Inspection on 22/05/06 for Alexander House Private Nursing Home

This inspection was carried out on 22nd May 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.

Other inspections for this house

Alexander House Private Nursing... 02/12/08

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

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

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Alexander House Private Nursing Home 25-27 First Avenue Westcliff On Sea Essex SS0 8HS Lead Inspector Vicky Dutton, Christine Bennett. Key Unannounced Inspection 22nd May 2006 08:30 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.V295099.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.V295099.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 339635 Health and Home Limited Manager post vacant Care Home 25 Category(ies) of Dementia - over 65 years of age (12), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Old age, not falling within any other category (25) Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To provide care (with nursing) and accommodation for two service users who are under 65 years of age and whose details are known to the Commission. Suitable private accommodation to be provided to all service users in line with the National Minimum Standards for Older People by April 2007. Bathing facilities to be provided for all service users in line with the National Minimum Standards for Older People by April 2007. 5th December 2005 2. 3. Date of last inspection Brief Description of the Service: Alexander House is a two 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. The home is close to local bus routes. Alexander House is registered to provide personal care, nursing care and accommodation for 25 Older people. The home has 12 places for service users who have dementia. The home also has a condition on their registration that allows them to accommodate 2 specific residents who have a mental health condition, and two residents who are under 65 years of age. 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 registered provider currently provides nothing in the way of readily available written information about the service for potential service users. No copies of previous inspection reports or service users guides were available. Current fees for the home were quoted as being a flat rate of £551.25 per week. However during the course of the inspection other rates were discovered. One of £578.90 per week and one of £107.97 per day (£755.79 per week, or £3884.14 monthly). It was stated that there are no extra charges and that chiropody, toiletries, newspapers etc. will all be provided within the weekly fee. Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced ‘key’ site visit. The inspection was undertaken by two inspectors over a seven and a half hour period. At this inspection all the key standards, and the homes progress against their previous agenda for action were assessed. The registered providers usual representative, managing director and company secretary, was not available at this inspection. Inspectors were assisted by another member of the senior staff team at the home. A tour of the premises took place and care, staff, and other records were selected at random and inspected. A number of residents, a visitor and staff were spoken with. Questionnaires to seek peoples view about the quality of the service were given out to relatives and made available future visitors to the home. Questionnaires were also sent out in the post to relatives, and health and social care professionals that have contact with the home. The views expressed in the responses have been incorporated into this report. The home had been sent a pre inspection questionnaire before the site visit took place with a request that this, and other information to facilitate the sending out of questionnaires, be returned to the Commission for Social Care Inspection (CSCI) by the end of April. This did not happen so information was not available to inspectors before the site visit took place. The relevant information was requested several times at inspection but was not provided on the day. It was eventually agreed that the information required should be sent/brought into the Commission offices no later than Friday 26th May. It was finally received on Tuesday 30th May. What the service does well: Staff at the home were welcoming and helpful with the inspection process. Residents spoken with made some positive comments about staff at the home, and also the food provided at the home. Staff had a caring attitude towards residents. Visitors are made welcome at the home. Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 6 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 Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families are not given comprehensive information about Alexander House. This does not enable them to make an informed choice about the home before they move in. The home always visits potential residents to assess their needs. However this is not always an effective process in assessing the suitability of residents to move into the home, or of formulating care plans and preparing for an admission. EVIDENCE: A Statement of Purpose of the home was available, but, as at previous inspections, no service users guide could be produced. Senior staff confirmed that they did not give out any written information to prospective service users when they carry out assessments. The relative of a resident being admitted during the inspection said that no written information had been given to her. Copies of a revised Statement of Purpose and a Service Users Guide were received following the inspection. Future visits will assess if prospective Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 9 service users are now given adequate information about the home before deciding to move in. Resident’s needs are assessed before they move into the home. A relative confirmed that the managing director/company secretary had visited to carry out the assessment. However in one case looked at the assessment was carried out, social work information was acquired and admission all took place on the same day. This is not good practice, as it may not allow for proper planning and preparation for the admission. In another case the pre-admission assessment had not been dated so it was not possible to know if the assessment had taken place prior to admission. It was of concern that two recent admissions to the home have taken place of residents that fall outside the categories that the home is registered to provide care for. One service user with a mental health condition had been admitted and another with a learning disability. In both cases the homes assessment stated that the primary care need of these residents was now their dementia care needs. In one case this was confirmed by a social worker. Staff have only very recently received training in dementia care and mental health issues, although the home has been registered to provide services in for people with dementia for some time. Training records showed that staff have received training in other relevant aspects of care However staff had received no training in any aspects of learning disability. Feedback from some visiting professionals showed that it was not always felt that staff at the home demonstrated a clear understanding of residents needs. A relative confirmed that she had visited the home with a social worker prior to their relative’s admission. Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning at the home is comprehensive but does not always provide an adequate basis to ensure that residents’ health, care and social needs are fully met. Development is needed to ensure that care plans are put in place in a timely manner, are up to date and used by all staff. EVIDENCE: The care plan files of several residents were viewed as part of this inspection. The format used is complex, and information is often repeated. For the planned admission that took place during the inspection only the brief assessment and hard to read social work information was available. No care plan had been prepared in readiness. In general care plans addressed residents assessed needs. The exception to this was a resident admitted out of category with a mental health condition. There was no mention of this in care plans. In some cases information about managing care needs was not current. One resident had a risk assessment in place for the use of bed rails, whereas no bed rails were in place. The situation was alternatively being managed by the use of mattresses on the floor. This was not mentioned in the care plan. There was no evidence to show that a multi-disciplinary approach had been Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 11 taken in making these decisions or deciding what would be the safest way of managing the risk. Another issue about the care planning system in use at the home is that they are kept separately from daily care records. This is not good practice and will not encourage staff to actively use care plans. Examples of this were seen where care needs such as keeping legs elevated and recording fluid input and output were identified on care plans but not carried out in practice. In the response to this inspection report the registered provider(s) recognised that ‘Further work is required to bring the care planning process to a higher level, we are happy with the current progress being made in this area’ Generally the home is proactive in meeting resident’s healthcare needs, and evidence of interventions by/referrals to other health care professionals were identified. Feedback from two visiting health care professionals indicated that that the home did not always communicate well with them, or work in partnership. They also felt that there was not always a suitable member of staff to confer with. Appropriate health assessment tools, such as tissue viability, (Waterelow) are used but do not always appear consistently in the care plan file. For one resident with a sore on heir heel, no Waterlow score had been completed. The person in charge said that these records are sometimes kept in a separate folder. Appropriate pressure relieving equipment was available, but it was not always clear how the decision to use a specific piece of equipment was arrived at. Good nutrition records are maintained for breakfast lunch and supper, but drinks/snacks at other times are not recorded. Therefore a full record is not maintained and it appears that some residents are going from 17.00 one day to 10.00 on the following day with no food or drink. The home has just acquired a new blood pressure monitor device. This however only has one size of cuff. To be of use for all resident different sizes will need to be provided. Following the site visit the registered person(s) said that this was now to be provided. Medication systems were not viewed at this inspection as a CSCI pharmacy inspector had carried out an audit during the previous week. As a result of this four additional requirements were made and are included within this report. Additionally at this inspection it was noted that there were many unnamed pots of creams in residents bedrooms. During the inspection staff were noted to address residents appropriately. Residents confirmed that they received their own post and could use a telephone in private. Shared rooms had dividing curtains in place. In one case this was very stained. In terms of dignity and respect, the environment of the home does not support a valuing people ethos. Further details of this will be given in the environment section. No care plans identified resident’s wishes in relation to dying or death. It was identified that four residents at the home have no family or advocate to look Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 12 after their interests, so it is important that these issues are discussed and recorded. Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff at the home do what they can within their resources and abilities, but residents at the home currently receive little in the way of positive stimulation or activity. Development is needed to make sure that residents have their social and occupational needs properly assessed and met. Resident’s food and drink intake needs to be better recorded. EVIDENCE: During this inspection residents mostly sat passively in chairs in the lounge areas of the home, or wandered around the corridors. There was little interaction between residents. This is not helped by the layout of chairs in the main lounge area of the home. Much staff interaction was task orientated, although one member of staff did try to engage residents in some singing during the morning. An activities book is maintained. This showed entries under individual names with items such as reading newspaper, watching TV, crosswords and listening to music. Staff spoken with felt that this area was improving as they now had regular visits from the library and could get videos and music out for residents. Musical entertainers regularly visit the home. Care plans have a section headed up ‘social interests’ but this does not present as a real attempt to assess and address residents’ occupation and activity Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 14 needs. Some residents were noted to receive and enjoy a daily paper. During the inspection residents were often left unsupervised for unacceptable periods of time. A new resident admitted during the inspection was left to their own devices. Staff did not try to engage them or get to know them. Development should continue to show how resident’s activity/occupational needs are properly assessed and met. Lack of resident stimulation was confirmed by comments received from relatives. All staff employed at the home are from overseas/have a different ethnic background from the resident group. This practice may not assist in meeting resident’s cultural needs. Due to staffing levels choice in terms of daily routines/rising retiring times is limited. Residents confirmed that when only two staff are on they ‘just start at the top and work down’. This was borne out when inspectors toured the building as residents on the top floor were already up and downstairs. The home employs no English staff. One resident said that staff spoke in their own language when attending to their care needs. Feedback from one visiting professional commented on the difficulties in communicating with staff when the ‘senior manager’ was not available. In general feedback on staff from residents, relatives and one visiting professional was positive and said that staff were polite and helpful. The home seek to meet residents spiritual needs. It was reported that some residents no go out to church on a Sunday. Another resident receives regular visits from a priest. Residents can receive visitor’s at any time. Responses from relatives said that they were able to have visits in private. However out of six responses from visiting professionals, four said that visits could not be conducted in private. Information on advocacy services was noted to be available. This was however out of date as it referred to a monthly surgery, which no longer happens. The senior member of staff on duty said that four residents have no family and they will have advocates appointed as soon as they are available. Residents are able to bring in personal possessions. Although not specifically viewed at this inspection, the registered person(s) has confirmed that a full record of possessions (including furnishings brought in by residents) is now kept. At lunchtime during the inspection food was plentiful and well presented. Residents are able to have a drink of wine with their meal. The home has a four week menu plan in place. The cook gave examples of where choice is given. Appropriate help and encouragement was given to residents to ensure that they had sufficient food and drink. Resident’s generally spoke well of the food offered by the home, and those that were able confirmed that they were offered choice. See comments under standard eight relating to nutrition records. A member of staff confirmed that only a few residents have supper and that the remainder go to bed early. If residents do not have a later supper then the gap between food being offered to residents is too long. The large round dining table at the home does not provide sufficient dining space for the 25 residents that the home is registered to provide care for. It also does not Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 15 promote resident choice. A number of residents remained in lounge chairs throughout the inspection visit, eating from over bed style tables, or being assisted whilst in a slumped position in easy chairs. The home should evidence that this is in line with resident’s individual choices, as this practice will not help to promote individual health and mobility. These issues have been raised at previous inspections and not addressed. Alexander House Private Nursing Home DS0000040206.V295099.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. To keep residents safe, development is needed to make sure that all staff have a clear understanding of adult protection issues and procedures. The homes policy regarding this needs to be reviewed. EVIDENCE: The homes complaints process is on display for visitors and residents. No new complaints had been recorded since the previous inspection. From a previous inspection a requirement in respect of complaints had been made of the home. This related to the need for the home to demonstate that they investegated complaints in a thorough and consistent manner. As no complaints had been recorded as being received since this time, the requirement then made has been carried forward. The person in charge confirmed that she had recently undertaken training in adult protection. In spite of this, an initial explanation of the process to be followed indicated that any incident would be investigated by the home. It was only after further discussion that it was stated that all incidents would be reported to social services to investigate. The homes policy in this matter was similarly confusing, saying in one place about investigating any incidents and in another about reporting to social services. To ensure that residents are kept save the policy and staff practice need to be reviewed. Following the inspection the managing director for Health and Home wrote and challenged the CSCI view regarding reporting POVA incidents to Social Services. Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 17 Alexander House Private Nursing Home DS0000040206.V295099.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The standard of the environment and furnishings is generally poor and does not provide residents with a well maintained, attractive and homely place in which to live. EVIDENCE: Alexander House has conditions on their registration that the premises and facilities must be brought up to current National Minimum standards by 2007. Work to achieve has begun in a small way and some bedrooms have started to be refurbished. As stated earlier the current environment is very poor and does not support a valuing people ethos. At this visit it was of concern that items were being stored on and around the external fire escape. Items included a saw, plasterboard, building materials and unused equipment. On the bottom flight of steps a large piece of wood was sticking through the treads. This was removed by the person in charge. In one area of the fire escape tiles were noted to be cracked/loose presenting a potential hazard. Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 19 The home has two lounge areas and a small dining area. Décor and furnishings in communal areas are in poor condition. The carpet in the main lounge area is very stained. As previously pointed out the layout of furniture in the main lounge does not encourage communication or companionship between residents. The home has a pleasant garden that is marred by the storage of some unused items and materials. Feedback from relative also indicated some dissatisfaction with the poor condition of some aspects of the environment. The home currently has insufficient and suitable toilet and bathing facilities to meet the needs of residents. On the ground floor two toilets are used for storage. Only one assisted bath is provided. The home has a condition on their registration that sufficient and suitable toilet and bathing facilities be provided by 2007. Two sluices are provided, neither of these have suitable hand washing facilities provided. On the first floor one toilet had an unsafe seat. Hoists are available to assist residents. Although pressure relieving equipment was noted to be available residents care plans did not indicate what equipment was to be used for individual residents, how this had been assessed or how the equipment was to be used. Corridor areas of the home are very narrow and sloping. They would be difficult for residents to independently negotiate in a wheelchair. Toilets at the home are out of commission as they are being used for storage. Storage remains insufficient and some remaining toilets, bathrooms and sluices are cluttered with other equipment. A number of wheeled commode chairs were stored in these areas and noted to be in a poor condition. Alexander house is registered to provide care for residents who have dementia. In spite of previous advice about this, limited appropriate signage is provided to assist these residents with orientation. In relation to dementia a number of hazards were noted around the home. Latex gloves had been discarded in open bins in toilet/shower areas. Items such as steredent and mouthwash were available in a resident’s bedroom. The home has a call bell system in place but during the morning residents in bed were noted to have no access to their call bell and no means of summoning assistance. In common with the communal areas of the home, resident’s bedrooms are generally shabby. Furnishings and décor are in a poor condition. One room is particular was not deemed ‘fit for purpose’. The person in charge was advised to ensure that alternative accommodation is offered to the service user/their family. The room was very small and the resident has high dependency needs that requires the use of a hoist. This places both the resident and staff at risk of injury. One wall of the room showed water egress or damp. The covering of the two armchairs in the room was torn. Furnishings were extremely shabby. Rooms are not fitted with locks and lockable storage is not available. It was noted that the registered provider asks residents/their relatives to sign a sheet on admission to say that they do not wish for these facilities to be provided. Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 20 This is not satisfactory, and residents should have the option of these facilities as indicated by the National Minimum Standards. This has been pointed out at previous inspections. Where rooms are being refurbished this is sometimes being done whilst occupied by residents. Light fittings above beds are not properly fixed and wires are showing. Radiator covers are unfinished and a potential hazard to residents. In one room a new sink had been fitted but this was chipped. The fanlight window in this occupied room was also broken and a potential hazard if used by the resident. Bedding in all rooms, where this was looked at, was in a very poor condition. Residents were laying on mattress covers instead of a proper bottom sheet. Sheets were extremely thin and worn. Pillows and duvets were also in some instances in poor condition. Where headboards were in place these were sometimes in a stained condition. Some chest of draws or bed side tables had handles missing and could not be opened by residents. Water temperatures were tested randomly around the home. In most instances the water flow was poor, the taps difficult to use and the water only came out at a tepid temperature. A relative commented on the small size of the sinks provided and the difficulty in using the push taps. One room however discharged water at a high temperature. To keep residents safe water temperatures are regularly monitored by the home. It was noted that one sink was recorded to discharge water at a much higher temperature than recommended. There was no evidence that any remedial actions had been taken to address this. When the home is refurbished it should be ensured that the water taps in private and communal accommodation are suitable for residents to use with ease, as the current design of push taps is not suitable. The home was generally warm and well ventilated. On the day of inspection the home was generally odour free. The home has suitable laundry facilities available. A number of infection control issues were identified during the inspection. The homes sluices have no hand washing facilities. Bins in the laundry, kitchen and some toilet/shower areas had no lids. Staff at the home felt that the premises were now kept much cleaner and that proper cleaning schedules were in place. This was borne to a degree out by observation. However because of the general state of poor décor and repair of the building improvements in cleanliness did not have a big impact. Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 21 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): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels at the home are not adequate to meet the holistic needs of residents. EVIDENCE: On the day of inspection the home was accommodating 17 (18 following an admission) residents. When the inspectors arrived at the home there were only two care staff on duty and the registered nurse. Another member of staff came on duty at 09.00. On viewing the staff rota it was seen that this is the normal pattern. Again after 17.00, there are only two care staff and a nurse on duty to meet the needs of residents. Dependency levels at the home are high. In discussion with staff it was established that eight residents require two staff at all times to deliver personal care. Four residents remain in their rooms at all times. A high number of residents at the home have dementia. The number of staff on duty, their experience and skill mix did not meet the needs of these residents. Residents were left either isolated or unsupervised for unacceptable periods of time. Interaction and rapport with residents was not always adequate. Residents reported that there is not enough staff on duty. When they ring for attention, help is often not forthcoming. One resident said that this had in the past led to their being incontinent. Staff are employed to cover the kitchen, and domestic staff are provided. Apart from one day, domestic cover is only provided in the morning. No laundry cover is provided so this is an additional task that care staff must carry Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 22 out. Although the level of hours worked by staff appears to have reduced, most staff only have one day off a week. Staff spoken with felt that there was now more flexibility in this and, if they requested it, they could now have an extra day off. The person in charge confirmed that no staff at the home have started or completed and NVQ in care. Four staff files were viewed to see if recruitment practices protect residents. One member of staffs file was not available and had to be collected from another home. This was because the member of staff works on both sites. Two staff had CRB checks in place that were dated after their start date at the home. No POVA first check had been completed. For another member of staff, two references had been identified on the application form. One was a friend and the other a co-worker. Only one of these and a ‘to whom it may concern’ testimonial was in place. These practices are not in line with current guidance and have the potential to place residents at risk. There was evidence to show that staff receive an adequate level of training. A file viewed had a ‘First day induction’ sheet in place. Another document identified that that a big range of topics including principles of care, the organisation and role of the worker, safety at work (moving and handling, health and safety, fire, emergency aid, safe food handling and infection control) and other items had been covered in one day. The person in charge explained that the knowledge for these topics was acquired over time and the date stated represented when staffs competence had been tested and evidenced. Because of this it was not possible to judge if staff received essential training such as moving and handling at the very start of their employment. The home need to show that induction processes are to skills for care standards, and that staff are fully equipped to meet residents needs. Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 23 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): 31, 32, 33, 35, 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has had no stable management structure in place for some time. Development is needed to establish effective quality assurance systems. Health and safety issues identified in this report have the potential to place residents at risk and must be addressed. EVIDENCE: In spite of pressure from CSCI, Alexander House has been without a registered manager, or stable, long lasting management arrangements in place for nearly three years. Currently no acting manager is in post. This situation has called the fitness of the registered provider into question. At the moment a senior member of staff from another home attends Alexander House for three hours on four days a week. It is proposed that she may apply to be the registered manager at some point in the future. It was reported that the managing Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 24 director/company secretary also ‘helps out a lot’. This lack of consistent management does not provide residents with a secure and consistent environment. As a Limited Company Health and Home are required to appoint a ‘Responsible Individual’ (RI) to carry out monthly monitoring visits to the homes. (see below) The Company is currently without an RI. Although a named individual has been proposed, no confirmation of this has been received. Systems for consultation with relevant residents and other parties and quality assurance have not yet been developed by the home. At the previous inspection it was reported that questionnaires had been developed and that these would be distributed before Christmas. The person in charge at the time of the inspection was clear that no work towards establishing a robust quality assurance system had yet been carried out. The delay in setting up these processes is no longer acceptable. The registered provider is required (by The Care Homes Regulations) to nominate a person (the RI) to carry out monthly visits to the home. These visits should include talking to residents and staff to seek their views on the service. These have been received on a regular basis. Sometimes they are quite brief and do not evidence genuine consultation with residents and their families. The person in charge said that the registered provider has gained accreditation under the Investors in People Scheme. Policies and procedures at the home are dated January 2004 with a review date of January 2005. These have clearly not been reviewed. On the day of inspection the home was only holding monies for one resident. An adequate record was kept, and receipts for purchases were attached to the record. As stated in the ‘brief description’ at the front of this report there was some discrepancy about the charging policy and level of fees charged by the home. The person in charge was able to demonstrate that systems are being put in place in relation to the supervision of staff. However no actual supervisions have taken place as yet. The home employers liability certificate was noted to have expired in January 2006. It was requested that a copy of the up to date certificate be sent in to CSCI. This was subsequently received. During this inspection a number of health and safety issues were identified. The home is registered to provide care for residents with dementia yet disposable gloves and other potentially hazardous materials were noted to be left in open bins. Potentially hazardous items were available in the homes office area such as sharps and scissors. The office is often left unattended and open. Residents have free access to this area. Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 25 Staff records viewed indicated that training in core areas was adequate and up to date. Staff spoken with said that they had undertaken relevant training. Fire and testing records were viewed. These were satisfactory but there were only two entries under ‘fire prevention training’: 20/02/05 and 28/01/06. On this occasion only 5 staff names were identified as attending, and some of these have now left. All staff should attend regular fire drills and training. This must be addressed so that residents can be confident that staff will react appropriately in the event of an emergency. Following advice from the fire department, a fire risk assessment has been produced for the home. Some current servicing/safety certification for systems and equipment at the home could not be found/provided. It was requested that these be sent in to CSCI to show that a safe environment is being maintained for resident’s. This was received, the work having been undertaken by a member of staff retained by the company. The registered provider stated that they were fully competent to carry out this task. Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 26 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 2 X 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 X 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 1 1 1 2 1 2 1 STAFFING Standard No Score 27 1 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 3 1 2 2 Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 Requirement The registered person(s) must not offer accommodation to a service user unless their needs have been fully assessed by a person competent to do so, and the home can meet their assessed needs. This refers to the fact that there was no evidence of staff training in learning disability prior to admission. Staff at the home must receive training appropriate to the work they are to perform. This refers to the need for staff to have specific training and knowledge relevant to residents assessed needs and conditions. Previous requirement date of 01/08/05 and 11/04/06 not met. 3. OP7 15 A detailed service user plan of care must be drawn up in consultation with service users, families and significant multidisciplinary personnel. The care plan must reflect all aspects of service users assessed needs, DS0000040206.V295099.R01.S.doc Timescale for action 01/07/06 2. OP4 18 01/08/06 01/07/06 Alexander House Private Nursing Home Version 5.2 Page 28 include risk assessments for appropriate areas. This refers to the shortfalls identified at inspection. Care plans must be put in place in a timely fashion. Previous requirement dates of 01/07/05 and 11/04/06 not met. 4. OP8 17(2) Schedule 4 12(a) 13(5) The registered person(s) must ensure that an adequate nutrition record is maintained. The registered person(s) must ensure the health and welfare of residents. tissue viability assessment and appropriate health and safety management of care needs. Medication, including prescribed creams must be safely stored. Previous requirement of 11/04/06 not met. The registered person must ensure that risk assessments are completed for all residents who self medicate. From pharmacy inspection. The register person must ensure that records of medicines prescribed and administered are accurate and up to date. From pharmacy inspection. The register person must ensure that facilities provided for the storage of medicines controlled under the Misuse of Drugs Act, 1971 are reserved solely for the storage of such drugs. From pharmacy inspection. The registered person must ensure that records of medicines controlled under the Misuse of DS0000040206.V295099.R01.S.doc 01/07/06 5. OP8 01/07/06 6. OP9 13(2) 01/07/06 7. OP9 13(2)17(1 a)Sch3(3i ) 01/07/06 8. OP9 13(2) 01/07/06 9. OP9 13(2) 01/07/06 10. OP9 13(2) 01/07/06 Alexander House Private Nursing Home Version 5.2 Page 29 Drugs Act, 1971 are made in accordance with the Act and associated Regulations. 11. OP9 13(2) From pharmacy inspection. The registered person must ensure that medicines that are no longer required are disposed of promptly and appropriately to a licensed waste disposal company. From pharmacy inspection. The registered Person must ensure that the routines of daily living and activities made available are flexible and varied to suit service user’s expectations, preferences and capacities. Activities and stimulation must be provided that meet individual assessed needs. Previous requirement dates of 14/01/05, 01/08/05 and 01/02/06 not met. 13. OP16 22 The registered person must establish an effective complaints procedure. This refers to the need for complaints to be dealt with consistently. This requirement was not fully assessed on this occasion, as no complaints had been received by the home. The requirement is therefore carried forward. 14. OP18 13 18 Staff should receive training appropriate to the work they are to undertake and residents must be protected from harm. This refers to the need for all staff to undertake sufficient training in adult protection, that they are fully aware of procedures to be DS0000040206.V295099.R01.S.doc 01/07/06 12. OP12 16 01/07/06 14/07/06 01/08/06 Alexander House Private Nursing Home Version 5.2 Page 30 followed. 15. OP19 23 A planned programme of maintenance and refurbishment must be developed for the home in order that systematic improvement of the environment takes place. Plans must be sent in to the CSCI as to how the home intends to meet their conditions of registration in relation to the home. No systematic or specific programme of works has been received (Previous requirement date of 01/02/05, 01/08/05 and 01/02/06 not met.) The registered person(s) must ensure that residents have suitable washing facilities. This refers to the sinks in resident’s bedrooms and the lack of adequate bathing and toilet facilities. 01/07/06 16. OP21 23 01/01/07 17. OP22 23 The premises must be suitable to 31/05/06 achieve the aims and objectives. The home is registered to provide care for residents with dementia. Adequate orientation and directional signage must be in place to assist these residents. Equipment used for residents must be properly assessed and maintained. Appropriate storage must be provided for equipment. Repeated again at this inspection. The premises must be suitable to 01/07/06 achieve the aims and objectives. The home must provide accommodation for each service user, which is furnished and equipped to assure comfort and DS0000040206.V295099.R01.S.doc Version 5.2 Page 31 18. OP24 23 Alexander House Private Nursing Home privacy, and meets the assessed needs of the service user. This refers to the many issues identified in the body of the report. Previous requirement dates of 01/05/05,01/12/05 and 01/05/06 not met. 19. OP26 13 The registered person(s) must make arrangements to prevent the spread of infection at the home. Hand washing facilities with hot water must be available in areas where infected material and or clinical waste are handled. This with particular reference to both the homes sluices and some communal toilet areas. Previous requirement dates of 01/02/05, 01/08/05 and 14/02/06 not met. 20. OP27 18 The registered person(s) must ensure that at all times suitably qualified and competent staff are on duty in sufficient numbers as are appropriate to meet the health and welfare needs of service users. Staffing ratios must ensure that the number of staff employed and on shift is sufficient to meet the assessed needs of service users in the home. This is a repeated requirement. The last compliance date of 11/04/06 not met. 21. OP29 19 The registered person(s) must ensure that robust recruitment procedures are maintained to protect residents. 01/07/06 01/07/06 01/08/06 Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 32 22. OP30 18 The registered person(s) must 01/08/06 ensure that there is a robust staff induction, training and development programme, which ensures staff fulfil the aims of the home and meet the changing needs of service users. Suitable systems to record this information should be developed. Although it is recognised that progress has been made further work is required to prevent ambiguity of information. Previous requirement dates of 01/02/05, 01/07/05, 01/01/06 and 11/02/06 not met 23. OP31 8&9 The registered person(s) must 01/09/06 appoint a person to manage the home with sufficient care, competence and skill to meet the needs and welfare of the residents. The registered person(s) must establish and maintain a system of reviewing and improving the quality of care at the home. Reports of findings must be sent in to CSCI. Previous requirement of 01/03/06 not met The registered person(s) must ensure that staff at the home receive regular formal and documented supervision to support them in the work they carry out. Previous requirement dates of 01/02/05, 01/07/05 and 01/01/06 not met 01/09/06 24. OP32 24 25. OP36 18 01/07/06 26. OP38 12, 23 The registered person(s) must ensure that the home is run in a way that promotes the health DS0000040206.V295099.R01.S.doc 01/07/06 Alexander House Private Nursing Home Version 5.2 Page 33 and welfare of residents. This refers to the issues raised in the body of the report and includes the need to evidence that staff are adequately trained in fire procedures and have taken part in drills. 27. OP38 12 The registered person(s) must 01/07/06 ensure that the home is run safely for the protection of service users. This refers to issues noted in the body of the report and includes issues relating to the homes office area. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations Potential service users should be given comprehensive written information about the home in a format that they can understand to assist them in making a decision about care. The home should assist residents and other parties in understanding and using the homes complaint procedure, by making sure that it is displayed in a clear manner. A photograph of each resident should be available with their MAR sheet. A blood pressure monitoring cuff(s) capable of meeting the needs of all residents should be provided. 2. OP16 3. 4. OP9 OP8 Alexander House Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Private Nursing Home DS0000040206.V295099.R01.S.doc Version 5.2 Page 35 - 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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