Inspection on 27/11/07 for Alexander Court Care Centre

This inspection was carried out on 27th November 2007.

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 21/08/06

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 HOMES FOR OLDER PEOPLE Alexander Court Care Centre 320 Rainham Road South Dagenham Essex RM10 7UU Lead Inspector Ms Gwen Lording Unannounced Inspection 27th November 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alexander Court Care Centre DS0000029331.V353926.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 Care Centre DS0000029331.V353926.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 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8709 0080 020 8593 7584 alexander@schealthcare.co.uk www.schealthcare.co.uk Southern Cross (LSC) Ltd 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) Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st August 2006 Brief Description of the Service: Alexander Court is a purpose built care home providing nursing care for 82 adults. The home is registered to care for three different service user groups. People who are over the age of 65 years and physically frail or who have a diagnosis of dementia and people who have a physical disability. The home is operated by Southern Cross Limited a company, which operates similar homes across the country. The home is situated in Dagenham and has good access to local facilities and transport links. The home is divided into five separate units and all rooms have en suite facilities divided into 5 units. Accommodation is in single bedrooms with en-suites and a passenger lift services all floors. On the day of the inspection the range of fees for the home was between £585.0 and £850.00 per week. A copy of the Statement of Purpose and Service User Guide to the home is made available to both the resident and their family. A copy of both these documents and the most recent inspection report are available at the main reception and on request. Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which started at 9.30am and took place over six and a half hours. The inspection was undertaken by two inspectors, namely the lead inspector Gwen Lording and Sandra Parnell-Hopkinson. The manager was available throughout the visit to aid the inspection process. This was a key inspection in the inspection programme for 2007/2008. Discussion took place with the manager; several members of nursing and care staff; kitchen and laundry staff; activities co-ordinators; and the home’s administrator. The inspectors spoke to a number of residents and relatives; and where possible residents were asked to give their views on the service and their experience of living in the home. Nursing and care staff were asked about the care that residents receive and were also observed carrying out their duties. A tour of the premises, including the laundry and main kitchen was undertaken and all areas were clean and tidy with no offensive odours. The files of several residents on each unit were case tracked, together with the examination of other staff and home records. This included medication administration, staff rotas and training records, maintenance records, complaints and staff recruitment procedures and files. Information was also taken from an Annual Quality Assurance Assessment (AQAA), which was completed and returned by the manager. This is a selfassessment process, which all providers are required to complete once a year. Additional information relevant to this inspection was also obtained from monthly Regulation 26 monitoring reports and Regulation 37, notification of events. Surveys were sent out to the home prior to the inspection for completion by staff and residents and there was a very good response. Several residents were asked how people living in the home wished to be referred to. The majority expressed a wish for the term resident to be used and this is reflected accordingly in the report. The inspectors would like to thank the residents, staff and visitors for their input during the inspection, and to those people who completed surveys. What the service does well: Although many of the residents have continence problems there were no offensive odours in any areas of the home, and staff were observed implementing continence programmes for residents. Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 6 In discussions with relatives the inspector was told: “We have been very happy with the care at this home, the manager is approachable if we have any concerns. The care staff are wonderful and really seem to know the residents”. During the inspection staff were seen to be providing good personal care and all residents appeared clean, well groomed and appropriately dressed. There is a very relaxed atmosphere throughout the home and residents appeared unhurried in their everyday activities. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2, 3, 4 & 5 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. A pre-admission assessment is undertaken for all prospective residents. Care plans are drawn up from the information in this assessment ensuring that the needs of the residents are identified, understood and met. The home does not offer intermediate care. EVIDENCE: Individual records are kept for each resident and a number of files were examined on each unit, including the records of the most recently admitted residents. All records inspected have assessment information recorded and the information had been used to continue assessment following admission to the home and develop written care plans. The records showed that residents, Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 9 where possible and their relatives/ representatives are involved in the assessment process. Where appropriate, information provided by the placing authority was also included, together with either a contract or a statement of terms and conditions. In discussions with some relatives, the inspector was informed that they had been able to visit the home prior to the admission of their brother, and had an opportunity to talk to the manager, staff and some of the residents. They said: “This visit really helped us to decide that this was the right home for our brother, and we have been pleased with the care he is receiving”. The manager has worked with the local Primary Care Trust to improve communication with hospital staff and ensure that the home is provided with more comprehensive information when residents are transferred back to the home following a hospital admission. The manager was provided with a copy of the Commission’s ‘Policy and Guidance on Provision of Fees Information by Care Home’s’. This sets out what information care home providers need to include in the Service User Guide regarding fees and terms and conditions, and is in a format that is easy to understand. Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 & 11 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Residents’ health, personal and social care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify and meet residents’ needs. There are clear medication policies and procedures for staff to follow. However, there are some inconsistencies in the storage of medication, which may result in unsafe practices EVIDENCE: The home is currently in the process of introducing new care planning documentation, which is being implemented gradually across all units of the Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 11 home. The new care planning documentation has the potential to be an effective working tool for all members of staff, that is nurses and care staff. Individual care plans were available for each resident and a total of twentyfour residents were case tracked across the five units, and their care plans and related documentation inspected. Care plans were generally comprehensive and detailed around health and personal care needs, and to a lesser degree the individual’s social care needs. There was evidence to show that care plans were being reviewed on a monthly basis, or more frequently if necessary, and those viewed had been updated to reflect changing needs and current objectives for health and personal care. However, whilst all care plans were being regularly reviewed, several care plans require re-stating as they were dated 2005 and 2006. In some files viewed there were specific ‘night’ care plans, but staff must ensure that such plans are available for all residents. Currently care plans are very much health focused, and more attention needs to be given to the social care needs of the residents. The documentation/ health records relating to wound management; management of insulin dependant diabetes; catheter care and recently admitted residents were examined. The records for these residents were found to be detailed and maintained up to date. In discussion with the senior nurse on Daffodil House, she demonstrated an awareness that some behaviours exhibited by residents living with dementia, such as refusing food, quiet rocking, or really challenging behaviour, could be due to an individual experiencing pain, or other discomforts. She was very well aware of the need to exclude this when trying to understand what residents were trying to express through their behaviour. Although many of the residents have continence problems there were no offensive odours on any of the units, and staff were observed implementing planned continence programmes. Risk assessments are being routinely undertaken on admission around nutrition, manual handling, continence, risk of falls and pressure sore prevention; and are being reviewed on a regular basis. Records are maintained of nutrition, including weight loss or gain with appropriate action being taken where necessary. Monitoring charts such as fluid intake/ output; turning regimes and blood sugar monitoring, were up to date and being adequately maintained. Files evidenced involvement from G.P’s; tissue viability nurse; diabetic nurse specialist; dietician; and speech and language therapy team; optical, dental and chiropody services. The inspector spoke to one resident who is confined to bed because of their physical condition. The resident said that they often found it difficult to find a comfortable position, and this is a concern that has also been raised by family members. The manager has requested an assessment by an Occupational Therapist to ensure that the current bed and mattress are appropriate to this resident’s specialist needs. Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 12 All staff were observed to treat residents with kindness, respect and there was also positive interaction observed between residents and staff. They understood the need to promote dignity through practices such as the way they addressed residents and were observed knocking on bedroom and bathroom doors before entering. Staff spoken to were able to demonstrate a good understanding of the needs of the individual residents. The inspectors spoke to a number of residents and asked about the care in the home. One resident spoken to said: ‘All the staff are really nice. They are patient with me and helpful’. Another commented: ‘The staff are very friendly and caring towards me’. Comments from relatives spoken to included: ‘The home is exceptionally clean’. ‘Staff are very friendly’. ‘If I have a problem I speak to the manager who sorts it out’. An audit was undertaken for the handling and recording of medicines within the home and a sample of Medication Administration Record (MAR) charts were examined on each unit. There are clear medication policies and procedures for staff to follow and discussions with staff and the review of medication records show that staff are following policies and procedures. However, on Blossom and Rose houses it was noted that insulin was not being stored in line with the product license. This was discussed with the nurses in charge of the respective units and the necessary action was taken around the correct storage of the insulin. The manager has recently reviewed the times of the administration of medicines so that resident’s mealtimes are not interrupted unnecessarily. It was apparent in discussions with staff on all units that they were able to care for people who may be dying, and that they would treat all residents with care and dignity at such times, and the necessary religious rites observed where appropriate. The manager was also very aware of the need to increase staffing levels at such times, to ensure that the needs of all residents could still be met without putting additional pressure on staff. The development of care plans around ‘End of Life’ wishes and needs are now being developed throughout the home. The inspector was able to evidence information in care plans around preparing for deterioration, death and dying of an individual. On the day of the visit three residents were being supported/ accompanied by staff to attend the funeral of a fellow resident who had died recently. One relative had written: ‘Thank you for being such an important part of Mum’s life. You gave her a much appreciated happy ending’. Alexander Court Care Centre DS0000029331.V353926.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Residents are given the opportunity to take part in a variety of activities and the lifestyle within the home matches the preferences of residents with regard to their age, capabilities, social and recreational interests and their individual needs. Whilst the nutritional needs of the residents are well considered, the presentation and choice of meals, and the levels of staff available to assist residents at mealtimes needs to be improved. This will ensure that mealtimes are seen as being important and enjoyable for all residents. EVIDENCE: The home employs two full time activity co-ordinators. There is a general programme of planned activities for all residents, which includes regular visits Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 14 by professional entertainers. All residents have a leisure and activities record which forms part of their care plan. There is a well-equipped designated activity room. The activity co-ordinators are organising more activities outside the home and a recent addition to the in house programme has been the introduction of a ‘Themed Restaurant’ night once a month. This has included Greek, Chinese, Italian and American food themes, and these have proved to be a great success. Residents families are invited to attend and one resident commented: “It was such a treat to enjoy a meal with all my family including my young grandchildren”. The weekly ‘Film’ afternoon has also proved popular with the recent purchase of a large, wall mounted, flat screen TV. Annual festivals are celebrated and these include the birthdays of all residents. Staff were seen to be interacting with some residents, and although there is a very good activities programme for the whole home, with the development of life histories staff could be more involved in individual activities with each resident. The manager and staff are very aware of the need to minimise any reduction in the freedom of residents to walk about the home, and realistic risk assessments are in place that balances safety with the individual’s right to be as free and in charge of their actions as possible. The manager also ensures that the rights of all residents living in the home are recognised and addressed, and balances the needs of all with the needs of individuals. One of the inspectors observed lunch being served on Daffodil House (dementia unit), and it was apparent that more staff were required at this peak activity time. Although some residents were being assisted, other residents had to sit and wait for their meal. Many of the residents needed either supervision by staff or assistance with eating. Residents living with dementia may benefit from the use of, for example, pictorial menus, finger foods, small nutritious snacks, smaller portions and more flexible eating at times to maintain independence and exercise choice around food and eating. Dining tables had not been routinely laid and condiments were not available on each table. Some residents had pureed meals, but these did not look appetising, and one member of staff was seen to mix the whole pureed meal together when giving assistance to a resident. Residents were not given a choice at the mealtime, but had had to make a choice the day previously. This is not good practice as people living with dementia experience short-term memory loss, and would not remember what they had chosen the day before. This area does need to be developed through the provision of pictorial menus or other methods such as making available to residents before the actual mealtime, small portions of the meals so that they can see, smell or touch the food and thereby make an informed choice. Mealtimes for all residents should be an enjoyable experience, and the manager is directed to the Commission’s report Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 15 Highlight of the Day, which addresses the area of meals and mealtimes in care homes. One of the inspectors was able to observe part of the lunchtime meal being served on Rose house. All dining tables were laid with cloths, napkins, condiments, cutlery and glasses. One member of care staff was serving the meal and two other carers were assisting residents. An additional carer on induction training was also in attendance. Drinks and snacks are freely available throughout the day, and during the night on all units. A visit was made to the main kitchen and one of the inspectors was able to discuss the storage, preparation of food and menus with the head cook. He was fully aware of those residents requiring special diets such as diabetic and pureed meals. Custards, porridge and drinks are made with full cream milk and added cream and butter wherever possible, to supplement the diets of those residents with reduced food intake, weight loss, or diminished appetite. The kitchen was clean, food in the refrigerators was in date order and clearly labelled, as were dry goods and fresh foods. There is an ‘off menu’ which is available each day. In discussions with the cook it is apparent that residents on Bluebell house mainly take up this option. Fresh fruit is provided daily and on request, but perhaps this could be prepared into bite size pieces to make it more appealing and easier to eat. Approximately half of the Commission’s surveys completed by residents commented adversely on the quality of the meals. Comments included: ‘Food could be better’. ‘Please improve the meals’. ‘The food is not very good sometimes’. Two residents commented positively on the meals: ‘The food is good’. ‘Food very good indeed’. In discussions with two relatives the inspector was told:’Generally the food is okay, but it could be better, and more appropriate for people who have dementia. Often the skin is left on the chicken, and my brother does find this difficult to cut’. The manager is actively addressing these concerns about the quality of the meals. She has recently changed the home’s supplier of fresh meat and is working with kitchen staff and residents to make improvements to the menus. Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The manager and staff make every effort to sort out any problems and concerns. Residents and their relatives can be confident that their complaints and concerns will be listened to and acted upon. All staff working in the home have received training in safeguarding adults to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a written complaints policy and procedure for dealing with complaints, and staff spoken to were aware of the complaint procedure and how to deal with complaints and concerns made to them. The complaints log was inspected and indicated complaints received, details of investigation, action taken to resolve and the outcome for the complainant. Less formal concerns/ issues of dissatisfaction are currently recorded in the individuals care plan. However, it is recommended that the manager also record such concerns in the central complaints log so that during inspection or audit all information is recorded in one source. This will also highlight any trends/ patterns for subsequent follow up action by the manager and to inform areas for service improvement. Those residents spoken to were aware of how to complain and to whom. Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 17 All staff working in the home have received training in safeguarding adults and this is included in induction training for all staff. This was evidenced on staff files and the training schedule. Those staff spoken to were conversant with the action to be taken if they had any concerns about the safety and welfare of residents or if they witnessed any suspected abuse. Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 23, 24 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The overall atmosphere in the home is very welcoming. The physical environment is clean, comfortable and meets the needs of people living in the home. EVIDENCE: The building was toured by the inspectors at the start of the visit, accompanied by the manager, and all areas were visited again later during the day. Some bedrooms were seen either by invitation of the residents, whilst others were seen because the doors were open or being cleaned. The majority of the Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 19 bedrooms seen were very personalised and were reflective of the occupant’s interests, culture and religion. However, there were still several bedrooms, which appeared very bare, and this was especially true of Blossom House. Improvements are being made to the décor and signage on Blossom, Jasmine and Daffodil House (dementia units) such as colour schemes, touch and feel materials on the walls and appropriate pictures, in line with good dementia care guidance. Signage on individual bedroom doors is now aiding the orientation of residents and enabling them to find their bedrooms. Work has begun on Jasmine to change the look of the bedroom doors so that they look like the front door of a house, that is they are different colours and have a number, letter box and door knocker. However, it would also be useful if the name of the resident who occupies the room could also be put on the door. Whilst the inspectors were touring the home, and were on Jasmine House, a resident living with dementia asked, when pointing at a letter box, ‘How will I know who lives there’. There were no offensive odours and the home was clean and tidy throughout. The décor, furnishings and fittings are being maintained to a good standard. A maintenance person is employed and there is an effective system in place for staff to report items requiring attention or repair. The laundry area was visited and this was found to be clean, with soiled articles, clothing and foul linen being stored appropriately, pending washing. The laundress was aware of health and safety regulations with regard to the handling and storage of chemicals. Personal Protective Equipment (PPE) such as clothing, gloves, masks and goggles were available and in use. Some staff commented in surveys returned to the Commission, that there was sometimes an insufficient supply of disposable gloves. This was discussed with the manager who said that there was always a good supply of disposable gloves, but that she had had to discuss with staff the inappropriate use of such items. For example, staff had often worn two or more pairs of gloves at once. On the day of the visit disposable gloves, wipes and aprons were in plentiful supply and available at prominent sites throughout the home. Hand washing facilities and alcohol sanitisers are prominently sited and staff were observed to be practising an adequate standard of hand hygiene. The manager has received and is fully aware of her responsibilities around the recent legislation regarding smoking in care homes, which came into effect on the 1st July 2007. Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 20 Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The written procedures for the recruitment of staff are robust and provide safeguards for people living in the home. However, the manager must ensure that all such procedures are consistently followed by staff around the recording and follow up of any verbal references. The home employs staff in sufficient numbers to meet the personal and nursing care needs of the residents. However, the increased needs of residents, particularly with dementia, at peak periods, such as mealtimes and social activities, may mean staffing levels being increased at these times. EVIDENCE: The staffing levels of qualified nurses and care staff were sufficient to meet the nursing and personal care needs of residents. However, staffing levels need to be reviewed especially during meal times and individual activities. At all times there must be enough staff available to meet the needs of people using the service, with more staff being available at peak times of activity. The staffing structure must be based around delivering outcomes for people using the service. In discussion with the manager it was evident that some additional hours have already been agreed for Daffodil house. However, the organisation Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 22 also needs to ensure that the staffing levels on both Jasmine and Blossom house may also need to be reviewed to ensure that the assessed needs of residents are always met. A record is maintained of staff training and records showed that staff have undertaken training in essential areas such as fire safety, infection control, moving and handling, nutrition, food hygiene and safeguarding adults. Other training undertaken by staff has included safe handling of medication, nasogastric feeding, pressure care and management of supra-pubic catheters. The AQAA completed by the manager stated that 50 of care staff are qualified to National Vocational Qualification (NVQ) level 2 or above, and another cohort of staff are currently in the process of enrolling. Several staff spoken to confirmed that they have undertaken training in dementia care, and that this has given them an increased awareness of the needs of people living with dementia. A discussion took place with the manager around the recently introduced Mental Capacity Act 2005, and the impact it will have upon the delivery of care to vulnerable people. It is essential that all staff working in the home receive adequate and appropriate training in this important area. The files of the two most recently employed staff were inspected. Both files were in good order with necessary checks such as Criminal Records Bureau (CRB) disclosures, Nursing and Midwifery Council (NMC) PIN numbers, Statement of Entry, and application forms duly completed. However, on one file despite repeated requests to one named referee, they had not sent a written reference. A verbal reference had been obtained but this was not on the individual’s file, and had not been followed up in writing. The written procedures for the recruitment of staff are robust and provide safeguards for people living in the home. However, the manager must ensure that all such procedures are consistently followed by staff around the recording and follow up of any verbal references. Southern Cross Limited; as an organisation, employs a workforce from diverse cultures and backgrounds. It was apparent at the time of the inspection that generally the ethnicity of the staff team was different to that of the people living in the home. In discussion with the manager and staff they were able to demonstrate an awareness of the importance of understanding and appropriately meeting the needs of all residents, wherever possible around equality and diversity issues. The home celebrates diverse cultural festivals and incorporates activities in consideration of individual’s ethnic backgrounds. It is important that the manager continues to reinforce this awareness through staff training and supervision. This will ensure that the spiritual, dietary, cultural, sexual and any other diverse need of service users at Alexander Court is met through meaningful ‘person centred’ care. Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The manager of the home is a well qualified and experienced person and residents benefit as the home is run in their best interests. Staff are appropriately supervised and the health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The manager has the qualifications and experience to manage the home and is able to demonstrate a clear understanding of the diverse care needs of the residents accommodated in the home. Ms Starbuck is very resident focused Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 24 and works continuously to improve the service and provide an increased quality of life for residents with the support of a committed staff team. From viewing staff records and talking to staff it was evident that staff receive regular supervision, which includes observation, peer and one to one supervision. Staff meetings are held regularly and are minuted. The responsible individual undertakes Regulation 26 monitoring visits on a monthly basis to monitor and report on the quality of the service being provided in the home. A copy of the report of each visit is provided to the manager and was available on the day of the visit for the inspectors to view. However, in the future a copy of each report must be sent to the Commission. Currently the manager does not act as an appointed agent for any resident. Residents’ financial affairs are managed by their relatives/ representatives. The home has responsibility for the personal allowances of a several residents. Through discussion with the home’s administrator and records inspected, there was evidence to show that residents’ financial interests are safeguarded. Secure facilities are provided for the safekeeping of money and valuables held on behalf of residents. A wide range of records were looked at including fire safety; emergency lighting; lift and hoist maintenance/ service; gas and electrical certificates, and accident/ incident reports. All these were found to be in good order and up to date. Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 25 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13(2) Requirement The registered persons must ensure that insulin is stored appropriately at all times and in line with the product license. The registered persons must ensure that all residents receive a varied, appealing, wholesome and nutritious diet, which is suited to individual assessed needs. The registered persons must undertake a review of staffing levels to ensure that there are sufficient staff at peak times, such as mealtimes and when undertaking social activities. The registered persons must ensure that the home operates a robust recruitment procedure in line with regulation and the home’s recruitment policy. All verbal references must be recorded on the individual’s file and followed up in writing. Timescale for action 27/11/07 2 OP15 16(2)(i) 31/01/08 3 OP15 OP27 18 28/02/08 4 OP29 19 Schedule 2 27/11/07 Alexander Court Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 27 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 Care Centre DS0000029331.V353926.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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