Inspection on 10/06/08 for Alexandra Care Home

This inspection was carried out on 10th June 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Alexandra Care Home 20/06/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Alexandra Care Home Park Road South/Wargrave Road Newton-le-willows Merseyside WA12 8EX Lead Inspector Lynn Paterson Unannounced Inspection 10th June 2008 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 Alexandra Care Home DS0000068316.V362723.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. Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra Care Home Address Park Road South/Wargrave Road Newton-le-willows Merseyside WA12 8EX 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) 01925 220963 01925 220964 alexandra@fshc.co.uk Tameng Care Limited (wholly owned subsidiary of Four Seasons Health Care Limited) vacant post Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48), Physical disability over 65 years of age (3) of places Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 48 Old Persons and up to 3 Physical Disabilities (PD(E). The Service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. One named Service User aged 62 Date of last inspection 20th June 2007 Brief Description of the Service: Alexandra Care Home is a purpose built home, The home provides nursing and personal care. for 48 elderly persons over 65 The home is situated on a busy road, within a residential area of Newton-le -Willows and is located close to local transport, shops and community facilities. There are 48 single bedrooms, 20 of which have en-suite facilities. The home has 2 hydraulic passenger lifts. The Registered Manager is Mrs Karen Byrne. The fees range from £361.00 -£499.00per week. Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means that people who use the service receive good quality outcomes. An unannounced visit was carried out over an eight -hour period, and the methods used to assess the service, included discussion with the people living in the home, their representatives, the registered manager and staff. To ensure that the home is managed in the residents best interests records on staffing and health and safety were looked at. Five care files were randomly selected and assessed in detail to ensure that they contained full information to enable staff to have sufficient guidance to support each individual. Five staff files were looked at to ensure that the recruitment and selection process ensures the protection of the people living in the home. A tour of the premises was carried to assess the environmental standards of the premises and activities of daily life for the people living in the home were observed. The manager completed the Annual Quality Assurance Assessment (AQAA) and returned it to us prior to the inspection. This is a self-assessment document, which gives information about how the home has improved in the last twelve months, plans for ongoing development of the service and barriers to improvement. What the service does well: Care files are detailed and show that a thorough assessment of need has been carried out prior to any placements being offered. This ensures that people who wish to live in the home can be assured that all assessed needs, will be met. The home provides people with good clear information packs prior to admission to enable them to have full details about the home before making a decision to move in. Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 6 Staff, are trained, motivated and well supported to carry out good quality care and support for the people living in the home. Comments from people living in the home and their representatives included: “The staff are kind and caring and do all they can to make us feel at home” “Staff help me to do everything now, I cannot do much for myself. Where would I be without them”? “The manager is good she checks that we are being well looked after. The staff are very good and work very hard. We get lots of attention but we are quite happy just sitting here knowing we are safe”. “I visit here most days and am very pleased with the way the staff treat my wife. They are very good to her. She always looks nice and is clean and has her hair and nails done. Staff, always tell me anything that has happened and I am invited to all meetings and things. This is a very nice home” “My friend was in another home before this and was very poorly. He went into hospital and came here afterwards. He was still very ill but the improvements have been wonderful, s/he looks great now and it must be down to the high standards of care received. Staff, are marvellous” Staff spoken with said they enjoyed working at Alexander Care Home and were well supported by the manager. What has improved since the last inspection? Some improvements have been made to the premises and the manager has endeavoured to make the accommodation more homely. Since the last inspection improvements have been made to care planning, safe handling of medication, staff training and staff supervision. All requirements from the last key inspection have been met. Care planning is being updated with the plans being more person centred and holding detailed information about life history and interest. Medication management has been reviewed and new systems implemented in respect of the ordering of medication. Staff training programme’s are in place Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 7 to ensure that all staff has completed mandatory training. Resident’s financial records are clear and accessible. The home has employed additional staff to organise activities and interests for the residents. The activities programme appeared to be very varied and staff and people living in the home said that the activities co-ordinator had consulted with everyone in the home to make sure that interests, capabilities and choices were covered. 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. Alexandra Care Home DS0000068316.V362723.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 Alexandra Care Home DS0000068316.V362723.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): 1.3.6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All people who live at Alexandra Care Home have had their needs assessed and assured their needs will be met, prior to being offered a placement. EVIDENCE: People living in the home confirmed that they had been provided with a statement of purpose and brochure about the home before they made the decision to move in. A resident’s representative said he had received full information about the home prior to his wife being admitted. He said that he and his wife were invited to have a trail visit, an offer he took up. He said that on this visit staff explained about all the services provided and he and his wife Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 10 were able to view the kitchen and have a meal and see the rooms that were available. He said that he feels he made the right choice and thinks the home is wonderful. Care files show that a comprehensive assessment of each individual need is carried out before a placement is offered. This is to ensure that the service is able to meet all assessed need via the staff skills and equipment provided in the home. The manager advised that she encourages prospective residents to come and look at the home to assess the quality for themselves. Staff record show that staff receive training in customer care and enquiry management to make sure that anyone who is considering moving into the home and/or their representatives are provided with full information to enable them to make a fully informed need about their future. The home does not provide intermediate care. Alexandra Care Home DS0000068316.V362723.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Residents health and social care needs are monitored and met and staff treat them with respect. EVIDENCE: Five care plans were looked at in detail. This showed that a care plan is provided for each person living in the home, which is detailed and personalised to ensure the needs of each person are met. Risk assessments are also completed to identify and minimise risk. Care plans viewed held information relating to equality and diversity to include age, disability, gender, culture, heritage, sexuality, mental capacity and interests and staff revealed that they develop the plans in partnership with Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 12 each individual to try to provide a holistic package of care. However staff said they were in the process of making further improvements to care plans to make sure they were fully person centred and held detailed information not only about current need but included life story details to enable staff to have even better understanding of peoples past and be able to engage in meaningful conversations and reminiscent. Care planning files record all social and health care needs and detail the care and support that has been provided. Record show that all residents are registered with local doctors and receive services from specialist medical services as required. There was evidence of medical intervention clearly set out in peoples care plans to include chiropodists and district nurses and tissue viability nurses. The manager advised that qualified nursing staff hold responsibility for the management of medication. Staff, were observed administering medication and using the systems as per the homes medication policy in respect of the recording of medications. Medication records viewed were well -maintained as were the mediation rooms and storage systems. Discussions with staff who give out medication revealed they were knowledgeable in all aspects of medication management and complete their own weekly audit to monitor systems and ensure the re ordering and stock control systems are effective. Discussion with people who live in the home revealed that they feel staff always treat them with dignity and respect. Residents said that staff always call them by their preferred name and if they need to see a doctor or nurse or receive any medical treatment they are always treated in private to avoid them any embarrassment. Annual customer survey results also confirmed that residents are satisfied with the staff and services provided in the home. It was noted that the care plans are in the process of update. Whilst all residents revealed that they have had full input into the care plans it is recommended that staff ensure all new documentation is signed to show it has been developed in full partnership with the resident and/or their representative. Alexandra Care Home DS0000068316.V362723.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The lifestyle provided at the home meets all individual needs. EVIDENCE: The home have recently employed an additional activities co-ordinator who has spent time with each resident to find out exactly what activities they would like to occur in the home. After this consultation the co-ordinator has drawn up an activities programme to suit all preferences and capabilities. This programme includes picnic in the park, planting seeds, feeding birds, film nights, using memory boxes, museum of life, themed events and reminiscent. Staff and residents have commented on how varied and innovative the programme is. Discussions with the co-ordinator have highlighted how she has worked with each resident to find out their background and interests and has gone out into the community to find ways to develop the activities programme using some community resources. For example memory boxes and other reminiscent projects have been provided on loan by St. Helens Local Authority resources, Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 14 Newsletters and religious magazines have been provided for residents on request and films and DVD’s have been acquired from family and friends. Residents have expressed delight about the extra activities and comments included: “I feel that this new programme will improve my days” “This activities lady is like a breath of fresh air to this home” “I am very happy that we will be doing more things”. Staff have also said they feel the improved activities programme will enhance the lives of the people living in the home. During discussions residents said they could go about their day as they wished and could have visitors at any time they liked. Residents were observed eating their lunch and everyone appeared to enjoy their meal. A number of residents needed assistance to eat and three staff were seen helping them in a polite discreet manor. In discussion residents said the food was fine and they generally enjoyed it. Some residents appeared uncertain if they were given choices of menu at mealtimes but the menu confirmed that choices were provided at all mealtimes with the menu choice for lunch that day being chicken casserole or salad. The layout of the home provides four separate units for up to 12 people in each unit. Each comprises a lounge and dining room combined with a small kitchen area off the main lounge. Although the central kitchen provides the main meals the unit kitchens enable staff to make drinks and snacks for the residents on request. Alexandra Care Home DS0000068316.V362723.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are protected through a good complaints process and staff training is in place in respect of safeguarding all people who live in the home. EVIDENCE: The homes complaints procedure is available in the Statement of Purpose. Most people said they would speak to the Staff or the Manager if they had concerns. Staff felt they could air their views with the Manager and could openly speak up at Staff meetings. The pre inspection questionnaire indicated that the home had no outstanding complaints and the manager advised that she used a standardised complaints investigation and outcome form to make sure any complaints were recorded and tracked from start to finish. A number of residents and their representatives spoken with said they knew how to complain and said that they also knew who to speak with if they had Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 16 any concerns. Residents said they were encouraged to air their views, good or bad, and staff always asked them if everything was OK. Staff training records show that all staff has received some training in respect of protecting vulnerable adults form abuse. During discussion staff demonstrated an understanding of the different types of abuse that can occur and the actions they should take in the event of them suspecting or knowing an incident of abuse had occurred. The home has a copy of St.Helens safeguarding policy and the manager advised that staff could attend St. Helens training if required. The manager revealed that she has undertaken a “train the trainer” course in safeguarding vulnerable adults and is intending to cascade this training to all her staff as an ongoing process. Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 17 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): 19.26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is in need of refurbishment to some areas to ensure all services are fit for purpose. EVIDENCE: The overall standard of the building is adequate and it was noted that some work has been carried out to make it appear homely. However some parts present as institutional in appearance and would benefit from refurbishment. There is a large garden area around the property that is in need of some attention to ensure it is suitable for the use of residents and their families. Exterior steps to the laundry area should be fenced off to ensure the safety of the people living and working in the home. Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 18 Improvements need to be made to the ground floor bathroom and the first floor shower room to make them safe and accessible for the residents. Ongoing redecoration is required throughout the home and en-suite flooring replaced. The bedrooms areas would also benefit from replacement carpets as required and the provision of secure window dressings. The home presented as clean tidy and free from unpleasant smells at the time of the visit. Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the training and skills to enable them to provide needs led care to the residents EVIDENCE: The pre inspection questionnaire (AQAA) indicated that staff has completed a range of training and further training is planned for the forthcoming year. Staff said they were also able to access specialist training to include training in dementia care and challenging behaviour. Residents said that staff were nice and friendly and looked after them well and they were generally very happy with the services provided. A random selection of staff files was examined to ensure that the home used a recruitment and selection process to safeguard the people living in the home. The files viewed clearly showed that the recruitment process included all the relevant safety checks such as Criminal Records Bureaux clearances and satisfactory references. Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 20 Staff rotas show that staff, are provided in adequate numbers and skill mix to meet the assessed needs of the people living in the home. Discussions with staff revealed that they feel supported by their line managers and receive good quality training to enable them to develop their skills. Staff supervision records and training files show that staff, receive one to one supervision and there is a training and development programme in place to ensure they receive mandatory and specific training as an ongoing process. Examples of planned training included safeguarding and health and safety. Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 21 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): 31.33.35.38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Alexandra Care Home is managed in a way to make sure the best interest of the people who live there are maintained and protected. EVIDENCE: The registered manager has been managing the home for a number of years. She is qualified and experienced in care management for older people and has recently completed a safeguarding vulnerable adults, train the trainer course to enable her to carry out this training to all her staff. Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 22 When asked what they felt the home did well, residents said that staff had been working in the home for a long time and everyone knew each other, which was good. They also said that they were asked about what they wanted for the home every day and were invited to residents meeting to discuss how the home was run. The management structure of the home is clear, as are lines of accountability. The manager was on duty throughout the visit and was able to provide all policies, procedures and documentation with immediate effect. Records show that in the wider organisation, Regional Managers, human resource staff and central administrators have some input into the home. Alexandra Care Home has a quality assurance system, which is based on residents and their representative’s opinions of the service. Surveys are undertaken by way of questionnaires to find out if everyone is happy with the staff and services provided. Resident’s finances are well managed and records maintained that are available to each resident on request. The home employs a maintenance worker who carries out general maintenance and safety checks on fire protection and other equipment in the home to ensure the residents health and safety. Staff records show that staff have completed a range of training in respect of health and safety and in discussions staff revealed that they were knowledgeable and fully understood their responsibilities in respect of the health safety and wellbeing of the people living in the home. Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 23 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 30/08/08 1 OP19 12 2 OP19 12 Steps to the laundry area must be made safe to include the provision of gated /fenced security to ensure the safety of the residents. The home must ensure that the bathrooms and shower rooms are refurbished to ensure the safety and accessibility of the residents. 30/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Refer to Standard OP7 OP19 Good Practice Recommendations Updated care plans should hold the signatures of the resident to show they have been involved with this update of informaiotn. It is recommended that the home continues with its refurbishment to window dressings and replace floor covering to en suites and bedroom areas to ensure the DS0000068316.V362723.R01.S.doc Version 5.2 Page 25 1 2 Alexandra Care Home comfort and safety of residents. Alexandra Care Home DS0000068316.V362723.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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. 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