CARE HOMES FOR OLDER PEOPLE
Alexander Court Care Centre 320 Rainham Road South Dagenham Essex RM10 7UU Lead Inspector
Rhona Crosse Unannounced Inspection 25 July 2005 09:00 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 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 Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Alexander Court Care Centre Address 320 Rainham Road South, Dagenham, Essex RM10 7UU Telephone number Fax number Email 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 8709 0080 020 8593 7584 Life Style Care PLC Vacant CRH Care Home 82 Category(ies) of DE(E) Dementia - over 65 (30) registration, with number OP Old Age (40) of places PD Physical disability (12) Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 03 June 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. Accommodaton is in single bedrooms with ensuites.ADD IN AS LAST. Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection as unannounced this means that the home did not know the inspector was coming. The inspection took place between 0.900 and 15.15. Since the last inspection the home has a new acting manager in post. It was a requirement at the last inspection that the manager must put forward an application for registration with the Commission by 30/8/05. The home is registered for 82 service users, currently there are 72 people accommodated. The home was without a named GP for a period of time after the homes GP died. A new GP was visiting service users at the time of the unannounced inspection. This inspection was a follow up inspection due to concerns about the operation of the home and to check whether the requirements made at the last unannounced inspection on the 3 June 2005 had been met. These requirements were given a timescale for compliance by 30/6/05. Therefore not all standards were inspected at this inspection, but will be inspected at further inspections. Service user’s daily records, care plans, accident records, food and fluid charts were inspected. Staff employment records, training records and dates of supervision were inspected. As a result of 2 adult protection investigations and concerns about the operation of the home, the home was served with a Statutory Requirement Notice. This was due to the home failing to seek appropriate medical attention when falls by service user’s occurred that resulted in fractured bones. The majority of the requirements set at the inspection of 3/6/05 had been met within the timescale and other requirements were met in advance of the timescale set. However the timescale for the manager to put forward her application to register with the Commission will be stated again in this inspection report as this requirement remains within the timescale for compliance. Due to poor recording of fluid charts an Immediate Requirement Notice was served on the home. Any further failure to ensure that fluid charts are fully completed and evidence the amount of fluids provided to service user’s may result in formal action being taken against the home. What the service does well:
Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 Page 6 Activities were taking place on the day of the unannounced inspection. There was an activities programme displayed on each unit to show what activities would be taking place this week. Care plans are being updated now with more information being recorded. What has improved since the last inspection?
The home has been without a registered manager for some time, with area managers covering the role. There is now an acting manager in post who has started to address the problems within the home. Relatives meetings have taken place since she was appointed. Staff meetings have also taken place with nursing staff, care staff, chef’s and kitchen staff and domestic staff. Minutes are kept of these meetings. All staff have now completed re-training in lifting and handling on an individual basis with the deputy manager. They have also completed a questionnaire about the principles of lifting and handling these were seen on staff files. This requirement was met before the timescale set for compliance. Records inspected at random showed that Diabetic monitoring of blood sugar levels have improved. The specialist diabetic nurse has been contacted by the manager for advice. The home now has a system of checking medication daily with an overall weekly check also taking place. The recording of nasal gastric feeding had improved. Some work is still required in the completion of food charts. The manager is setting up training for all staff in dealing with accidents and emergencies as this has not been dealt with appropriately in the past. Inappropriate storage of old furniture is no longer stored under stair wells and no fire extinguishers were observed to have access to them blocked, as was the case at the last unannounced inspection. Storage of other equipment was observed to be appropriate. Accidents are being recorded, although filing in this area needs attention to detail. The bedroom that had an odour of stale urine at the last unannounced inspection was free from odours at this inspection. Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 Page 7 The hob of the oven was very dirty and not being cleaned daily at the last inspection, this practice has now changed. Heated trolleys were in the process of being cleaned. 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 Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 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 standard(s) 3. Standard 6 is a service the home does not provide. This standard is well managed. EVIDENCE: Although this standard had been inspected at the last inspection and the standard was met, a new service user had been admitted to the home. The inspector checked the information provided for admission. All information was held on file including the pre assessment form which gave good information about the current needs of the service user. Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 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 standard(s) 7 and 8 Standard 7 was met in relation to care plans being updated on a monthly basis or as changes occurred. Standard 8, regarding health and welfare is not met. As a result of 2 adult protection investigations where medical assistance was not appropriately sought for 3 service users’ who had fractured bones, the home was served with a Statutory Requirement Notice. At the last unannounced inspection of the 3/6/05 a requirement to improve the recording of fluid charts was made. As a result of this requirement not being met at this inspection an Immediate Requirement Notice was served on the home on 25/7/05. The above issues place service users at risk. The home must comply with both the legal Notices served and improve the service provided or further formal action may be taken against the home. EVIDENCE: The manager stated that she had monitored the completion of fluid charts on one particular unit. These had improved, however one observed by the
Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 Page 11 inspector was incomplete and the home could not evidence that they had provided appropriate amounts of fluid to that service user. On another unit there was very poor recording with no monitoring of the amount of fluids taken by nursing staff. For one service user (A) for the 4/7/05 only 270mls of fluid were recorded as being provided and accepted. For the 7/7/05, 190mls of fluid were recorded as being provided. On the 8/7/05, 370mls of fluid was recorded as being given. For the 12/7/05 the chart was not totalled, the recordings added up to 200mls of fluid being provided. On the 22/7/05 200mls of fluid were recorded as being taken. The amount of fluids provided is well below an acceptable level. On some days an amount of over 900mls and up to 1,057mls was recorded showing a great fluctuation in fluid intake. Daily records were inspected to see if any request to encourage fluids was recorded due to the low intake of fluids on particular days. No entry was made to prompt staff to encourage an appropriate amount of fluid intake. This is poor practice. The home must ensure that each individual is provided with adequate amounts of fluid. The minimum and maximum amount should be recorded on the fluid chart to enable staff to identify if service user’s are either ‘at risk’ of not drinking enough fluids or that they are accepting fluids to an acceptable level. For one service user whose assessment stated that they had a catheter in situ and had renal failure, there was no fluid balance chart. This is poor practice. The intake and out put of fluid can easily be recorded when a catheter is in situ and give a clear indication of fluid retention long before other signs and symptoms are apparent. Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 the other standards will be inspected at further inspections. Activities are well managed. EVIDENCE: The home has a full time activities co-ordinator and an activities room with suitable equipment to undertake a range of activities. An activities plan was displayed on the different units identifying the activities taking place this week, activities take place on a daily basis. Bingo was taking place on the morning of the inspection and other activities in the afternoon. Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 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 standard(s) This standard will be inspected at further inspections. EVIDENCE: Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 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 standard(s) 23 and 26 the remaining standards were inspected at the inspection of the 3/6/05 These standards inspected were well managed. EVIDENCE: There was a requirement that bedroom 44 had to have better odour control. This room was inspected and found to be free of odours along with a random selection of other bedrooms inspected. Specialist equipment is provided for pressure relief such as specialist mattresses and beds. There are hoists and other lifting aids provided by the home. At the last inspection it was observed that equipment was inappropriately stored in en-suites. A random selection of bedrooms were inspected. All equipment was appropriately stored. Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The staff numbers were in line with the staffing notice. However, this notice was set some time ago and the needs of service users have changed and new service user’ are being admitted with more complex needs. The staffing levels need to be reviewed. The recruitment and selection process was found to have information missing from some staff files therefore the home are not protecting vulnerable service users by the employment practices. Staff training has not been well managed and staff require statutory training to be provided. EVIDENCE: The staffing levels meet the staffing notice set by the previous registration authority. However the abilities of the current service users and the new service users admitted suggests that these staffing levels should be reviewed. particularly in light of the recent poor operation of the home. Staffing levels may need to be increased at key times throughout the day. The manager stated that she is currently carrying out an assessment of the needs of service users accommodated to look into the staffing levels to establish where improvements in staffing levels need to be made. The rota for the home was inspected. The week commencing 1/7/05 covering 2 weeks (the rota runs from Friday to the following Thursday each week). The rota for care staff by unit does not always record the hours of working when
Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 Page 16 staff have been asked to cover a shift. For one staff member ‘sick’ is written through her rota for the 2 weeks recorded, therefore it cannot be established what shifts the person would normally have worked and where cover has been provided. All staff hours must be identified on the rota. For another staff member 2 shifts 9-1 have been crossed through but no cover is identified for these shifts. A random selection of staff files were inspected. It was observed that one staff member (A.E.) had only one written reference on file. Another staff member (F.L.) had stated she had worked at another nursing home but a reference had not been taken up from that home. The references taken up did not relate to the work she was currently employed to do. Also the referees who provided the request for a reference did not state in what capacity they were known to the staff member. Therefore it could not be established if these people were giving an employers reference or a character reference. No induction programmes could be produced for the staff who’s files were being inspected. Some files held staff appraisals others did not. Some held job descriptions others did not. Each staff member must have an induction programme. The employment files of staff must be standardised with all information required by legislation. All documents should be held securely in files. The home has a training file that identified each staff member’s training achieved. From inspection of this it showed that this file was well kept with information readily retrievable. There were varying degrees of training being provided and accepted by staff. Some full time staff had good training records. Other full time staff had not undertaken the statutory training required that should take place annually. This must be addressed with urgency. Staff must be appropriately trained for the role they are required to undertake. Due to the concerns raised at the last inspection and following the 2 adult protection investigations all staff have now undertaken lifting and handling training. 8 staff are currently undertaking NVQ level 2 training. Other training undertaken by some staff this year is: Wound care 24/6/05, supervision 17/5/05, basic first aid 9/5/05. Currently several staff are undertaking infection control training in Chelmsford and following this medication training is to take place. Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, standard 38 was inspected at the last unannounced inspection ion 3/6/05 The home will benefit from a permanent manager in post. The acting manager must put forward her application to register with the Commission by 30/8/05. As the new acting manager has only just taken up her post and is been dealing with urgent issues, the rest of the standards relating to the management of the home will be inspected at further inspections. EVIDENCE: The new acting manager has already started holding relatives/service user’s meetings and these took place on the 7/7/05, minutes of the meetings are kept. Staff meetings have also taken place and the issues that have to be addressed have been discussed with the staff. Minutes of these meetings also are kept.
Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 Page 18 The manager has spent time monitoring the practices of the home since she commenced duties on 28/6/05. A staff member was suspended for insubordination on the 19/7/05. A disciplinary meeting took take place as a result of this. The Commission were not informed of this suspension and should have been informed under Regulation 37. The home must ensure that they notify the Commission when there is a reportable incident. A Regulation 37 notification must be provided detailing the action and outcome of the suspension. Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x 3 x x x 3 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 3 x x x x x Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 Page 20 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. Standard OP8 Regulation 17(1)(a) schedule 3(k) Requirement The home must ensure that fluid charts are appropraitely completed and that service users are given their individual amount of fluids to keep them hydrated to an appropriate level. The home was served with an Immediate Requirement Notice with the complianace date of 23/8/05. This requirement is repeated from the last inspection Food charts must identify the actual meal content not record (fed by daughter) with no further information provided. When the assessment of the wheelchair user has been made the outcome naming the service users must be provided in writing to the Commission The Immediate Requirement Notice served on the home by the Commissions pharmacy inspector must be complied with Staffing rotas must reflect the hours the staff cover. (some shifts covered did not identifiy the hours of staff covering for sickness/annual leave/absence). Employment documentation must hold the information Timescale for action .23/8/05 2. OP8 17(1)(a) schedule 3(k) 14(2)(a) 23/8/05 3. OP8 30/9/05 4. OP9 13(2) 4/8/05 5. OP27 18(1)(a) 30/9/05 6. OP27 19 1-8 30/9/05
Page 21 Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 required by legislation. 7. OP27 18(1)(a) Staffing levels must be reviewed and increased on units where necessary to meet the changing needs of service users. An increase may be required at key times, (getting up, meal times and going to bed). Staff must be appropriately trained for the work they are to perform. All statutory training required for each staff member should be identified and commenced. The manager must apply for registration with the Commission This requirement is repeated from the last insepction report. The home must inform the Commission of any significant events (eg. staff suspension) A Regulation 37 report must be sent to the Commission. 30/9/05 8. OP30 18(1)(c) (i) 30/9/05 9. OP30 30/8/05 10. OP30 37 4/8/05 and ongoing as necessary. 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 OP8 OP27 Good Practice Recommendations The manager must monitor the health and welfare of service users both visually and by documentaton of their care. Staff recruitment information must be more thoroughly checked to ensure the information provided is correct and that references are appropriate for the post applied for. Alexander Court Care Centre G55_S0000029331_Alexander Court_V240482_250705_Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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