CARE HOMES FOR OLDER PEOPLE
Alexander Court Nursing Home 2 Lydgate Court Crookes Sheffield South Yorkshire S10 5FJ Lead Inspector
Sue Turner Key Unannounced Inspection 25th April 2006 7:30 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 Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alexander Court Nursing Home DS0000021763.V291513.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 Alexander Court Nursing Home DS0000021763.V291513.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. 24th January 2006 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. A copy of the previous inspection report was on display and available for anyone visiting or using the home. Information about how to raise any issues of concern or make a complaint was on display in the entrance hall. The manager confirmed that the range of monthly fees from 1st April 2006 were £404 - £483 per week. Additional charges included newspapers, hairdressing and private chiropody. Alexander Court Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out this inspection, which was unannounced and took place over 8 hours from 7.30 am to 3.30 pm. An inspection of the environment was undertaken. Records were examined, including: 3 care plans, complaints, staff recruitment and training, menus and fire records. All of the Commission for Social Care Inspection (CSCI) key standards were checked. Interactions between staff and service users were observed. The inspector spoke with a proportion of the staff on duty (5), and 7 service users. Discussions with the homes manager and administrator also took place. Two relatives visiting on the day of the inspection were also spoken to. What the service does well: What has improved since the last inspection?
A number of carpets, curtains and furniture had been replaced around the home, which had enhanced the appearance of the home and given it a more homely feel. Throughout the inspection there were no unpleasant odours within the home.
Alexander Court Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 Page 6 One service user had been provided with a specialist chair that had improved their quality of life. Substances that could be hazardous to health were all securely stored. The manager had invested a significant amount of time in re-training the staff in the safe administration of all medications. A check of medication found that there were no discrepancies and resulted in the previous requirements issued being removed. Three staff recruitment files were checked and all required information was readily available. Staff spoken to said that they were receiving formal one to one supervision from their line manager. 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 Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexander Court Nursing Home DS0000021763.V291513.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): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was not providing sufficient updated information to inform service users about their rights and choices. Assessments prior to admission took place. Trial visits to the home were encouraged. This enabled staff to be aware of service users needs to ensure that they could be met. EVIDENCE: Service users spoken to said they had received a copy of the service user guide. A copy of the guide was on display, however information within this was out of date and inaccurate. Staff spoken to said that assessments were undertaken prior to admission to ensure the home could meet prospective service user needs. These were carried out by the home’s manager or qualified staff. Copies of care management assessments were seen on the files checked.
Alexander Court Nursing Home DS0000021763.V291513.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, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information recorded within the revised care plans is sufficient and all care plans should be amended to this format, so that service users health and welfare needs are clearly identified. Service users were given assistance in accessing health care services, which ensured that their quality of life was maintained and improved. Service users were protected by the homes procedures for the administration of medication. All staff at the home respected service users privacy and dignity. EVIDENCE: Three care plans were sampled. These contained varied information on aspects of personal, social and health care needs. The plans included information on the staff action required to ensure assessed needs were met. The plans contained detail of all health care contacts, appointments and treatments, and the home supported access to these to ensure health was
Alexander Court Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 Page 10 maintained. Access to dentists, chiropodists and opticians was available. A chiropodist was visiting the home at the time this inspection took place. Moving and handling, and falls risk assessments had been undertaken for all service users to keep them as safe as possible. The manager stated that she was in the process of transferring to the revised format seen in two of the three care plans sampled. The new format was appropriate and included all of the detail required. The inspector believes that in order to fully meet the service users health and welfare needs the new formats should be used for all. All three care plans checked had been signed by staff stating that they had been reviewed each month. Medication was securely stored and Medication Administration Records (MAR sheets) were up to date. The manager had undertaken the re-training of staff and medication was stored in blister packs, to further ensure safe administration. Staff were observed respecting privacy by knocking on doors before entering. The interactions between staff and service users appeared respectful and caring. Service users spoken to said the staff were ‘kind’ and ‘helpful’. Alexander Court Nursing Home DS0000021763.V291513.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, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were able to make choices about daily living and social activities. A range of activities was offered which suited the preferences of the service users. The home had an open visiting policy, which assisted in maintaining good relationships with service users family and friends. A varied diet was provided and sufficient drinks were offered, which promoted the service users well being. EVIDENCE: Service users said they were able to get up and go to bed when they chose, and were seen to use different areas of the home according to their choice. The home had an activities worker who provided a range of appropriate social opportunities inside the home. Service users said they enjoyed the range of activities offered. Service users and relatives said that that they were able to see their visitors in private and that they were made welcome at any time, which helped them, maintain contact.
Alexander Court Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 Page 12 Service users were able to bring personal items with them into the home. All of the bedrooms seen were individually personalised and very homely. This was important to service users as it helped them retain control over their immediate environment. All service users spoken to said that they were satisfied with the food served. They said they were offered choice and variety. They also said that they were offered ‘more than enough’ cold and hot drinks throughout the day and if requested at night. Alexander Court Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The homes record of complaints was clear and accessible and evidenced that appropriate action was taken following any concerns raised. Staff had not been provided with essential training in adult protection procedures to ensure service users were safe, and to inform staff of the procedures to follow if an allegation was made. EVIDENCE: The homes complaints policy was on display in the entrance area of the home. It contained relevant information and informed the reader who to contact external to the home, should the complainant wish to do so. The homes record of complaints was well organised, as a consequence information was easily obtained. The manager said that there was one outstanding complaint that she was in the process of investigating. Since the last inspection CSCI have received three complaints about the service. The provider investigated each one and appropriate action was taken to address their findings. Staff spoken to were aware of their responsibilities in reporting any complaints or allegations. The homes adult protection policy included information on local procedures. Staff spoken to said that they would report any allegations of abuse to their senior manager. Staff said they had not received any training in adult protection procedures, however they were able to describe types of abuse that service users could be susceptible to.
Alexander Court Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 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, 20 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was, in the main, maintained to a high standard, clean, and fresh smelling. Homely touches had been provided to create a comfortable environment, communal areas were well maintained, and service users bedrooms were well decorated and personalised. EVIDENCE: The majority of the home was in the main, well maintained. The home was clean and free from odours. Appropriate facilities were provided to meet the needs of the service users. All areas of the home were accessible to the service users. Homely touches had been provided to create a comfortable environment. In the main communal areas were well maintained, and service users bedrooms were well decorated and personalised. A number of carpets
Alexander Court Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 Page 15 had been replaced and a programme of replacement for other carpets was underway. The ground floor dining room was in need of re decoration and replacement floor covering. The manager stated that this refurbishment had been budgeted for and would begin the following month. A requirement issued at the previous inspection regarding the renovation or replacement of dining room furniture had not been actioned and is therefore carried forward to this report. A number of external windows were in need of replacement or repair as they had ‘frosted’ and could not be clearly seen through. Alexander Court Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff were employed in sufficient numbers. Recommended levels of NVQ trained staff had not been achieved and some staff had not received training in moving and handling, which did not ensure staff had the competencies to meet the service users needs. The details held and recorded in staff recruitment files were accessible and complete, therefore ensuring the protection of service users. EVIDENCE: The homes rota indicated that agreed levels of staff were being maintained to meet the needs of service users. Service users spoken to felt that enough staff were provided. One relative spoken to said that they didn’t think there were as many staff ‘around’ as there used to be. This could have been because occupancy levels were reduced, thus reducing minimum staffing numbers. Of the 25 care staff, 2 staff had achieved NVQ level 2 in care. A further 6 staff had applied to undertake the training, but had not yet commenced. This falls extremely short of the recommended 50 of care staff trained to NVQ level 2 in care by 2005, as required in the National Minimum Standards. Three staff records were checked. There had been a good improvement in staff recruitment records. All of the information required to be obtained was on hand.
Alexander Court Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 Page 17 Staff spoken to said that they had undertaken induction training prior to commencing their duties at the home. They said they had covered such things as fire, health and safety, COSHH and personalised care. Staff spoken to said they had not all received training in moving and handling. Alexander Court Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 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, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager’s leadership approach benefited service users and staff. The lack of quality assurance audits means that the home cannot be run in the best interests of the service users. Service users monies were safely handled, which ensured that finances were accurate and safeguarded. The health, safety and welfare of service users were not fully promoted due to the number of concerns around health and safety requirements. EVIDENCE: All of the service users, staff and relatives spoken with said the manager was approachable and supportive.
Alexander Court Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 Page 19 Recorded quality assurance visits by the registered provider had not been carried out each month, as required by the regulations. A report was seen in the home for visits that were undertaken in February and March; these had not been forwarded to the CSCI. The manager stated that she had consulted with service users and relatives regarding the service provided, via meetings and individual one to ones. Minutes of a relatives meeting was seen in the home, however there was no other recorded quality monitoring system. Staff spoken to said that they had received formal supervision from the manager, which they had found useful and informative. Three service users monies were checked. Receipts, records and money all tallied and all were kept securely. During the inspection a number of concerns relating to the health, safety and welfare of the service users were observed: • Two members of staff were seen to inappropriately transfer two service users from their wheelchair into a lounge chair. • One emergency call system in the ground floor bathroom was tied up and out of reach of service users. This was untied immediately at the inspector’s request. This was a requirement at the previous inspection. • 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. This was a requirement at the previous inspection. • Not all staff had taken part in a fire drill. This was a requirement at the previous inspection. The manager was asked on the day of the inspection to ensure that prompt action was taken to address the above issues. Alexander Court Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X X X X 3 STAFFING Standard No Score 27 3 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 1 Alexander Court Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 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. Standard OP1 Regulation 5 Requirement The service user guide must be updated to ensure all of the information included is up to date and accurate. Information within all care plans must be reviewed, updated and transferred on to the revised format. All staff must be trained adult protection procedures. The ground floor dining room must be redecorated and the floor covering replaced. All windows must be assessed and replaced as needed. 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 and 1 April 2006 not met). There must be 50 of the care staff trained to NVQ Level 2 or equivalent. All staff must receive training in the safe moving and handling of service users. Timescale for action 01/06/06 2. OP7 15 01/07/06 3. 4. 5. 6. 7. OP18 OP19 OP19 OP20 OP20 18 16 23 16 23 23 23 01/08/06 01/06/06 01/12/06 01/06/06 01/08/06 8. 9. OP28 OP30 18 18 31/12/06 01/08/06 Alexander Court Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 Page 22 10. OP33 24 11. OP38 13 12. OP38 13 13. OP38 13 There must be a system in place to review and improve the quality of the service offered. A copy of the review must be forwarded to the CSCI and made available to service users. All staff must undertake fire drills and practices as per the homes policy and procedures. Fire drills and practices must be recorded. Confirmation of this must be put in writing on completion. (Previous timescale of 24 January 06 and 13 April 06 not met). Timescale agreed with the manager on the day of the inspection. All fire doors must be kept locked. (Previous timescale of 24 January 06 not met). Timescale agreed with the manager on the day of the inspection. Emergency call systems must be left within reach of service users. (Previous timescale of 24 January 06 not met). Timescale agreed with the manager on the day of the inspection. 01/08/06 15/05/06 25/04/06 25/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Alexander Court Nursing Home DS0000021763.V291513.R01.S.doc Version 5.1 Page 23 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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