CARE HOME ADULTS 18-65
Alexander Family Nursing Home Oakhurst 1 Parker Close Carshalton, Surrey SM5 3HF Lead Inspector
Alison Ford Announced 14 July 2005 9:00 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Alexander Family Nursing Home Address Oakhurst, 1 Parker Close, Carshalton, Surrey, SM5 3HF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8669 1111 020 8669 7070 Mrs Denise Deroy Parker Care Home 18 Category(ies) of Physical Disability, Learning Disability, registration, with number Terminally Ill of places Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1 - A variation has been granted to allow sevice users currently residing in the home who are over the age of 65 to be accommodated until such time that the home is no longer able to meet their needs or their placement ceases. 2 - A maximum of four service users over the age of 65 may be accommodated in specified rooms on the lower ground floor. Date of last inspection 14/02/05 Brief Description of the Service: Alexander Family Home is an attractive chalet style residence in Carshalton designed and adapted, by the proprieter, originally to suit the needs of a relative.As it was a private home it has retained a very comfortable, well maintained, and homely atmosphere. Now registered as a care home it provides accomodation for up to eighteen residents who may have physical or learning disabilties or be terminally ill. Four older people also live in the home and a variation to registration has been granted to allow them to remain there. The home is situated close to the centre of town and is well served by public transport links.Accomodation is provided over two floors and consists of four double and eight single bedrooms all with en-suite facilities and there are also assisted baths on each flooor. A large dining room is adjacent to the kitchen and there is a lounge on each flooor, one of which opens onto a well maintained garden. The proprieter of the home is very involved in its running and she and her team are commited to providing a high standard of care within a family type environment. Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first inspection for the year 2005/2006 and was an announced visit. It was conducted in the presence of the proprietor and the finance director who were welcoming and receptive to the inspection process. A tour of the premises was undertaken, a sample of care plans was assessed, and documentation pertaining to the appointment of new staff and various certificates essential to the maintenance of the home were seen. On the day of the inspection several residents were out, however, four members of staff, five residents and two relatives were spoken to. Two of the pre - inspection questionnaires, which are routinely sent out, had been returned and one relative was spoken to on the telephone. Neither, the home or the Commission have received any complaints since the last inspection and no additional visits have been necessary. There had been no accidents requiring hospital admission and no untoward incidents. The home has been without a registered manager for some while however an application has recently been submitted to the Commission for consideration. What the service does well:
This home provides a safe, comfortable and well-maintained environment for up to eighteen residents with a range of complex care needs. The home has had extensive adaptations to accommodate those with a range of disabilities. There is an emphasis on providing care within a homely rather than institutional atmosphere and residents are encouraged to undertake activities that are suited to their abilities. Trips out are arranged on a regular basis for those who are able to participate. There is a committed staff team in the home many of whom have been there for some time and the Registered Provider is very involved in the running of the home and often accompanies residents when they go out. Those residents and relatives that were spoken to, were very appreciative of the care that they received in the home agreeing that staff were “generally pleasant and caring “ and the meals served were “very good “ At this visit, as before, the atmosphere within the home was very welcoming and staff and residents were positive and cheerful. Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 6 What has improved since the last inspection? 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 Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 A comprehensive pre-admission assessment, undertaken by the proprietor or a senior staff member, ensures that resident’s physical, psychological and healthcare needs can be met in an environment, which will promote their independence and wellbeing. However frequent reviews of service users healthcare needs will ensure that the home is still able to provide the care they require. EVIDENCE: Care plans of three residents were assessed although none have been admitted since the last inspection and many of them have been there for some years. The pre admission assessments were, however, present along with those from the care managers. These were comprehensive and covered all aspects of the resident’s physical and psychosocial needs and formed the basis of subsequent care planning. There was evidence that these are reviewed on a regular basis to ensure that they reflect the current situation. The nursing team are considering how to improve the documentation and are confident that the appointment of a new registered manager will facilitate this. Those residents requiring nursing interventions are assessed by the Primary Care Trust nurse assessor however a requirement was made that this must be repeated should a resident’s physical condition deteriorate in order ensure that the most appropriate equipment is always provided.
Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,,9 Residents in this home are supported to make decisions and take risks within a managed framework so that they can maintain as independent a life as their disabilities allow although they are not always aware how this information is planned and documented. EVIDENCE: All the residents have an individual care plan; four of which were assessed at this visit. They are based on the “statement of need” compiled by the home’s staff and outline the personal and social support that will be required along with any nursing interventions that will be required. Tissue viability and moving and handling assessments undertaken regularly identify those most at risk. One of the residents and a relative spoken to were unaware of the content of these care plans and a requirement is given that their content must be discussed with them and that there must be documented evidence that it has been done. Residents are encouraged to exercise choices about all aspects of their daily living within a managed framework and to take risks where possible. Some go swimming; others accompany staff to the shops. Several are taken out on organised visits. Some of the residents have independent advocates and there are plans to introduce them for others.
Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15,16,17 Residents in this home are encouraged to undertake activities, which will provide stimulation and interest to their lives, and they are encouraged to continue their relationships with their relatives so that family links will be maintained. A well-balanced and varied diet is provided to ensure that resident’s nutritional needs are met. EVIDENCE: Residents living in this home are unable to work due to their complex care needs however a range of activities and pastimes are on offer to provide interest and stimulation including games, puzzles and exercises to music. Several attend an art class and some go swimming. Trips out are organised in conjunction with Sutton Community Council and the home is exploring the possibilities of purchasing their own transport in order that these might be increased. Four residents recently went on a barge, which has been adapted for those with disabilities and enjoyed lunch in a pub. Others visited The Imperial War Museum. Relatives that were spoken to confirmed that visitors are always welcome in the home or to join residents in their activities and the maintenance of contact with family and friends is encouraged.
Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 11 All residents have locks on their bedroom doors however none have elected to use them. Staff were observed treating them kindly and with respect and those that were spoken to agreed that staff were generally agreeable. All those that were spoken to agree that the food served within the home is of a high standard and the menus were seen to be varied and nutritious. The cook spends time talking to residents to establish their preferences and will always provide an alternative meal choice. The registered provider frequently joins residents for lunch, which is served at a large table to promote a congenial and homely setting. . The kitchen area was observed to be clean and tidy and records were generally well kept. Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18.19. Residents are generally confident that staff will support them with their healthcare needs in a sensitive manner, which will maximise their dignity and independence. EVIDENCE: Personal support is provided to residents in private and they are able to choose when they get up and go to bed. All rooms have en-suite facilities and there are hoists and other aids in use within the home in order to maintain independence. A requirement was previously made, under standard 2, to review the suitability of equipment should a residents health deteriorate. Advice is sought from other members of the multidisciplinary healthcare team, such as physiotherapists, as required although some concerns were raised regarding the manual handling needs of one resident. In order to ensure that the home can continue to meet their specific assessed needs, a requirement was made to obtain additional input from a physiotherapist and include the resident and relative in the discussion Residents in this home generally have complex nursing needs, which they would be unable to manage themselves even if supported. Care plans that
Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 13 were seen, reflected regular review of these however; a requirement was made to involve residents and their relatives in these. A key worker system is in place although discussion with a relative revealed that they are not always made aware of which member of staff that is. It was recommended that some way should be found to ensure that residents and their relatives are made aware of this information. Two residents have pressure sores and although care plans indicated that these were being treated appropriately, they would benefit from more detailed recording of the progression of the wound healing process. A requirement was made that a either a recognised monitoring tool or photographic evidence must be used. It was also recommended that any nursing interventions should be carefully recorded in the event that evidence of them being undertaken should be required. Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Residents in this home are confident that any concerns or complaints that they might raise would be dealt with promptly and they feel reassured that they are generally protected from abuse and neglect. EVIDENCE: There is a clear and appropriate complaints policy which all residents and their families have access to. The complaints book is kept in the entrance hall and was seen: there had not been any complaints since the last inspection. There is an adult protection and whistle blowing policy within the home. Two new members of staff had been employed since the last inspection without clearance from the Protection of Vulnerable Adults register. A requirement is issued under standard 34 concerning this. Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,30 This home provides a clean comfortable and well-maintained environment with specialist adaptations, which ensures that resident’s needs are met. EVIDENCE: The home is an attractive chalet style house that has been designed and adapted to suit the needs of the residents and is in keeping with its surroundings. Previous inspections have highlighted the problems of accessibility within the home due to the absence of a passenger lift. Materials have now been purchased and the construction of the lift should commence within the next two months. Requirements about the lift will not therefore be repeated on this occasion although the situation will be reviewed at the next visit. The home was clean on the day of the inspection and is well-maintained however still does not offer a sluicing disinfector. There has been considerable discussion over the possible site of installation of this and further advice must now be sought and an action plan submitted to the Commission. Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 Recruitment policies in the home are not always robust therefore residents cannot always be confident that they are fully protected by them. EVIDENCE: The files of two recently appointed members of staff were seen and both were incomplete. References were not available and clearance had not been gained from the Protection of Vulnerable Adults Register or Criminal Records Bureau. The Registered Provider agreed to deal with these issues immediately and one staff member would have her duties re-arranged until the relevant clearance checks had been made. The other had a very recent clearance certificate from a previous employer and had been working in the home for some while via an agency. It was agreed that satisfactory confirmation would be sought promptly, the situation will be monitored closely and a requirement issued to reflect this. Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The home is run in the best interests of the residents and they can generally be confident that their health and safety is protected as far as reasonably practical. EVIDENCE: A selection of maintenance certificates, including fire safety, was viewed and was found to be in order. Insurance certificates were seen and were appropriate. Documentation showing testing of fire alarms and emergency lighting was available. Kitchen records were up to date apart from those illustrating probe temperatures of hot food although an assurance was given that these were undertaken. The importance of recording these was explained. A range of policies and procedures were in place and records of accidents and incidents in the home were seen. Thermostatic valves are in place on taps however a requirement was issued that water temperatures must still be tested and recorded weekly. Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23
ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x x 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Alexander Family Nursing Home Score 3 2 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 19 yes Are there any outstanding requirements from the last inspection? 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 2 Regulation 13(1)(b) Requirement The Registered Provider must ensure that residents who require specialist equipment are reassessed if their healthcare needs change and be able to provide evidence that these can still be met. The Registered Provider must ensure that there is evidence that residents and their relatives are aware how their care is planned and evaluated. The Registered Provider must ensure that, where residents healthcare needs change, advice is sought from an appropriate member of the Primary Healthcare Team. The Registered Provider must ensure that there is evidence that residents and their relatives have been involved in the care planning process. The Registered Provider must ensure that there is a recognised tool in use to monitor, record and evaluate the progression of wound healing. The Registered Provider must install a sluicing disinfector in the home if nursing care is to be Timescale for action 1/10/05 2. 6 15(2) 1/10/05 3. 19 13(1)(b) 14/7/05 and henceforth 4. 19 15(1) 1/10/05 5. 19 12(1)(a) 1/10/05 6. 30 23(2)(k) To be agreed
Page 20 Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 7. 34 19(1)(b) 8. 42 13(4)(c ) 9. 42 13(4)(c ) provided and provide evidence that advice has been sought from a relevant authority. ( Previous timescale 30/11/04 not met ) The Registered Provider must ensure that no new member of staff comences their employment until all of the documentation as detailed in Schedule2 of the Care Homes Regulations is available. The Registered Provider must ensure that there is evidence that temperatures of hot food are monitored. The Registered Provider must ensure that the temperature of water intended for total body immersion is tested and recorded weekly. 14/7/05 and henceforth 14/7/05 and henceforth !/10/05 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. 2. Refer to Standard 15 (2) 15(2) Good Practice Recommendations It is recommended that a method should be found to ensure that residents are made aware of the members of staff who are their key workers. It is recomended that all nursing interventions are accurately recorded in order to provide evidence that they have occured . Alexander Family Nursing Home G53-G53 S19070 Alexander Family Home V198420 140705 Stage 0.doc Version 1.30 Page 21 Commission for Social Care Inspection Croyden, Kingston & Sutton Office 8th Floor, Grosvenor House, 125 High street, Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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