Inspection on 07/06/07 for Alexander Court Care Home

This inspection was carried out on 7th June 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 03/12/07

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 Jerry Crehan, Mrs Susan Golphin & Mr Mark Andrews Unannounced Inspection 7th June 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.V342781.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.V342781.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 www.southerncrosshealthcare.co.uk 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.V342781.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 8th June 2006 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 £347 to £500. Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection compromised an unannounced visit to the home that took place over 8 hours on 7th June 2007. Opportunity was taken to tour the premises, look at care records and policies, and communicate with the home’s service users in addition to its staff, and the Acting Managers. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. Disruption resulting from changes in Management and a resulting lack of Managerial oversight has meant that pre-inspection information requested by the Commission was not provided. However, service user survey information has been provided and comments are incorporated within the report. There have been recent referrals to the Adult Protection team one of which involves alleged medicine mismanagement. 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 not to accommodate any new service users while this investigation in progress and concerns about care practices at the home. Three inspectors, including a specialist pharmacist inspector, carried out this inspection visit. Alexander Court is one of several homes in Norfolk owned by the Proprietors. What the service does well: • • An assessment of all new service users is carried out and all prospective service users are invited to the home with their relatives. Care staff show a commitment and dedication to their work in very difficult circumstances, with little consistent leadership. They maintain good relationships with, and have respect for people who use the service. There are good records of complaints, that consider corrective action to be taken and consideration for future preventative action. Many bedrooms are reasonably decorated and furnished, with evidence of personal possessions that reflect personal choices and options. This is a secure patio area that is very popular with service users, with raised flowerbeds that are well maintained. • • • Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: • The care of service users with dementia and cognitive impairments must be improved. They are being cared for by staff untrained to provide the specialist care they require. Health care practices do not promote the health and welfare of people who use the service. There are serious shortfalls in the home’s ability to safely manage medication practices, which places the health and welfare of service users at risk. A range of activities based on individual interests and wishes must be available. People who use the service have little or nothing they can do to satisfy their social and recreational needs. There are environmental improvements required to improve the ambience of the home, particularly on the first floor. People who use the service must be better protected from possible abuse and from poor care practices by a range of measures these include: consistent Management of the service, clear leadership, supervision of staff and support for staff, staff training in a range of mandatory and specialist areas (each indicated in this report), and suitable numbers of competent and experienced staff deployed to work at the home. • • • • • 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.V342781.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 & 4 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. Prospective people to use the service have their needs assessed, and access to all of the information they need about the service they may choose. The care of service users with dementia and cognitive impairments should be improved. EVIDENCE: The home has an assessment pro-forma (pre-admission assessment) used by the Manager or Acting Manager when collecting information. The document is well designed to help to ascertain the level of support required by prospective service users. A service user at the home commented that they were ‘shown around the home on a one to one with Manager who was helpful and made us feel at ease’. Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 9 There have been no new service users accommodated at the home since 30th April 2007. This follows an agreement between the Proprietor and the Commission to suspend all further admissions to the care home until adult protection investigations, lead by Norfolk Police, have taken place and are resolved to the satisfaction of all relevant parties. While this suspension is in place the Commission has and will review the information from the investigations on a regular basis and make a judgement as to whether satisfactory and safe arrangements are in place for the care of service users. The home currently accommodates several service users with significant dementia care requirements and cognitive deterioration. The home must take steps to provide and monitor care for these service users, ensuring their care is based on current good practice and guidance. It is recommended that monthly reviews for these service users considers the need for a wider review of their care and health (including mental health) needs, to consider the need for more specialist care (See Recommendation 1). Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 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. Service users health and their access to health care services are not adequately promoted by the service. Medication practices do not safeguard the health and welfare of people who use the service. EVIDENCE: Several care files were looked at during the site visit. Each contained individual care plans and risk assessments. There was no evidence that service users or their relatives are involved in the care review process or in care review meetings (See Repeated Requirement 1). Care files are messy and would benefit from being filleted following a review of information held, its value and purpose considered (See Recommendation 2). Risk assessments need to be reviewed. Some risks have been identified, but the safeguards and actions required by staff are not as clear as they could be for this vulnerable group. The care file of a service user indicated they have no wounds or open pressure areas, however, the person has been identified by Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 11 the home as at high risk of developing pressure areas to the extent that professional advice is sought. This has not been done. The Acting Manager was asked to arrange for the dietician to advise and also for the tissue viability nurse to visit and assess, as they may be able to offer different ways of promoting mobility and good tissue tone without using continual bed rest. Contact was made with health care professionals during the course of the inspection visit. Another service user’s care file indicates they have a poor appetite and records show the service user being monitored with a fluid chart in place as well as a close observational chart. However, it is not clear from records why the observation is taking place or why there is a need to measure fluid input and output. Care records for a service user seen indicate close observation needed as they can be aggressive. One of the care staff is able to manage the service user when they get agitated, by what is described as talking them down. This is a skill developed to deal with this person, not an agreed approach developed for dealing with confrontational situations or challenging behaviour. Care records need to be more detailed and highlight risks in more detail (See Requirement 2). Reviews are out of date for some service users (See Requirement 3). Some service users spoken with were complementary about the healthcare provided at the home, one person stated that ‘they are marvellous if you are ill’. Pharmacist inspector Mr M Andrews conducted the inspection of the medication Standard. This inspection follows a similar inspection undertaken on 3rd May 2007 when serious concerns were identified in relation to the home’s medicine management practices. There have also been two recent referrals to the Adult Protection team following allegations including one involving alleged medicine mismanagement. The findings of this inspection were discussed with the Acting Managers on the day. The inspector found the home has made some improvement to the systems in place for medicine administration, however, service user identifying photographs are so far not available alongside medication records for all service users (See Recommendation 3). The inspector found, however, that there were a number of medicines remaining in small plastic vessels that had not been given in preceding days. This is unsafe practice as it could lead to errors. It is consistent with staff taking short cuts when administering medicines under time pressure (See Requirement 4). The use of psychoactive (and sedative) medicines prescribed on a PRN (as required) basis was examined. Whilst the home is sometimes recording reasons for the administration of such medicines, frequently there were no records. In addition, records seen were on the reverse of the medication charts and generally brief. There were few daily care note records indicating that the use of these medicines was justified. There were also records indicating that some such medicines were not given to service users occasionally but on a regular basis. This remains of serious concern because service users cannot be assured that these medicines are always given appropriately. The home has so Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 12 far not developed care plan guidance for each service user to inform staff of the appropriate administration of the medicines (See Requirement 5 and Recommendation 4). At the time of the previous inspection a recorded risk assessment for a service user self-administering insulin by injection was found not to include evidence that the service user was able to safely administer the injections. To date this has not been resolved (See Repeated Requirement 6). On conducting audits of medication records against medicines available for administration in the first floor dementia unit there was found to be no medicines unavailable for administration to service users. This is seen as an improved outcome when compared to the previous inspection. For most medicines not supplied in the monitored dosage system there were audit trails in place to assist in enabling medicines to be accounted for. This is good practice. However, on conducting sample audit trails there were found to be several discrepancies where medicines were both in surplus and deficit. This is of concern because for these medicines, records do not demonstrate that medicines have been given to service users in line with their prescribed instructions. An internal audit conducted at the home the day before inspection also identified similar discrepancies (See Repeated Requirement 7 and Recommendation 5). The inspector also identified two serious medication-related incidents arising in the dementia unit. The first related to a service user initially prescribed Sinemet 275mg tablets for the management of Parkinson’s disease who also receives the same equivalent medicine Co-careldopa at the same strength following discharge from hospital between 22/05/07 and 26/05/07. The second related to antipsychotic medicine olanzapine tablets where the dose had been changed by the prescriber on 22/05/07 from 5mg daily to 2.5mg. This was because the service user was experiencing serious side-effects. At the time of inspection, however, it was found that the dose had been changed back to 5mg daily without further prescriber authority. Full investigations into these incidents were requested of the Acting Managers. During inspection the GP surgery was contacted to clarify and order a new prescription. The inspector also requested that all medication charts are checked for accuracy as a matter of urgency (See Requirement 8). During inspection it was established that some members of staff authorised to handle and administer medicines had received medicine management training. In the dementia unit, however, there are currently only four members of staff with such authority. One member of staff said that she was frequently working around 50 hours per week and often undertaking double shifts. This may have implications for the safety of medicine management in this unit (See Recommendation 6). It was noted that the temperature of the medicine refrigerator in the dementia unit has recently been above the upper limit of the accepted temperature range. This issue was also identified during the previous inspection and to date has not been resolved (See Repeated Requirement 9). Care staff observed and spoken with at the inspection show a commitment and dedication to their work. They maintain good relationships with, and have Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 13 respect for people who use the service. There is little evidence of support or supervision of care staff by senior staff. Those working at the home, including staff acting in a senior capacity, are working long hours and recognise that one of the consequences of this is a lack of attention to detail in care and healthcare. Alexander Court Care Home DS0000065309.V342781.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): Standards 12, 13, 14, 15 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. People who use the services have access to an adequate diet, though specialist dietary advice is seldom sought. People who use the service have little or nothing they can do to satisfy their social and recreational needs. EVIDENCE: The Acting Manager stated that an activities coordinator for the home had been appointed and would be in post soon; however, the situation over recent months for service users social and recreational needs has been very poor. There has been (and still is) very little social stimulation or established activity in place at the home. This was confirmed by the Acting Manager and by the majority of service users spoken with. One service user spoken with stated that ‘some people get depressed because there’s nothing to do, we used to have exercises and we like a good old sing song’; another service user said that ‘there is a complete absence of any activities’ (See Requirement 10). On the day of the inspection visit a service user was celebrating their 90th birthday and their family asked to use one of the sitting rooms to lay out a splendid birthday party tea with drinks, to which everyone was invited. Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 15 Each service user spoken with confirmed that they could have visitors when they wish, and that they can see them in private. Some service users access the local community, with and without support from the home. It is hoped that the new activities coordinator will, with the assistance of the Manager, encourage more involvement with local community groups (See Recommendation 7). The capacity for many service users at the home (particularly those who have dementia and live on the first floor) to exercise personal autonomy and choice is limited. This is as a consequence of the service users mental health, but also a consequence of the insufficient training and supervision for staff. At present the routines of the home are such that service users basic needs for physical and personal care are the priority and care beyond this either limited or not available. Service users are asked about lunch and are offered two options for their lunch and their sweet. The main meal of the day is served in the early evening. Service users likes and dislikes are known by the kitchen staff, and their meals planned accordingly. Supplement foods are available to service users when their appetite is poor, however Management have not sought dietary advice on how service users meals can be improved or tailored to meet special needs. No evidence was available in care files that a dietician had assessed service users nutritional intake, or that sufficient nutrition could be gained through natural and fresh foods rather than supplements (See Requirement 2). One agency staff member was reminded to cover a plate of food and then to reheat the meal after it had been left uncovered in reception whilst attending to another service user. It was noticed that information relating to service users who are diabetic was listed on a large notice in the main sitting room on the first floor. It was explained that this information was mainly for agency staff working at the home. It was pointed out that the information was on view to everyone and a breach of confidentiality, and could also be said to be institutional practice – the notice was removed during the visit. Service user comments about the meals at the home were mixed. Some service users appreciated the choice on offer and were complimentary about the food in general stating that ‘the food is lovely, they will find something for you if you don’t like it’; others were critical with a view that the meals are ‘too bland’. Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 People 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. People who use the service have access to an effective complaints procedure. People who use the service have not been protected from abuse or from poor care practice. EVIDENCE: The home has a detailed complaints procedure and information on how to make complaints is detailed in the ‘service users guide’. Copies of the complaints procedure are available in the home’s reception area, and are issued to service users and their relatives. Service users asked about who they would go to with a concern or complaint indicated that they would speak with the Manager, or with a senior ‘nurse’ or carer. Those spoken with were clear that these staff were good at dealing with concerns or complaints. Records of complaints are kept at the home and were seen at the inspection. They included the complaint, findings of the investigation, corrective action to be taken, consideration for future preventative action. This is good practice. From discussion with care staff and a review of training records it was evident that staff have received training in the protection of vulnerable adults and understand their responsibility to report abuse or possible abuse. There have also been two recent referrals to the Adult Protection team following allegations, one of physical assault by a service user against another Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 17 service user, and one involving alleged medicine mismanagement. Both allegations were followed up promptly by the home, and remedial action has been taken. However, it is of considerable concern that service users at the home are not protected by the arrangements for training and supervision of staff in dementia care or in dealing with challenging behaviour. Adult Protection team investigations (lead by the Police) into alleged medicine mismanagement and wilful neglect is ongoing at the time of this report. However, is evident from the previous inspection of the medication standard and from this inspection also that service users are still not fully protected by the homes medication practices (See Requirement 11). Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 21, 22, 24, 26 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. Some areas of the home are not well maintained and should provide more dignity and comfort. People who use the service are not protected by good practices designed to control infection. EVIDENCE: A tour of the premises was undertaken. The grounds and patio area were safe and well looked after. Many bedrooms are reasonably decorated and furnished, with evidence of personal possessions that reflect personal choices and options. Many service users like to use the home’s patio area in good weather. This is a secure area with raised flowerbeds that are well maintained. It was noted that service users using this areas occasionally call for staff help and assistance, but are reliant on messages being taken by other service users or by staff Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 19 passing at the time they need help. There was discussion with staff at the time of the inspection visit about the options to address this, including hand held, or pendant type call systems. It is recommended that Management make their own assessment of which option is best suited to the needs of service users and the home (See Recommendation 8). Corridor walls have collages of household, kitchen, mechanical items to aid with memory and reminders about every day things. Doors to bedrooms have a photograph of the service user to help with memory and identify rooms as an aid memoire. There are some ongoing maintenance and repair issues. These include flooring in the lobby area to the laundry, where tiles have been removed. A flickering light outside room number 5 on the first floor, and centre light in the same room that does not work. A broken bedroom door lock was repaired during the inspection visit. One of the two baths on the ground floor is broken. A service user living on the ground floor commented ‘I’m scheduled for a bath on Mondays’ but added that ‘the home can’t adhere to a bathing schedule’ (See Requirement 12). There are other environmental issues requiring attention on the first floor of the home. These include the main floor corridor that is uncarpeted. The product used to clean the surface has an unpleasant smell and leaves the floor looking dull and slightly tacky to the touch (and squeaky if wearing rubber soled shoes). The day of the inspection visit was warm and sunny, and radiators were unseasonably hot. Rooms and corridors were over warm and stuffy with stale odours lingering as a consequence. The staff room is cluttered and untidy as it is being used to store unwanted items. This needs to be reviewed and made a more pleasant place where staff can take a break or meal in comfortable surroundings. The laundry area is untidy and disorganised with surplus clothing and coat hangers. Access to the fire extinguisher was partly impeded as a consequence. The Acting Manager should check practices in this area against the infection control policy of the home. Agency staff were seen carrying uncovered soiled clothing, walking from one working area to another wearing the same plastic aprons and gloves. They do not appear to be aware of the procedures for infection control (See Requirement 13). Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 20 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 poor 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 service are not provided the specialist care they are assessed as needing. Staff in the home are not supported, skilled, experienced or trained to fully meet the needs of people who use the service. EVIDENCE: There were seven care staff (including a senior carer on each floor) on duty at the time of the inspection, in addition to the Temporary Acting Manager. Three staff on duty were agency staff, although they seemed to be familiar with many of the home’s routines. Senior staff at the home stated that they try to use the same small team of agency staff where they can to provide continuity for service users. These staff were caring for 45 service users at the time of the inspection visit, though the home is registered to provide care to 47. The Proprietor’s have agreed with the Commission not to accommodate any new service users while there is an adult protection investigation in progress and concerns about care practices at the home. This agreement was confirmed at the end of April 2007, and there is evidence that the Proprietor’s have fully complied with the agreement. Current service users are being cared for through established routines for the running of the home, rather than an assessed individualised approach to their Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 21 care. Problems encountered by staff are being solved by trial and error, with care that is reactive rather than proactive and planned. Whilst staff seen and spoken with at the inspection visit have a reasonably good knowledge and understanding of service users needs, often care is not based on the agreed care plan or approach. Care is reactive to service users presenting behaviours or needs. The staff currently managing day-to-day care at the home are without four of the senior staff that usually work at the home. It is to their credit that under such circumstances they are providing any reasonable level of support to people who use the service. However, this is clearly not a situation that can be sustained (See Requirement 14). There are thirty-one care staff employed to work at the home. There are currently only six staff with NVQ 2 (or above) training. However, a further eleven are currently undertaking this training (See Repeated Requirement 15). Sample staff files and discussion with carers provided evidence that service users are protected by good recruitment practices. Sample staff files seen and discussed with Management and staff provided evidence of good induction training, some mandatory training (including medication, adult protection, first aid, health and safety and fire) and some specialist training. However, there are significant deficits in other mandatory training for staff. There were no staff with any form of specialist training in dementia care at the home at the time of the visit (though this is evidently planned), nor are there staff with suitable training in managing challenging behaviour (See Requirements 16 & 17). These are serious deficits in a service that is registered to provide specialist dementia care for up to 29 people, and reflect poor management of and investment in the home by the Proprietor. Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36, 37, 38 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. People using this service are at risk through an absence of a safe and proper Management approach from the Proprietor. Training, development and supervision of staff is inconsistent and staff lack leadership. EVIDENCE: There is no Manager in place at the home, which has been drifting without purpose and direction for several months and has resulted in poor outcomes for the residents. The Proprietor has not been sufficiently involved in the control and direction of the service, making inadequate plans for its Management. The Proprietor’s transferred the most recent Manager of the home to another of their services. The Proprietor had promoted a senior carer Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 23 to this position in an acting capacity; however, at the time of the inspection visit the home was being supported on a temporary basis by managers from other homes owned by the Proprietor in Norfolk, and by the Regional Operations Manager. Whilst these arrangements have been necessary in the absence of an on site management presence at a time of concern about care and practice at the home, they will by their nature have an impact on the services these staff also have responsibility for. Management have established an improvement plan for the service, where they have identified areas for action, by whom and by when. However, visiting Managers understandably each bring their own approach. This has resulted in a lack of consistent direction, some confusion, anxiety and low morale for staff. Management advised that the appointment of a new manager and deputy has been made, with both due to take up posts in early July (See Requirement 18). Changes in Management have disrupted any coordinated approach to measuring the quality of the service provided to those using the service, and other ‘stakeholders’ like relatives and visiting professionals. There are some processes at the home for monitoring quality, such as audits of medication, care and the environment (See Requirement 19). It is clear that staff have not benefited from direction and formal supervision of their work. Comments from staff and a review of records support this. Some staff have not received any formal supervision for approximately six months (See Requirement 20). Staff spoken to described the difficulty in the allocation of work to (and the supervision of) agency staff who are needed at the home at present. It is recommended that a special file could be created with basic details and procedures for agency staff to follow, including short summaries of service users and their needs, and any special input or observations required (See Recommendation 9). The confidentiality and privacy of service users is generally supported at the home. The example referred to earlier in relation to people who are diabetic was dealt with at the time of the inspection visit. However, it was also observed that the main notice board in the reception area sometimes has information on it relating to the observation or monitoring of a service user and initials are used as a means of identification. It was agreed that this could be seen as institutional practice and information of this nature should be discreetly maintained and shared with staff in a more confidential setting. Notice boards can then be used to offer more interesting information to service users on a daily basis. Maintenance and fire equipment servicing and training records seen were satisfactory. Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 24 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 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X 2 3 X 2 X 1 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 1 2 1 Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 25 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 31/07/07 2. OP7 12(1)(b) 3. OP7 15(2)(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 The Manager must ensure that 31/07/07 the care plans and risk assessments indicate the care, treatment and supervision of people who use the service, and that these incorporate professional advice. This is to assist in ensuring the health and welfare of service users. All people who use the service 31/07/07 must have care plans that are regularly reviewed. This is to ensure that care plans appropriately reflect current, assessed needs. This Requirement Is Repeated Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 26 4. OP9 13(2) & 13(4) 5. OP9 13(2) & 13(4) 6. OP9 13(2), 13(4) & 14 7. OP9 13(2) & 13(4) 8. OP9 13(2) & 37 9. OP9 13(2) & 13(4) People who use the service must have medicines administered by staff who follow safe procedures. This is to protect people’s health and welfare. People who use the service must have medicines of a psychoactive nature prescribed on a PRN (as required) basis administered only when it is justified and this can be demonstrated by record-keeping practice. This is to protect peoples health and welfare. This Requirement Is Repeated People who use the service who self-administer their medicines must have their health and welfare protected by comprehensive and recorded risk assessments, which are reviewed on a regular basis. This Requirement Is Repeated 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 People who use the service must have investigations carried out by staff in relation to two medication-related incidents identified during the inspection. People who use the service must have medicines requiring refrigeration stored within the accepted temperature range to ensure such medicines are safe for use. This Requirement Is Repeated DS0000065309.V342781.R01.S.doc 07/06/07 07/06/07 07/06/07 07/06/07 07/06/07 07/06/07 Alexander Court Care Home Version 5.2 Page 27 10. OP12 16(2)(n) 11 OP18 13(6) 12 OP21 23(2)(c) 13 OP26 13(3) 14 OP27 18(1)(a) 15 OP28 18(1)(a) 16 OP30 18(1)(c) (i) 17 OP30 18(1)(c) (i) People who use the service must be provided with facilities for recreation to suit their individual needs. All staff must be appropriately trained. This is to help safeguard people who use the service from being placed at risk of harm or abuse. The Manager must ensure that bathing equipment at the care home is in working order. This is to ensure facilities at the home are provided to meet the needs of people who use the service. The Manager must ensure that all staff are aware of the home’s procedures for infection control. This is to help to safeguard service users and staff from infection and control the spread of infection. The Manager must ensure that there are, at all times, suitably qualified, competent and experienced staff working at the care home. This will ensure that people using the service have their needs met. The Manager must ensure that staff receive NVQ 2 training appropriate to the work they perform. This will help to ensure that people using the service have their needs met. The Manager must ensure that staff receive training in dementia care. This will help to ensure that the mental health needs of people using the service are met. The Manager must ensure that staff receive training in dealing with challenging behaviour. This will help to ensure the safety and dignity of people who use the service. DS0000065309.V342781.R01.S.doc 31/07/07 31/07/07 31/07/07 30/06/07 31/07/07 30/09/07 31/07/07 31/08/07 Alexander Court Care Home Version 5.2 Page 28 18 OP31 9 19 OP33 24(1) &(2) 20 OP36 18(2) The service must have a 30/09/07 Manager that meets the requirements of the Care Standards. The Manager must ensure that 31/12/07 the views of people who use and are associated with the service are sought and included when making decisions that effect outcomes for people living at the home. All staff at the home must be 30/06/07 formally supervised. This will help to ensure that care provided meets the needs of people who use the service and the philosophy of care in the home. 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 OP4 Good Practice Recommendations It is recommended that monthly reviews for these service users considers the need for a wider review of their care and health (including mental health) needs, to consider the need for more specialist care It is recommended that care files are reviewed, ‘filleted’ and brought up to date. It is recommended that service user-identifying photographs are made available alongside medication records to assist in safe medicine administration. 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. It is recommended that more trained staff are deployed in the dementia unit for the management of medicines. It is recommended that the competence of staff authorised to manage medicines is assessed on a regular basis via supervision events. It is recommended that the home should encourage more involvement with community groups. DS0000065309.V342781.R01.S.doc Version 5.2 Page 29 2. 3. 4. 5. 6. 7. OP7 OP9 OP9 OP9 OP9 OP13 Alexander Court Care Home 8. 9. OP22 OP36 It is recommended that Management make their own assessment of which call bell option is best suited to the needs of service users using the home’s patio area. It is recommended that a special file be created with basic details and procedures for agency staff to follow, including short summaries of service users and their needs, and any special input or observations required. Alexander Court Care Home DS0000065309.V342781.R01.S.doc Version 5.2 Page 30 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.V342781.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!