Inspection on 04/07/06 for Alexander House

This inspection was carried out on 4th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alexander House 17/11/05

Alexander House 06/04/05

Alexander House 27/08/04

Alexander House 04/05/04

Alexander House 16/02/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

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

CARE HOME ADULTS 18-65 Alexander House 16 Tivoli Road The Park Cheltenham Glos GL50 2TG Lead Inspector Mr Paul Chapman Key Unannounced Inspection 4th July 2006 09:00 Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 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 DS0000016359.V306660.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexander House Address 16 Tivoli Road The Park Cheltenham Glos GL50 2TG 01242 513525 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) Dr Ahmed Elbanna Mrs Lesley Elbanna Mrs Lesley Elbanna Care Home 9 Category(ies) of Learning disability (5), Mental disorder, registration, with number excluding learning disability or dementia (3), Old of places age, not falling within any other category (1) Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th November 2005 Brief Description of the Service: Alexander House is a three storey period town house with accommodation for eight adults with a range of disabilities. The home is conveniently situated in Cheltenham, which enables service users to access local community facilities. Service users also have access to transport that is provided by the home and this enables them to access facilities in several other local towns. The home is staffed 24 hours a day, seven days a week. Family and friends are welcome to visit the home at any time and service users can meet them in private if they wish to. In general the service users organise their own activities, but sometimes the manager will organise trips or activities. Service users access a local College and Day Services. Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and completed over 6.5 hours with the manager, one member of staff and 6 service users being spoken to during that time. The inspector case-tracked six of the service users’ care needs examining their files, talking to them where possible. In addition to this other records required to be kept by the Care Homes Regulations 2001were also examined. A tour of the environment was conducted with the manager and a number of the service users’ bedrooms were seen. As part of the inspection the CSCI have asked the manager to supply them with the names and addresses of other people involved with the service users and their care. The CSCI will send questionnaires to each of these people when they have received the addresses from the manager. Their comments will be noted and may be used as part of a future inspection. What the service does well: What has improved since the last inspection? Staff training records were comprehensive with certificates available for the courses that had been completed. Courses that had been completed included Fire safety, medication administration and first aid. Food Hygiene training has been arranged to update previous training. Two staff are currently completing a course in community mental health and NVQ’s are being completed. Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager completes a thorough assessment of prospective service users needs and this minimises the risk of a person being wrongly admitted to the home. EVIDENCE: No new service users have been admitted to the home since the previous inspection. The inspector has assessed previous admission processes and found them to be comprehensive and meet the criteria of these standards. Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care assessments are completed for all of the service users and care plans are developed from this document. Review of these assessments is needed to measure service users current needs. Care plans seen address peoples’ needs and are regularly reviewed by the staff ensuring that changing needs are also met. Service users are able to make decisions about their lives and staff will support them with this if they wish. Risks to the service users are identified and steps are taken to minimise them through risk assessment. EVIDENCE: The inspector examined six of the service users’ personal files whilst completing the site visit. All of the files examined contained a copy of a Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 10 comprehensive needs assessment completed by the manager 3 to 4 years ago in most cases. These are good documents but are in need of review. All of the service users had care plans in place to meet various assessed needs. All of these care plans were regularly reviewed by staff. Conversations with service users throughout the day confirmed that they were aware of their care plans and personal files. Staff use a “day book” that details what activities service users complete each day and any other relevant information. A recommendation would be for some of the past information to be archived to make it easier to use. During conversations with the service users they gave examples of being able to make decisions about their lives. These included their day-to-day activities, holidays and how they spent their money. One person has an advocate. All of the personal files examined by the inspector contained risk assessments completed by the staff. The risk assessments examined clearly identified the activity to be completed, the potential risk, the assessed level of risk and the actions required by the staff to minimise those risks. The majority of the risk assessments had been reviewed, or renewed within in the previous six months. The inspector found some assessments that were in need of review and made the manager aware of this. Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users lead active and varied lifestyles supported by the staff where appropriate or independently. The home provides the service users with a range of healthy and nutritious meals and snacks. EVIDENCE: Service users at the home are at the older end of the Younger adults (18-65) spectrum and the activities they are involved in reflect that. Service users spoke about activities they are involved in and the staff spoken confirmed what had been said. Activities included attending a Social Club, eating out, going to the pub, college, going bowling and swimming, playing badminton, shopping in Cheltenham, visiting friends. A number of activities are organised in house including massages and exercise with an appropriately qualified person and cooking sessions with the staff. Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 12 The day before this inspection one service user had returned from a holiday to the Czech Republic and Poland with the manager. People are able to maintain and develop hobbies; one person is building a dolls house. Service users are able to fulfil their spiritual needs, some stated that they regularly attend a local church. The majority of service users have contact with their families. In addition they spoke about visiting friends and their friends coming to the home to see them. Conversations with service users provided evidence that their rights are respected in that they were able to make decisions about their lives and where appropriate staff supported them with advice. All of the service users are registered to vote. All of the service users spoken with stated that they thought the food at the home was nice and that they had input into the menu. In between meals snacks were available. Service users continue to be more involved preparing meals. One person explained that they now cook their own meals three days a week and they wished to do increase this. The inspector spoke to the manager about this with the permission of the service user. Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are able to manage their own personal care needs but these are monitored by the staff team. Medication administration must be monitored to ensure that errors and risks to the service users are kept to a minimum. EVIDENCE: None of the service users require regular support in completing their personal care. The daily living and needs assessment completed by staff identifies the personal support required by service users. Where needs are identified they are addressed by staff. A completed form showed input by staff, service user and a relative. Service users’ files gave numerous examples of the input of other professionals to meet their needs where staff were unable to. The manager makes good use of other professionals. Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 14 Records were available that showed service users had attended appointments with doctors, opticians, dentists and others regularly. The inspector recommends that these records should be kept in their files, as it would make them easier to access. Medication administration was examined. Errors were found in the records for four of the six people case tracked by the inspector. This was brought to the attention of the manager. The errors appeared to be where staff had failed to sign confirming that the medication had been given to the service users. One of the service users looks after their own medication. They have a locked cabinet in their bedroom where they store the medication and staff prompt them to ensure that they take the medication. No risk assessment had been completed for this procedure and the inspector has asked the manager to complete one. Whilst examining the service users’ personal folders the inspector noted that each person has a form completed by staff to record when various aspects of personal care have been completed. The records seen by the inspector showed that all aspects of personal care were completed regularly and observations throughout the day raised no concerns. Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure in place enables the service users to make their views heard if they are unhappy about anything. EVIDENCE: The inspector spoke to the majority of the service users that he was case tracking. Each of them confirmed that they were aware of the complaints procedure and stated that they felt they could make a complaint if they wished. Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is a comfortable and spacious and provides the service users with a safe environment. Bedrooms are personalised by the service users who are able to exercise choice as to their style and colour schemes. EVIDENCE: The home provides the service users with a homely comfortable environment with adequate communal space. At the time of this inspection the home was clean and tidy with no offensive odours. To the rear of the home is a large garden that is well maintained. Some service users allowed the inspector to see their bedrooms. The rooms seen were personalised their possessions and decorated to a good standard. One of the staff team stated that the manager intended to replace the kitchen in the near future. Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 17 The inspector identified two shortfalls. The first being the entrance door to the kitchen was wedged open. This is a fire door and should not be wedged open. The manager must ensure that this practice ceases and the inspector recommends fitting a “self-closing” mechanism. Secondly, at the top of the stairs on the second floor the carpet must be re-fixed. It was loose due to the work being completed on the hard wiring but must be fixed properly at all times to minimise the risk to people. The inspector recommends that the manager tidy the area under the stairs in the basement, as it was a little untidy at the time of the inspection. At the previous inspection an engineer was replacing the hard wiring in the home. The majority of this has been completed, but it is still not finished. The manager explained that she has been addressing and it will be finished as soon as possible. Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users are supported by a competent staff team that have received the appropriate training to meet the current needs of the service users. To minimise the risks to the service users all potential staff are subject to a thorough recruitment procedure. EVIDENCE: All staff have job descriptions. Staff training records were comprehensive with certificates available for the courses that had been completed. Courses that had been completed included Fire safety, medication administration and first aid. Food Hygiene training has been arranged to update previous training. Two staff are currently completing a course in community mental health and NVQ’s are being completed. The home has a settled staff team. Since the previous inspection the manager has employed her two sons to work at the home. The manager discussed that process with the inspector and documentation gathered as part of that process was examined. No other new staff have been employed since the previous Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 19 inspection. At previous inspections the inspector has discussed recruitment with the manager and examined previous recruitment records which were found to be satisfactory. The staff rota showed that a sufficient number of staff were on duty at all times. The manager explained since the previous inspection all of the staff team have completed PRT training to enable them to manage behaviour that may challenge. Five of the staff team have completed their fire safety training while others are completing induction training. Other mandatory training is being organised and completed as required. Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed by an appropriately qualified person who provides the staff with direction and support. This, in part leads to the service users receiving a quality service that is led by their needs. EVIDENCE: The manager is a trained nurse and has completed her Registered Manager’s Award. The Registration certificate and Employer’s Liability Insurance certificate were both clearly displayed in the home. Observations and conversations with the service users and staff during the inspection support the manager’s approach in creating an open, positive and inclusive atmosphere in the home. Examples of this are the staff and service Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 21 user meetings, staff training, and comments from all parties about the manager’s day-to-day approach. Staff training and care plans (that are regularly reviewed) provide mechanisms that promote quality assurance. In addition to this service users also complete surveys regularly where they are able to identify any issues or concerns. The home has policies and procedures which are reviewed and updated periodically. Records seen during the inspection were well maintained and stored securely in the homes office. Comprehensive records are kept of safety checks that are made regularly by staff. These include regular tests of fire safety systems, fridge/freezer temperatures and the use of the food probe. The gas safety certificate showed that a qualified engineer had checked the system in February 2006. All of the fire safety equipment had been checked in December 2005. Alexander House DS0000016359.V306660.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 23 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 YA20 Regulation 13(2) Requirement The manager must monitor the home’s medication administration to ensure that any future errors are highlighted and addressed. The manager must ensure: The fire door to the kitchen is not wedged open, and a self closing mechanism is fitted if they wish the door to be open at all times. The carpet at the top of the stairs must be secured. Timescale for action 25/08/06 2. YA24 13(4)(a) 25/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The manager should review the service users’ needs assessments. The manager should archive some information from the Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 24 2. YA9 daybook, as it may be easier to use. The manager should audit the risk assessments to ensure that the staff are reviewing them as required. Alexander House DS0000016359.V306660.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 DS0000016359.V306660.R01.S.doc Version 5.2 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!