CARE HOMES FOR OLDER PEOPLE
Alexander Residential Home Victoria Road Morley Leeds West Yorkshire LS27 9JJ Lead Inspector
Sue Dunn Unannounced Inspection 1st May 2007 09:45 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 Residential Home DS0000001409.V335657.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 Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Alexander Residential Home Address Victoria Road Morley Leeds West Yorkshire LS27 9JJ 0113 253 2046 0113 2527732 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) Mr Peter Morris Mrs Margaret Morris Mrs Wendy Evered Care Home 32 Category(ies) of Dementia - over 65 years of age (10), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (32) Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That the category LD(E) be used for the individual named on the accompanying notice. 25th July 2006 Date of last inspection Brief Description of the Service: Alexander residential home is a large detached Victorian style house with an extension known as ‘the Cottage’ to the rear. The home provides residential care and accommodation for 32 older people including a number with dementia. It is located close to the community of Morley, to the south of Leeds. The building has a passenger lift and stair lift on one short flight of steps. Corridors in some parts of the home have several steps. There are lounge areas which are also used for dining on both floors of the home. All but one of the bedrooms is for single occupancy, some have en-suite facilities, others just a hand washbasin. The home is reasonably close to a range of suitable local amenities, including shops and pubs. There is good access to public transport with a bus stop right outside the entrance. There is a small area for off road parking. The home has a large garden but this is not easily accessible for older people. A decked area with level access from the front door has been created to make it easier for service users to sit outside. Because of the proximity of the main road this area is to be made more secure with a gate and intercom system to reduce the risk for service users. The fees for the home range from £375 - £412.52 per week. Chiropody, hairdressing, personal clothing and newspapers are not included in the fees. Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcomes for service users. The inspection report is divided into separate sections with judgements made for each outcome group. The judgements reflect how well the service delivers outcomes to the people using the service. The categories are “excellent”, “good”, “adequate” and “poor”. More detailed information about these changes is available on our website – www.csci.org.uk. The present proprietors have owned the home for ten years and have made a number of improvements during that time, which are ongoing. Information supplied since the last inspection was used as part of the inspection process. One inspector carried out the inspection visit arriving at 9:45am without prior arrangement and leaving at 4:30pm. During the visit, people who use the service, staff, visitors and the manager were spoken with, the care records of three service users were case tracked, staff records and other documentation was examined, there was a tour of the building and care practices were observed. What the service does well:
The service user contract is well set out giving a detailed explanation of the responsibilities of the home and the rights and responsibilities of the person living in the home. The care files included a good overall summary of the needs identified and acted as an index to each area of care covered by a care plan. This made it easy to find relevant guidance on care in each care file. The home has adopted an excellent approach to the subject of end of life care providing information and leaflets for families. This has helped staff and families to support people to die peacefully in their own room. A first time visitor to the home wrote to say how impressed he was with what he saw. The staff were welcoming ‘I didn’t feel I was disrupting any routine or that I was a nuisance. The home was secure, warm, friendly and comfortable. Staff were courteous and patient with residents and visitors alike’. The home keeps a record of activities and each person’s participation. Activities are varied and have included outings to the theatre. A monthly relatives forum organises social and fundraising events for the benefit of people living in the home. Most of the bedrooms are of a good size allowing people plenty of space for personal possessions and furniture. Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 6 The proprietors are aware of some of the limitations of the building and are planning to carry out building work to improve the environment Staff were observed to acknowledge any complaints with an apology and assurances they would deal with the complaint. The home has a good staff training programme and has exceeded the minimum number of staff who have achieved the National Vocational Award (NVQ). What has improved since the last inspection? What they could do better:
Pre admission assessments could be improved by including more detail of overall needs so that the home can prepare a basic care plan for the day of admission and avoid admitting anyone whose overall needs cannot be met. Care plans could be improved by using a format which allows space for review notes and amendment of care plans as needs change to ensure staff have up to date guidance on how each person’s care needs are to be met. The manager had ordered a new care plan package. Daily progress notes did not explain how staff carried out care to show if their approach had been effective. This is particularly important information to share between staff who are caring for people with dementia. It was apparent that some people were intolerant of the behaviour of those with dementia. Staff should monitor the mix of abilities of the people living in the home and take action to ensure those who have dementia are not abused by other people living in the home or cause undue distress to others by behaviours associated with their illness. The complaints log should be used to show how any complaints/grumbles are dealt with. One of the bathrooms looked rather shabby in contrast with standards seen elsewhere in the home. The cupboard door needed replacing, the floor covering needed sealing and the area redecorating. The oven in the kitchen was old and discoloured and there was no extractor fan. Fridge capacity was limited for the food to be kept cool during the summer months. The manager is advised to seek advice from the environmental health department on how facilities could be improved.
Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 7 There should be written evidence to show that staff recruitment and selection meets equal opportunities criteria. Doors must not be propped open with fire extinguishers or any other item which prevents closure in the event of a fire. Copies of monthly reports on the conduct of the home should be sent to the CSCI. 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 Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, (6 N/A) People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The rights of people who use the service are protected by a detailed contract setting out the responsibilities of both parties. People have their needs assessed before entering the home but this process could be improved with the inclusion of more detail to ensure the home only admits people whose overall needs can be met. EVIDENCE: A copy of a signed contract was seen for one person. It was one of the most detailed and easy to read contracts the inspector had seen. The date of admission and the number of the room to be occupied was included. There was a detailed explanation of the home’s expectations and what the person could expect from the home in the way of facilities and services including
Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 10 involvement in care plans, self-medication, fire safety, personal belongings, complaints and residents meetings. A pre admission assessment in one file had been carried out by the manager two days after a written referral which gave a brief background history of events leading up to the person’s need for more permanent support. The assessment was continued on the day of admission to the home. The admission form provided prompts for the person gathering the information but limited the amount of information recorded. The assessment should give enough information to enable the home to describe how it can meet overall needs and avoid admitting anyone whose needs can’t be met. The manager was advised to include more detail. Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans were easy to follow but did not lend themselves to amendment as needs changed. Improvements could be made by incorporating aspects of both types of care plan in use. People were protected by the medication systems. End of life care is handled with compassion and understanding. EVIDENCE: The manager had recognised that the care plans needed more work and was waiting for a commercially produced manual on care planning which included templates which the home could use. Two types of care plan were being used. The one devised by the home had a simple system of numbering identified needs and giving a brief guide to staff on how the needs were to be met. The format was good as a summarised overview of needs and was easy to follow, but did not lend itself to review and amendment as needs changed.
Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 12 A care plan recommended for use with people with dementia used a tick box system for identifying behaviours. It was difficult to find guidance for care in this. Risks had however been identified and an action plan put in place. It was apparent that individual choices were respected. Daily progress notes could have included more detail to show what staff did, for example, how they settled people who were distressed. One person spoken with said she would have liked more information from staff about day to day events as she was concerned about the deterioration of her relative. There was written guidance in one care plan after the district nurse had shown staff how to use a piece of equipment. All staff who handled medication had received training. One carer was able to explain what each medication was given for. A medication audit was carried out in February. The manager had sent all relatives a letter about end of life plans and had a selection of information leaflets from the funeral directors. She felt that this open attitude to such a difficult subject had enabled the staff to help one person to die peacefully in her own room with the support of her family. Alexander Residential Home DS0000001409.V335657.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service have the opportunity to make choices about their lifestyle and are supported to enjoy social and recreational activities inside and outside the home. A healthy and varied diet is offered but mealtimes could be improved by extending the dining space as proposed. EVIDENCE: A first time visitor to the home wrote to say how impressed he was with what he saw. The staff were welcoming ‘I didn’t feel I was disrupting any routine or that I was a nuisance. The home was secure, warm, friendly and comfortable. Staff were courteous and patient with residents and visitors alike’. An activity book records the level of each person’s participation in activities. Activities have included the pat a dog scheme, 3-weekly library visits, monthly communion, outings to the theatre and pantomime, contact with local schools, raffles, garden party. The home has a monthly relatives forum, which has helped in the organisation of some events for the benefit of people living in the home.
Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 14 One person was seen to go out to local shops, signing the in and out book each time he left the home. A lively game of dominoes was taking place on the day of the visit. Others were moving freely about the home, watching passers by or absorbed with handbags or other items or watching TV. There was a general state of well being. The people in one lounge were however intolerant of one person’s wanderings and kept shouting ‘go’, ‘get away’ each time she entered the room. Staff should monitor the mix of abilities of the people living in the home and take action to ensure those who have dementia are not abused by other people living in the home or cause undue distress to others by behaviours associated with their illness. Staff have had training on nutrition and during the course of the visit were seen to encourage people to drink fluids. People spoken with said they enjoyed the main meal of the day. The dining arrangements are not ideal due to the limitations of space which means some people have to eat from bed tables rather than enjoying the social aspect of sitting at a dining table. The planned building work is intended to create more space for dining. Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 15 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): 16, 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service The home acknowledges any concerns raised by residents or their families but does not record to show how they are dealt with. People in the home are protected by the home’s policies and procedures. EVIDENCE: There were no complaints recorded in the complaints log though care files showed that one person had complained about the way the meals had been served. On the day of the visit another person was overheard saying she was not satisfied with the meal that day as the meat was tough. A member of staff was overheard apologising and saying she would speak to the cook. Both events should have been logged and described what had been done to resolve the issues. A relative said she felt she could approach the manager with any concerns. Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 16 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): 19,20,21,23,24,25,26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service The home offers a safe and homely environment for those who live there. EVIDENCE: The proprietor of the home is planning to extend the lounge and dining areas at which time access will be improved to the garden area. This is currently reached via a steep flight of stone steps and is not secure. A decked area to the front of the house gives some outdoor space which residents can access. A gate is to be fitted to reduce the risk of people with dementia going out unaccompanied onto the busy main road. Some ground floor carpets had been replaced others are to wait until any building work has been completed. Corridors had been redecorated and toilet doors painted in colours which made it easier for people living in the home to distinguish one area from another.
Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 17 The bathroom floor covering identified as a hazard at the last visit had been repaired but this looked rather makeshift and the appearance of the bathroom, which also had a cupboard door hanging loose on its hinges let down standards seen in other areas of the home. Bedrooms were of a good size to allow people to furnish them with personal possessions. All doors had locks which some people were seen to use for the security of their personal possessions. The kitchen was clean and orderly but the oven was old and discoloured and there was no extractor for ventilation. The fridge capacity was limited particularly for the amount of food to be kept cool during the summer months. The laundry was clean though space was limited in this area due to it’s layout. Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 18 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): 27, 28, 29, 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service People living in the home are protected by the recruitment and selection procedures but there should be a record of each interview to provide evidence that candidates are offered equality of opportunity. The home has a good training programme which gives staff the skills and knowledge needed to care for the people living in the home. EVIDENCE: There were 6 care workers on duty at the time of the inspection which was a satisfactory ratio in a home where communal and sleeping accommodation is situated over 2 floors. One of the senior staff is responsible for coordinating training. The home showed a real commitment to staff training with 80 of care workers having the NVQ award. Staff were observed to constantly interact with the people living in the home and introduce activities in the absence of the activity coordinator. An NVQ assessor was visiting staff on the day of the inspection to support those doing the NVQ. Other training since the last inspection has been Nutrition and Health, Infection control and working with people with dementia. Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 19 Two staff files were inspected for the purpose of judging the quality of recruitment and selection processes and a recently appointed care worker was spoken with. A full work history and two written references were seen The manager explained that whenever possible two people conduct an interview and if more than one candidate the proprietor will meet them and a joint decision is made about the appointment. Criminal Record Bureau checks are completed by an umbrella organisation (Medilink) before people start work. The interview documentation could not be inspected fully as the proprietor had accidentally taken the keys to the place where the files were stored. A care worker said he had been working with an experienced care worker, had been shown the call system and fire procedure and was booked to do a fire drill, moving and handling training and NVQ. The manager said the induction training period is between 4-6 weeks and is all recorded. Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 20 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): 31,32,33,37,38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service The home is well managed and the interests of the people living in the home are seen as important to the manager. Systems are in place to safeguard the staff and the people who live in the home. EVIDENCE: The Manager is experienced and has the NVQ award in management. The proprietor visits the home regularly and works closely with the manager. The proprietor was said to complete reports on the progress of the home but these are not being done monthly. Copies of the reports are requested as a way of keeping the CSCI informed of the planned developments in the home.
Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 21 The proprietor has plans for the further development and improvement of the home and is awaiting planning permission for the first stage. His plans include improving facilities for people with dementia. The manager holds regular staff meetings and keeps staff informed about developments in care. The new form for self assessment (AQAA) was discussed at a recent senior management meeting. The manager uses a purchased quality auditing system which aims to look at different areas each month. The care plans and fire safety were the most recent audits. The fire officer who visited the day before the inspection was satisfied with the fire risk assessments and had suggested three more hold open devices be fitted to doors. A fire extinguisher was being used to hold a door open. This was moved by the manager immediately. Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 22 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 x 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 3 3 x 3 4 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 x x x 3 2 Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP16 Regulation 22 Requirement The manager must ensure any complaints are recorded in a way which shows how they have been resolved Staff must be reminded that doors must not be held open with anything that prevents them closing in the event of a fire Timescale for action 30/06/07 2. OP38 23 31/05/07 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 OP7 OP18 Good Practice Recommendations Daily progress notes should explain how staff carry out care to show if their approach has been effective Staff should monitor the mix of abilities of the people living in the home and take action to ensure those who have dementia are not abused by other people living in the home or cause undue distress to others by behaviours associated with their illness Consideration should be given to upgrading the old kitchen equipment and improving the appearance of the bathroom
DS0000001409.V335657.R01.S.doc Version 5.2 Page 24 3 OP19 Alexander Residential Home 4 5 OP29 OP31 There should be written evidence of the interview process Copies of monthly reports by the proprietor on the conduct of the home should be sent to the CSCI Alexander Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Residential Home DS0000001409.V335657.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
