Inspection on 24/05/05 for Alexander House

This inspection was carried out on 24th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Alexander House 27/11/08

Alexander House 05/02/07

Alexander House 18/07/06

Alexander House 23/08/05

Alexander House 14/01/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Alexander House 140-142 Folkestone Road Dover Kent CT17 9SP Lead Inspector June Davies Unannounced 24th May 2005 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 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 H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Alexander House Address 140/142 Folkestone Road, Dover , Kent CT17 9SP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01474 833696 Nicholas James care Homes Limited Mrs Elizabeth Lindsay Care Home 46 Category(ies) of Older Persons 46 registration, with number of places Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th January 2005 Brief Description of the Service: Alexander House comprises of two large detached properties interconnected at the rear by a group of three summerhouses. The property is situated in the town of Dover, and is close to all public transport services. The home is registered to provide care for 46 elderly people, this includes three intermediate care beds. The bedrooms in the home are situated on both ground and first floor, with shaft lifts giving access to the first floor. The home has five communal lounges plus pleasant sitting areas in the summerhouses. There is a paved courtyard between the two properties and a small garden to the rear of the property. Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 11.10 a.m. It took place over five and a half hours. Some members of staff and a total of eighteen residents were spoken during this visit. There were workmen in the building fixing venting for the new washing machine and tumble drier. It was obvious during a tour of the building that there was a programme of refurbishment for the building that was beginning to take place. All care staff have new uniforms and looked very smart, and said they were happy in their work. During conversations that took place with many of the residents it was evident that they were contented and happy with the care they were receiving. It was noted that some requirements from the previous inspection had not been met, and other requirements were made during this inspection. What the service does well: What has improved since the last inspection? What they could do better: Pre-admission assessments and care plans and records of personal care given need to be more informative to ensure the home meets the needs of each individual resident. Proper supervision of medication practice needs to take place, to ensure that errors do not occur. Staff need to pay particular attention to the prevention of cross infection, and the health and safety of the residents. Requirements have been made for medication, prevention of cross infection and the health and safety of the residents. Staff recruitment practices need to improve to protect the safety of the residents in the home. Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 7 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 Standards Statutory Requirements Identified During the Inspection Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4. The home should improve both the terms and conditions and pre-assessment forms so that residents are clear about their fees, and what level of care they will receive when coming to live at Alexander House. EVIDENCE: Each resident is issued with a copy of the terms and conditions when coming to live in the home, some of the residents spoken to during the visit, said that they were aware that they had signed the terms and conditions of their stay, and other residents could not remember anything about terms and conditions. Copies of the terms and conditions of residence are kept on private files in the office, and on inspection of these documents it was noted that while the terms and conditions set out the number of the room to be occupied, the fees payable was not clear, but the deputy manager said that the front page of the terms and conditions was under review and would give clearer guidance as to the breakdown of fees and who would be responsible for paying part or the whole of the fee, and a recommendation has been made that terms and conditions of residence is reviewed. Eighteen residents were spoken to, most said that they had all their needs met by the care staff in the home, but on viewing the pre-admission assessments Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 9 it was seen that they did not contain sufficient information to assess the needs of the residents prior to admission into the home, this pre-admission form is at the present time under review and a new format will be issued to the home from head office in a few weeks, therefore a recommendation has been made that new pre-admission assessments are produced. Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Improvements need to be made to the production of care plans, and the information contained within them. Medication should be supervised on a regular basis to ensure that errors do not occur. EVIDENCE: Some residents spoken to said that they were not aware of their care plan, and others did say that they knew there was a care plan somewhere, they were not aware of regular reviews. Care plans seen, were not always completed on each page, and did not give clear guidelines to staff on the needs of individual residents. For example:- how many care staff would need to be involved in manual handling, or what areas of personal care would require the assistance of a carer. The area manager was in the building during this visit and told the inspector that care plans are in the process of being changed. A new care plan was seen by the inspector, which potentially will cover all the care needs of the residents, but will only be as good as the information put into it. A requirement has been made that information within the care plans is improved upon, to give a more holistic picture of the residents needs, and to be more informative to care staff using the care plan. Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 11 Residents spoken to said that the staff were very good, and that they were given assistance to have access to full health services, of G.P’s, district nurses, opticians, dentists, and the chiropodist. There was no evidence to show that staff check on all areas of personal hygiene, and it was not clear whether residents had had nails attended to, their hair washed or tissue viability assessed on a regular basis. Care staff were observed giving out medication at lunch time, and this was carried out professionally and competently. MAR sheets were signed off appropriately once the medication had been given to the resident. It was noted that one resident requested some pain killers, and these were not available in the home, it was also noted that refrigerated medications, were being kept together with external creams in the refrigerator, and one eye ointment did not have the date of opening written onto the tube. A requirement has been made in relation to these errors. All residents spoken to stated that care staff respect their privacy and dignity, and this was observed when the inspector was being shown to a bedroom by a member of staff, where the carer knocked on the residents door before entering the room. It was noted during a tour of the home, that toiletries belonging to a resident had been left in a bathroom, and a resident’s soap in another bathroom, residents personal toiletry items should be respected and returned to their bedrooms and a requirement has been made in respect of this. Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 The home needs to improve on the activities offered to the residents, and perhaps more social events could be organised, as many of the residents clearly enjoy these. Meals are nutritious and balanced and offer a healthy and varied diet for the residents. EVIDENCE: Residents said that there were not many activities in the home, and that they missed the craft lady coming into the home, but many of the residents looked forward to the armchair exercises which take place every week. The deputy manager said that the registered manager is advertising at the present time for an activities co-ordinator to work in the home for 10 hours each week. A recommendation is being made that an activities co-ordinator is recruited as soon as possible. Some of the residents spoken to said that from time to time they have coffee mornings and barbeques, people come into the home from outside, and they enjoy these events taking place. Residents also said that they look forward to the ‘Ark’ coming into the home every month, they can then sing along to the hymns, and enjoyed listening to the bible readings. All residents said that they were able to have visitors at any time. Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 13 A number of residents were spoken to at lunch-time, and all said how good the food was in the home, how they were offered choices if there was something they did not like, and that their dietary needs were catered for. On observation it was noted that meals were attractively served, in quantities to meet the individual needs of the residents. Some residents said that they were also offered a cooked tea, but choose sandwiches instead as they are always full after their cooked lunch. It was also observed that cold drinks are served with the lunch-time meal. Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The complaints policy and procedure could be produced in a larger font and placed at eye level in a prominent place for the residents to read. The home is making good progress in reviewing policies and procedures in relation to abuse, and also in providing POVA training for staff, to protect the residents in the home. EVIDENCE: The recently reviewed complaints policy and procedure was displayed in the home. Some residents did say that they were not aware of the complaints policy and procedure but that they would complain to the manager or deputy manager if they needed to. The deputy manager said that there had been no complaints made to the home since the last inspection. The policy and procedure for abuse has recently been reviewed, and the home also has a copy of Kent County Councils guidelines for the protection of vulnerable adults. POVA training for staff has been booked in four sessions starting at the beginning of June. The deputy manager said that all staff will need to attend. Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 26 While some improvements have been made, other areas of the home still require attention, and it is important that attention is paid to health and safety issues within the home, and the prevention of cross infection, from stale water and wet mop heads. EVIDENCE: At the present time there is a programme of investment taking place in the home, in regard to carpeting, decoration, provision of new equipment and furniture. There are areas in the home that need to be improved upon, these were pointed out to the deputy manager and the area manager, both stated that these are part of the refurbishment programme. Two residents said they were pleased that a carpet had been replaced in the back hallway outside a communal bathroom on the ground floor. The home has a certificate from the Environmental Health Officer for clean food, and the building meets the requirements of the fire safety officer. A recommendation has been made on this occasion, that all areas that may prove to be a health and safety hazard receive attention, during the refurbishment of the home. Residents stated that there were several comfortable areas in the home where they were able to sit if they did not wish to spend time in their own bedrooms. It was noted Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 16 that the kitchen/sitting area provided for intermediate care residents, had been cleaned and was not at the present time being used as a storeroom for aids. It was noted during the tour of the premises that a small side kitchen used for preparing teas, had a wet mop and bucket with clouded water under the work surface, and it was pointed out to staff and the deputy manager, that there was a risk of cross infection, and these cleaning aids should not be kept in the kitchen. A requirement has been made on a previous inspection in regard to the prevention of cross infection. During this visit it was noted that a new industrial washing machine had been fitted into the laundry room. The washing machine has a sluicing facility. All communal toilets had the provision of paper hand towels and liquid soap. Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 While the staffing the levels in the home are good, further attention needs to be paid to NVQ, work related training. The procedures for the recruitment of staff are not robust and do not offer protection to people living in the home. EVIDENCE: From evidence seen during this visit, the staffing levels in the home meet the needs of the residents. Residents spoken to during the visit said that nothing was too much trouble for the staff, and staff were always there when needed. The duty rota accurately reflected the number of staff on duty on the day of the visit. Evidence was available to show that some staff had completed NVQ level two or three, but at the present time does not meet the requirement of 50 , although the deputy manager stated that a further seven members of staff were about to embark on NVQ level two training in the near future. A recommendation is being made that the home continues to work towards training staff to NVQ level two. During the visit the deputy manager said that a new member of staff had commenced work that morning, and that she was shadowing an experienced member of staff until such time as the CRB was received, but during discussion with a member of care staff who was feeding a resident in her bedroom, the member of care staff stated that she had only started work that morning. On further investigation it was found that a POVA first check had not been carried out on this new member of staff prior to recruiting. Therefore a requirement is being made that all potential new staff must be POVA first checked prior to taking up employment, and that they must shadow until such a time as the CRB check has been received back into the home. Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 18 A programmed of training is about to commence in the home for all mandatory training, this programme is aimed at staff renewing their mandatory training certificates, and some staff who will be doing their mandatory training for the first time. Evidence was also available to show that the deputy manager is a qualified manual handling trainer, and her certificate was seen to be in date. Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 There are some areas and practices in the home, which do not promote the health and safety of the residents. While all staff will soon receive training in aspects of health and safety, it is important that they practice what they learn. EVIDENCE: In some communal areas of the home, the joins in the carpets need attention paid to them to protect the health and safety of the residents. It was explained during the visit, that carpets would be part of the refurbishment programme. Evidence was available to show that all staff have a programme of training arranged, to cover moving and handling, fire safety, first aid, food hygiene and infection control. All policies and procedures in relation to health and safety have recently been reviewed. A requirement is being placed in relation to wheelchairs, which during a tour of the building were seen not to have footrests in place, this poses a big risk of injury to any resident’s using the wheelchairs. Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 20 Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 x 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 2 Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement Care plans should be completed fully and should accurately state, what assistance the resident will need and how many staff will be needed to support the resident to carry out the task. A record is kept of all personal care given to a resident by care staff. (Previous requirement timescale of 11/02/05 not met). All eye drops and ointments to be dated on bottle or tuve on the day of opening, and only to be used for 28 days after that date. (Previous requirement timescale of 11/02/05 not met.. Where a medication is prescribed for a resident this should always be available Toiletries belonging to a resident must be returned to their bedrooms after bathing. Mops and buckets should be left clean and dry, and should have appropriate storage areas. (Previous requirement timescale of 1/03/05 not met) The Registered Manager to ensure that POVA first checks are carried out prior to any new member of staff taking up H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Timescale for action 1/07/05 2. 8 12 1/07/05 3. 9 13 1/07/05 4. 5. 6. 9 10 26 17 12 13 1/07/05 1/07/05 1/07/05 7. 29 19 1/07/05 Alexander House Version 1.20 Page 23 8. 29 19 9. 38 23 employment in the home. (Previous requirement timescale of 11/02/05 not met) All new members of staff must be supervised by an experienced member of staff until CRB check is received. All wheelchairs to have footrests in situe, to prevent risk of injury to the residents using wheelchairs. (Previous requirement - timescale of 11/02/05 not met) 1/07/05 1/07/05 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. 2. 3. 4. 5. Refer to Standard 2 3 12 19 28 Good Practice Recommendations All residents should receive a contract of terms and conditions stated what the fee for there stay at the home will be. Pre-admission assessments must be holistic and cover in detail the assessed needs of the prospective resident.. Residents should be provided with leisure and social activities to meet their needs.. Refurbishment programme to include repair to carpet seams, and protruding strips through plaster to two wall corners on first floor and ground floor.. The home to continue to ensure that staff are trained to NVQ level 2 or above. Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection 11th Floor, International House, Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alexander House H56-H05 S62424 Alexander House V225161 240505 Stage 4.doc Version 1.20 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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