Inspection on 08/06/06 for Alexander Court Care Home

This inspection was carried out on 8th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 07/06/07

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 Key Unannounced 8th June 2006 10:00 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.V299580.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.V299580.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.V299580.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 24th January 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 monthly fees for care at the home is £1352 - £1860. Alexander Court Care Home DS0000065309.V299580.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 and took place over 7.45 hours. Opportunity was taken to tour the premises, look at care records and policies, and communicate with the home’s service users in addition to visiting relatives and professionals, staff and the manager. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. Seven comment cards were received prior to the inspection from service users and relatives, which gave broadly favourable comments about the care staff at the home, but expressed concern about the numbers of carers available. What the service does well: What has improved since the last inspection? The delivery of care that reflects the needs of individuals is the most significant achievement of the staff and manager. An evidently less ‘institutionalised’ approach to care was observed, though this may be having an impact on staff time. Continued improvements have also been hampered by the home currently undertaking a change to its care planning process. There are welcome improvements in process to the home’s environment with redecoration, the installation of locks to communal toilet doors and the anticipated replacement of door handles. The appointment of an activities coordinator is welcomed as the availability of activities generally at the home has declined recently. Alexander Court Care Home DS0000065309.V299580.R01.S.doc Version 5.2 Page 6 The manager has developed appropriate means of communication for service users, relatives and others to be aware of what is happening at the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alexander Court Care Home DS0000065309.V299580.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.V299580.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 The assessment process for admission to the home is good. EVIDENCE: There is an admission procedure that adequately guides the manager, or other senior staff responsible for assessment, as to actions to be taken to ensure service users needs are assessed prior to a move to the home. A review of sample service user files provided evidence of assessments and pre-admission assessment completed by the home. The home does not provide intermediate care. Alexander Court Care Home DS0000065309.V299580.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The overall quality outcome for these standards is poor, as the care planning system still does not adequately provide staff with the information they need to meet the health and care needs of service users. There is evidence that the personal care needs of service users are not met. EVIDENCE: A sample of service user care plans was reviewed. These set out care requirements in reasonable detail in many instances, though the fact that the home is in a period of transition toward another care planning format was evident. As indicated at the last inspection some care plans contained evidence of the gathering of relevant ‘social’ or ‘life’ history information; though has still not been extended to include all service users. This may, in part, be due to the transition toward a new care plan format. A care plan for a service user identified as presenting with challenging behaviour did not provide care staff with information as to the action they should take when challenging behaviours are exhibited. An assessment completed for a service user admitted to the home for a period of respite care had not been formulated into a draft care plan, consequently Alexander Court Care Home DS0000065309.V299580.R01.S.doc Version 5.2 Page 10 the action needed to be undertaken by care staff to meet the service users needs was not clear. It is recommended that the current transition toward a new format for care planning at the home be used as an opportunity to directly involve service users (and their relatives) in their care planning, and in developing a wider understanding of the service user through social or life history information. Service users spoken to appear satisfied with the healthcare provided at the home, and confirmed that there is access to a range of health professionals including GP’s, district nurses and chiropodists. The meeting of personal care for service users appeared reasonable, however, there are exceptions including service users whose finger nails require cutting, and several comments received from relatives mention service users toilet needs not attended to quickly enough, other aspects of lack of personal care such as hair and tooth care, infrequent bathing, and whether male service users are shaved if they wish are referred to. It is emphasised that comments received from relatives also praise staff for the hard work they do. It is apparent from accident records that a proportionately high number of accidents occur at the home between 7pm and 12pm (see comments in staffing Standards). These include slips, accidents whilst moving and handling and falls from bed or chair. An inspection of medication records and practice was undertaken. Medication administration records were satisfactory. There is evidence of the completion of risk assessments for service users who are responsible for administering their own medication. These service users have also been provided with suitable storage facilities for this medication. Storage arrangements were also reviewed. It is recommended that the practice of labelling drug trolley door shelves with service user names and storing their medication above the label is considered only as a guide for staff with responsibility for administering medication. This practice was in evidence for a variety of containered and liquid medication. It is evidently clear that individual medication can become mixed, and therefore presents the risk of its being wrongly administered. Aside from this storage arrangements are satisfactory. When asked whether care staff listen and act on what they say, service users gave favourable responses. Comment cards received prior to the inspection also reflected this, though acknowledged that staff are sometimes too busy to respond promptly. Service users spoken to stated that their right to privacy is respected at the home, and that visitors are made welcome and can be seen in private if they wish. Alexander Court Care Home DS0000065309.V299580.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The overall quality outcome for these standards is adequate, though the social and recreational options available do not fully satisfy the needs of service users. Contact with friends and relatives is supported by the home. Meals at the home are adequate, though some service users have to wait too long for assistance to eat. EVIDENCE: A dedicated activities coordinator had been appointed earlier in the week of the inspection. The manager anticipates that an activities programme will be developed with the involvement of service users. This is welcome as service users and relatives spoken with and who completed comment cards are concerned about the absence of suitable activities at the home. Those who commented indicated that activities were either usually or sometimes available, and that the availability of activities has decreased over the past year. At the time of the inspection service users were involved in a range of activities. These included trips into the town nearby with friends or relatives, gardening, watching the television and reading. The home supports choice for service users and control over their lives in many areas. Examples of this include supporting contact with relatives and friends, Alexander Court Care Home DS0000065309.V299580.R01.S.doc Version 5.2 Page 12 enabling service users to manage their own affairs and to bring and keep their own possessions with them. The majority of service users spoken to stated that they usually like the meals at the home, and that there is choice available. This was reflected in comment cards received prior to the inspection. Meals seen at lunchtime on the day of the inspection looked appetising. The lunch menu on offer included cottage pie with vegetables and potato, or pasta and a mince sauce, or a vegetarian option. The home uses a combination of fresh and frozen produce. Fresh fruit is available to service users and there were finger foods available both morning and afternoon for service users. There are significant numbers of service users on the first floor of the home who require some form of assistance with eating. Service users are given choice as to whether meals are taken in the main dining area or in their own bedrooms. It was noted that those service users who require assistance and preferred to take their meal in their own bedroom were waiting for significant periods before they could be assisted with their meals. Though meals served were apparently still hot having been kept in the hot plate. Alexander Court Care Home DS0000065309.V299580.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The overall quality outcome for these standards is good as there are satisfactory arrangements in place to deal with complaints that service users are aware of. Service users are protected from abuse by appropriate policies and training. EVIDENCE: Service users both spoken to at the inspection and those who sent comment cards prior to the inspection indicated that they know how to make a complaint. Service users spoken to stated that they felt confident that they would be listened to. There has been one complaint since the last inspection of the home, which is outstanding and will be investigated by the manager. Records of staff training included training on induction and ongoing training in adult protection. Staff understanding of the principles and components of training provided is tested. Staff spoken to were aware of basic issues connected with adult protection and were aware of the home’s ‘Whistle blowing’ policy. Alexander Court Care Home DS0000065309.V299580.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 & 26 The overall quality outcome for these standards is adequate, as although a reasonable standard of accommodation is provided by the home, redecoration and other improvements are necessary to maintain the environment and protect personal belongings. EVIDENCE: The home provides a reasonably well-maintained and safe environment. There was some internal redecoration taking place at the time of the inspection. The manager stated that the redecoration would extend to the first floor, which is the area in most need. As indicated at the last inspection notable efforts have been made to improve the communal and bedroom areas for service users on the first floor. However, these efforts have been compromised by the home’s difficulty in managing the challenging behaviour of a service user. The improved signage for service users previously noted has been removed, and the incidence of breakages of personal possessions has evidently increased, thereby compromising the adequacy of the environment for some service users. An example of this was a service users bedroom with few personal belongings and only one drawer present in a three drawer bedside cabinet. Alexander Court Care Home DS0000065309.V299580.R01.S.doc Version 5.2 Page 15 Following a requirement at the home’s last inspection locks to communal toilets on the first floor have been provided. The home appeared clean and hygienic, with cleaning in progress at the time of the inspection. Alexander Court Care Home DS0000065309.V299580.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The overall quality outcome for these standards is poor as there are shortfalls in the numbers of staff on duty to meet service user need. There are also shortfalls in the home’s training programme (including NVQ) to address service user needs. EVIDENCE: There were forty-six service users accommodated at the home at the time of the inspection. Twenty-nine service users live on the first floor and 18 service users live on the ground floor (though there was a vacancy at the time of the inspection). Between four and five staff are deployed to work on the first floor and two staff on the ground floor during the day (there are four staff at night). This provides a total of between six and seven care staff to the forty-six service users currently accommodated, which at times may provide an adequate staffing level. However, at the time of the inspection it did not. Service users and particularly their relatives have noted this making comment at the inspection and within comment cards received by the Commission prior to the inspection. Evidence of the inadequacy of the ratio of care staff to meet the current needs of the service user group has been reflected in other sections of this report. These include the lack of service user or relative involvement in care planning, and the inadequacy of some of these plans. There is also evidence of the lack of some aspects of personal care required to meet service user need as well as the significant time service users who require assistance with eating have to wait for assistance. The difficulty the home is experiencing in managing the Alexander Court Care Home DS0000065309.V299580.R01.S.doc Version 5.2 Page 17 implications of challenging behaviour for service users, their belongings and the wider home environment. It is also of concern that accident statistics point to a disproportionately high incidence of accidents between 7pm and 12pm, when after 8pm there are only two care staff guaranteed to be working on the first floor with up to 29 service users. There is currently 26 of care staff with training at NVQ level 2 (or above), falling short of the 50 minimum required by the National Minimum Standard. A sample of staff files were inspected to verify that the checks required by regulation have taken place. There was evidence of appropriate checks being undertaken except CRB checks. The manager advised that the evidence of the carrying out of these checks (and their results) is held at the proprietor’s head office. A requirement has been made in this report that these records are available within the home. Staff training records seen provided evidence of appropriate induction training for care staff, however there are current deficits in infection control training for staff and in the number of staff qualified to administer first aid. The manager indicated that she was aware of the latter, and has been sourcing training to rectify. Care staff spoken and observed generally have a good understanding of service users needs. Alexander Court Care Home DS0000065309.V299580.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 The overall quality outcome for these standards is adequate as the home is well managed by the manager who service users, staff and relatives speak favourably of. Service users financial interests are safeguarded. The home attempts to act in the best interests of service users though staffing inadequacies may compromise their health, safety and welfare. EVIDENCE: The manager was appointed to the post of General Manager in November 2005. She is a Registered Mental Nurse with management experience in the care sector. Service users, relatives and staff spoke in favourable terms about the manager and her approach since she has been in post. The home has a variety of processes to ensure that it is run in the best interests of service users. These include various staff meetings, service user meetings and bi-monthly relatives meetings. The home is also subject to regular audits undertaken by the provider, including those required by Alexander Court Care Home DS0000065309.V299580.R01.S.doc Version 5.2 Page 19 Regulation and provided to the Commission. The manager undertakes an annual questionnaire that seeks the views of those living in or associated with the home. It is recommended that the results of these surveys be shared with everyone provided with the questionnaire. Service users financial interests are safeguarded by the home; their relatives manage the vast majority of service users financial affairs. Staffing inadequacies, which are particularly evident on the first floor, may compromise the health, safety and welfare of service users. Alexander Court Care Home DS0000065309.V299580.R01.S.doc Version 5.2 Page 20 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X X X 3 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Alexander Court Care Home DS0000065309.V299580.R01.S.doc Version 5.2 Page 21 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 2 Standard OP7 OP7 Regulation 15(1) 15(1) Requirement The registered person must prepare written care plans with the involvement of service users. The registered person must ensure that individual care plans set out action required by care staff to manage behaviour and meet needs. The registered person must develop a suitable programme of activities in consultation with service users and having regard to their needs. The registered person must provide adequate private and communal accommodation for service users. The registered person must ensure that staff are working in such numbers as are appropriate for the health and welfare of service users. The registered person must ensure continued progress toward meeting a minimum ratio of 50 NVQ 2 (or above) trained staff. This Requirement is Repeated The registered person must DS0000065309.V299580.R01.S.doc Timescale for action 08/06/06 08/06/06 3 OP12 16(2)(n) 08/06/06 4 OP19 23(2)(e) 08/06/06 5 OP27 18(1)(a) 08/06/06 6 OP28 18(1)(a) 31/10/06 7 OP29 19(1)(b)(i 08/06/06 Page 22 Alexander Court Care Home Version 5.2 ) 8 OP30 18(1)(c) ensure that evidence of CRB checks is available at the home. The registered person must ensure that persons employed to work at the care home receive training appropriate to the work they perform. 08/06/06 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 the current transition toward a new format for care planning at the home be used as an opportunity to directly involve service users (and their relatives) in their care planning, and in developing a wider understanding of the service user through social or life history information. It is recommended that the practice of labelling drug trolley door shelves with service user names and storing their medication above the label is considered only as a guide for staff with responsibility for administering medication. It is recommended that the results of customer satisfaction surveys be shared with everyone provided with the questionnaire. 2 OP9 3 OP33 Alexander Court Care Home DS0000065309.V299580.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V299580.R01.S.doc Version 5.2 Page 24 - 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!