CARE HOMES FOR OLDER PEOPLE
Alexander Court Nursing Home 2 Lydgate Court Crookes Sheffield South Yorkshire S10 5FJ Lead Inspector
Sue Turner Unannounced Inspection 24th January 2006 9:00 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 DS0000021763.V261357.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000021763.V261357.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Alexander Court Nursing Home Address 2 Lydgate Court Crookes Sheffield South Yorkshire S10 5FJ 0114 268 2937 0114 268 2945 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) Southern Cross Healthcare Services Limited Post Vacant Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places DS0000021763.V261357.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One service user named on the Application for Variation of Registration form dated 19/8/03, who is in the category DE/E; Dementia for people 65 and over, may reside at the home. 13th April 2005 Date of last inspection Brief Description of the Service: Alexander Court is a purpose built home for older people, which provides 60 places for people with personal and nursing care needs. All bedrooms have an en-suite facility. It is in a residential area of Sheffield with good access to public services and amenities for example shops, pubs, and public transport. It is built on three levels serviced by a lift. The home has single and double rooms and a suitable number of lounges and dining rooms. The home has a car park and lawned areas. DS0000021763.V261357.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day between 9.00 am and 1.45 pm. An inspection of most parts of the building and grounds was carried out. A number of records, relating to those living in the home and management paperwork were checked. Time was spent talking with groups of service users in communal areas and individually with two service users. One relative visiting the home was spoken to. The manager and three members of the staff team were interviewed about various aspects of the service. Other members of the staff team were also consulted throughout the day. What the service does well: What has improved since the last inspection?
Since the last inspection the service user care plans had been revised to make sure that full and accurate information was kept for each service user. The manager and qualified staff were working hard to ensure that these would be fully completed by February. A new television had been provided, that had a large clear screen that was clearly visible to the service users using the ground floor lounge. Work had also been undertaken in the same lounge to ensure it was adequately ventilated. Service users commented positively that communication between themselves and staff had improved. The manager stated that at recruitment, potential employees were assessed to measure their command of English.
DS0000021763.V261357.R01.S.doc Version 5.1 Page 6 The fire system and emergency lighting tests were taking place as per the homes policy and procedures. 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. DS0000021763.V261357.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000021763.V261357.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were checked as the key standards were checked and met at the last inspection. EVIDENCE: DS0000021763.V261357.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9. The information in the three care plans checked was adequate to ensure that the service users health needs could be fully met. Current medication practices undertaken by staff placed the service users at possible risk or harm. EVIDENCE: Care plans set out in detail the service users needs and the action to be taken by the qualified and care staff at the home to ensure all these could be met. Service users said that the care they were receiving was good and that the staff were “very nice”. One relative said that the care delivered by staff was “excellent” and that the staff showed “love and care” to their relative. Prescribed medications were checked for three service users. These were kept in lockable trolleys and administered by qualified staff. The majority of medications were dispensed from blister packs. Medication was signed for at the time of administration. The code ‘F’ was used when medication was not given, the reason why it wasn’t given was not clear. At breakfast the inspector observed a member of staff, signing to confirm she/he had administered
DS0000021763.V261357.R01.S.doc Version 5.1 Page 10 medication and then left the medication on the table, at the side of the service user. The service user subsequently dropped the medication on the floor. The inappropriateness of this was pointed out to the member of staff and the manager immediately. DS0000021763.V261357.R01.S.doc Version 5.1 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 and 15. On the whole service users had a choice of lifestyle within the home and the meals served at the home were of a good quality and alternatives were offered. Activity sessions could be better matched to suit the service users preferences and capabilities. EVIDENCE: A friendly and very welcoming feel was evident in Alexander Court. Service users said they chose when they got up and went to bed and had a choice of food at mealtimes. Service users said that the quality of food served was good. Breakfast was served in a pleasant relaxed manner and the service users were seated comfortably at the table. In one lounge the activities worker sat with service users looking at a poetry book, the television was also on which detracted attention from the activity and resulted in there being a lot of noise but very little stimulation for the service users. The inspector felt that the activities worker was unsure how they could lead or introduce activities and would recommend that staff undertake further training.
DS0000021763.V261357.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were checked as the key standards were checked and met at the last inspection. EVIDENCE: DS0000021763.V261357.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25 and 26. The environment within the home was maintained to an adequate standard, providing a comfortable home for service users. New dining room furniture and some new carpets would further enhance the environment. Heating, lighting and ventilation met the needs of the service users. EVIDENCE: Throughout the morning there was an unpleasant odour in the communal areas. A number of carpets had been replaced however there were others that were marked and needed either thorough cleaning or replacing. Most areas of the home were clean, tidy and well maintained. Lounge and dining areas were domestically furnished. Dining room chairs and tables were scratched and damaged, resulting in the dining room looking unappealing and unwelcoming. The manager stated that estimates to replace the furniture were being sought. Bedrooms and communal areas were naturally ventilated. Central heating could be controlled in the service users own rooms.
DS0000021763.V261357.R01.S.doc Version 5.1 Page 14 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): 28 and 29. Detail held and recorded in staff recruitment files, although improved since the last inspection, did not fully protect service users who lived at the home. Service users cannot be measured to be in safe hands at all times due to the lack of NVQ trained carers at the home. EVIDENCE: Twenty-eight carers were employed at the home; none had completed NVQ Level 2 or equivalent. This falls extremely short of the requirement within the Care Homes Regulations that states by 2005, 50 of the care staff must be trained to NVQ Level 2. Three staff files were checked. Two were satisfactory; one had insufficient information to check any gaps in employment. DS0000021763.V261357.R01.S.doc Version 5.1 Page 15 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): 36 and 38. There was a positive style of management in the home and staff morale had improved which will ultimately benefit the health and welfare of the service users. The health, safety and welfare of service users, staff and visitors to the home was not promoted and protected, placing all at possible risk of harm. EVIDENCE: Three members of staff were spoken to. Staff said they did have management support and were able to speak to the manager at any time and about any subject. Staff said they were not receiving formal one to one supervision on a regular basis. The manager stated that she was in the process of starting the formal supervision of all staff. During the inspection a number of issues were observed relating to the health and safety of the service users. A record of staff undertaking fire drills was not
DS0000021763.V261357.R01.S.doc Version 5.1 Page 16 available. However staff spoken to said that they had undertaken fire practices and were aware of what to do in the event of there being a fire at the home. A sluice door and two linen cupboards on the first floor had notices on them stating, “Fire door, must be kept locked”. The doors were unlocked and staff were asked to lock the doors immediately. Emergency call systems in two bathrooms were tied up and out of service users reach. These were untied immediately at the inspector’s request. Medication creams and toiletries that could be hazardous were seen on dressing tables in service users rooms. These were also moved to a safe place. DS0000021763.V261357.R01.S.doc Version 5.1 Page 17 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 2 X X X X 3 2 STAFFING Standard No Score 27 X 28 1 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 X 1 DS0000021763.V261357.R01.S.doc Version 5.1 Page 18 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 OP9 Regulation 13 Requirement The reason why medication has not been administered must be clearly recorded. (Previous timescale 15 June 2005 not met). Medication must be safely administered. Staff must ensure that service users take any medications signed out as administered. Administered medications must not be left unattended. The worn carpets must be either thoroughly cleaned or replaced. Dining room tables and chairs must be renovated or replaced. (Previous timescale 1 September 2005 not met). The cause of the unpleasent odour must be found and action taken to resolve. There must be 50 of the care staff trained to NVQ Level 2 or equivalent. Staff must not be employed until full and satisfactory information has been obtained. (Previous timescales of 1 Oct 2004 and 13th April 2005 not
DS0000021763.V261357.R01.S.doc Timescale for action 24/01/06 2. OP9 13 24/01/06 3. 4. OP20 OP20 23 23 01/06/06 01/04/06 5. 6. 7. OP26 OP28 OP29 23 18 19 24/01/06 31/12/06 01/04/06 Version 5.1 Page 19 8. OP36 18 9. OP38 13 10. 11. 12. OP38 OP38 OP38 13 13 13 met). Care staff must receive formal supervision at least six times per year. (Previous timescales of 1 July 2005 not met). All staff must undertake fire drills and practices as per the homes policy and procedures. Fire drills and practices must be recorded. (Previous timescale of 13 April 2005 not met). All fire doors must be kept locked. Emergency call systems must be left within reach of service users. Substances hazardous to health must be stored securely. 01/04/06 24/01/06 24/01/06 24/01/06 24/01/06 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 OP12 Good Practice Recommendations Increased training opportunities should be provided for staff surrounding the benefits of activities for service users. DS0000021763.V261357.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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