Inspection on 01/05/07 for Alexander Care Centre

This inspection was carried out on 1st May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Alexander Care Centre 28/04/09

Alexander Care Centre 29/04/08

Alexander Care Centre 08/06/06

Alexander Care Centre 15/12/05

Alexander Care Centre 19/08/05

Alexander Care Centre 14/09/04

Alexander Care Centre 05/02/04

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

CARE HOMES FOR OLDER PEOPLE Alexander Care Centre 21 Rushey Mead Lewisham London SE4 1JJ Lead Inspector Pam Cohen Unannounced Inspection 1st May 2007 10:00 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 Alexander Care Centre DS0000007002.V337230.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. Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexander Care Centre Address 21 Rushey Mead Lewisham London SE4 1JJ 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) 020 8314 5600 020 8690 6100 alexandercare@mchealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Limited Haiqin Li Care Home 78 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Old age, not falling within any other of places category (0), Physical disability (0), Physical disability over 65 years of age (0) Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 20 patients, frail, elderly persons aged 60 years and above (female) and 65 years and above (male) 28 residents, elderly persons and persons aged 55 years and above with physical dependency 8th June 2006 Date of last inspection Brief Description of the Service: The Alexander Care Centre is a modern, purpose built care home for Older People: Southern Cross Healthcare Services Ltd is the registered provider. The home provides for a maximum of 78 people with dementia care needs, residential care needs, and nursing care needs. There are 68 single rooms and five shared rooms, each with en-suite facilities. Residential fees range from £466.88 to £533.50 monthly and nursing fees from £596 to £675 On the day of inspection there were five vacancies. The home is situated in its own grounds in a cul-de-sac in a residential estate. It is close to local shops and public transport. There is car parking at the front of the building and two gardens to the side and the rear. Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 2 days at the beginning of May. The manager was present to facilitate the inspection, as were team managers and staff on each floor. The inspector toured the premises and met with the chef and the maintenance man. She was also able to speak to people living in the home, relatives, a social worker reviewing a placement and the home’s nurse from the care homes support team. She checked documentation and staff files and 10 of care plans were sampled. What the service does well: What has improved since the last inspection? What they could do better: Care plans are not always to the required standard, meaning that the support needed for all aspects of a person’s care may not be properly assessed. This is especially true for people suffering from dementia. They cannot also be sure that the support they are given always respects their needs for privacy and dignity. Activities provided in the home are not sufficient or varied enough to provide people with leisure activities of their choice. People suffering with dementia are especially disadvantaged by lack of stimulation and orientation. Food provision is neither varied nor nutritious enough, and little provision is made for people from ethnic minorities. Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 6 It is not clear that there are enough management hours to ensure that the home is properly run and the individual needs of the people living there are met. 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. Alexander Care Centre DS0000007002.V337230.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 Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information on the home is good as are procedures leading up to admission to the home. However people who suffer from dementia cannot be sure of getting the care their special needs merit. EVIDENCE: The home has a good Service User Guide containing all necessary information, and this has been updated since the last inspection. Files showed that before admission to the home all necessary multi-disciplinary assessments are obtained. Where possible people visit the home first. Each prospective resident was assessed by a senior member of staff and the prospective resident or their relative is informed in writing that their needs can be met. A draft care plan is then drawn up. As at the last inspection, the home has the capacity to meet the assessed needs of people on the nursing and residential care units. However the requirement left at that inspection, that the environment, care and activities on Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 9 the dementia care unit should be based on current good practise, has not yet been met. The home does not offer intermediate care. Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home cannot be sure that all their needs are correctly assessed or that any risks they face are minimised. Neither can they be sure that the support they are given always respects their needs for privacy and dignity. Peoples’ health care needs including medication administration are dealt with well. EVIDENCE: Care plans were checked on each unit and were not yet found to be of a standard which would mean that the proper care could be ensured for people in all areas of need. The inspector was told that people suffering from dementia had a dementia assessment, however of three care plans seen, two had no such assessment and one had been filled in so badly as to be of no use. The care plans for people suffering from dementia were formulaic not individual. They do not detail a person’s level of dementia or how it affects their functioning. They say that the person should be oriented using equipment Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 11 that the home does not possess and for everyone they talked of a rest period with no individualised assessment or reason for this. Care plans in general still do not have life histories and do not well address social or emotional needs. Personal care is often not detailed enough and does not address the wishes of the individuals. Lastly some parts of care plans were found to be incorrect. A woman who was said to have dentures had her own teeth, someone with high blood pressure was said to be taking medication which needed to be monitored for side effects, but they were taking no such medication. In relation to risk, there were risk assessments seen that assessed an individual as at high risk of falls but then there was no plan on how to minimise this. There was also a nutrition assessment which showed that a service user was at risk of poor nutrition. There was a care plan written to address this but the actions needed were not carried out and the person continued to lose weight. There were also people with high moving and handling risk areas who did not have care plans to cover these. An urgent requirement was left to address this issue. Apart for the nutritional screening and weight monitoring, health care needs were dealt with well with good monitoring and treatment. The nurse from the Care Home Support Team who knows the home well said that she was very satisfied with the health care given on the nursing unit. Medication issues were dealt with well and the home is now checking, when people come into the home, whether they wish to self medicate. During the inspection, the inspector saw several instances of health care being given in the lounge which would have been better given in private; these included optician’s examinations, giving medication through a stomach tube and taking blood for a test. She also saw that people on this unit had blue plastic aprons when eating their meals rather than normal protection. Many people’s toiletries were also still stored in plastic boxes on the floor. As was noted at the last relatives meeting not all rooms have a key to lock the door. All these practises take away from people’s dignity. Alexander Care Centre DS0000007002.V337230.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): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Visitors to the home are made extremely welcome and opportunities for residents who are able, to have choice and control over their life, are good. Activities provided in the home are not sufficient or varied enough to provide people with leisure activities of their choice. People suffering with dementia are especially disadvantaged by lack of stimulation and orientation. Food provision is neither varied nor nutritious enough, and little provision is made for people from ethnic minorities. EVIDENCE: The activities programme for the home continues to be inadequate. As noted at the last inspection “Service users do not have individual social care plans, the programme is sparse and the recorded take-up of those activities offered reflects this.” In particular, the activities offered are during the week with none time tabled for the weekend. Also activities for people suffering from dementia are poor and they need very much more stimulation and orientation. A relative who filled in a survey noted the need for visits to the garden and relatives of someone on the ground floor who visit often, although generally happy with the home were not with the level of formal activities. They pointed Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 13 out that informal activities do not happen either, that the floor had only one board game, that the television was on all the time although most people could not see it, and that appropriate music was not often played. There were some positive signs which need to be built upon. The home has been chosen for a research project which includes seven sessions for staff on activities for people with dementia and that started on the day of inspection. There were also notices in the home announcing preparations for a trip to Dulwich Park and minutes of relatives’ meetings showed that activities were on the agenda. People living in the home are able to have visitors when they wish. One relative in a reply to a survey said “staff give excellent assistance to family and attention to family relationships.” People are also able to make decisions according to their abilities. They are able to personalise their rooms as much as they wish, including the colour of the walls, and if they are able to keep control of their personal finances. They can also make decisions as to where they want to eat. Food provision does not seem to be giving people a balanced and nutritious diet and does not provide sufficient choice. The menu published does not reflect what is cooked or provided. Just under 10 of people living in the home are Afro-Caribbean but little or no food that they would be familiar with is being served. Grapefruit or prunes are on the menus for breakfast but none was seen. Fresh fruit is also on the menu as a choice for every meal; however it was found that the only fruit in the home was about 40 bananas and 8 satsumas and only enough is ordered every week to give each resident about 4 pieces of fruit a week. One relative replying to a survey asked for more fresh fruit. There is little fresh vegetables in evidence other than salad stuffs. The chef and a relative confirmed that vegetables were usually frozen. The menu was also repetitive with a reliance on carbohydrates. A survey displayed in the home showed only 50 of people satisfied with food provision. Alexander Care Centre DS0000007002.V337230.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): 16,18. Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. Complaints are well dealt with and all aspects of policy and procedures to protect people who live in the home from abuse are in place. EVIDENCE: The home has a complaints policy which meets requirements and which has been updated. The complaints book showed that complaints received are properly investigated and responded to. The manager has received 3 complaints since the last inspection, one of which had also been sent to the CSCI. People living in the home and their relatives said they would know how to complain but that their complaints were adequately dealt with on their unit and they did not need to go to the manager. The company’s protection of vulnerable adults arrangements conforms to regulation. Staff receive training on prevention and detection of adult abuse. Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 15 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): 19,20,21,22,23,24,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable, clean, well-maintained home that is suitable for their needs. However, dining space on the nursing floor is not adequate for service users’ needs. Also the needs of people suffering from dementia are not served by their environment. EVIDENCE: Most areas of the environment are as at the last inspection and so can be restated. Alexander Care is a modern, purpose built home, suitable for its stated purpose. Bedrooms fulfil size requirements and all are wheelchair accessible. There are sufficient safe, assisted bathing and shower facilities available together with toilets situated near communal rooms. In addition, all bedrooms have en-suite facilities that included a toilet and washbasin. Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 16 There is a good variety of communal space but the present configuration means that the nursing unit does not have a dining room and the dining room for the EMI unit is on a different floor. In general the environment is not yet suitable for people with dementia, in terms of cues to help people orientate themselves and colours and textures to stimulate them. There are two large, pleasant garden areas; some garden furniture has been bought and the inspector was told that a gardener is being brought in for a day a week in order to improve these spaces. The building is well maintained and on the day of inspection was clean throughout. Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are deployed in adequate numbers and there is a good level of NVQ training. However people who live in the home cannot be sure that their individual needs can be met by staff who have training in the appropriate areas. EVIDENCE: The staff group has stayed extremely stable since the past inspection and so staff are still deployed in an adequate number and skills mix at both day and night. NVQ training now means that almost 70 of staff have an NVQ qualification. However the management of the other training to ensure that staff can meet the needs of people who live in the home, is currently not working well. Staff appraisals have either not been done, or only been partially done and so staff training needs are not being identified; this is exacerbated by the fact that records of what training has been done are not up to date. Also training is pro-active based on what is available rather than what is needed. Because of the stability of the staff group recruitment practises could not be properly checked. Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 18 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): 31,32,33,35,36,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is competent and qualified to manage the home but it is not clear that she has enough management hours underneath her to complete all tasks needed. Service users’ finances are subject to proper safeguards and most Health and Safety systems are in order. EVIDENCE: The registered manager is a qualified nurse, has the NVQ level 4 in care and management and works extremely hard to provide the best level of care to people living in the home. However there is evidence at this inspection, such as the number of repeat requirements, that showed that she is not able to fully influence the work in the home and thus drive up standards. One clear reason for this would seem to be the lack of management time. The team leaders on Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 19 each floor are not supernumerary and one of them is also functioning as a deputy. There is a good level of quality monitoring in place, with providers monthly visits and surveys to people who live in the home and their relatives. The results from these surveys are compiled into a report. These surveys should include the views of other stakeholders from outside the home. Policies and procedures for dealing with the monies of people living in the home are robust and audited internally. Supervision of staff is happening on a regular but this needs to be at least six times a year. All aspects of the premises are well looked after in terms of Health and Safety; and systematic checks are carried out and recorded where needed. However a lack of care plans for people with moving and handling requirements leaves them and staff at risk. Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 20 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 3 X 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 2 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 2 X 2 Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP4 Timescale for action 12(1)(a,b) The registered person must 30/09/07 ensure that the environment, care and activities on the EMI units are based on current good practise. Target date of 30/09/06 not met. 15(1) The registered person must 31/07/07 ensure that care plans are individualised and address all aspects of care needs including social, emotional and those associated with dementia. Target date of 30/09/06 not met. 13(4)(b,c) The registered person must 30/06/07 ensure where a risk area is identified a plan must be written to determine how to minimise the risk 12(4)(a) The registered person must 31/07/07 ensure that service users’ rights to dignified care are upheld at all times. Target date of 31/07/06 not met. 16(2) The registered person must 30/09/07 (m,n) ensure that social and leisure activities are developed in full DS0000007002.V337230.R01.S.doc Version 5.2 Page 22 Regulation Requirement 2. OP7 3. OP7 4. OP10 5. OP12 Alexander Care Centre consultation with service users and reflect their assessed needs. Target dates of 28/02/06 and 31/10/06 not met. 6 OP15 12(2,3) The registered person must ensure that there is a choice of food to cater for individual and cultural preferences. Target date of 30/09/06 not met. The registered person must ensure that the food provision is balanced and nutritious. The registered person must ensure that there is adequate dining space for all service users Target date of 31/10/06 not met. The registered person must ensure that there is a training programme based on the training needs of carers and the support needs of people living in the home. The registered person must ensure that they can demonstrate that there are sufficient management hours within the home. A report must be drawn up showing the management tasks needed to run the home with an estimation of the time needed. This must be sent to the commission. The registered person must ensure that staff receive supervision at least 6 times a year. The registered person must ensure that an audit is done of all people who have moving and handling needs to ensure they have moving and handling care plans. 31/07/07 7. 8. OP15 OP20 14(1)(a) 23(2)(g) 31/07/07 31/10/07 9. OP30 18(1) (c)(i) 31/10/07 10. OP32 10(1) 31/07/07 11. OP36 18(2) 31/08/07 12. OP38 13(5) 18/05/07 Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 23 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 OP33 Good Practice Recommendations It s recommended that visiting professionals should be surveyed as part of the home’s quality monitoring process. Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH 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 Alexander Care Centre DS0000007002.V337230.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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