Inspection on 03/12/07 for Alexander Court Care Home

This inspection was carried out on 3rd December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Alexander Court Care Home 07/06/07

Alexander Court Care Home 08/06/06

Alexander Court Care Home 24/01/06

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Alexander Court Care Home Raymond Street Thetford Norfolk IP24 2EA Lead Inspector Mr J Crehan, Mrs H Stephenson & Mr M Andrews Unannounced Inspection 3rd December 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 Home DS0000065309.V356023.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 Home DS0000065309.V356023.R01.S.doc Version 5.2 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 alexandercourtnh@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Application Pending 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.V356023.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named person with the category DE for the duration of that person’s residence and until that person reaches the age of 65; once either scenarios occurs this category will lapse and the registration will revert to DE(E) 29. 7th June 2007 Date of last inspection 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. The range of weekly fees for care at the home is £341 to £500. Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. This report gives a brief overview of the service and current judgements for each outcome group. Before the inspection the Manager of the service completed a lengthy questionnaire about the service. Fourteen comment cards were received from relatives of people who use the service; five comment cards were received from people who use the service and six from staff who work at the home. These generally reflected very positive views about the home, its management and the care provided by staff. Many comments received via comment cards or received directly on the day of the visit to the home noted the recent improvements at the service since the arrival of the new manager Ms R Claxton. This key inspection compromised an unannounced visit to the home that took place over 7 hours on 3rd December 2007. Opportunity was taken to tour the premises, look at care records and policies, and communicate with residents, visiting relatives, visiting professionals, care staff and the manager. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. The inspection of the medication standard was conducted by pharmacist inspector Mr M Andrews. This inspection follows a similar inspection undertaken on 03/05/07 and 07/06/07 when serious concerns were identified in relation to the home’s medicine management practices. Since the last inspection there have been two reported medication-related incidents during July 2007 where the health and welfare of residents was placed at risk. The findings of this inspection were discussed with Ms R Claxton. Adult Protection team investigations (lead by the Police) into alleged medicine mismanagement and wilful neglect was ongoing at the time of this report. The Proprietor’s have agreed with the Commission (and commissioners of care services) not to accommodate any new residents while there remain concerns about care practices and this investigation is still in progress. As a result of poor outcomes for people who use the service following the last inspection visit the Proprietor was asked to provide an improvement plan with clear timescales. The improvement plan provided to the Commission dealt comprehensively with the requirements identified in the last inspection report, and has evidently been a useful guide for the manager in addressing many of the difficulties that faced the home. Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 6 What the service does well: • • Care practice observed during the visit was good. Care staff were caring, respectful and attentive in their approach to residents. Meals looked well prepared and well balanced. Residents were complimentary about their lunch and the quality of meals in general. Recent changes to menus were clearly a response to the views and wishes of residents and their preferences. There are good records of complaints, that consider corrective action to be taken and consideration for future preventative action. Sample staff files and discussion with carers provided evidence that residents are protected by good staff recruitment practices. • • What has improved since the last inspection? • • Individual care plans (and risk assessments) have improved. Those seen indicate the care required to meet the individual needs of residents. Visiting professionals to the home commented on improvements over the past year and particularly since the new manager has been in post, noting that residents appear more settled and calm when they visit. The home’s social and recreational activities programme is developing and becoming more varied since the appointment of an activities coordinator. Residents said how much the social activities had improved since the activities coordinator had commenced. Staff in the home are better trained and supervised, and in sufficient numbers to adequately support the people who use the service. The Proprietor has developed a suitable training strategy. A manager is in post who has undertaken the appropriate professional training and who is experienced in managing services for older people. The well-being of residents has improved because the manager shows strong leadership and that she is committed to providing good quality care. • • • • Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 7 What they could do better: • Medication management and administration at the home has improved, however there remain some medication practices which do not safeguard the health and welfare of people who use the service. Residents care plans describing their individual care requirements are improved, however, there is evidence that these are not always followed. There are no facilities for residents to meet visitors privately other than in their own bedrooms. On the first floor the smaller of two lounges is used by some people to meet. This is unsatisfactory at present and will be compromised further when the area is used for activities as planned. To ensure that the mental health needs of people using the service are met there should be qualified, competent and experienced staff on duty who are trained in providing care to people who have dementia type illnesses. There should be staff available at the home at all times who are qualified to administer first aid if required. • • • • 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 Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Although this outcome area was not inspected. There is nothing to suggest that this people would not experience adequate outcomes in this area. EVIDENCE: This key standard was not inspected on this occasion. There have been no new admissions since the last inspection of the home due to a suspension on new placements agreed by the Proprietors the Commission and by commissioners of care services. This suspension was in place at the time of the last inspection. There were 36 residents living at the home at the time of the inspection visit. Alexander Court Care Home DS0000065309.V356023.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): 7, 8, 9, 10 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care provided at the home and care plans are improved, however, there is evidence that these are not always followed. Medication management and administration at the home has improved, however some medication practices do not safeguard the health and welfare of people who use the service. EVIDENCE: Each resident has an individual care plan and a sample of these were reviewed. Care plans include admission information, health, social and mental health care needs and risk assessments relevant to them, to enable them to be independent where possible. Each care plan has recently been reviewed. Each plan seen includes a risk assessment of individual care needs, such as moving and handling, continence, trips, and nutritional needs with weight management included. Some care plans contained additional information about the residents’ background in the form of a life story to assist the care staff to build a relationship with residents as individuals. Where this kind of information was in place it was completed very comprehensively. However, the Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 11 majority of care plans seen offer very limited individual social or life history of the resident. It was explained that this is work that is currently in progress and evidence of some progress was seen. It is recommended that social or life story work carried out by care staff and the activities coordinator at the home must continue as this contributes to improving the care for residents as individuals (See Recommendations). A resident had a fall in the corridor of the first floor during the mid morning. Through discussion with staff and a review of their care plan it was evident that they are at risk from falls. A falls risk assessment was in place that identified them at ‘very high risk’ from falls and gave instruction to staff as to what measures should be taken to reduce the risk of falling. A part of this care plan advised that staff should make sure the resident used their walking aid. However, she was not using her aid at the time of her fall in the corridor, so had evidently not been adequately supervised (See Requirement 2). Care staff were observed to be following correct procedures for hoisting residents throughout the day. Care plans and risk assessments indicate the care required to meet the individual needs of residents, and these incorporate professional advice from G.P’s, C.P.N’s and other visiting professionals. There is evidence of regular review and some evidence of the involvement of residents or relatives in those files sampled. (See Repeated Requirement 1). Visiting health professionals were spoken with during the inspection, including the District Nurse and Community Psychiatric Nurse. They commented on an improvement at the home over the past year and particularly since the new manager has been in post, noting that residents appear more settled and calm when they visit. They indicate that the home contacts them appropriately when necessary. Pharmacist inspector Mr M Andrews conducted the inspection of the medication standard. The inspector found the home has made some improvement to the systems in place for medicine administration. Resident-identifying photographs are now available alongside medication records for all residents. There was documentary evidence on medication charts where doses of medicines had been reviewed or discontinued by prescribers. Ms Claxton reported during the inspection that the home has made alternative arrangements for medicine supply and said that there have been occasions when the supply of medicines had been delayed. This has been resolved by obtaining newly prescribed short term courses of medicines from local pharmacies. On examination of current medication records there was little evidence of the non-availability of medicines therefore there is improvement in this area. The use of psychoactive (and sedative) medicines prescribed on a PRN (as required) basis and administered at the discretion of care staff was examined. There are fewer such medicines in use when compared to previous inspections Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 12 representing an improved outcome for residents. However, it was noted that for the use of these medicines the home still does not have written guidance available alongside medication charts to assist staff when considering the use of such medicines. There were, however, written protocols in place for the use of laxatives and painkillers prescribed for discretionary administration. Ms Claxton said that three care plans for such medicines were missing and agreed they should be held alongside MAR charts to assist in the safe use of such medicines (See Recommendations). The home now has a recorded risk assessment for a resident self-administering insulin by injection demonstrating that the home supervises the resident’s safety in self-administering this medicine. At the time of the previous inspection it was required that risk assessments are undertaken which include evidence that community nurses had been involved in checking that the resident can safely self-inject insulin. At the time of this inspection, Ms Claxton said that as the resident self-administers insulin at 10.00pm community nurses had declined to monitor this. It was noted that some residents are currently prescribed and administered eye drops. These medicines are of limited life after opening (28 days) but the home has not taken steps to ensure the medicines are used only for their limited lifetime therefore at the time of inspection their duration of use could not easily be determined. One container of eye drops was labelled with a date of supply of 07/11/07 and may have been close to expiry. Eye drops are usually safely handled by dating the containers at their time of opening (See Requirement 3). On conducting sample audit trails of medicines to attempt to account for them there were found to be a significant number of discrepancies where medicines were both in surplus and deficit. This is of serious concern because for these medicines, records do not demonstrate that medicines have been given to residents in line with their prescribed instructions. Most of the audit discrepancies identified during the inspection were checked and agreed with Ms Claxton during the inspection. Some discrepancies indicated that important medicines such as warfarin were not being given to residents as prescribed. There were also discrepancies of painkillers. Ms Claxton said that the home was routinely conducting internal audits. The most recent audit of medicines said to be carried out on 20/11/07 identified only two discrepancies and gave the home an overall score of 89 . The inspector told Ms Claxton he was concerned that the internal audit was unreliable (See Repeated Requirement 4 and recommendations). The inspector also identified record-keeping inadequacies in relation to the receipt of some medicines, the supply of medicines to hospitals when residents are admitted from the home and exact doses of some medicines administered when prescribed with variable doses (e.g. co-danthramer suspension 5-10ml at night). Without these records medicines cannot be accounted for and so Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 13 records do not confirm that medicines have been given to residents as prescribed. The inspector also identified records indicating that cardiovascular medicine furosemide liquid was given at double dose to a resident on 21/11/07 and 22/11/07. There was also evidence that two medicines prescribed for topical application were not being applied as prescribed (See Requirement 5 and recommendations). Ms Claxton confirmed that members of staff authorised to handle and administer medicines had received medicine management training. In addition, it was said that further training was being planned for all care staff. Medicine refrigerator temperature records were noted during this inspection to have recently been within the accepted temperature range. Observed care practice during the visit was good. Care staff were caring and attentive in their approach. Comments from service users seen on the day and in comment cards included ‘carers are nice – they make time to speak to you’, ‘it’s an excellent home in every respect’, ‘generally the response is good and prompt from staff.’ It was noticed that residents appearance was good, with the ‘little things’ being followed through such as many of the ladies wore make up and jewellery, as they may if they were at home. Residents spoken to stated that their right to privacy is respected at the home, and that their visitors are made welcome and can be seen in private if they wish. A resident stated that the Catholic priest visits them at the home when they ask for this. Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the services have access to a good diet and meals that are well prepared. Social and recreational activities are on offer at the home and sufficiently varied meet individual’s expectations. EVIDENCE: The home’s activities programme is developing and becoming more varied since the appointment of an activities coordinator. A group of residents were observed discussing topical news, and the hairdresser visited and several residents had their hair done. Inspectors spoke to several residents in the lounges and three in their own rooms in private. All residents stated how much the social activities had improved since the activities coordinator had commenced. Residents also spoke of the recent concert that some had attended at the local Guild Hall and how much they had enjoyed it. A resident on the first floor spoke about a trip they had taken with the activities coordinator to the local museum. Another resident spoke about looking forward to the home’s Christmas party. Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 15 Several residents on both floors of the home spoke of how much they had enjoyed cooking biscuits and making homemade sweets. One visitor spoke about how her mother has one to one sessions with the activities coordinator, enjoying a hand massage. The care plans record the activities that each resident has during each week. There were many visitors to the home throughout the day of the inspection. A musical afternoon takes place most weeks when an outside musician visits to play requests. Individual activities take place such as reminiscence, cards and games. Many of the residents ask to play bingo and this is arranged on a weekly basis, although those who do not wish to take part have their choice respected. Two of the fourteen comment cards received from relatives/visitors to the home note particular improvements to the provision of activities at the home over recent months ‘activities are greatly improved after the appointment of new activity person’, though two comment cards indicate there are further improvements required ‘garden needs maintaining, and in warmer weather residents should be taken down to the garden’. The manager described forthcoming environmental improvements to the home. Some of these will be to adapt a lounge area on the first floor into an activities room for residents. Discussion with residents and observation during the visit to the home provided evidence that the home supports their contact with relatives and friends, and that it enables residents to bring and keep their own possessions with them. As indicated above, there were many visitors to the home at the time of the inspection visit. However, it was noted that there are no facilities for residents to meet visitors privately other than in their own bedrooms. On the first floor the smaller of two lounges is used by some people to meet. This is unsatisfactory at present and will be compromised further when the area is used for activities (see environment section of this report). The bedrooms seen on the day of the inspection visit were reasonably furnished and equipped to suit the resident’s daily lifestyle and reflect their personal choices and preferences. Advocates are in place for residents who require someone to represent their interests. The lunch menu on the day of the inspection visit was roast turkey, mashed potato, carrots and cabbage. This was followed by fruit crumble and custard. The meals looked well prepared and well balanced. Residents were complimentary about their lunch and the quality of meals. Some residents had evidently opted for alternative options, while others with special dietary requirements had their needs met also. Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 16 A four weekly menu has been developed for the home. At the time of the visit the residents were experimenting with taking the main meal of the day at lunchtime. Up until recently the main meal has been provided in the early evening. These measures were clearly a response to the views and wishes of residents and their preferences. Many residents on the first floor of the home require assistance at lunchtime, and it was observed that care staff had difficulty in supporting their needs effectively despite the fact that there were four staff on duty. It is recommended that the manager consider staggering the lunchtime, or making other arrangements in order that residents can be assured of getting the support they need by carers who are not under pressure to support others at the same time (See Recommendations). Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 17 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): 16 & 18 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for responding to the concerns and complaints of people who use the service are good. People who use the service are protected from abuse. EVIDENCE: The manager keeps a record of all complaints. The home has dealt with five complaints since the previous inspection. All five of these complaints have been resolved with the required action taken. The majority of residents spoken to say they prefer to speak to the new manager or team leader if they have any concerns. There were no complaints from residents during the day of inspection. They also stated that the manager visits them everyday to check that they are properly cared for. A copy of the complaints procedure is displayed in the front hall. The manager advertises that she is available to visitors at a designated time if they have any concerns to discuss, although she states she can be available at any time. The home has an adult protection policy in place; this is discussed with staff when they commence employment. Staff spoken to have a basic Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 18 understanding of ‘whistle blowing’, and various forms of abuse. The manager has ‘Protection of Vulnerable Adults’ (POVA) training in place for the 5th & 14th December to update all the staff working at the home. The manager and deputy have attended a three-day POVA training course and have a clear understanding of their role within the care field. The home has made a number of appropriate referrals through the Norfolk adult protection protocol. The home has an ongoing adult protection investigation at present into alleged medicine mismanagement and wilful neglect. This is being lead by the Norfolk Constabulary and concerns allegations made prior to the last inspection of the service. It is evident from the inspection of the medication Standard (Standard 9) in this report that residents are still not fully protected by the homes medication practices. Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 19 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): 19, 21, 24 & 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment at the home is safe, and reasonably well maintained. It should be better designed to support the needs of people with dementia who use the service. EVIDENCE: A tour of the home’s environment was undertaken and there is evidence of ongoing replacement of old or worn carpets and furniture. The manager stated that she has been allocated a budget by the Proprietor for some major refurbishment and redecoration to improve the environment generally. This is welcomed as parts of the home are in need of redecoration, such as the dining area on the first floor and the corridor areas. Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 20 Bathing equipment that was faulty at the last inspection had been fixed and improved. However, at the time of the inspection one of the bath hoists broke. Manager ordered part required immediately. Accommodation for residents is decorated and furnished to a satisfactory or good standard. Doors to service users private accommodation is lockable and there are lockable facilities within each bedroom for money and valuables. The home is generally well equipped to provide comfort and meet the assessed needs of people who use the service. As indicated earlier in this report, there are plans to alter parts of the environment to change the use of some areas around the home to fulfil a different function. The plans described by the manager are a reasonable response to improve overall services offered at the home and fit with the policies of the Proprietor. If the plans go ahead these should consider the needs of residents and look to improve the environment on the first floor of the home in particular. At present the first floor does not provide a conducive setting for the provision of care for (up to) twenty-nine people with dementia and there is evidence that the high number of negative incidents (including assaults by residents on other residents) reported by the home are partly as a consequence of the inadequacies of the environment. There is a large lounge/dining room and a smaller lounge that (it is proposed) will become the activities room. There are no other communal areas other than bathrooms and corridor space. There is no quiet area for residents to spend time or to meet with relatives or visitors other than their own bedroom accommodation (See Requirement 6). The home is clean and tidy with appropriate infection control and hygiene practices in operation. There is a programme of infection control training for all staff beginning in January 2008. Alexander Court Care Home DS0000065309.V356023.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 who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are better trained and in sufficient numbers to adequately support the people who use the service. For this outcome to be good, people who use the service should be supported by staff with sufficient specialist training and expertise. EVIDENCE: There was sufficient staff on duty to fulfil their roles on both ground and first floors of the home. The duty rota confirmed that one team leader and two care staff covered the ground floor, one team leader and four care staff covered the first floor where dependency levels are higher. Overnight, the home is managed by a senior carer and three care staff who covered both floors. Staff communicate with each other on both floors using a radio. The home employs twenty-nine care staff, with adequate numbers of ancillary staff in place. Staff breaks are staggered to ensure that staff are available to meet residents needs. It was observed that call bells used by residents did not ring for long when attention from staff was required. Staff observed Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 22 throughout the day on both floors of the home were attentive to the needs of residents, respectful toward them and good at maintaining their dignity. The dementia qualifications of senior staff and care staff at the home are limited. All staff have recently received dementia awareness training, and many staff have experience of providing dementia care. However, there is an absence of staff at the home who are trained to a higher level. This is a significant factor given the home’s substantive registration is to provide specialist care to people with dementia. The recent steps taken by the Proprietor and manager to improve training and awareness are welcome, but further progress needs to be made. The manager has more advanced dementia training (she is a ‘Yesterday, Today, Tomorrow’ (YTT) trainer) and is being supported by the Proprietor to undertake a professional dementia qualification (See Requirement 7). Ongoing investment in staff training and support will be required to achieve the consistency and ‘ownership’ of care for residents with dementia at the home. Staff training records and discussion with the manager provided evidence that fourteen staff had attended challenging behaviour training. However, only one has an up to date first aid qualification (See Requirement 8). The home falls behind with the recommended NVQ training with only two care staff having NVQ level 3 and four staff having NVQ level 2. The manager stated that a further ten care staff have registered to commence NVQ training (See Recommendations). Sample staff files and discussion with carers provided evidence that residents are protected by good recruitment practices. Staff training records provided evidence of a range of mandatory such as health and safety, fire and moving and handling training with refresher courses where necessary; this was supported in discussion with care staff. The manager stated that all new staff undertake a three day company induction course, although all staff are commencing the ‘Skills for Care’ induction training as a refresher. Positive comments about the home and its staff were received from relatives and visitors to the home, such as ‘we have found the care to be excellent’ and ‘they are very welcoming now and there are some very good carers’. Other comments from residents included: ‘I sometimes have to wait for someone to come when I need them’, and ‘the home has improved in the last three months, but I would like to be put in a comfortable chair after meals’. Alexander Court Care Home DS0000065309.V356023.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): 31, 33, 36 & 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home promotes the health and care of people who use the service. Residents well-being has improved because the manager shows she is committed to providing good quality care. EVIDENCE: The manager although, not yet registered with CSCI has just completed the Registered Managers Award, and has NVQ level 4 in Management. She has many years of experience as both a proprietor and manager of services for older people. Whenever the manager is away from the home the deputy manager or one of the two team leaders is in charge of the home. However, the deputy manager has changed recently and this is regrettable as this service does need a period of stability at management level if the progress noted at this inspection is to be maintained. Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 24 The manager arranges residents, relatives and staff meetings, this was confirmed when speaking to a variety of people during this site visit. The most recent quality assurance exercise of the service was seen, with a record of how changes have been made as a consequence of taking on board the views of residents and others associated with the home. This exercise is a vast improvement for the residents since the new manager has been in post. Staff attend supervision with the manager or the deputy with the relevant records contained within the staff files. Staff commented positively about how well supported they felt since the new manager has been at the home, and that there have been significant improvements at the home since she took up post in the summer. The manager is described by staff as approachable, committed, and ‘firm but fair’. Other staff comments included: ‘I think we do a good job in taking care and meeting the needs of service users’, and ‘Alexander Court is an enjoyable place to work, the manager is very supportive and committed’. Comments from residents and their relatives were extremely positive and her efforts since taking up post in the summer have been noted in their comments to the Commission at the site visit and in comment cards, they include: ‘improvement under new manager’, ‘now there is a new manager I have noticed a big improvement’, ‘things are improving – now I am updated about problems’ and ‘as the care home has new management things are improving’. Maintenance records seen were satisfactory. Alexander Court Care Home DS0000065309.V356023.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 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X 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 2 2 X 3 X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 3 Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15(1) Requirement Timescale for action 31/01/08 2. OP7 12(1)(b) All people who use the service must have care plans that are drawn up with their participation. This is to ensure that all aspects of the health, personal and social needs of the service user are met. This Requirement Is Repeated from 07/06/07 inspection. The Manager must ensure that 03/12/07 the care home is conducted so as to make proper provision for the care and supervision of service users. This is to assist in ensuring the health and welfare of service users. People who use the service must have eye preparations safely handled by staff who follow safe procedures to ensure they are not used following their limited expiry times. 03/12/07 3. OP9 13(2)& 13(4) Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 27 4. OP9 13(2) & 13(4) 5. OP9 13(2) & 13(4) 6. OP19 23(2) (a&i) 7. OP27 18(1)(a) 8. OP27 18(1)(a) People who use the service must have medicines administered in line with prescribed instructions at all times and this can be demonstrated by the home’s record-keeping practices to protect their health and welfare. This Requirement Is Repeated from 03/05/07 and 07/06/07 inspections. People who use the service must have medicines received into the home, administered with prescribed variable doses and provided for hospital admission on their behalf fully recorded so that they can be accounted for at all times. The manager must ensure that the layout of the premises meets the needs of service users, and that they have suitable facilities to meet visitors in private accommodation separate from their own private rooms. The manager must ensure that there are at all times suitably qualified, competent and experienced staff in providing dementia care. This will help to ensure that the mental health needs of people using the service are met. This Requirement Is Repeated from 07/06/07 inspection. The manager must ensure that persons employed to work at the care home receive training appropriate to the work they perform. (First Aid) 03/12/07 03/12/07 31/03/08 31/03/08 29/02/08 Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 28 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 OP7 Good Practice Recommendations It is recommended that social or life story work is carried out by care staff and the activities coordinator at the home as this contributes to improving the care for residents as individuals. It is recommended that detailed care plans are written for the use of PRN medicines of a psychoactive nature for the management of psychological agitation and provided for easy reference by staff. It is recommended that internal auditing employed by the home to monitor medication management quality and identify discrepancies arising is effectively implemented. It is recommended that the manager consider staggering the lunchtime, or making other arrangements in order that residents can be assured of getting the support they need by carers who are not under pressure to support others at the same time. It is recommended that all care staff are supported to undertake NVQ 2 (or above) training to update their skills. 2. OP9 3. 4. OP9 OP15 5. OP28 Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. Extracts may not be used or reproduced without the express permission of CSCI Alexander Court Care Home DS0000065309.V356023.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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