Inspection on 30/06/09 for Alexander Heights

This inspection was carried out on 30th June 2009.

CQC 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 19/08/08

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 24/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Alexander Heights Alexander Heights Winsley Hill Limpley Stoke Bath BA2 7FF Lead Inspector Roy Gregory Key Unannounced Inspection 30th June 2009 09:00 DS0000028312.V376221.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Alexander Heights DS0000028312.V376221.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 Vacant, application pending from Sarah Robinson Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th August 2008 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. The accommodation is on the first floor of a purpose built unit, with access via a passenger lift or stairs. There is a terraced area, adjoining a conservatory style lounge. People have access, if they are independent or have support, to wellmaintained gardens at ground level. Accommodation is in single rooms, each with en suite facilities. One suite provides a twin bedroom, sitting room and bathroom. Communal areas consist of the conservatory, a dining room with servery, a games room and small lounge. Meals are prepared in a central kitchen that serves all the site. Alexander Heights also shares use of laundry facilities with the other units on site, which comprise independent living apartments and houses, a nursing home and a care home for older people with dementia. The care village occupies a rural site between Bath and Bradford on Avon. A regular bus service stops at the main entrance and there is plentiful parking on site. The weekly fees for the home are dependent on the size of the room occupied. Information provided to visitors to the home, as at June 2009, showed that a smaller room costs £670, a larger room £710, and the suite £1000. Additional charges for chiropody, hairdressing and personal items apply. Alexander Heights DS0000028312.V376221.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. Two inspectors visited Alexander Heights unannounced on Tuesday 30th June 2009 between 9:00 a.m. and 5:00 p.m. and returned the following day from 9:00 a.m. to 2:25 p.m. During the inspection we met individually with a number of residents, in the communal rooms and individual rooms. This allowed for discussion about their experience of care provided, and for observation of care interactions, including the service of meals. The entire home was toured. Ms Sarah Robinson, the acting manager, was available throughout the inspection time. We spoke with various staff on duty, including the activities organiser. At the end of the inspection we gave feedback to Sarah Robinson and Lisa Beeson, the provider company’s responsible individual for the service. Documentation examined during the inspection included care plans and records of care, risk assessments, medication records, evidence of activities provided, accident records, complaint records and records of staff recruitment, training and supervision. We saw how the home had carried out its own quality assurance survey of residents in April 2009, and their analysis and further use of the results. Sarah Robinson returned the home’s Annual Quality Assurance Assessment, which gave some descriptive and numerical information. During the inspection we met with the visitors to three people who live at the home. On 30th April 2009 our pharmacist inspector carried out a random inspection of medications practice in the home and we took account of that report in this inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visits to the home. They take into account the views and experiences of people who live there. What the service does well: The home has good arrangements for liaison with health professionals when people need to access health services. The home employs an activities organiser for three days per week. Some external entertainments were bought in. People had opportunities for chatting, Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 6 manicure, joining games and crafts, and going out into the gardens or onto the terrace. Visitors told us they felt welcomed, and staff showed they knew many visitors well. One person’s relative told us they felt they worked in partnership with the home, with a good exchange of information. People living in the home told us they could choose easily between joining group activities, sharing communal rooms and enjoying their private space. They got up and went to bed when they chose. One person said, “There’s absolute choice about daily routine. I have a bath when I want. I join in games and quizzes and can be private when I want”. People could take their meals where they chose. Many people liked to join others in the dining room for lunch, which was the main meal of the day, but some people preferred to eat alone in their rooms. There was a choice of main meal. Residents had been asked for opinions about meal service and had seen improvements made as a result. All care staff either had achieved NVQ (National Vocational Qualifications) or were working towards the same. All the staff were undertaking training in customer care. Training was well organised, so staff were kept up to date with essential training that promoted the safety and wellbeing of residents. The activities organiser had trained in therapeutic activities for older people and two staff had recently trained in leadership skills. All care staff received training in the handling of medicines. What has improved since the last inspection? Before admission to the home, people receive an assessment that takes account of all their care and support needs, including useful life history information. Medication practices, including administration and recording, have been improved in line with requirements and recommendations made by our pharmacist inspector at previous inspections. We identified no concerns about administration of medicines at this inspection, although some issues related to medication highlighted the need for more detail in people’s care plans. Radiators in people’s rooms have been fitted with controls such that people can maintain the temperature of their room as they wish. Complaint investigation records showed that complaints received detailed and timely attention, with outcomes notified to complainants. The service has resolved issues around the safe keeping of people’s monies, and associated practices, by withdrawing this as a service offered. We saw that residents and their families had been consulted on this and were able to make acceptable arrangements for such transactions as people need to make. Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 7 A large screen television and DVD player had been installed in the dining room, so people could watch things like films and live sport together, if they wished. Some areas of the home had been redecorated. In looking at recruitment records, we were able to establish that no one commenced work until their suitability to work with vulnerable people had been established. We recommended at the previous inspection that more purposeful use should be made of data collected through the service’s annual questionnaire survey. Sarah Robinson had collated the results of the April 2009 survey and used them as the basis for setting agendas for residents’ meetings. This included arranging a meeting between residents and the catering manager to discuss identified food issues. What they could do better: Care plans were in place for all people living in the home, but they were lacking in detail about some needs, for example, how use of certain medicines impacted on other areas of someone’s life. The plans also require more detail so care workers know precisely how to provide the support people need. The care plans for managing pressure area care did not show how risks were to be managed or monitored. Information about the management of continued good health for people with identified needs such as diabetes needs to be collated in one part of their care plan. Therefore a requirement we made at our previous key inspection, that care plans must fully reflect people’s needs and how they are to be supported, has not yet been met. Some people were receiving assistance with eating their meals from a domiciliary care agency, at additional cost, although the home’s statement of purpose says this is a service provided by the home within the fees charged. This may indicate the home is unable to provide sufficient staff at meal times. We think the statement of purpose should explain why the home may not be able to provide for all needs, and why additional charges may therefore be incurred. We saw good working relationships between staff and residents, but there were comments from both that suggested staff availability to residents comes under pressure at certain times. The home has a very long central corridor, so staff work in relative isolation from each other. With three care staff working throughout the day, when any one of them gives extended attention to an individual resident or support to the activities organiser, this isolation increases and the staff are less well placed to monitor events within the home. Therefore we are recommending a review of staffing levels to identify when they are under too great a pressure to provide for all residents’ needs, so corrective action can be taken. A significant shortfall at this inspection was the poor state of the servery from where residents’ meals and drinks are served. Whilst we were told that new Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 8 kitchen units were on order for a complete refit, which would resolve some of the most offending issues, the cleaning standards in this room were poor and we were concerned that such a state of affairs had been allowed to reach such a low point. Utensils and work surfaces, the refrigerator and microwave oven were dirty, with many items being stained and worn. Aside from the risk to hygiene posed by this situation, such practices indicated a lack of regard for the dignity of those who were served from this area. We also found examples of dirty furnishings and fittings elsewhere in communal rooms, and wheelchairs were dirty. Therefore we have had to make a requirement that equipment, furniture and fittings in the servery and communal rooms is assessed for fitness for purpose and replaced or made good. We also need to see that cleaning schedules are adjusted and monitored to ensure the situation does not deteriorate. As with care plans, environmental risk assessments need to show more detail about the nature of risks identified and how the risks can be minimised. In some cases this will require obtaining specialist advice, such as from the fire and rescue authority. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 9 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.V376221.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5 (Key Standard 6 is not applicable to this service as intermediate care is not provided). People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Efforts are made to ensure that as much information as possible is gained about prospective residents to ensure their needs can be met. Prospective residents and their families are encouraged to visit to see for themselves what is being offered. The statement of purpose is kept up to date so that prospective residents and their relatives can know about the service, but it does not explain why and how people might purchase domiciliary care services additional to the care provided by the home. EVIDENCE: We looked at the pre-admission records for three people who had come to live at Alexander Heights since our previous key inspection. In each case an assessment had been completed, with records of who was involved in the assessment and where and when it took place. The assessment documentation Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 11 considered a range of appropriate areas, sufficient to determine that the person’s needs could be provided for, and to commence care planning. This demonstrated compliance with a requirement made at the previous inspection, for improved assessment procedures. On admission, further documentation showed that essential information was confirmed and that assistance was given to people to settle in. One person told us they liked how their family, with the help of home staff, had set up their room ready for them to move into. Another person said they had stayed for a trial week before making up their mind to move in. They considered the information initially provided to them had proved accurate and “the service is as it was sold”. A table in the main corridor contained copies of the service’s statement of purpose and service user guide, including details of fees payable. We were given a copy of the latest version of the statement of purpose. As we have highlighted through recommendations at previous inspections, the statement of purpose does not give information about the opportunity to purchase additional services from the provider company’s domiciliary care service. Instead, that service’s statement of purpose is left for consultation alongside the home’s document. The home’s statement of purpose states how care needs will be met by the home, suggesting the care home fees will cover the meeting of all assessed needs. Therefore the home’s statement of purpose is the place where there should be an explanation of circumstances in which needs cannot be met in the usual way but can be provided for at extra cost. Alexander Heights DS0000028312.V376221.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had good access to health care provision but greater detail in care plans would provide staff with better information and guidance to support people effectively. People were treated with respect and their right to privacy was upheld. Residents were largely protected by the home’s procedures for the safe handling of medicines. EVIDENCE: Care plans drew on initial assessment information and subsequent reviews of people’s needs. For example, a main reason for one person having sought a care home place was that they had a history of falls. Their care record included a falls risk assessment, and there was a care plan directing staff on safe care that minimised the risk of falling. Care plans showed they were reviewed monthly, with amendments showing they were working documents. However, in the main, we found little detailed information or guidance on what staff were expected to do in order to meet assessed needs. For example, “Encourage to Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 13 join in activities so X doesn’t become bored or depressed” was an appropriate care planning aim, but there was no guidance or suggestions as to how to achieve this outcome. We saw that people’s risks of developing pressure damage were always assessed. A person confirmed to us that their care plan was correct in describing them as ‘mainly self caring’. They had been involved, as indicated in their plan, in discussing how pressure damage could occur, and had agreed to inform the staff of any possible indicators arising. We saw no evidence in people’s plans of any re-assessment of pressure risks. The care plans for managing pressure area care did not show how any risks were to be managed or monitored. One care plan stated “to maintain good skin condition. Staff to observe skin areas when assisting personal care. To ensure creamed if becomes sore”. But once an area is sore or marked, some damage has already occurred. Care plans for pressure area monitoring did not consider preventative measures to reduce risks, such as appropriate nutrition and hydration, exercise or use of preventative equipment. We saw that some people had pressure reducing mattresses on their beds. As well as certain risk assessments that were considered for all residents, there were individual assessments for issues that were specific to individuals. These might concern health conditions, such as diabetes, or life choices, such as high alcohol use. However, information about the management of continued good health for people with such identified needs was not collated in one part of their care plan. For one person with diabetes, for example, we had to look in their health care plan, their medication care plan and the front sheet where contact information was, to establish what the guidance was for managing their wellbeing. One person’s care plan identified a medical condition that “has affected [them] from using [their] frame correctly.” There was no guidance on how they should be supported to use the frame to walk. We had a detailed discussion with Sarah Robinson about the need for care plans to contain more detail, and to be better ordered, in order to meet and monitor people’s needs more effectively and consistently. Therefore a requirement we made at our previous key inspection, that care plans must fully reflect people’s needs and how they are to be supported, has not yet been met. Staff maintained daily reports on each resident, using a standard form. This was limited in its usefulness, because some sections were not relevant to some people, yet staff were inclined to complete each section. For example, one section concerned presentation of behaviours, but this was not an issue for most residents, so staff wasted time reporting non-occurrence. This also indicated a lack of person-centred awareness; it would be more desirable to frame the report form to fit each resident, so staff only report on matters that relate to individual care plans. This in turn would greatly facilitate reviews of care plans. Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 14 Our visit took place during a period of exceptionally hot weather. We asked people if they were given extra drinks during the hot weather. One person said no. Another person said “if you ask for them”. We saw a risk assessment for dehydration. It stated “good supply of cold drinks kept in fridge.” We saw that all those people who we visited in their bedrooms had their call bells within easy reach. They also had a jug of juice or water to help themselves to. One person told us that “staff come quickly if I ring my bell.” We asked another person whether staff came if they rang their call bell. They told us that staff came as soon as they could. Another person told us that one staff had answered their call bell saying “I’ve got two people on the commode, we are short staffed, I’ll come back.” We were informed that people admitted from the local area tended to keep their existing GP arrangements, whereas those admitted from farther afield were registered with a local GP with whom the home has a close working relationship. Although this liaison means that health concerns are referred quickly for attention, we saw no evidence of people being offered alternative arrangements from which they could make choices. We saw that the home gets a good service from the GP and from community nurses, as surgeries are held on site twice a week. Further to our pharmacist inspector’s visit (see below), Sarah Robinson had recently made improvements to the system of exchanging information about warfarin users to promote good practice and emphasise where respective responsibilities lay. People living in the home appeared comfortable in how they were dressed. They received evident support to hair, make-up and nail care. Records showed where people had declined the offer of assistance to any aspect of their care. In some instances, people had signed disclaimers, for example, if they did not wish to be checked routinely by night staff. We observed that staff usually knocked on people’s doors before entering, and showed awareness in other ways of people’s privacy. One resident said their experience was that younger staff tended to be more diligent about such matters. A resident said she found “all staff helpful and sympathetic to my needs”. The care plan for a male resident showed they required personal care assistance, and the offer of such assistance, from male care staff only. None of the people we spoke to expressed any concerns about staff respect for their privacy and dignity. However, we considered that staff etiquette at the dining table could be more person-centred with less matter-of-fact language. Our pharmacist inspector visited Alexander Heights on 30th April 2009 to look at all the arrangements for the handling of medicines in the home. All the medicines were stored securely and appropriately. Since the previous key inspection a separate recording sheet had been introduced to record the use of medication prescribed ‘as required’ to show the exact time of administration. Medication administration records were completed at the time of administration and accurately reflected people’s treatment, although not all the Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 15 creams and lotions that had been used had been signed for by the staff applying them. Some people chose to look after their own medicines. The medication administration records for these people did not always detail the level of self medication undertaken, so the pharmacist inspector made a requirement for reviewable risk assessments to be done for all people who manage their own medicines so they could look after their own medicines in a safe, supported manner. We found at this inspection that the risk assessments were in place, and that the application of topical creams was being recorded well and in a manner that suited individual residents. The medicines administration record charts gave staff clear guidance about many individual needs, including highlighting where two people had similar names to ensure their medicine administration needs did not become confused. However, some issues related to medication again highlighted the need for more detail in people’s care plans. We saw that one person was taking two different types of pain relief. There was no detail in the care plan about why each medication should be taken. During the second day of our inspection Sarah Robinson amended the forms to show this information. We saw that one person was taking medication delivered via an adhesive patch. The care plan showed no detail about changing the site of the patches or where they were to be placed on the body. We saw that one person was prescribed an anticoagulant. Their care plan showed no detail about which foods or substances to avoid when taking this medication. Alexander Heights DS0000028312.V376221.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to exercise choice over daily routines and from the activities offered, including availability of religious services. There is scope for more person-centred provision of social stimulation. People keep in contact with family and friends and visitors are welcomed. An extensive menu is offered and people choose where to take their meals. EVIDENCE: The home employs an activities organiser for three days per week. She began her working days by seeing people individually, so they knew she was available and she could find out if people had particular wishes for activities for the day. She had built up resources of games in order to promote social mixing, opportunities for physical movement and mental exercise. She had use of a CD Rom designed for staff in her position, which contained a wealth of ideas and resources. A small lounge was used as a base for many activities, including craft-based activities. A large screen television and DVD player had been installed in the dining room, so people could watch things like films and live sport together, if they wished. The activities organiser used some interactive Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 17 games with groups using this television. There had been some film evenings, with members of staff lending films and residents served with popcorn and drinks. The activities organiser spent significant time seeing people individually in their rooms, to talk, offer manicures and engage through preferred activities. As a result, she acquired a lot of knowledge about people’s backgrounds and current interests. However, she was unaware that care plans contained life history information, gathered through assessment, or that the care planning process could be enhanced by the incorporation of information and observations that she could contribute. Given her specialist role, it would be desirable for the activities organiser to use assessment information as a starting point for how the home will promote the activity and social needs of each resident and to contribute directly to reviews of care plans. Individual plans could show what things people liked to do and how they responded to different activities or social situations. This was recognised within the service’s ‘AQAA’ as an improvement they aim to make, along with organising more outings. There has therefore been progress in the home’s response to our recommendation for a review of activity provision but there remains scope for a more co-ordinated and person-centred service. The statement of purpose gives a summary of social and activity provision as it is, in line with a previous recommendation. The care village had a minibus that could be used for residents of the care home. It was about to be replaced, as it could not cater for the mobility needs of most residents. There had been very occasional trips out, for example to Longleat and the Bath Pump Rooms. One person told us “there’s not much to do during the day. We do have trips out but not at the moment. We had a tour of the countryside.” Many residents, however, made use of the grounds of the care village itself. We saw that some were independent in using the lift and going out unaccompanied, whilst others went out with visitors or requested staff assistance. The terrace offered another opportunity to enjoy fresh air. One person told us that they had free access to the garden and could use the passenger lift. Another person told us “we have tea outside. They take me down in a wheelchair.” Some external entertainments were bought in. A singer had proved very popular in April 2009 and had been re-booked for a date in July 2009. However, the activities organiser was unsure of the budget available to her for arranging entertainments and trips and for buying resources. She carried out some fund-raising among residents and staff. She had some liaison with the activities organiser employed in other units on the site, something she would like support to develop in order to promote practice. Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 18 An Anglican communion service was held in the home fortnightly, whilst a Roman Catholic service was available downstairs, to share with people that lived elsewhere within the care village. Many of the residents of the home had moved in from independent living accommodation on the site. They valued being able to maintain friendships with former neighbours by visiting or receiving visits. One resident enjoyed going out for newspapers for others. People told us about joining in organized activities. There was a succession of visitors to residents, at all hours, during our time at the home. Many people also had telephones in their rooms. Visitors told us they felt welcomed, and staff showed they knew many visitors well. One person’s relative told us they felt they worked in partnership with the home, with a good exchange of information. People living in the home told us they could choose easily between joining group activities, sharing communal rooms and enjoying their private space. They got up and went to bed when they chose, which had not been the case when we last carried out a key inspection. One person said, “There’s absolute choice about daily routine. I have a bath when I want. I join in games and quizzes and can be private when I want”. One person said the days could seem long, as they spent most of their time in their room. There was evidence from care records and from talking to the activities co-ordinator that staff were aware of this person’s perception and were taking steps to alleviate it. This was an example of a need for more co-ordination between the activities coordinator and the care staff. The person had a care plan for ‘communication’, which directed staff to encourage the person to leave their room and to use the dining room for meals, but there was no discrete plan for identifying and meeting social needs. The communication plan also omitted the fact the person had a hearing problem, which affected their confidence in socialising. People could take their meals where they chose. Many people liked to join others in the dining room for lunch, which was the main meal of the day, but some people preferred to eat alone in their rooms. One person chose to take breakfast in the small sitting room. The lunch tables had name cards to designate people’s preferred places. This was as a result of residents’ requests made through the residents’ meeting. Wine or other alcoholic drinks were not offered with meals. A bar was available downstairs for an hour on Friday evenings. We saw a cupboard with alcoholic drinks in the conservatory with a settee in front of it. There was a rolling menu for main meals, with two choices offered at each. Residents thought the spacing of the menu meant it was not repetitive, but there were comments that the same item on the menu could be quite different on different occasions. Another criticism was that starters and main courses could have too many ingredients in common. One person thought the use of elaborate names for dishes should be dropped, as the food was relatively plain and that was what people liked. One person told us “First class meals. My Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 19 favourite is fish and chips and we have it once a week. I also like fish fingers.” Another person told us “the food’s pretty good. I have sandwiches for supper which they bring to my room. I have my breakfast here and go to the dining room for other meals.” The day’s menu was displayed on a music stand in the conservatory, but we found few residents were aware of the menu before they sat down, suggesting an alternative arrangement might suit people better. We saw that one person was following a vegetarian diet. Ms Robinson told us that staff checked daily that special meals were available for them. We observed that people were invited to make their choices from the following day’s lunch menu during the meal. This was said to assist the kitchen in sending the required quantities to the unit. However, people were asked in any case at the table, which option they would like, without reference to the completed sheet, so it should be possible to provide choice at the point of service. This would avoid compromising the enjoyment of a meal by having to think about the following day’s. Service in the dining room was slow but friendly, although as remarked earlier in this report, people could have been given more individual attention and choices could have been offered in a less blunt way. The food served was good quality and included fresh vegetables. One person had to ask for one of the sweet choices, which was on the menu but had not been offered. Portions were of a ‘sensible’ size and attractively served, but people were served with all the vegetables rather than being asked preferences, so there was some wastage of unwanted vegetables. Crockery was of good quality, but glassware was badly degraded by repeated dishwashing. Sarah Robinson ordered new drinking glasses on being told this, which will resolve the shortfall in quality but means an opportunity for resident consultation about preferred replacements has been missed. We noted that some people were supported with eating their lunch by staff from the domiciliary care service that is part of the care village provision. We asked why the home’s staff were not able to provide this support, within the fees being paid for care, given that the home’s statement of purpose states, “care staff are available to provide discrete, sensitive and individual help with eating and drinking for those needing it”. Ms Beeson told us that the families had asked for this additional service. We noted that details of the domiciliary care service were provided at the information point in the main corridor. The management view was that residents and their supporters had a right to access any services they required. Ms Beeson said the company did not actively seek opportunities to provide additional services. Those people who were supported to eat by the domiciliary staff had both first course and main course taken to them at the same time. This meant that the main course would get cold. Those people who had their meal taken to them in their bedrooms by care staff had each course delivered separately. Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is provision for receipt of and response to complaints. Staff and management understand and exercise responsibilities in respect of keeping residents safe. EVIDENCE: A copy of the complaints procedure was displayed on a table in the corridor. The contact details for the Commission were out of date. We asked people what they would do if they were unhappy with anything. One person said “I would go to Sarah (Ms Robinson) and she’d put it right.” Another person told us “I don’t like to complain because I might get staff into trouble.” The home’s complaints record showed three complaints had been received and investigated using the home’s complaints procedure since the previous key inspection. All had been upheld and apologies had been given. The process followed was in line with a recommendation we made at the previous key inspection. There was also a record of ‘non-formal’ complaints received verbally and acted upon quickly, without recourse to the formal procedure. Three complaints had been received this way, all concerning food issues. They showed they were followed up with the individuals making the complaints, to ensure their satisfaction with how the service had resolved them. Six written compliments had been received since the previous inspection. Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 21 All staff had received training in abuse awareness and safeguarding procedures within the previous two years. Staff were given copies of the ‘No Secrets’ guidance to the local inter-agency safeguarding procedures, and further copies were available from the hall table where visitors signed in. Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 & 26. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment and furnishings showed signs of neglect, although service users’ personal rooms were comfortable, personalised and clean. Low standards of cleaning in some areas posed a risk to hygiene and showed poor regard for the people being provided with a service. EVIDENCE: We began our tour of the home at the kitchenette from where meals were served to the dining room and drinks and snacks were prepared. Members of staff also stored food of their own here, for breaks. The units and work surfaces were of a kind used for domestic kitchens. They were badly deteriorated, with evidence of water ingress to exposed chipboard over a very long period of time. Whilst we were told that new units were on order for a complete refit, which would resolve some of the most offending issues, the Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 23 cleaning standards in this room were poor and we were concerned that such a state of affairs had been allowed to reach such low state. The microwave oven was very dirty inside and out. Vacuum serving flasks were cracked and stained. The venetian blind, extractor fan and window ledge were covered in dust and grime. There were cracked tiles, and kitchen utensils were kept in open plastic boxes, which had accumulated some deposits in the bottom. Medicine pots had been washed and left to dry on top of the water boiler, which was stained. There was a set of worn and stained laminate trays. Aside from the risk to health posed by this situation, such practices indicated a lack of regard for the dignity of those who were served from this area. Both fire doors were wedged open. There was uncovered and undated food in the fridge. There were uncovered containers of breakfast cereals in one of the cupboards. The shelves in the cupboards had deposits on them. The chopping board was badly marked and had become stained. Moving into the dining room and conservatory, we found some armchairs had soiling beneath seat cushions and some had badly worn arms. The conservatory had been recently redecorated, but carpets were ‘tired’. A wooden tea trolley that was in daily use had encrusted food debris in the corners. We saw that some dining chairs had a build up of sticky deposits on the seats and under the arm rests. By the time we visited for the second day, Sarah Robinson told us that she had informed the site cleaning manager who had arranged for the chairs to be thoroughly cleaned. Wheelchairs stored in the smaller sitting room were in need of cleaning. The medicines storage room had a lot of debris on the floor. The sluice room was clean but had a dripping tap, which also had a broken lever. We saw that staff had access to disposable gloves and aprons. There were foot operated bins for disposal of clinical waste. Sarah Robinson showed us quotes she had obtained for new curtains for the conservatory. She told us that some of the residents had helped choose the colour scheme. Ms Robinson told us that she was seeking approval for the work to be done. Bath/shower rooms and toilets were clean, apart from one bath where the plug hole had accumulated deposits. That room was also excessively hot, with no adjustment possible to the radiator, which was both uncomfortable and wasteful. Bedrooms were well-proportioned and clean. Many were very personalised. People expressed satisfaction with their accommodation and with the standard of cleaning. Many people used some furniture of their own. Furniture provided by the home was mainly of pine, with many items looking very worn, although some new furniture had been recently provided. Heating and lighting in people’s rooms met expected standards; a requirement made at previous inspections, to ensure people could adjust temperature controls in their own Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 24 rooms, had been met. Rooms on one side of the home had attractive views over the gardens. We noted that windows on the exterior of the building were in a poor condition, although those of Alexander Heights perhaps less so than others. We were informed there was a maintenance plan that took account of the need to replace windows in the future. The conservatory, dining room and corridors had all been recently repainted. We asked people about the laundry service. One person told us “they collect my laundry every day. They are very good.” We heard no negative comments about the laundry service. We did not visit the laundry. We made a requirement at the previous key inspection that cleaning schedules be revised so that the environment is cleaned to a good standard and well maintained. We saw that some action has been taken to address this, as reflected in the standards of personal rooms and the main corridor. The shortfalls in standards in the communal areas and servery had to do more with cleaning tasks generally done at night rather than by the daytime housekeeping staff. Sarah Robinson was addressing this (see final section of this report). Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers are insufficient to provide for all assessed needs at all times. People are protected by the nature of recruitment procedures, and staff receive appropriate training and qualifications, although not all have received an induction specific to their role. EVIDENCE: The staffing rotas provided for three carers to be available throughout the day (8:00 a.m. to 8:00 p.m.), in addition to which the activities organiser worked thirty hours per week. Generally the day shifts included one senior carer. There were two waking care staff working at night. The home has benefited from a stable staff team, most of whom have gained NVQ (National Vocational Qualification) to level 2 or 3. Those without NVQ were working towards it. All the staff were undertaking training in customer care through a local college and the certificates were awaited. We talked with staff who were on duty. They conveyed a sense of pride in their work, but found the staffing level enabled them to cover only ‘the basics’ for much of the time. By this they meant ensuring people received personal care, including baths, when they wanted, call bells were responded to, and meals were served wherever people wanted them. This matched what we were told by people Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 26 living in the home, who had few concerns about staff availability where it was essential. The care staff saw the consistent activities provision as having made a positive difference to the lives of people living in the home. However, their own opportunities to provide one-to-one interaction with residents were limited. For any member of staff to engage in this way, especially to accompany someone into the grounds, entailed leaving all other tasks to just two staff on the unit. This also applied to one or more care staff assisting the activities co-ordinator to run a group session. The layout of the home makes it impossible for staff working at one end to have any awareness of what is going on at the other end. It has been noted earlier in this report that some residents’ supporters have found it necessary to purchase external domiciliary care to provide people with assistance to enjoy their meals. This is another indicator that at key times of pressure, staffing levels are stretched. We asked people living in the home about access to baths and showers. One person told us “I have to fight like mad to have a shower. It’s not always easy to get one and I don’t like to ask as the staff are not always available. I have to wait for someone to help me.” We asked them if they could have a shower everyday. They told us that they had been used to having a daily shower at home but now only had one once a week. We looked at this person’s care plan. It stated that they were to be offered a bath three times a week. In contrast, another person told us “I have a bath when I want one. I arrange it with my key worker.” Another person said “you can have a bath or shower every day”. One of the people we spoke with told us “They are helpful with what they can do. I don’t need them at night.” Another person told us it was “always difficult to get staff to come when I want them.” They went on to describe staff as “lovely” and talk about their key worker. Another person told us that although staff were busy they did find the time for a chat. One person told us “I’ve got used to not asking for things as you know they haven’t got the staff or staff are on holiday. I feel sorry for the staff if they are doing the drinks at night and the bells are going”. Staff considered training within the care village to be well organised. We have seen on inspections of other units that mandatory courses are repeatedly on offer to staff working across the whole site. This included fire training, abuse awareness, infection control, risk assessment, first aid, health and safety, food hygiene and moving and handling. The activities organiser had trained in therapeutic activities for older people in February 2009. Two staff had recently trained in leadership skills. Other courses some staff had completed, included diabetes care, pressure sore prevention and training in loss and bereavement. All care staff received training in the handling of medicines. The service had a link with the local co-ordinator for ‘Skills for Care’. Sarah Robinson indicated in the service’s ‘AQAA’ an intention to arrange more training around specific needs associated with old age. Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 27 In looking at recruitment records, we were able to establish that no one commenced work until their suitability to work with vulnerable people had been established. We restated a requirement at the last inspection that staffing documentation must evidence a robust recruitment procedure. Some recruitment records commenced since that time did not support compliance with that requirement, for example, by not having two references. However, this has been an issue with the provider company as a whole. We have seen it resolved through our inspections of another registered service on the care village site, where it was necessary for us to issue a statutory requirement notice about this aspect of management. Checking recruitment records is made more difficult by the fact that people are employees of the care village rather than of individual establishments. Sometimes a person is recruited in one capacity but later transfers to another. We saw that one member of care staff had started work in the central kitchen. They had undergone an induction into health and safety, but there was no evidence of an induction into the care role. Another person’s induction had been within the domiciliary care agency. Staffing records did not clearly show people’s history of transfer, or how they were helped to make an effective transfer from one role to another. Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 28 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Day to day management of the home has been compromised in some ways by the reduced availability of a registered manager. Significant progress has been made on opening channels of participation for users of the service and their supporters. People living in the home control their own money, or their supporters do, without intervention from the home. Staff supervision has been of good quality but insufficient frequency. A range of measures provides for people’s health and safety, but some require more attention to detail. EVIDENCE: Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 29 The registered manager for the home at the time of inspection was Jean Chapman. For much of the previous year she had been seconded to give management support to another of the registered units in the care village, and she was on the point of leaving the company to advance her career elsewhere. Day-to-day management of Alexander Heights was being carried out by the head of care Sarah Robinson, who anticipated making application for registration as manager in due course. She had gained NVQ level 4 and the Registered Managers Award. She continued to have supervision and guidance from Jean Chapman, and also from Lisa Beeson, the ‘responsible individual’ for the service. Sarah Robinson projected a passion for her role. She felt well supported in it, both by the chain of management and company administrative support. She had been working through reviews of risk assessments and looking at management systems generally. She had a comprehensive knowledge of the content of people’s care plans and current care issues in the home. We saw that Ms Robinson was working some of the care shifts. We advised that as acting manager she should reduce the number of shifts she works in order to concentrate on her management and administrative duties. It is important also that the head of care position be filled as soon as possible, for the same reasons. Sarah Robinson had carried out some night-time and weekend checks in the home to understand how it worked at those times. She had identified the shortfalls in meeting night-time cleaning schedules in the servery. She intended convening a meeting of night staff to address issues arising on their shifts. There was a record of monthly monitoring visits by Lisa Beeson on behalf of the provider company, to oversee how the service was provided. These records supported Sarah Robinson’s account of how priority issues were identified and addressed. They incorporated evidence that residents’ views were actively sought. There was a record of annual questionnaire surveys carried out with residents, their supporters and health professionals from 2006 to 2009, but excluding 2008. The latest survey had been carried out in April 2009. Sarah Robinson had carried out an analysis of responses and used this as the basis for setting agendas for residents’ meetings. Residents’ comments gathered by any means were overwhelmingly centred on meals provision. A meeting had been organised with the kitchen manager. A resident told us they had seen changes implemented as a result of that meeting. There was evidence of other issues having been directed to the maintenance staff for attention. The consultative process demonstrated attention to our recommendation that action plans should be developed from questionnaires. At our previous key inspection, we found that the home provided safe keeping of personal monies for some residents, but the system in use was not well managed. Following consultation with residents and families, the home now Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 30 has a policy of not providing such a facility. The main items of expenditure that residents incur are for hair care and chiropody. They or their families or other representatives receive bills direct for such services. Staff supervision records showed staff received some individual supervision. Sarah Robinson was open about the irregularity of supervision but showed us she was drawing up supervision contracts with staff and moving towards better planned provision. Records of supervision sessions showed that when it took place it was of good quality. Supervision included some checks against performance indicators. Staff were subject to annual appraisals. There was a list of ten members of staff who were currently trained as first aid ‘appointed persons’, which indicated when their refresher training would be due. We saw the home’s evacuation plan, which was kept together with procedures to deal with a range of emergencies such as flood, gas leak and loss of function of the central kitchen. We were informed that residents did not access the servery, where there were a number of hazards, so it was of concern that the fire doors to the room were both wedged open. A resident told us that the sluice room was not kept routinely locked, although it was locked when we visited. We saw that an external contractor had undertaken a health and safety audit in January 2009. Sarah Robinson was carrying out reviews of environmental risk assessments. We identified that a risk assessment about battery charging for a resident’s mobility scooter needed more detail. The hazards were recorded as “fire hazard if left in doorway” and “hazard for resident and staff, health and safety hazard”, but with no detail of what sort of hazard or strategies to adopt to reduce or eliminate the hazard. These should include attention to fumes that may be produced, and the nature of flooring underneath. We looked at the accident records for people who use the service. There was no evidence that the accidents were being regularly reviewed. To do so would enable management to consider whether there were any patterns to the occurrence of accidents, and thereby to take preventative actions. However, actual records were good and a requirement made at the last inspection to notify the Commission of all incidents affecting residents’ wellbeing has been complied with. Some doors had been fitted with automatic self closing devices. We saw that free-standing fans were being used in the corridors to reduce the heat on what was a very hot day. We also saw that some of the people who use the service had free-standing heaters in their bedrooms. We looked at the risk assessments on the use of the fans and the free-standing heaters. There was no evidence that the home had consulted with the Fire and Rescue Authority on the risks of using these appliances. Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X 3 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X 3 X 1 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person must ensure that care plans fully reflect people’s needs and how they are to be supported. (This requirement is restated from the previous key inspection as further progress has yet to be made). The registered person must ensure that care plans for managing pressure area care show fully how assessed risks are to be managed and monitored. The registered person must ensure that care plans include guidance to staff where there are dietary or other implications of medicines taken by individuals. The registered person must ensure that all equipment, furniture and fittings in the servery and communal rooms is assessed for fitness for purpose and replaced or made good as appropriate. The registered person must ensure that cleaning schedules are revised so that the DS0000028312.V376221.R01.S.doc Timescale for action 30/09/09 2. OP7 13 (4)(c) 30/09/09 3. OP9 13 (2) 30/09/09 4. OP19 16 (2)(g) 30/09/09 5. OP26 23(2)(d) 30/09/09 Alexander Heights Version 5.2 Page 33 6. OP30 18 (1) 7. OP38 13 (4)(a) environment is cleaned to a good standard and well maintained. (This requirement is restated from the previous key inspection as progress has not been made in all areas). The registered person must 30/09/09 ensure that all people employed as care staff receive an induction specific to that role. The registered person must 30/09/09 ensure that environmental risk assessments demonstrate a detailed analysis of all hazards and how they are to be addressed. 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 statement of purpose should provide an explanation of circumstances in which needs cannot be met in the usual way but can be provided for at extra cost. This was identified at the last inspection but has not been addressed. Daily reports should be tailored to individuals’ care plans so they reflect the extent to which planned care is delivered. Information and guidance on managing people’s specific health conditions should be readily identifiable and accessible within their care plans. Encourage staff to address people at the dining table in an individual way. Care plans should include specific consideration of people’s social and activity needs, based on consultation between key workers and the activities organiser, and taking account of the life history and preferences information gathered at assessment and subsequently. The complaints information should be updated to show DS0000028312.V376221.R01.S.doc Version 5.2 Page 34 2. 3. 4. 5. OP7 OP8 OP10 OP12 6. OP16 Alexander Heights 7. 8. 9. 10. OP27 OP36 OP38 OP38 current contact details for the Care Quality Commission. There should be a review of staffing levels to identify when they are under too great a pressure to provide for all residents’ needs, taking corrective action as indicated. Care workers should receive one-to-one formal supervision at least six times per year. The accident records should show evidence of regular review as a means of identifying and rectifying any repeat patterns that may emerge. Risk assessments for the use of free standing electrical appliances should show evidence of obtaining the advice of the Fire and Rescue Authority. Alexander Heights DS0000028312.V376221.R01.S.doc Version 5.2 Page 35 Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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