CARE HOMES FOR OLDER PEOPLE
Alexandra Court 110 Victoria Road East Thornton Cleveleys Lancashire FY5 3SZ Lead Inspector
Mrs Christine Marshall Unannounced Inspection 16th January 2007 11:30 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 Court DS0000066787.V327619.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 Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Alexandra Court Address 110 Victoria Road East Thornton Cleveleys Lancashire FY5 3SZ 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) 01253 853645 01253 827397 Maria Mallaband Care Group Limited Mrs Cynthia Margaret Underwood Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Alexandra Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service is registered to accommodate a maximum of 37 service users in the category of older people (OP) Date of last inspection Brief Description of the Service: Alexandra Court is a unique care establishment in that it provides 34 individual apartments, each with its own lounge, kitchenette, bathroom and bedroom. There is a spacious communal lounge area, conservatory and communal dining area, all of which are furnished and decorated to an extremely high standard. The building is set in its own very well maintained grounds and provides parking to the front area for staff and visitors. The home is conveniently located for local facilities and amenities, including a library and bowling green, which are within comfortable walking distance. Care is provided on a 24-hour basis including waking watch care throughout the night. The service has changed owners and it is now part of the Maria Malliband Care Group. The registered manager is Mrs Cynthia Underwood. At the time of this visit, (16/01/07) the information given to the commission showed that the fees for care at the home were from £495 to £550 per week, with added expenses for hairdressing, chiropody and newspapers. Alexandra Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of Alexandra Court included a site visit to the home that was done between late morning and mid-afternoon; the visit was unannounced, which means that the owners, staff and residents did not know it was taking place until the inspector arrived. Time was spent sitting and talking with people who use the service, alongside their relatives, and observing the day-to-day routines of the home and care staff, as they provided support. A tour of the home included looking at apartments, lounges and dining areas, kitchen and laundry rooms. This was to assess whether the home provided a comfortable, homely environment for the enjoyment of everyone, and to ensure the residents’ safety. Comment cards were given out at the home for residents and relatives to fill in; fourteen were returned, and generally showed a good level of satisfaction with the care at the home. Resident’s were spoken with and their comments included – “It’s lovely here.” “I have been here two years and I wouldn’t want to be anywhere else.” “I have a lovely apartment and I am very happy.” A visiting relative said that they were happy with everything at the home and had no complaints to make. A visiting GP commended the home. Discussions took place with the area manager Nicki Donaldson and registered manager Cynthia Underwood. Care staff were also spoken with and administration records were looked at. Everyone at the home was friendly, welcoming and co-operative throughout the visit. Alexandra Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
Care plan systems are in the process of being changed and those that have been completed are a great improvement from the old system. Care is now reflected in the written records. The completion of this system change is planned over the next six months. Alexandra Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 7 Residents and their relatives have benefited from meetings with the new owners and manager and regular resident meetings have been held since the change in April 2006. Staff recruitment procedures now make sure that all pre- employment checks are followed so that the residents are protected. Induction and training records for each member of staff have now been completed fully to make sure that residents’ are cared for by appropriately trained and competent carers. 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 Court DS0000066787.V327619.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 Court DS0000066787.V327619.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): Standards 2 & 3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides more than enough information about their service, and gathers good information about prospective residents, so that their needs can be met. EVIDENCE: The home provided contracts of care for each resident and these were seen; four residents were asked if they had a written contract of care and each said that they had.
Alexandra Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 10 The pre-admission assessments were looked at for the most recently welcomed residents and these were completed extremely well; they were very comprehensive and included all aspects of physical, social and psychological care, making sure that the prospective resident’s strengths and needs were identified, and that the home could provide the care that was needed. These assessments were done by the manager Mrs Underwood, and agreed by the resident and/or their family. Three residents were asked if they had been visited before going into Alexandra Court and confirmed that they had been assessed before entering the home. Generally all residents were assessed by the same tool, thus promoting equality of assessment and care provision. These assessments were extremely good. Alexandra Court DS0000066787.V327619.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): Standards 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. The residents health and social care needs were met and people were treated with dignity and respect at this home. EVIDENCE: Care plans are written records that describe the care that is given to each resident. A new system is being introduced and the completion of this changeover is planned for the next six months. Three of these were looked at and found to be very informative and individual. All aspects of care had been considered, including a good social history. Residents saidy that they knew about their care plans.
Alexandra Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 12 Residents said that they had the GP of their choice and that they had regular visits to the chiropodist, dentist, optician and also hearing aid services. A chiropodist called during this visit. The medication policies and procedures make sure that the residents are safe. Senior carers are trained to give out medicines, which is done through the Nomad system; this is where daily doses of tablets are put in a cassette and popped out when it is time to take them. Residents who take responsibility for taking their own medicines sign a disclaimer for this. The medication system was looked at and found to be satisfactory. Some general advice was given to the manager and the senior carers, who also give out the drugs, about double signatures on any hand-written instruction on the medication records. This advice was readily accepted by all. The residents were seen to be treated with respect, privacy and dignity, and there were good personal interactions between residents and carers. All residents hold the locks to their apartments and their privacy is an integral part of the care that is given in this establishment. Alexandra Court DS0000066787.V327619.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): Standards 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 residents benefit by being supported, so as to promote the quality of their daily lives. EVIDENCE: The residents at Alexandra Court live very independent lives and are mostly able to pursue their interests and activities. However three residents indicated that they would like more communal activities and the manager is now making every endeavour to facilitate this. There is a full choice of breakfast and morning tea or coffee with biscuits: The carers visit each resident every day to take their order for the following day’s midday meal.
Alexandra Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 14 On the day of the visit, the midday meal looked very appetising. There is equality of choice for every resident and any preferences that are requested are catered for, for example vegetarian and diabetic food. The evening meal also offers full choices, with afternoon tea and suppers available. The residents said that the food was “good”, “very nice” and “nicely presented.” One resident said that she had a restricted diet and would like more variation; this was passed on to the manager, who readily agreed to visit the resident and discuss the menus. The dining room was very light and very well furnished and the mealtime was relaxed and unhurried, with the carers helping discretely when needed. Alexandra Court DS0000066787.V327619.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): Standards 16 & 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents benefit by being supported and protected. EVIDENCE: There are policies and procedures in place for complaints, whistle-blowing and adult abuse issues, and the three members of staff on duty staff said that they were aware of these. There have been no complaints either to the home or to the Commission for Social Care Inspection. The residents were asked if they knew about the complaints procedure and who they would speak to if they were unhappy; each of those spoken to said that they knew about the procedure and who to speak to; however they insisted that they had no complaint to make at all. All staff had undertaken elder abuse awareness training and three members of staff confirmed this.
Alexandra Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,20,21,22,24 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents were provided with an extremely comfortable environment and all apartments were very personalised. This means that residents feel at home with their belongings around them. EVIDENCE: A tour of the home showed that the general environment was exceptionally well furnished. Alexandra Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 17 There was equal access to all areas of the home for residents and visitors with mobility problems, in that there are wheelchair ramps and a passenger lift in place. There was an abundance of aids and adaptations in place in each apartment, to help with the residents’ toilet and bathing needs. There was also a general communal shower room. All of the residents that were sppoken to said that they were happy with their apartments, and that they were kept exceptionally clean and hygienic. The laundry area was very clean and hygienic, and each resident had their own laundry done separately. This is commendable. Policies are in place for the prevention of any cross infection and staff said that they knew about this. Alexandra Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. The residents care needs were met through adequate staff provisions who were appropriately recruited and trained. EVIDENCE: Staff recruitment files were examined and contained the records that are required under Schedule 2 of the Care Homes Regulations; this showed that all staff must be put through rigorous employment checks before they start to work at Alexandra Court. Staff induction and training records that were examined were fully completed. Staff said that they had been given induction and mandatory training and were confident that they had the knowledge that they needed to do their job.
Alexandra Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 19 Training dates for up-dates on fire safety have been arranged for all staff. Staff went about their duties quietly and efficiently and said that they were encouraged to be proactive in improving the quality of care that was provided at the home. The residents said that they were very happy with the staff and the care that they received. The National Vocational Qualification (NVQ) levels remain below the necessary 50 . However, the manager is now in the process of enrolling three more members of staff on an NVQ programme and this should then bring up levels to 50 . Alexandra Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. The residents were supported and there were quality systems in place to make sure that they were protected. EVIDENCE: There was a quality monitoring system in place (Investors in People) and the area manager said that there were plans to work toward an organisational quality standard.
Alexandra Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 21 The results of a recent quality survey were posted on the notice board near the reception. The area manager visits the home very regularly and provided reports every two months that are sent to the commission. Staff said that they had regular meetings and minutes of these were seen. All health and safety checks were done. The home did hold some personal monies for residents and records of this were kept. Current safety servicing certificates were in place, making sure that the residents were in a safe environment. Alexandra Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 4 4 4 4 4 4 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 Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 1 Refer to Standard OP7 OP28 Good Practice Recommendations The new care plan system should be completed and implemented according to plan, by July 2007. 50 of care staff should complete National Vocational Qualification (NVQ) level 2 as soon as possible. Alexandra Court DS0000066787.V327619.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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
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