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Inspection on 21/02/06 for Alexander House (Clifton Road)

Also see our care home review for Alexander House (Clifton Road) for more information

This inspection was carried out on 21st February 2006.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a quiet, calm atmosphere for residents. Residents looked well cared for and made positive comments regarding the home, the food that they receive and the staff. The staff team has remained stable since the last inspection. Staff were welcoming and responsive to residents needs.

What has improved since the last inspection?

Records of changes in medication have been maintained and medical appointments have been recorded. The fire alarm has been tested weekly. These issues were raised at the last inspection of the home.

What the care home could do better:

Residents commented that the provision of more activities would improve their quality of life. The recording system for care plans, risk assessments, personal care and assessments must be reviewed to ensure residents needs are recorded in full with appropriate details to ensure their needs can be met. Records of residents weight must include actions taken following significant weight gain or loss. Staff must complete training in the protection of vulnerable adults. The staff training record should be easily accessible and the record of fire drills should include details of staff members present.

CARE HOMES FOR OLDER PEOPLE Alexander House (Clifton Road) 12 Clifton Road Wimbledon London SW19 4QT Lead Inspector Emma Dove Unannounced Inspection 21st February 2006 11:35 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.V284593.R01.S.doc Version 5.1 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.V284593.R01.S.doc Version 5.1 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 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.V284593.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14 & 16/09/05 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. Twenty people are currently residing at the home with one person in hospital. The home is owned and managed by Keychange Charity, a Christian organisation which has ten other residential services in England. The home is in a residential area off the Ridgway 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. Residents have access to a large well-maintained garden to the side of the home. The home is staffed twenty-four hours a day. Three meals are provided daily with snacks and drinks available in between mealtimes. Alexander House (Clifton Road) DS0000027217.V284593.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over the course of five hours on the 21st February 2006 by one regulatory inspector. The inspection consisted of examination of records, inspection of communal areas of the home, talking with residents, the registered manager and staff. The inspector had the opportunity to speak with twelve residents and two members of staff. Residents made positive comments about the home, their bedroom, the staff and the food provided at the home. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alexander House (Clifton Road) DS0000027217.V284593.R01.S.doc Version 5.1 Page 6 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.V284593.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 A Statement of Purpose and Service Users Guide are available, ensuring prospective residents receive information to make an informed choice regarding moving into the home. EVIDENCE: The Statement of Purpose and Service Users Guide to the home have not changed since the last inspection of the home. Both documents contain information for prospective residents, their relatives and placing social workers to decide whether to move into the home. Alexander House (Clifton Road) DS0000027217.V284593.R01.S.doc Version 5.1 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 Care planning systems need to be developed to ensure residents wishes and needs are fully recorded and can be met. The recording system for residents health care requirements needs updating to ensure all information is included. The homes medication policies, procedures and practices protect residents from harm. EVIDENCE: The home uses the Standex system which includes printed forms for staff to complete covering residents assessment of need, care plan, daily recording, appointments, activities, key worker input and personal care records. One file examined did not contain the recent assessment, the information sheet was only partially completed, however the daily recording was detailed. Another case file examined included a detailed assessment which identified that the individual is at risk of falling downstairs, however no separate risk assessment was in place. Daily records regarding a fall for one resident were confusing and did not clearly indicate what medical advice had been sought and actions staff had taken. The record of one individual’s weight indicated a loss of eight kilograms over the course of three months with no evidence that medical advice had been sought. All residents are registered with a GP and the manager reported that they receive good support regarding residents health care. The recording systems Alexander House (Clifton Road) DS0000027217.V284593.R01.S.doc Version 5.1 Page 9 in place for medical appointments and nutritional screening require updating to ensure residents needs are fully recorded and can be met. Staff administer medication from a monitored dosage system. Medication is appropriately stored at the home. Medication Administration Record Sheets were signed and up to date. Records are maintained of medication received at the home and of medication returned to the pharmacist. Staff have completed training in the administration of medication and the manager completes an assessment of staff before they commence administering medication. Alexander House (Clifton Road) DS0000027217.V284593.R01.S.doc Version 5.1 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Residents dietary needs are catered for with a balanced and varied menu available. EVIDENCE: The menu is displayed on the wall in the entrance hall which residents can access. The menu is varied with cultural and religious diets catered for. A hot meal is served at lunchtime with a lighter snack provided in the evening. Residents take meals together in the dining room. Residents comments regarding food included: ‘the food is very good’; ‘the food is good’ and ‘I like the food’. Alexander House (Clifton Road) DS0000027217.V284593.R01.S.doc Version 5.1 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Appropriate polices and procedures are in place to protect residents from harm. EVIDENCE: One member of staff completed training in the protection of vulnerable adults in 2003. All staff must complete this training to ensure they fully understand issues relating to protection of vulnerable adults. Failure to comply with this requirement could result in enforcement action being taken. Staff selection and recruitment practices include the required checks taking place prior to new staff commencing employment at the home. Alexander House (Clifton Road) DS0000027217.V284593.R01.S.doc Version 5.1 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Residents live in a safe appropriately maintained environment. EVIDENCE: The general programme of maintenance and redecoration of the home continues with work continuing on the future development of the home. Residents and staff confirmed that they are kept up to date with future plans for the home. Alexander House (Clifton Road) DS0000027217.V284593.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 & 30 Residents benefit from a mix of long standing a new members of staff who demonstrated a commitment to meet residents needs. Staff have access to training and development courses. EVIDENCE: The published staffing rota identified that three members of staff are on duty during the day with two members of staff at night. The registered manager, domestic and catering staff are available in addition to these staff levels. The staffing levels were observed to be appropriate during the course of the inspection. Five members of staff have completed NVQ to Level 2 with six members of staff in the process of completing NVQ to Level 2. One member of staff is currently doing NVQ to Level 3. In addition staff have completed training in fire safety, manual handling, communication and report writing, medication and dementia care. The system of recoding training sessions staff have attended is confusing and should be reviewed to ensure ease of referencing courses staff have completed and those that require updating. Staff confirmed that they have access to training courses which help them complete their tasks. Alexander House (Clifton Road) DS0000027217.V284593.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 & 38 Residents finances are securely stored with appropriate records maintained at the home. The fire safety systems are sufficient to protect resident and staff. EVIDENCE: The manager reported that finances are held for some residents. Random examination of residents finances identified that it is securely stored, up to date and correct. The manager reported that receipts are given to relatives for monies paid to residents and that any finances left when a resident leaves the home is returned to relatives or passed to the next home. This was clearly recorded for one resident who had recently moved to another home. The fire alarm has been tested weekly since the last inspection of the home. One fire drill was recorded to have taken place in 2005, the manager reported that staff have completed training sessions which included a drill in November. This was not clearly recorded. The record of fire drills should include a list of staff in attendance. Alexander House (Clifton Road) DS0000027217.V284593.R01.S.doc Version 5.1 Page 15 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 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Alexander House (Clifton Road) DS0000027217.V284593.R01.S.doc Version 5.1 Page 16 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 (1 & (2) Requirement The registered person must ensure that care plans include sufficient detail to determine that appropriate care can be given. (previous timescale of 11/11/05 not met) The registered person must ensure that care plans are reviewed every month. The registered person must ensure that regular records are maintained of residents weight with actions taken in the case of weight loss or increase. The registered person must ensure that all staff complete training in the protection of vulnerable adults. (previous timescales of 24/11/04 & 11/11/05 not met) Timescale for action 18/04/06 2. OP7 15 18/04/06 3. OP8 12 (1) a 18/04/06 4. OP18 13 (6) 18/04/06 Alexander House (Clifton Road) DS0000027217.V284593.R01.S.doc Version 5.1 Page 17 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP12 OP30 OP38 Good Practice Recommendations Consideration should be given to the provision of more activities at the home. The staff training record must be clear with easy access to training individual staff members have completed. The record of fire drills should include the list of staff in attendance. Alexander House (Clifton Road) DS0000027217.V284593.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 (Clifton Road) DS0000027217.V284593.R01.S.doc Version 5.1 Page 19 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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