Inspection on 07/06/05 for East View Housing

This inspection was carried out on 7th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

East View Housing 23/09/08

East View Housing 06/10/06

East View Housing 02/11/05

East View Housing 02/11/04

East View Housing 07/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Alexandra House Rest Home 2 - 4 6 Pembroke Crescent Hove East Sussex BN3 5DH Lead Inspector Jane Jewell Unannounced 27 April 2005 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 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. Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Alexandra House Rest Home Address 2 - 4 6 Pembroke Crescent Hove East Sussex BN3 5DH 01273 774277 01273 720814 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Alexandra Rest Home Limited Mr O De La Motte Mrs M H De La Motte Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (OP) 26 of places Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of people accommodated must not exceed twenty-six (26). 2. The people accommodated will be aged sixty-five (65) years or over on admission. Date of last inspection 15 th October 2004 Brief Description of the Service: Alexandra House is privately owned residential care home for up to twenty-six older people. The home has been owned and managed by the current providers since 1983. It is located within walking distance of local amenities in Hove and bus routes into Brighton. The premises consist of three Edwardian houses converted for its current use. Accommodation is presented across three floors, ground, first and second floor, with access to the first and second floors via stairs or a shaft lift. Resident accommodation consists of nineteen single and two shared bedrooms with communal facilities including two lounges, dinning room and an enclosed rear garden. The front area is paved to provide off road parking. The homes literature states that its aim is to preserve dignity whilst providing care in a private environment. The home is a member of the Registered Care Homes Association (RCHA). Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place in order to establish the progress made towards meeting the significant number of outstanding requirements made from previous visits to the home. Four additional visits have been made to the home since the last unannounced inspection. Plans are in place for the sale of the home as a going concern. The inspectors recognise the challenges faced by the manager during the sale of the home and appreciate the difficulties faced in this unsettled period. However, due to the continuing delays in the sale of the home it remains a priority that progress must be made towards addressing the key areas for improvement highlighted in this report. The inspection was undertaken by two Regulation Inspectors and took place between 12pm and 6pm. There are fourteen residents currently living at the home. The inspection involved a tour of the premises, examination of the homes records, discussion with management, consultation with four staff on duty and thirteen residents. In order that a balanced and thorough view of the home is obtained, this inspection report should to be read in conjunction with the previous inspection reports. The Inspectors would like to thank the residents, staff and management for their assistance during the inspection. What the service does well: What has improved since the last inspection? Due to the intended sale of the home there has been limited progress towards meeting the significant number of outstanding requirements. Where progress has been made this relates to improvements to some administrative tasks to help towards the smooth running of the home. Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 6 Some further improvements have been made to the environment, including the fitting of locks to bedrooms doors, redecoration of parts of the building and mixer valves to hot water outlets. Attempts have been made to improve the choices of food provided to address resident’s individual preferences. What they could do better: The continuing delays in the sale of the home has lead to some practices that do not promote and safeguard the health, safety and welfare of the people using the service. For example care planning, risk management and continuity of care and limited number of staff on duty. This is placing residents at risk and their needs cannot be fully met. This is a matter of serious concern to the Inspector to which the manager has been written to separately. As a matter of priority the manager must address the shortfalls in practices noted within the agreed timescales to ensure that during this unsettled period residents needs are addressed and their safety protected. Subsequent to the inspection the home was purchased and the registration category changed to dementia care. A monitoring visit was undertaken on the 23/5/05 to establish the progress made towards addressing the outstanding areas of concern. This visit highlighted that progress has been made to address some of the shortfalls in practices noted in this inspection report. A copy of the letter resulting from this visit can be obtained from the CSCI or contacting the home. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 4 There is insufficient evidence to confirm that the home can meet the needs of all residents accommodated. EVIDENCE: Residents generally spoke of a quiet and contented life at the home and looked relaxed and reasonably comfortable in their surroundings. There is a wide range of needs amongst residents, including several who have developed dementia, physical disabilities to one who is very independent. It remains essential that staff have the necessary skills to meet these needs through undergoing core and specialist training. The manager has not yet implemented training and development to a satisfactory level. Staff consulted were not aware of the needs of residents as they have no involvement in the care planning process, nor familiarised with care plans during their induction. There have been no new admissions to the home for several months. Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9 and 10 There is no clear or consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet resident’s needs. The management of individual risks faced by residents must be managed more effectively to ensure that residents are reasonably safeguarded from risk to themselves and others. Not all of the homes practices preserved residents’ privacy and dignity. EVIDENCE: The home uses pre-printed care plan booklets that are made up of various risk and needs assessments and are completed and updated by the deputy manager. It was previously agreed with the manager that while the deputy was on leave and due to the then imminent sale of the home, that all care plans must be reviewed by the 21/3/05. This was in preparation for the prospective owners undertaking their own care planning process. It was also agreed that following their review any changes in needs and preferences would then be recorded in the daily notes. However due to ongoing delays in the transfer of the home it remains essential that care plans provide staff with the necessary guidance to meet residents needs. Staff consulted were not aware of the care plans for residents and no resident had seen or felt that they had been involved in their development. This is in Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 10 spite of residents recently being asked for their individual food preferences and occupation. Staff did however show an understanding of the basic needs of each resident. It was previously recommended that care plans evidence that residents have been involved in their development and agree with its contents. This had not been undertaken and has now been made a requirement. The standard of daily recording was noted to be good with a clear account of actions and events that had occurred. It remains recommended that staff involved in care planning undergo training on how to complete them, which takes into account the tone of language used. Personal risk assessments are undertaken on each resident to identify any potential risks faced or posed by them. There remains a need for these to be regularly reviewed, include the actions needed to manage any identified risks and that a resident leaving the home unescorted be risk assessed. In addition there is a need to ensure that a risk assessment is undertaken on residents who wish to self-administer their medication to demonstrate the capabilities of the individuals to safely be responsible for these medications. Policies and procedures for medications were not observed on this occasion. MAR charts observed demonstrated that medication was signed for appropriately. The home is changing suppliers next month. This standard will be thoroughly inspected at the next inspection when the new system will have been implemented. A resident informed the Inspector that their privacy and dignity is respected. However, a staff member was observed to enter a residents’ room without knocking. This was fedback to the manager. It was previously recommended that procedures be developed on the promotion of resident’s privacy and dignity. This had not been undertaken at the time of inspection and in order to support good practices this has now been made a requirement. Staff were noted to be undertaking personal care in private. Consultation with health care professionals was reported to take place in private. Resident’s personal appearance was presented in such a manner that preserved their dignity. However incontinence sheets are used on some chairs in the lounge, which were unsightly and did not preserve some residents dignity. This issue has previously been raised during inspections of 2003 and had been remedied, the manager is once again recommended to review their use. The home employs male care assistants, who were sensitive to the issues around their gender while undertaking personal care. The Inspectors were assured that where a resident expressed a preference that this was always respected. Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14 and 15 It remains a concern that due to regular changes in staff and their limited involvement in care planning staff were not always familiar with the individuality of residents and the choices that this affords. Residents are provided with limited stimulation. There are insufficient numbers of staff on duty to provide/initiate activities for residents to participate in. EVIDENCE: The manager was previously required to develop a programme of activities based on the likes and dislikes of residents and which is made available to them. A notice board informed residents that there are a variety of activities on offer throughout the week. However this was not being undertaken. One resident stated there was ‘not enough activities’. A staff member who works full time said that they had not observed any activities in the past month. A resident was overheard telling a staff member ‘I’m bored sitting in there, I’m going to my room.’ One resident prefers to stay in their own bedroom and not participate in any house events and this is respected by the home. It was previously identified that not all of the routines of daily living were determined by resident’s individual preferences/choice for example: breakfast time, rising and going to bed. The manager was previously required to review the deployment of staff at peak times, in order to ensure that the routines of daily living are flexible and determined by the needs/preferences of residents. There was no evidence to confirm that this had been undertaken as three Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 12 residents continue to state that breakfast is served too early and the staff consulted spoke of the bedtime routine that they follow. The kitchen was clean and well equipped to provided suitable facilities for catering. The main midday meal is cooked and prepared by a member of the management team who it was reported had designated hours for cooking. The manager was previously required to ensure that food hygiene training is undertaken for all staff involved in the preparation and cooking of food. It could not be established whether this has been undertaken and therefore this requirement remains outstanding. In line with previous requirements the cook has compiled a list of the likes and dislikes of each resident and made some alterations to the menu accordingly. It was previously recommended that a list of alternative meals be displayed to promote choice. There was a handwritten note on the notice board advising residents what meals or alternative was available for the day. On arrival at the home, an Inspector briefly spoke to at least six residents who were seated at the dining table. No one was aware of what food was being served, nor what was available as an alternative. Record of meals provided showed that the vast majority have the main meal provided. Individual preferences of a large/small meal and variations to the meal were respected. There were various comments from residents regarding the food ‘almost sometimes too much to eat’ to ‘not that good’. When feedback was given to the cook on the continuing variable feedback on the standards of food she stated that when she seeks feedback from residents no negative comments are made. She could therefore not make any adjustments or alterations to the food. Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Adult protection in the home is poor with the lack of staff training and understanding of adult protection issues potentially leaving residents vulnerable and at risk. EVIDENCE: A copy of the East Sussex Multi Agency guidelines on the Protection of Vulnerable Adults is available as a reference. Information is available on different types of abuse, the possible indicators and a flowchart on what to do if abuse is suspected. The majority of staff have not undergone training in adult protection, this includes the manager. Applications to the Criminal Records Bureau (CRB) had been made in respect of existing staff but not for two new staff supplied by the prospective owner. This matter was discussed separately with them. A joint adult protection investigation was undertaken in March 2005 with CSCI and social services in response to concerns raised regarding: poor care practices, management of falls, standards of food and medication. The concerns were found to be partially substantiated. Although some progress has been made to address the shortfalls in practices, there remain some outstanding requirements; relating to care planning, care practices and the environment. Brighton and Hove contracts have chosen to not place any further residents at the home until these issues are addressed satisfactorily. Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20, 21,22,23,24,25 and 26 Standards of decoration, and cleanliness are variable with parts that have been decorated and cleaned to a good standard with other parts looking worn and unclean. Some poor practices were noted in the management of infection control, which placed staff and residents at risk. EVIDENCE: The home is located in a residential area of Hove, and is conveniently located near to local amenities, including shops, pubs and buses into Brighton. Seven bedrooms were decommissioned by the home during the summer of 2004 and following agreement with CSCI these rooms have been re-opened. Since the previous inspection locks have been fitted to bedroom doors, mixer values fitted to the remaining hot water outlets and some redecoration of bedrooms. Due to the sale of the home not all works listed in the homes redecoration plan have been completed. Therefore, standards of maintenance and décor is variable, with some bedrooms decorated to a good standard with others in need of redecoration. Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 15 Shared space consists of a small and large lounge and separate dining room. The large lounge is currently not used by residents. The heating was noted during previous visits to the home as not providing sufficient heat in this lounge or in one bedroom. The manager reported that this is being addressed. Some chairs in the small lounge look worn and some are in need of replacement. The outdoor space consists of a south facing garden, which is laid to lawn with flowerbeds, shrubs, trees and small patio area with seats, making this an attractive social space for residents to enjoy. The manager was previously required to make safe some loose and raised paving slabs, on the rear patio so they do not prevent a trip hazard. This had not been undertaken. Access to the garden is through the kitchen via steps, which residents are not permitted to use. Access to the garden is therefore via the front and the use of paths around the side of the home. Three ground floor bedrooms have their own steps leading directly to the garden. Because of access issues to the garden, not all residents are able to freely access this space at will, but need staff assistance to guide or support them. Therefore it remains recommended that this be reviewed and access to the garden is made assessable to all from inside of the home. The home is not designed to offer a service to people with physical disabilities and the access arrangements and lack of handling equipment within the home would make it unsuitable for residents with a significant permanent restricted mobility. Bedrooms have a call point that is cancelled at the point of call and those checked were in working order. One call bell cord was temporally trapped by a bed frame and could therefore not be easily accessed. This was feedback to the manager who agreed to address this. During the inspection every bedroom was visited, and were seen to be personalised and furnished in line with the National Minimum Standard. The home was previously required to ensure that window restrictors had been fitted to windows that pose a risk from falls or security. This had not been undertaken and the manager was immediately required to address this. Some bedroom windows could not be opened and therefore this limited access to fresh air. Care staff undertake cleaning duties as part of their duties. Standards of cleanliness were variable with some areas cleaned to an acceptable standard while some areas such as commodes; extractor fans and some bedrooms were not. One resident stated that they could not recall the last time their bedroom was cleaned. In parts of the home there were malodorous odours. Staff were observed using poor infection control practices by not regularly changing protective clothing after undertaking personal care tasks. Although Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 16 disposable equipment is available it is stored in the kitchen area and not easily accessible throughout the home as previously required. Laundry facilities are located in the basement of the home and access to this is through the kitchen or walking around the outside of the building. Suitable arrangements are in place to ensure that laundry carried through the kitchen does not pose a risk of cross contamination. There is one sink in the laundry, which has a variety of uses including pre-soaking clothes. There remains a need to ensure that adequate hand washing facilities are available. The home has established that laundry equipment does not currently comply with the Water Fittings Regulations 1999. Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The numbers and deployment of staff are insufficient to meet the aims, objectives of the home and the individual needs of residents. The lack of understanding and induction of care plans for new staff may lead to some needs of the residents not being met. Recruitment practices undertaken by the prospective owner were not robust and do not provide safeguards to protect residents. EVIDENCE: Upon arrival at inspection there was one care assistant and cook on duty, with the manager temporarily absent from the home. This staffing level was insufficient to meet the needs and welfare of residents. The manager was immediately required to increase staffing levels to safeguard resident’s safety and welfare. As previously noted the manager was required to review the deployment of staff to ensure that resident’s individual preferences and routines could be respected, with particular reference to the early morning. Three residents continue to state that they receive breakfast too early by the night staff. Staff consulted stated they are not involved in care planning and received no induction on understanding them. Needs of residents were found out during the working day and the staff member asking questions. Generally residents spoke positively about the current care staff employed with particular reference to their kindness, with some saying how busy staff were and often had to rush to get everything done. One resident spoke of how many different staff there has been recently and this was quite confusing for some Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 18 residents who have greater needs. No resident was able to name the care staff on duty during the inspection. The manager reported difficulties in currently maintaining minimum staffing levels due to staff turnover. Agency staff have recently been used to cover some shifts. The manager has not employed any new staff since the previous inspection due to the sale of the home. The prospective new owners had supplied two staff to cover shifts, their recruitment documentation was held by the prospective owners and viewed by the Inspectors. These revealed that recruitment practices fell well short of the required standard. The prospective owners were asked to undertake immediate action in order to safeguard residents, which was subsequently confirmed as being undertaken. The poor standards of recruitment practices were discussed separately with the prospective owners. It was previously recommended that procedures be developed on the recruitment of staff, this had not been undertaken. Training records were not inspected on this occasion and therefore it was not possible to assess whether previously made requirements of staff being inducted to NTO specification within six months of appointment had been fully met. There remains a need for staff to undergo training in the care of older people including Alzheimer’s and dementia. In line with previous requirements all night staff have now undergone manual handling training. Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36, 37 and 38 Progress must be made by the manager towards addressing the shortfalls in practices noted prior to any sale of the home. Not all of the homes practices promote and safeguard the health, safety and welfare of the people using the service. This is in relation to risk management, fire safety and infection control. EVIDENCE: The registered manager is a RGN and has considerable experience in managing care services for older people. Managerial responsibilities are spilt amongst a management team. This is made up of family members and includes the manager, deputy and senior carer. The deputy manager oversees much of the administration systems and a senior carer and manager the dayto-day running of the home. The majority of residents spoke positively about the management approach. The Inspectors recognise the challenges faced by the manager during the sale of the home and appreciate the difficulties faced in this unsettled period. Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 20 However, due to the continuing delays in the sale of the home it remains a priority that progress must be made towards addressing the key areas for improvement highlighted in this report. Staff on duty stated they received some direction and informal supervision from the cook or manager whilst on duty. It was not possible to assess whether permanent staff undergo formal supervision, as no permanent staff were on duty during the core time of the inspection. It remains recommended that staff that undertake supervision receive training in supervision techniques. Not all records required by law and for the effective and efficient running of the home were maintained and up to date, this includes: care planning, risk assessments, staff/residents meetings, fire drills and hot water temperatures. The manager has archived many documents in preparation for the sale of the home, some documents containing personal information about past residents had been stored in an unlocked empty bedroom. The manager was immediately required to ensure that records containing personal information be kept secure at all times. Since the previous inspection mixer values have now been fitted to the remaining hot water outlets. Outlets checked showed that hot water was delivered within the required safe temperature range. The manager was previously asked to ensure that suitable measures are implemented to monitor hot water temperatures to ensure that a safe temperature is now maintained. The manager reported that this had not been undertaken. Some systems to support fire safety are in place, including alarm and emergency lighting checks and service contracts for fire fighting equipment are in place. There remains a need for regular fire drills and practices to be held and a record maintained of the outcome and the staff attending. This remains particularly important in light of the numbers of non-permanent staff being used. Several bedroom doors were previously noted not to close properly, and thus prevent a risk in the event of fire. This had not been satisfactorily addressed and in addition several more were also identified during this inspection. The manager was again immediately required to address this. A record of accidents is kept and was seen to be up to date with no specific patterns identified. An example of good practice was noted whereby following several falls medical intervention was sought in order to establish any medical reason for the falls. Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 1 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 2 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 2 15 2 COMPLAINTS AND PROTECTION 2 2 x 2 3 2 2 1 STAFFING Standard No Score 27 2 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 2 x x x x 3 2 1 Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 22 YES 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 7 Regulation 15(2)(c) Requirement That unless it is unpractical to do so service users are consulted regarding the development and review of their care plan, are notified of any changes to the plan and sign to indicate that they are aware and agree with of the contents of the plan. That care plans and personal risk assessments are reviewed and updated regularly to reflect changes in needs and preferences of service users. (Outstanding from investigation of 3/3/05) That a risk assessment is undertaken on service users leaving the home unescorted, which records the actions to manage identified risk and is reviewed frequently. (Outstanding from inspection of 9/11/04.) That comprehensive personal risk assessments are expanded to include how identified risks will be managed. (Outstanding from inspection of 21/7/03) That written risk assessments are completed for those service users wishing to self medicate Timescale for action 30-6-05 2. 7 15(2)(b) Immediate 3. 7 13(4)(c) Immediate 4. 7 13(4)(c) Immediate 5. 9 13(4)(c) Immediate Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 23 6. 10 12(4)(a) 7. 12 16(2)(m) 8. 14 12(2) 9. 15 13(4)(c) 13(5) 10. 18 19(4)(b) (i) 11. 19 23(2)(d) 12. 20 13(4)(c) 13. 25 23(2)(p) 14. 15. 25 25 23(2)(P) 13(4)(c) which records the actions to manage identified risks and is reviewed frequently. That procedures be developed on the promotion of service users privacy and dignity. (This was previously a recommendation.) That a programme of activities be developed based on the likes and dislikes of service users and which is made available to service users. (Outstanding from investigation of 3/3/05) That the routines of daily living are flexible to meet service users individual preferences and routines. That staff undergo training in food safety and hygiene and a record of attendance maintained of the training. (Outstanding from inspection of 21/7/03) That staff only commence employed following the completion of a satisfactory Criminal Records Bureau and POVA check. (Outstanding from inspection of 9/11/04.) That the lists of works in the home’s plan of re-decoration and repair is undertaken within the timescales stated. (Outstanding from inspection of 9/11/04.) That loose and raised paving slabs, in the rear patio are made safe to prevent a trip hazard. (Outstanding from inspection of 9/11/04.) That adequate heating is provided in all parts of the home. (Outstanding from investigation of 3/3/05) That bedroom windows are able to be opened to provide suitable ventilation. That a window restrictor be fitted to the window in bedroom five. (Outstanding from inspection of 30-6-05 30-3-05 Immediate 30-1-05 Immediate 30-5-05 Immediate 30-3-05 30-6-05 Immediate Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 24 9/11/04.) 16. 17. 26 26 23(2)(d) & 16(2)(k) 13(3) That all parts of the home are kept clean and free from offensive odours. That appropriate hand washing facilities are available in areas where infected material is handled. (Outstanding from inspection of 22/6/04) That adequate quantities of disposable protective clothing is made readily available to staff. (Outstanding from inspection of 9/11/04.) That the deployment of staff is reviewed to ensure adequate staffing levels at peak times as is appropriate for the health and welfare of service users. (Outstanding from inspection of 9/11/04.) That at all times adequate staffing levels are maintained to ensure the health and welfare of service users. That the required employment and recruitment documentation is obtained prior to employment commencing and that copies are retained. (Outstanding from inspection of 9/11/04.) That staff receive induction training to NTO specification within six months of appointment. (Outstanding from inspection of 22/6/04) That staff undergo training in the care of older people including Alzheimer’s and dementia. (Outstanding from inspection of 1/12/03) That individual records and home records are stored securely. That suitable measures are implemented to monitor hot water temperatures to outlets accessible to service users. 30-6-05 30-6-05 18. 26 13(3) Immediate 19. 27 18(1)(a) Immediate 20. 27 18(1)(a) Immediate 21. 29 19(1)(b) (i) Sch 2 (14) 18(1)(c) (i) Immediate 22. 30 30-8-05 23. 30 18(1)(c) (i) 30-8-05 24. 25. 37 38 17(1)(b) 13(4)(c) Immediate Immediate Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 25 26. 38 23(4)(e) & Sch 4(14) 27. 38 13(4)(c) (Outstanding from inspection of 9/11/04.) That fire drills and practices are held at regular intervals and a record maintained of the outcome and staff attending. (Outstanding from inspection of 22/6/04) That fire doors are able to be closed independently and securely. (Outstanding from investigation of 3/3/05) Immediate Immediate 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. 2. 3. 4. 5. 6. 7. Refer to Standard 7 10 20 29 32 36 37 Good Practice Recommendations That staff involved in care planning undergo training on their completion, which takes into account the tone of language used. (First made at inspection 9/11/04) That the use of incontinence sheets used to protect chairs in the lounge be reviewed. That the garden is made easily accessible to all service users from inside the home. (First made at inspection 22/6/04) That procedures be developed on the recruitment of staff. (First made at inspection 9/11/04) That staff and service users meetings are undertaken and a record maintained of the meetings. (First made at inspection 9/11/04) That staff that undertake supervision receive training in supervision techniques. (First made at inspection 1/12/03) That written confirmation is provided to privately funded service users on the decision to become permanent following the trial period of admission. (First made at inspection 22/6/04) Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 26 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 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 Alexandra House Rest Home H59-H10 S14170 Alexandra House Rest Home V220063 270405 Stage 4.doc Version 1.20 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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