CARE HOME ADULTS 18-65
Alexandra Centre For Physical Disability & Sensory Impairment 23 Howard Road Queens Park Bournemouth BH8 9EA Lead Inspector
Gill Kennedy Unannounced 27 June 2005 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 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 Stationary 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 Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Alexandra Centre For Physical Disability & Sensory Impairment 23 Howard Road, Queens Park, Bournemouth, Dorset, BH8 9EA Address Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 528420 01202 528420 Care Services (Bournemouth) Ltd trading as Alexandra Centre For Physical Disability & Sensory Impairment Mrs Sylvia Jean Rundell CRH 14 Category(ies) of PD - 14 registration, with number SI - 14 of places Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Day care provision for a maximum of 5 service users in the category PD. One named service user (name known to CSCI) in the category PD(E) residing at the Centre. Date of last inspection 10 March 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 PH category. Two bedrooms are registered as doubles but only one 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 assessed via a ramp for wheelchair users. The home is located in a quiet residential area but close to all local amenities. 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. Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection had been conducted as part of the normal inspection process legally required. Mrs Rundell, the registered manager, was available throughout the inspection and Mr Nathoo, the proprietor, was present for part of the inspection. Both were helpful and co-operative and were available to answer questions and provide documentation as needed. The files of three residents were read during this inspection. Three residents were spoken to in private. One visitor was also interviewed in private. Three staff files were inspected and two staff spoken to. A selection of bedrooms and the communal areas plus the laundry were seen during this inspection. The time taken on this inspection was 7 hours, and 11 standards were inspected. The terms resident and service user used in this report are interchangeable. What the service does well:
The home provides a friendly and informal setting for residents. Two residents commented on the welcome they had been given by Mrs Rundell when they moved into the home and this had made a big impression upon them. The residents compared the Alexander Centre favourably with experiences they had in other homes and one person said ‘This is the home for me’. This resident went on to say he/she felt treated as an individual and had implicit trust in the manager who was approachable and would sort out any concerns residents may have. The other residents spoken to and a visitor to the home shared this view. Residents feel able to make decisions for themselves and air their views in regular residents meetings. They are able to pursue the lifestyle they choose and personal support is offered to them in a sensitive way by caring staff. The home was found to be clean, comfortable and well maintained, providing a pleasant environment for residents. Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 7 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 Standards Statutory Requirements Identified During the Inspection Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 8 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 standard(s) None of these standards were assessed. EVIDENCE: Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 9 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 standard(s) 6,7, and 8 There was little to indicate that service users had been actively involved in drawing up their care plans. Residents felt able to make decisions for themselves and seek support from staff when needed. Systems are in place for residents to express their views and influence aspects of life in the home. EVIDENCE: Since the last inspection Mrs Rundell has been working hard to re-write care plans and there is a variety of risk assessments covering nutrition, moving and handling and so on. However, to become more service user focused there needs to be active involvement of residents in their care planning where practical. One resident whose records had not yet been updated was surprised to learn that information dating back several years had not been changed on his/her care plan. Further progress on the new care plans can be assessed at the next inspection. Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 10 Residents regarded the Alexander Centre as their home and feel able to come and go as they wish. Routines are seen as flexible, for example service users feel able to have a bath as frequently as they chose, one person had asked for his/her evening meal to be served later and this was arranged. Evidence was seen of regular residents meetings as Mrs Rundell keeps informal notes of each meeting. Instead of providing written minutes outlining actions that need to be addressed she finds it more productive to have face-to-face contact with residents about how any issues will be progressed. Residents confirmed that they appreciated this approach and felt fully involved in the decisions that have been reached. Of the three CSCI comment cards returned one person said they would like to be more involved with decision making in the home. Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 11 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 standard(s) 13,15 The home is active in helping residents to be part of the local community as a way of enhancing their social contacts. Visitors are welcomed into the home and residents encouraged to have fulfilling personal relationships. EVIDENCE: The day before the inspection a garden party had been arranged involving the Mayor. This had been a great success and residents had enjoyed the day and being involved in the preparations prior to the event. Residents expressed pleasure at the amount of money they had raised to contribute to their social fund. One resident spoken to was also actively involved in organising the Shop Motability Scheme at two shopping centres. There is open visiting in the home and a visitor spoken to said she is always made welcome and sees her relative in private. One resident said ‘ we are all one big family’. Mrs Rundell explained that residents could be supplied with a fold up bed if they wished to have a visitor stay in their room and there was space for this, although two residents spoken to appeared unaware that this was possible. All residents spoken to confirmed that visitors were made welcome and offered refreshments.
Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 12 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 standard(s) 18,20 Support is offered to residents in a way that meets their needs. Any residents who are self medicating would have a risk assessment. EVIDENCE: Residents felt that personal care and support was provided to them in a sensitive way. Mrs Rundell said that thought would be given to gender issues in relation to personal care being supplied and this was confirmed in discussion with one service user who said female staff always provide personal care. Another resident said she always selects what she wishes to wear and staff give any assistance that she needs. Standard 20 was not fully assessed. There are currently no residents who are self medicating. Mrs Rundell is in the process of updating one resident’s care plan that is out of date and still indicates this person is self-medicating. Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 13 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 standard(s) 22,23 Residents are confident they can express their views which will be respected and where necessary action will be taken. Whilst there are some systems in place to protect residents from abuse, employment policies and practices are not sufficiently robust and could place residents at risk. EVIDENCE: It was clear from talking with residents that if they had any concerns or complaints they would feel confident in approaching Mrs Rundell, who they find accessible and a good listener who would act quickly to deal with their concerns. One resident gave an example of action that had been taken when he/she felt talked down to, and was pleased with the way the matter had been dealt with. The residents spoken to and those who replied to the CSCI comment cards said they felt safe and well cared for in the home. There are policies and procedures in place to protect residents. Both members of staff interviewed indicated they would act appropriately if they had any concerns about service users welfare, although one staff member was not aware of the Whistleblowing policy. Eight staff who had been doing NVQ’s had a section on abuse issues as part of their evidence for study and there has been some in house training, although the training record indicates that this needs to be updated. Currently there are poor employment policies and practices and this is covered in more detail in Standard 34. Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 14 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 standard(s) 30 The home was found to be clean with no unpleasant odours. EVIDENCE: There are policies for the control of infectious diseases and staff confirm that they are supplied with suitable equipment to perform their tasks safely. The laundry is appropriately situated and there are sluicing facilities on the washing machine that washes at a minimum of 65oC to control the risk of infection. A tour of the communal areas in the home and of some bedrooms demonstrated that the home was clean and hygienic. Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 The homes recruitment policy needs to be updated to reflect the checks and balances that must be in place before staff are appointed to ensure the protection of residents is paramount. EVIDENCE: The files of three staff were read. In only one case was a CRB check in evidence. Mrs Rundell acknowledged that ten of her staff did not have CRB checks, some having been employed after July 2004 when all new staff should be checked on the POVA*first list as a minimum prior to starting work. As this is an issue that has been highlighted on previous inspections an immediate requirement was made and Mrs Rundell said she would ensure obtaining these checks was a priority. *Protection of Vulnerable Adults. Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Generally, systems are in place to ensure the welfare of service users. However, fire training and moving and handling training must be kept updated to protect residents at all times. EVIDENCE: Records were seen to indicate that equipment was regularly serviced and there was regular testing of services provided in the home. For example, yearly testing for Legionella and there is an up to date electrical certificate on file. It was confirmed that all water outlets are thermostatically controlled and evidence was seen that water temperatures are regularly monitored. Discussions with care staff confirmed that they record water temperatures and were aware that 43oC was the recommended temperature for bath water. A maintenance manager assumes responsibility for staff fire training and since the last inspection he has developed a comprehensive list that indicates at a glance the position regarding staff fire training. During discussion on the
Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 17 inspection it was accepted that all staff who cover night duties must have fire training on a three monthly basis and the registered persons confirmed this would be done. Eight care staff will need training within the month to keep to this timetable. Whilst the majority of staff had current moving and handling training the home’s training record indicated that there were five staff who did not. Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 3 x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x x x 3 Standard No 11 12 13 14 15 16 17 x x 3 x 3 x x Standard No 31 32 33 34 35 36 Score x x x 1 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Alexandra Centre For Physical Disability & Sensory Impairment Score 3 x x x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 19 YES Are there any outstanding requirements from the last inspection? 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 23/34 Regulation 19(4)(b)S chedule Requirement The registered person must operate a thorough recruitment procedure base on equal opportunities and ensuring the protection of service users. It is required that the registered person ensures all staff employed have completed a CRB check. (Timescale 26.03.04 not met.) All staff employed after the 26th July 2004 must also have a POVA first check as a minimum before starting work. All care staff must have an enhanced CRB check. The home must be able to demonstrate that all care staff have current moving and handling training provided by an appropriately qualified person. Timescale for action Immediate 2. 42 13(5) 31.07.05 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 6 Good Practice Recommendations Work should continue on care plans involving residents or
D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 20 Alexandra Centre For Physical Disability & Sensory Impairment their representatives in drawing up the plan and making it readily available to them. Alexandra Centre For Physical Disability & Sensory Impairment D55 S3909 Alexandra Centre V215506 270605 Stage 4.doc Version 1.20 Page 21 Commission for Social Care Inspection 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
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