CARE HOMES FOR OLDER PEOPLE
Alexander House Savile Park Road Halifax West Yorkshire HX1 2XH Lead Inspector
Liz Cuddington Unannounced Inspection 16th November 2006 11:40 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 House DS0000043321.V311240.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 House DS0000043321.V311240.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Alexander House Address Savile Park Road Halifax West Yorkshire HX1 2XH 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) 01422 345666 01422 345666 Pam@eldercare.org.uk Eldercare (Halifax) Ltd Pamela Dawn Reid Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th February 2006 Brief Description of the Service: Alexander House is a former vicarage, which was opened as a care home for older people in 1984. A purpose built extension was added some years ago and the home now provides personal care and accommodation for up to twenty people. The house is situated next to St Judes church in the Savile Park area of Halifax. It is on a bus route and there are local shops nearby. There is a comfortable lounge, a dining room, and a conservatory that is used as a second lounge. There is an outside seating area for use during the better weather. The private rooms consist of two twin and sixteen single bedrooms, and many of the rooms have en suite facilities. Alexander House has a no smoking policy. The fees are from £415.00 to £420.00 per week. Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group, for example ‘Choice of Home’, and ‘Health and Personal Care’. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers these outcomes to the people who use the service. The judgement categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded in the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk Over an inspection year care homes usually have one or two inspections; these may be announced or unannounced. One inspector carried out the site visit, which lasted a total of five and a half hours. The methods I used to gather information included conversations with residents and staff, case tracking, examining records and touring the home. I also sent out questionnaires for residents and their relatives to complete. The comments made on the questionnaires and during conversations provide a valuable insight into how Alexander House is viewed by the people who use the service. This purpose of the inspection was to assess a selection of the National Minimum Standards for Care Homes for Older People. I looked at twenty-four of the thirty-eight standards. At the last inspection in February 2006 no requirements and one good practice recommendation were made. The recommendation from the last inspection has been met. Just one good practice recommendation has been made been made following this inspection. This was an excellent inspection and the home continues to make significant improvements. The manager and staff work hard to keep standards high, and to raise them where possible. I would like to thank the ladies and gentlemen who live at Alexander House, and all the staff, for their welcome and hospitality and for taking the time to talk to me during the inspection. Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 6 What the service does well:
Thorough pre-admission assessments are completed for every prospective resident of Alexander House. The care plans show in detail how each resident’s personal, social and healthcare needs are to be met and the plans are developed and reviewed in consultation with the resident or their relatives. The comments made in the questionnaires I sent out complemented the staff and the manager on their commitment to providing a high standard of care and support for the residents of Alexander House. One relative praised the ‘positive approach’ of the staff, another said that their relative was ‘happy to be there’. The advice of specialist healthcare professionals, such as the tissue viability nurse, is sought where this is appropriate. The medications are securely stored and the record charts are signed at the same time as medicine is offered. The home’s staff are considerate and respectful towards the residents at all times. There are activities available in the home and those residents who are able to do so still manage to get out and about. The ladies and gentlemen who live at Alexander House are able to exercise their personal choice in all aspects of their daily lives The mealtimes are relaxed and sociable occasions. The menus are varied, with a choice of main courses and desserts at lunchtime and a range of foods available at teatime. Residents and relatives said they are aware of how to make a complaint. The home has suitable adult protection policies and procedures. Since the last inspection new carpets have been fitted in the hall stairs and landings throughout the house. These areas have also been re-decorated and the overall effect is attractive and welcoming. Many of the bedrooms have been re-decorated and also have new furniture and fittings. The grounds are well maintained and the manager and residents told me that the patio, which is accessible to everyone, was well used throughout the summer. The home is kept clean and fresh throughout and the residents and relatives confirmed this in the questionnaires. There are enough staff on duty at all times to meet the needs of the residents and the home. The staff files showed that all the necessary recruitment procedures are completed. Ten of the fifteen care staff have a National Vocational Qualification (NVQ) in care and four other staff are working towards achieving their level 2 award. There is a wide range of other training courses available and staff are allowed the time to attend. One to one supervision is carried out every two months with all the staff. There is a range of quality assurance measures in place including questionnaires, which are sent to residents, relatives and visiting professionals.
Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 7 The information obtained is put into a newsletter and displayed on the home’s notice board. The manager acts on this to improve service quality for the residents of Alexander House. The home’s kitchen is very clean and well organised. Regular appliance testing is carried out. The staff are up to date with all the mandatory training such as basic food hygiene, fire safety and health and safety. New members of staff receive a high standard of induction and foundation training. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alexander House DS0000043321.V311240.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 House DS0000043321.V311240.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): 3 Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive pre-admission assessment is carried out before offering someone a place at the home. EVIDENCE: Thorough pre-admission assessments are completed for every prospective resident of Alexander House. The manager prefers the person to visit and stay for a meal, to allow him or her to gain a proper feel for the home before making a decision. If this is not possible then senior staff will visit the person in their own home or in hospital. A comprehensive range of information is gathered to enable the manager to decide whether or not the home can meet the individual’s needs.
Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 10 On the day of the inspection two members of staff went out to visit someone to carry out a pre-admission assessment. Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 11 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 & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The care plans show in detail how each resident’s personal, social and healthcare needs are to be met. The plans are developed and reviewed in consultation with the resident or their relatives. Medications are stored and administered safely and accurately. Staff treat residents with respect at all times. EVIDENCE: I looked at a number of care plans. They were comprehensive and showed in detail how each person’s care and support was to be provided. There were risk assessments in place for various areas of care such as falls, moving and handling, continence, pressure areas and mental health. The residents’ healthcare needs were well recorded and comprehensive. The details included people’s nutritional requirements and any specialist healthcare that was
Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 12 needed. A progress sheet is kept when someone is unwell. All healthcare appointments and their outcomes are recorded. Pressure relieving cushions and mattresses were in place for those people who need them. The advice of specialist healthcare professionals, such as the tissue viability nurse, is sought where this is appropriate. Daily records of significant occurrences are kept for each resident. There is a detailed list of the individual’s favourite and least favourite things. The care plans are kept under review and there was evidence to show that the service user, or their representative, had been involved in developing and reviewing their plan. The medications are securely stored and when a member of staff administers medicines the Medicines Administration Record (MAR) charts are signed at the same time. The charts also show when someone has not taken a dose of their medicine, and the reason. When I checked the amounts of medicines in stock against the amounts received and administered, I found the numbers were accurate. The home’s pharmacist and an independent trainer provide medicine administration training for the senior staff. During the inspection I saw that staff are considerate and respectful towards the residents. The comments that people made to me during the inspection visit, and in the questionnaires, confirmed this. Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 13 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to choose how they spend their time. A range of activities is available. Support for people to manage their finances, and information about advocacy services is available. The meals are of a high standard and mealtimes are relaxed and sociable. EVIDENCE: There are activities available in the home and those residents who are able to do so still manage to get out and about. I did receive some comments from residents and relatives that they would like there to be more opportunities to go out. At present the staff are covering the role of the activities co-ordinator, who has recently left. The manager is recruiting for a replacement. The care plans I looked at included a record showing whether or not the resident enjoyed a particular activity. The questionnaires also confirmed that people like the opportunity to take part in a variety of activities in the home, as well as outside.
Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 14 From my own observation, and comments made by residents, the ladies and gentlemen who live at Alexander House are able to exercise their personal choice in all aspects of their daily lives and the staff respect that choice. During the inspection I saw visitors being welcomed into the home. There are two lounges and the bedrooms have comfortable chairs in them. There are arrangements for religious observance within the home, for those who cannot go out to attend church. The mealtimes are relaxed and sociable occasions. The menus are varied, with a choice of main courses and desserts at lunchtime and a range of foods available at teatime. There is also a choice of food at suppertime. If a resident does not like any of the choices then the cook will prepare an alternative dish. Drinks and snacks are always available. The people I spoke to said the meals are very good. The people who completed the questionnaires I sent out also said they liked the meals. If a resident prefers to eat in his or her own room then this wish is respected. Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 15 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives are aware of how to make a complaint. The home has suitable adult protection policies and procedures. EVIDENCE: The returned questionnaires confirmed that people generally know how to make a complaint. The people I spoke to also said they would know how to raise any concerns, if they needed to. The home has adult protection and ‘whistle-blowing’ policies and procedures in place that cover the way any concerns or allegations of abuse or poor practice would be handled. Protection of Vulnerable Adults training has been completed by most of the staff. The remaining staff are scheduled to do the training in the near future. Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 16 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, 20, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The house and grounds are well maintained, attractive and accessible. There are suitable adaptations fitted. The bedrooms are well furnished, the doors can be locked and they all have secure storage spaces. The laundry is clean and well equipped. The whole house is clean and hygienic. EVIDENCE: Since the last inspection new carpets have been fitted in the hall stairs and landings throughout the house. These areas have also been re-decorated and the overall effect is attractive and welcoming. Many of the bedrooms have been re-decorated and also have new furniture and fittings such as vanity units, have replaced the washbasins. The newly decorated rooms are attractive and colour co-ordinated. The residents have been involved in choosing the
Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 17 décor for their own rooms, as well as for the shared areas of the house. The lounges and dining room are to be refurbished next year. The grounds are well maintained and the manager and residents told me that the patio, which is accessible to everyone, was well used throughout the summer. The tubs of flowers and hanging baskets were planted by the residents. There are adaptations in the home to assist people’s mobility and independence. I observed that the home is clean and fresh throughout and this view was confirmed by comments from residents and relatives. New flooring has been laid in the laundry and a wash hand basin has been fitted. One of the washing machines has an integral sluice wash programme. Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 18 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 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff are employed in sufficient numbers to meet the needs of the residents. Mandatory CRB and POVA checks have been carried out and the staff files showed that all other recruitment procedures have been completed. There is suitable staff training available and the files contained the necessary records. Ten of the fifteen care staff have achieved an NVQ in care. EVIDENCE: There are enough staff on duty at all times to meet the needs of the residents and the home. The home does not use agency staff. Members of the staff team provide additional shift cover. I looked at a selection of staff files. They all included completed application forms and two written references. The files showed that satisfactory Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register checks have been obtained. I was assured that no new staff would start work until a POVA register check had been completed. Then, if the CRB check had not been received, they would work only under the supervision of an experienced staff member.
Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 19 Ten of the fifteen care staff have a National Vocational Qualification (NVQ) in care. Of these, seven staff have an NVQ at level 2, two at level 3 and one at level 4. Four staff with a level 2 qualification are now taking the level 3 course and four other staff are working towards achieving their level 2 award. The manager works hard to make sure that staff have all the necessary training to help them do their work as well as possible. There is a wide range of courses available and the records confirmed that the staff are allowed the time to attend. Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 20 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, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is sufficiently experienced to run the home. The home has effective quality assurance systems in place. Some of the home’s policies and procedures need to be reviewed. Staff have completed moving and handling training. Residents’ finances are correctly handled. Confidential records are securely stored. The kitchen is clean and hygienically maintained. Mandatory staff training is up to date. Staff induction and foundation training is thorough. Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager has experienced difficulties with her training providers but expects to complete the Registered Managers’ Award by February 2007. In addition the manager attends other training to keep up her professional development. The manager has the experience necessary to manage the home effectively. There is a range of quality assurance measures in place including questionnaires, which are sent to residents, relatives and visiting professionals. The information obtained is put into a newsletter and displayed on the home’s notice board. The manager acts on this to improve service quality for the residents of Alexander House. A senior manager in the organisation makes regular visits to the home and internal quality audits are also carried out. Accurate records are kept of the small amounts of money that service users leave with the office for safekeeping, and of any transactions carried out on their behalf. The money is stored securely. All confidential records are securely stored in a room which is locked when unoccupied. At present the manager takes one to one supervision every two months with all the day staff. A senior member of the night staff team takes supervision with the night staff. The manager plans to train one of the senior day staff to take on some of the supervision work. Records of discussions held during supervision are kept. The home’s kitchen is very clean and well organised. Refrigerator, deep freezer and hot food temperatures are taken regularly. On the day of the inspection the small electrical appliance testing was being carried out. The staff are up to date with the mandatory training such as basic food hygiene, fire safety and health and safety. A trainer comes into the home to deliver infection control training to all staff. I saw evidence that new staff receive a high standard of induction and foundation training. This gives them a good basis for their NVQ training and helps them understand their role and responsibilities, especially when they are new to care work. Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 22 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 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 3 3 X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 OP31 Good Practice Recommendations The manager needs to complete the Registered Manager’s Award in order to meet this standard. Alexander House DS0000043321.V311240.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection St Paul’s House 23 Park Square (South) Leeds LS1 2ND National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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