This inspection was carried out on 8th February 2006.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.
The inspector found there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.
CARE HOME ADULTS 18-65
Alexander Family Nursing Home Oakhurst 1 Parker Close Carshalton Surrey SM5 3HF Lead Inspector
Alison Ford Unannounced Inspection 8th February 2006 10:45a Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 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.V274200.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 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.V274200.R01.S.doc Version 5.1 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 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 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.V274200.R01.S.doc Version 5.1 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. 14th July 2005 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 who may have physical or learning disabilities 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. Accommodation 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 floor. A large dining room is adjacent to the kitchen and there is a lounge on each floor, one of which opens onto a well-maintained 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. Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes second inspection for the year 2005/2006 and was an unannounced visit. A tour of the premises was undertaken and five residents and five members of staff were spoken with. Over the course of the two inspections all of those standards considered, by The Commission, to be key top the inspection process have been assessed and this report should be read in conjunction with the one produced following the last inspection on 14th July 2005 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. Since the last inspection, a new Registered Manager has been appointed to the home and this inspection was conducted with her and the deputy manager. What the service does well: This home provides a safe and comfortable 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. 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 that were spoken to, were appreciative of the care that they received in the home agreeing that staff were “caring “ ” it was a nice place to live “ and the meals served were “quite good “ At this visit, as before, the atmosphere within the home was very welcoming and staff and residents were welcoming and cheerful. Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 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 DS0000019070.V274200.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 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 the following standard(s): 1,2 Residents and their relatives do not always have all of the information required for them to know exactly what they will have to pay for. Resident’s can be confident that their healthcare needs are regularly reviewed to ensure that they remain met. EVIDENCE: Concerns had been raised since the last inspection about costs that had been applied that were not in the original contract. The Registered Provider must ensure that the Statement of Purpose details exactly what the resident must pay for. Care plans now contain evidence that healthcare needs are regularly reviewed to ensure that they remain met and that support and interventions are appropriate. Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 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 the following standard(s): 7 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. EVIDENCE: 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. Some residents are able to be taken out on organised visits. Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 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 the following standard(s): These standards were no assessed at this visit. EVIDENCE: Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 18,20 Residents can be confident that staff will support them with their healthcare needs in a sensitive manner, which will maximise their dignity and independence and that medication policies and procedures will protect them. 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 Residents in this home generally have complex nursing needs, which they would be unable to manage themselves even if supported. Some care plans now contain evidence that relatives have been consulted and have been made aware of the support and interventions that are being provided. A Key Worker system is being introduced in response to previous recommendations. None of the residents are able to self medicate and records and storage are managed in a way which will protect them. Some issues were discussed about the frequency of medication reviews and healthcare assessments. A recommendation is made that there should be evidence available to show that these are occurring according to the National Service Framework best practice guidelines. Photographic evidence of wound healing is now in place.
Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 Page 12 Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 23 Residents can be reassured that procedures are in place to ensure that they are protected from abuse and neglect. EVIDENCE: An assurance was given that no new members of staff have been employed prior to obtaining relevant clearance from The Criminal Records Bureau and Protection Of vulnerable adults Register. Adult protection and whistle blowing policies are in place in the home. Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 24,30 This home provides a homely environment with specialist adaptations, which ensures that resident’s needs are met however they cannot always be sure that it will be clean. Residents cannot be sure that their safety will be maintained in the event of a fire. 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. A passenger lift has now been installed to allow residents accessibility to all parts of the home. The home still does not have a sluicing disinfector although a site for it is now planned; this situation will be monitored in the future. Several residents wish their doors to be kept open and these must be fitted with closers that would make sure that they shut in the event of a fire. Advice is being sought from the fire safety officer with regard to the fire safety in the home. On the day of inspection some areas were not very clean and, although some allowances were made in acknowledgement of recent building work, bathrooms and toilets were quite dirty. The Registered Provider must ensure that
Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 Page 15 domestic staff are employed in sufficient numbers to ensure that the home provides a clean and hygienic environment for residents to live in. Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34,35 Recruitment policies within the home have been improved to ensure that residents can feel confident that they will protect them. Staff training is not always sufficient to ensure that residents needs will be met. EVIDENCE: Staff files were not available for inspection however an assurance was given that no new members of staff are now employed without all of the necessary documentation being available to provide evidence that all required checks had been undertaken. One member of staff was experiencing problems obtaining the renewal of their work permit. Advice was taken from Work Permits UK and this situation will be monitored closely. There has been a limited amount of staff training although more is planned. The Registered Provider must ensure that all staff receive training appropriate to the work that they undertake. Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 There is no method currently in place to monitor residents views of the care and services that that they receive or the success of the home in meeting its objectives. EVIDENCE: There is not currently any form of quality assurance monitoring tool in use in the home, and relatives meetings do not occur. The Registered Provider must introduce some method to measure how well the home is meeting its objectives and supplying the care and services that residents want. Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 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 Standard No Score 1 2 2 3 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 X 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X 3 X X X 2 X X X X Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 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 YA1 Regulation 4 (b) Requirement Timescale for action 08/02/06 2 YA24 23(4) 3 4 YA30 YA30 23(2)(d) 23(2)(k) The Registered Provider must ensure that residents are aware of all charges that will be payable to the home prior to their admission. The Registered Provider must fit 30/05/06 automatic door closers, which operate in the event of a fire, to where residents wish their doors to remain open. The Registered Provider must 08/02/06 ensure that the home is kept clean at all times. The Registered Provider must 30/05/06 install a sluicing disinfector in the home if nursing care is to be provided and provide evidence that advice has been sought from a relevant authority. (Previous timescale 01/10/05 not met) The Registered Provider must ensure that all staff receive training appropriate to the work that they are expected to do. 5 YA35 18(1)( c ) 30/05/06 Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 Page 20 6 YA39 24(1) The Registered Provider must ensure that an effective quality assurance monitoring tool is introduced to gain the views of residents and their relatives. 30/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard 20 Good Practice Recommendations It is recommended that all residents have regular medication reviews in line with current best practice guidelines. Alexander Family Nursing Home DS0000019070.V274200.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Croydon, Sutton & Kingston 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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