Care Home: Alton House

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What the care home does well There was evidence that information about residents have been obtained before they went to live at the home. This means that staff can have an understanding of residents needs to ensure these can be met before an offer of admission is made. Residents needs are known through updated care plans and risk assessments, residents dignity and privacy is maintained and their rights as citizens are upheld and encouraged. Residents are satisfied with the food provided and are able to choose what they have to eat. They are supported by trained and enthusiastic staff who understand the needs of people who have a dementia condition. The environment is being upgraded and the fitting of new carpets and decorating is taking place. Plans are in place to provide more rooms with ensuite facilities. An experienced and competent manager manages the home. A quality assurance system in place, which enables the manager and provider to continually improve the service.The provider visits the home every couple of weeks and produces reports to advise the manager and us on the conduct of the home and any actions being taken. There is a newsletter produced every few months, which informs residents and their relatives on the development of the service. What has improved since the last inspection? We saw that all residents had a copy of their terms and conditions. We could see from care plans that assessments included residents mental health needs as well as their emotional and physical needs. Those residents who shared a room did this with their consent or their relative`s agreement if they were not able to consent themselves. Screens were in place to promote resident privacy. A new wet room and disabled toilet facility has been installed. This means that residents will be able to have more comfortable bathing facilities. Those staff that have been recruited since the last inspection have had all necessary checks undertaken including a full employment and health declaration taken. This means that the appropriate people are employed to care for residents. What the care home could do better: Comments received back from relatives and residents and entries in care records indicate that residents would like to engage in more activities. The recruitment of an activities coordinator has improved upon the previous arrangements and this area should be further developed to meet resident`s needs. CARE HOMES FOR OLDER PEOPLE Alton House 37 St Leonards Avenue Hayling Island Hampshire PO11 9BN Lead Inspector Kathryn Emmons Unannounced Inspection 31st March 2008 09:20 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alton House Address 37 St Leonards Avenue Hayling Island Hampshire PO11 9BN 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) 023 9246 2910 vikram@altonhousecarehome.com Alton House Partnership Mrs Elaine Herridge Care Home 18 Category(ies) of Dementia (18), Dementia - over 65 years of age registration, with number (18), Mental disorder, excluding learning of places disability or dementia (18), Mental Disorder, excluding learning disability or dementia - over 65 years of age (18), Old age, not falling within any other category (18) Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All Service Users must be aged at least 55 years. Date of last inspection 3rd November 2004 Brief Description of the Service: Alton House is a large, detached property set in a quiet residential area of Hayling Island and provides accommodation for a maximum of eighteen older people, including those with dementia and/or mental health needs. Accommodation is provided with ten single bedrooms, five of which have ensuite facilities, and four double bedrooms, of which two have en-suite facilities. The home has a large lounge/dining room and a smaller, quieter lounge. The layout of the communal areas is open-plan with archways leading into each area. Outside is an attractive, well-maintained garden that is accessible to service users. The rates for accommodation are between £395 and £550 a week. Alton House DS0000061683.V359649.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. A visit to the service took place on 31 March 2008. This visit was unannounced and took place over 5.5 hours. The registered manager and the registered provider were present for the visit. Care received by three residents was looked at in detail. This is a method called case tracking. This included looking at their personal records, a range of general home records and staff detail records. Staff were spoken with and the care they provided was observed. Nine relatives, 3 staff and 5 health care professionals completed the comment cards we had sent out before the visit. We also received a completed self-audit document completed by the manager, to provide information before we did a site visit. We also looked at how the provider makes information about their service, including CSCI reports available to prospective service users. What the service does well: There was evidence that information about residents have been obtained before they went to live at the home. This means that staff can have an understanding of residents needs to ensure these can be met before an offer of admission is made. Residents needs are known through updated care plans and risk assessments, residents dignity and privacy is maintained and their rights as citizens are upheld and encouraged. Residents are satisfied with the food provided and are able to choose what they have to eat. They are supported by trained and enthusiastic staff who understand the needs of people who have a dementia condition. The environment is being upgraded and the fitting of new carpets and decorating is taking place. Plans are in place to provide more rooms with ensuite facilities. An experienced and competent manager manages the home. A quality assurance system in place, which enables the manager and provider to continually improve the service. Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 6 The provider visits the home every couple of weeks and produces reports to advise the manager and us on the conduct of the home and any actions being taken. There is a newsletter produced every few months, which informs residents and their relatives on the development of the service. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Through pre admission assessment systems residents can be confident that their assessed needs can be met when they are admitted to the home, but they need to receive written confirmation of this.. Up to date information enables residents to make an informed choice regarding living at the service. EVIDENCE: All residents are assessed before being admitted to the service. We could see from looking at care plans that full assessments had been obtained from other health care professionals such as care managers. In one file we saw that the care manager had written to the resident informing them that the service could meet the residents needs. The manager needs to ensure that all other prospective residents receive written confirmation, from the home, that their needs can be met at the service. Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 9 Two documents are in place called the service user guide and the statement of purpose. These two documents are available to residents and their relatives and inform them of the services they can expect if they live at the home. Details also include who the staff are and what jobs they do, what the environment is like and what to do if they have any concerns. We saw that contracts were in place, which had been signed by the resident or their relative. The service does not offer intermediate care but will provide short stays for people if they have a mental health condition or a dementia type condition. Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments, which are regularly reviewed, and updated enable residents to have their needs met. Clear and robust medication systems enable residents to receive their medication safely. Systems in place provide access to health care professionals. Resident’s dignity and privacy is maintained. EVIDENCE: We looked at care plans and risk assessments for three residents these contained comprehensive assessment tools including a mental health test tool which was used every two months to asses the memory ability of residents, this then forms part of the review of the care plans. Care plans had been reviewed with the involvement of the residents and their relatives and where possible these had been signed by the residents. Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 11 There were good links with the district nursing team, community mental health team and the local doctors surgery. We received comments such as “The staff carry out our requests well” “The residents are well cared for and are referred to us when necessary”. Records in care plans showed that residents have access to chiropodists, dentists and opticians. One resident we spoke with said they had recently seen the chiropodist and optician. Medication is managed safely and all staff have received training. We saw that the medication trolley was kept secure; there was photo identification in the medication records book so staff were ensuring they were giving medication to the right person. Doctors written consent had been obtained for homely remedies such as cough mixture and Paracetamol so this could be available for residents if needed. Residents were spoken to in a sensitive way and interactions between residents and staff were valuing of residents. A comment received from a relative said, “Even though my relative has a dementia the staff work hard to maintain their dignity”. We saw an example of dignity being upheld when a couple of residents were assisted to take their meals. Privacy was maintained and examples of this were knocking on the door before entering and ensuring screens were used in shared bedrooms. Any discussions regarding residents took place in the manager’s office. Records were kept secure so no one could read private and confidential information regarding residents. Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with activities and are supported to continue with hobbies they enjoyed before living at the service. Further development of the activists programme would enable all residents to have sufficient activities available to meet their abilities. Staff have an awareness of residents spiritual and emotional needs. Residents have control over who visits them. Dietary needs and preferences are catered for. EVIDENCE: Comment cards received said that mainly people were satisfied with the activities provided. Three comment cards informed us that that residents and relative would like to see a few more trips outside of the home planned. This was discussed with the manger who said that trips out did take place when the weather was good. Since the last inspection visit an activities coordinator has ebon employed for 8 hours a week. Outside activities are bought in such as “Music for health” and entertainers. The activities organiser is working with each resident to find suitable activities for them to be involved with. We saw Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 13 that staff had time to sit and all with residents and residents were engaged in various activities such as group discussion, knitting watching television and looking at magazines and books. Care records showed what activities residents had joined in with. Records should also show when residents were offered an activity and chose not to join in. This wile assist the staff in identifying the best times to provide activities to residents and those activities that individual residents benefit from. The staff had an awareness’ of the individuality of residents and religious needs are met by visiting clergy. Not all of the Staff have English as a first language but there was no indication this causes any communication difficulties for residents. There is a mixture of male and female staff and male and female residents. The manager provides equality and diversity training for all staff. We received comment cards back from relatives who said they were made to feel welcome when they visited the service and that they were kept informed of their relatives welfare and progress. Staff told us that visitors were able to visit when they wanted and staff support residents to speak with relatives on the phone. One comment card said “Whenever we ring from abroad the staff will always get my (relative) and help them use the phone to speak to us”. There are various areas around the home where residents can speak with visitors in private. Comment cards and comments from residents indicated that they were very satisfied with the food provided. One comment made was that there did not seem to be a lot of fresh fruit. We saw in the kitchen, bananas and apples and oranges. The cook told us that a delivery of fresh fruit and vegetables was made weekly. There are two cooks who cover every day. All food is homemade and there are choices at each mealtime. We saw three residents needed a soft diet. This was presented in a pleasing way and residents were able to choose where they took their meals. We saw residents being given the option of wearing an apron when eating their meals but this was optional. There is a menu board, which informs residents what the meal is. We spoke to the cook about special diets for residents, these are provided,such as sugar free and high fibre. Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaints policy on display enables people to know how to make a complaint. A Safeguarding adult’s policy provides staff with a working awareness of what constitutes abusive practice. EVIDENCE: All comment cards received showed that people always knew who to speak to if they had concerns; the complaints procedure is on display in the entrance hallway of the home. Pre inspection self audit information informed us that in the last 12 months 3 concerns were raised with the manager. These were all resolved to the satisfaction of the people who had raised the concerns. A log is maintained of all complaints and concerns raised. A resident we spoke with said if they were unhappy they would speak with the manager. Staff told us if they had concerns they would speak straight to the manager or to the owner. Pre inspection self audit information informed us that the manager is continuing to consult with relatives and residents by having more regular meetings. Staff said they felt they had sufficient knowledge of residents to know if they were unhappy without them needing to use verbal communication. This means that those residents who are not able to verbalise their concerns are still able to make these known. Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 15 Since the last inspection all staff have revived training in safeguarding adults policies and procedures. Staff we spoke with were able to say what action they would take if they believed they saw any practice which constituted abuse. Comment cards indicated that residents felt safe at the service. Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and comfortable and safe environment. Specialist equipment such as hoists maximize residents independence and enable staff to carry our care safely. EVIDENCE: Since the last inspection visit a new shower room has been installed. This means that residents who may have difficulty in using a bath are able to have their bathing needs met in comfort. An ongoing maintenance plan is in place and a maintenance person in employed. On a tour of the home no obvious hazards were noted. Bedrooms are personalised with personal possessions such as photographs and small pieces of furniture. We saw two bedrooms, which were shared. These Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 17 were spacious and enabled a hoist to be manoeuvred safely. New carpets have been fitted and plans are in place to provide more ensuite facilities in bedrooms. Comment cards informed us that the home was ”always” clean and another informed us “This home never smells” we found the home to be clean and fresh during our visit. Call bells are in place and within reach of residents. Communal areas were airy and well decorated. There is a garden to the back of the home where residents are free to sit out in. There were no restrictions on residents walking around the service and support was available if residents wanted to go out of the service. Pre inspection self audit information informed us that new furniture is being purchased for the sitting room and dinning room. This means that residents continue to live in a comfortable and safe home. Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An enthusiastic and trained care team cares for residents. The organisations recruitment procedures ensure residents are cared for by safely recruited staff. EVIDENCE: Currently lunch times are very busy and three residents require full support with taking their meals. Staff indicated in comment cards that this was a very busy part of the day. The manager and provider told us that an advertisement has been placed in the job centre and two new staff were due to start work in the home in the next couple of weeks. Currently the manager and ancillary staff assist during the lunchtime. Staff told us that at all other times their was sufficient time to provide care in an unhurried way. Residents told us they never felt rushed and if they needed help staff would assist promptly. We looked at three staff files including the file of the newest member of staff. A recruitment policy is in place and all files seen contained the correct checks such as references, completed application form and Criminal Record Bureau checks and identification. This means that staff have been recruited safely and residents can be confident that they are cared for by people who have the necessary skills and attitude to care for them. Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 19 We spoke with two staff who told us about the recruitment process and induction programme. We could see that all staff receive an induction and work in the service for a couple of shifts as an additional member of staff. Pre inspection self audit information informed us that 40 of staff have a National Vocational Qualification (NVQ) in care this means that they have additional skills and knowledge to care for the residents. A training plan is in place and we could see from records and certificates on display that staff had attended mandatory training such as infection control, first aid and medication management and additional training such as Mental Capacity Act training. Staff were seen caring for residents during the visit. Staff were skilled in engaging with residents and understood what residents were indicating were their needs. Comment cards received made very positive comments such as “We are very satisfied with the care (our relative) received.” “ They care and it shows. The home is welcoming. Nothing is too much trouble and they endeavour to give my relative the care she needs” and “I have been happy with what I see at the home”. Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 35,36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An experienced and competent manager who has a good rapport with residents, relatives and visitors manages the service. Residents are protected by the services health and safety polices and procedures. Financial management systems keep residents monies safe. Quality assurance systems show how the service is run in the best interests of the service users. EVIDENCE: The Registered Manager is Mrs Elaine Herridge . Mrs Herridge has many years experience of managing services for people who have mental health needs or dementia type conditions. Comment cards contained may positive comments Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 21 such as “Elaine is excellent” “A very good manager and”” “is always welcoming and leads a good team”. Residents we spoke with said they could speak to the manager “About anything even just a chat some days”. Staff told us that the manager had “good leadership skills” and was “approachable and fair”. The manager was observered speaking with residents and this was in a kind and professional manner. Staff told us and we saw records that supervision sessions take place every couple of months .This enables staff to raise any issues they may have such as training needs or information regarding residents. A quality assurance system is in place so residents and visitors to the home can see how the provider intends to develop the service and action any points residents raise. Residents and relatives are given a questionnaire to complete every couple of months and an audit visit is carried out every month by the Provider. These reports are kept in the service and the manager uses them to form part of the homes business plan. A newsletter is produced every 3 months for residents, staff and relatives to inform them of any changes to the service such as new residents and staff. Staff told us they saw the provider a couple of times a month and that he would always speak with staff and residents and “ask them how they were getting on”. We looked at financial records for three of the residents. Monies were held in a safe way and a clear audit trial was in place to ensure resident’s money was safeguarded. Pre inspection information evidenced that polices and procedures are maintained. Records are in place at the home, which show that servicing of equipment and systems such as the fire safety system, heating system and lift are up to date. Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 23 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 OP12 Good Practice Recommendations Residents records need to record what activities resident’s enjoy and they find purposeful. This will enable appropriate activities to be provided to meet residents individual abilities. Alton House DS0000061683.V359649.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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