CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE
Alexander Court Care Centre 320 Rainham Road South Dagenham Essex RM10 7UU Lead Inspector
Ms Rhona Crosse Unannounced Inspection 29 September 2005 09:15 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 Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People 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. Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 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 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 Care Home 82 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (40), of places Physical disability (12) Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25 July 2005 Brief Description of the Service: Alexander Court is a purpose build care home providing 24 hour nursing care to 80 service users. The home comprises of 5 units each unit has it’s own bathrooms bedrooms and communal lounge areas. Each unit is staffed separately. The home is set back from a busy road and has it’s own grounds and ample parking space for visitors. There is a mix of age and need within the home, therefore this report relates to older people and younger adults who have physical disabilities. Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced therefore the home did not know the inspector was coming. The inspection commenced at 09.15 hours and ended at 18.15 hours. The premises were inspected. Documentation was inspected (care plans, risk assessments, daily records, accident reports and records relating to healthcare needs). Discussions took place with service users and relatives who were visiting at the time of the inspection, the manager and staff. The home has a new acting manager who has put forward an application to become the register manager with the Commission. The acting manager took over the home at a time when there were serious concerns about the operation of the home. Alexander Court has been poorly performing for some time and due to concerns about the operation of the home the Commission have met with the Providers and the new acting manager. This meeting discussed what improvements must take place to bring the home up to the National Minimum Standards and comply with the Care Homes Regulations 2001. As a result of this meeting the providers were asked to undertake weekly monitoring visits to the home and write a report on their findings, this report was to be provided to the Commission. This task has been undertaken by a designated senior manager. A consultant has been employed to work with the acting manager to look at the operation of the home and give advice on improvements that could be made. The home has also had over and above the required amount of inspection visits (2 per year). The Commission served a Statutory Notice on the home as the home took too long to seek medical attention for service users who had been involved in accidents. This means is the home delays again seeking medical attention the Commission could prosecute them. The Commission will continue to monitor the operation of the home through unannounced inspections. Two adult protection cases were instigated this resulted in Barking and Dagenham Social Services not filling any vacancies the home has, until the outcome of the investigations are completed. The local authority made recommendations arising from their investigations. These included those concerning: completing body maps, more appropriate staff handovers and careful use of cot sides, following a service users admission to hospital she was found to be “nutritionally deficient”. The owners of this home have agreed to get a nutritionalist/dietician to advise about the food provided to all service users and send the results to the Commission. Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 6 Since the last inspection there has been an improvement in the operation of the home, but there is still a lot of work that has to be undertaken by all staff at the home to improve and maintain an acceptable level of care as evidenced in this report. What the service does well: What has improved since the last inspection?
The home has a new GP who visits and holds a ‘surgery’ there each week. There has been an improvement in the reviewing of care plans. Fluid charts are now being appropriately completed. The manager has completed a dependency assessment for each service user. The dietician from King Georges hospital has visited the home to assess the dietary needs of several service users and give advice. The specialist diabetic nurse has also been asked to visited the home and given advice. All staff have been assessed on how they are lifting and handling service users. Further lifting ad handling training is also being provided by an outside trainer. Each care plan now identifies the manual handling equipment required for the service users. On the day of inspection service users were not seen left in wheelchairs that were not designed for that purpose, all were seated in arm chairs. Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 7 A training plan has been put into place and training has commenced. Training in the protection of vulnerable adult has taken place over 2 days in September. In August health and safety training took place and dealing with falls and injuries also took place. The specialist diabetic nurse is to visit the home on the 4/10/05. Food hygiene training is booked to take place on the 11/10/05, health and safety training is to take place on 12/10/05. Manual handling training is to take place on the 17 & 18 October and health and safety training for night staff is booked to take place on 1/11/05. A comments book has been placed on each unit for service users to make comments about the food provided. Dementia training is also to take place this year. The manager is a qualified trainer and will hold these training sessions herself in November. The manager is a trained nurse, she is to commence the NVQ 4 managers training this year. The manager is considering starting a ‘library’ to provide information that staff can read about specific medial conditions they may be dealing with. What they could do better:
Closer monitoring of all care plans is required as the inspector observed from daily records that changes recorded were not always reflected in the care plans when the needs of a service user changed. Where there was a weight loss recorded, the information was not acted upon to reassess the care required and no food chart was commenced. For a further service user the care plan identified two types of diet (pureed and soft diet). The exact type of diet the service users should be having must be recorded. There was no risk assessment for ‘swallowing’ this must be put into place. One accident, although recorded in the accident book was not then referred to in the daily records. Staff would therefore not know to look for any signs and symptoms of a fall later in the day. For another service user the ‘falls’ care plan had been updated, it stated there were no falls reported for the last 4 weeks. However the inspector found that the service user had a fall prior to the updating of the care plan. One accident was poorly recorded with information in the daily records contradicting the entry made on the accident form. In discussion with the nurse who completed the record it was established why the contradiction in recording had occurred. However all staff must clearly state in any record the care being provided at any one time. A risk assessment for one service user had not been updated as required (on the 21/8/05 and 24/9/05 the service user had locked the bedroom door from inside and then the service user had fallen to the floor). Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 8 For a further service user who has Epilepsy had no care plan to inform staff what to do in the event of a seizure taking place. Also the risk assessment did not link the information in the daily records that stated that the service user was refusing the medication to control the seizures. This may have serious implications to the health of the service user. This highlights the importance of cross-referencing information held in different documents to ensure the wellbeing and health of this service user. During an inspection of the lounge a tablet was found by the inspector on a lounge chair. Anyone administering medication must ensure that service users have enough water to enable them to swallow any medication given and that they do not hold medication in their mouths. The inspector saw two instances of poor manual handling. This places the service users at risk. This was brought to the attention of the manager. Comments made about poor response to call bells and an inappropriate verbal response by staff to a service user who was requesting assistance were raised with the manager, and must be dealt with. This could be achieved either through formal written supervision or by discussing staff attitude in a general staff meeting. The action taken by the manager is to be provided to the Commission in writing identifying how this has been dealt with. 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 DS0000029331.V254020.R01.S.doc Version 5.0 Page 9 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) Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 10 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): 3. The home does not provide the service standard 6 applies to. These standards were met. Assessments are carried out to ensure that the home can meet the needs of any proposed service user. EVIDENCE: The home carries out its own written pre-admission assessment prior to any service user being admitted into the home. Assessments were observed to be appropriate and held on service users files. Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 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, 10 and 11. Standard 9 will be inspected at further inspections. Standard 9 (medication) was inspected by the pharmacy inspector prior to the last inspection of the home. A separate report was written for this inspection. There has been improvement in general in relation to information held in care plans, risk assessments and other documentation. Of a random selection of care plans, closer monitoring is required to ensure the health and wellbeing of service users is not compromised by lack of updating records as changes occur. EVIDENCE: Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 12 Continued monitoring of all care plans is required as the inspector observed from daily records that changes recorded were not always reflected in the care plans when the needs of a service user changed. Also where there was a weight loss recorded, the information was not acted upon to reassess the care required and no food chart was commenced. For a further service user the care plan identified two types of food pureed and soft diet. As there is a marked difference in the consistency of these diets the records must be changed to reflect the exact type of diet the service user should be having. (this person had been assessed recently by the speech and language therapist). There was no risk assessment for poor swallowing function which could lead to choking or aspiration of food/fluids, this must be put into place. One accident although recorded in the accident book was not then referred to in the daily records. Staff would therefore not know to look for any signs and symptoms of a fall later in the day. For another service user the ‘falls’ care plan had been updated, it stated there were no falls reported for the last 4 weeks. However the inspector found that the service user had a fall prior to the updating of the care plan. One accident was poorly recorded with information in the daily records contradicting the entry made on the accident form. In discussion with the nurse who completed the record it was established why the contradiction in recording had occurred. All staff must clearly state in any record the care being provided at any one time. A risk assessment for one service user had not been updated as required (on the 21/8/05 and 24/9/05 the service user had locked the bedroom door from inside and then the service user had fallen to the floor) placing themselves at risk. For a further service user who has Epilepsy had no care plan to inform staff what to do in the event of a seizure taking place. Also the risk assessment did not link the information in the daily records that stated that the service user was refusing the medication to control the seizures. This may have serious implications to the health of the service user. This highlights the importance of cross-referencing information held in different documents to ensure the wellbeing and health of this service user. During an inspection of the lounge a tablet was found by the inspector on a lounge chair. In discussion with the nurse it was established who had been sitting in the chair and what the tablet was (Lisinopril 2.5mgs). Anyone administering medication must ensure that service users have enough water to enable them to swallow any medication given and that they do not hold medication in their mouths. Information relating to the needs and wishes of service users at the time of death are being entered onto care plans.
Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 13 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 and 15. Standard 14 will be inspected at further inspections. Standard 12 is well managed with activities well planned and carried out throughout the day. Service uses should be more involved with menu choices. This should be discussed by the cook with the more able service users. EVIDENCE: It was stated that there are no restrictions placed on visiting times by the home. Throughout the day visitor’s were seen to come and go at different times. Local services within the community are used for recreational purposes.
Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 14 In discussion with service user who were able to give a view of the service provided they stated, “yes we have a choice of what we want to eat, but I can’t remember what I’ve chosen for today.” “there is a 5 minute menu of alternatives choice that’s good if you change your mind, they’ll cook you something else if you ask”. Comments in relation to the food provided were in general supportive of the cook and praised his efforts to provide an appatising meal. Two service users made comment that the salmon was “over cooked and hard”. Other comments were “ we would like more interesting puddings instead of cake and custard” “more fruit would be nice, that will help our systems to get going, you get sluggish when you get old.” All service users praised the cook for the good roast dinners provided both during the week and at weekends. Service users said “the roast dinners are good, very good we always get a nice roast.” “Spaghetti bolognaise is very good”. The omelettes provided by the home were criticised. These omelettes (brought in ready prepared as frozen food) were said to be “omelettes are like the soles of your shoes, rubbery”. “If the cook makes them himself they are fine, we don’t like the rubbery ones”. Pastry was said to be sometimes undercooked (puff pastry on pies) and rice pudding was said to be “sometimes stodgy and needed more milk and a drop of jam in it.” “We would like more fresh vegetables”. In discussion with the cook it was established that there is always one fresh vegetable served each day as well as frozen vegetables. The cook should address the above comments as although there was some unhappiness about particular foods, in general all were satisfied. The home has started comment books for service users and staff to assist service users to make suggestions to the cook on all units to gauge what is liked and where any improvements need to be made. In the afternoon the cook was observed taking fresh fruit around the units. The main meal on the day of inspection was a roast chicken dinner. In discussion about the choice of when to rise in the morning and time to go to bed at night, service user state “yes you have a choice about going to bed, I don’t like to go early, some do, they want to go to bed straight after tea.” “You can go to be when you like” I go up to my room in the early evening” I like time to myself by then”. A random selection of records evidenced that service users go to bed at different times, some staying up to watch films on the television on a regular basis. Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 15 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): 16 and 18 The manager must address concerns raised with the inspector by service users and relatives in this section of the report. The home is responsible for the conduct of staff at all times and must therefore deal with the concerns raised. The home must be run in the best interests of service users and ensure service users are protected from abuse of any kind. EVIDENCE: The home has a policy and procedure for dealing with complaints. All staff have attended training in the protection of vulnerable adults. In discussion with service users and relatives it was established that there were varying degrees of satisfaction with the service provided. Issues around good practice and poor practice were raised. These were discussed with the manager who must take the appropriate action to satisfy the concerns raised. This could be achieved by holding a general staff meeting about staff attitude, or through formal written supervision with staff identified. For one service user the physical care given by a particular member of staff was said to be good. However there was an instance where the staff member
Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 16 made an inappropriate comment to a service user who was requesting assistance. This comment was also heard by a relative. Care staff must not suggest that a service user will ‘get into trouble’ if a call bell is rung for assistance. This is an unacceptable statement for a staff member to make. This must be addressed by the manager. Staff must provide appropriate care to service users at all times and must be courteous and helpful. It was also stated that sometimes call bells are left unanswered for long periods of time. This should be investigated by the manager. A service user said that a face flannel was pushed into her face and she was told to “wash your face with that” the service user demonstrated to the inspector how this was done and was quite upset by recalling this. This must be addressed by the manager to ensure staff provide appropriate care at all times. Comments made were also in praise of staff and the service in general that is being provided since the new manager has been in post. Relatives said “there has been changes for the better, nothing is too much trouble for the staff.” “The staff seem to have endless patience, I couldn’t do the job.” Relatives stated that “if we raise any concerns they are dealt with by the manager.” Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 17 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, 21, 22, 24, and 26. Odour control is poor on unit 3 and needs to be improved (the odour in the lounge area was being investigated by the manager at the time of the inspection). Odour control in unit 1 in the shower room was poor. These standards are not well managed and reflect on the comfort of service users. EVIDENCE: Although there is a programme of redecoration taking place, the woodwork in Unit 1 requires decoration as this is badly scored by wheelchairs and general wear and tear.
Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 18 The bath hoist in unit 1 was found not to be working appropriately when tested by the inspector. The manager had not been informed of this. This must be repaired to provide a choice of bathing facilities as the only other option is using the shower room. A random selection of bedrooms were inspected. The majority were clean and tidy. Bedroom 61 had a poorly made bed. The manager remade the bed with a care assistant. Bedroom 57 had a pillow that was lumpy and misshapen this was removed immediately by the manager and replaced with another pillow. The shower room in unit 3 (daffodil unit) requires decorating. This room had an odour of stale urine as soiled clothing was placed in a laundry bag stored in this room. This bag does not have the ability to close therefore the odour from the soiled clothing was overpowering in this room. This is poor infection control. All soiled clothing should be taken to the laundry room straight away after the service user has been changed. There is an odour problem on unit 3 in the lounge area. This must be addressed. Unit 4 and unit 5 were clean, tidy and free of odours. Specialist lifting equipment, specialist beds and pressure relieving equipment is provided by the home. Aids and adaptations are provided in bathrooms and W.C.’s. Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 19 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 and 30. Standard 29 was inspected at the last inspection. All service users had a needs assessment carried out by the manager to ensure that staffing levels met the needs of the service users accommodated. It would appear that staff deployment was not appropriate rather than a shortage of staff. Now this has been addressed the wellbeing of service users should improve. Staff training is now taking place this will assist staff to care appropriately for service users. EVIDENCE: Staff training is now being addressed with training taking place. A training plan has been put into place and training has commenced. Training in the protection of vulnerable adults has taken place over 2 days in September. In July medication training took place. In August health and safety training and food hygiene training took place. Training in dealing with falls and injuries also took place in August. The specialist diabetic nurse is to visit the home on the 4/10/05. Further food hygiene training is booked to take place on the 11/10/05 and further health and safety training is to take place on 12/10/05
Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 20 Manual handling training is to take place on the 17 & 18 October and health and safety training for night staff is booked to take place on 1/11/05. There were sufficient staff at the time of the unannounced inspection to meet the needs of service users. However due to the number of unexplained accidents in the home, they must be vigilant with the supervision of service users. Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 21 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): 36 and 38. Standard 36 (staff supervision) is now being put into place. This is an important part of the management of the home as this identifies staff competency and can also be used to identify areas where improvements need
Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 22 to be made in work practice, therefore improving the standard of care for service users. EVIDENCE: Staff are receiving formal written supervision sessions. The manager has supervised the trained nurses, some of which have had several supervision meetings. The manager is aware that all staff must have the minimum of 6 supervision sessions within one rolling year. The inspector saw two instances of poor manual handling (a sling was not straightened out when being used and was crumpled up on the inside of the service user’s legs, this will cause discomfort when being lifted and can also cause bruising. A service user was assisted to get up out of a wheelchair without the brakes of the wheelchair being applied). This was brought to the attention of the manager. Poor manual handling places service users at risk. All staff must have basic training in first aid. Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 23 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 x 2 x 3 3 4 x 5 x 6 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 ENVIRONMENT Standard No Score 19 1 20 X 21 3 22 3 23 X 24 2 25 X 26 1 STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 X 32 X 33 X 34 X 35 X 36 3 37 X 38 2 Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 24 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 OP7YA6 Regulation Requirement Timescale for action 15/12/05 2 OP8YA9 3 OP8YA19 4 OP8YA19 5 OP8YA17 6 7 OP15YA17 OP18YA23 15(1) & (2) Care plans must be updated as changes occur to the needs of service users. Car plans must hold all information about the needs of service users. 14(2)(a) & Risk assessments must hold all (b) the relevant information relating to the current needs of the service user. 12(1)(a) The home must make proper 13(4)(c) provision for the care of service users (medication found on a lounge chair). 17(1)(a)(k) Accidents recorded in the accident book should also be recorded in the daily records to ensure that staff are aware to look for signs and symptoms of a fall that may appear later. 16(2)(i) Improve the quality of cooking in the areas identified in the report (as discussed with the Chef). 12(3) Ascertain and take into account service users wishes about menu changes they would like. 13(6) & The manager must ensure that 12(1)(a) staff attitude to service users is appropriate and that staff work
DS0000029331.V254020.R01.S.doc 15/12/05 31/10/05 31/10/05 31/10/05 15/12/05 31/10/05 Alexander Court Care Centre Version 5.0 Page 25 8 OP18YA23 12(1)(a) 9 10 11 12 13 OP19YA24 OP19YA24 OP19YA24 OP26YA30 OP26YA30 23(2)(c) 23(2)(d) 23(2)(d) 16 (2)(k) 13(3) & 16(2)(k) 13(5) within the framework of the code of conduct. The manager should investigate the comments that call bells are sometimes are not answered for a long time. Repair the bath hoist in unit 3 Decorate the shower room n unit 1 (walls and woodwork. Decorate the walls and woodwork in unit 1 Odour control is poor on unit 3. This must be improved. Also in unit 1 in the shower room. Do not store foul laundry in the shower room of unit . Soiled clothing should be taken to the laundry room. Moving and handling service users must be carried out appropriately (2 instances of poor moving and handling were observed). All staff must be trained in basic first aid. 30/11/05 30/10/05 31/12/05 31/12/05 30/11/05 31/10/05 14 OP38YA42 31/10/05 15 OP38YA42 13(4)(c) 31/12/05 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 OP15YA17 Good Practice Recommendations The cook is recommended to discuss new menus with service users to ensure they met their likes/dislikes. Alexander Court Care Centre DS0000029331.V254020.R01.S.doc Version 5.0 Page 26 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
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