assessment (AQAA). This provides us with information about what has happened in the home during the last 12 months. This was returned to us by the date requested and contained the information we asked for. This unannounced inspection was carried out by one inspector on 30th and 31st July 2009. We spoke to the manager, staff and most of the people who live here. We looked the care files for three people and three staff files as well as other records and documents kept by the service. This was to help us to assess the quality of life for people who live in the home and the service’s performance against the national minimum standards. The atmosphere in the home was relaxed and friendly. A tour of the building found it to be suitably furnished, clean and tidy. People we met appeared healthy and well looked after. What the service does well: The home is well run and people are provided with a clean, comfortable and safe environment in which to live. Bedrooms are decorated and furnished to their personal taste and their right to privacy is respected. Care is provided by a stable, competent and trained staff team who meet people’s needs in accordance with their individual plans. There are suitable arrangements in place to support people to live the lifestyle they choose, maintain relationships with family and friends and access community-based services. People are encouraged to express their views and there are systems in place to protect them from harm or abuse. Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Although care plans are regularly reviewed by the service arrangements should be made for these to be reviewed at least once every six months with the individual and people who are significant in their lives to ensure the plans continue to meet their needs and preferences. Decisions made on a person’s behalf should be clearly recorded and regularly monitored to ensure these are made in their best interests. The service should seek advice for people who experience difficulty in taking their medication with the prescribing healthcare professional. A system should be produced for senior staff to report to the manager on the practice of newly appointed staff they are working. Fire risk assessments should be reviewed at least once every year to ensure the safety of people in the home continues to be protected. An annual develop plan should be produced for people to be fully confident that their views underpin the service’s self-monitoring and review of its own performance as part of its quality assurance system. Alphonsus House DS0000004837.V377172.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. Alphonsus House DS0000004837.V377172.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 Alphonsus House DS0000004837.V377172.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, 4 & 5 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 are provided with the information they need to make an informed choice about where to live. The service has reviewed its procedures to ensure the needs and aspirations of people who may wish to come to live at the home are fully assessed and the service can be confident all their needs can be met. EVIDENCE: People who live in the home and relatives who responded to our survey told us they had been provided with enough information to make a choice about where to live. A copy of the Statement of Purpose and Service User Guide is available in the home. The Service User Guide has been provided to people living in the home in a pictorial format. The manager told us the Statement of Purpose will also be produced in a similar format. Information provided to us by the service show there has been no new admissions since our last visit. It has reviewed its referrals and assessment Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 10 process including arrangements for visits and trial stays for people who may wish to come and live in the home. This is to provide people with opportunities to get to know the home, assess their compatibility with other people who live in the home and to be confident the service is able to meet the person’s needs. Staff told us they understand the revised procedures. The process includes the assessment of people’s physical, emotional and social needs, their personal preferences and how these can be met. The service has consulted with healthcare professionals, such as the Learning Disability and Autism services and Occupational Therapists, when it has re-assessed the needs of people living in the home. Information about what a person likes to do and how they interact with others are kept on their files. A written contract was seen on the files we looked at and were signed and dated by the individual and/or their representative, the manager and key worker. These should be produced in alternative formats, such as audio or pictorial, for people who do not read. Alphonsus House DS0000004837.V377172.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, 8 & 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. Each person has a care plan to meet their individual needs and personal preferences. However, more suitable arrangements should be made to review these plans with the individual and significant people in their life to ensure these continue to meet their needs and preferences. People are consulted with and provided with opportunities to participate in all aspects of life within the home and are well supported to take risks as part of an independent lifestyle. EVIDENCE: We looked in detail at the care plans for three people who live at the home. These have been produced from the assessments carried out by the service Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 12 and contain information about the individual’s personal, health and social needs, what the person is able to do on their own and s/he likes and dislikes. The service takes a person-centred approach to care planning and this is reflected in how the majority of the care plans are written. For example, one person’s plan shows how s/he likes to be supported to carry out tasks such as shopping or making a snack. It identifies what tasks s/he can carry out for themselves and where support is required. Another person’s plan states “I can be aggressive in crowded places” and shows how best to support them in the community. Care plans are reviewed monthly by the service, using the daily recordings made by staff to monitor their progress. This is to ensure their plans continue to reflect their needs and how these are to be met. However, there was little evidence to show care plans are reviewed with the individual, their relative/representative and relevant agencies. The manager is advised each person’s care plan should be reviewed with them and significant people in their lives at least once every six months. The manager told us people living at the home have good access to independent advocates and four people are currently receiving this support. We saw people choosing how they spent their time. For example, watching the television or playing on the WiFit console and others preferred to relax in their bedrooms. Staff we spoke told us some people are able to make their own decisions about how they wish to spend time, such as going out unaccompanied to visit family and friends. However, others have limited communication skills and are unable to express their wishes when choosing a meal for the menu, for example. In such circumstances the member of staff uses their knowledge of the person to make a decision on their behalf. The daily records do not fully reflect where decisions have been made on the person’s behalf. The manager told us she would address this and arrange for these records to be regularly monitored to ensure the decisions made are in the person’s best interests. The staff records we looked at show training on the mental capacity act and deprivation of liberties safeguarding have yet to be arranged. The manager told us the company is in the process of arranging this training. The service has re-introduced group meetings where people are able to meet in their individual houses to discuss the day-to-day running of the service. The minutes of a meeting held in one of the houses shows they were provided with an update on the progress being made in re-decorating the home. People asked for new items to be purchased, such as a dining table, crockery and pictures. Another ‘house’ discussed activities and holidays which led to the suggestion of compiling a leisure resource book which most people thought would be a ‘good idea’. Staff we spoke to told us they encourage people to be involved in the daily running of the home such as laying the table or washing up after meals. Each person has their own “house day”, based on their individual ability, to clean Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 13 their bedroom and prepare the lunch of their choice. This enables people to maintain and develop their independent living skills. The service, wherever possible, supports people to live as independent lifestyle as possible. This is evidenced through the risk assessments carried out which shows tasks or part of tasks an individual can carry out for themselves and the strategies identified, wherever possible, to minimise risks. For example, one person’s risk assessment shows s/he is able to travel independently, while another is not aware of the dangers and needs to be accompanied when in the community. The person who travels independently explained the bus routes they take to visit different members of their family. S/he also told us they were starting a work placement in a few weeks and already knew which buses they would need to get. A discussion took place between the person and a member of staff about arranging for her/him to be supported on some “practice runs” so s/he would know how long the journey takes and where to get off the bus. The person seemed pleased with this. Another person has limited mobility. A risk assessment has been carried out and staff trained in manual handling to ensure the person is safely transferred to where they want to be using a hoist. Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 14 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, 14, 15, 16 & 12 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. The service is providing people with better opportunities for learning and development within the community. They are supported to live the life they choose and take part in meaningful activities and maintain relationships with family and friends. The meals provided meet people’s dietary needs and personal preferences and are served in a pleasant environment. EVIDENCE: Information provided to us by the service tells us it has been developing plans to support people further with their personal development and explore better education and occupation opportunities. For example it plans to provide Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 15 people training in food hygiene. One person who lives in the home told us, with pride, s/he had recently completed a college course and would be starting a work placement in September. Other people are supported to attend day centres during weekdays. Staff told us frequent discussions are held with day centres to ensure people continue to enjoy going. We spoke to two people who told us they like going to their day centre, joining in the activities and meeting with friends. The information in their files shows when they attend and how they will get to and from the centre. For people who cannot access the community as freely as others they are supported by staff to develop their personal and social skills at home. For example, we saw one person being encouraged to iron their shirt and another went out shopping supported by a member of staff. Activities are also provided that encourage mobility and exercise. One person spent some time making use of the sensory equipment in their bedroom and three other people were playing on the WiFit game in the lounge. Staff spoke to us about people’s different preferences about how they like to spend their time. For example one person prefers to remain at home watching television and sometimes spends time in the garden. S/he does occasionally enjoy a trip to the local shopping centre. Details for supporting her/him on trips out are detailed in her/his care plan. During out visit we saw some people popping out to the shops, or making their own way to visit family and friends. One person was looking forward to meeting up with friends in the evening at a local disco. Information provided to us by the service tells us it is looking to provide a wider range of activities for people to choose from. We saw activity planners had been produced for the summer months and displayed in the halls for everyone to access. A trip to Blackpool had been cancelled due to bad weather. A person whose name was down for this trip said s/he had been looking forward to the trip and is expecting it to be re-arranged. The service offers people the choice of holidays or, if they prefer, a selection of day trips. The deputy told us the cost is similar for whichever option is chosen. People we spoke to who enjoy going on holiday told us they always have a good time. The deputy showed us the forms being completed on some people’s behalf for travel and leisure passes. This shows us the service is being pro-active in developing opportunities for people to socialise and exercise more. The service has its own transport which is used for people who public transport is not suitable. Staff told us the communal activity books and individual activity plans are checked regularly by senior staff and discussed at meetings to ensure the plans continue to meet people’s needs and wishes. The service arranges for an aroma therapist to visit regularly which people find relaxing. Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 16 The care plan for one person informs staff that if s/he is showing signs of restlessness or agitation they should be encouraged to use the sensory equipment in their bedroom which has a calming affect. The staff we spoke to and observations made shows there are other times when the person likes going to her/his room to use this equipment. This is not recorded on her/his activity plan as something they enjoy. The manager said this would be addressed. The manager told us everyone, staff and people who live here, recently did a sponsored walk to raise funds to purchase sensory equipment for one of the ‘houses’. She showed us the room which had already been decorated by the handy person and said discussions were being held with people about the kind of equipment they would like. We were told visitors are welcome at any time but people living in the home usually prefer to go to visit family and friends at their house. The service supports people in different ways, according to their needs, to maintain relationships with family and friends. A taxi is arranged for one person, while some travel by bus, with or without the company of staff, and others are provided with transport by staff. There are suitable systems in place to ensure people who are staying overnight, or for a few days, with family have everything they need. Information provided to us by the service shows it does not have a policy for Sexuality & Relationships. The manager told us the company had produced one which is in the draft stage. Arrangements are being made to discuss this at an area meeting, “Your Voice”, with representatives of people who use the company’s services and at the managers meetings. The service is able to accommodate a limited number of people who use wheelchairs or have limited mobility. People where observed following their preferred routines and moving freely around the ‘houses’ they were in. They are able to get up and retire to their rooms when they like. Information about preferred routines is included in their care plans. Staff provides suitable levels of supervision and support in ‘high risk’ areas, such as the kitchen and bathrooms, according to the person’s care plan and risk assessments. The service does not employ any catering staff and the information provided to us show all staff have completed a course on basic food hygiene and almost half are trained in malnutrition care and assistance with eating. Menus are produced in pictorial formats and alternative meals are provided on request. A meal comment book has been provided and the views are sought and recorded for people who are unable to write. The minutes show that meals options are discussed at house meetings to ensure people’s likes and dislikes are catered for. Dietary needs are detailed on the individual’s care plan. People are encouraged to go on shopping trips with staff. This allows them to be involved in the choice of products purchased. We saw fresh Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 17 vegetables from the garden being prepared for the evening meal in each of the houses. Early in the day we observed staff supporting one person, using hand over hand, to make a sandwich and being given lots of encouragement. A person in one of the other houses was being supported by staff to prepare a meal for everyone in the same house. The evening meal we saw being served in one house was a well presented salad with a baked potato. Most people choose to take their meals at the table in the dining areas but are able to dine in other areas, such as the lounge, and at a time of their choosing. One person commented that another person living in the same house is a good cook. A person in another house told us they enjoy cooking, especially pasta dishes. Alphonsus House DS0000004837.V377172.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. The service provides people with support in the way they prefer and require to meet their physical and emotional health needs. This would be further improved by producing a policy on promoting continence and providing staff with training. There are procedures and systems in place for staff trained in the safe handling and administration of medication to follow and people are provided with support, wherever possible, to administer their own medication. EVIDENCE: Care plans provide detailed information about how people like to be supported with their personal care, for example when bathing or showering. Staff we spoke to told us support is always provided in the privacy of a person’s bedroom or bathroom. People who live in the home and relatives who Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 19 responded to our survey tell us people are treated well and their individual needs are responded to by staff. The people we met were suitably dressed for their age and weather conditions. Those we spoke to told us they sometimes seek the advice of staff about what would be best to wear, but mostly make their own choices. Two people were seen sitting in wheelchairs and staff told us one person requires assistance when transferring, for which a hoist is used, and the other prefers to use her/his wheelchair rather than sit on a chair in the lounge because this would restrict her/his ability to move around the house without the assistance. Information provided to us by the service show five people living in the home have continence issues. However, the service does not have a policy on managing incontinence and no training has been provided to staff. We were told staff make regularly checks on them throughout the night and personal care is given when required. The records kept show when personal care was provided but not the time when the checks took place. The time checks are made should be recorded and monitored to ensure people are not being disturbed unnecessarily. We discussed with the manager the need to produce a policy, to provide training for staff and ensure detailed records are kept to promote continence wherever possible. The files we looked at provide good details about people’s healthcare and health action plans have been completed. The records show regular appointments are kept for routine checks such as the dentist and chiropodist. One person was identified as having trouble with her/his hearing, although chose not to wear a hearing aid. The person has since received treatment and her/his hearing has shown some improvement. This shows the service is working closely with healthcare specialists. The service has policy and procedures for the safe handling and administering of medication. It was last reviewed in 2006. The manager is advised to ensure this is periodically reviewed and updated where applicable. In the main there are good arrangements for the ordering, receipt and safe storage of medication. The home uses a monitored dosage system, where possible, and these are stored in each of the three houses that make up the home. Good arrangements are made for medication needed to be taken outside the home. People are encouraged to manage different aspects of their medication, depending on their ability, and others have their medication managed for them. One person’s care plan and risk assessment details what they do for themselves. For example s/he fetches their own glass of water and ‘pops’ the tablet/s out of the cassette to take under the supervision of staff. This shows the service promotes people’s independence in different aspects of their lives and identifies strategies to support people to do so safely. Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 20 We looked at the medication administration record (MAR) sheets for three people. These appear to be completed appropriately, with no gaps in the recordings. One person was identified with swallowing difficulties and his care plan stated “tablets should be crushed”. There was no record of this on the person’s MAR sheet and no record of any discussion being held with the doctor who prescribed the medication. The manager is advised, in the best interests of the person, to obtain written confirmation from the doctor confirming this method of administering this person’s medication is acceptable. Another person’s file has protocol for administering paracetomol “as required” and written approval from the person’s doctor for acceptable “over the counter” remedies. This is dated 2007 and the manager is advised to seek updated approval at the person’s next medication review. Medication is only administered by staff trained to do. A record of all training undertaken by them is kept on their file. The manager also carries out periodic competency checks on staff practice. The manager is advised to monitor practice against the information provided on the MAR sheets to ensure directions for administering are being followed. The service last received an audit visit from their pharmacist in July this year. Comments on the service’s arrangements for managing medication and recordings were “good”. This was the same for the previous two visits. Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 21 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, & 24 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. The service has suitable systems to ensure any concerns raised by people who live in the home and other interested parties are listened to and acted upon. There are procedures in place to promote people’s well being and safeguard them from abuse. EVIDENCE: A copy of the service’s complaint procedure is available and was reviewed by the service in January. The records show two complaints have been received by them since our last visit. Details of the complaint, the investigation and action taken are kept in the complaints folder together with notification to the complainant about their findings. The records show no evidence was found to support either of the complaints. Surveys returned to us by people who use the service and relatives tell us they all know how who they would approach if they were unhappy or concerned about anything. The complaint procedure is available in a pictorial format. The service also provides an in-house “grumble book”. Any comments or requests made are discussed at various meetings held in the home. The deputy told us this system works well and the service is becoming better at addressing requests and resolving issues promptly. No concerns or complaints were raised with us during this visit. Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 22 Policies and procedures for the safeguarding of vulnerable adults are kept available in the home. Information provided by the service show three safeguarding referrals have been raised. The manager confirmed these issues had been resolved. However not all the information was available in the folder. The manager was advised to develop a system for tracking information in/out of the home. As with complaints any safeguarding issues are discussed in staff meetings and people living in the home are provided with easy read guidance on abuse. The minutes of house meetings show issues about keeping safe and reporting concerns/incidents are discussed. We looked at the records for three staff which shows safeguarding training has been attended by them. Staff we spoke to told us they were aware of procedures for reporting any issues of concern and were confident these would be addressed appropriately by the manager. No safeguarding issues were raised with us during this visit. The service does not act as appointee for people living in the home that are unable to manage their own finances. However, it does manage small amounts of personal allowance. There are suitable procedures in place and the records kept of all transactions. Regular audits are carried out by the manager for which records are kept. Periodic audits are also carried out by a representative of the organisation. There are times when some people display behaviour that can challenge the service. Care plans and risk assessments are produced for managing these and strategies are identified to reduce the risk of injury occurring to the individual or other people. Discussions are held with behaviour specialists, where required. Detailed records are kept of such incidents and are closely monitored to ensure the strategies in place remain appropriate. The manager told us the home has a “no restraint” policy. Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 23 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. The service has made further improvements towards the standard of décor and furnishing to provide people with pleasant, safe surroundings in which to live. It is clean, free from odours and hygienic. EVIDENCE: There is off-road parking available at the front of the premises which has been re-surfaced. The service has continued to make progress to improve the environment. The rear gardens are pleasantly landscaped and a small vegetable plot has provided people with some fresh produce. One person was sitting on the garden bench enjoying the fine weather. A designated smoking area has been Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 24 provided for people who wish to smoke. Suitable arrangements have been made for accessing the three houses that make up the home which is more respectful to the people who live there. We looked around the home and it was clean and tidy. Two people showed us their bedrooms which they said they were pleased with. There were items on display, such as family photographs and ornaments and posters, reflecting people’s individual personalities and interests. They told us they are looking forward to being more involved in choosing new furniture and furnishing for the home. Work has been carried out to replace one of the en-suite bathrooms to wetroom (shower) which makes it easier for this person. Bathrooms and toilets have been re-decorated and re-furbished. New flooring has been laid and new settees purchased for the lounges. Since our last visit the service has employed a new handy person who has already carried out some of the remedial work that needed to be done and some re-decorating. The manager and staff told us being able to get some repairs completed the same day has made a difference to the environment. The laundry is well organised with information displayed on infection control and the control of substances hazardous to health (COSHH). Personal protection clothing, such as aprons and gloves, are readily available. The staff team has received training in the prevention and control of infection. People who responded to our survey stated the home is “always” fresh and clean. Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 25 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): 31, 32, 33, 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 are supported by a stable, competent and trained staff team who know them well and understand their needs. The service’s recruitment procedures ensure they are safeguarded from harm or abuse. EVIDENCE: We looked at the rotas to see which staff members were planned to be on duty. It showed us a minimum of two staff are on duty in each house when all the people living there are at home. There is also a senior person on duty for staff to refer to for advice and guidance. The deputy told us the recent change in shift patterns had seen a reduction in sick leave and in the use of bank or agency staff. She said absences are now covered by members of the team which means people are looked after by staff they know. The staff team is made up of people of different ages and life experiences who have a clear understanding of their roles and responsibilities. Information Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 26 provided to us by the service show almost 75 per cent of the staff team have achieved the National Vocational Qualification (NVQ) Level 2 or above. We looked at three staff files in detail each had information about when the staff member completed this qualification. One person’s file showed us this had recently been completed by them. The others are longer serving members of staff and achieved the qualification several years ago. We looked at the recruitment files for a recently employed member of staff. We found the required pre-employment checks had been undertaken such as references and CRB checks (Criminal Record Bureau) before an applicant took up their post. She told us she had been provided with a detailed induction and was in the process of completing the last section of her/his booklet. The deputy told us newly appointed staff work with an allocated senior, or experienced, member of staff until the manager is satisfied with their practice. The manager is advised to introduce a system for senior staff to report on the practice of newly appointed staff they are working with. The records should be monitored by the manager and discussed with the staff member in her/his supervision sessions. There were three written records of supervision held with the most recently appointed member of staff. Information provided to us by the service show 23 of the 24 staff employed at the home have completed an induction programme that meets with the Skills for Care specifications. Records of training attended by staff are kept on their individual files and on a training matrix. This makes it easier to see when periodic training updates, such as for fire safety and first aid, should take place. The records show as well as health and safety training for example infection control and manual handling – safer people handling, staff have also undertaken training in person-centred planning and in meeting specific needs such as caring for people with autism, epilepsy and dementia for the older people who are living in the home. Two members of staff told us they found the training in caring for people with autism particularly useful. The manager told us some staff have not been provided with training in working with people with learning disabilities or did so a number of years ago and she is arranging more courses. She told us she is able to contract with external trainers for specific courses if these can not be provided by the company’s training section or within the timescales needed. Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 27 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 live in a home which is well run and meets their needs. However, for people to be fully confident their views will be acted upon an annual development plan should be published by the service. Good arrangements are made to ensure safe working practices are followed. However, fire risk assessments should be reviewed at least once every year to ensure the health, safety and welfare of people living in the home is fully protected. EVIDENCE: Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 28 The service is run by a well qualified and experienced manager who undertakes regular training to update her own knowledge and skills. She is supported to carry out her duties by an experienced senior staff team and stable team of care staff. The manager tells us she feels well supported by her line manager. Regular visits are made to the home by a representative from the company to monitor its performance. The reports of these visits are well detailed and include action required to be taken by the service. The service also has its own monitoring systems which include issues such as environmental standards, risk assessments and accidents/injuries. The accident folder is well organised. It is monitored on a regular basis and shows any action taken to reduce the risk of similar incidents occurring. People are provided with various opportunities to express their views such as house meetings, individual meetings with staff and questionnaires. Staff was able to identify independent people, such as family or advocates, who will support people living in the home to express their views about the service. The information gathered from the service’s monitoring of its own performance and comments received from people living in the home, family and others should be analysed. An annual develop plan should be produced on its findings for people to be fully confident their views underpin the self-monitoring and review of the service. We looked at a random selection of information held in respect of appliances and equipment, such as the portable electrical appliances, gas appliances and fire detection and equipment. This shows appropriate systems are in place for regular checks and servicing to take place. Periodic training in fire safety is provided for staff. The fire drill records have been expanded to include the names of staff in order to monitor their regular participation. The fire risk assessment has not been reviewed for over twelve months. The manager is advised the fire service require this to be carried out at least once a year. Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 29 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 3 2 3 3 X 4 3 5 2 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 3 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 4 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Version 5.2 Page 30 Alphonsus House DS0000004837.V377172.R01.S.doc 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. Standard Regulation Requirement Timescale for action 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 YA6 Good Practice Recommendations Care plans should be reviewed at least once every six months with the individual and significant people in their lives to ensure the plans continue to meet the persons needs and preferences. People should be provided with contracts in suitable formats, such as audio or pictorial, to meet their individual needs. Decisions made on a person’s behalf by the service should be clearly detailed in her/his records and regularly monitored to ensure these are made in her/his best interests. Accurate records should be kept of all checks made on people during the night. These should be monitored regularly to ensure people are not being disturbed. A policy managing incontinence should be produced and training provided for staff. The staff should work with people in the home to, wherever possible, promote Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 31 2. 3. YA5 YA7 4. YA18 5. YA20 6. YA23 7. YA35 8. 9. YA39 YA42 continence. Medication should only be administered as instructed by the prescribing doctor. The manager needs to discuss the swallowing difficulties the person has in taking tablet/s with her/his doctor and only crushed with the doctor’s consent. This is to ensure the person’s health is fully safeguarded. The manager is advised to implement a system for tracking information in/out of the home in respect of safeguarding issue to ensure a record is kept of investigations carried out, by whom and outcomes. The manager is advised to introduce a system for senior staff to report on the practice of newly appointed staff they are working with. The records should be monitored by the manager and discussed with the staff member in her/his supervision sessions. An annual development plan should be produced for people to be fully confident their views underpin the selfmonitoring and review of the service. The manager is advised to review fire risk assessments at least once every twelve months as required by the fire service. Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 32 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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. Alphonsus House DS0000004837.V377172.R01.S.doc Version 5.2 Page 33 - 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!