Inspection on 02/12/08 for Alexander House Private Nursing Home

This inspection was carried out on 2nd December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alexander House Private Nursing... 13/12/07

Alexander House Private Nursing... 06/02/07

Alexander House Private Nursing... 22/05/06

Alexander House Private Nursing... 05/12/05

Alexander House Private Nursing... 10/05/05

Alexander House Private Nursing... 18/10/04

Alexander House Private Nursing... 25/05/04

Alexander House Private Nursing... 12/12/03

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Alexander House Private Nursing Home 25-27 First Avenue Westcliff On Sea Essex SS0 8HS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Carolyn Delaney     Date: 0 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Alexander House Private Nursing Home 25-27 First Avenue Westcliff On Sea Essex SS0 8HS 01702339635 01702431096 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Health and Home Limited care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 25 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. Date of last inspection Brief description of the care home 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 who have dementia or other mental health conditions. Accommodation is provided on three floors in nine single and eight double rooms. Two bedrooms have en Care Homes for Older People Page 4 of 26 25 25 0 Over 65 0 0 25 Brief description of the care home 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. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a routine unannounced inspection, which included a visit made to the home between the hours of 11.45 and 17.50 on 2nd December 2008. As part of the inspection process we reviewed information we have received about the service since the last inspection, which was carried out on 13/12/07, including notifications sent to us by the manager of any event in the home, which affects residents such as injuries, deaths and any outbreak of infectious diseases. We also looked at the information the manager provided us with in the homes Annual Quality Assurance Assessment. This document is a self-assessment which the registered provider / owner tell us what they do well, how they evidence this and the improvements made within the previous twelve months. We sent surveys to the home for residents, staff, their families and health care professionals to complete and tell us what they think about the home. We Care Homes for Older People Page 6 of 26 received surveys from two residents, seven staff and ten health care professional / relatives. the views and comments expressed by these people were reflected in the report. When we visited the home we spoke with two residents and three members of staff. We also observed how staff interacted with residents when supporting them with activities such as meals, mobilising and providing recreation and stimulation. During the site visit, records including residents care plans and assessments, and staff training files were examined. A brief tour of the premises was carried out and communal areas including lounge and bathrooms were viewed. In addition some residents bedrooms were viewed. Information obtained was triangulated and reviewed against the Commissions Key Lines for Regulatory Activity. This helps us to use the information to make judgements about outcomes for people who use social care services in a consistent and fair way. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who move into the home are assured that their assessed needs will be met. Evidence: We were told in the Annual Quality Assurance Assessment that people looking for a care home are provided with detailed information about the home. We were also told that a comprehensive assessment of their needs is carried out before a person is offered a place in the home. During the inspection we looked at a copy of the statement of purpose and service users guide. These documents describe the aims and objectives of the home and provides people with information about what it is like to live there, including details of the daily routines, staffing levels and skills and how to make a complaint if a person is unhappy. We looked at how the needs of two people who had recently moved into the home had been assessed. We saw that a detailed assessment of both persons physical and Care Homes for Older People Page 10 of 26 Evidence: mental health needs had been carried out before they were offered a place in the home. There was information about the support both people needed in order for them to carry out activities of daily living such as washing and dressing, eating and drinking and mobilising. Specific wishes for each person were recorded such as the time they like to get up and go to bed, any particular food likes and dislikes they have. Once the assessment is carried out the manager made a decision as to whether the home would be able to accommodate the persons needs this was recorded in the assessment. People who completed surveys told us that staff are attentive and are quick to respond to residents needs and they feel that the home meets the needs residents. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are well cared for and staff support them in a way which suits their needs and wishes. Evidence: We were told in the Annual Quality Assurance Assessment that residents are cared for in accordance with their needs and staff treat residents as individuals. Staff who completed surveys told us they have up to date information about the people they support and care for. One person said We give residents the utmost care just as we would our families. Relatives and healthcare professionals told us that they are kept up to date with important issues affecting residents. One person told us staff care for a mixed group of residents and respect their privacy and dignity when carrying out personal care. During the inspection visit we looked at how information about residents needs was recorded in care plans. We looked in dept at the care plans for two residents. We saw that information was recorded in a detailed way and clearly described what support the Care Homes for Older People Page 12 of 26 Evidence: person needed to maintain personal hygiene. We saw that staff encouraged residents to remain as independent as possible and they had recorded in each persons care plan what residents could manage to do regarding washing and dressing. Both persons preferences for getting up and going to bed, food likes and dislikes were recorded. We saw that staff assess risks to the health and safety of residents and record these in a risk assessment plan. Risks such as injuries due to falls, weight loss and developing pressure sores as a result of poor mobility were assessed and plans developed to minimise these. Staff review the assessments regularly and amend information where there have been any changes. We looked at accident records and these showed us that there are few incidents of accidents or incidents affecting residents in the home and there had been no serious injuries within the past twelve months. Records indicated that residents are assisted to access medical treatments and routine healthcare screening such as hearing and eye tests. Qualified nurses are responsible for administering medicines to residents. At the time of the inspection all of the people living in the home relied upon staff to ensure that they receive their medicines as prescribed by their doctor. We looked at how staff administer and keep records for medicines in the home and the storage arrangements. We saw that records were well maintained and medicines were stored safely. Staff administer medicines in accordance with the instructions made by residents doctors. The manager told us that one resident would regularly refuse medicines and therefore they were administered covertly in drinks as instructed by the doctor. This persons relative had written a letter to the manager stating that in their opinion the resident did not have the mental capacity to make decisions about what is best for them. We advised the manager that a assessment of the persons mental capacity should be carried out by a suitably qualified person to support the decisions made about the way they were treated. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can make decisions and choices about their daily lives. Evidence: The manager told us in the Annual Quality Assurance Assessment that the culture of the home is one where residents can make choices about their daily routines and the records we looked at during the inspection confirmed this. We were told that there is an open visiting policy, outside entertainers are organised and activities are attempted within the home. Relatives who completed surveys told us they were able to keep in touch with residents and staff are keen to maintain good links with relatives. The manager provided us with a staff guide and menu for activities designed to meet the needs of people who have dementia or other mental health conditions. During the inspection we looked at how staff record residents interests. We looked at records for two residents. Staff had recorded for both how they wished to spend their time and we saw that that both people were given the opportunity to participate in activities which they enjoy. One resident told us they go out about three times a week and they enjoy reading and participating in activities provided in the home. During the inspection we observed that some residents who have more complex needs and they did not participate in activities. We discussed this with the manager and advised that they look Care Homes for Older People Page 14 of 26 Evidence: at ways to keep these people occupied and stimulated. There is a planned menu and the manager told us that they ask staff what they would like to eat before meals are cooked. On the day of the inspection residents were offered chicken kievs, mashed potatoes and vegetables for lunch. Some residents who had difficulty in chewing were provided with a soft diet and staff were available to assist and support residents as needed. Some residents enjoyed a glass of wine with their meal. In the evening residents were offered a choice of sandwiches or eggs and chips. The majority of people we spoke with us said that they liked the food Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are treated well and safeguarded from harm. People are assured that any complaints or concerns will be taken seriously and investigated fully. Evidence: The manager told us in the Annual Quality Assurance Assessment that the culture of the home is one where people are encouraged to complain if they are unhappy and where staff view complaints as opportunities for improvement. We were also told that staff are trained to help safeguard residents from abuse. Residents, relatives and health care professionals who completed surveys told us they knew how to make a complaint and who to speak with if they were unhappy. People told us that the manager had responded appropriately to any concerns raised. During the inspection we saw that the homes complaints procedure was displayed where visitors and residents could access it. The manager told us that there had been no complaints made since 2005 and residents we spoke with said they had no complaints about the home. Staff who completed surveys and those we spoke with during the inspection told us that they knew what to do if residents, their families or advocates raised any concerns. The manager told us that she would refer any allegations of abuse to the local safeguarding team. We saw that staff working in the home had received training to Care Homes for Older People Page 16 of 26 Evidence: help them recognise signs of abuse and how to deal with this, including how to report their concerns. We looked at how staff were recruited to work in the home. We saw that checks are carried out including Criminal Records Bureau disclosures, PoVA First and references from each persons previous employer are obtained before they are employed. These checks help to ensure that only people who are suitable to care for older people are employed and that residents are safeguarded. We have received no complaints or allegations about the home since the last inspection. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean, safe and comfortable home. Evidence: We were told in the Annual Quality Assurance Assessment that accommodation meets the needs of residents and is overall to a high standard. The manager told us that all essential repairs and maintenance is carried out and there are procedures in place for preventing the spread of infection. During the inspection we saw that staff have had training in respect of the control of the spread of infection. As identified at the last inspection there were inadequate facilities for staff to wash their hands after using the sluicing facilities. The manager told us that there were plans to improve these facilities subject to local authority planning permission. All areas of the home we saw were clean and free from unpleasant odours. Residents have access to two large lounge areas and a dining area. Residents bedrooms looked comfortable and personalised. We saw that some bedrooms had been redecorated. The manager told us that bedrooms are redecorated once they become vacant. Some areas of the home were in needs of redecoration and a number of people who completed surveys commented that the overall decor of the home could be improved. One person said new chairs and furniture may benefit residents. We observed that some residents with physical disabilities did not appear to be comfortable in the chairs Care Homes for Older People Page 18 of 26 Evidence: provided for them. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are cared for by a team of competent staff. Evidence: We were told in the Annual Quality Assurance Assessment that there is a robust policy for recruiting, training and supporting staff. Residents and relatives who completed surveys told us that staff have the right skills and experience to look after residents properly. People told us that staff are kind, caring, attentive and that they genuinely care for residents. Staff told us that they were recruited thoroughly and they receive training, which is relevant to their work and the needs of residents. They also said that there are sufficient numbers of staff on duty to care for residents. One resident said I cannot fault the staff here, they are all very hardworking and caring. During the inspection the manager told us that residents were cared for by one qualified nurse and three care staff during the day and one nurse and one carer staff at night. We looked at staff rotas and these indicated that staffing levels were maintained and that staff do not work too many hours without a break and that staff have at least one day off each week. This helps to ensure that staff are fit to care for residents properly. We looked at how staff are recruited to work in the home. We looked at the files for two people who had recently started work in the home. We saw that references had Care Homes for Older People Page 20 of 26 Evidence: been obtained from each persons previous employers and that a satisfactory Criminal Records Bureau disclosure and PoVA First check had been obtained before individuals started work. We also saw that once a person commenced work they undertook a period of induction to help them familiarise themselves with the homes policies and procedures and the needs of residents. There is an ongoing programme for staff training and development. The majority of training provided was provided in house and delivered using videos followed by an assessment of learning. One healthcare professional who completed a survey commented that staff are not always up to date regarding changes in practices around caring for people with Alzheimers disease. The manager told us that external training for staff in respect of mental health, dementia and mental capacity have been planned to commence early next year. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of residents. Evidence: We were told in the Annual Quality Assurance Assessment that there is a manager in post who is in daily control of the home and a staff team to support them. We were told that residents are made aware of inspection reports and are asked for their views about the home so that quality can be monitored and improved upon if necessary. Staff who completed surveys told us that the manger meets with them regularly to give support and to discuss how they are working. We saw that staff are regularly supervised and supported to help them care for residents. Relatives and health care professionals made positive comments about how the home is managed. One person said I have placed a number of people in Alexander House and have been impressed with the way staff and management have developed care plans to meet individuals needs. Another person told us The home has provided Care Homes for Older People Page 22 of 26 Evidence: good quality care to some of our most challenging clients. During the inspection we saw that residents, their relatives, advocates and health care professionals are consulted with on an annual basis and asked for their views about the care provided by the home and to identify areas where improvements could be made. The manager then compares the results with those from the previous year so as to indicate where improvements have been made. Where areas for improvement are highlighted then a plan is put in place make the necessary changes. At the time of the inspection the manager was in the process of analysing the results from this years survey. We looked at how the home is maintained and the checks that are carried out so as to ensure that equipment and systems are kept in safe working order. Staff check hot water temperatures regularly to ensure that they are appropriate. Regular checks are carried out for fire, gas and electrical and installations and equipment and records and certificates are kept in respect of their checks, maintenance and repair. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 23 Appropriate hand washing facilities must be provided for when staff deal with soiled or infected materials. To help control the spread of infection. 15/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 In order to ensure that residents are supported in making decisions about their care and treatment, and where there is an issues as to the individuals capacity to make decisions an assessment should be carried out and recorded in their plan of care. The range of activities provided should be reviewed and arrangments made to provide opportunities for stimulation for people who have complex mental health needs. The overall decor of the home could be improved upon to enhance the experiences of people who live there. 2 12 3 19 Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!