CARE HOMES FOR OLDER PEOPLE
Alexander Court Care Home Raymond Street Thetford Norfolk IP24 2EA Lead Inspector
Mr Jerry Crehan Unannounced Inspection 24th January 2006 10:45 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 Home DS0000065309.V280210.R01.S.doc Version 5.1 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 Home DS0000065309.V280210.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Alexander Court Care Home Address Raymond Street Thetford Norfolk IP24 2EA 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) 01842 753466 01842 753467 Ashbourne (Eton) Limited Position Vacant Care Home 47 Category(ies) of Dementia - over 65 years of age (29), Old age, registration, with number not falling within any other category (18) of places Alexander Court Care Home DS0000065309.V280210.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: The Care Home may accommodate up to 18 older people, and 29 older people who may have a diagnosis of dementia. The total numbers not exceed 47. Date of last inspection 30th June 2005 Brief Description of the Service: Alexander Court is a purpose built care home providing residential care for up to 47 older people, 29 of whom may have a diagnosis of dementia. Built in 1998, the home is situated in the town centre of Thetford giving easy access to local shops and other community facilities. The accommodation is provided on two floors serviced by a shaft lift and stairs. All rooms are designed for single occupancy and contain en-suite toilets and wash hand basins. There are enclosed patio areas and grounds. Alexander Court is one of several homes in Norfolk owned by the proprietors. Alexander Court Care Home DS0000065309.V280210.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6.5 hours. Opportunity was taken to tour the premises, look at care records and policies, and communicate with many of the forty-seven service users, visiting relatives and staff members in addition to the manager. What the service does well: What has improved since the last inspection?
The home is commended in the report for making efforts to make service users bedrooms more accessible, and to promote their use as an alternative to the main communal areas. The home now offers finger foods to service users with dementia as a means to maintain nutrition. The facilities on the first floor have been improved by the installation of a servery that enables staff, service users and relative’s easier access to drinks and snacks if required. Other environmental improvements at the home are noted. These include better signage for service users in both communal areas and on bedroom doors, objects of interest introduced into the environment, and improvements to personalising bedroom areas for service users on the first floor. The quality of the care and the experience for service users with dementia as a consequence of each of the above areas of improvement has improved. The home has experienced a period of significant difficulty over the past year; however, the newly appointed manager has made a positive impact in managing the home in a relatively short time. This is confirmed in feedback from service users and staff. Alexander Court Care Home DS0000065309.V280210.R01.S.doc Version 5.1 Page 6 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 Home DS0000065309.V280210.R01.S.doc Version 5.1 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 Home DS0000065309.V280210.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, 6 The home provides clear information that would assist service users in making an informed choice as to the home’s ability to meet their needs. The needs of prospective service users are appropriately assessed. EVIDENCE: There is an admission procedure that adequately guides the manager, or other senior staff responsible for assessment, as to actions to be taken to ensure service users needs are assessed prior to a move to the home. Evidence of assessment was seen. Assessment evidently involves service users directly. The home has clear written information available to prospective service users, which would provide them with a good understanding of the home’s capacity to meet individual need, including needs arising from dementia. The home does not provide intermediate care. Alexander Court Care Home DS0000065309.V280210.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&8 Service users health and personal care needs are well attended to, though further improvements in respect of falls should be made. EVIDENCE: Individual care plans were sampled and provided evidence of the involvement of service users, and of regular review. Some care plans seen also contained evidence of the gathering of relevant ‘social’ or ‘life’ history information; this should be extended to include all service users. The accuracy of individual care plans was reflected in feedback from service users, who indicated that care staff are aware of their needs. The recording of information in respect of service users falls must provide more detail of the time and circumstances of the fall in order that appropriate interventions can be carried out. Most of this information was available within care plan documentation though is not easily accessible. Care plans refer to the involvement of a variety of community health professionals. Service users confirmed access to, among others, the G.P, chiropodist and optician. Alexander Court Care Home DS0000065309.V280210.R01.S.doc Version 5.1 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 15 The home is developing a range of leisure and social activities to satisfy most service users. Visitors are made welcome. EVIDENCE: A dedicated activities coordinator has been appointed on a part time basis since the last inspection of the home. Relatives spoken to indicated that activities at the home had improved and that there was more for service users to do. A weekly programme of activities is established and made available within the home. At the time of the inspection some service users were undertaking a trip into the local community, others were undertaking activities or passing time in communal areas or in their own rooms. The home is commended for making efforts to make service users bedrooms more accessible, and to promote their use as an alternative to the main communal areas. Service users indicated that their visitors were made welcome at the home at any time of their choosing, and that they usually saw visitors in the privacy of their own rooms. Service users are supported to manage their own affairs, and have promoted the use of external agents (e.g. advocates) where necessary. Service users gave a reasonable response as to the quality of the food at the home. There were two main meal options on the day of the inspection, with
Alexander Court Care Home DS0000065309.V280210.R01.S.doc Version 5.1 Page 11 further alternatives provided if preferred. The home now offers finger foods to service users with dementia as a means to maintain nutrition. It was also evident that every service users bedroom now has water available for service users throughout the day. The home is commended for these improvements. Another improvement to the facilities on the first floor is the installation of a servery that enables staff, service users and relative’s easier access to drinks and snacks if required. Alexander Court Care Home DS0000065309.V280210.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 The arrangements for protecting service users legal rights are satisfactory. EVIDENCE: Service users have access to relatives or friends, many of whom assist service user in managing their affairs. As already indicated there is also access to support from independent advocacy services. Service users are able to take part in the political process, voting by postal ballot. Alexander Court Care Home DS0000065309.V280210.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21, 23, 24, 25 Service users live in an improving environment that is comfortable and safe, though there are maintenance issues that compromise service user privacy. EVIDENCE: There are suitable and adequate toilet, shower and bathing facilities that are accessible for service users, though it was noted that a locks to two communal toilets on the first floor were missing compromising service user privacy. Communal toilets contained open top bins for paper waste. It is recommended that swing top bins be provided in toilets to ensure waste is discretely stored. Service users own rooms appear to suit the individual needs and preferences of their occupants with all of the bedrooms designed for single occupancy. Notable efforts have been made to improve the bedroom areas for service users on the first floor. Service users have been further supported in recognising their own rooms through personalised information on bedroom doors. Other signage has improved and objects of interest introduced. Bedrooms are evidently much more easily accessible for service users, who were observed using their bedroom space more than at previous inspections of
Alexander Court Care Home DS0000065309.V280210.R01.S.doc Version 5.1 Page 14 the home. Bedrooms on the first floor were more personalised and looked more comfortable than at previous inspections of the home. Bedrooms on the ground floor were also clearly personalised with service users own furniture and possessions. Bedrooms are naturally and individually ventilated. All bedrooms and communal areas have natural light with artificial lighting supplementing the available natural light where necessary. Bedrooms are all centrally heated and heating can be controlled in the service users own room. Alexander Court Care Home DS0000065309.V280210.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 28 Staff at the home are employed in sufficient numbers, have a good understanding of service users support needs. The staff training programme addresses service user needs, though numbers of NVQ trained staff remain too low. EVIDENCE: There were six members of care staff an activities coordinator and the manager on duty at the time of the inspection supporting forty-seven service users living at the home, providing an adequate staffing level. Staff working with service users with dementia is evidently provided access to appropriate training to this specialist role. It is evident from staff spoken to that there is access to induction training and a full range of mandatory training. Comments from service users and relatives were favourable about the care provided by staff at the home. The manager advised that 15 of care staff have achieved NVQ 2 training (or above), with a further five staff registered to undertake the training, which would provide a ratio of 33 that is still below the minimum 50 trained members of care staff trained at NVQ level 2 (or above). Alexander Court Care Home DS0000065309.V280210.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 37, 38 The home is well managed by a new manager who is well regarded by service users, relatives and staff alike. The home is run in the best interests of service users. EVIDENCE: The new manager was appointed to the post of General Manager several months ago. She is a Registered Mental Nurse with management experience in the care sector. Both service users, relatives and staff spoke in favourable terms about the new manager who is evidently well thought of despite her relatively short time in post. It was also evident during the inspection that the manager had familiarised herself with the needs of the service users at the home. The manager described strategies that are and will be employed at the home to ensure that it is run in the best interests of service users. These include regular audits of care and premises, and relatives and residents meetings (that
Alexander Court Care Home DS0000065309.V280210.R01.S.doc Version 5.1 Page 17 have already taken place). Regular staff meetings have been established; a customer care audit (in the form of a questionnaire) will be carried out. These measures described are welcomed and outcomes measured at future inspection. Service users financial interests are safeguarded by the home; their relatives manage the vast majority of service users financial affairs. The home has appropriate policies and procedures, and satisfactory record keeping practices. It seeks to promote the health, safety and welfare of its service users. Alexander Court Care Home DS0000065309.V280210.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X X X 2 X 3 3 3 X STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 X X 3 3 Alexander Court Care Home DS0000065309.V280210.R01.S.doc Version 5.1 Page 19 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 OP8 Regulation 13(4)(b) Requirement Timescale for action 24/01/06 2 OP21 12(4)(a) 3 OP28 18(1)(a) The registered person must ensure that appropriate interventions be carried out in respect of service users identified at risk of falls. The registered person must 24/01/06 ensure that the home is conducted in a manner that respects the privacy and dignity of service users. The registered person must 30/06/06 ensure continued progress toward meeting a minimum ratio of 50 NVQ 2 (or above) trained staff. 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 OP21 Good Practice Recommendations It is recommended that swing top bins be provided in toilets to ensure waste is discretely stored. Alexander Court Care Home DS0000065309.V280210.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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