CARE HOME ADULTS 18-65
Alexander Family Nursing Home Oakhurst 1 Parker Close Carshalton Surrey SM5 3HF Lead Inspector
Alison Ford Key Unannounced Inspection 27th March 2008 11:15 Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 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 Family Nursing Home DS0000019070.V360714.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 Adults 18-65. 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 Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Alexander Family Nursing Home Address Oakhurst 1 Parker Close Carshalton Surrey SM5 3HF 020 8669 1111 020 8669 7070 denise.deroyparker@btinternet.com 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) Mrs Denise Deroy Parker vacant post Care Home 18 Category(ies) of Learning disability (0), Physical disability (0), registration, with number Terminally ill (0) of places Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A variation has been granted to allow service 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. A maximum of four service users over the age of 65 may be accommodated in specified rooms on the lower ground floor. 28th August 2007 2. Date of last inspection Brief Description of the Service: Alexander Family Home is an attractive chalet style residence in Carshalton, designed and adapted by the proprietor, originally to suit the needs of a relative. As it was a private home it has retained a very comfortable and homely atmosphere. Now registered as a care home it provides accommodation for up to eighteen residents, with nursing needs, who may also have physical or learning disabilities. The home is situated close to the centre of town and is well served by public transport links. Accommodation is provided over two floors and consists of five double and eight single bedrooms all with en-suite facilities and there are also assisted baths on each floor. A large dining room is adjacent to the kitchen and there is a lounge on each floor, one of which opens onto the garden. The proprietor of the home is very involved in its running and she and her team are committed to providing a high standard of care within a family type environment. At the time of this inspection information regarding fees payable was not available. A copy of the homes Statement of Purpose, Service User Guide and the latest inspection report can be obtained from the home. Inspection reports can also be obtained from The Commission for Social Care Inspection via the internet. Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was the homes first key inspection visit as part of the inspection process for the year 2008/2009 and was unannounced. When writing this report, consideration has also been given to other information gathered throughout the year such as, records of incidents and accidents, complaints and other documentation required to be kept by the home as evidence of its commitment to the health and safety of the people who use the service. There have also been conversations with residents, their relatives and members of staff. Prior to the visit the homes Registered Provider had submitted an Annual Quality Assurance Assessment (AQAA). This is a document that is completed by The Providers and supplies information about the home, giving information about how well they consider they meet the needs of the people who use this service and their future plans. This home is registered with The Commission for Social Care Inspection to provide care for adults age 18-65 although a previous variation was in place to allow older people who were already living there to remain. On the days of this inspection there were 12 residents living in the home. One trained nurse was on duty with three care staff, supported by a cook, domestic and maintenance staff. The acting manager was attending a funeral of one of the residents and joined us halfway through the inspection. During the inspection a tour of the premises was undertaken; a sample of care plans were assessed, documentation relating to health and safety was seen and several of the residents and members of staff were spoken with. Menus and kitchen records were seen and the lunchtime meal was served during the visit. There have not been any complaints about this service since the last inspection. What the service does well:
Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 6 This home provides a clean, safe and comfortable environment for up to eighteen residents with a range of complex care needs. There have been extensive adaptations to accommodate those with a range of disabilities. Individual rooms are spacious with en-suite facilities and they have been personalised by residents. There is an emphasis on providing care within a homely rather than institutional environment and the atmosphere is that of an extended family. Many of the residents sit in the lounge together and eat their meals around a large table, often joined by the Registered Provider. As before, the atmosphere within the home was very warm and staff and residents were welcoming and cheerful. People that use the service told us that the care that they received was very good and they enjoyed the meals served in the home. One said that “it was a very nice place to live in “ and that they liked the fact that they “ could always do what they wanted, and get extra cups of coffee if they wanted them“. 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. At times she accompanies residents when they go out and has taken some of them away on short holidays. Staff training and development is ongoing and the majority of the care staff have achieved an NVQ level 2 qualification. Other training sessions have been provided in response to the needs of the residents. Various records required to be kept were seen and these were generally in good order demonstrating a commitment to the health and safety of residents and staff. What has improved since the last inspection? What they could do better:
Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 7 Although the people who use this service generally consider that it meets their needs, there are several issues that have been identified at previous inspections and have still not been addressed. These are now being referred to the enforcement team within The Commission. People who may be considering moving into the home need to be able to access sufficient information to help them decide if it will suit them. Previous inspections highlighted the need for them to have all of the information that they needed to make their choices, including information regarding fees. The Registered Provider states that this would be discussed this at the time of admission but it is still not available to anyone who is viewing homes and trying to make a decision about which one would suit them or their relative. Overall, there is a lack of evidence that people who use this service are given the chance to contribute to their care in any way. Neither pre-admission assessments nor care plans show that they have been consulted about how they would prefer to be supported or been able to influence how they would like to live their lives. Although the disabilities of some of them would make this difficult there are others who would be able to participate in this process and they must be given this opportunity. Previous inspections also highlighted the need for there to be some way available for anyone using the service to be able to comment on the care and facilities in the home. In response to this and to comply with the regulations, a questionnaire was devised however, there is no evidence to show that it has been distributed either to residents, their families or others who use the service such as care managers and healthcare professionals. The home still has no registered manager. Apart from a short period in time there has not been anyone in this role for several years. It is acknowledged that there is an acting manager and that the staff team is stable with a very low turnover however, this role is essential to provide leadership for staff and the effective day-to-day running of the home in which the aims and objectives of the home are achieved. There are appropriate policies and procedures in place within the home to ensure the safety and well being of both the residents and the people who work there. However, those that are intended for the people that live in the home would not be easy for them to read and understand. Consideration must be given to providing them in alternative formats, such as large print, pictorial and audio versions, which would be more suitable. Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 8 Care Homes Regulations are in place to ensure that the people who use services are protected from those who have been judged as being unsuitable to work with them. However, despite previous requirements, evidence of appropriate checks having been undertaken in this home are not available for inspection. An assurance has been made that they are carried out, but personnel files are not kept on the premises. If this practice is to continue there must be a method available for us to validate this during the inspection process. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards1, 2 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people who use this service have an assessment undertake, by a senior nurse, to make sure that their healthcare needs can be met however, they still do not have access to all of the information that would help them decide if the home was suitable for them. EVIDENCE: A copy of the Service User Guide is hanging outside each resident’s room with other information including a copy of the latest inspection report. Despite several previous requirements, the Service User Guide still does not comply with current regulations, as in, there is no information regarding the range of fees and extra charges that might be payable. The AQAA states that these would be discussed at the time of admission and based on individual need. However, The Care Homes Regulations 2001 amended 01/09/06 states that this information must be available in the Service User Guide. This is not just to satisfy The Commission, but also to provide any current and prospective service users with all of the information that they need to help them decide if the home will be suitable for them. Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 11 This will therefore now be referred to the enforcement team within The Commission regarding action to be taken to ensure that this regulation is complied with. Consideration must also be given to producing this documentation so that it is suitable for the people for whom it is intended such as larger print and illustrated text. One new resident has been admitted since the last inspection. He had not been well enough to be involved in the admission process but was able to tell us how happy he was with the placement, which had been chosen for him by his Care Manager. Assessments showing how his identified care needs were to be met were seen in his care plan from both the Care Manager and the nursing staff although there was not any evidence to show that he had been consulted about his preferences. During the inspection he was able to talk to us at great length about how he felt about his admission to the home and about the support that he needed. It is considered that he would have been quite able to discuss how he would like his care needs to be met and should have been offered this opportunity. The last inspection made a requirement that there must be evidence available to show that residents are given this opportunity to contribute to the preadmission assessment where they are able. This has not been addressed and so advice will be obtained from the enforcement team within The Commission. Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service have an individual care plan outlining the care and support that they need. However, there is limited evidence available to suggest that they have been consulted or asked for their views about how this will meet their needs and preferences. EVIDENCE: Each resident has an individual care plan and three of these were seen at this inspection. Nursing care needs are appropriately documented and reviewed on a regular basis. Factors, which might lead to the formation of pressure sores, are monitored regularly and appropriate equipment is in use. There is some evidence to show that individuals are involved in some decision making such as day-to-day activities but for most people this is limited. Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 13 While it is acknowledged that some residents living in this home have complex care needs, and their capabilities are limited there is still little to suggest that they or their families or representatives are involved in deciding how they would like to be supported or cared for. There must be more evidence available to show that residents have been encouraged to participate in the process, their views have been sought and they have been able to influence their care. This issue was highlighted at the last inspection and will therefore be referred to the enforcement team for advice. There is limited information available, in their care plans, about residents social needs and preferences or about their past lives and achievements. Gaining this information would help care staff to understand more about the people that they are caring for, and also to plan activities that will suit their interests and capabilities. Some of the residents do have access to an advocacy service. Few of them would be able to manage their own finances and the Registered Provider is an appointee for those who do not have a representative to manage their affairs. Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are able to enjoy range of activities, which will provide stimulation and interest to their lives. Some of them are able to maintain their links with the local community and visitors are always welcome so that family relationships 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. There has been marked improvement in the range of activities that are On the day of this visit, several residents were in the lounge, they had just completed a musical session, which is apparently always popular, and several of them said how much they enjoyed it. The housekeeper has taken on the role
Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 15 of coordinating the activities in the home. She is working with residents to try and discover more about their interests and provide sessions that will appeal to them and suit their capabilities. Some residents are able to attend an art centre and others are able to go out of the home with members of staff or their families. Visitors are always welcome into the home and residents could see them in private if they wish or sit in one of the large and pleasant lounges. All residents have locks on their bedroom doors however; none have elected to use them. Staff interaction with residents is good. Many of them have been working at the home for some time and they enjoy a good relationship with them. The fact that so many residents sit together in the lounge, and eat their meals seated around a large table also helps to promote the family atmosphere in this home. All those residents that were spoken with agree that the food served within the home is of a high standard and the menus that were seen in the kitchen were varied. These are currently being revised and amended. There are also menus in the lounge, however they are out of date. So that residents and their visitors know what will be served on that day, these must be updated when the new menus are printed. The chef has a good relationship with the residents and spends time talking to them about their preferences. He will always provide an alternative meal choice if it is wanted and extra snacks and drinks are always available. 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 very clean and tidy and appropriate records were well kept. This includes a record of the food that is actually eaten by residents on a daily basis to show that they are receiving a nutritious and well balanced diet. Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards18, 19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use this service know that staff will support them with their healthcare needs in a sensitive manner. Procedures are in place for the safe ordering, and disposal of medication although administration procedures could still be improved to minimise the risk of errors. EVIDENCE: Personal support is provided to residents in private and they say that 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 help residents move safely. Advice is sought from other members of the multidisciplinary healthcare team, such as physiotherapists, and the Tissue Viability Nurse as needed. Residents in this home generally have complex nursing needs, which they would be unable to manage themselves even if supported. Three care plans were seen at this visit. These showed that where residents need help and
Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 17 support this is identified with the ways that they will be addressed. Regular reviews take place to make sure that any changes are noted and care plans are amended accordingly. Records of medication storage and administration were seen. It is acknowledged that there was no evidence of any errors although the system for ordering and storage is unusual. Attempts have now been made to simplify the audit trail and there is regular monitoring. It was suggested that evidence of the audit should be made in a book rather than just a number entered on the Medication Administration Sheet, which might be misinterpreted. Currently no resident would be able to manage their own medication. Some concerns were raised about the practice of putting individual medication into named pots in the treatment room and then carrying it to the residents on a tray. It is considered that there could be a potential risk of having several pots on the tray at one time and the tray being put down if the nurse was distracted for some reason. It was suggested that a better practice would be to have some sort of lockable trolley, which could be taken around the home. Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22,23, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people who use this service consider that any concerns that they might have will be addressed appropriately. There is still no evidence available to show that appropriate checks are in place to ensure that residents are protected from harm. EVIDENCE: There is a clear and appropriate complaints policy which all residents and their families have access to although it is only produced in a standard format. The recommendation to have all documentation produced in a format / language appropriate for all residents is noted under standard 1. The complaints book is now kept in the entrance hall and was seen: the few concerns that were detailed had been dealt with in a timely way. Staff were able to demonstrate an awareness of issues around adult abuse and whistle blowing and have all received relevant training. Staff files are still being kept in a central office and there is therefore no way of checking that the required pre-employment checks are being undertaken. If the Registered Provider does not wish to keep personal information regarding
Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 19 staff in the home, there must be some record available to show if and when it has been obtained, including disclosure reference numbers. This is so that we can ensure that appropriate checks are being made and staff who have been judged as being unsuitable to work with vulnerable people are being prevented from doing so. The requirement for this evidence is addressed under standard 34. Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use this service live in a home, which is clean comfortable and well maintained with specialist adaptations, which ensures that their 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. Bedrooms are very spacious and three separate sitting areas provide an above average amount of communal space with access for residents requiring wheelchairs. Residents all benefit from en-suite facilities and there are two assisted baths. A passenger lift ensures that all areas of the home are accessible for people who may have limited mobility. This means that those with bedrooms downstairs could sit in the upstairs lounge and everyone can get down to the garden.
Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 21 On the day of the inspection the home was warm, fresh and clean. Carpets have recently been replaced throughout the home. Some concerns were raised about the recent introduction of CCTV into the home. This has been installed both at entrance areas and within the home in communal areas. It is generally considered that this should be limited to entrances for security purposes so that there is no way that it might impinge on resident’s privacy. We were not able to discover the rationale for the installation of this into the home. Care must be taken to ensure that it does not impinge on the daily life of those people who are using this service. Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 22 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use this service can be generally be confident that staff will have the necessary skills and expertise to meet their needs although there is still no evidence available to show that recruitment procedures are robust. Staff training ensures that residents healthcare needs will be met and staff supervision means that future needs can be identified. EVIDENCE: Many of the staff have worked in the home for some time and gained a great deal of experience in working with the residents. Most of them are qualified to at least NVQ level 2 and some are undertaking a level 3. There has been an increased emphasis on training in the home over the last year, and training videos have been purchased. However, it is recommended that the use of these should be monitored and experienced teachers used to deliver some sessions, rather than a reliance on videos. Also that a senior member of staff should be developed as a moving
Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 23 and handling trainer in order to provide ongoing support and assessment for care staff. Staff supervision is now in place to monitor staff performance and to identify future training needs. One newly appointed staff member was able to explain the pre-employment checks that were made before she started work. However, there are still no records being kept in the home. As noted, under standard 23, if the Registered Provider does not wish to keep this information in the home there must be some record available to show if and when it has been obtained, including disclosure reference numbers. This is so that we can ensure that appropriate checks are being made and staff who have been judged as being unsuitable to work with vulnerable people are being prevented from doing so. This issue was raised at the last inspection and will therefore be referred to the enforcement team of The Commission for advice. Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 24 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards37, 39,42. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use this service can be sure that there is an intention to run the home in their best interests however, the continued lack of a Registered Manager means that effective day to day running of the home is compromised. There is still no quality assurance monitoring system in place to give residents the opportunity to influence the running of the home. EVIDENCE: This home is still without a Registered Manager although apparently an advertisement has been placed. This situation has been ongoing for at least four years now with a brief interlude when a manager was in post. Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 25 It is acknowledged that there is a stable experienced staff team and a trained nurse has assumed this responsibility, which has generally maintained good quality outcomes for the people who use this service. However, this is an essential role, which provides leadership and clear lines of accountability for staff and continuity of care for residents. Evidence of the Registered Providers attempts to recruit a suitable person to this role must now be made available to the Commission and advice will be taken as to the necessary steps that need to be taken with regard to this continued failure to appoint a manager to the home. Previous inspections highlighted the need to find a way to monitor the views of the people who use the service. Attempts to gain information from questionnaires have apparently not been successful in the past. A new questionnaire was devised, seemingly to respond to the requirement. However, to date there has been no evidence available to show how this has been distributed. It would seem to be left in the home for visitors to pick up, rather than being actively promoted. Consideration must be given to making it available to a wider audience such as care managers, advocates and other healthcare professionals who visit the home. Given that this issue was raised at the last inspection it will be referred to the enforcement team of The Commission. A fire risk assessment has now been produced which has apparently been approved by the Fire Safety Officer. This includes information about evacuating residents from the home. This is not standard practice and it is recommended that advice should be taken from the Fire Safety Officer. There has been a recent fire drill carried out in the home and there is a designated person in charge of fire procedures. Records were available to show that equipment is well maintained and that health and safety practices and procedures are in place. Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 26 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 Standard No Score 1 2 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 3 X Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 27 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 YA6 Regulation 12(2) Requirement Care plans must contain more detailed information about that past lives and achievements of the people who are using this service. This will enable staff to understand more about them and to provide activities, which suit their interests and capabilities. Menus that are in the dining room must be updated to reflect the meals that are going to be served. Then people who use the service and their relatives will then be able to see what they will be having and whether they would like it. There must be evidence available to show the Registered Managers attempts to recruit a suitably qualified and experienced person to manage the home. Timescale for action 30/07/08 2 YA17 12(2) 30/07/08 3 YA37 8(1)(iii) 30/07/08 Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 28 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 YA1 Good Practice Recommendations It is recommended that consideration should be given to producing all of the documentation that is intended for residents in a format, which will be easier for them to read and understand. It is recommended that a lockable trolley should be provided for medication to minimise the potential risk of errors occurring. It is recommended that there should be a separate book for recording the medication audit. It is recommended that a lockable medicine trolley should be obtained to minimise potential errors during the administration of medication. It is recommended that there should be some staff training from appropriately qualified trainers as well as the training videos that have been purchased. It is recommended that advice should be sought from the fire safety officer regarding evacuation procedures in the event of a fire. 2. 3 4 5 6 YA20 YA20 YA20 YA35 YA42 Alexander Family Nursing Home DS0000019070.V360714.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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