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Inspection on 22/11/05 for Alexander Residential Home

Also see our care home review for Alexander Residential Home for more information

This inspection was carried out on 22nd November 2005.

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

Service users and staff said that good care was provided in the home. A significant number of service users said they were happy living in the home. A varied number of activities are regularly organised for service users.

What has improved since the last inspection?

The environment has improved by redecorating, some new carpets and new lounge chairs have been supplied.

What the care home could do better:

The quality of the food was good but meals were repetitive. Staff training records must be updated. Staff must continue to improve the care plans so that all individual needs are recorded. Ensure that staff sign all records. The providers must protect everyone in the home by ensuring that fire doors are effective in case of fire by not wedging open.

CARE HOMES FOR OLDER PEOPLE Alexander Residential Home Victoria Road Morley Leeds West Yorkshire LS27 9JJ Lead Inspector Susan Knox Unannounced Inspection 22nd November 2005 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 Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 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.V267728.R01.S.doc Version 5.0 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 Learning disability over 65 years of age (1), Old registration, with number age, not falling within any other category (32) of places Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the category LD(E) be used for the individual named on the accompanying notice. 21st June 2005 Date of last inspection Brief Description of the Service: Alexander residential home is a large detached building, with an extension to the rear. It is located to the south of the city of Leeds. There are a number of facilities suitable for older people, including a lift, and several lounge areas, which are located on both floors of the home. A number of bedrooms are en-suite. This home provides residential care and accommodation for 32 older people. The home is reasonably close to a range of suitable local amenities, including shops and pubs and has good access to public transport; a bus stop is located at the entrance. Car parking facilities are available. Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out in one day starting at 9.45 am and finishing at 3.15 pm. The acting manager Ms S Haigh was present throughout the inspection. She had been in post for two weeks and her application to be the registered manager has been submitted to the CSCI. It is acknowledged that at the time she was still unfamiliar with people in the home, records, procedures and the building. Most of the day was spent in talking to service users and staff about the standards of care at the home. Positive comments were made. Some of the building and a number of documents including care plans were inspected. Feedback about the findings from the inspection was given to Ms Haigh. What the service does well: What has improved since the last inspection? What they could do better: The quality of the food was good but meals were repetitive. Staff training records must be updated. Staff must continue to improve the care plans so that all individual needs are recorded. Ensure that staff sign all records. The providers must protect everyone in the home by ensuring that fire doors are effective in case of fire by not wedging open. Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 6 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 Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 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 Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 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, 4, 5. Appropriate information is made available to prospective service users and/or relatives in order for them to make an informed judgement about the suitability of the home. Assessments are carried out before admission and sufficient information is gathered together to ensure that the home can meet individual needs. Service users must not be admitted out of category until agreement as been reached with the CSCI. EVIDENCE: The acting manager was still relatively new to the home and could not find the statement of purpose. This was available at the last inspection. Service user guides were available in service user’s bedrooms. The acting manager advised that she would carry out pre admission assessments before agreeing to a placement. In addition she would also invite the service user to spend a day at the home. This was also confirmed in discussions with service users. The local authority assessments were available Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 9 in the three sets of documentation checked but the home’s assessment could not be located. An application for a variation of registration has been made to the CSCI. One recent admission came under the new category and should not have been admitted until agreement was reached. The CSCI is currently waiting for an amended statement of purpose and details of any proposed changes to the environment and staff training. Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 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. Further work is necessary to care planning to ensure that all needs are being addressed. Service users and/or representatives must be included when planning care. Staff were aware of the health and safety implications in using bed rails. EVIDENCE: Three sets of care documentation were reviewed and care plans were in place for all three. The plans covered the majority of needs assessed pre admission but some important details were missing such as one having diabetes. One file included detailed information from the hospital about the physical exercises that were needed. There was nothing in the care planning to show that staff were meeting this need. The present method of recording progress and the day and night record made it difficult to see if there was any improvement or deterioration of service user’s needs. The acting manager is going to make some changes in this area. Monthly evaluation of care needs was also difficult to assess. Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 11 In the files checked there was no evidence of service user or relative involvement in care planning. A number of records were unsigned. Care records are legal documents and the person making the record must record their signature. Risk assessments were in place for bed rails and moving and handling. The decision to use bedrails included family involvement. This should also involve the GP or district nurse. Staff showed a good understanding of health and safety as one record showed that this equipment was removed as it added to the risk of injury. District nurses were visiting service users with tissue viability needs and they complete their own documentation. But in these cases the home needs detailed care planning to inform care staff about special equipment such as mattresses or cushions, any daily repositioning or bed rest and what to do if dressings need attention. One member of staff had written in a progress report that the district nurse should be contacted about a dressing. There was no evidence of any progress. From discussions with service users and staff it was clear that health needs were being met but detailed records are required in order to protect the service users and staff. Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 12 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, 14, 15. The home does well in arranging a number of activities that stimulate service users. The meals provided are of good quality. This could be further improved if a definite choice was provided for the main meal of the day and menus were reviewed. EVIDENCE: The home continues to provide a number of activities to stimulate service users. A member of care staff also undertakes the duties of an activity coordinator; set hours are in place for activities. Notice boards displayed the latest activities and events. Each service user has an individual activities plan. Service users confirmed their enjoyment and described good relationships with care staff. The home maintains contact with the local community such as local churches, shops and schools. One new admission wanted to maintain contact with the local church and although staff confirmed that this happens it was not part of the care plan. The information in the personal background record provided good information about past life but this identified need should be in the care plan so that it is not overlooked. Care planning should address all needs not just health. Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 13 At the time of the inspection the cook was preparing the main meal. It was noted that a good selection of fresh vegetables were being prepared and also available, including fresh fruit for following days. Service users spoke positively about the meals that are provided and described the choice available at breakfast. Service users and staff confirmed that choice is available whether this is bed times, food or clothes. Choice of food is available for breakfast and the evening meal but the main meal is set. Staff explained that soup or sandwiches are provided if the main meal is not wanted. At the last inspection it was said that the provision of a main meal choice should be considered. This has not happened. It was said that although the quality of the meals including cooking was good there was repetition of meals. Menus need to be reviewed. Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 14 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): 18 The senior staff team have received adult protection training and would be able to ensure the safety of service users if concerns were raised. EVIDENCE: Service users said that they would approach staff if they had concerns. During discussions with staff it was confirmed that three senior staff have attended the local authority Adult Protection training. Policies relating to Abuse and Adult Protection are available to them. Although as it is early days in the employment of the new manager she could not locate the documents. From discussions the acting manager was aware of current documentation such as ‘No Secrets’ in relation to adult protection issues. Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 15 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, 26. Refurbishment is ongoing to provide the service users with a comfortable, homely and safe place to live. Some work is required urgently in order to provide the same standard for all service users. The standard of cleanliness is good. But infection control practices must improve in order to protect service users. EVIDENCE: A random number of communal areas and bedrooms were seen. The decorators were working in the corridor areas. Since the last inspection the main lounge, entrance and a bedroom have been redecorated and re-carpeted to very good effect. New easy chairs have been provided. The application for variation is a proposal to admit service users with dementia. The providers must ensure that the environment meets these needs such as colours and signage that aid orientation. One shared bedroom is in need of refurbishment and this was agreed with the provider at the last inspection. This has not been done. Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 16 The majority of bedrooms are very personalised and many display the service user’s possessions. A number of service users preferred to remain in their rooms. In discussions service users confirmed that they were comfortable in their rooms. The providers intend making the garden more secure with additional fencing. At the last inspection it was noted that the wooden area between the bay windows ground and first floors is showing signs of rotting. The acting manager was unsure if this work had been done. There are sufficient bathrooms and WC’s for the numbers of service users and many bedrooms have en suite facilities. Liquid soap and paper towel dispensers are located in the majority of these areas. However, a number of paper towel dispensers were empty. Fabric towels and bars of soap were seen in most bathrooms. Infection control guidelines state that service users should keep personal towels and soap in their rooms. If required in communal areas they should be taken back to bedrooms after use. The refurbishment of the bathroom in the ‘cottage’ area still needs completing. There was evidence that this bathroom was being used but it was also used as storage and there was tripping hazards. The floor covering needs to be re-laid as it is unfinished. This bathroom needs to be put back in use urgently as this facility is required. This has been referred to in a number of reports. Cleanliness and odour control was to a good standard in the areas checked. Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 17 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, 30. Staffing levels are sufficient to ensure that the service user’s needs can be met. The acting manager is aware of the procedures to follow when recruiting staff in order to protect service users. Staff training is ongoing but records must be kept up to date. In order to protect service users all new staff must receive an induction into working in the home. EVIDENCE: A copy of the rota for the week of the inspection was provided and this showed that staffing levels were appropriate. No concerns were raised about staff other than service users saying they were over worked at times. The acting manager advised that recruitment had taken place and new staff were due to start work. She was unable to access staff recruitment files so these could not be checked. She was aware that care staff must not be employed until suitable references and CRB or POVA clearance is received. One new member of staff confirmed that references and CRB clearance had been obtained by the home before she started work. Training files need to be updated as these showed in some cases no training had been attended since 2003. Senior staff confirmed that they and others had Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 18 just completed courses relating to Administration of Medication, Food Hygiene and an Activities course. In discussions with one new member of staff about an induction none had taken place. The new manager advised that this would be dealt with. Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 19 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): 33, 37, 38. The providers are failing to provide a report about the standard of care in the home to the manager or the CSCI. Up to date records must be kept in order to protect service users and staff and show what is happening in the home. The providers are failing to keep the service users and staff safe by not addressing the wedging/ propping of fire doors. EVIDENCE: There is a requirement for providers who are not in charge of a home on a daily basis to make unannounced monthly visits to the home and then submit a report of the visit to the manager and the CSCI. These visits should include talking to service users, visitors and staff in order to form an opinion about the standard of care. Also carry out an inspection of the building and records of Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 20 events and complaints. Then prepare a written report. The providers do visit almost daily but monthly reports are not made available as required. Some important information had not been recorded in care plans and other records were not available for inspection or required up dating. It is recognised that there has been a period of time between one manager leaving and another starting. Fire testing records were checked. Fire alarms have been tested weekly but emergency lights were last checked in May 2005. The manager was aware of this oversight. A staff fire drill was held August 2005 and included the names of staff attending. However, the one before was dated September 2004. The acting manager was advised that staff drills are required at least twice annually and must include night staff. Still outstanding from the last inspection was the fire doors adjacent to the main office that were still wedged/propped open. Part of the intumescent strip to one bedroom door in the same area was missing. The manager was able to show me the replacement strip due to be fitted. Due to redecoration a number of fire extinguishers were not bracketed to the wall. The manager was aware that these need to be replaced once work is finished. Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 21 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 x 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 3 2 2 x x x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x x x 2 2 Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 22 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 2 Standard OP4 OP7 Regulation 12 Requirement Timescale for action 22/11/05 15/12/05 3 4 5 6 7 OP15 OP21 OP24 OP26 OP30 8 9 10 OP33 OP37 OP38 Ensure that no service user is admitted out of category. 15 Ensure that care planning includes all assessed needs. Evaluate monthly. Include evidence of service user/representative involvement. 12 Review menus and include a definite choice for the main meal of the day. 23 Complete the work started in the cottage bathroom and put back in use. 14 Ensure that the environment in the shared bedroom is upgraded. 13, 16 Ensure that that infection control policies and procedures are followed. 12, 13, 18 All new staff must receive an induction. Update staff training records to reflect courses attended. 26 The providers must ensure that monthly reports are made to the manager and copied to the CSCI. 17 All records in the home must be up to date and signed by the person making the report. 23 The testing of emergency lights DS0000001409.V267728.R01.S.doc 15/12/05 31/12/05 31/12/05 22/11/05 15/12/05 15/12/05 22/11/05 15/12/05 Page 23 Alexander Residential Home Version 5.0 must be carried out monthly. Fire doors must not be wedged open. Staff fire drills must be held at least twice a year and include night staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Alexander Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Residential Home DS0000001409.V267728.R01.S.doc Version 5.0 Page 25 - 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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