Inspection on 29/04/08 for Alexander Care Centre

This inspection was carried out on 29th April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Alexander Care Centre 28/04/09

Alexander Care Centre 01/05/07

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 Pauline Lambe Key Unannounced Inspection 29th April 2008 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.V361482.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.V361482.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 Ltd 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.V361482.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 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. The home has 68 single rooms and five shared rooms, each with en-suite facilities. Adequate communal space and bathing facilities are provided. 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. Fees for residential care range from £380.65 to £575.00 and for nursing care from £533.00 to £725.00. Alexander Care Centre DS0000007002.V361482.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 1 star. This means the people who use this service experience adequate quality outcomes. Two inspectors from the Commission completed the site visit for this unannounced key inspection was on 29th April 2008. On the day of the inspection 76 residents were in residence and the home had two vacancies. The registered manager was on duty and assisted with the inspection. The last key inspection was done on the 1st May 2007. The inspection included a review of information held on the service file, a tour of the premises, inspecting records, talking to residents, relatives, staff and management and reviewing compliance with previous requirements. Feedback on the service was obtained during the inspection from residents, relatives and staff and from some relatives, residents and staff through survey questionnaires sent out by the Commission. Management and staff had worked together to improve standards in the home. Resident and relative feedback indicated satisfaction with the quality of care provided. Feedback from staff showed they were satisfied with their working conditions, the training and support they received. Improvements were needed to medicine management as some errors were noted in relation to this standard. What the service does well: The service provided relevant information for people wishing to live in the home and admission procedures were good. Systems were in place to monitor and meet resident’s healthcare needs. Complaints were well managed. Mealtimes were well organised and efforts made to meet the cultural dietary needs of residents. Even though only one activity organiser was employed a wide range of activities were provided. Staff training was good and 70 of care staff employed had NVQ level 2 qualifications or above. Since the last inspection staff turnover was very low. Visitors were made very welcome and presented as relaxed in the home and when communicating with staff. Attention was given to providing a safe, clean environment for residents and others. The garden was well maintained. Alexander Care Centre DS0000007002.V361482.R01.S.doc Version 5.2 Page 6 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. Alexander Care Centre DS0000007002.V361482.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.V361482.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): Standards 3, 4 and stand 6 did not apply to the service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were admitted to the home based on the outcome of a preadmission assessment. Management confirmed in writing to residents that the service was suited to meeting their needs. EVIDENCE: Residents were admitted to the home based on the outcome of a preadmission assessment. The assessment format covered all areas of need and included an optional dementia assessment. Care records seen included preadmission assessments and some included care manager assessments. There was evidence to show that residents received written confirmation that based on assessment the service was suited to meeting their needs. Alexander Care Centre DS0000007002.V361482.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 – 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans were prepared to show how needs were to be met and were kept under review however some seen were not up to date. Satisfactory arrangements were in place to ensure resident’s healthcare needs were met. Some improvements were needed to medicine management. No concerns were raised in relation to how resident’s dignity and respect were addressed. EVIDENCE: Five sets of care records were viewed in total, four files were viewed in full and an additional file was viewed in relation to wound management. Care records seen included pre-admission assessments, risk assessments and care plans. Care plans were prepared to show how assessed needs would be met. Care staff spoken with said they had time to read care plans. Care plans seen were reviewed monthly and there was evidence to show that these were discussed with residents and relatives. Two care plans for a resident on the dementia nursing unit were out of date and did not reflect the changes to the persons needs. Staff said the changes to the resident were recent and the care plan would be rewritten. Some guidance for staff in care plans was vague for Alexander Care Centre DS0000007002.V361482.R01.S.doc Version 5.2 Page 10 example one person’s nutrition care plan said to weigh weekly “if necessary”. An issue seen on one care plan in relation to the person’s emotional needs had not been addressed. For example the person was very unhappy and wanted to go home. Although staff were aware of this issue and were working with the family to address the persons needs there was no guidance in the care plan to show how staff were to support the person. Risk assessments seen were up to date and included guidance for staff on how to reduce the risk for example in relation to moving & handling, pressure sore care and prevention, meeting nutritional needs, use of bedrails and for people that smoked or had a history of self- neglect. During lunch on the dementia nursing unit two care staff were observed lifting a resident up in the armchair using an underarm lift. The resident was immobile and the staff nurse said that the staff involved would be spoken with about the incident. Residents and relatives spoken with said they were satisfied with the quality of care provided. A reviewing officer from the Primary Care Trust was seen briefly in the home and said that the service provided a good standard of care and staff worked together to meet resident’s needs. Residents and relatives spoken with or who provided feedback in surveys indicated satisfaction with the way healthcare needs were being met. Requirements 1 and 2 recommendation 1. Residents were registered with a GP and supported by staff to receive regular dental, optical and chiropody care. Other healthcare such as dietician advice, physiotherapy and tissue viability advice were obtained as needed to meet individual resident’s needs. Records seen for residents with pressure sores showed that appropriate equipment was provided and the people were seen by the tissue viability nurse. Policies and procedures dated 6/1/06 were provided in relation to medicine management and available to staff. Medicine management was viewed on the residential and dementia units. On both units medicines were correctly stored and records were kept for receipt, administration and disposal of medicines. Controlled drugs were also correctly managed and stored. None of the residents managed their own medicines. Medicines were supplied in blister packs or individual containers and were provided by the chemist with preprinted administration charts. Receipt of medicines was recorded on the administration charts and medicines for disposal were recorded in a separate book. The date medicines were removed for disposal was not recorded. Medicine records and supplies were checked for two residents on each unit inspected. On the dementia nursing unit one person’s medicines were correct but the other persons had two errors when checking the amounts supplied, administered and remaining. One of the medicines checked had one dose too many and one had 11 doses unaccounted for. Of the two peoples medicines checked on the residential unit two errors were noted, one for each person. When the amount of medicines remaining was checked against the amount received and administered one dose was missing for one person and two doses for the other person. Staff did not record the amount of medicine they administered for one person when a variable dose of a medicine was Alexander Care Centre DS0000007002.V361482.R01.S.doc Version 5.2 Page 11 prescribed. Homely remedy medicines were provided and a list agreed with the GP. Not all the medicines agreed by the GP were in stock and three medicines not on the GP list were in use. The GP list included some topical applications. Records for homely medicines were not well maintained and in view of this it was not possible to complete an audit trail. The staff training record provided showed that since the last inspection 7 members of staff received training on medicine management. A system was in place to maintain a medicine profile for each resident. A discussion took place with the manager about the need to have a protocol in place for ‘as required’ medicines for residents who lacked capacity and to have a competency assessment completed annually for staff who managed medicines. Medication audits were carried out but the final section that identified errors found during the inspection was not always completed. Requirement 3 and recommendation 2. Care plans seen included resident likes and dislikes. Two care plans seen said the person preferred female care staff and this choice was accommodated. Residents and relative spoken with were satisfied with the way staff provided care and interacted with them. Staff knocked on bedroom doors before entering and responded to resident’s requests for assistance in a polite, timely and helpful manner. Alexander Care Centre DS0000007002.V361482.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): Standards 12 – 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements were in place to provide resident’s with social activities and to support family and friend contact. Where possible residents were enabled to make personal choices and menus seen showed a balanced, nutritious and varied diet was provided. EVIDENCE: One full time activity person was employed. This person was very motivated and had a good understanding of the value of activities for older people and changed the activity programme weekly. The activity programme was varied and included an even spread of activities planned to take place on each of the units. The programme showed that there were three different activities planned for the mornings and afternoons on most days. The home used a local bus company for outings, which was funded by the provider and the plan was to provide monthly outings in the warmer months. Some residents recently enjoyed a trip to Dulwich Park and some seen said how much they enjoyed this. The activity person had attended various training sessions such as safeguarding adults and dementia awareness course called ‘yesterday, today and tomorrow’. He said he found the quarterly activity coordinators meetings a very beneficial source of information. There was a bingo session Alexander Care Centre DS0000007002.V361482.R01.S.doc Version 5.2 Page 13 taking place in the main lounge on the morning of the inspection and a number of residents said they loved playing bingo. One relative said that there were regular activities and trips but said the people living in the home needed more stimulation. “It would be nice if there was more for them to do”. The activity person said that he completed a life history record for residents, which he retained and care staff complete a ‘PAL’ checklist, which showed the activities they liked and their interests. The progress records in the care plans viewed indicated the people had watched snooker, attended a club, visited Dulwich park, played bingo, joined in music session and received visitors. Considerations should be given to providing additional activity hours or ensuring that care staff use opportunities throughout the day to engage residents in activities. Recommendation 3. The service had an open visiting policy and visitors seen said they could visit when they liked and could spend all day in the home if they wished. One relative was seen interacting with staff and residents, making a drink and they looked relaxed and comfortable in the home. One relative said that their relative had lived in the home for a couple of years. The relative said that the resident was happy and settled and the resident said they liked the home “very much”. The relative also said that staff were helpful, the bedroom was always kept clean, food was good and there were regular activities and outings, some of which they had attended. None of the residents spoken with raised concerns about visiting arrangements and many said they enjoyed and welcomed family visits. As mentioned some care records seen included resident’s choice and preferences. Residents spoken with knew staff and the manager by name and said staff helped them choose clothes for the day, decide where they wanted to spend their day, what meal to have and whether to join in organised activities. People were observed choosing what to eat and drink at lunch. One resident said “there are no restrictions” we can get up and go to bed when we want. One relative said their family member could “come and go as they pleased”. Some residents did not have the ability to make decisions and care plans seen showed how their needs were to be met. Lunch was observed on the dementia unit and in the ground floor dining room. Most of the residents were escorted to the main dining room on the ground floor for meals however they could have their meal in their room or the unit lounge if they preferred. A number of residents on the dementia nursing unit had their lunch in the unit. The meal was brought from the main dining room, was covered and assistance given to residents to have their meal where needed. Staff showed a good understanding of resident needs at this time and provided assistance where needed. The meal in the dining room was well organised, tables were laid with clothes, serviettes, condiments and cutlery. The meal was served in a calm manner and residents were offered a choice of meal. Residents were asked if they wanted gravy and this was added to suit individual taste at the tables. Residents spoken with said they enjoyed their Alexander Care Centre DS0000007002.V361482.R01.S.doc Version 5.2 Page 14 meal and staff were in attendance should assistance be needed. The menu for the day was displayed and the choice and variety of food was good and the menu looked well balanced. A number of alternative dishes were available and this included traditional West Indian dishes such as rice, salt fish and plantain. The home also had a small number of residents from China and Vietnam. These people should be consulted to see if there are dishes other than rice dishes that they would like to be included on the menu. There was a large bowl of fresh fruit in the lounge on the residential unit. Residents had access to fluids in their rooms and between meals had tea and biscuits served. The kitchen was not inspected on this occasion but records seen showed an environmental health inspection was undertaken on the 22/5/07. The report included some requirements and recommendations and the manager said that these had been addressed. Recommendation 4. Alexander Care Centre DS0000007002.V361482.R01.S.doc Version 5.2 Page 15 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): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements were in place to manage complaints and safeguard adults. EVIDENCE: A complaints policy and procedure was provided and a system in place to record complaints made about the service. Since the last inspection 3 complaints had been made to management, the Commission referred one of these. The Commission also received an anonymous complaint about staffing levels and staff training. This complaint was not upheld. Records seen were satisfactory and showed how complaints had been managed. Residents and relatives spoken with said they knew how to make a complaint and feedback received in Commission surveys supported this comment. A policy and procedure was provided in relation to safeguarding adults. Since the last inspection the local authority investigated one allegation of abuse and found no evidence to support the allegation. Staff spoken with displayed a good understanding of safeguarding adults and how they would manage such an incident. Staff said and the staff training matrix showed that since the last inspection a high percentage of people had received training on this topic. Alexander Care Centre DS0000007002.V361482.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): Standards 19, 21, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment was satisfactorily maintained but some areas such as the bathing facilities and hairdressing room would benefit from repairs and redecoration. Bedrooms varied with some being more personalised than others. Procedures and systems were in place to manage infection control. EVIDENCE: The home was clean and tidy but looking worn and tired in places, particularly the bathing facilities on the ground floor. Residents and relatives spoken with commented on the recent painting and refurbishments carried out. For example the lounge on the nursing unit had been repainted and had new laminate flooring fitted. On the residential unit a new carpet was fitted in the corridor and two conservatories were built with money allocated by the Department of Health. All areas of the home seen except the bathrooms and hairdressing room were pleasantly decorated, clean and welcoming. The hairdressing room was well equipped with variable height washbasins and Alexander Care Centre DS0000007002.V361482.R01.S.doc Version 5.2 Page 17 mirrors but some of the paintwork was chipped, the flooring was split and the area behind the door was very dusty. The flooring in the medicine room on the nursing unit was stained and looked unsightly. The dementia unit had new bedroom doors fitted, which replicated ‘house front doors’ in design and were painted in different colours to help residents identify specific areas and their own rooms. The worktops in the kitchenettes areas on the nursing units required replacement as they were badly stained. The fridge in the dementia unit must be replaced as it was beginning to rust and the seal was damaged. Requirement 4. Adequate toilet and bathing facilities were provided. On the day of the inspection it was noted that there was a problem with the hot water supply to areas of the home. Staff said this had been an issue for some time and the manager said it was being addressed. Following the inspection the Commission received written confirmation that the repairs had been completed and the hot water supply was fully working. On all units seen some of the paintwork and the seal around the base of the toilet pans was damaged and stained. Some of the bathroom wall tiles were broken and cracked and some of the flooring in these rooms was marked. On the residential unit two showerheads were missing and the bathroom behind the carer’s desk was out of use. The colour scheme in the bathrooms was rather dull and uninviting and consideration should be given to making these areas ore homely. Requirement 4 and recommendation 5. All bedrooms had en-suite facilities that included a toilet and washbasin. Bedrooms seen on the nursing unit were clean, tidy and personal and residents spoken with did not raise any concerns about their environment. On the dementia nursing unit bedrooms were clean and tidy but some were very bare and lacked a personal touch. On the residential and nursing unit some of the residents had bought in personal items of furniture, or their favourite chair and paintings. This made their rooms look personal, welcoming and homely. Family photographs were displayed in a number of the rooms seen and some people had their own personal telephone. In some bedrooms personal clothing seen had been marked using the room number and not the person’s name. Recommendation 6 Sluice facilities were provided on each unit. Staff had access to protective clothing and hand-washing facilities were located where waste was handled. Waste and soiled linen was appropriately managed. Alexander Care Centre DS0000007002.V361482.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): Standards 27 – 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team had the skills and training to meet the needs of the residents. Adequate staffing levels were maintained and some improvements were needed to recruitment procedures. EVIDENCE: The staff team comprised of a full time manager, a deputy manager with some allocated management hours, trained nurses, care assistants, domestic and ancillary staff. Staff turnover since the last inspection was very low. Staff rosters seen before and at the time of the inspection showed adequate staffing levels were maintained. Residents and relatives spoken with did not raise any concerns about the staff or staffing levels. Comments made included “I am happy with my care, the staff and the food”, “staff are very nice”, “staff are kind and considerate” and “staff provide a good level of care and meet the needs of the residents”. The registered person was committed to NVQ training and 70 of care staff had achieved NVQ 2 qualification or above. Recruitment files for three staff employed since the last inspection were inspected. These were found to mainly comply with regulation but two files did not have a recent photograph of the person and one file did not have a health statement. Requirement 6. Alexander Care Centre DS0000007002.V361482.R01.S.doc Version 5.2 Page 19 A copy of staff training was seen and showed that since the last inspection staff had access to training relevant to their role. For example staff had access to training on the following topics; customer care, care planning, managing challenging behaviour, dementia awareness and the ‘yesterday, today and tomorrow’ dementia training, bed rail safety, nutrition, infection control and medicine management. Staff spoken with said they received enough training and on topics needed to fulfil their roles. Alexander Care Centre DS0000007002.V361482.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): Standards 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed and systems were in place to ensure safety is maintained. A review of quality assurance review was completed. Satisfactory systems were in place to manage resident’s personal finances. EVIDENCE: The manager is registered with the Commission, has a nursing qualification and an NVQ level 4 in care and management. A deputy manager and unit team leaders support her in her role though this was done with them having limited management time. Management and staff presented as a cohesive team who worked together to meet the needs of the residents and to maintain and raise standards of care. Feedback from residents, staff and relatives about management was positive. Staff said they felt supported, received relevant training and regular supervision. Residents spoken with knew the manager Alexander Care Centre DS0000007002.V361482.R01.S.doc Version 5.2 Page 21 and did not raise any concerns about the management of the service. Feedback comments from relatives included “the manager is top class”, “I am very happy in all respects, particularly management” and “the manager is approachable and helpful”. The home had systems in place to monitor and improve the standard of care provided. This included resident and relatives meetings, comprehensive audits and satisfaction surveys. Results from audits were collated and where necessary an action plan was devised to address any shortfalls. The area manager visited the home regularly to spoke with staff and residents and to assess the service. During some of these visits audit results were checked to ensure that the managers findings were accurate. The results from a recent satisfaction survey were displayed in the reception area. The results indicated that most people were happy with the facilities and care provided in the home but some people felt activities and food could be improved. The manager said the results of the audits were fed back to the relevant staff members but relatives were not always made aware of the action taken by the manager to address any issues identified. Recommendation 6. The administrator was able to store some personal money for residents and locked cabinets were provided for money and valuables in each bedroom. A receipt was provided for any money received by staff for safekeeping and also kept for money spent such as hairdressing and chiropody fees. Three receipts were checked at random and were found to be correct. Money was kept in a joint account for residents and the administrator said interest was given to all of the people that used the account. Bank statements for the joint account were stored in the office but were not inspected during this visit. Money was stored securely and up to date records were maintained. The manager and the operations manager carried out random checks to ensure that staff were following company procedures in relation to management of resident’s personal allowances. Valuable items such as passports and bus passes were recorded in individual care records. The computer system included a section for recording valuables but this was not being used. The use of this record would make it easier to complete regular checks and audits of the safe contents. Recommendation 7. From the information provided and records inspected attention was given to providing a safe environment for residents and others. A maintenance technician was employed who attended to day-to-day repairs and regular inhouse safety checks. Safety records checked included service of moving & handling equipment, gas service, an environmental health inspection report and in-house checks on window restrictors, hot water temperatures and bedrails. All records were well maintained and up to date. Fire safety records were also inspected and were accurate and up to date. The last service of the fire alarm system was done on 19/10/07, weekly alarm tests were carried out and fire drills held at time to include day and night staff. The last fire drill for Alexander Care Centre DS0000007002.V361482.R01.S.doc Version 5.2 Page 22 night staff was on 31/3/08 and for day staff on 4/3/08. Notifications were sent to the Commission as required regulation 37. Alexander Care Centre DS0000007002.V361482.R01.S.doc Version 5.2 Page 23 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Alexander Care Centre DS0000007002.V361482.R01.S.doc Version 5.2 Page 24 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. 1 2 Standard OP7 OP7 Regulation 15 13 Requirement Timescale for action 02/06/08 3 OP9 13 4 OP21 23 Care must be taken to update care plans when a resident’s needs change. Staff must follow moving & 02/06/08 handling guidance for individual residents. Residents must not be moved using an underarm lift. 02/06/08 Accurate records must be kept for all medicines brought into the home. When a variable dose of a medicine is prescribed staff must record the dose given. Homely remedies must only be given with the agreement of the GP, must not include topical applications and accurate records must be kept to enable an audit trail to be completed. Medicine audits must identify the errors found and indicate how these will be rectified. The repairs to the toilet pans and 01/07/08 bathroom tiles must be addressed. The hairdressing room must be kept clean, the flooring repaired and the room repainted and made more inviting for residents. DS0000007002.V361482.R01.S.doc Version 5.2 Alexander Care Centre Page 25 5 OP29 19 The fridge on the dementia nursing unit must be replaced. The worktops in the kitchenette areas must be replaced where needed. On the residential unit two showerheads were missing and the bathroom behind the carer’s desk was out of use. These issues must be addressed. All the information required by regulation must be obtained for employees and made available for inspection. 02/06/08 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 Refer to Standard OP7 OP9 Good Practice Recommendations Care plans should include how staff will support resident’s emotional needs. A protocol for ‘as required’ medicines should be in place for residents if they lacked capacity. An annual assessment of staff competency should be completed for those responsible for managing medicines. The assessment should be recorded and made available for inspection. Management should consider increasing the allocated activity hours in view of the size of the home and the needs of the residents. Also staff should be encouraged to be more active in engaging residents in activities at quiet times of the day. To ensure all ethnic minority resident’s meal choices are incorporated into the menu management should consult with them. Consideration should be given to redecorating the bathrooms and making these areas more pleasant and homely for residents. To ensure resident dignity is not compromised names not room numbers should be used to identify personal clothing. DS0000007002.V361482.R01.S.doc Version 5.2 Page 26 3 OP12 4 5 6 OP15 OP21 OP24 Alexander Care Centre 7 8 OP33 OP35 Management should ensure that feedback from satisfaction audits is provided to residents and relatives together with any action taken to address shortfalls in the service. The administrator should maintain a list of valuables held in the safe so that these items can audited. Alexander Care Centre DS0000007002.V361482.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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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