CARE HOMES FOR OLDER PEOPLE
Alexander Court Carnarvon Street Thatto Heath St Helens Merseyside WA9 5QN Lead Inspector
Mrs Lynn Paterson Unannounced Inspection 17th November 2005 2:30 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 Court DS0000022398.V267505.R01.S.doc Version 5.0 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 Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Alexander Court Address Carnarvon Street Thatto Heath St Helens Merseyside WA9 5QN 01744 818500 01744 811541 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) St Helens Housing Association Mrs Barbara Helen Morrison Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service Users to Include up to 33 (OP) Date of last inspection 27th May 2005 Brief Description of the Service: Alexander Court Care home is situated in a residential area of St,Helens, close to shops and local amenities. The home is purpose built and comprises of seven separate cluster areas all of which accommodate small groups of six residents within. Each cluster provides single occupancy bedrooms, lounge and kitchen and bathroom and toilet facilities. 2 clusters have en suite facility. All accommodation is on ground floor level. The home provides a communal dinning room and conservatory/games room area and has large well maintained grounds, which are safe and accessible. Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of Alexander Court was undertaken during the afternoon of 17th November 2005 and was carried out on an unannounced basis. The inspector examined care files, daily records, policies and procedures, met with 16 residents, the health and safety manager, the assistant manager, 4 staff members and toured the building to gain information for this report, a summary of which is recorded below. What the service does well: What has improved since the last inspection?
The pre assessment and care planning documents are currently under review and are being updated as a requirement of the previous inspection. The revised paperwork was available for inspection, however did not contain any written information as to assessed need or care planning and therefore could not be measured at this time. Existing documentation did not hold sufficient information about assessed need or care practices necessary to met assessed need. Staff training records show that training is an ongoing process in the home. Health and safety policies and practices are updated and revised as necessary.
Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 6 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 Court DS0000022398.V267505.R01.S.doc Version 5.0 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 Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The pre admission documentation does not hold sufficient information to enable the home to assure that assessed need can be met within the home. EVIDENCE: Three case files examined held some detail of the pre assessment process being carried out however the information on file was limited. Staff advised that the admission procedure is not adequate to guide staff on the actions to be taken to ensure that new residents needs are properly assessed and planned for. Residents spoken with said that staff always ask them what they want them to do for them but could not remember what had occurred during the pre admission period and what information had been supplied as to care needs. Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 9 The shortfall in pre admission assessment had been noted at the last inspection when a requirement was made for action to be taken to ensure that proper assessments were carried out on all prospective residents prior to admission. Whilst the home were able to provide some evidence that documentation had been revised they were unable to prove that the written pre assessment methods had altered and as a consequence information recorded was not sufficient to identify that the home could meet the needs of the individual. Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8. Limited progress has been made on improving resident’s health, personal and social care plans to make sure that all needs are identified and met. This has a potential to place residents at risk EVIDENCE: Individual care plans viewed revealed that little progress has been made on the requirement to ensure that all aspects of health, personal and social care needs are identified and planned for. Plans remain basic and whilst new documentation has been provided nothing had changed from the previous inspection. The care plans gave little indication of the actual care given and residents spoken with advised that they were not sure what care needs were recorded in their file but they expressed satisfaction with their care provision and said that all care needs were verbally discussed with the care staff and care carried out accordingly. It was noted however that all files viewed had significant events recorded and clear daily records and held details of health needs and health access, although one file viewed did not have a risk assessment in place in respect of oxygen usage and storage. Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 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): 12.15 Social activities are now well organised and provide stimulation and interest for the residents. Meals are nutritious, balanced, appetising and well -presented and offer a health and varied diet for all the people living in the home. EVIDENCE: All residents spoken with said they loved the food and that it was always good. Residents were observed congregating in the dining room awaiting their meal and comments made included “we love our meals”,”we can have what we like you know”, ”the cook is excellent”, ”food is prepared and served just as we like it”, ”I look forward to every meal time”. Discussion with the cook and her assistant revealed that they take pride in the food provision in the home and make sure that menus are developed in partnership with the residents and that food suits all the individual taste. The dining room was spacious and homely and the atmosphere was most pleasant at the time of the inspection. A tour of the kitchen revealed that it was very well managed and maintained at the time of the visit. The activities programme showed that activities are arranged to take place most days and are open to all residents as they choose. Residents spoken with said they were provided with sufficient activities and interests in the home to keep them occupied.
Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 12 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): Not inspected at this time. EVIDENCE: Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 13 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): 26 The home was clean, pleasant and hygienic at the time of the visit. EVIDENCE: A tour of the building revealed that it was clean and hygienic and that laundry facilities were in place, which met the requirements of this standard. The assistant manager was able to evidence that the home had policies and procedures in place for infection control to include the safe handling and disposal of clinical waste and the use of protective clothing. Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 14 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): .27.29.30 The procedures for the recruitment of staff are robust and offer protection to the people living in the home. The deployment and number of staff available during the night is not sufficient to meet the needs and the layout of the building. However the home provides training and support to make sure that staff is trained and competent to do their jobs. EVIDENCE: The assistant manager was able to provide information to evidence that the home have clear procedures for the recruitment of staff in line with St. Helens Housing policies. This includes the provision of references backed up by telephone calls, police checks, clear interviewing format and intensive induction prior to the commencement of carrying out care practices. Records show that staff turnover is very low and as a consequence staff are able to provide consistent care to the residents. Residents spoken with advised that the staff were kind caring and efficient and comments included “I don’t know what we would do without them”, ”they are all very kind and helpful”,” They are good at what they do and treat us all very well”, ”the manager is wonderful, she is so helpful and kind”. Staff said they were provided with relevant training and encouraged to develop their skills. Staff comments included “ we are well supported by the registered home manager”,” we are provided with training and supported in our role”,” training is ongoing and interesting”.
Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 15 The staff rota showed that staffing levels during the day are adequate to meet the needs of the individual residents, however night care provision appears low. The home is registered to provide residential care for 33 older people and at the time of the inspection it was noted that over half the residents were of medium to high dependency levels. The accommodation is on ground floor level and covers a vast area comprising of seven separate units each providing five or six individual bedrooms. Currently three night staff is on duty to provide full coverage of the seven units providing accommodation for 33 residents. Some residents may need the assistance of 2 carers, leaving just one staff member to provide cover. Notifications and accident records revealed that 2 residents had experienced falls outside the building during the night hours. It is recommended therefore that the home employ 4 night waking staff to ensure that staff provision is commensurate with need. Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 16 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): 33.35.38 The home arranges residents meetings and use quality assurance methods to make sure that the home is run in the best interest of the residents. Monthly audits and documentation ensure that resident’s financial interests are safeguarded and the health safety and welfare of residents and staff are promoted and protected by policies, training and safety procedures. EVIDENCE: Discussions with residents and staff revealed that residents meetings are arranged on a regular basis to make sure that all their views are heard as to how they feel the home should be run. Staff advised that minutes of the meetings were recorded and the content examined by management staff with a view to running the home as per resident’s wishes, wherever possible. Staff advised that quality assurance questionnaires are also used to gain information from residents and their representatives as to their thoughts of the quality of the services provided by the home. Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 17 Residents spoken with said in general they managed their own finances, however staff advised where necessary small amounts of money was held in the individual residents account and written records were made of any transactions made on their behalf. Records seen in respect of resident’s finances during the inspection were clear and accurate. Health and safety issues were discussed with the assistant home manager and the company health and safety manager and they advised that all staff had received the mandatory health and safety training and all policies and procedures were in place that were reviewed and updated on a regular basis. The health and safety manager evidenced that good quality risk assessments were in place for all areas of the building to include the storage and management of oxygen. However during a tour of the premises it was noted that oxygen cylinders had been stored inappropriately in unit 7 of the home. This was immediately discussed with the assistant manager who advised that she would ensure correct storage occurred as a matter of urgency and would pass on concerns to staff who were responsible for unit 7. Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 18 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 x 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X 4 STAFFING Standard No Score 27 3 28 X 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP3 OP7 Regulation 14 12 Requirement Timescale for action 01/01/06 3 OP27 15 Pre – admission assessment documentation must include full details of all assessed need. Care plans must contain details 01/01/06 of assessed need and identify how the care delivery will take place. Care plans must show that they have been completed in partnership with the resident and/or their representative. Staffing must be provided in 01/01/06 sufficient numbers and skill mix to meet the needs of the current residents of the home Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 20 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 OP38 OP8 Good Practice Recommendations Risk assessments that have been carried out in respect of the building must be adhered to. This includes the storage of oxygen on the premises Risk assessment must be included in residents care plans to include the management and storage of oxygen. Alexander Court DS0000022398.V267505.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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