Inspection on 19/08/08 for Alexander Heights

This inspection was carried out on 19th August 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Alexander Heights 30/06/09

Alexander Heights 05/09/07

Alexander Heights 21/09/06

Alexander Heights 06/12/05

Alexander Heights 11/07/05

Alexander Heights 17/02/05

Alexander Heights 21/10/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 04/12/2008.

CARE HOMES FOR OLDER PEOPLE Alexander Heights Alexander Heights Winsley Hill Limpley Stoke Bath BA2 7FF Lead Inspector Alison Duffy Unannounced Inspection 19th August 2008 09:15 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 Heights DS0000028312.V368245.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 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 Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexander Heights Address Alexander Heights Winsley Hill Limpley Stoke Bath BA2 7FF 01225 722888 01225 723017 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) Avonpark Care Centre Limited Jean Carole Chapman Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th September 2007 Brief Description of the Service: Alexander Heights is a residential care home registered to care for 28 older people. The home is not registered for Nursing Care. Intermediate Care is not provided. The home is located within a Care Village in Limpley Stoke near Bath. Mrs Jean Chapman is the registered manager. The accommodation is on the first floor of a purpose built unit. Access is gained via a passenger lift or stairs. There is a terraced area, adjoining the air-conditioned conservatory style lounge. People have access, if they are independent or have support, to well-maintained gardens at ground level. There is a small shop, library and a GPs surgery within the complex. People have their own room with an en-suite facility. Communal areas consist of the conservatory, a separate dining room, a games room and two lounges. There is a central kitchen and all laundry is undertaken within facilities also used by other units on site. Staffing levels are maintained at three members of care staff on duty throughout the waking day. There are also domestic staff and an activities organiser. A member of staff is employed for the servery to serve breakfast, lunch and supper. The manager is on duty Monday to Friday and is able to assist when required. The complex provides central catering, laundry and maintenance staff. At night there are two waking night staff and an on call management system. The fees for the home are dependent on the size of the room occupied and the individual needs of people. This ranges, on a weekly basis from £630.00, up to £1000.00, for a suite, which includes a sitting room. Additional charges for chiropody, hairdressing and personal items apply. People are able to access domiciliary care, physiotherapy and other services, as they would do in their own home. Alexander Heights DS0000028312.V368245.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 key inspection took place over two days. The first day took place on the 19th August 2008 between the hours of 9.15am and 6.30pm. The second day was on the 18th September 2008, between 9.30am and 1.45pm. There were two inspectors throughout the inspection. Mrs Chapman and Ms Robinson, head of care, received feedback. The pharmacy inspector visited to look at the medication systems. The findings of this visit are detailed within this report. We used an ‘expert by experience’ with this inspection. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. We met with people who use the service in their own rooms and within communal areas. We spoke with the staff members on duty. We looked at the management of peoples’ personal monies. We observed the serving of lunch. We looked at care-planning information, training records, staffing rosters and recruitment documentation. We toured the accommodation and saw bedroom and communal areas. As part of the inspection process, we sent surveys to the home for people to complete, if they wanted to. We also sent surveys, to be distributed by the home to peoples’ relatives, their care managers, GPs and other health care professionals. The feedback received, is reported upon within this report. We sent Mrs Chapman an Annual Quality Assurance Assessment (AQAA) to complete. Information from the AQAA is detailed within this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Some assessments and care plans would benefit from greater detail in order to ensure people are fully supported. The exact time of administration of medicines prescribed ‘as required’ must be recorded so that an accurate record of the dose given is kept. All medicines must be given in accordance with the prescriber’s instructions. Special care must be taken when transcribing these instructions onto the medication administration record so that people receive their medicines as prescribed. Cleaning schedules and staff deployment must be reviewed to ensure the environment is cleaned to a satisfactory standard throughout. Requirements to ensure that people are able to regulate the temperature of their room have not been addressed. Without being able to do this, some people are uncomfortable within their room. Staff must ensure that they follow procedures when dealing with peoples’ personal monies held for safekeeping. The remainder of cash must be counted after each transaction, to ensure it corresponds with the balance sheet. On no account must staff receive money from any person using the service. Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 7 Staffing levels should be reviewed to ensure sufficient levels are in place to meet people’s needs and enable people to have one-to-one time with staff. The environmental risk assessments in place require review. 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 Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 8 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 Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Standard 6 is not applicable to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People should be given sufficient information prior to their admission about the cost of their care. People are assessed before being offered a service, yet greater detail within assessment documentation, would ensure that more information is available to staff to meet individual need. EVIDENCE: Within the AQAA, it is stated ‘all potential residents are assessed in their own home and a welcome pack containing the Service Users Guide and information about the unit is given to them. The GP or, if in hospital, the Consultant, are requested to give their medical opinion as to the suitability of a placement and whether we can meet the individuals needs appropriately.’ One person confirmed that they were assessed before their admission to the home. They said ‘they came to see me in hospital on the Thursday and said I Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 10 could move in that afternoon, but I said it was too quick, so I came on the Friday.’ We looked at the assessment documentation of a person newly admitted to the service. The form containing details of the initial enquiry was headed Fountain Place Nursing Home. The assessment format contained information about the person’s basic care needs. There was very little information about the person’s current medical condition or how it was to be managed. The section on medication was not filled in. We saw that the person needed assistance to wash and dress. The actual support required was not expanded upon. The person had a small ulcer yet this information was not transferred over to care planning documentation. Within the assessment, under the heading social requirements, it stated ‘very quiet lady.’ There was no further detail about the person’s social interests. Mrs Chapman told us that the fees for living at the home are calculated depending on the size of the room and the person’s needs. There was no evidence as to how this was undertaken. Within the Statement of Purpose we saw that the fees were described as ‘from £630.00.’ We advised greater clarity to this information so people were clearly aware of what they needed to pay, before their admission. We saw that two people received a domiciliary care service from the care village. This was to support them with their personal care routines. Mrs Chapman told us that family member’s had asked for the additional support for their relative. People paid an additional cost for this service. We made a recommendation at the last inspection to clearly state this service, within the Statement of Purpose. There was no evidence that this had been addressed. There were a number of comments from people about the cost of the service. One person said ‘I worry a lot about my money running out.’ Another person said ‘a couple of people have to pay for domiciliary care to be provided, if our needs changed we would have to pay for it.’ Within their report, the ‘expert by experience’ stated ‘although costs are high, as one person told me, to stay in a hotel in Bath would cost a lot more.’ Mrs Chapman told us that since the last inspection, the levels of dependency within the home had decreased. Two people, who use the service, commented that dependency levels remain high. One person said ‘people here need nursing. It’s more like a nursing home now. People who are independent are left to their own devices.’ Another person said ‘its like a nursing home. The needs of the people here have changed. We don’t have many reviews but when we do I am involved.’ Mrs Chapman told us that people’s needs are regularly reviewed. In the event of deterioration of their health, people may remain in the home while awaiting a place in the care village’s nursing home. Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 11 Alexander Heights does not provide intermediate care, so standard 6 is not applicable to this service. Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While care planning has improved, greater detail would enable staff to have more information to support people effectively. People have good access to health care provision. The home has clear procedures for the safety of people who receive medication, however checks must be put in place to ensure that all medicines, particularly those with more complex dosing regimes, are given and recorded accurately. EVIDENCE: People told us they were happy with the care they received. One person said ‘I have help from the staff to get up, go to the toilet and get dressed. They are wonderful.’ Another said ‘they take me to have a bath and help me.’ Within their report the ‘expert by experience’ stated ‘everyone said that they were as content there as they would be anywhere if they could not be in their own homes.’ Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 13 We looked at a sample of care plans. We saw that staff had developed the content of the plans since the last inspection. Each care plan had a front sheet detailing a summary of the person’s needs. We saw however, that some aspects of need were not identified. For example, one person was recovering from surgery. There was no detail as to how the person’s condition should be managed other than ‘ensure XX has his/her physio weekly.’ We advised greater clarity to statements such as ‘dressing/undressing: one female member of staff to carry out this task.’ We said this did not inform staff of the actual support they needed to give. Another plan stated ‘staff to monitor XX to ensure s/he does not become constipated or develop a urinary tract infection.’ There were no details, as to how staff should do this. We saw that some entries gave clearer information. This included the support a person needed to maintain their hygiene needs and maintain healthy skin. There was good acknowledgment that the person ‘thought they were a nuisance.’ In response to this, it was stated ‘staff to be patient and give reassurance at all times.’ We advised that greater detail, as to the person’s management of their anxiety, be stipulated. As good practice, the need for the person to have their call bell in easy reach was stated. Within another plan, it was stated ‘visual impairment – staff to interact and communicate with XX in a tone and phrase that she is comfortable with.’ We said greater detail and clarification would ensure more effective communication. We saw it was stated within one plan, ‘encourage XX to the dining room for meals and to participate in organised activities. This will prevent him/her from becoming socially isolated.’ The person told us that they liked their own company and had never been one to socialise. They spoke in detail and therefore, would potentially benefit from one-to-one support rather than a group activity. At the last inspection, we made a recommendation that fluid charts should be totalled at the end of each day in order to evaluate people’s fluid intake. We saw that staff were recording specific quantities yet daily amounts were still not being totalled. We saw that one person was prescribed insulin. The actual dosage of the medication was recorded on the person’s care plan. Information did not detail whether the district nurse administered the injection or whether the person did it him/herself. Mrs Chapman told us that staff monitored the process yet the person injected him/herself. We said this should be clearly documented within the care plan. We said the parameters of the person’s blood sugar levels to demonstrate wellbeing should also be stated. We advised that greater clarity be given within the daily records. For example, one record stated ‘medication given as charted. Washed and dressed by care Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 14 staff. Domiciliary carer to assist with feeding today. Fluids encouraged. Pads changed when needed.’ People told us that they had good access to health care professionals. They told us that district nurses and GPs regularly visited. Mrs Chapman confirmed that the GP could be contacted at any time for advice. She said ‘we are very lucky with the support we are given. They are all very good.’ Within their survey, a GP reported satisfaction with the service provided. We saw that some people were receiving a high level of physiotherapy. We did not see any assessments whereby the need for physiotherapy had been identified. We did not see any referrals to the NHS, regarding physiotherapy input. Mrs Chapman told us that some family members had requested physiotherapy for their relative. She said that as waiting lists for an NHS physiotherapist were so long, a private physiotherapist used in all of the village’s services had been contacted. We said people should be given the choice of available services rather than be given the name of one professional. Mrs Chapman told us that people could use who ever they wanted to. We did not see any evidence to support this statement, as we found people were using the physiotherapist who usually supported the care village. Within their report the ‘expert by experience’ stated ‘a number of people had rather dirty teeth and in one case several teeth probably needed attention by a dentist. I was told by another gentleman that there is no regular visit arranged for a dentist.’ We saw that one person’s glasses were dirty and needed cleaning. When we arrived, the drugs trolley had been left unattended in the corridor. There was unsecured medication on the top of the trolley. Our Pharmacist Inspector looked at the arrangements for medicines in the home. Medicines were stored appropriately and records maintained. A procedure was available for staff to follow and information about medicines was easily accessible. All staff who administer medicines had had training in safe handling of medication. An appropriate nurse had trained some staff in specific techniques, so that they could undertake certain, more complex tasks. Staff we spoke to had a good understanding of the importance of safe procedures when giving medicines. Records for the treatment of some people with an anticoagulant medicine were not completely clear and easy for staff to follow. We drew the manager’s attention to published guidelines, which should be followed. All medicines are recorded on the medication administration record, including creams and lotions. A separate sheet is used to accurately record the doses of medicines prescribed ‘as required’; although we saw some instances where this had not been used. Guidelines for the safe use of these medicines were documented in the care plan. Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 15 When we looked at the controlled drugs records we saw that an error had been made in following the prescribed instructions for two people’s medicines. This was corrected at the time of the inspection and the manager asked to undertake an investigation into the incident. We saw that staff knocked on peoples’ doors and waited to be asked in, before entering. We saw a member of staff deliver mail to people. They asked one person is they wanted support to read the information. We saw that staff spoke respectfully to people although within an activity, people’s dignity was not fully promoted. This is addressed within the next section of this report. Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While activities are undertaken, greater consideration in relation to individual need would be beneficial. People are generally encouraged to follow their preferred routines. Visitors are welcomed. An extensive menu is available giving choice and a varied selection of food. EVIDENCE: There is an activities coordinator who works 30 hours a week. They also work in another of the services within the care village. We saw an activity plan on the notice board, which detailed the planned activities for the week. Specific activities included a game of Boggle, Play your Cards Right, Scrabble and Countdown. There was also quoits, cards, bingo and a horse racing game. Within their report, the ‘expert by experience’ stated ‘there was a lady who came three times a week to arrange entertainments of various kinds and all those who took part said that they enjoyed her visits. While I was there she was going round and giving everyone an invitation to a tea party to be held on Saturday at 4.30pm. One gentleman said little happened at the weekend. Several clients said they went out for a walk in the grounds, which are quite extensive.’ Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 17 In the afternoon we saw a quiz, taking place. There were two members of staff in the lounge but only one staff member was conducting the quiz. We said the second member of staff could have used the opportunity to undertake another activity or one-to-one work with people. We said greater consideration should be given to the chosen activity and the ability of people. For example, some questions were very easy, which caused some people to become restless and agitated. There was lots of praise when a person got the answer right. We said this came over as being slightly patronising and did not promote respect. Staff used terms such as ‘darling’ and ‘sweetheart’, which did not promote people’s dignity. The manager showed us a file, where the activities coordinator recorded who had attended the activities. The majority of the entries stated ‘XX really enjoyed the quiz,’ ‘XX enjoyed playing scrabble’ and ‘XX enjoyed playing quoits’ etc. We said this was not person centred and did not capture the person’s experience of the activity. We said staff members should not find themselves ‘speaking for the person’. We saw within this file, there was personal information about people using the service. We said this was not an appropriate place to keep this information. People made various comments about activity provision. One person told us ‘XX [the activities organiser] comes in and does my nails for me on Fridays, I choose not to join in activities but people come to me with the gossip.’ Another person said ‘I play scrabble three times a week. I try to support the activities lady so I go to almost everything except the horse racing.’ Another person said ‘I stay in my room at the moment, but when I am better I will go to the activities. I don’t cut myself off though, I keep the door open so that I can wave to people.’ One person said ‘I don’t do any activities really, I play scrabble, but not many can manage to play. The games they play here are not really my cup of tea.’ Some people told us that they spent large amounts of time in their room. They chose not to join in with the activities on offer. One person said ‘not a lot to do, you’re left to your own devices. Some days can be long.’ Another person said ‘I stay in my room, I don’t go to the activities, as I can’t see.’ Other comments included ‘there’s not a priority for staff to sit and chat. I would love them to. The days seems endless,’ and ‘I spend most of my time in my room.’ One person said ‘I get very bored.’ Within the AQAA, it was stated ‘we have opening visiting hours and this has more recently been utilised by one family visiting at 8am before work and returning to sit with their XX after work until 10pm.’ People told us that they were able to have visitors at any time. One person said ‘staff encourage me to be independent. My XX pops in a lot and they make him/her feel welcome.’ Another person told us that they spent large amounts of their time with their friends in the communal areas of the sheltered accomodation complex, within the care village. Further comments included ‘I have my own phone so that I can talk to my XX daily’ and ‘when my visitors arrive they always make them a Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 18 cup of tea.’ A visitor told us ‘I visit at different times without notice and they are always very welcoming.’ We saw that some people went out with their family. There was no evidence that staff provided social activity provision within the local community. People told us that they could follow their preferred routines. They could spend time in their room when they wanted to. One person told us there was no pressure to join in with activities or to socialise with others. The majority of people told us they could get up and go to bed when they wanted to. However, one person said ‘they wake me up at 7o’clock and then I sit in my chair. They have to get so many people up before they go off duty at 8am.’ Within their report, the ‘expert by experience’ stated ‘people took their breakfast in their rooms and felt this was a good arrangement as they were not in a hurry to get up.’ All food is cooked in the care village’s central kitchen. It is then transferred up to the home in a ‘dumb waiter.’ Each meal consists of three courses. There is also a choice of each meal. We saw that the meal looked appetising and well presented. Within their report, the ‘expert by experience’ stated ‘several people made good comments about the food, though one lady and another gentleman said they wished the vegetables were cooked a bit more. They understood that it was the modern way not to overdo them.’ Mrs Chapman said this would be addressed with the chef. We received various comments about the food. These included ‘the food is lovely, but the meals are too big. We have a choice of food’ and ‘I go to the dining room for my main meal. I think the food is good, not as hot as it could be sometimes.’ One person said ‘food is quite good but variable. Sometimes I have friends in the dining room [downstairs] and it always seems nicer food down there.’ Another person said ‘the food is very good, but I have no bottom teeth so I find eating anything hard a bit difficult. I have breakfast in my room and can choose to have a cooked breakfast or cereal and toast. One carer spoils me, s/he brought me a boiled egg this morning.’ One person told us they felt the cutlery was very heavy. Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are aware of how to make a complaint yet a more positive attitude towards complaints would be beneficial. Adult protection systems are in place to safeguard people from abuse. EVIDENCE: People are given a copy of the home’s complaint procedure on their admission to the home. We saw a record of formal complaints is maintained. We advised that concerns, which are raised and addressed on a day-to-day basis, should also be recorded within the complaint’s log. Within the AQAA, it was stated ‘having this open door policy enables residents and their relatives to feel comfortable to come and speak openly to me and know that they will be given time and listened to, with the knowledge that their concerns will be addressed immediately, in all cases.’ While acknowledging this, we advised that a less defensive approach to complaints be adopted. For example, one complaint, raised issues with a relative’s care. Weight loss and the need for more staff assistance were identified. Rather than fully investigating the complaint and negotiating a satisfactory way forward, the complaint was insufficiently addressed. The relative was informed that the person was of a sufficient weight and would not wish to receive assistance due to being very proud. We saw that a sticker had been put onto the documentation. The sticker stated ‘not upheld!’ Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 20 People told us that they were aware of how to raise concerns. One person said ‘the manager pops in to see me. If I had any complaints I would see her.’ Another person said ‘the manager is very nice but I wouldn’t complain unless I had to.’ A further comment included ‘ I know who to complain to, we discuss things and moan to ourselves but there is no way to feed back how we feel.’ Another person said ‘I’m not really ok here. They are very good at looking after me but I’m still not ok. The manager is very good and I have chatted to her about it.’ Another person said ‘I would tell my family if I was unhappy about anything.’ Mrs Chapman told us that all staff have undertaken training in safeguarding adults. She said staff are given a copy of the local adult protection reporting procedures ‘No Secrets in Wiltshire and Swindon.’ We saw a copy of the procedure on the notice board in the staff office. Staff told us they would immediately report any suspicion or allegation of abuse. We saw that a person had made a complaint about a member of staff. They said the staff had been abrupt and rude to them. Documentation showed that Mrs Chapman had investigated the complaint. We said in future, any such incident should be discussed with the local safeguarding adults unit. Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recent decoration of the main corridor has improved the environment for people. Some people are negatively affected through not being able to control the temperature of their room. While the home, is generally cleaned to a satisfactory standard, some areas need greater focus. EVIDENCE: The home is located on the first floor and is accessed via a passenger lift or a staircase. The main entrance/exit door is linked to the call bell system yet we were able to walk into the home without being challenged. All rooms provide singe occupancy and include an en-suite facility. This may be a toilet or a toilet and shower. Rooms vary in size and there is also a suite. The suite consists of a bedroom, sitting room and bathroom. There are additional communal bathrooms with assisted baths. Communal areas consist of a dining room and two communal lounges. Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 22 Within the AQAA, it was stated ‘the main corridor has been painted and gives a much cleaner, fresher look to the home. Resident’s bedrooms are being decorated and soft furnishings being replaced.’ The AQAA confirmed that within the next twelve months further bedrooms and both the dining rooms are due to be decorated.’ We saw that the dining room was in need of decorating, as the wallpaper was in places, coming away from the wall. Within their report, the ‘expert by experience’ stated ‘at present it [the environment] is in a good state of repair though window frames may need replacing in the future, as they are part of the original building and are made of wood and therefore no double glazing. The rooms were comfortably furnished and several clients had brought in items from their own homes. There were two lounges and a conservatory, which were available. The dining area was very nicely laid up about 12.30pm just before I left at lunchtime and looked ideal.’ At the last and subsequent inspection we made a requirement that people must be able to maintain the temperature of their room at a standard acceptable to them. This has still not been addressed. Within a regulation 26 report, which was undertaken by a senior manager in June 2008, we saw that ‘problems with the heating’ was stated. Mrs Chapman told us that she was not aware of how or when the regulators on the radiators would be addressed. She advised us to talk to Ms Lisa Beeson, the responsible individual, for further information. Within their report, the ‘expert by experience’ stated ‘the radiators had no adjustment valves on them and so they were either on or off. The day I was there it was comfortably warm outside and as a result most clients had their windows open, as the rooms were too hot.’ We saw people who had had their heating turned off completely, as they were too warm. We saw one person who was very cold in their room. They were sat with their coat on. We brought this to the staff’s attention. The staff member immediately adjusted the heating for the person. Another person said ‘It’s very cold in here, I am fine here apart from always being cold.’ We said that Ms Beeson must inform us, as to how the shortfalls in the heating systems, are to be addressed. On a tour of the accommodation we saw that there was a leak in the conservatory roof. The rain was dripping onto the carpet. We alerted staff to this and they said that work was planned to address the matter. We saw that one toilet seat in a person’s en-suite was broken. There was sticky tape on many of the mirrors. Mrs Chapman told us that this was because new soap dispensers had been purchased. The sticky tape was left when the old units had been removed. We saw that window restrictors were in place. We advised that Mrs Chapman checked latest health and safety guidance, to ensure the restrictors meet current legislation. Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 23 At the last inspection we made a requirement that the use of bed rails must be authorised by a qualified health care professional. We said the rails must be monitored and reviewed on a regular basis. We saw that one person had bed rails. They did not have bumpers on the rails. There was no evidence of a formal assessment regarding the use of the bed rails. Within the person’s care plan it stated ‘bed rails checked every 30 minutes.’ There was no evidence of this. The requirement has therefore not been met. Mrs Chapman told us that a new post of housekeeper has been developed. The role covers two other services within the care village. Within the AQAA, it is stated ‘she ensures that domestic staff complete their tasks to a high standard.’ People had varying views about their accommodation. One person said ‘I have a shower in my room but I would prefer a bath.’ Another person said ‘my family decorated the room and paid for the carpet for me, they would have done it but my family wanted to do it.’ Another person said ‘once a fortnight the cleaners come in. I have a new carpet, but I didn’t pick it, they just came and did it.’ Further comments included ‘it’s fine here, I have a lovely view of the trees,’ ‘I was able to bring in some of my own furniture, but the room is rather small’ and ‘this is a pokey room isn’t it, the view is the best thing.’ One person told us ‘they keep the room clean and the laundry is very good.’ Another person said ‘while I had my shower they changed my bed so that I have nice clean sheets.’ We saw that the majority of the windowsills were dusty. There were two over bed tables, which had debris on them. One person told us that their carpet was stained. We saw this was so. Other comments people made included ‘they clean up every day,’ ‘the carpet is a bit grubby, could do with a clean, I don’t know how often the cleaners come in’ and ‘the base of my small table is dirty. It needs cleaning.’ Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 24 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. 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. Some people’s experiences demonstrate that staffing levels are maintained at a minimum level and do not enable sufficient time for social interaction. Staff training is promoted yet training records do not evidence that all staff are up to date with the training available. Documentation is needed to show that all staff are robustly recruited. EVIDENCE: We saw that staffing levels are maintained at three care staff on duty throughout the waking day. There are usually two, sometimes three domestics on duty. There is one person who assists with the serving of meals. At night there are two waking night staff. The staffing rosters demonstrated that five staff are contracted for 48 hours a week. We saw that one member of night staff was contracted for 60 hours a week. They had worked five consecutive nights with one night off. They then worked six more nights. Within their file we saw that their hours were to be reviewed after six months. This had not been done. We advised that the safety of this arrangement be considered and adjusted accordingly. People were complimentary about the staff team. Specific comments included ‘I would never complain about the staff as they are wonderful. Waking night staff are also very good,’ ‘the staff are very good, they come quickly when I Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 25 call them’ and ‘they all look after me very nicely.’ One person told us ‘all staff are very good, XX is exceptional. Very much a people person, down to earth and approachable, a real asset.’ There were a number of comments about staff being very busy and over stretched. One person said ‘the only time we can chat to staff really is when they do our personal care.’ Another person said ‘staff are lovely, all very good but so busy, it’s like a nursing home here.’ Further comments included ‘XX is very good but always totally run off her feet’ and ‘it’s a treat to have the inspector to talk to for a while’. One person said ‘the staff are lovely. They have such a hard job. There is never enough staff. They never have the time to sit and chat. We can only chat when they are helping me. They come to me as soon as they can.’ Another person said ‘the staff are very sweet, most of them treat me nicely, but there’s always a few grumbles. They seem to be run off their feet, sometimes I would like to sit and chat. We all have a key worker but even s/he doesn’t call in and say how are you?’ Within their report, the ‘expert by experience’ stated ‘everyone commented on the kindness of the staff and how nothing was too much trouble.’ Within surveys, staff told us they had training related to their role. As a means to improve the service, two staff said ‘listen to staff more.’ With the AQAA, it was stated that 80 of the staff team have a National Vocational Qualification. The AQAA later stated ‘all staff are encouraged to undertake NVQ training and all mandatory training to ensure that current information and best practice are followed by all. All staff receive mandatory training annually to ensure that they are equipped with up to date skills and knowledge. Staff also utilise the knowledge and advice from District Nurses and Physiotherapists to enable them to give best care to each resident.’ We saw that a training matrix was in place. This covered the period of September 2008 to August 2009. First Aid, manual handling and two sessions of safeguarding vulnerable adults had been arranged for the remainder of this year. We saw that health and safety, protection of vulnerable adults, fire awareness, first aid, infection control, basic food hygiene and manual handling had been completed. Additional courses such as tissue viability, dementia and the control of hazardous substances, had been arranged. Within individual training records, we saw that some staff were not up to date with their mandatory training. One record showed the date of the person’s last training session to be 16.1.06. Another record showed that the person had only completed infection control and manual handling training. There was a list of staff who had passed their level 2 award in Health and Safety yet not all staff identified, worked in the home. We saw that the housekeeper attended health and safety training. The head of care told us that she had recently completed her Registered Manager’s Award. Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 26 At the last inspection we made a requirement that documentation must demonstrate a robust recruitment procedure. Mrs Chapman told us that there had not been any new staff since the last inspection. We were therefore not able to ascertain, if the requirement had been met. Within the AQAA, it was stated ‘before starting work all staff are interviewed by a manager and senior staff, they then have to wait for two satisfactory references to be received by the manager and a POVAFirst/CRB clearance before they can work with residents.’ We saw that a member of the village’s domiciliary care agency was working as part of the staffing roster. We asked for the recruitment documentation of this person. Mrs Chapman told us that the information was not available, as it was stored at the main office of Avonpark Care Centre. We saw that one person was recorded on the staffing roster, as a domestic. They also completed care shifts. There was no evidence within documentation of the process followed to employ the person as a carer. We saw that Criminal Record Bureau (CRB) certificates were stored in sealed envelopes. We advised that the date of the CRB’s should be written on the envelope. Alternatively, a checklist could be used to evidence the various stages of the recruitment process. We did not see photographs of the staff members within their file. We saw that induction programmes were in place. These were basic and contained aspects of health and safety. Discussions about care practices and people’s individual care needs were not evident. Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from a supportive, encouraging management style. While a quality auditing system is now in place, an action plan would assist with directing ongoing developments. Staff must ensure they follow policies and procedures when managing peoples’ monies, which are held for safekeeping. Systems are in place to promote peoples’ health and safety. EVIDENCE: Mrs Chapman has been the manager of the home since May 2006. She has the Registered Manager’s Award and undertakes short training courses with the staff team. One member of staff told us that Mrs Chapman was approachable and they felt comfortable in raising any issues with her. Another staff member said that Mrs Chapman has worked very hard to develop and improve the Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 28 service offered to people. Mrs Chapman told us that she aims to involve staff and ensure they are fully supported to undertake their role. Within the AQAA, it is stated ‘as the manager, I have an encouraging and supportive nature and am enthusiastic to develop the skills of my staff team.’ Within their report, the ‘expert by experience’ said ‘Jean the head lady in charge was friendly and helpful to all she had dealings with while I was there, both clients and staff.’ At the last inspection, we made a requirement that a formal quality assurance system must be implemented. We saw that this had been addressed in part. There was a quality audit, which was recorded as being undertaken on the 1st February 2008. This was a comprehensive document. All matters were ticked as being met. We saw that the audit covered aspects such as the environment, management, medication, infection control and catering. The document stated that questionnaires had been sent to people using the service. We did not see the returned questionnaires. There was no evidence of any evaluation. We did not see that an annual development plan had been developed. There was no evidence of resident’s meetings taking place. One person told us that such meetings were not held. We were told that there had been two recent deaths in the home. We had not been informed of these under regulation 37. A number of people have placed small amounts of their personal monies, for the home to hold safely. We looked at the systems for managing this. We saw that some entries within the records were not dated. Some entries were unclear. One record showed a figure as a debit and a credit. Only one member of staff had signed the majority of transactions within the record. There was one administrative error, which was made in April 2008. The error had not been identified until July 2008. This was despite thirteen transactions and a reconciliation of the balance sheet. We saw that one person had given staff £5 cash for petrol, for a hospital appointment. We said this practice must be stopped. We saw that fire safety was satisfactorily managed within the home. There was a fire floor plan and a fire risk assessment in place. The risk assessment had changes in dates, as evidence of review. We saw that two staff had attended a fire marshal’s training course. All except two staff were up to date with their fire instruction. Fire drills had taken place as required. A number of environmental risk assessments were in place. Many of these were dated 2006 so were in need of review. We saw that each room had an individual risk assessment, which had been reviewed in February 08. Portable electrical appliances had been tested, as required. Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 29 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 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 3 Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 30 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 OP3 Regulation 14 Requirement The registered person must ensure that assessments contain sufficient detail to fully evidence the person’s needs and the support they require. The registered person must ensure that care plans fully reflect people’s needs and how they are to be supported. The registered person must ensure the use of bed rails are authorised by a qualified health care professional. There must be evidence that the rails are monitored and reviewed on a regular basis. The registered person must ensure that medication is not left unattended but secured securely at all times. The registered person must ensure that the exact time of administration of medicines prescribed ‘as required’ is recorded so that an accurate record of the dose given is kept. The registered person must ensure that all medicines are given in accordance with the DS0000028312.V368245.R01.S.doc Timescale for action 18/09/08 2 OP7 15 31/12/08 3 OP8 13(4)(c) 30/11/08 4 OP9 13(2) 18/09/08 5 OP9 13(2) 18/09/08 6 OP9 13(2) 18/09/08 Alexander Heights Version 5.2 Page 31 7 OP25 23(2)(p) prescriber’s instructions. Special care must be taken when transcribing these instructions onto the medication administration record so that people receive their medicines as prescribed. The registered person must 31/01/09 ensure that people are able to maintain the temperature of their room at a standard acceptable to them. The registered individual must inform us of how they intend to do this with agreed timescales of when the work will be undertaken. This was identified at the last inspection but has not been addressed. The registered person must 18/09/08 ensure that cleaning schedules are revised so that the environment is cleaned to a good standard and well maintained. The registered person must 18/09/08 ensure that documentation evidences a robust recruitment procedure. This must include a sequence of events such as the completion of an application form and medical declaration before commencing employment. We were not able to assess this requirement, as there had been no new staff to the service. The requirement will be addressed at the next inspection. The registered person must ensure that staff check each transaction when managing people’s personal monies held for safekeeping. Staff must not accept money from people using the service. The registered person must DS0000028312.V368245.R01.S.doc 8 OP26 23(2)(d) 9 OP29 19(1)(a) 10 OP35 13(6) 18/09/08 12 OP31 37 18/09/08 Page 32 Alexander Heights Version 5.2 ensure that CSCI is notified without delay of any incident, which affects the well being of a person. 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 OP1 Good Practice Recommendations The opportunity of purchasing additional support from a domiciliary care agency should be identified within the Statement of Purpose. This was identified at the last inspection but has not been addressed. The daily records should contain aspects contributing to peoples’ quality of life rather than day-to-day physical care tasks. This was identified at the last inspection yet there was little evidence of this within daily records. The daily total of food and fluid intake within specific charts should be calculated and monitored to ensure an adequate level. Specific amounts of fluid are now being documented yet the daily amounts are not being totalled. National Patient Safety Agency advice should be followed for the safe administration and recording of anticoagulant therapy. (www.npsa.nhs.uk/patientsafety/alerts-and directives/alerts/anticoagulant) A review of activity provision should take place to ensure that the individual needs of all people using the service are addressed accordingly. Documentation such as the Statement of Purpose and the Service User’s Guide should give accurate information regarding the provision of social activities within the home. This was identified at the last inspection but has not been addressed. Peoples’ choices of when they receive assistance to get up should be reviewed so that they are supported at a time convenient to them. When investigating a complaint, any evidence used should be fully documented. Information should identify whether DS0000028312.V368245.R01.S.doc Version 5.2 Page 33 2 OP7 3 OP8 4 OP9 5 6 OP12 OP12 7 8 OP14 OP16 Alexander Heights 9 OP27 10 11 OP27 OP33 each aspect of the complaint is upheld, not upheld or not substantiated. This was identified at the last inspection but has not been addressed. Staffing levels should be kept under review and be adjusted in relation to peoples’ changing needs. This was identified at the last inspection. A housekeeper post has been developed and activity hours have increased yet the number of care staff on duty at any one time, remains the same. The number of hours staff work should be kept under review to ensure people’s health and wellbeing. Feedback received from relatives’ questionnaires, as part of the home’s quality assurance system should be coordinated and displayed. An action plan should be agreed to address the issues raised. We did not see evidence of this but will address the recommendation further, at the next inspection. Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 © 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 Alexander Heights DS0000028312.V368245.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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