Inspection on 19/12/07 for Alexander House (Clifton Road)

This inspection was carried out on 19th December 2007.

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 (Clifton Road) 07/12/06

Alexander House (Clifton Road) 21/02/06

Alexander House (Clifton Road) 14/09/05

Alexander House (Clifton Road) 21/09/04

Alexander House (Clifton Road) 27/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2009.

CARE HOMES FOR OLDER PEOPLE Alexander House (Clifton Road) 12 Clifton Road Wimbledon London SW19 4QT Lead Inspector Liz O`Reilly Key Unannounced Inspection 19th December 2007 10:00a 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 (Clifton Road) DS0000027217.V356807.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 (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexander House (Clifton Road) Address 12 Clifton Road Wimbledon London SW19 4QT 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) 0208 946 7147 020 8879 1110 Ruthe@keychange.org.uk Keychange Charity Mrs Elizabeth Dhliwayo Care Home 21 Category(ies) of Dementia (9), Old age, not falling within any registration, with number other category (21) of places Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 2006 Brief Description of the Service: Alexander House is a registered care home for up to twenty-one older people including nine people who may have dementia. The home is owned and managed by Keychange Charity, a Christian organisation which has ten other residential services in England. The service is in a residential area off the Ridgeway in Wimbledon, close to bus routes with links to rail services. It is fairly close to Wimbledon Village, Wimbledon Common and churches of different denominations. Alexander House is a three-storey domestic style property which has been extended to accommodate the current residents. A lounge, sun lounge, dining room, office, kitchen, toilets, bathroom and bedrooms are available on the ground floor. Bedrooms, bathrooms and toilets are available on the first floor of the extension, and on the first and second floor in the original house. A stair lift is provided on the staircase to the first floor in the original house. All bedrooms are single. People have access to a large well-maintained garden to the side of the home. Fees range from £490 to £602 per week. Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two regulation inspectors on 19th December 2007. We had the opportunity to speak with people who use the service, care staff, catering staff and the manager. Surveys were sent out to people who use the service, relatives, staff and care managers. The manager has completed an assessment of the service for the CSCI. Judgements in this report are based on information provided from all of the above sources as well as observations we made at the time of the visit to the home. What the service does well: What has improved since the last inspection? Feedback from people who use the service indicated that the meals provided have improved since the last inspection when more negative comments were received about the food. Certain staff members have made improvements in adding more information on the personal likes and dislikes of individuals into the care plans. We also found certain instances where people who use the service have been encouraged to add information on their personal history which can provide staff with a greater understanding of individual experiences and interests. Plans are now in place to commence the refurbishment of the building in the very near future which will provide significant improvements for people who use the service. Alexander House (Clifton Road) DS0000027217.V356807.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. The summary of this inspection report can be made available in other formats on request. Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, 5 & 6 People who use this service receive adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People can visit the home before making a decision about moving in. An assessment of the needs of each person is carried out before they are admitted but this provides only basic information. This service does not provide intermediate care. EVIDENCE: The majority of people we spoke to told us that they had chosen to move into Alexander House because it was either, convenient for relatives and friends to visit or that it had been recommended to them. An assessment of the needs of each individual is carried out before they move into the home. Where this is carried out by the local authority a copy of the assessment is provided to the service. We asked to see the assessment carried out for the most recent person to move in. This assessment had been carried out by staff from the home. We found the assessment to be very basic with a significant amount of areas not assessed including; medical history, Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 9 sleep, eating and drinking, personal hygiene, social and personal history. The information gathered at the pre admission assessment should be used to set up an initial care plan. This had not been done. Two people who use the service and one relative raised in surveys concerns about the mix of people with different needs in the home. This was also raised by one person we spoke to during the visit. The concerns are around the ability of the service to provide for the needs of people with physical needs along side those people with dementia or impaired memory. One person was clearly distressed by the actions of another person using the service. This is an issue that should be considered and addressed by the organisation. Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use this service receive poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans are not in place for each individual. The plans need to be more person centred and address the health, personal and social care needs and wishes of each individual. Information on how the needs and wishes of individuals will be met is not clearly set out for staff to follow. Medication records are not up to date and the recording of Controlled Drugs is poor. The current lack of adequate accurate recording has the potential to put people who use the service at risk. EVIDENCE: Three of the four people who returned surveys told us they “usually” received the care and support they needed and one person said they “always” received the support they needed. One relative said their family member “always” received the care and support they expected and another relative said “usually”. One person told us they were looked after well as they could talk and make their needs known and make choices. One person told us that they were helped to have a bath once a week and that was enough for them. Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 11 We looked at the files for four people who use the service. We found on one file staff have included good information on the personal history, the likes and dislikes and the social preferences of the person. However this was not consistent across the sample we looked at. In one instance there was no care plan, the pre admission assessment was not available on the file and the front sheet, which should contain personal information, was not fully completed. The personal care record showed only two entries although this person had been living in the home for twenty four days. None of the long term care plans and needs assessments we looked at had been signed or dated and none had been fully completed. Short term care plans, which are used to provide staff with information on how needs and wishes will be met, were not available in two of the files we examined. In one file we found one area, personal hygiene, covered by a short term care plan. In the other file two areas had been covered by a short term care plan, personal hygiene and hearing. The last review of these care plans had taken place in August 2007. At the time of the last inspection of this service a requirement was made for care plans to be reviewed every month. This requirement has not been met. Risk assessments were not fully completed. If people are to be supported in a consistent and safe manner and to take part in activities of their choosing risk assessments need to be in place and be reviewed on a regular basis. Keyworker notes in one file indicated that one person was not eating well and was losing weight. These entries covered July to November 2007. However we found no evidence that any action had been taken and the long term care plan stated that this person ate and drank well. The lack of information for staff on the needs and wishes of the people they support and in particular the lack of information on how these are to be met is of concern. Medication was seen to be safely stored and staff have been provided with training on the management of medication. However the record of medication given was not up to date or accurate. We found staff had signed medication as given when it had not been and not signed when it had been given. The majority of medication given the day before this visit were not signed for. In one instance a medication had been marked as “course completed”. This was not the case, the manager informed us that this medication had run out. Medication received was recorded on the medication administration sheet but medication still in stock had not been added to these numbers therefore an audit of the medication could not be done. Staff are administering one Controlled Drug. The records for this medication were not accurate. According to the records kept at least five doses of this medication were missing. Staff could not provide any explanation as to how Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 12 this error had occurred. The separate record for this medication showed a large number of alterations and corrections. At the time of the last inspection of this service a requirement was made that accurate and up to date records are maintained for all medication administered was made. This requirement has not been met. A recommendation was also made for all medication records including those for Controlled Drugs to be checked at each staff handover and for senior staff to check the records on a regular basis. This recommendation is carried forward. Staff were seen to respect the privacy of people who use the service in providing personal care and support. Staff were discreet in approaching people to offer support. Alexander House (Clifton Road) DS0000027217.V356807.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 People who use this service receive good quality outcomes in this areas. This judgement has been made using available evidence including a visit to this service. Activities are arranged in the home. There is scope to improve opportunities for activities by making sure there is a full social care plan for each person taking into account individual interests and abilities. The service has good contacts with community religious centres. People are offered a well balanced diet and enjoy the meals. EVIDENCE: Three people who use the service told us via surveys that “sometimes” there were activities which they could take part in. One person said there “usually” were activities to their liking. One person told us that they had hoped there would have been more activities on offer when they moved in. During our visit one person said there was “not much to do”. One member of staff said that the variety of activities was one area where the service could be improved. The activities programme lists games on Monday, Wednesday and Friday. When we arrived thirteen people were sitting in the lounge. The television was on with the news, but no one was watching. After lunch people returned to the lounge with the television on but again no one watching. One person was Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 14 reading the newspaper and three people went to the entrance hall area to play games. These people told us this as a regular session for them, which they enjoy. People from a local church visit once a month for afternoon tea, bringing home baked cakes. Three people told us they very much enjoyed these events. Religion is an important part of the lives of many people who use this service. A communion service is held every month and people will be supported to attend religious centres in the community. People who use the service told us that “the food is very good”, “the cook is very good”, “lunch was good today” and people confirmed that there is always an alternative available if they do not like or want what is on the menu. One person told us that the suppers had improved lately. The temporary cook who was on duty on the day of our visit was well informed of individual preferences. A four week menu showed that a good variety of food is on offer and staff keep a record of food for each person which ensures that everyone is provided with a balanced diet in line with their needs and wishes. Alexander House (Clifton Road) DS0000027217.V356807.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 People who use this service receive adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in place for complaints or concerns to be investigated and recorded. Improvements could be made in the way people receive feedback from staff and in protecting the privacy of individuals. Staff have received the appropriate training to ensure that people who use the service are safeguarded from abuse. EVIDENCE: We found people who use the service knew how to make a complaint. One person told us that although they knew how to make a complaint but that doing so provided “little effect” and another person told us they were “not always listened to”. One person told us that they had no concerns or issues, but they did not feel that complaints were responded to. There is a complaints procedure which ensures that a record is kept of any complaint. A complaints record is available in the entrance hall. We found five complaints on the record. One person had raised concerns about the type of chairs used in the dining room. The outcome completed by staff stated, ‘nothing wrong with the chairs’. Three complaints concerned the lack of hot water, the response was noted as ‘there is hot water’. These responses do not address the individual’s issues or acknowledge that they are an issue for the person. Further work should be carried out with staff on responding to complaints to ensure that people feel their concerns have been acknowledged and dealt with appropriately. Consideration should be given to keeping the details of Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 16 complaints or concerns in a more private area particularly when actions taken and responses include information about individuals who use the service. We are aware that a pastoral visitor attends the home each week and people who use the service can speak to this person if they have any concerns. Care needs to be taken to make sure that information is provided in writing to the CSCI should the safety of any person have been put at risk, including any incident where a person is ‘missing’ from the home. Staff have received training on safeguarding adults which ensures that they have an understanding of their responsibilities to report any concerns or allegations which may be reported to them. A copy of the local authority procedure for the safeguarding of adults is available in the home. Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 17 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 & 26 People who use this service receive adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service enjoy a satisfactory and clean living environment. The home is not purpose built or modern therefore there can be maintenance problems. However the organisation is planning a major refurbishment of the building to commence in the near future. EVIDENCE: People who use the service were mostly happy with the environment. Individuals told us “it’s very comfortable”, “I am very happy with my room” and “I’m quite comfortable here”. One relative felt there could be a quicker response to maintenance issues and that people would benefit from easier access to the garden. One person commented on the furniture in the conservatory, they felt the chairs were too low for many people who use the service. We did observe one person having some difficulty in getting up from these seats. This is something which should be considered during the refurbishment programme. Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 18 We found the home to be clean and fresh in virtually all of the areas we saw. But there was a strong odour in the conservatory. This should be addressed. At the time of this visit we were informed by people who use the service and staff that the hot water supply was causing problems. We are aware that these problems are related to the age of the building and that efforts were being made to solve the problems. We are also aware that the work planned will address these issues. However staff informed us that they were transporting hot water around parts of the building. In order to ensure the safety of staff and people who use the service a risk assessment should have been in place for this activity. This assessment should cover the risk from spillages, moving and handling and the temperature of the water. No assessment had been carried out. We have since been informed by the organisation that the problems with the hot water supply have been rectified. Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 19 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 People who use this service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are generally enough staff on duty to meet the needs of people using the service. However the support available to the manager needs to be addressed. ( See Management and Administration). The recruitment procedures assist in protecting people who use the service. Staff have opportunities for further training but the record of training needs to be updated to ensure that all staff receive the appropriate training. EVIDENCE: The majority of feedback we received about the staff was positive. Staff were described as “very good”, “helpful”, “kind” and that they “do listen to me”. One person felt that, occasionally staff did not listen to them and another person felt that there should either be more staff or an activities organiser to provide a better mix of activities. We found staff respected the privacy of individuals and responded to requests and comments in a caring and appropriate manner. We examined a sample of staff files and found appropriate checks had been carried out before people started work. These included Criminal Records Bureau checks and satisfactory references. In order to comply with amendments made in legislation a full record of employment history must be Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 20 sought for each new employee along with written confirmation, from their last employer, of why they left if this was a caring role. We found staff were offered opportunities for further training but the record of training was not clear, the record seen indicated that the only training received in 2007 was fire training. The manager and staff informed us that they had taken part in other training. In order to ensure that all staff are provided with up dates on the training they have received at the appropriate time and are offered training to increase their skills and knowledge of current good practice, a clear record of training must be kept in the home. Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 21 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 People who use this service receive adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager has the qualifications and knowledge to carry out their role. However the lack of a deputy manager or administrator has impacted on the service. Further work needs to be done on consulting with people who use the service and their representatives. Staff are not being provided with regular supervision. Regular checks are carried out to protect the health and safety of people who use the service but this needs to be monitored. EVIDENCE: People who use the service and their representatives made positive comments about the home manager’s personal approach. However concerns were raised in certain areas. One person told us that they were “not sure who to speak to at week ends” when the manager was not available. Another person Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 22 suggested one improvement could be, a board to let people know who is in charge each day. One person told us that changes were made without consultation or announcement. They described this as “very frustrating”. Better communication was suggested as one way in which the service could be improved. Discussions with the manager indicated that the lack of a deputy manager or other support has impacted on the service. This is evident in the lack of regular resident meetings, staff not in receipt of regular one to one supervision, the omissions in the staff training record, and the comments received from people who use the service and their representatives in relation to communication. The CSCI also received one complaint about the service which indicated that the manager was not always readily available. We observed the manager being asked to meet with a significant number of people and deal with various issues during our visit. We were informed that a quality monitoring and assurance system had been developed. This has not been implemented. In order to ensure that the service is run in the best interests of people who use the service, taking into account their views and opinions quality monitoring needs to be in place. People who use the service can deposit small amounts of money with the home for safekeeping. We found the records kept for this money to be up to date and accurate. Staff carry out checks on the service to ensure the health and safety of people who use the service, staff and visitors. We found the majority of checks had been completed. However checks on the hot water accessible to people who use the service had not been carried out on a regular basis. Staff who had previously been checking the temperature of the water before they supported people to get into the bath were no longer doing so. The manager informed us that the record had fallen into the water and had then been stopped. We are aware that the majority of problems with the hot water supply are around water being too cold. However in order to ensure the health, safety and welfare of people who use the service the temperature of the water must be checked on a regular basis and at each time someone is assisted into a bath. The use of baths that may not be hot enough is also a concern. In order to ensure the health and safety of people who use the service, staff and visitors, risk assessments must be in place for all working practice topics which may pose a risk. Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 23 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 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement In order to ensure that the needs of people who use the service are met and delivered in the way they wish a care plan must be in place for each individual. Evidence that these plans have been complied in consultation with the individual or their representative must be in place. Care plans must include details of how the needs and wishes of individuals will be met. The provision of care plans was the subject of an urgent requirement made on 20/12/07 2. OP7 15 Care plans must be reviewed each month. Timescale of 18/04/06 and 01/03/07 not met 3 OP8 12(1)(a) In order to ensure that the health of people who use the DS0000027217.V356807.R01.S.doc Timescale for action 01/03/08 01/03/08 01/03/08 Version 5.2 Page 25 Alexander House (Clifton Road) service is maintained and promoted action must be taken and recorded where staff note a significant loss of appetite or weight. 4. OP9 13(2) In order to ensure the health and 15/02/08 welfare of people who use the service an accurate and up to date records of all medication must be maintained. Timescale of 01/03/07 not met. The recording of medication was the subject of an urgent requirement made on 20/12/07 5. OP27 18(1) In order to ensure that the 01/03/08 needs of people using the service are met information on how the manager of the home will be supported with the day to day running of the service must be provided to the CSCI. In order to ensure that people who use the service are supported by an appropriately trained staff group an up to date record of staff training must be in place. To ensure that the service is run in the best interests and in consultation with people who use the service an annual review of the care provided, taking into consideration the opinions of residents and other stakeholders must be carried out. Feedback from people who use the service must be made available to people living in the home and prospective service users. 01/04/08 6. OP30 13(2)(5)1 8(1) 7. OP33 24 01/06/08 Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 26 Timescale of 01/07/07 not met. 8. OP38 13(4) To ensure the health, safety and welfare of people who use the service weekly checks must be carried out and recorded on the temperature of hot water accessible to residents. Timescale of 01/03/07 not met. The temperature of the water must be taken and recorded before anyone is assisted by staff into a bath. The checking of hot water temperatures was the subject of an urgent requirement made on 20/12/07 9. OP38 13(4) To ensure the health and safety of people who use the service, staff and visitors risk assessments must be carried out for any working practice which may pose a risk. To ensure that the service can provide the appropriate care and support to individuals a full assessment of needs must be carried out before anyone is admitted to the home. 01/03/08 01/03/08 10. OP3 14(1) 01/03/08 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 OP7 Good Practice Recommendations Staff should work towards developing a more person DS0000027217.V356807.R01.S.doc Version 5.2 Page 27 Alexander House (Clifton Road) centred care plan which includes not only the physical needs of the person but also the social, cultural, emotional and religious needs and wishes of the individual. Consideration should be given to requesting a more detailed life history from residents or their representatives which they are willing to share with the staff group. 2. OP9 It is recommended that all medication records including those for any controlled drugs are checked at each staff change to ensure that any missing signatures are explained as soon as possible. Senior staff should carry out regular checks on the records to make sure they are up to date and accurate. Individual medication profiles should be maintained setting out all the medication prescribed, when it was prescribed and when discontinued. 3. OP12 A review of the activities on offer should be carried out to ensure that the range and opportunities for activities meet the needs of the people who use the service. A review of the way the complaints system operates should be carried out taking into consideration the way information is fed back to individuals. A review of the way in which information is shared with people who use the service and their representatives should be carried out to improve communication in the service. 4. OP16 5. OP33 Alexander House (Clifton Road) DS0000027217.V356807.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South London Area Office 8th Floor Grosvenor House 125 High Street Croydon Surrey CR9 0XP 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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