Inspection on 06/04/05 for Alexander House

This inspection was carried out on 6th April 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Alexander House 04/07/06

Alexander House 17/11/05

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 Gloucestershire GL50 2TG Lead Inspector Paul Chapman Announced 6 April 2005 09:00 th 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Alexander House Address 16 Tivoli Road The Park Cheltenham Gloucestershire GL50 2TG 01242 513525 Not known Not known Dr Ahmed Elbanna 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) Mrs Lesley Elbanna Care Home 9 Category(ies) of MD - Mental Disorder (3) Both registration, with number OP - Old People (1) Both of places LD - Learning Disability (5) Both Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Not applicable Date of last inspection 27th August 2004 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 D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was completed over five hours with the manager, one member of staff and 6 service users being spoken to during that time. Service users’ files were examined along with other records required to be kept by the Care Homes Regulations 2001. A tour of the environment was conducted with the manager and all of the service users bedrooms were seen. What the service does well: What has improved since the last inspection? Assessment of prospective service users is more comprehensive. Service users’ personal files continue to be developed by the manager. The manager and staff have reviewed service users needs in respect of promoting and maintaining their independence skills. Service users gave examples of these. Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 6 What they could do better: 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 D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 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 standard(s) 2, 3, 4, 5 Prospective service users are assessed and supplied with information about the service provided at the home. EVIDENCE: The home has a Statement of Purpose and Service User’s Guide that has been examined previously. A service user admitted to the home four weeks before this inspection spoke about the process. They stated they were happy with the admission process and had settled in well to the home. Their file contained an assessment completed by Social Services and a daily living assessment completed by staff with the service user and their relative. This identified their ability to complete tasks like personal care, household tasks and going out alone. The manager had spent time with the service user on their visits before admission and had written notes of her observations; these were used as part of their assessment. Two other service users files were case tracked, both contained comprehensive assessments. Each service user’s file seen by the inspector contained a contract. Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 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 standard(s) 6, 7, 8, 9, 10 Service users are involved in planning their care and these needs are addressed appropriately by the staff. Risks are assessed enabling service users to live independent lives. EVIDENCE: One service user spoken with explained the needs that are addressed by their care plan. Examination of this care plan confirmed what the service user had spoken about. All of the care plans seen were developed from the assessments and regularly reviewed by staff. This was supported by an annual review with other significant people (relatives, Social Workers, etc.) Care plans and risk assessments were signed by the service users in most cases. Service users stated that they had house meeting the previous week where they discussed what holidays and day trips were going to be organised. Five meetings had taken place since the previous inspection. Regularly reviewed risk assessments were present for each service user. Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 10 Service users’ records are stored securely in the homes office. Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 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 standard(s) 11, 12, 13, 14, 15, 16, 17 Independent lifestyles are promoted and supported by staff. Meals are nutritious and balanced and offer a healthy and varied diet for the service users. 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 staff spoken to 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. Service users are able to fulfil their spiritual needs, some stated that they regularly attend a local church. Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 12 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. Since the previous inspection some service users now have more input into preparing meals. An example of this is that one service user recently cooked the Sunday lunch for all of the service users. A shortfall identified during the inspection related to the recording of the actual food consumed. It is recommended that the home start recording the meals for each service user after they have eaten. Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 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 standard(s) 18, 19, 20, 21 Staff assess and review service users needs. Where they are unable to meet them other specialised professionals are involved. EVIDENCE: 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. Medication administration was being managed correctly at the time of the inspection. The home has recorded information to meet the criteria of standard 21 for all of the service users, except the one who has recently moved in. The manager stated that this would be addressed in the future. Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 14 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 standard(s) 22, 23 The home’s complaints procedure is unclear to the service users. EVIDENCE: In conversation with service users they were able to explain what action they would take if they wished to make a complaint. But, they were unclear about the homes complaints procedure. This was brought to the attention of the manager and a requirement of this report is for service users to receive some training in this area. At previous inspections the home’s adult protection policy has been examined and judged to have met the standard. When staff were asked what steps they would take if they had an allegation made to them, or witnessed an incident they were able to explain the appropriate steps to take. Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 15 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 standard(s) 24, 25, 26, 27, 28, 29, 30 The home’s decoration and furnishings are of a good standard and provide service users with a safe environment. EVIDENCE: The home is decorated to a good standard throughout and areas have been refurbished since the previous inspection. Service users spoken to during the day stated they thought the home was comfortable and they enjoyed living there. The manager stated they are to replace the floor covering in the dining room with a laminate floor. To the rear of the property is a good-sized garden that is well maintained. A requirement of this report is to replace the floor covering in the entrance to the kitchen. All of the service user’s bedrooms were seen during the inspection and were found to be decorated to a good standard and personalised with their possessions. Service users stated that they chose the colours and styles and one service user stated that they were going to redecorate their room with Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 16 staff support. Another service user stated that they felt their bedroom could do with redecorating and this was brought to the attention of the manager. All of the bathrooms and toilets were seen and found to be in good order. Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36 Staff understand their roles, are appropriately trained, and supervised regularly by the manager. 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 and no new staff have been employed since the previous inspection. The staff rota showed that a sufficient number of staff were on duty at all times. Staff confirmed that supervision sessions were held regularly. Records showed that on average staff received 4 sessions per annum and it was discussed that the standard states that 6 sessions should be held per annum. Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40, 41, 42 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 recently 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 user meetings, staff supervision and training, and comments from all parties about the manager’s day-to-day approach. Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 19 Staff training, supervision, service user assessments 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. A shortfall the manager must address relates to the home’s hard wiring being checked by an approved engineer. Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 20 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. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 2 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Alexander House Score 3 3 3 2 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 2 x D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 21 No 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 22 Regulation 22 Requirement The manager must ensure that all of the service users have a copy of the homes complaints procedure. The manager must explain this process to each person to ensure they understand it fully. The manager must replace the floor covering in the entrance to the kitchen. The manager must ensure that the buildings hard wiring is inspected and certified by a qualified engineer. Timescale for action 17/06/05 2. 3. 24 42 23(2)(b) 13(4)(a), 23(4) 22/07/05 30/09/05 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. Refer to Standard 17 Good Practice Recommendations The manager and staff should record the actual food consumed by the service users. Alexander House D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 22 Commission for Social Care Inspection 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 D51_D03_S16359_AlexanderHouse_V215157_060405_Stage4_A.doc Version 1.20 Page 23 - 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!