Care Home: Alpine Lodge

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What the care home does well What has improved since the last inspection? Training and education has improved at the home. The Registered Manager has now completed her Registered Manager`s Award. The majority of staff have either completed or are doing national vocational training. This means that a stable staff group who have all the skills and knowledge to care for people in a safe and appropriate way will care for people. The standard of decoration, furniture and furnishings has also improved greatly at the home. Communal areas have been decorated. New furniture has been purchased and a programme of decoration means that the home is a pleasant place for people to be. What the care home could do better: Prior to moving into the home people who use the service must be given enough information about the home to decide whether it is the best place for them to be. To enable this to happen the manager must update the Statement of Purpose and Service User Guide to include information listed in the standards and accurate information about restriction of movement and what can be expected when living at the home. The manager should also keep hand written notes used during the pre admission process. This will show that the home have assessed the person thoroughly before deciding whether the staff at the home can meet their needs. Protecting people who use the service must be seen as a priority at Alpine Lodge. This must be done by making sure all staff are aware of the correct local procedures to be followed if an allegation of abuse is made in the absence of the manager Recruitment practices must be addressed as a matter of urgency. The Manager must not employ a person at the care home until information and documents listed in schedule 2 are obtained including; photograph, evidence of identification and two written references. All staff who work on a regular basis at the home must have these recruitment checks in place. Any information obtained must be maintained in such a way that shows checks are robust. This includes what level CRB (criminal record bureau) check is carried out. Other records must also be improved at the home. Service user plans must clearly show how care is to be given and show that it has been given. This will improve communication and mean that care will be given in a more consistent way. The manager should look at ways of recording health care conditions to monitor any deterioration or signs of illness.The manager should also ensure staff follow the routines that are expected to ensure people are cared for in a safe way. Staff should be reminded to regularly record fridge and freezer temperatures and label food within fridges. Staff should also be reminded to lock the medicine trolley to the wall when not in use. The manager should ensure she performs supervision sessions for staff on a regular basis. This will be an opportunity to highlight training needs. Mandatory training programmes should be updated as planned. CARE HOME ADULTS 18-65 Alpine Lodge Alpine Road Torquay Devon TQ1 1RB Lead Inspector Clare Medlock Unannounced Inspection 22nd July 2008 09:00 Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 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 Alpine Lodge DS0000018312.V368153.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 Adults 18-65. 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. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alpine Lodge Address Alpine Road Torquay Devon TQ1 1RB 01803 295514 01803 400214 agnes@alpinelodge.rch.co.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) Alpine Lodge RCH Ltd Mrs Helen Agnes Rochester Care Home 23 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (23), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (23) Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23 July 2007 Brief Description of the Service: Alpine Lodge is registered for up to 23 people who may have mental health needs. The number of people who actually live at the home is effectively limited to 21 to provide them with single rooms. The one double room is used as a large single room. The large detached house is in a residential area of Torquay within walking distance of the town centre, although a steep hill sometimes puts people off walking back from town. There is a mini bus, which can be used for this purpose. There are two cabins at the front of the house, which are used as the managers office, staff office and accommodation for 3 staff. There is a small parking area, with gardens to the front of the building and a ramp leading to a patio area at the side. The house can be accessed to the front via shallow steps, with additional steps and stairs throughout the rest of the building. These steps might pose a problem for people with mobility problems who live in the home. The accommodation is laid out over three floors. Two flats with their own kitchen facilities are located in the basement, with other bedrooms on the ground and first floor. The ground floor also has a TV lounge, a games room, quiet room, dining room, kitchen and laundry room. There is one bathroom and three shower rooms and additional toilet facilities. CCTV is in operation in the kitchen, linen room, front entrance and office. Fees averaged £450 at the time of this inspection but vary depending on need. Copies of inspection reports are available from the manager. Alpine Lodge DS0000018312.V368153.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 inspection was unannounced and took place on Tuesday 22nd July 2008. Prior to the inspection the Manager was sent an AQAA (Annual quality assurance assessment). This document provides us with an overview of what is happening in the home. It tells us about staffing levels, any recent complaints, fees, and information about general maintenance and policies within the home. Before the inspection we also sent out questionnaires to people who use the service, their family and friends, and staff. We received seven surveys from people who use the service, one survey from a health care professional and one survey from a relative. This information gives us a picture of what life is like at the home and helps to focus on what we need to look at during our inspection. At the inspection we ‘case tracked’ four people who use the service. This means we looked in detail at the care three people receive. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us. During the inspection we spoke with the Manager and two senior care staff. We spoke with five people who use the service. We also observed interactions between staff and people who use the service. We also looked around the home, inspected medicine records, five staff files and other records. What the service does well: The admission procedure shows that staff make assessments to decide whether they can meet the persons needs. When at the home people are involved in decisions about their lives and are able to play an active role in the care their receive. All of the people we spoke with at the home said they were happy at Alpine Lodge. People told us that they are involved in planning their care and are involved in the reviews that are held between staff at the home and specialist mental health teams. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 6 Staff have detailed knowledge and understanding of each persons mental health needs, physical health care needs and behaviour patterns of each person. Staff understand the importance to respect a persons decision to make individual choices and are on hand to assist when appropriate. Health professionals are complimentary about the care at Alpine Lodge. Comments included ‘Sometimes clients would chose completely inappropriate lifestyles and in those circumstances staff would encourage the client to adopt a more healthier lifestyle’ and ‘The staff have considerable experience at managing difficult patients. They do have patients that decline to engage with primary health service. Staff have attended well being training and do attempt to encourage patients in the right direction’ The manager regularly meets with each person to ask whether they are happy with the staff, the care, their rooms and life at the home. People tell us the food at the home is very good. People said they see their GP when necessary and have seen the dentist and chiropodist depending on need. Specialist health care professionals work closely with the home. Medications are well managed at the home. All staff receive training in the protection of vulnerable adults (POVA). Staff told us they would have no hesitation in reporting abuse and knew to speak with the manager if they had concerns. The many improvements in the décor and furnishings at the home mean that people now live in a home that is homely and furnished to a good standard. Each person has their own room which they are able to put pictures or posters up as they please and bring small items to personalise their room. People at the home told us that staff were all kind and respectful. One relative survey said ‘I think they look after their patients very well. I know my son is happy at Alpine Lodge. The staff are very kind and helpful’ The majority of staff now either have NVQ (National vocational qualificationformal care education programme) qualifications or are doing the training. The staff team is stable at present. Agency staff are not used by the home. Staff prefer to cover any shortfalls between them. People who live at the home told us that they are happy living here. They value their private and communal rooms, the management style, and the food. They know they can come and go as they wish, have confidence in the manager and staff, and mostly enjoy living with their fellow residents. All people who live at the home consulted told us that they appreciated being able to live here. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Prior to moving into the home people who use the service must be given enough information about the home to decide whether it is the best place for them to be. To enable this to happen the manager must update the Statement of Purpose and Service User Guide to include information listed in the standards and accurate information about restriction of movement and what can be expected when living at the home. The manager should also keep hand written notes used during the pre admission process. This will show that the home have assessed the person thoroughly before deciding whether the staff at the home can meet their needs. Protecting people who use the service must be seen as a priority at Alpine Lodge. This must be done by making sure all staff are aware of the correct local procedures to be followed if an allegation of abuse is made in the absence of the manager Recruitment practices must be addressed as a matter of urgency. The Manager must not employ a person at the care home until information and documents listed in schedule 2 are obtained including; photograph, evidence of identification and two written references. All staff who work on a regular basis at the home must have these recruitment checks in place. Any information obtained must be maintained in such a way that shows checks are robust. This includes what level CRB (criminal record bureau) check is carried out. Other records must also be improved at the home. Service user plans must clearly show how care is to be given and show that it has been given. This will improve communication and mean that care will be given in a more consistent way. The manager should look at ways of recording health care conditions to monitor any deterioration or signs of illness. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 8 The manager should also ensure staff follow the routines that are expected to ensure people are cared for in a safe way. Staff should be reminded to regularly record fridge and freezer temperatures and label food within fridges. Staff should also be reminded to lock the medicine trolley to the wall when not in use. The manager should ensure she performs supervision sessions for staff on a regular basis. This will be an opportunity to highlight training needs. Mandatory training programmes should be updated as planned. 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. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 9 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 Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The admission procedure shows that staff take steps to decide whether they can meet the persons needs. Changes would mean this process is more robust. The information available for people about Alpine Lodge is inaccurate and misleading in places. EVIDENCE: People we spoke with told us they either came from hospitals or other care facilities. Two people we spoke with said they had asked to come to Alpine Lodge. One had been unhappy at a previous home and another had stayed at Alpine Lodge as respite. One person we spoke with had been at the home and had considered moving but changed their mind because they were happy at the home. The manager explained that people are carefully assessed prior to moving to the home. The manager showed one case she had rejected and explained that the impact on other people in the home would have been detrimental. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 11 The manager told us she meets the person before they come to the home and gets information from other health care professionals before making a final decision to accept them. The manager told us she does make informal notes at this assessment but does not keep these notes. The home does have a detailed referral form, which is sometimes used. Discussion was held regarding the importance of showing that the home have assessed a person thoroughly before moving to the home. Most referrals are from members of specialist mental health teams, sometimes using the Care Programme Approach. These are therefore usually appropriate, made on the basis of professional assessment prior to admission. Some people moving to the home have appropriate restrictions and conditions they have to agree to, prior to moving to Alpine lodge. These agreements are part of the admission process and agreed by the person, staff at the home and members of the specialist mental health team. Health care professionals were asked in surveys what does the service do well. One comment read ‘Alpine Lodge manages difficult to manage individuals in their own unique way. They provide a needed service to those that other homes may not consider’ There is a Statement of Purpose and Service User Guide available at the home. Both documents were in the process of being updated because they contain insufficient or inaccurate information. The manager showed us the new document, which still needs to be amended and improved to reflect the service that is actually provided. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People are involved in decisions about their lives and are able to play an active role in the care their receive. Improvements to record keeping would reflect the knowledge of staff and the level of care that is actually provided. EVIDENCE: All of the people we spoke with at the home said they were happy at Alpine Lodge. One person said he was far happier at Alpine Lodge than he was at a previous home. Relative surveys asked what does the service do well. One comment read ‘I think they look after their patients very well. I know my son is happy at Alpine Lodge. The staff are very kind and helpful’ People told us that they speak with staff about their plan of care and are involved in the reviews that are held between staff at the home and specialist Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 13 mental health teams. Care plans showed that people are asked to sign to show they agree to the plan of care and any restrictions that are placed on them. Each person has an A4 wallet, which contains care, plans and reviews. Staff told us they use the computer system to input any changes in care or conditions of each person. Inspection of the computer records showed the information entered did not reflect the in depth knowledge each member of staff had of each person. Staff were able to recall detailed knowledge and understanding of each persons mental health needs, health care needs and behaviour patterns of each person. Staff knowledge about the needs and changes in condition of each person rely on verbal communication, which can be affected when regular staff are absent or distracted. This shortfall may mean that information is not passed on or not monitored effectively. Risks assessments had been highlighted for each person, with ways staff should minimise the risks. The records are reviewed on a regular basis and updated when needed on or before review. Staff understand the importance to respect a persons decision to make individual choices and are on hand to assist. One example was provided where a person had made a decision about their care which were not in their best interest. Staff, although fustrated, respected the decision but had involved specialist health care professionals to ensure the decision was an informed decision. Health professional surveys commented ‘Sometimes clients would chose completely inappropriate lifestyles and in those circumstances staff would encourage the client to adopt a more healthier lifestyle’ and ‘They do have difficulty engaging a group of clients. All I can say is they do try!’ and ‘The staff have considerable experience at managing difficult patients. They do have patients that decline to engage with primary health service. Staff have attended well being training and do attempt to encourage patients in the right direction’ The manager told us she does not hold resident meetings anymore because due to the needs of the people who use the service the meetings were not useful. The manager told us that instead she regularly meets with each person to ask whether they are happy with the staff, the care, their rooms and life at the home. Records showed this last happened in May 2008. One person we case tracked stated ‘The care I receive is very good and the staff look after me very well. The food is good and I have no suggestions, I like my room the way it is and do not want anything done to it.’ Other comments from the September 2007 survey had been addressed such as having a ceiling painted. Alpine Lodge DS0000018312.V368153.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service are supported to take part in activities and maintain relationships. EVIDENCE: The manager, staff and a visiting health care professional all told us that the main problem they face is encouraging people to engage in meaningful activities. One health care professional wrote ‘Clients appear to be happy there; they do have difficulty engaging a group of clients. All I can say is they do try!’ and ‘When clients have wanted more on, staff have accepted this and been facilitative’. This viewpoint was supported by the manager who told us one person had said they wanted to take up fishing. Staff had facilitated this, purchased equipment, but the person later changed their mind. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 15 People who use the service told us they are free to come and go as they please. There is a missing person policy, which is followed by the home on a regular basis. Communication links with Commission for Social Care Inspection and the local police station are maintained in these situations. The people we case tracked said they were happy living at the home and were never bored. One person told us they preferred their own company and did not like going out unless they had to. This person told us staff regularly asked them to join in with things and ‘kept on’ about cleaning their room. Another person said there was plenty going on at the home if people wanted to join in. Another person told us they enjoyed the trips but it was ‘the same people that go because the others can’t be bothered’. People we spoke with had family, but contact depended on personal relationships and where family live. Some people saw their family on a regular basis, but others maintained relationships on a more ad hoc basis depending upon the wishes of people who use the service. Staff said they arrange contact with family and friends on an individual basis. Examples of this were given. During the inspection, one person was heard playing a guitar, another was sitting in the garden and others were wandering around the house or were in their room. In the afternoon staff and people who use the service were enjoying the sun in the back garden. This appeared to be enjoyed by all. We were told there is a table tennis table and Wii (computer game), which some people use occasionally. Board games, jigsaws, books and televisions are also available. People who use the service are able to bring small pets with them to the home. There is also an aviary in the back garden and a bird within the TV room. The manager told us there is a mini bus, which is used to take people out on trips, to appointments and at other convenient times. Staff told us that a few people will walk into town but find the hill coming back to the home a bit too much, staff then endeavour to pick them up from the town in the mini bus. People are encouraged and sometimes prompted to be involved in the domestic routines of the home. People who use the service are expected to change their bed linen and keep their rooms clean and tidy. Staff explained that they would support where appropriate but usually have to prompt. People who use the service all told us the food at the home is very good. There is a four week menu, but staff told us this was not being followed accurately as the people who use the service often request alternative foods and the stock within the freezers are being ‘run down’ in order that the freezer could be cleaned. Staff also told us that staff from overseas have also been cooking different food for people who use the service. The response to this has been positive and people now often request the alternative meals to be cooked. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 16 People told us they are offered a choice of meal each day. Sometimes a cooked breakfast is offered but there are eggs available each day. One person told us the food was so good he had put on weight and his skin had improved because of the fresh fruit and vegetables he was given. The same person said he had stopped having ‘seconds’ as he had started to put on weight. One person was being encouraged to adopt a healthy diet. Evidence was seen to show this process was being supported and well managed by staff. There is a ‘tuck shop’ where people are able to buy sweets and treats. For other requests people ask the manager to buy treats when at the cash and carry. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The satisfactory level of care and communication means people are cared for in a safe way. Further improvements to care plans are needed and would mean communication would improve and care could be provided in a more consistent and safe way. EVIDENCE: People said they are able to provide their own personal care but staff have to ‘nag’ them sometimes to do it. One person said staff cut his hair, which he really appreciated. Another person said staff help her with her individual needs such as putting colour on her hair. People said they see their GP when necessary and have seen the dentist and chiropodist depending on need. Specialist health care professionals work closely with the home. On the day of inspection one person was having a review of care. Records showed that health care reviews are held on a regular basis. Staff said the majority of people are able to provide their own care and only two people need help with personal care at present. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 18 Records showed that people who use the service attend appointments relating to their health. A calendar in the kitchen prompts staff to remind people when these appointments are due. Staff accompany people when they attend appointments relating to their health care. Staff and the manager told us that although the physical and mental health needs of people who live at the home are assessed and attended to appropriately, this can sometimes be subject to the willingness of the person to accept the treatment they need. Where people decline treatment other health care professionals are consulted to ensure people who use the service are making informed decisions about their care. One health care professional survey commented ‘Sometimes clients would chose completely inappropriate lifestyles and in those circumstances staff would encourage the client to adopt a more healthier lifestyle’. Staff knowledge was in depth. However, records kept did not always reflect the care that was actually given or kept in a way that could monitor minor changes in condition. An example of this was for one person who had lost weight and was displaying signs of ill health. Staff could explain in detail what had been done about this and how the condition was managed. However records kept were insufficient and did not reflect the care that had been provided or show how the weight had changed over a period of time. Medications are well managed at the home. Staff said only those staff that have received medication training are able to administer medications. One senior carer is responsible for ordering and returning medication. A local pharmacist supplies medications to the home and prompts ordering of repeat prescriptions. Blister pack systems are used at the home and work well. Storage facilities were suitable, however the medication trolley was not secured to the wall. Secure facilities are available for the storage of controlled drugs. Homely remedy policies are displayed, and MAR (Medicine administration records were completed to a high standard and showed signs of good practice such as two signatures on hand written entries on the MAR sheet. People told us they get their medications on time. At the time of inspection, none of the people who use the service were self-medicating, although staff gave assurances that this is possible. The arrangements regarding terminal care and care after death were not clearly recorded. Staff gave an in depth account of the religious wishes of some people at the home. Examples were given by the manager regarding issues around ageing and how some people at the home would be cared for if the home are no longer able to meet their needs due to ageing. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that complaints and allegations of abuse would be dealt with appropriately. Improvements in staff training, specific recruitment procedures and staff knowledge would help to protect people from risk. EVIDENCE: The Commission for Social Care Inspection have not received any complaints about Alpine Lodge since the last inspection. Surveys showed that minor issues raised by health care professionals have been dealt with appropriately. These issues are recorded in individual’s records. One comment read ‘Staff at Waverley House were concerned last year……. These concerns were taken up by Agnes and the issue was addressed’. Surveys from people who use the service asked Do you know who to speak to if you are not happy? All seven replies were yes. People we spoke with said they felt happy living at the home and would go to their key worker, CPN (Community psychiatric nurse) or the manager if they were unhappy. The manager told us that the home had received no formal complaints. Although no complaints had been formally recorded it was suggested the manger keeps a log of concerns despite how minor they are to enable staff to monitor trends in minor issues. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 20 All staff receive training in the protection of vulnerable adults (POVA). Staff we spoke to, said this training is provided at another home and was due to be renewed soon. The manager confirmed this was in the process of being arranged. Discussion about local free alerter training was held and the importance of being aware what the local procedures are. The manager had a Devon County Council Alerter Guide, which contained some contact numbers but not the new care direct helpline number. Staff told us they would have no hesitation in reporting abuse and knew to speak with the manager. Staff were less sure of whom to report alerts to in the absence of the manager. All staff said if they were unsure of what to do they would speak with staff from Commission for Social Care Inspection or the police directly if abuse was obvious. Staff were not clear about the local safeguarding team. Staff told us they have had a CRB (Criminal record bureau-police check) performed. Records show that an ‘umbrella’ organisation perform this check and responses sent to the home. From the details kept it was not clear whether the check was standard or enhanced or whether it included the POVA check. The manager gave assurances that it was the full-enhanced disclosure, which contains the POVA check. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The many improvements at the home mean that people now live in a home that is homely and furnished to a good standard. EVIDENCE: A tour of the building showed that much time, effort and money have been spent on improving the environment at Alpine Lodge to keep it clean, safe and in a good state of repair. New furniture and furnishings have been provided. The dining area appeared domestic in style and a pleasant place to eat meals. A ‘visitors lounge’ was welcoming and had been refurbished. New carpets had been installed and redecoration of communal areas and private rooms has taken place and continues as part of the on going programme. People who use the service were seen to be using the outside space because of the fine weather. The deck area was popular. People told us that they go into the garden sometimes but usually only to have a cigarette. Because of the “No Smoking” legislation, the home now boasts a dedicated yet attractive smoking Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 22 shelter created by joining two arbours together. Smokers are able to sit undercover, but have access to open sides as per the specification for smoking shelters. Staff say that although smoking in the home has reduced some people have to be reminded not to smoke inside the house. Risk assessments regarding smoking are in place. All rooms are for single occupancy at present. People are able to put pictures or posters up as they please and bring small items to personalise their room. Some people have been offered new furniture but this has been declined. All rooms have a lockable facility if people chose. People we spoke with said they did not want to lock their door. Reports from the fire department and environment health were seen. Appropriate action has been taken regarding any recommendations made. All areas of the home appeared clean. The kitchen was clean however fridge and freezer temperatures had not been taken since June and some food in fridges had not been covered or dated. A maintenance person is employed on a regular basis so repairs are carried out swiftly. All areas of the home appeared well maintained and free from obvious risks. There appeared to be sufficient bathrooms and shower rooms at the home. The majority of people were fully mobile and therefore did not require specialist equipment, hoists or adaptations. One person with reduced mobility had been provided with an aid to assist with walking. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The dedicated staff group mean that people who use the service are cared for in a consistent way. However, recruitment procedure is disorganised and inadequate in places and does not show that the necessary pre employment checks have been performed. EVIDENCE: Staff files showed that all staff are issued with job descriptions to enable them to understand their roles and responsibilities. Some new staff find it difficult not to take over and perform tasks for people in the home rather than supporting and encouraging people to do what is needed themselves. The manager said that this is a gradual process but new staff are gently reminded about what is in the best interest for each person. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 24 People at the home told us that staff were all kind and respectful. One relative survey said ‘I think they look after their patients very well. I know my son is happy at Alpine Lodge. The staff are very kind and helpful’ The majority of staff now either have NVQ (National vocational qualificationformal care education programme) qualifications or are doing the training. On the day of inspection an NVQ assessor was visiting the home. She explained that 5 staff were doing the course and getting on very well. Staff explained that an outside organisation provide both mandatory training and specialist training. This has included dealing with aggressive behaviour. Staff were very knowledgeable about what triggers each persons behaviour and how staff can reduce these triggers or deal with them. The staff team is stable at present. Staff we spoke with had been at the home for over 10 years. The manager has tried to recruit local staff to work at the home but has now achieved a full complement of staff by using overseas staff. People in the home said the overseas staff were lovely. Agency staff are not used by the home. Staff prefer to cover any shortfalls between them. The home operate an on call rota for senior carers and management cover out of hours for staff to use in times where support is needed. Recruitment is poor at the home. Staff files were disorganised and full of irrelevant information. New overseas staff had been recruited through an agency, so recruitment procedures had been followed by the agency but not verified by the home. One staff member working at the home was a relative of the manager. There was no staff file or CRB present. The manager explained that this person was self employed and visited the home regularly to perform manual tasks and was not employed to care for people who use the service. Two files of long standing staff were inspected; these files did not include the information to show that the recruitment process was robust and performed in the best interest of people who use the service. Staff said they received supervision from the manager. Records showed supervision was last performed in November 2007. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Alpine Lodge is a well-managed safe home run in the best interests of people who live at the home. EVIDENCE: The manager has worked for Alpine Lodge for over 15 years and has a NEBSM certificate (National Educational Board of Supervisory Management). She has completed an NVQ 4 and the Registered Managers award. People who use the service were very complimentary about the manager and her staff team. Staff were equally positive about the manager. People who live at the home told us that they are happy living here. They value their private and communal rooms, the management style, and the food. They know they can come and go as they wish, have confidence in the manager and staff, and Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 26 mostly enjoy living with their fellow residents. All people who live at the home consulted told us that they appreciated being able to live here. Staff meetings are held on a regular basis where staff are encouraged to share ideas. Staff said that usually ideas are bought up more informally on a day to day basis but were always listened to by the manager. Staff thought the home was well managed and that people who use the service get a good level of care. On the day of inspection review documents were being prepared for staff to ensure they were aware of policies relating to the home. Effective quality assurance systems are in place at the home. The manager speaks regularly with each person in the home to ensure they are happy with life at Alpine lodge. A recent Quality assurance survey has been performed on health care professionals, people in the home and some relatives. Findings were generally positive. On the day of inspection an audit of the finances was taking place. This member of staff visits the home to ensure invoices and accounts are dealt with appropriately. The manager also produces an annual plan of what is to be achieved for the following year. Records are generally well maintained and securely stored. Insurance certificates are displayed in the office. Commission for Social Care Inspection certificates are on display and reflect the service that is provided. The manager displayed an understanding of the health and welfare of the people who use the service and of the staff. Maintenance certificates for fire systems, gas safety and electrical safety are provided each time the safety checks are performed. All staff have received mandatory training although the manager told us she was in the process of arranging refresher training for staff. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 27 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 2 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 1 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 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 1 2 3 3 3 3 3 3 2 3 Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 28 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 12 (1) a Requirement Timescale for action 11/11/08 2. YA34 19 (1)b schedule 2 The manager must ensure provision is provided to meet the health and welfare needs of people in the home. This must include ensuring records show how care needs are to be met and what care ha been given. The manager must ensure no 11/11/08 staff work in the home unless full and satisfactory information listed in schedule 2 is obtained 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 YA1 Good Practice Recommendations The manager should ensure the new Statement of Purpose and Service User Guide contain: • All information listed within the standards and regulations. • Information which shows what the service provides including restrictions The manager should keep handwritten records of all assessments performed to show that each person has DS0000018312.V368153.R01.S.doc Version 5.2 Page 29 2. YA2 Alpine Lodge 3 4 5 6 7 8 9 YA19 YA20 YA22 YA23 YA23 YA23 YA24 10 11 12 YA34 YA36 YA42 been thoroughly assessed before moving to the home. The manager should introduce ways that mental and physical conditions can be clearly monitored. This could include the use of weight charts. The manager should ensure the medicine trolley is securely fastened to the wall when not in use The manager should keep a record of all concerns and complaints to monitor trends in minor issues raised The manager should record what level of CRB check is performed to show that all checks have been performed. The manager should consider accessing the Devon County Council Alerter training The manager should ensure staff have quick access to the correct local contact numbers for alerting allegations of abuse The manager should maintain good kitchen hygiene by: • Ensuring fridge and freezer temperatures are monitored • Ensuring food in the fridge is covered and labelled The manager should consider organising staff recruitment and training records to show the process meets equal opportunities and meet the standards The manager should show that supervision sessions are held on a regular basis The manager should continue with the planned programme of updating staff on mandatory training. Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Alpine Lodge DS0000018312.V368153.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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