Inspection on 21/08/06 for Alexander Court Care Centre

This inspection was carried out on 21st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 Court Care Centre 27/11/07

Alexander Court Care Centre 29/09/05

Alexander Court Care Centre 25/07/05

Alexander Court Care Centre 03/06/05

Alexander Court Care Centre 10/02/05

Alexander Court Care Centre 20/05/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Alexander Court Care Centre 320 Rainham Road South Dagenham Essex RM10 7UU Lead Inspector Ms Rhona Crosse Key Unannounced Inspection 21st August 2006 10:00 X10029.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 DS0000029331.V309033.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 and Care Homes for Adults 18 – 65*. 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. DS0000029331.V309033.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexander Court Care Centre Address 320 Rainham Road South Dagenham Essex RM10 7UU 020 8709 0080 020 8593 7584 admin@lifestylecare.co.uk 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) Life Style Care Plc Miss Nicola Starbuck Care Home 82 Category(ies) of Dementia - over 65 years of age (50), Old age, registration, with number not falling within any other category (20), of places Physical disability (12) DS0000029331.V309033.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection September 2005 Brief Description of the Service: Alexander Court is a purpose built home for 82 adults. The registration is split into older people, people with dementia and adults with physical disabilities. The home is divided into 5 units. Accommodation is in single bedrooms with en-suites. DS0000029331.V309033.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced this means that the home did not know the inspector was coming. The manager was at the home when the inspector arrived. Interviews were to take place later in the morning for new domestic staff. The inspection focused mainly on the service users health care records. An inspection of the premises took place and each of the 5 units were inspected. The inspector spoke with service users, relatives who were visiting at the time of the inspection, and staff as part of the inspection process. A new deputy manager has been employed. It was observed that there is a good working relationship between the manager and deputy manager. The home has continued to improve the record keeping and the care being provided and is offering a good standard of care. Maintenance of the building has improved and there is an ongoing programme of redecoration taking place. New sideboards have been bought for the lounge in the unit for people with physical disabilities. The fees for the home are assessed individually dependent on the needs of the service user. However fees range at present from £545.00 per week to £800.00 per week (the higher charges are for young people with physical disabilities). What the service does well: The service the home is providing has improved and the home is now more open to ideas and discussion between relatives and the new registered manager. There was a good atmosphere within the home and staff were bright and cheerful. There have been some staff changes since the new manager took over, but this appears to have been beneficial to service users and the staff teams. Care staff on all units were observed to be respectful to service users and attended to their needs quietly and professionally. From discussion with service users it was established that they were happy with the service provided. One service user named a member of staff who was a particular favourite stating ‘I miss him he’s on holiday at the moment, I am looking forward to him coming back to work’. Relatives spoken with stated: ‘the staff do their best they are very caring’. ‘Things have improved greatly since the new manager took over’. For one service user who does not speak, a staff member speaks Cantonese and can converse with the service user who will nod approval. The service user is well able to make his needs known to the rest of the staff team using gestures and body language. DS0000029331.V309033.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Fluid charts on one unit only (physical disabilities) were not always being totalled. Greater care needs to be taken to ensure that all records are appropriately completed to evidence the care being provided. On one unit a service users smokes but there is not a risk assessment completed for smoking for this person who has physical disabilities. DS0000029331.V309033.R01.S.doc Version 5.2 Page 7 For one service user who requires 1-1 with 24 hour observation being carried out, this person is never left alone. Due to this the home should complete an infringement of rights record as the service user has no private time to himself due to his medical condition. A night observation chart was not completed for 14/8/06 between the hours of 06.00 and 08.00 and again on the 17/8/06. The home has to be able to evidence the care they provide therefore all documentation in relation to observation charts should always be completed. 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. DS0000029331.V309033.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) DS0000029331.V309033.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 5, standard 6 does not apply to the home. The quality in this outcome area is good therefore there are more strengths that weaknesses. The home endeavours to ensure that anyone wishing to live at the home has the appropriate information prior to admission and the length of the admission process is arranged around the needs of each individual. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an admission policy and procedure and the admissions process can be designed around the needs of the service user. Some service users may after one visit want to move into the home, others may need a phased admission process visiting several times. DS0000029331.V309033.R01.S.doc Version 5.2 Page 10 All service users have a thorough assessment carried out by the home prior to admission to ensure that the home can meet their needs. Placing authority assessments were observed to be held on file and are provided prior to admission. Service users are issued with contracts or terms and conditions of residence. Or alternatively the have a contract provided by the placing authority. DS0000029331.V309033.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are 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 & 11 The quality in this outcome area is good therefore there are more strengths than weaknesses. The home has improved the record keeping and this has enhanced the care being provided to service users. Some omissions were observed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Health care records were inspected on each of the 5 units. There was evidence of referrals to the specialist diabetic nurse, dietician, tissue viability nurse, chiropodist and opticians. GP visits were well documented. A random selection DS0000029331.V309033.R01.S.doc Version 5.2 Page 12 of service users care plans were inspected. All care plans chosen by the inspector had been updated as changes occurred or were due to be updated later in the month. This is a very good improvement since the last inspection. On one unit the needs of a service user had changed and the nurse was to update the care plan, however the information held in the daily record highlighted the change of need to keep staff informed. From discussion with staff they gave the correct information relating to the update of the care required. From the inspection of service users weight records it was observed that weight has increased for some under weight service users or remained stable after nutritional screening had taken place (at previous inspections weights recorded showed weight loss and weight instability). In discussion with staff on all of the units they were clear and informative about the needs of specific service users the inspector asked about. In discussion with service users they confirmed that staff treat them with dignity. One service user who is very able mentally stated:’ the staff do their best some are better than others but they all look after me well.’ ‘The only concern I have had whilst I have been here was when an agency staff member did not wash her hands, I get infections very easily, her hygiene was poor and I told her about it and I told the manager. Nicki sorted it out and we have not had that woman back here, she was an agency nurse not one of the staff here’. From observation by the inspector of the care being provided and the attitude of staff to service users confirmed that they are appropriately cared for. Staff spoke to service uses quietly when they were to attend to any personal hygiene and all observed had a good rapport with service users whatever their needs were. There is a mix of male and female staff so anyone wishing to have the same gender care would be able to have this. Privacy and dignity was said to be respected by staff. One service user stated: ‘they bath me and take care to treat me with dignity they don’t embarrass me’. Another service users stated: ‘The staff speak to you nicely and don’t leave you with no clothes, they cover up the bits that they are not washing’. Medication administration and recording was inspected on two of the five units. On unit 4 the medication Senekot had been signed as being administered but this medication had not been administered and remained in the monitored dosage system. Medication should be signed for at the point of administration. A random selection of medication that was not held in a monitored dosage system were counted all were found to be correct. Medication prescribed to be administered PRN (when necessary) was checked medication signatures corresponded with medication held. However it is good DS0000029331.V309033.R01.S.doc Version 5.2 Page 13 practice to record the ‘start date’ of all PRN medication, it is then easier to check that this medication has been administered appropriately. All controlled drugs held corresponded with the documentation. Although each service users needs at the time of death are recorded these relate only to their physical and medical care, not their personal wishes. Personal wishes should be added to the plan of care. DS0000029331.V309033.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the 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 The quality in this outcome area is good therefore there are more strengths than weaknesses. Records evidenced that service users are given as many choices as their abilities allow to enhance their daily living. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has 2 activities co-ordinators and they undertake activities in the activities room or on the units or undertake one to one activities. The activities co-ordinators take time to find out what service users like to do and arrange activities around their choices. The younger people were said like the DS0000029331.V309033.R01.S.doc Version 5.2 Page 15 quizzes. Service users come from other homes to Alexander Court to take part in some of the activities they provide. This is seen as good practice as service users are able to mix with different people. More service users are taking part in activities and this was confirmed in discussion with service users and from observation of service users leaving the units to go down to the activities room. One service user stated: I enjoyed the exercises this morning I always go to them’. Another service user stated: ‘ I went out to the local café yesterday’. Another service uses said: ‘I went out with my friends and had ‘one too many’ and that did not agree with me, I won’t do that again.’ One relative was visiting and was taking his daughter out on a shopping trip. He felt that the service they provide was good and that the home tried to encourage his daughter to get involved activities, although this was not always easy. Service users are encouraged to maintain links with the local community and relatives and friends are encouraged to visit at any time. Relatives and friends were seen to visit on the day of inspection. In discussion with relatives they stated: ‘We come in at different times and are always made to feel welcome’. ‘It is like one big family we are always made to feel welcome’. A service user stated: ‘my friends come in to see me, they come in at different times’ no one tells them they can’t come in if I am having something done they wait until the nurses are finished with me, but that’s not very often as they usually come in after the nurses have finished’. There is a 4 week menu and menu’s are displayed on each unit. The nutritional needs of service users have been monitored and menus have been changes as a result of discussions with the dietician and service users. Service users confirmed in discussion that they can have alternatives to the menu and there is a ‘5 minute’ menu displayed on the tables. The chef will cook anything from that menu if a service user does not want any of the main menu choices. A comments book has been provided on all the units for comments from service users about the meals provided, or comments from staff who have assisted service users to eat that are unable to make comments themselves. This is seen as good practice as the home is endeavouring to take on board the wishes of service uses. Comments from service uses were: ‘I like the food here, you get plenty of it’. ‘You get a variety of things to eat, sometimes I don’t like it’. When the inspector asked if the service user had asked for something else the reply was ‘no I don’t like to ask for something else’. The cook was said to go and speak with service users more often now, to talk about the meals prepared and if there was anything service uses would like that is not on the menu. Service users confirmed that they are able to rise and go to bed when they wish. Some service user like to go to bed early, others like to stay up and DS0000029331.V309033.R01.S.doc Version 5.2 Page 16 watch TV, particularly the younger service users. Care plans identified the times of going to bed. Not all service users were up when the inspector arrived and some were just getting up evidencing that choice is given whenever possible. In discussion with one service use she said: ‘I like this dress, the staff got it out for me, I choose what I want to wear’. Service users were suitably dressed for the time of year and all looked well groomed. DS0000029331.V309033.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The quality in this outcome area is good therefore there are more strengths than weaknesses. The right to complain, along with the training of staff in the protection of vulnerable adults ensures the safety of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedure. Any complaints made are recorded along with the action taken to investigate the complaint. Relatives visiting at the time of the inspection stated: ‘You just have to speak to Nicki if you are not happy about anything’. ‘You just have to tell Nicki and it is sorted out, I have raised a few things and they got dealt with that’s what you want’. ‘My daughter is well cared for here, I could not ask for anything else I have no complaints’. The staff are good and you can speak to any of them’. Service users spoken with stated: ‘I have no complaints I am happy here’. ‘If you had something you were not happy with you would tell the staff and it would get changed’. DS0000029331.V309033.R01.S.doc Version 5.2 Page 18 Staff have attended training in the protection of vulnerable adults (POVA) throughout this year. DS0000029331.V309033.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) 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, 22, 23, 24, 25 & 26 The quality in this outcome area is good therefore there are more strengths than weaknesses. A well maintained home benefits the service users. Service users are able to choose how they wish their rooms to be decorated and the ability to bring personal items with them enhances their lives. This judgement has been made using available evidence including a visit to this service. DS0000029331.V309033.R01.S.doc Version 5.2 Page 20 EVIDENCE: The inspector chose bedrooms at random to inspect on all of the 5 units. All were found to be clean and tidy and free from odours. The building has an ongoing programme of redecoration therefore the rooms that need attention are to be decorated so no requirements have been made in the light of this. Many of the bedrooms are individually decorated and full of personal possession. In one bedroom a service user is a supporter of a football club and the players have visited and signed their names on his wall. Other rooms were full of personal possession making the rooms very homely. The grounds were tidy and well maintained The bathrooms and toilets were clean and tidy. Specialist lifting equipment and aids and adaptation in bathrooms and toilets is provided. Pressure relieving mattresses and chair cushions are also provided. Clinical waste was appropriately stored awaiting collection. The laundry room was clean and tidy. Laundry comes to the laundry room in separate bags identifying foul linen. The kitchen was clean and tidy. The dry store was tidy and well organised. Fridge and freezers were clean and fridge and freezer temperatures were being taken and recorded daily. DS0000029331.V309033.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the 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 The quality in this outcome area is good therefore there are more strengths than weaknesses. The recruitment systems that are in place protect the vulnerable service users. Service uses benefit from a well trained staff team, all staff are allocated training dependent on their needs and all have a training plan to ensure they have the skills to meet the needs of the current service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was sufficient staff on duty at the time of the unannounced inspection. The home appeared much more organised at the time of this inspection. Staff were observed to be busy with the work allocated to them on each of the units. Seven staff hold NVQ level 2 qualifications. The home is aware that 50 of the staff team must hold this qualification and training is being undertaken. DS0000029331.V309033.R01.S.doc Version 5.2 Page 22 Since the new manager took over training programmes have been put into place and all staff now have a training record. Up dating training and new training sessions that have taken place this year are: In January- Food hygiene, COSHH (control of substances hazardous to health), POVA (protection of vulnerable adults, Communication and medication practice. In February - Health & Safety, Bereavement, infection control, POVA, COSHH, food hygiene, understanding dementia, artificial feeding (pump system), Multiple Sclerosis study day, clinical practice. In March- POVA, Understanding dementia, First aid, food hygiene. In April the training was - Understanding dementia, food hygiene, health & safety, Fire training, POVA. In May - Clinical skills, understanding dementia, Activities training, Catheterisation, Fire training and POVA. In June - Moving & Handling, Epilepsy, Palliative care, POVA and food hygiene. In July the training was Dementia, Health & Safety, Food Hygiene, Tissue Viability and pressure care. August’s training is Pressure Care First aid and COSHH. In August: COSHH, Pressure care, First aid. In September – Fire training, moving & handling and clinical practice. In October – Palliative care, Moving & Handling. Training for November and December has yet to be booked. The recruitment and selection of new staff was inspected all information required by legislation was held. DS0000029331.V309033.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) 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, 32, 33, 35, 36 & 38 The quality in this outcome area is good therefore there are more strengths than weaknesses. The manager is appropriately trained and competent to run the home in the best interests of service users. Service users participate in the running of the home as far as their abilities allow. This judgement has been made using available evidence including a visit to this service. DS0000029331.V309033.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager has just completed her Registered manager’s award and is waiting for her certificate. The manager is appropriately qualified being an RGN and also a Dementia trainer. The manager updates her training as necessary to ensure she has the skills and knowledge to operate the home effectively. Staff meetings take place and minutes are kept. The manager has been monitoring records since she took over the home and this has improved the recording of all care given. In discussions with staff it was stated’ Nicki keeps an eye on everything, we are doing well don’t you think.’ ‘The records are much better now Nicki monitors them.’ From observation of records there was information relating to the change in the needs of a service user. Due to this the night staffing levels were increased. This is seen as good management practice ensuring the home is run in the best interests of the service users as their needs change. Service users finances were inspected. All accounts are held on computer and accessed by the administrator. The administrator stated that relatives ask for a breakdown of the accounts from time to time. One relative speaking to the administrator at the time of the inspection was someone who liked to keep a check on how her relative’s money was being spent on her behalf and always has a statement of account given to her. A random selection of money held in safekeeping, along with receipts were inspected. It was observed that one service user had paid for a bus fare of a staff member. This is not acceptable practice, the home must pay any transport costs for staff who have to accompany a service user to go out, or go to get shopping for a service user. This bus fare £1.20p was immediately refunded to the service user’s account from the petty cash. Another service user had over the amount that should have been in the account (£1.53) A further service user had 5p less than they should have had. The administrator must check all receipts with money held in safekeeping and rectify the errors and confirm in writing where these errors arose. Staff are having formal written supervision sessions and a record is kept of this. The home is aware that all staff must have 6 supervision sessions within and one ‘rolling’ year. Induction programmes are undertaken by all new staff evidence of these were observed to be held in the files of 2 new staff employed. DS0000029331.V309033.R01.S.doc Version 5.2 Page 25 A quality assurance system is operational. The analysis of the latest quality assurance questionnaire must be made and the information must form part of the Service Users Guide, this must be completed annually. Accidents were appropriately recorded and these records are held on each unit. Daily records inspected corresponded with information recorded on the accident records. The records are held in a main file and identified month by month. This is seen as good practice as the home can quickly identify if a trend is appearing at any particular time. All health and safety documentation was held as required as reported on in Regulation 26 visit reports. DS0000029331.V309033.R01.S.doc Version 5.2 Page 26 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 1 2 3 4 5 6 Score ENVIRONMENT Standard No Score 19 3 20 3 21 3 22 3 23 3 24 3 25 3 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 3 33 2 34 x 35 2 36 3 37 X 38 3 x 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 DS0000029331.V309033.R01.S.doc Version 5.2 Page 27 No 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 OP8 YA19 OP9 YA20 Regulation 17(1)(a) schedule 3 13(2) Requirement Observation charts and fluid charts must be fully completed at all times. Medication must be signed at the point of administration (medication remained in the blister pack but had been signed as being administered). The personal wishes of service users at the time of death should be added to the care plan. Risk assessments to be completed for all needs (smoking). An infringement of rights record for one service user who has 24 hour observation needs to be drawn up. Complete an analysis of the quality assurance questionnaire and add this to the Service Users Guide. Finance records and money held in Timescale for action 30/09/06 22/08/06 3 OP11 YA21 15(1) & (2) 30/11/06 4 5 OP14 YA7 OP14 YA7 15(1) & (2) 15(1) & (2) 30/09/06 30/09/06 6 OP33 YA39 24(1)(a) 30/12/06 6 OP35 A23 17(2) schedule 4 9 30/09/06 DS0000029331.V309033.R01.S.doc Version 5.2 Page 28 safekeeping must be correct at all times. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 YA20 Good Practice Recommendations Record the start date of all medication prescribed to be administered when necessary (PRN). DS0000029331.V309033.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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. DS0000029331.V309033.R01.S.doc Version 5.2 Page 30 - 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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