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Inspection on 13/12/07 for Alexander House Private Nursing Home

Also see our care home review for Alexander House Private Nursing Home for more information

This inspection was carried out on 13th December 2007.

CSCI found this care home to be providing an Good service.

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.

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

Alexander House provides a friendly, family type atmosphere where residents` relatives and friends are made welcome. Assessments are undertaken with full involvement of the multi-disciplinary team prior to admission to ensure residents` needs are appropriately met. Regular review meetings are also held with multi-disciplinary input. Care planning is closely monitored and reviewed. Personal and health care needs are met with emphasis on rehabilitation to improve mobility. The quality, variety and choice of meals provided are good with nutritional intake and regular weight monitoring undertaken. There is good retention of staff and residents are therefore cared for by staff that know them well. Positive feedback was received from both residents and their relatives on the caring nature of staff.

What has improved since the last inspection?

The quality assurance programme has been established and includes regular audits and service user surveys the outcome of which is used to develop an annual plan for the home. Staff supervision is well established with formal sessions undertaken as recommended in the National Minimum Standards. A dependency level tool has been introduced to determine the dependency needs of residents. Additional moving and handling equipment has been purchased. The Department of Health Guidance on infection control has been obtained, staff have received updated training and an audit of the home has been undertaken. Some structural alterations are underway to provide a new staircase and widen corridor to enable easier wheelchair access. Some communal rooms have been decorated.

What the care home could do better:

Social activities need further development to ensure residents receive mental stimulation to include those with dementia. The refurbishment of the premises whilst in progress has been slow. Advice and guidance still needs to be sought to ensure that improvements and redecoration to the premises is sensitive to the needs of people with cognitive impairment. Recommendations are made to ensure the administration of prescribed creams is confirmed by the signature of the person who administers the cream.

CARE HOMES FOR OLDER PEOPLE Alexander House Private Nursing Home 25-27 First Avenue Westcliff On Sea Essex SS0 8HS Lead Inspector Diana Green Unannounced Inspection 13th December 2007 10:00 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 Private Nursing Home DS0000040206.V357817.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 Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexander House Private Nursing Home Address 25-27 First Avenue Westcliff On Sea Essex SS0 8HS 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) 01702 339635 01702 431096 Health and Home Limited Mrs Edith Kasonde Care Home 25 Category(ies) of Dementia (25), Mental disorder, excluding registration, with number learning disability or dementia (25), Old age, of places not falling within any other category (25) Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC. to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Dementia - Code DE. Mental disorder, excluding learning disability or dementia - Code MD. 2. The maximum number of service users who can be accommodated is: 25 Date of last inspection 6th February 2007 Brief Description of the Service: Alexander House is a three storey private home situated in a quiet residential area of Westcliff on Sea, close to the seafront. The home is registered to a small company, Health and Home Ltd. The home is close to local bus routes. Alexander House is registered to provide personal care, nursing care and accommodation for 25 Older people. Accommodation is provided on three floors in nine single and eight double rooms. Two bedrooms have en suite facilities. Other facilities include two communal lounges and a dining area on the ground floor. A passenger lift provides access to all levels within the home. Visitors’ parking is available at the front of the property. There is a well-maintained garden to the rear for residents to use. The fees range from: £535.47 - £836.40 per week There are currently no extra charges for hairdressing, chiropody or toiletries. The registered person has advised that the service does reserve the right to charge for additional goods and services. This information was provided to the CSCI on 18/12/07. Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 5 Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection lasting 5 hours. The inspection process included: discussions with the manager, Assistant to the Director, the cook, five residents, five care staff, one relative and feedback from health and social work professionals; a tour of the premises including a sample of residents’ rooms, bathrooms, communal areas, the kitchen, the laundry and the sluice-rooms; an inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). Evidence was also taken from the Annual Quality Assurance Assessment completed by the management of the home and submitted to the CSCI. Twenty-five standards were inspected and two requirements made. The manager, Assistant to the Director and staff were welcoming and helpful throughout the inspection. What the service does well: What has improved since the last inspection? Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 7 The quality assurance programme has been established and includes regular audits and service user surveys the outcome of which is used to develop an annual plan for the home. Staff supervision is well established with formal sessions undertaken as recommended in the National Minimum Standards. A dependency level tool has been introduced to determine the dependency needs of residents. Additional moving and handling equipment has been purchased. The Department of Health Guidance on infection control has been obtained, staff have received updated training and an audit of the home has been undertaken. Some structural alterations are underway to provide a new staircase and widen corridor to enable easier wheelchair access. Some communal rooms have been decorated. 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 Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 8 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 Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good based upon sampled inspected standards 1, 3, 4 and 5. People looking to live at Alexander House received sufficient information to enable them to make a decision and had their needs fully assessed prior to admission to ensure they could be appropriately met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a statement of purpose and service user guide that met regulatory requirements and had been reviewed since the previous key inspection. A relative spoken with confirmed that they had received a copy prior to admission being agreed on behalf of their loved one. Copies were displayed in the entrance of the home for visitors’ information. Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 10 The manager stated that pre-admission assessments were carried out at home or hospital where possible by the proprietor or registered nurse. Care management assessments were obtained where relevant and seen on the care records viewed. A sample pre-admission assessment form was seen, and included all elements of need as indicated under this standard. The home does not provide intermediate care. Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good based upon sampled standards 7, 8, 9 & 10 The health and personal care needs of residents are well met through care planning that is closely monitored and regularly reviewed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of three files were viewed that included dementia and non-dementia residents. All files contained a pre-assessment form completed prior to admission and used to develop care plans. Additional individual assessments had been completed in regard to specific needs (e.g. risk of falls, moving and handling, dependency, continence, nutrition, skin condition, etc.), and it was positive that these being regularly reviewed. Nutritional intake was monitored and regular weight monitoring was undertaken and seen in the records viewed. An appropriate range of care plans were present on the sample of files viewed, Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 12 and these generally contained a good level of detail of the action required by staff to help the person meet their needs. The records confirmed evidence of good monitoring of health care needs with prompt referral to GPs and health care professionals and appropriate follow up action being taken. The home had positive relationships with the local mental health team whose representatives were fully involved in regular reviews of residents. The Assistant to the Director said that telephone advice was also obtained from the local Alzheimer’s Society as needed. The records confirmed that residents were enabled access to outpatient services; chiropody treatment was provided regularly and annual eye tests were undertaken. Positive feedback was received from a relative spoken with who said they found the standard of care very good and their loved one had improved tremendously and their mobility had improved since admission to Alexander House and any request they made for assistance was immediately forthcoming. Another relative said ‘they look after my (loved one) very well’. The home had medication policy and procedures that were available for staff guidance. Registered nurses administered all medication at the home and all had current Nursing & Midwifery Council (NMC) registration. Medication was supplied through a local pharmacy in pre-dispensed packs and individual containers and appropriate ordering and disposal procedures were followed. Supplies were stored in a locked trolley in the office that was secured to the wall. A wall cupboard and Controlled Drugs (CD) cupboard were also provided. The drug fridge was also stored in the office and regular monitoring and recording of room and refrigerator temperatures were undertaken. The medication administration records and supplies for four residents were inspected. All medication was available as prescribed and the medication administration records (MAR) were well recorded. The administration and recording of prescribed creams was discussed. The home had developed a protocol for their administration whereby care assistants administered prescribed creams and informed the registered nurse once the task was completed. The registered nurse then signed the MAR sheet to confirm the cream had been applied. This was subsequently discussed with the pharmacist inspector who confirmed that this did not comply with medicines regulations and only the person administering the cream should confirm by their signature. A report system for medication errors had been introduced since the previous key inspection to provide a monitoring tool and to ensure appropriate action was taken in the event of an error being made. During the site visit, staff were noted to treat residents with courtesy and dignity and to address them by their preferred name. However feedback received from one relative indicated this was not always the case and sometimes ‘nicknames’ were used. Locks were not routinely provided on doors to individual resident’s rooms and the home’s policy regarding this was detailed in the statement of purpose. Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 13 Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good based upon sampled standards 12, 13, 14 & 15 People living at Alexander House can expect to be supported to maintain contact with their friends and relatives and to be encouraged to have some involvement in social activities but development of therapeutic activities are needed to promote well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The resident’ files viewed contained a social assessment and information on their past interests. Care records detailed activities that individual residents had taken part in. The home does not employ a designated activities organiser; all care staff have responsibility to engage with residents in various activities. Evidence of an activities programme was seen displayed in the home, and individual records were maintained of residents’ involvement in the activities. Staff were involving residents in a karaoke session during the site visit and individual activities, for example scrabble were being played with Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 15 other residents. However three relatives who completed surveys said they would like to see more activities provided. Comments included ‘more activities and encouragement and assistance other than for personal needs’; ‘I would like to see more interaction and mental stimulation; ‘games such as bingo, ludo, cards, beetle drives, raffles to keep the brain stimulated’. Information received from the home stated that open visiting hours are promoted in the home. Residents confirmed that their friends and relatives could visit at any time, and they could meet with them in private in their rooms. One relative spoken with said they found the home to have a very friendly environment and staff always welcomed them in a friendly manner. Information received from the home stated that contact with religious representatives was promoted and care records viewed also indicated residents’ religious needs had been discussed as part of their assessment. From observation it was evident that residents were enabled choices about their daily life in the home, especially in regard to where they spent their day, meals, taking part in activities etc. For instance one resident had chosen to have wine with their meal and this was seen served with their lunch. Many of the rooms seen were well personalised, showing that people could bring their own possessions into the home with them. Information on advocacy services was included in the statement of purpose and available in the home. A menu was observed displayed in the lounge/dining area. The home operates a four weekly menu that included seasonal variations and was changed to meet residents’ preferences. Residents spoken with were generally positive about the meals served at Alexander House. The main meal served on the day of the inspection looked and smelt appetising, and residents observed were enjoying this. The lunch comprised a choice of chicken breast or shepherd’s pie served with carrots, broccoli and potatoes. Hot and cold drinks were seen being served during the day. Food stocks were stored in an outside building and were seen to be appropriately stored and plentiful. Menus viewed showed an appropriate range of meals, with choices available at all meals. Residents spoken with also confirmed they were able to have an alternative choice of meal if the main meal was not to their liking. One relative stated in a completed survey ’the food is very wholesome and cooked well’; and another said when asked what the home did well ’nutrition and dressing etc.’. Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good based upon standards 16 & 18. People living at Alexander House can expect to have their complaints listened to and acted upon and to be protected from abuse by robust policies, procedures, staff training and practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints procedure that included the timescales within which complainants can expect a response. The procedure was included in the statement of purpose and displayed in the entrance of the home. No complaints had been received by the home of CSCI since the previous key inspection. Procedures in place ensured that all concerns, complaints or allegations made would be referred to the Proprietor for investigation. A resident and a relative spoken with during the site visit confirmed they were aware of the complaints procedure and knew who to complain to should they need to. The home had a policy and procedures for safeguarding vulnerable adults and maintains a copy of the safeguarding adults policy and procedure produced by Southend-on-Sea Unitary Council. The records confirmed that all staff had received relevant training and most had received updated training since the previous key inspection. Records inspected showed that appropriate preAlexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 17 recruitment checks on new staff were undertaken prior to appointment (see standard 29). There had been no allegation of abuse made since the previous inspection. Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate based upon standards 19, 22 & 26. People living at Alexander House can expect to live in a homely environment that is generally well maintained and odour free. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A partial inspection of the premises was made that included communal areas, several bathrooms, a number of residents’ rooms, the kitchen, the sluices and the laundry. Some structural alterations were underway in the home to install a new staircase that would enable the corridor to be widened once the original staircase is removed. A lounge was also being decorated in time for the festive season. Whist some redecoration had taken place there were some residents’ rooms and communal areas that would from some improvement to decor. The gardens had been hard surfaced since the previous key inspection and the Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 19 director said there were plans to provide some planting and seating to enable residents to access them in warmer weather. However there were no ramps to enable access to the gardens. Records provided evidence that the building complied with the requirements of the local fire and environmental health department. The home had a passenger lift to enable access throughout the premises. There were grab rails and aids in bathrooms and toilets to meet the needs of residents. Assisted baths and toilets were provided. The Assistant to the Director said that there would be improved access for wheelchairs once the corridor was widened. Call systems were provided throughout all individual and communal rooms. Pressure relief equipment was assessed and provided by the district nursing service to meet the needs of residents. All equipment was serviced as per manufacturers recommendations and confirmed from the records inspected. There were robust policies and procedures for infection control in place that included a contingency plan in the event of a pandemic. All staff received training during induction and at regular updated sessions as seen from the record of training. The home was generally clean although some dust was inevitable from the alterations taking place. However one room had a malodour that was reported at the previous key inspection; the manager said that carpeting had been replaced and advice had been sought regarding the continence management needs of the resident. This was also discussed with the proprietor who is considering how the problem regarding an alternative floor covering can be resolved. Evidence of environmental risk assessments undertaken and minimised were seen from the records inspected. A copy of the Department of Health Guidance for infection control had been obtained since the previous key inspection and an audit of the home undertaken. The laundry room was small and had no separate areas for clean and dirty laundry. Despite the limited space, the management of laundry was well organised. There was one washing machine and one drier in working order. Systems were in place to minimise risk of infection via the use of red bags for any laundry soiled by body fluids, placed directly in the washing machines and washing machines had the capacity to carry out sluice wash cycles. A sluice room with mechanical sluice was located in the nearby room but no hand washing facilities were available in the room to ensure adherence to safe infection control practices. Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good based upon standards 27,28, 29 & 30. People living at Alexander House can expect to be cared for by a stable and skilled staff team with staffing levels that are appropriate to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were twenty residents at the home. Staffing numbers and skill mix met the levels agreed with the CSCI; from inspection of the staff duty rota and discussion with staff and residents, there was evidence that staffing levels were well maintained, and met the needs of residents. One relative spoken with said they were impressed with the staff ratio to residents and said that staff had a caring nature and spent time talking with residents. All relatives were unanimous in their view that they found the staff caring in their approach with residents. The home had with 9 care staff with NVQ level 2 qualifications or above. The percentage of staff with NVQ level 2 training or equivalent was therefore more than the 50 needed to meet the standard. Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 21 The recruitment files of four recently employed staff were inspected. All had evidence that the required checks had been obtained (two satisfactory references, CRB/POVA checks) and evidence of identification and photographs obtained before the individuals commenced employment at the home. All had received a statement of terms and conditions of employment. The Assistant to the Director reported that one new member of all staff was enrolled on induction to Skills for Care Standards (records were not inspected). The home had an established training programme. The training records seen confirmed that staff had completed training on Protection of Vulnerable Adults, fire safety, and moving and handling and health and safety. Training had also been provided on first aid, food hygiene, infection control and loss and bereavement. Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good based upon standards 31, 33, 35, 37 & 38. People living at Alexander House can expect to live in a well managed home where their views are listened to and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is a registered nurse with current Nursing & Midwifery Council (NMC) registration and there was evidence from the records of recent updated training having been undertaken. From information received and discussion with her it was evident that she is appropriately trained and Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 23 experienced to carry out her role competently and is well supported by senior management. Evidence was received from the home that there is a quality assurance programme that includes an annual audit of the home that is used to develop an annual plan. A copy of the report was provided to the CSCI. Annual stakeholders surveys were undertaken as part of the audit and included the views of residents, their relatives and professionals. A number of internal audits were regularly undertaken, for example medication, health and safety etc. The home monitored all complaints and compliments and also had a suggestion scheme for residents and visitors. Relatives meetings are held regularly where issues, for example the meals are discussed. Visits made under regulation 26 were undertaken monthly as required and reports of findings made. There were no monies held on behalf of residents. All residents had a relative or representative to assist in management of their finances. No manager or employee was appointee for any resident. All transactions were made through invoicing directly to the individual/representative. Records held on behalf of residents were kept up to date and were stored safely in secure facilities. Records viewed at this inspection included: the statement of purpose, service user guide, care plans, medication records, staff recruitment and training records, maintenance records, accidents/incident records and fire safety records. The home had health and safety policies and procedures and a designated care assistant who was responsible for health and safety in the home. The records confirmed that staff had attended relevant health and safety training. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g. checks on fire equipment, fire alarms and emergency lighting, hot tap water temperatures, etc.). All accidents, injuries and incidents were well-recorded and appropriate action taken. Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 24 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 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 3 17 X 18 3 3 X X 3 X X X 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? no 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 OP12 Regulation 12(1) & 16(2)(m) & 16(2)(n) Requirement Social and therapeutic activities must be further developed to meet all residents’ needs including those with dementia. Timescale for action 31/03/08 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. 2. 3. Refer to Standard OP9 OP10 OP12 Good Practice Recommendations To ensure residents receive medication as prescribed, the person who applies the cream should confirm by their own signature. To ensure residents are treated with respect care staff should ensure they are addressed by their preferred name. To ensure residents, including those with dementia receive social stimulation, care staff should receive training on the provision of social and therapeutic activities for older people. To ensure there is no risk of infection the malodour in the room identified should be removed. 4. OP26 Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ 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. Extracts may not be used or reproduced without the express permission of CSCI Alexander House Private Nursing Home DS0000040206.V357817.R01.S.doc Version 5.2 Page 27 - 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. 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