CARE HOMES FOR OLDER PEOPLE
Alexander Court Carnarvon Street Thatto Heath St Helens Merseyside WA9 5QN Lead Inspector
Mrs Lynn Paterson Unannounced Inspection 25th May 2006 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 Court DS0000022398.V295323.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 Court DS0000022398.V295323.R01.S.doc Version 5.2 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.V295323.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service Users to Include up to 33 (OP) Date of last inspection 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. Weekly fees charged are currently £351.00. Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of Alexander Court took place over a period of six hours on 25th May 2006 and was undertaken on an unannounced basis. The inspector met with the manager, senior officer, five care staff members, cook and kitchen staff and 30 of the 32 residents living in the home. Records care files, policies procedures and other documentation was examined and a tour of the premises was carried out. Fieldwork included case tracking five residents, which involved reading all documentation relating to the residents daily living and speaking with the residents and staff who were associated with their care. What the service does well:
Staff, were observed interacting well with residents and the atmosphere in the home during the visit was one of calm and comfort. Staff advised they were “well managed” by the home manager who they said was good at her job and was fair and equal in her practice. Residents spoken with said the food provision was excellent and menus were varied and choices available at all times. Observations of the residents eating lunch identified that the presentation and preparation of the meal was greatly appreciated by the residents who all were seen to eat and enjoy their lunch. Activities notification seen around the home revealed that activities were arranged on a daily basis and residents said they had enjoyed gentle exercise class prior lunch. All residents spoken with said they were happy and contented at Alexander Court and comments included “its very nice to be here, good food, staff help you and are most kind”, “I have been here quite some time now and it is very nice, staff do care about us you know and they do their very best for us”, ”I have been in other homes and I feel that this home know how to treat us. It is the best home I know and I love it here”. Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Care plans viewed were bulky and held duplicated information about health and social care needs. Some care planning information lacked clarity about actual assistance needed with recordings such as “ need minimal assistance”, comments that do not give sufficient detail as to the level of assistance necessary to meet assessed need. The manager agreed that information contained on the care plans should be reviewed as a matter of urgency. Staff advised that daily staff handover information as recorded in staff diary is passed on to staff members as they change over shifts, however this information sharing is not recorded as to who has given or received the handover information. In discussion with the manager it was agreed that
Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 7 signatures of who ever gives and receives the information should be recorded as a good practice issue. Staff shortage had impacted unfavourably upon the home and as a consequence agency staff were frequently employed to carry out care practices in the home. It was noted that agency staff were not provided with written care planning information and were provided with instruction from permanent care staff or merely acted upon their own initiative. In discussion the manager agreed that all staff working in the home should have access to written care planning information, a system she revealed se would put in place as a matter of urgency. It was noted from information received from the pre inspection questionnaire and gained from a tour of the premises that the home had made changes to the property without prior discussion with CSCI, which could be seen as a breach of regulations. The interior changes included the removal of four residents lounge areas and the addition of four en-suite bedrooms, which the manger advised would extend the space of the bedroom areas from the current registration for 33 residents to 37 residents. This variation to the conditions was discussed with the home manager and it was agreed that the home would not take any further admissions until the situation had been resolved. This action was in breach of regulation 39(h) Care Home Regulations 2001. 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.V295323.R01.S.doc Version 5.2 Page 8 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.V295323.R01.S.doc Version 5.2 Page 9 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home carries out a full assessment of need on each resident prior to admission being agreed. EVIDENCE: Three case files viewed held information to show that pre admission assessments had been carried out prior to a placement being offered. Discussion with the home manager revealed that she undertakes a pre assessment on each resident who makes application for admission to Alexander Court. It was noted from records that recent request made by a person currently residing in the Manchester Area had been processed with the home manager making arrangements to accompany the persons family to Manchester to ensure that a full needs assessment had been undertaken to ensure all needs could e met prior to the offer of a placement in the home. Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 10 Further discussions with residents and staff identified that no people are admitted to the home without a full assessment of need being carried out prior to admission. Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 11 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. Health and personal care needs are addressed, however care -planning documentation does not fully identify how care practices should be carried out to meet assessed need. EVIDENCE: Three care plans examined held much duplicated information about health and personal care needs. However some information provided identified the need but did not clearly detail how the necessary care practices should be carried out. Care plan details included “minimal assistance needed”, “some assistance needed”. Staff spoken with about their perception of “minimal assistance” gave differing ideas of what assistance was needed and it was necessary to advise the manager that the care plans needed to be more explicit in their detail of care provision. This would ensure that care practices met need and a consistent approach provided by staff involved in the residents care provision. It was noted from staffing records that three agency workers were on duty during the visit and in discussion it was revealed that they do not read the care plans prior to administering care practices. It was stated that agency staff are
Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 12 told what to do by permanent staff members or they “just get on with it”. This was discussed with the manager who advised that if they need additional staff they try to get agency staff that has previous knowledge of Alexander Court in an attempt to provide consistency for the residents. She advised that she would ensure that care plans were provided to all staff on duty at all times. Medication records viewed and staff observed carrying out medication administration revealed that the home have revised and updated their medication management systems to a good standard. Staff spoken with identified they had received training in care provision and had understanding of the needs of older people. Residents spoken with said they were well looked after by kind caring people and comments included “ these care staff are so good to us, nothing is too much trouble for them”, “we are looked after so well, they are kind you know”, ”we don’t know what we would do without them”. Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 13 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. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Activities and interest are arranged to suit the wishes of the residents. Food provision is varied well presented and of a high standard. EVIDENCE: Residents spoken with said they had an enjoyable lifestyle at Alexander Court. They said they could do what they wished, meet with friends, chat with each other, watch television, sit in the grounds or participate in activities as arranged by staff. One resident said she had enjoyed being part of a gentle exercise class earlier in the day and she was looking forward to a game of Bingo later on. Records showed that activities were arranged each day and all residents were notified of the weekly activity programme provided. Observations of residents eating lunch identified they were provided with a varied choice of wholesome food that everyone appeared to enjoy very much. All residents were seen to “empty their plates” and comments included “this food is always wonderful”,”we get fabulous meals”, ”we are given choices all the time”, “I have never had a bad meal yet and I have been here some time”, ”Better than a five star hotel”. Food sampled during the inspection was tasty,
Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 14 well presented, well prepared and most enjoyable. The menus viewed showed that a varied nutritious choice of food was available each day and the kitchen was seen to be hygienic and well managed at the time of the visit. The cook and kitchen staff showed full knowledge of all resident’s dietary needs likes and dislikes and the ding room atmosphere and food organisation was seen to be commendable. Alexander Court DS0000022398.V295323.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 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. Staff are trained and knowledgeable in all aspects of adult protection and the complaints system in the home is know to residents and their families, is accessible and residents are confident any complaints will be listened to and quickly acted upon. EVIDENCE: The complaints policy identified the complaints process and residents spoken with advised that they knew how to complain if they wanted to. Residents spoken with said that the home manager and staff asked them each day if they were all right and if they wished to speak/complain about anything. Residents revealed they felt comforted by this attention and were never afraid to speak their mind. The complaints book was viewed and it was noted that no official complaints had been recorded since the previous inspection. Staff spoken with, were clear in their understanding of what constituted adult abuse, and of what to do if they suspected abuse was taking place? Staff training records revealed that staff, were provided with ongoing adult protection training and staff said they found the training to be useful and informative. Alexander Court DS0000022398.V295323.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19.26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean pleasant and hygienic and has a clear maintenance programme to ensure that residents live in a safe environment. EVIDENCE: A tour of the premises revealed that the home was clean, hygienic and free from unpleasant odours. The manger advised that the home had a strict health and hygiene code and they updated all policies, procedures and practices in respect of health and safety to ensure wherever possible the residents lived in a clean and safe environment. Maintenance records viewed identified that the home utilised the services of a maintenance person who was able to carry out maintenance as and when it was needed. Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are adequate however on occasions the skill mix is inappropriate due to the use of nonpermanent staff that does not have full knowledge of the home or of the residents needs. EVIDENCE: The staff rota showed that the mix of staff on duty was 2 permanent care staff, 3 agency care staff, 1 senior carer and the registered manager. Staff spoken with advised that on occasions when agency staff were utilised it was necessary to “tell them what to do” as the agency staff did not know the home or the residents needs. Agency staff spoken with said they had to familiarise themselves with the layout of the home and identify which rooms were which if the alarm call bell rang. It was also stated that agency staff did not have access to the residents care plan and as a consequence other staff told them what to do and how to provide assistance/personal care for the residents. However residents spoken with said they were always well looked after although not always by people with whom they were familiar. Comments included “they are all good to us”, ”they help us with anything we want”, ”they are kind and helpful at all times”.
Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 18 Discussion with the home manger identified that eight staff had left the home since the previous inspection and as a consequence agency staff needed to be employed to fulfil the staffing ratio until more permanent staff could e recruited. The manager advised that she attempted to utilise agency staff who knew the home and would therefore be able to provide a more consistent approach to the care of the residents but she advised that this was not always possible. Although the staffing levels and skill mix was seen to be adequate at the time of the visist, it was agreed that efforts would be made to recruit and select permanent staff as a matter of urgency. In the meantime it was agreed that all staff who are responsible for the provision of personal care will have full access to the relevant care plans to ensure that needs led services are provided as per the residents wishes. Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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): 31.33.35.38. Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The manager is respected by staff and residents, who perceive her to be a very good manager and say she works with the residents to make sure the home is run in their best interests. EVIDENCE: Discussion with staff and residents of Alexander Court revealed that the home manager was admired and respected for her management skills. Comments included “she is very approachable and listens to what we have to say” ”her office is open to everyone”, ”she is such a nice person, someone you can trust”, “we always know what is going on, she passes on all information so there is no need for us to guess”. ”She certainly knows how to manage this home”. Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 20 Discussions with the manager identified she was fully committed to her role and was continuously updating her knowledge to ensure she was able to fully discharge her management responsibilities. She revealed that she had recently completed an equality and diversity course in which she was able to reflect upon her own values and deal sensitivity with issues surrounding prejudices, false judgements and assumptions and have clearer knowledge of how to manage these situations. Residents said they had meetings and discussions about what they wanted to do in the home to include activities, outings and menus. Residents also commented on the nice atmosphere in the home and the fact that everyone spoke to each other and passed on information. Staff said that the manager was honest and fair and “had a very happy staff team due to her excellent ability to manage the home”. Other comments included “the manager provides us with stability and values us and encourages us to do well”, ”she is so good at managing this home she helps us to identify our strengths and weakness and to build on both”. Records showed that the residents financial interests being protected to include 16 residents being subject to power of attorney and all pocket money records being subject to weekly audits with double signatures being recorded. Health and safety records appeared well managed and it was noted that the organisation used the services of a general health and safety manager who held responsibility for the implementation of staff training in all aspects of health and safety and policies protocols and practices in this area. Up to date documentation was in place to include fire safety, essential service maintenance and building risk assessment. Record also showed that all staff were in receipt of annual mandatory training as an ongoing process. However the comments recorded in the “could do better” section of this report identified the responsible individual was in breach of regulation 39(h) Care Home Regulations 2001, as they had not provided the appropriate application’s to CSCI to vary the accommodation in the building to replace 4 residents lounge areas with 4 en-suite bedrooms. The home has been instructed not to utilise these bedrooms whilst action is being considered by CSCI. Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 21 Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 22 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 23 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 Standard OP7 Regulation 12 Requirement Care plans must contain details of assessed need and identify how the care delivery will take place. Care plans should contain consistent information and be clear to understand. Staffing must be provided in sufficient numbers and skill mix to meet the needs of the current residents of the home Timescale for action 01/07/06 2. OP27 15 01/07/06 3 OP21 39(h) The home must not utilise any of 25/05/06 the 4 extra en-suite bedroom areas until further discussion/action has taken place between the responsible person and a representative of CSCI RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 24 1. OP7 It is recommended that the current care plan format be reviewed to ensure that information is not duplicated throughout. It is recommended that all daily diary records be signed by the person who records this information and also by the person with whom this information is shared with at handover. It is recommended that the manager proceed with a staff recruitment drive as a matter of urgency. It is recommended that staff that are employed in either a permanent or temporary capacity to provide personal care and support to residents be provided with access to the care plan to ensure that all care practices are carried out as per the residents wishes. 2. OP7 3 4 OP27 OP27 Alexander Court DS0000022398.V295323.R01.S.doc Version 5.2 Page 25 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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