Inspection on 08/06/06 for Alexander Care Centre

This inspection was carried out on 8th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 01/05/07

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 8th June 2006 09:00 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.V298170.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.V298170.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 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.V298170.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 15th December 2005 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 are 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 £450 to £502 monthly and nursing fees from £575 to £636. 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.V298170.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 during the days of the 8th and 9th of June, although the inspector had visited briefly the previous evening, to follow up a concern about evening staffing levels. The manager facilitated the inspection on both days. The inspector was able to speak to service users and some of their visitors, as well as staff, the pharmacist, a nurse from the Care Home Support Team and a Social Worker. At the time of the inspection there were two vacancies. What the service does well: 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. Alexander Care Centre DS0000007002.V298170.R01.S.doc Version 5.2 Page 6 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.V298170.R01.S.doc Version 5.2 Page 7 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 the following standard(s): 1,3,4,6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Information on the home is good and readily available and prospective users’ care needs are assessed well. Service users suffering from dementia cannot be sure of getting care geared towards their special needs. EVIDENCE: The home has an accessible Statement of Purpose and Service User Guide which contain all necessary information. The home also has a statement of terms and conditions which conforms to requirements. Before Service Users enter the home the manager obtains a Community Care Assessment with full information on their care needs. She also visits the prospective Service User and completes a pre-admission assessment which looks at all areas where support and care are needed, to ensure that the home can meet the service user’s needs; a letter is sent out to confirm this although copies were not always kept on file. From evidence seen at this visit, the home has the capacity to meet the assessed needs of service users in the nursing and residential care units. Alexander Care Centre DS0000007002.V298170.R01.S.doc Version 5.2 Page 8 However, at the moment it is not providing dementia care based on current good practise. The environment is not geared towards reality orientation or stimulation. Care plans do not have information available on the needs that an individual’s dementia means for their care, and do not contain strategies to deal with behaviour caused by dementia. Activities available are not geared towards service users who suffer from dementia. The home does not provide intermediate care. Alexander Care Centre DS0000007002.V298170.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 at least once during a 12 month period. 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. Service users’ basic care needs are well recorded and reviewed in their individual plans, however they cannot be sure yet, that all their social and emotional needs are covered; this is especially true for service users on the EMI units. Health care in the home is good. Medication administration is generally good but two mistakes in administration of medication not in dosette boxes, meant that those service users were put at risk. Service users also need to be included in a process to decide whether they should be administering their own medication. Service users suffering from dementia need to be assured that their dignity will be maintained at all times. EVIDENCE: Care plans were seen on all units. Those on the nursing unit were of a good standard. They showed assessment of health needs, strategies for dealing with problem areas, and appropriate monitoring and liaison with health care professionals. They also contained good risk assessments and strategies for dealing with any areas of risk. Care plans on the residential unit were also of a good standard. Those on the dementia unit needed more information on the impact that dementia has on service users’ care needs. They also need to look Alexander Care Centre DS0000007002.V298170.R01.S.doc Version 5.2 Page 10 at strategies for dealing with challenging behaviour and ways of occupying the individual. Care plans on all units, still need more detail on service users’ social and emotional needs and on the dementia unit especially, need more information on life histories. Also, the home must ensure that care plans are individualised as parts of the care plan were the same for most service users. These parts were especially those dealing with personal care, moving and handling and, on the dementia unit, sleep. Reviews of care plans were generally up-to date. On all units there was evidence that service users’ health care needs are well met. When there have been concerns on these units, as with pressure care, appropriate training has been arranged. The nursing unit showed that they were able to deal with complicated health care needs and the nurse from the Home Care Support unit confirmed that she was “very happy” with the care she sees there. At the moment no service users manage their own medication and their wishes and abilities in this area are not assessed. Administration of medication was checked on all units. On the residential care unit it was seen to be good. On the other two units, although generally good, there were two instances of maladministration; one of medication signed for and not given, and the other of medication not being administered in compliance with the GP’s instructions, and not being properly recorded. The pharmacist who supplies the home said that he has no concerns other than the ongoing one of poor communication when ordering repeat prescriptions. Generally service users were seen to be treated with respect and service users and their families said that the care they received was given in privacy and with kindness. However at the evening visit a female service user suffering from dementia was seen in the lounge inappropriately dressed, in a manner which did not respect her dignity and which care staff should have noticed. Also when the toiletries of some people on the dementia unit were checked they were extremely sparse; this meant that either personal care was not being given as needed, or that communal supplies were being used. Also the toiletries were being stored in way that would not be acceptable in peoples’ own homes. They were in a plastic box in a wardrobe with toothbrushes at the bottom and consequently in an extremely unpleasant state. Alexander Care Centre DS0000007002.V298170.R01.S.doc Version 5.2 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 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 Service users do not have access to enough activities to suit their needs; however they are able to welcome visitors at any time and are helped to exercise choice in many areas of life. This choice is not guaranteed at the moment with food provision, and mealtimes were not seen to be an enjoyable or social occasion. EVIDENCE: Activities in the home do not offer service users adequate stimulation or entertainment. Service users do not have individual social care plans, the programme is sparse and the recorded take up of those activities offered reflects this. Staff try to provide meaningful activity as shown by the informal singsong and “knees up” seen on the EMI unit in the evening. There is also an enthusiastic and able activities organiser. However, this is a large home with three separate units with people with different needs and capabilities. The organiser is not able to cover it on his own and has not had training on organising activities for people with physical disabilities or with dementia. The Nurse from the Care Home Support team was worried about the “lack of stimulation” for service users on the dementia unit. Visitors who were otherwise happy with life at Alexander Care were unhappy about the lack of Alexander Care Centre DS0000007002.V298170.R01.S.doc Version 5.2 Page 12 activities for their relatives. There is no transport and service users are not able to go out on trips. Service users are able to have visitors when they wish and visitors said that they are always made welcome. Service users are able to bring personal possessions into the home for their rooms. There is information available about advocacy schemes and there is a good system for ensuring that if service users wish to, and are able to, handle their finances, or any part of them, this is facilitated. Service users and their relatives gave mixed opinions as to the quality of meals at Alexander care. One described the menu as “a fiction” and it was found that the chef was often not cooking what was on the menu. As a result the system of finding out what service users wanted to eat was not being used and choice could not be guaranteed. About 10 of service users are African-Caribbean but the only provision for them is a curry three times weekly. One relative said that her mother had got used to not having the food she was used to. The nursing floor does not have a dining room and the dining room on the dementia unit is on a separate floor and was not being used during the inspection. As a result service users on these units were eating meals in the same armchair that they had been sitting in all day. Alexander Care Centre DS0000007002.V298170.R01.S.doc Version 5.2 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 the following standard(s): 16,18. Quality in this outcome area is 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 procures to protect service users from abuse are in place. EVIDENCE: The home has a complaints policy which meets requirements and the complaints book showed that complaints received are properly investigated and responded to. The manager had not treated problems that a family had brought up as a formal complaint; had this happened the family might have felt more re-assured that their concerns had been heard. The company’s Adult Protection Arrangements and POVA Referral Procedure are available in the home and conform to requirements. The manager has dealt promptly and properly with any allegations of abuse. Most staff have now had training on this aspect of care. The systems to protect service users’ finances are good. Alexander Care Centre DS0000007002.V298170.R01.S.doc Version 5.2 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 the following standard(s): 19,20,21,23,24,26. 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. The garden is pleasant but needs proper gardening input and adequate garden furniture so that service users can make full use of it. EVIDENCE: 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. The building is well maintained and on the day of inspection was clean throughout. 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. There are two large, pleasant garden Alexander Care Centre DS0000007002.V298170.R01.S.doc Version 5.2 Page 15 areas. But that designated for the EMI unit is being under used as it is on a different floor from the unit and both that and the other garden are not well maintained and do not have sufficient garden furniture for service users to make good use of it. Alexander Care Centre DS0000007002.V298170.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Well trained staff are deployed in numbers which means they are able to meet service users’ needs. Recruitment policies and procedures are in place to protect service users. EVIDENCE: Staff are deployed in an adequate number and proper mix of nursing staff, senior staff and care staff. These numbers are the same until 8pm when night staff take over. Staff and the manager said that if extra hours were needed they were provided and that staff support each other well. The home has approximately 50 care staff with NVQ qualifications and an ongoing commitment to accessing this training. Team leaders also are to have the opportunity to undertake NVQ training in management. The home has a good training programme and the manager maintains records of what training has been delivered in order to ensure that all necessary training has been given. New carers undergo induction training in line with standards. When the staff appraisal system is in place the manager will be able to draw up individual training plans to feed into a pro-active training plan. Two files for recently recruited staff were seen. All actions necessary to ensure that staff were suitable for employment had been taken. Alexander Care Centre DS0000007002.V298170.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The manager is competent and qualified to manage the home. She ensures that service users’ finances are subject to proper safeguards and that Health and Safety systems are in order. Staff supervision now takes place as needed. The quality assurance system in place still needs some additional work, so that it conforms to standard. EVIDENCE: The registered manager is a qualified nurse and has the NVQ level 4 in care and management. She has put robust systems in place to manage the home including one for ensuring that all staff have adequate, formal supervision. Visitors commented that they had seen changes for the better over the past year. The home consults with service users, their families and friends through meetings, a weekly manager’s “surgery” and through a survey. The scope of Alexander Care Centre DS0000007002.V298170.R01.S.doc Version 5.2 Page 18 this consultation needs to be widened to include other “ stakeholders”, such as visiting professionals. The results also needed to be published and distributed annually. Arrangements for dealings with service users’ financial interests and monies were discussed with the manager and administrator. This discussion was of especial relevance as recently there had been an incident where a service users’ monies had not been dealt with properly by staff. However it was seen that the policies and procedures in place were robust, and the home had responded promptly. The home was inspected and no health and safety concerns were evident. Records showed good monitoring of all systems in place to ensure health and safety for service users and staff. Alexander Care Centre DS0000007002.V298170.R01.S.doc Version 5.2 Page 19 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 X 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Alexander Care Centre DS0000007002.V298170.R01.S.doc Version 5.2 Page 20 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 Regulation 12(1) (a)(b) Timescale for action The registered person must 30/09/06 ensure that the environment, care and activities on the EMI units are based on current good practise. The registered person must 30/09/06 ensure that care plans are individualised and address all aspects of care needs including social, emotional and those associated with dementia. The registered person must 30/09/06 ensure that service users are able to self medicate if they wish, and are safely able, to do so. The registered person must 31/08/06 ensure that medication administration is according to prescription and is properly recorded, and that requests for repeat prescriptions are timely. The registered person must 31/07/06 ensure that service users’ rights to dignified care are upheld at all times. The registered manager must 31/10/06 ensure that social and leisure activities are developed in full DS0000007002.V298170.R01.S.doc Version 5.2 Page 21 Requirement 2. OP7 15(1) 3. OP9 12(2)(3) (4)(a) 4. OP9 13(2) Sch 3 5 OP10 12(4)(a) 6. OP12 16(2) (m,n) Alexander Care Centre 7. OP15 12(2)(3) 8. 9. OP20 OP20 23(2)(g) 23(2)(o) 10. OP33 24 (1,2,3) consultation with service users and reflect their assessed needs. Target date of 28/02/06 not met. The registered person must ensure that there is a choice of food to cater for individual and cultural preferences. The registered person must ensure that there is adequate dining space for all service users. The registered person must ensure that the gardens are well maintained, and accessible in terms of provision of adequate garden furniture. The registered provider and manager must develop a system for conducting an annual audit which involves service users and their families and ensure that the results of this audit and service user satisfaction surveys are published and made available to current and prospective service users. Target date of 28/02/06 not met. 30/09/06 31/10/06 31/10/06 31/10/06 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 Refer to Standard OP1 OP12 OP15 Good Practice Recommendations It is recommended that copies should be kept of letters sent out confirming that the home can meet prospective service users’ needs. It is recommended that the home consider how to organise trips out for service users who would like this. It is recommended that wherever possible main meals are not served in the armchair where the service user sits DS0000007002.V298170.R01.S.doc Version 5.2 Page 22 Alexander Care Centre 4. 5. 6. OP16 OP20 OP36 7. OP36 during the day. It is recommended that all concerns raised by service users or families should be recorded as complaints and formally investigated. It is recommended that the home consider the best way to ensure that service users on the EMI unit access the dining room and the garden as needed. It is recommended that the registered manager should explore supervision and other management training needs with senior care staff and provide any training identified to ensure effective staff supervision This is a repeat recommendation from the last report It is recommended that all staff receive annual appraisal of their performance. Alexander Care Centre DS0000007002.V298170.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 Alexander Care Centre DS0000007002.V298170.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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