Inspection on 11/09/06 for Alexandra Centre For Physical Disability &Sensory Impairment

This inspection was carried out on 11th September 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alexandra Centre For Physical... 18/11/05

Alexandra Centre For Physical... 27/06/05

Alexandra Centre For Physical... 10/03/05

Alexandra Centre For Physical... 19/08/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

Honeybourne House

12 Orchard Mews

Stallcombe House

Stepping Stones

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Alexandra Centre For Physical Disability &Sensory Impairment 23 Howard Road Queens Park Bournemouth Dorset BH8 9EA Lead Inspector Carole Payne Key Unannounced Inspection 11th September 2006 09:00 DS0000003909.V311512.R01.S.doc Version 5.2 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 DS0000003909.V311512.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 Adults 18-65. 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. DS0000003909.V311512.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra Centre For Physical Disability &Sensory Impairment 23 Howard Road Queens Park Bournemouth Dorset BH8 9EA 01202 528420 F/P01202 528420 alexandra-farway@hotmail.co.uk www.alexandracentre.co.uk Care Services (Bournemouth) Ltd trading as Alexandra Centre for Physical Disability and Sensory Impairment. Mrs Sylvia Jean Rundell Care Home 14 Address 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) Category(ies) of Physical disability (14), Sensory impairment registration, with number (14) of places DS0000003909.V311512.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Day care provision for a maximum of 5 service users in the category PD. Date of last inspection 18th November 2005 Brief Description of the Service: The Alexandra Centre for Physical Disability and Sensory Impairment is registered to accommodate up to 14 service users under the PD category. Two bedrooms are registered as doubles but only one is currently used for shared occupancy. The home has been specially adapted to meet the needs of this group of younger service users. An attractive conservatory has been added affording extra communal space. Many of the occupational and leisure activities take place in this room. Alexandra Centre is fully equipped to ensure a totally inclusive environment for each individual. There is a garden, which can be accessed via a ramp for wheelchair users. The home is located in a quiet residential area but close to all local amenities. The fees at the Alexandra Centre are negotiated individually on admission, dependent upon the needs of prospective residents. The manager of the home can be contacted for further information. The report is made available on the website or on request within the home. The Centre also has a smaller vehicle for one wheelchair driver and a carer. Alexandra Centre offers both a caring yet busy and positive environment for the service users residing there. The Centre has it own bus, which can accommodate up to four wheel chair users. DS0000003909.V311512.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on the 11th September 2006 and took a total of 12 hours, including time spent in planning the visit. The inspector, Carole Payne, was made to feel welcome in the home during the visit. The manager, Mrs Jean Rundell, was present throughout the inspection. This was a statutory inspection and was carried out to ensure that the residents who are living at the Alexandra Centre are safe and properly cared for. Requirements and recommendations made as a result of the last inspection visit were reviewed. The premises were inspected, records examined and the daily routine observed. Time was spent in discussion with eight people living at the home, four visitors and five staff members on duty. Seven resident survey forms, two comment cards from external health and social care professionals and one comment card from a relative / visitor to the home were received prior to the inspection. Friends or family members had completed some resident survey forms on behalf of residents. Throughout the visit and following the inspection, the registered manager has demonstrated a commitment to address issues raised. What the service does well: Comments from residents returning survey forms included: ‘I am so happy now I live in the Alexandra Centre.’ ‘I am perfectly happy here and this is the place I love to be.’ The staff members are ‘warm and friendly.’ A health care professional and care manager / placement officer returning comment cards said that they were satisfied with the overall care provided to residents. An assessment of residents’ needs and wishes is carried out prior to residents moving into the home, enabling people to be assured that their needs and aspirations will be met by the service. Relatives of a resident who had recently moved into the service said that they had felt ‘impressed’ when they had visited the home and had felt confident that the service could meet their relative’s needs. DS0000003909.V311512.R01.S.doc Version 5.2 Page 6 Plans of care support staff to deliver care, which meets residents’ personal and healthcare needs, wishes and preferences. People living at the Alexandra Centre are assisted to make decisions about their lifestyles; this is supported by a clear process of assessing and identifying risks, helping residents to experience independence in their daily lives. Residents are supported to take part in activities, which reflect their interests, and preferences. One resident spoken with said that there is always ‘laughter’ in the home. The home benefits from having its own transport and a regular programme of excursions is arranged. Residents enjoy good links with the local community, enabling them to feel a part of the locality in which they live. For example one resident said that they enjoy undertaking voluntary work. Family members and friends are made welcome at the service, supporting people living in the home to continue to experience relationships, which are meaningful to them. Two relatives spoken with at the time of the visit talked of how welcome they feel when they come to the home. One resident said ‘My family can visit anytime.’ The home supports people to exercise their rights and take responsibility for their daily lives, enabling them to experience autonomy and independence. Residents make choices about what they would like to eat and when, benefiting from a varied menu to suit their individual preferences and needs. People living at the Alexandra Centre receive care, which is reflective of their needs, promoting physical and emotional well-being. The home has supportive care plans in place, which enable people to receive sensitive help with personal care. Residents are supported to retain responsibility for the administration of their own medication, according to their wishes. People living at the Alexandra Centre can feel confident that staff members will listen to any issues they raise. All resident survey forms returned said that people knew who to speak to if they were unhappy and knew how to make a complaint. The home has policies and procedures in place, which raise awareness of abuse, and support the protecting of people living at the service from harm. The home is maintained, decorated and furnished to a good standard. It is clean and hygienic with appropriate aids and adaptations in place. The environment, therefore, provides a safe, homely and comfortable place for people to live. DS0000003909.V311512.R01.S.doc Version 5.2 Page 7 Well-trained staff members enable the service to fulfil the needs and preferences of people living in the home. Clear management structures, and regular consultation with people living at the service, supports the running of the home in the best interests of residents. Good practices and procedures protect the safety and welfare of residents. What has improved since the last inspection? What they could do better: The registered person should develop full social care plans to support residents to experience a varied and active lifestyle. Although most medicines checked had been safely administered a number of items must be addressed to support the service’s commitment to safely handle and administer medicines in the home. Medicines returned to the pharmacy must be signed as received by the pharmacist. A system for auditing the safe handling of medicines must be devised, ensuring that there is a clear audit trail for each medicine from receipt, to administration, or disposal. Medicines must be signed for at the time of administration. The registered person must ensure that the required dose of tablets, which require cutting, can be efficiently administered. Staff members administering medication must check the prescribed instructions for each medicine, before administering medication. The registered person should amend the complaint’s policy to include the details of the Commission for Social Care Inspection, as the regulatory body. DS0000003909.V311512.R01.S.doc Version 5.2 Page 8 The registered manager must operate a thorough recruitment procedure and ensure all references and statutory checks are obtained before the applicant starts working at the home. Staff members should wear disposable aprons or over garments when working in the kitchen, serving food, or helping residents with eating, to reduce the risk of cross infection. A written annual development plan should be developed, supporting the running of the home in the best interests of residents. The registered manager should demonstrate that she possesses, or is working towards, a management qualification, which is equivalent to the Registered Manager’s Award. The registered person should consider making intranet access available to the home, to support the running of the service for the benefit of residents, in accordance with current good practice guidelines. 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. DS0000003909.V311512.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000003909.V311512.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. An inclusive assessment of residents’ needs and wishes is carried out prior to residents moving into the home, enabling people to be assured that their needs and aspirations will be met by the service. EVIDENCE: Pre-admission assessments were viewed for two residents who had recently moved into the home. Assessment details included activities of daily living, and specific needs. There was also information, which had been provided by external health and social care professionals, supporting the service to make a decision as to whether the person’s needs could be met by the home. The manager of the home had carried out both assessments. A prospective resident had visited the home prior to making a decision about moving in. The assessment had been carried out as part of the visit. This had enabled the manager and resident to assess if the environment was the right place for them. Relatives of the resident were spoken with during the inspection and said that they had felt ‘impressed’ when they had visited the home and had felt confident that the service could meet their relative’s needs. DS0000003909.V311512.R01.S.doc Version 5.2 Page 11 From the initial assessment carried out for a resident wishing to move into the service, the manager had liaised with local health services to ensure that the home could arrange the support required, enabling the service to safely care for the resident. One resident who had recently moved in said that they had wanted to live somewhere that would provide them with the help that they needed, but would also support them to pursue outside interests; they said that they felt sure when they moved in that the home would be able to provide this service. DS0000003909.V311512.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Detailed plans of care support staff to deliver care which meets residents’ needs, wishes and personal goals. Social care plans should be fully developed to support the full lifestyle experienced by people living at the home. People living at the Alexandra Centre are supported to make decisions about their lives, which enables them to experience a varied quality of life. A clear process of assessing and identifying risks supports people to enjoy independence in their daily lives. EVIDENCE: Assessments and plans of care were viewed for three people living in the home. From the assessments, individual plans are written, which inform the delivery of care in the home. Regular and detailed reviews are carried out on a monthly basis, or according to changing needs. Although some residents are DS0000003909.V311512.R01.S.doc Version 5.2 Page 13 unable to participate in goal setting, due to their physical disabilities, others do. One resident said that when they came to the home they had little confidence. They spoke of how staff members had supported them to set goals, and to gradually go out into the local community and participate in the life both inside and outside the home. Residents’ choices were reflected in their care plans, for example in relation to personal care. Residents have baths or showers as often as they want and are able to express a preference regarding the person, or gender of the staff member delivering care. Personal histories and records of participation in events in the home support social care provided and should be developed fully in terms of social care planning; supporting the varied and interesting range of activities and opportunities that residents enjoy. Residents are supported to make decisions and take control of their lives. This is reflected in plans of care, which describe how the person wishes to live and in feedback from people living in the home. Regular residents’ meetings support the consultation of people living at the service. During the visit the manager spoke with a person with communication difficulties. She took both time and care to allow the person to express their opinion about what they would like to happen. When decisions have been made regarding safety, in relation, for example, to the application of bed rails, people are consulted; on one file a resident’s representative had signed to indicate the agreement of the resident with the safety measures implemented. Two residents said how much they had chosen to participate in local groups in the community, enabling them to spend time with people who share their own interests. One resident described how they had received support from the staff at the home to be able to take control over their own money, visiting the local shops and taking responsibility for making purchases and decision-making. Residents at the Alexandra Centre feel able to participate in the life of the service. One resident spoken with said that they felt fully involved with the running of the home and were aware of the policies and procedures, which affected them, for example in knowing how to complain. Residents’ meetings are held regularly and minutes kept were viewed. From these meetings items arising are taken forward and discussed at staff forums. Residents also participate fully in responding to user satisfaction questionnaires. During the day, two residents spoke of the roles that they play in organising events in the home. At the moment an auction is being planned and one resident will be acting as hostess and another will be responsible for the gavel, to use when confirming bids. The activities coordinator said that residents would also be helping in making bidding cards, and would be generally participating in the preparations. The manager said that when new staff members apply to work at the home they are shown round and introduced to residents, whose opinions are sought in the selection of staff. A resident confirmed that they felt fully involved in deciding who they would like to help them with personal care. DS0000003909.V311512.R01.S.doc Version 5.2 Page 14 Detailed risk assessments are carried out in relation to nutrition, manual handling, falls and the risk of pressure sores as well as for specific areas of identified risk. Risk assessments are recorded when a resident moves into the service, enabling any potential risks or hazards to be identified and action planned to minimise the presenting risks. The home uses clinical assessment tools to assess specific aspects of healthcare and support. From these, clear plans are written to support staff members in delivering care safely. For example, a resident was at risk of falling out of bed. An assessment had been undertaken in consultation with the person and it was agreed that bed rails be used, which were in place on the bed, to reduce the risk of the person falling. When a particular risk had been identified in relation to nutrition appropriate monitoring had been introduced, in relation to regular weighing and monitoring of food intake and external healthcare professionals had been consulted as appropriate in care records sampled; for example in relation to obtaining suitable mobility equipment for a resident who was at risk of falls. DS0000003909.V311512.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. People living at the Alexandra Centre are well supported to take part in activities, according to their age, religion and peer group, enabling them to enjoy preferred interests and an individual lifestyle. Residents enjoy good links with the local community, enabling them to feel at home in the locality in which they live. Family members and friends are made welcome at the service, supporting people living in the home to continue to experience relationships, which are meaningful to them. The home supports people to exercise their rights and take responsibility for their daily lives, enabling them to experience autonomy and independence. Residents make choices about what they would like to eat and when, benefiting from a varied menu to suit their individual preferences and needs. DS0000003909.V311512.R01.S.doc Version 5.2 Page 16 EVIDENCE: One resident said that they enjoy undertaking voluntary work in the local community. Another resident said that they like going out to a local day centre and meeting people in their own age group. One person living in the home prefers to stay in their own room. They particularly enjoy watching their favourite sport on the television and have continued a previous hobby of collecting items in relation to transport. Although some residents are bed bound or spend a lot of time in their own rooms, records of social contacts show that time is spent in companionship and in enjoying previous interests; for example tapes, DVDs, manicures, listening to music and the radio or playing a board game. Two residents described how they like to go out shopping. One staff member said that she enjoys going with a resident to a local out-let, where they have a coffee and have a look around the shop. One resident, she said, would not wish to sit through a religious service, but likes to visit the local church. The mayor had attended a recent fete and local businesses were being encouraged to contribute to the fund raising auction that the home was planning. The manager demonstrated an awareness of the Disability Discrimination Act in looking at the needs of residents accessing facilities within the local community. The manager ensures that residents wishing to are supported to exercise their right to vote. Throughout the visit, staff members prioritised time to spend with residents. During the morning, one staff member was playing scrabble with a resident. The activities coordinator was making plans for the forthcoming auction. Staff members spent time chatting with residents. One resident said that there is always ‘laughter’ in the home. Regular outings are arranged in the community. The home benefits from having its own transport and excursions, details of which are displayed on a poster in the home. Two relatives spoken with at the time of the visit talked of how welcome they feel when they come to the home. One resident said ‘My family can visit anytime.’ During the visit the relatives met in private, with their family member, the care manager and a representative of the home. The relatives spoke of how ‘comfortable’ they now feel that their relative is both safe and well cared for. Personal records include details of family contacts and involvement. Pictures of events, such as the recent fete, show that families and friends are included in the life of the service. The activities coordinator said that invitations to key events are sent to all families and friends. During the visit the manager took care to knock on residents’ doors before entering, respecting people’s rights to privacy. One resident said that they hold a key to their door; other residents are offered the option of holding a key should they wish to, supporting residents to take personal responsibility for DS0000003909.V311512.R01.S.doc Version 5.2 Page 17 themselves and their surroundings. Staff members enjoy companionable relationships with residents and there was the constant hum of conversation during the visit. Although residents are encouraged to join in with shared activities, the wish for privacy and to make personal choices is respected. One resident said that they preferred to stay in their own room. They liked to have the door open, so that they can watch the comings and goings in the home. The preference to have the door closed at night was seen on one resident’s care plan, informing care provided. In the morning some residents had been up for some time. One resident said ‘I do what I want and the staff always support me.’ Some residents were in the lounge. One resident was sat outside on the patio and other residents were engaged in playing board games in the conservatory. One person living in the home said that they were planning an excursion with their family the following day. One resident said ‘I love the food.’ Another resident said that they are able to make choices about what they would like to eat, when and where. During the day residents ate at times to suit them, and their routine. A varied menu was on display. One resident said that they very much look forward to mealtimes. The cook confirmed that specialist dietary requirements catered for and a resident, who said that they were on a low fat diet, said that the menu provided was appetising. DS0000003909.V311512.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has supportive plans in place, which enables people to receive individualised assistance with personal care. People living at the Alexandra Centre receive care, which is reflective of their needs, promoting their physical and emotional well-being. Residents are supported to retain responsibility for the administration of their own medication according to their wishes. A clear system of auditing medicines from receipt to disposal will support the home’s practices in respect of handling residents’ medications. EVIDENCE: One resident described how their personal choices regarding help with care are respected by the home. They choose who they would like to provide their care and have baths / showers when they wish to. One staff member supported a resident’s comment that there is always ‘time to care’. The staff member said that they like to give time, particularly with people who need a lot of help with DS0000003909.V311512.R01.S.doc Version 5.2 Page 19 their personal care, ensuring that their needs are sensitively met. Individual plans assist staff to provide help with personal care in accordance with people’s wishes and needs. Residents make choices about what they would like to wear. Two residents spoken with had preferences regarding colour, and these wishes are respected. A hairdresser visits the home and some residents have retained their own hairdresser. One person living in the home said that they are able to choose who they would like to provide their care. Two residents commented that they had felt sad before they had moved to the home, but that the support provided had enabled them to feel in control over their lives and as one resident said ‘happy.’ Records showed that the home supports residents to access aids such as walking equipment and wheel chairs to enable them to experience independence. Contacts with physiotherapists, occupational therapists and speech and language therapists was documented in records, reflecting consultation to provide residents with necessary equipment and support, to enable them to experience independence and promote safety in day-to-day living. The manager said that when a new resident moves in a meeting is held to discuss the person’s needs and care. Staff members spoken with expressed a commitment to provide care in accordance with people’s wishes, and demonstrated in their practice a strong and effective knowledge of the needs of people living in the home. Where there is a difficulty in communicating staff members listen and respond sensitively to residents needs. The home seeks the involvement of relevant external healthcare professionals as appropriate, such as the multiple sclerosis and Parkinson’s nurse. Residents are supported to access local General Practitioner services of their choice. One resident has a preference regarding gender and this is respected. Representatives of local surgeries visit the home and residents wishing to are supported to attend local appointments. The manager expressed an awareness of people’s healthcare problems and noticing and reporting changes; she demonstrated an understanding of the needs of individuals, for example in recognising when an aspect of health may require medical intervention. Contacts with outside healthcare services are recorded on individual files, enabling conditions to be monitored. A list is maintained at the service of staff members responsible for the administration of medicines and their signatures, so that these can be identified on the Medication Administration Record (MAR) charts. All staff members undertaking the handling of medicines have undertaken training, including a distance-learning programme with a local college, according to records seen and discussion with the manager. The home uses a NOMAD DS0000003909.V311512.R01.S.doc Version 5.2 Page 20 system for administering medicines. Medications are safely stored in a locked trolley, which is secured to a fixed point when the trolley is not in use. One resident living in the home takes some responsibility for administering their medication. At present the medicines for the day are placed in time labelled pots and put in a container in a locked box, which is kept in the resident’s room. The resident is not able to take the medicines from the NOMAD system, due to dexterity problems. The resident wishes to maintain independence in administering his or her own medicines in this way. The pharmacist inspector was consulted at the time of the visit and it was recommended that the home ask the pharmacist if they can come and assess to see if suitable receptacles can be provided to enable the medicines to be made ready at the pharmacy, so that the resident can then take responsibility, according to a risk assessment, for safely administering medicines at the home, avoiding the need for staff members to dispense the medicines into pots. In the interim the manager was advised to ensure that two people sign that they have checked the medicines placed into pots. Receipts of medicines from the pharmacy are recorded on the Medication Administration Records and medicines returned to the pharmacy are detailed in a record book. At present the nurse in charge signs this. It was advised that the pharmacist is requested to sign to confirm receipt of the medicines at the chemist. Medicines for two residents were checked and most medicines detailed on the MAR chart corresponded to amounts held and efficient records had been maintained. One medicine was written up for administration in the evening, but was not marked at the pharmacy against the time for administration. The medicine had not been signed as being given, but had been removed from the packaging, which indicated that it had been given as prescribed. Another medicine was prescribed to be administered as half a tablet twice a day. The tablets had to be cut in half, but had not cut cleanly and two quarter tablets were in the bottle and an uneven half cut tablet. All other medicines checked for two residents had been given according to the prescribed instructions. The manager undertook to immediately contact the pharmacy regarding the issues and requested that the pharmacist inspector contact the home to help in setting up an auditing system, to support the safe administration of medicines. DS0000003909.V311512.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. People living at the Alexandra Centre can feel confident that staff members will listen to any issues they raise and act upon them. The current policy needs to refer to the correct registration authority to fully support this. The home has policies and procedures in place, which raise awareness of abuse, and support the protecting of people living at the service from harm. EVIDENCE: According to the pre-inspection questionnaire submitted by the home the service has received no complaints in the last twelve months. All resident survey forms returned said that people knew who to speak to if they were unhappy and knew how to make a complaint. A health and social care professional and care manager / placement officer returning comment cards said that they had received no complaints about the service. The home has a complaint’s policy, which needs amending to refer to the Commission for Social Care Inspection rather than the previous inspecting authority. The home has a complaint’s log for recording complaints received. The home has an adult protection policy, which is supported by local protocol guidelines. A copy of a flow diagram for referral of any issues of concern is DS0000003909.V311512.R01.S.doc Version 5.2 Page 22 included with the policy. Two staff members spoken with expressed an understanding of action to be taken in the event of a case of alleged abuse arising. Staff members have signed to say that they have read and understood the policy, and adult protection was referred to in records of supervision as a topic of discussion. Staff members undertake training as part of induction to the home, National Vocational Qualifications (NVQs) in Care and as part of the home’s mandatory training programme. Some training has been undertaken with local borough councils. There is a current issue of alleged adult protection. The home is acting to ensure that people living at the service are protected. DS0000003909.V311512.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is maintained, decorated and furnished to a good standard. It is clean and hygienic with appropriate aids and adaptations in place; the environment, therefore, provides a safe, homely and comfortable place for people to live. The use of an over garment by staff members when handling food will reduce the risk of infection to people in the home. EVIDENCE: The Alexandra Centre has a welcoming frontage to the building. There is a small area for parking and ramped access to the entrance. Communal areas are pleasantly decorated and comfortably furnished, providing homely surroundings. Individual rooms visited were personalised. Residents make choices about the colour schemes in their rooms and the way in which they are furnished. ‘This is just a lovely room’ said one resident. There is an assisted bathroom and shower room, both of which are spacious. Overhead hoists are fitted in some rooms, to assist, unobtrusively, with moving. Other aids and adaptations were seen in the home, which were appropriate to the needs of DS0000003909.V311512.R01.S.doc Version 5.2 Page 24 the individual, including call alarm pads and a rail to assist with standing, for one resident in their own room. There is a conservatory to the rear of the property, which opens out over a patio area, where tables and umbrellas offer pleasant seating areas in warmer weather. All areas visited were well maintained and this was reflected in records kept of routine maintenance. According to the pre-inspection questionnaire submitted by the service, and observation during the visit, new carpets have been fitted throughout the home. Progress has been made with double gazing windows. Solar panelling has been fitted and the home has carried out continuous redecoration according to the needs of the service and the wishes of people living at the Alexandra Centre. The home has a laundry to the rear of the home, which is accessed externally. The laundry is not used at night, keeping staff that work at this time safe. The home has one washing machine and one drier. Care staff members undertake all aspects of help and support, including laundry and cleaning. Appropriate hand washing facilities are located around the building. It was recommended to support good practice in relation to infection control that staff members wear disposable aprons / or suitable over garments when working in the kitchen, serving food and assisting residents with eating. DS0000003909.V311512.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Well-trained staff members enable the service to fulfil the needs and preferences of people living in the home. Residents are not fully protected by the home’s recruitment policy and procedures. Well-supported staff members, who are now receiving supervision regularly, enable residents to live in a happy, well-organised and homely environment. EVIDENCE: Residents returning survey forms said that staff always listens to them and act upon what they say. One said that this was sometimes the case and said that this was because they are independent. Staff members spoken with expressed a clear understanding of their roles and responsibilities in the home. Copies of job descriptions were seen on individual files. Staff members said they had some shared interests with residents and enjoyed taking part in and leading activities. Two staff members said that it was ‘not like coming to work.’ Residents accommodated at the home have a broad range of differing needs. DS0000003909.V311512.R01.S.doc Version 5.2 Page 26 Staff members spoken with had a perceptive and sensitive understanding of the needs of residents and what was important to them to give them a qualitative lifestyle. Staff members have clear responsibilities, for example only those members of staff who have undertaken relevant training undertake specific tasks, such as the administration of medicines. Six members of staff working at the home currently possess a National Vocational Qualification (NVQ) at level 3; four members of staff have an NVQ 2. In addition to this four members of staff are undertaking an NVQ at level 3 and one staff member is studying for an NVQ 2. There are currently twenty-one members of care staff working at the home. The service has an induction programme, which has been collated by the manager. No completed, or packs in the process of being completed were available for inspection. The manager confirmed that the staff members keep these. Assessing the Skills for Care programme and ensuring that the induction programme contains all relevant information was discussed. The Skills for Care website can be accessed at: http:/www.skillsforcare.org.uk/ This includes information regarding induction standards and there are downloadable knowledge sets and learning logs for areas of practice including: Dementia Infection Control Medication Workers not involved in direct care These knowledge sets are the first 4 of approximately 30 that are currently planned. They are designed to improve consistency in underpinning knowledge for the adult social care work force in England. They identify learning outcomes and are designed for use alongside the Common Induction Standards, which are also available from this web site. They also count as underpinning knowledge towards NVQs and link to the Health & Social Care National Occupational Standards. Two recruitment files were seen for staff members who had recently started work at the home. Both applicants had completed an application form and health declaration. There was no complete work history for either applicant. Copies of proof of identification were present on both files, including photographs. References had been taken from the most recent educational establishments attended, but not from the most recent employment, and without a work history it was not possible to ascertain if the staff members had worked with vulnerable adults previously. A requirement was made in the last report regarding the seeking of appropriate recruitment checks for staff members who had left the service, and then returned to work at the home. A staff member, who had left the service for a period of months, had completed a new application form but there was no updating reference on file. DS0000003909.V311512.R01.S.doc Version 5.2 Page 27 Although there were no individual learning plans on file, a training matrix had been completed, recording the current training status of staff members, enabling training needs to be identified and met. Copies of certification are held on individual files. The manager has started to introduce regular supervision for staff members. Records seen included discussion regarding areas of practice and training. The manager intends to expand this to incorporate philosophy of care in the home, monitoring of work with individual residents, and support and professional guidance. An annual appraisal will also be undertaken. Copies of the home’s grievance and disciplinary process and policy in relation to physical aggression towards staff were seen on individual files. DS0000003909.V311512.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A well organised home, with clear management structures, and regular consultation with people living at the service, supports the running of the home in the best interests of residents. Access to intranet and an annual development plan will support the home to plan improvements to the service and ensure that policies and procedures reflect current good practice guidelines. Good practices and procedures protect the safety and welfare of residents. EVIDENCE: Mrs Jean Rundell, the manager of the home, has many years of experience in care provision and management. She is not currently working towards the Registered Manager’s Award. Throughout the visit staff members consulted DS0000003909.V311512.R01.S.doc Version 5.2 Page 29 with her appropriately. A visiting care manager spoke highly of the service provided under Mrs Rundell’s management. Mrs Rundell demonstrated a thorough knowledge of the needs of each resident, and a good rapport was enjoyed with residents she spoke with. A happy and cohesive staff team were working in the home. People worked well together for the benefit of residents and had a clear understanding of their roles and responsibilities, under Mrs Rundell’s leadership. The pre-inspection questionnaire completed by the service includes details of policies and procedures currently in place, which support the running of the home in the best interests of residents. The service does not have access to intranet, which means that the manager and staff are limited in easily accessing good practice guidelines as well as the POVAFirst system, which gives employers the capacity to check applicants against the Protection of Vulnerable Adults list and to start employment, under supervision, pending the receipt of a Criminal Records Bureau check. Regular meetings are held in the home and minutes are kept of meetings with residents and staff members. People using the service are consulted regarding aspects of the running of the home. The outcomes of consultations conducted in August 2006 were viewed. The consultation includes all aspects of practice. A family and friends questionnaire is also used to seek people’s views. Feedback is used to plan future improvements. The manager intends to formalise this by producing an annual development plan. The home has detailed and well organised records for the routine maintenance of equipment and services in the home. The staff member responsible for maintenance takes pride in his role and the standards maintained. Details of routine maintenance carried out were provided in the pre-inspection questionnaire completed by the manager. Records were sampled for the routine checking of fire systems in the home. On the day of the visit fire training was being carried out. Completed accident records were sampled. It was recommended that records should be stored on the relevant resident or staff member’s individual file. During the tour of the environment it was noted that hazardous substances are stored out of reach of residents. Records are maintained for cleaning products in use in relation to the control of hazardous substances. Training records seen showed that staff members are updated in areas of safe working practice. DS0000003909.V311512.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 2 X 2 X 2 3 X DS0000003909.V311512.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 Requirement The registered manager must ensure that medicines are safely handled and administered; a) Medicines returned to the pharmacy must be signed as received by the pharmacist. b) The registered person must devise a system for auditing the safe handling of medicines, ensuring that there is a clear audit trail for each medicine from receipt to administration or disposal. c) Medicines must be signed for at the time of administration. d) The registered person must ensure that the required dose can be administered of tablets, which require cutting. The registered manager must operate a thorough recruitment procedure and ensure all references and statutory checks are obtained before making an appointment. (Previous timescale 31/01/06 not met.) DS0000003909.V311512.R01.S.doc Timescale for action 10/10/06 2. YA34 19 10/10/06 Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The registered person should develop full social care plans to support residents to experience a varied and active lifestyle. The registered person should amend the complaint’s policy to include the details of the Commission for Social Care Inspection. Staff members should wear disposable aprons or over garments when working in the kitchen, serving food or helping residents with eating, to reduce the risk of cross infection. The registered manager should demonstrate that she possesses, or is working towards, a management qualification, which is equivalent to the Registered Manager’s Award. The registered person should develop an annual development plan. The registered person should consider making intranet access available to the home, to support the running of the service for the benefit of residents, in accordance with current good practice guidelines. 2. YA22 3. YA30 4. YA37 5. 6. YA39 YA41 DS0000003909.V311512.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. 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