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Inspection on 06/02/07 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 6th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

What has improved since the last inspection?

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Alexander House Private Nursing Home 25-27 First Avenue Westcliff On Sea Essex SS0 8HS Lead Inspector Tim Thornton-Jones Key Unannounced Inspection 6th February 2007 09:30 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.V333680.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.V333680.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 F/P 01702 339635 Health and Home Limited Mrs Edith Kasonde 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 (3), Old age, not falling within any other category (25) Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To provide care (with nursing) and accommodation for three service users who are under 65 years of age and whose details are known to the Commission. Persons of either sex, aged 65 years and over, who require nursing care by reason of old age only (not to exceed 25 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 12 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a mental disorder (not to exceed 2 persons) One person over the age of 65 years who has a mental disorder and whose details were made known to the Commission in August 2006 The total number of service users accommodated in the home must not exceed 25 persons 22nd May 2006 2. 3. 4. 5. 6. Date of last inspection 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. 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. Current fees for the home were quoted as being a flat rate of £551.25 per week plus any Registered Nursing Contribution. The weekly fee may vary in accordance with the individual assessed needs. We were advised that there are no extra charges and that chiropody, toiletries, newspapers etc. The registered person has advised that the service currently waives the right to charge for additional goods and services. Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection indicates that significant improvement has taken place since the previous inspection. The area of most need remains the premises, in terms of the presentation of the environment and recommendations have been made regarding this. Staff are well trained for the most part and go about their tasks in a supportive and committed way. Questionnaires sent to relatives and stakeholders prior to the inspection, when returned, indicated that most were satisfied with the outcome of the service and included some positive comments. These included the friendliness of staff and acknowledgement of the improvements over the preceding months. Some questionnaires commented upon the décor and furnishing needing improvement. The care management of the home in terms of assessment and care plans were sound and complied with National Minimum Standards. On this occasion the same number of National Minimum Standards were assessed as at the previous inspection. The outcome indicates that all standards inspected have improved from compliance of 15 to 67 . Of those standards considered as ‘Key’ requirements, compliance improved from 20 to 63 . This is a positive achievement. What the service does well: What has improved since the last inspection? • This inspection highlighted that some considerable improvement to care delivery has taken place. Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 6 • All outcome groups within the range of National Minimum Standards have improved. 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.V333680.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.V333680.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good based upon sampled inspected standards 1, 3,4 and 5. This judgement has been made using available evidence including a visit to this service. • • • Service users benefit from the homes documentation and information. Service users benefit from the approach to pre-admission assessment and initial care planning. Service users benefit from the home’s capacity to meet the needs of individuals admitted to the home. EVIDENCE: The Statement of Purpose and service users guide documents where sampled were in accordance with regulatory requirements. Service users guides were stated to have been given to relatives where service users lacked mental capacity. Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 9 The service user admission procedures were discussed with the manager who explained that an admission assessment was undertaken prior to a person being admitted. Three service users’ care files were inspected. All three were found to have a comprehensive assessment in place that included all elements of need and that had been completed within the required timescale. Copies of care management assessments were being held on file in relation to the sample selected. All care files included a satisfactory plan of care that had been developed from the pre-admission assessment. Based upon the sample, the home was able to demonstrate suitable capacity to meet the needs of service users. The National Minimum Standard associated with the provision of intermediate care was not considered on this occasion, as the home does not provide for this type of care approach Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good based upon sample of standards 7 to 11 inclusive. This judgement has been made using available evidence including a visit to this service. • • • • Service users mainly benefit from the service arrangements for assessment, and healthcare. The medicine arrangements are compliant. Service users also benefit from the service arrangements for privacy and dignity. Service users benefit from service users plan of care generated from comprehensive assessment. Service users benefit from the homes practice regarding privacy and dignity. EVIDENCE: Three care files were inspected as a sample. Each file contained a care plan that included all of the key physical and social needs, providing good detail of the actions and support required by staff. Records indicated that plans were Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 11 regularly reviewed on a monthly basis. Service users and/or their representatives (usually their close relative) agreement to the care plan was confirmed by their signature. Risk assessments for important areas such as moving and handling/mobility, pressure area care, continence and nutritional needs together with falls frequency were recorded in the files sampled and had been regularly reviewed. Daily ongoing records were detailed and were able to evidence good monitoring of care needs with appropriate action having been taken where required. Three General Practitioner (GP) surgery’s support the home and attend as appropriate on request. The records examined confirmed that regular attendance by GPs, district nurses and practice nurses were evident. One resident had been supported to attend the surgery for their planned appointments and another attended their hospital out-patient appointments. Advice had been obtained, as required, by the home from a Clinical Nurse Specialist for Tissue Viability. Discussion with the manager confirmed that she was suitably aware of current research in the use of barrier creams for protection of skin for service users who receive continence care and had ensured that the appropriate product had been used. One resident told an inspector that a Community Psychiatric Nurse (CPN) regularly attended the home to accompany the person out of the home to visit the local community, including the library and that they enjoyed these outings. The records indicated that regular chiropody treatment had been provided for service users and that referrals had been made for service users to see a physiotherapist and occupational therapist. Annual eyesight tests were evidently carried out at the home by a visiting optician and service users received dental care as and when needed. Service users nutritional needs were being assessed at the point of admission and service users’ preferences discussed with them at that time. Resident’s body weight measurements were being taken monthly and closely monitored and where necessary, action taken to include appropriate food supplements as needed. The records of two service users who had previously lost an undue amount of weight confirmed that carers had taken action by providing supplements and consequently the weight of both service users had increased steadily to a more appropriate and healthier level. Pressure relieving mattresses and cushions were available to meet service users assessed needs needs. Where a risk of falling out of bed had been Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 12 assessed and identified, no bedrails had been fitted. Instead, the preferred solution to minimise the risk of injury was to provide additional mattresses on the floor by the side of beds in the event of a fall. A number of matresses were observed to be located against the bedroom wall behind service users’ beds rather than in a designated store, which might have been more appropriate. The Registered Person advised inspectors that matresses located within bedrooms are maintained an available for use as and when required following assessment. At the time of the inspection visit no service users were seen that are being supported due to presenting end of life care and support. The home does have policy and practice procedures relating to end of life issues and the underpinning structure of care were found to adequately support service users in this position as and when required. One resident’s review undertaken by the tisue viability nurse detailed the reason for not providing bedrails was that staff had not received training in their use, although this had been offered by the local PCT. It is important that key staff receive training in this area to improve the level of underpinning practice, particularly at the point of assessment. The Registered Person considered that the level of training for staff is adequate and that that suitable training materials are available at the home. The home had two hoists and three slings available for use and one handling belt. This is not considered sufficient for the number (thirteen) of service users who needed to use this equipment, however, the manager confirmed that an order had been placed for several more slings. More handling belts were also needed to enable them to be regularly laundered.. A review of all moving and handling equipment should be made to ensure service users needs are safely and appropriately met. Medication was stored in the main office within a lockable trolley that was secured to the wall, as required, when not in use. A separate medicines refrigerator had been provided since the previous inspection, and was now stored next to the trolley for ease of access. Systems were in operation for the monitoring of daily temperatures and records examined indicated temperatures of 25 to 25.8° Centigrade were being maintained, which is marginally above the recommended levels of 25°Centigrade. The manager stated that two fans were utilised in hot weather to reduce temperatures. A local Pharmacy supplies medicines in a monitored dosage type system and were checked by designated registered nurses against service users’ prescriptions. The home had arranged a contract with a licensed contractor for the disposal of medication since the previous inspection, which is an improvement. Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 13 Medicine stock levels were at an acceptable level. Separate storage was provided for controlled drugs but there were no controlled drugs in use at the time of this visit. Records made since the previous inspection now confirm that the full name and address of the supplier was recorded in the dedicated register. Medicines administration records were well recorded and there was a photograph of each resident held with individual Medicine Administration Record (MAR) sheet reflecting sound practice. Registered nurses administered all medication, a list of their signatures and initials being maintained to enable audit checking. Systems were also in place to ensure NMC Pin numbers were recorded and checked to ensure they were current. There had, however, been no recent updated training provided for those staff and those spoken with were not clear on the reason for some medication being given, or the possible side effects. Manufacturers medication information was however provided for individual medicines in accordance with good practice. The records seen confirmed that medication reviews had been undertaken by the service users’ GP at six monthly intervals as prompted by the manager or more frequently if needed. One resident was self-medicating and a risk assessment had been undertaken and lockable facilities provided for safe storage of medicines. Some prescribed creams (topical treatments) were held in service users’ rooms, administered by care staff, but signed on the MAR sheet by registered nurses. Advice was given to ensure that the person administering the creams is also the person who signs confirmation. This is based upon practice supported by a Pharmacy Inspector and within current Pharmaceutical guidance for care homes. This matter was subsequently discussed with the Registered Person who stated that it was the service normal practice to restrict the application of topical treatments by carers to that of ‘barrier’ creams. Whilst all staff had received training in the administration of prescribed medicines, a more comprehensively trained and experienced person would administer any other topical treatments for medicines that contain, for example, steroid or anti-biotic. The homes policy and practice documents have subsequent to the inspection visit been updated to reflect this. The service user and stakeholder questionnaires reviewed prior to this inspection visit indicated that a small proportion of relatives had some concern regarding service users clothes going missing following laundering and this will need to be addressed as part of the home quality assurance scheme. The overall approach of the staff within the home, supported by the documentation and policy and procedures, reflect positively in the way service users are treated. Staff were observed to communicate in a polite and friendly manner. Whilst none of the staff employed have English as their first Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 14 language, it was evident that each one took care in communicating with service users in addition to each other. It was noted that care staff are mindful of the challenges and issues associated with problematic communication and this enables a greater understanding of diversity issues within the home and the overall communication needs of service users. Relatives questionnaires received prior to this inspection indicated that some relatives have some concerns regarding communication issues between staff and between staff and service users. This would indicate a need for the home to consider quality assurance matters in this area. Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 15 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 on the basis of sampled standards 12 to 15 inclusive. This judgement has been made using available evidence including a visit to this service. • • • • Service users do not yet fully benefit from the home arrangements for social and leisure support. Service users benefit from maintaining contact with family and friends and the local community. Service users benefit from a flexible approach to the routines of daily living. Service users benefit from the home catering services. EVIDENCE: The routines of daily living and activities are flexible and designed to be as responsive as possible to service users who may present as unpredictable and changeable in their motivation and concentration. The Manager currently allocates a member of care staff to lead on social activities although this falls short of a pre-determined and structured range of opportunities. The inspection concluded that staff who are delegated this specific task of coAlexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 16 ordinating social activities should receive some suitable training or coaching that would enable a more informed and suitable activities. It was evident that some materials were available to engage service users in activities and carers do offer, as and when possible, impromptu activities for very short periods. For most, this approach is beneficial, however, this remains rather ad-hoc and is less able to ensure appropriate equality and to take full account of the diverse social needs of service users. It is recommended that some suitable assessment is undertaken, linked to quality assurance, with a view to identifying the range of social and leisure interests service users have. This information should then influence the deployment of staff, their training and development, and the overall strategy the service regarding social and leisure. The Registered Person has amended the service Statement of Purpose to make clear that social activities undertaken externally from the home and which is supported by care staff will be subject to individual contractual terms and conditions. Some of the Questionnaires received by relatives also commented upon their perception that social activities could be improved. The arrangements for relatives and friends to visit were detailed in the service statement of purpose document. This indicated that visiting was open access. Service users were supported in choosing the time of getting up in the morning and one resident said they could go to bed later in the evening, as they preferred. Two service users spoken with said that staff asked them what they would like to wear when they got dressed. The records confirmed that care staff had discussed the personal care needs of one resident, including their preferred time of getting up with their relative as the resident was unable to communicate their needs and choices. This is reflective of good practice. The kitchen was small but well organised. Food stocks were plentiful and included a good choice of fresh vegetables and fruit, which were appropriately stored. The lunch -time meal of roast chicken, boiled potatoes, carrots, greens beans and gravy was nutritious and appeared appealing and well presented. The meal was pureed for service users who require this and where evident, was served attractively in separate portions. Service users were provided with drinks during the meal and one had a glass of wine as a personal choice. One service user said the meal was very tasty and another said the food was always good. Carers were observed to appropriately assist those people who needed assistance with their meal. Care staff assisted several service users who have swallowing problems resulting from medical conditions. This was indicated in Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 17 their individual nutritional care plan and arrangements had been made for meals to be thickened. As detailed under National Minimum Standard 8, nutritional needs were assessed, weights monitored and appropriate action taken to ensure those at risk received supplements as needed Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 18 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 the sampled standards 16 and 18. This judgement has been made using available evidence including a visit to this service. • • Service users benefit from the homes arrangements to train staff in safeguarding adults and the policy and procedural arrangements. The home has an adequate complaint procedure and care staff are aware of the underpinning principles that promote the need for a robust complaint approach. EVIDENCE: Information received from service users families resulting from questionnaires indicated that previously expressed complaints had been dealt with in a satisfactory manner. One questionnaire stated; “one complaint was dealt with immediately and we were very satisfied with the outcome”. Two other questionnaires indicated that relatives were unaware of the home procedure for making complaints. The registered person stated that a summary of the complaint procedures are provided with documentation at the point of admission and often relatives mislay or forget they have received them. The service does have a suitable procedure in place for dealing with complaints and this is summarised within the service users guide. In discussion with both Managers and carers all were keen to ensure that any concerns and complaints are attended to at source although understood the Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 19 need for the home to respond to complaints appropriately as part of the home quality assurance approach. The service has an adult protection procedure and maintains a copy of the safeguarding adults policy and procedure produced by Southend-on-Sea Unitary Council. As part of this inspection a number of care staff were spoken with, subjects included practice issues associated with safeguarding adults and whistle blowing. All were able to demonstrate a clear understanding of the practice and principles that underpin anti-abusive practice and all acknowledged that the home had a policy and procedure in relation to this and was aware of how to access it. A good proportion of carers (about 75 based upon the homes records) have undertaken safeguarding adults training during the preceding 12 month period, which is positive. Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 20 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 for standards 19 to 26 inclusive. This judgement has been made using available evidence including a visit to this service. • • • • • • Service users do not fully benefit from the layout of the home, although the location is satisfactory being among properties of similar size, construction and age. Service users mainly benefit from the facilities, which have been maintained since the service was transferred to this authority, although plans are in hand to make further improvements. Service users benefit from the homes toilet and bathing facilities as a pre-existing service. Service users benefit from the accommodation although the environment would benefit from some improvement to décor. Service users do not fully benefit from prevention from presenting risks such as exposed hot water pipes and electrical outlets. Service users do not fully benefit from the whole of the environment being clean and free from offensive odours. EVIDENCE: Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 21 The home has two lounge areas and a small dining area. The décor within these areas would benefit from some improvement. Staff spoken with who expressed a view commented that the communal areas would seem more homely if there were perhaps more pictures and other attractive features. The shape of the sitting room, being a long rectangular shape, appears to limit the options available to situate chairs into social groups and may consequently restrict communication. The dining area is small for the number of persons accommodated and has one large circular table. Other small individual tables are available for service users to eat meals within the sitting room area, which is not ideal. This overall arrangement does not meet with revised National Minimum Standard; however, the accommodation currently available is similar to that being maintained at the time the homes registration was transferred to the CSCI. It is recommended that this arrangement be reviewed to identify ways in which service users could have increased options for taking of meals. The Registered Person stated that progressive steps to review and improve the situation as part of a phased plan of building improvement and refurbishment is being made. Furnishings in communal areas are serviceable, although as part of an overall review, some items will need replacement in due course. Water temperatures were tested at random and were found to be satisfactory. All of the washbasins tested, with the exception of one, had water temperature restrictors fitted. Mr Stavrinides advised us that the room in which the washbasin was located was due for refurbishment and the restrictor would be fitted as part of the work. The room was not occupied. Seven of the bedrooms have been refurbished and a further room was in the process of improvement with the remainder to be improved as the rooms become vacant. One bedroom was noted to have an electrical circuit breaker unit located a low level (just above the skirting board). This appeared to have been in situ for some time and we considered this to be a potential hazard to any service user occupying this room as it could easily be tampered with, although at the time of inspection the room was not occupied. Mr Stavrinides advised us that the fitting would be re-located to an alternative site prior to the room being used by service users. One bedroom was noted to have some exposed hot water pipes located under the hand washbasin, which could present as a potential scald risk to a service user. We were advised by Mr Stavrinides that this would be made safe as a priority. Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 22 The overall refurbishment of the premises were discussed at length with Mr Stavrinides who was able to describe the immediate and medium term plans for the improvements to the building. At the time of this inspection it was evident that contractors were around the premises undertaking a variety of improvement works. The plans include some considerable works internally that are intended to improve the width of some corridors and enable rooms to be more accessible and welcoming. Along with these works will inevitably be improvements to décor, which in the opinion of inspectors is needed and would provide a more pleasant environment for service users, visitors and staff. The home accommodates persons with cognitive and other mental frailties resulting from illness such as dementia. The registered person is strongly recommended to undertake consultation with specialist organisations that are able to advise on what improvements are likely to enhance service users understanding of their environment. The minimum space requirements in rooms within the home are unchanged since the homes registration was transferred to this authority and therefore comply as a ‘pre-existing’ service. Based upon the rooms visited on this occasion, all were observed to meet the minimum requirements set out in National Minimum Standards and where departures from this standard were evident, the reasons were adequately accounted for, for example, the room was not occupied or was undergoing refurbishment. Public liability insurance was being displayed. The premises were generally clean with no unpleasant odours with the exception of one room. From discussion with the manager it was evident that advice had been sought regarding the continence management needs of the service users although an ongoing solution had not yet been identified. Some attention was needed to ensure that dust was removed during vacuuming from the edges of carpets and baths and showers were properly de-scaled. Some equipment was noticed to have not been adequately cleaned following use. Appropriate staff hand washing facilities i.e. liquid soap and paper towels were provided throughout the building to reduce the risk of cross infection. Several items of equipment were observed to have been stored on the floor of bathrooms and en-suites. This was considered to pose an infection risk. The home did have infection control policies and procedures that included advice on MRSA, HIV, hand washing, and clinical waste handling and managing spillages but these did require updating. There was apparently no recent external guidance available and advice was therefore given to obtain a copy of “Infection Control Guidance for Care Homes” published by the Department of Health and to update policies and procedures as recommended. The home had a designated care assistant who had lead responsibility for infection control who provided regular training for staff by the use of a video, which is positive. Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 23 The manager was advised to contact a Clinical Nurse Specialist for infection control to further enhance the homes access to training. The laundry was rather small and appeared muddled. There was a large sink but no separate sink for hand washing. There were two washing machines in use, one with a hot cycle for disinfecting and two driers, one not in use. Several boxes for sorting residents’ personal items of clothing were stored on shelving. The bed linen and towels seen were well laundered. The room was also used for storage of mops and buckets used for cleaning and was considered to be inappropriate. Advice was given to ensure they were stored with their head up after use to ensure they dried efficiently. The home had a mechanical sluice stored in a small adjacent room used also for storage of equipment. There was no racking for the safe storage of bedpans, urinals etc and equipment i.e. sharps bins were stored on top of the sluice, indicating the sluice was not in day to day use. Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 24 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 for standards 27 to 30 inclusive.. This judgement has been made using available evidence including a visit to this service. • • • • Service users do benefit from support from staff, although it is unclear whether the level of staff is appropriate in terms of assessed needs. Service users benefit from staff who have been trained and show appropriate skills. Service users benefit from the homes recruitment practice. Service users benefit from the homes training and development approach, although induction training remains in need of being transferred to the Skills for Care 12 week induction programme. EVIDENCE: A case tracking approach was used on this occasion involving a sampling technique in relation to four staff. These were selected on the basis of a variance of experience and length of time employed. In addition to speaking with and interviewing as many staff as possible and observing their practice, the home practice, such as the way they were recruited, trained and supervised/supported in their work were also considered. The level of deployment of care staff and nurses were reviewed by considering the staff deployment roster. At the time of inspection three staff were Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 25 deployed throughout the main part of the waking day plus catering and supervisory staff. The ratio of care staff to service users must be determined according to the assessed need of service users. The service goes about this by taking into consideration service user reviews, shift reports, quality outcomes assessment and feedback from service users and staff. At the time of the inspection the service was unable to produce a demonstrable methodology, other than verbal explanation with supporting documents such as care plans, staff rosters, assessments etc, about how the process can be audited or replicated independently or verified as appropriate. We discussed this matter at some length with the responsible individual who presented various criteria for determining staffing ratios, the main point being, and acknowledged, that the number of staff in attendance does not necessarily equate to satisfactory levels of support for service users but must be adequate to meet presenting needs. The present position, however, is not able to clearly show how the organisation achieves this. The pre-inspection questionnaires sent to stakeholders noted relatively few comments regarding concerns about numbers of staff, although one staff member did comment that an increase in carers would benefit service users on the basis that more time would be available to provide social and emotional support and stimulation. To support this view it was noted that care staff are required, as part of their daily role, to undertake tasks that are not directly personal care related. These include tasks of cleaning, laundry and organising activities, for example. Presently, there is no available analysis of how these tasks, or time spent undertaking them, impact upon other care related roles that staff undertake or how these have been prioritised, other than using the informal methodology associated with staff deployment by the registered person as previously described. The Registered Person subsequently confirmed that care staff do not undertake cleaning duties as part of their allocated care hours, although this was not clear at the time of inspecting staff rosters. On the day of inspection there were no obvious or presenting signs that staff levels were having a negative impact on service user care, however, it is strongly recommended that the Registered Person present the ratio methodology in a manner that clearly shows the applied strategy and outcomes. It is further recommended that this approach be linked to the organisational quality assurance system. Subsequent to the inspection the registered person agreed to develop a tool that indicates how the service achieves appropriate staffing levels and skill mix. The files for the sample staff group were reviewed and all recruitment practice was in accordance with regulatory requirements. This included references, and other checks. The individual files did not indicate that staff were receiving planned and systematic induction in accordance with ‘Skills for Care’ twelve week core training. The service is undertaking an induction style training and Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 26 development approach and this will need to be translated into the new 12 week core skills induction standards approach for care settings. The training records for staff were well organised and indicate a wide range of relevant core skills training is being provided reflective of the needs of service users. Staff do receive induction training although the content and skills outcome groups need to be transferred to the Skills for Care induction training work books issued to all carers. The four staff interviewed were committed and understood the core values and principles associated with sound professional practice. Based upon the sample taken, recruitment practices were reflective of regulatory requirements in terms of checks and references. All staff employed at the home are overseas workers, many of whom are professionally qualified in a variety of healthcare related qualifications. The detail of how these qualifications relate to National Vocational Qualifications was not available, although it is understood that some information regarding this has been sent to the CSCI previously by the home that indicates that staff who attain an appropriate nursing qualification overseas can be considered as having a qualification to at least NVQ level 2. It is important that each member of staff have available as part of their training file, confirmation of whether previous qualifications or accreditation of prior achievement is equivalent to the minimum qualification for carers (NVQ2). Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 27 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 adequate based upon sample standards 31, 32, 33, 36, 37 and 38. This judgement has been made using available evidence including a visit to this service. • • • • • Service users benefit from the home being managed by an experienced and qualified person. Service users benefit from the management approach of the home. Service users do not yet fully benefit from the home quality assurance system. Service users benefit from the home policies and practice procedures. Service users do not fully benefit from the home approach to health and safety matters. EVIDENCE: Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 28 A registered Manager is now in place who has the necessary skills, knowledge and experience required to manage the home. The management style underpins a clear sense of direction and leadership supported by a strong senior management group. The service is subject to a quality assurance strategy and at the time of the inspection visit questionnaires had been sent to relatives and other stakeholders. The results of the questionnaires had been analysed to form some indication of the strengths and needs of the service delivery, although no report had been formulated to describe the extent to which the care home provides good quality services for service users. A request for the Annual Quality Assurance Assessment (AQAA) will be made in due course and the data from this assessment will inform the next inspection outcome. The home has a current and appropriate insurance cover for the business. Business accounts including the service financial plan were not viewed on this occasion. There were no presenting factors that would indicate a lack of effective and efficient management of the business. The registered person advised that no cash held in safe custody on behalf of service users is being held. Additional expenses are invoiced to relatives by arrangement. A supervisory system is in operation although not all staff records sampled were shown to be receiving formal supervisory support in accordance with the frequency set out in National Minimum Standards. Staff are, however, supported on a daily basis. Staff spoken with stated that a good team spirit was in existence and that all felt supported by each other and supervisors. The home, overall, has improved since the previous inspection regarding safe working practices, although a reference in this report has been made to exposed hot water pipes and an electrical sub-circuit switch placed in a position that may potentially cause harm to service users. Tradesmen were working at the home at the time of the inspection visit to make environmental improvements. Safety checks including infection control, fire, emergency lighting system and storage/disposal of hazardous items were reviewed and found to be satisfactory. The service user care records were stored on open shelves in the main office. There were two doors providing access to the office that were observed left ajar, this potentially compromising the security of records stored. This was discussed with the proprietor who took prompt action to ensure a coded lock was fitted that morning. Activities records that included residents’ personal details were also stored in an unlocked cupboard, in the dining room. This should be reviewed to maintain appropriate confidentiality. Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 29 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 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 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 2 3 3 3 3 3 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X N/A 2 2 2 Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 30 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 OP26 Regulation 13 Timescale for action The potential risk associated with 31/07/07 the spread of infection at the home needs to be improved via adequate hand washing facilities with hot water always available in areas where infected material and or clinical waste are handled. This is with particular reference to both the homes sluices and some communal toilet areas to protect both staff and service users. Previous requirement dates of 01/02/05, 01/08/05, 14/02/06 and 01/08/06 not met. Persons working at the care 31/07/07 home who care for service users must be appropriately supervised on a regular basis to ensure they are clear about their role and have opportunity for professional development that formal supervision provides. This ensures continuity and reliable practice to support service users. Previous requirement dates Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 31 Requirement 2. OP36 18(2)(a) 3. OP33 24 of 01/02/05, 01/07/05, 01/01/06 and 1/7/06 not met. A system of reviewing and 31/07/07 improving the quality of care at the home must be maintained to specify quality objectives, identify strengths and weaknesses within the service delivery and to support a plan of improvement. Reports of improvement action plans must be sent to CSCI. Previous requirement 01/03/06 not met. of 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. Refer to Standard OP27 OP38 Good Practice Recommendations It is recommended to establish a method of calculating the care staff requirement based upon the assessment of service user needs. It is recommended to review moving and handling equipment to ensure adequacy of number and type of equipment. This is particularly relevant to a second handling belt. It is recommended to include updated training for carers in medicine administration and infection control. It is recommended to monitor rooms where a high risk of odour is probable. It is recommended to obtain a copy of the “Infection Control Guidance for Care Homes” published by the Department of Health June 2006 and review policies and procedures accordingly. It is recommended to improve the décor in communal areas and to enhance homeliness in these areas for the benefit of service users. It is recommended to consider an alternative seating layout in the lounge and dining room to enhance social DS0000040206.V333680.R01.S.doc Version 5.2 Page 32 3. 4. 5 OP30 OP26 OP26 6 7 OP19 OP19 Alexander House Private Nursing Home 8 9 10. OP37 OP22 OP27 communication. It is recommended to review the arrangements for access to records. This refers specifically to activity records located within the lounge area. It is recommended to seek advice and guidance to ensure that improvements and redecoration to the premises is sensitive to the needs of people with cognitive impairment. It is recommended to ensure that carers who undertake assessments for health and safety (bedrails or similar) receive appropriate training where required. Alexander House Private Nursing Home DS0000040206.V333680.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Colchester Local Office 1st Floor, 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.V333680.R01.S.doc Version 5.2 Page 34 - 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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