Inspection on 26/02/09 for Alexandra Court

This inspection was carried out on 26th February 2009.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Alexandra Court 16/01/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Random inspection report Care homes for older people Name: Address: Alexandra Court 110 Victoria Road East Thornton Cleveleys Lancashire FY5 3SZ three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Marie Cordingley Date: 2 6 0 2 2 0 0 9 Information about the care home Name of care home: Address: Alexandra Court 110 Victoria Road East Thornton Cleveleys Lancashire FY5 3SZ 01253853645 01253827397 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Maria Mallaband Care Homes (2) Limited care home 37 Number of places (if applicable): Under 65 Over 65 37 old age, not falling within any other category Conditions of registration: 0 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 37 Date of last inspection Brief description of the care home 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. Care Homes for Older People Page 2 of 13 Brief description of the care home 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. Care Homes for Older People Page 3 of 13 What we found: Choice of Home We viewed a selection of assessments and were able to confirm that they had been completed prior to the residents moving into the home. This means that the manager can be sure that the persons needs can be met at the home and also means that carers have enough information to provide the right care from the point that the resident is admitted to the home. The assessments were comprehensive and covered all areas of daily life such as mobility, personal care and health care needs. Assessments also addressed peoples social care needs and included a social history, with details of peoples previous employment, hobbies and valued relationships. A Service User Guide is provided to anyone who is considering a move to the home. This document includes a variety of useful information including the facilities available, fees charged and arrangements for areas such as mealtimes and activities. We were able to confirm that the Service User Guide is currently available in large print as well as a standard written format. We made a recommendation that the guide be made available in additional formats such as audio to ensure that everyone has equal access to the information. Health and Personal Care As part of the visit a pharmacist inspector checked how medicines were being handled. We looked at medicines records, medicines stock, peoples care plans and observed part of the morning medicines round. We found medicines stock to be secure and the records to be generally well organised. Records of medicines received, given to people and disposed of were usually complete and accurate and there was a clear system in place for controlling medicines stock that made it simple to fully account for them. We observed part of the morning medicines round and saw best practice was not always being followed because staff were signing the records before people had taken their medicines. This could lead to incorrect and messy records if people then refuse or do not require their medicines. We also saw the use of a runner to give the medicines, this is not recommended because it could lead to medicines being given to the wrong person. The manager said that the medicines were done in this way to help speed things up but agreed that it was not best practice and she would make sure these procedures were put right immediately. We checked a sample of blistered medicines and found they usually added up showing they had been given to people correctly. However, when we checked some medicines contained in traditional boxes and bottles we found some mistakes that showed some medicines had been given at the wrong dose or missed completely. One medicine that is used to prevent stomach ulcers was missed on several occasions for three residents Care Homes for Older People Page 4 of 13 and another medicine used to help a persons breathing was missed on at least three occasions. The manager agreed that the medicines had been missed and said that she would review the way the records were arranged and carry out some observations of staff when giving medicines to help make sure these medicines would not be missed in the future. We found the general stock of medicines to be securely stored and a suitable fridge was available for cold storage. We found some old stock that had been kept and used as general stock for all and the manager said that some bottles of medicines were being shared to help save space. Medicines prescribed for one person must not be given to other people because it is against the law and could lead to serious mistakes. We looked at the times medicines were given and although the records stated the correct time to take them this was not always being followed. A current course of antibiotics was being given with food instead of before as was a medicine to treat high blood pressure. Giving medicines at the wrong time can stop them working properly. We looked at a sample of care plans and records to check if medicines and peoples health care needs were properly reflected in them. One person that was being supported with their diabetes medicines did not have enough information in their care plan to say how staff were to do this. The manager agreed that the care plan lacked enough detail and also agreed that more input was needed by the district nursing team to help make sure the care staff have the necessary skills to do it safely. We looked at how people who were looking after their medicines were supported. Whenever possible people were helped and encouraged to look after their own medicines to help retain some of their independence. However, we found the paperwork to support this was not detailed enough. No formal risk assessments had been carried out and no care plans had been developed to say how much and what type of support was needed to help people manage their medicines safely. We saw suitable paperwork to support this but it had not been completed. The manager agreed that this should be done as soon as possible and that regular reviews should be carried out to help make sure peoples changing needs are fully met. We checked how controlled drugs (medicines that can be misused) were handled. A cupboard was used for storage but this was not properly attached to the wall so it did not meet the requirements of the law. At the end of the visit we gave advice to the manager on how to put this right. A special register was used for record keeping and this was usually completed correctly. Having secure storage and witnessed records helps prevent the misuse of controlled drugs. We looked at how medicines were checked and how care staff were trained to give medicines safely. All carers had attended formal medicines handling training in the past but the manager said that staff were not formally observed when giving medicines out. Regular competency assessments on staff should be carried out to make sure they are handling medicines safely and to make sure they are following best practice. The manager said she carried out regular checks of the medicines and that the area manager came and checked the medicines on a monthly basis but no records of this were available. Formal recorded audits of the medicines help make sure medicines are being given to people correctly and help make sure staff have the necessary skills to handle medicines safely. We viewed a selection of care plans and found these to be of a generally good Care Homes for Older People Page 5 of 13 standard. Peoples care plans described their daily care needs and the action required by carers to meet their needs. There were examples where people had been given the opportunity to be involved in their own care planning and say how they would like their care to be provided. We viewed a care plan of one resident who had developed some complex needs during her stay at the home. Whilst the residents more complex needs were stated in her plan we noted that guidance for carers in relation to these needs was quite limited. We spoke with the manager and recommended that the care plan be developed to give carers more detailed guidance. This would help them approach challenging situations consistently and confidently. We found evidence that the home provide a good level of preventative care to help ensure that people dont develop pressure sores. However, we saw one example where a risk assessment showed that a resident was at risk of developing pressure sores but there was no specific care plan in place to address this. Whilst we were satisfied that the resident had received adequate care in this area, we made a recommendation that when people are assessed as being at risk of developing pressure sores, an individual plan is put in place as part of their care plan. Daily Life and Social Activities People who live and work at the home told us that there were a good variety of activities made available on a regular basis. One resident told us There is always something going on, we do some very pleasant things. We viewed care plans of several residents and found that their social needs had been addressed. Peoples hobbies and preferred activities were stated as well as the support they needed to engage in their valued pastimes. Carers told us that staffing levels were adequate and that there were usually enough carers on duty to spend time with people on a one to one basis. One carer said Its nice to be able to sit down and have a chat with the residents sometimes. The majority of people we spoke with were very complimentary about the quality and variety of meals served. One resident said The food is always excellent, and another said I have never had cause for complaint about the food at all. However, one resident told us that she sometimes felt the standard of food varied. This comment was fed back to the manager. We viewed the care plan of one resident who had been very underweight on admission and had been assessed as being at high risk of becoming more under nourished. It was pleasing to see that this person had gained almost one stone in weight after living at the home for a few months. Complaints and Protection The home has a clearly written complaints procedure in place. In discussion with the manager we were advised that the complaints procedure can be made available in large print. We made a recommendation that the procedure be made available in other formats such as audio, so that everyone has equal access to the information. Care Homes for Older People Page 6 of 13 People we consulted told us that they felt the manager was approachable and most people said they would be comfortable in raising any concerns they had. Records showed that the home had not received any complaints in the last twelve months and the Commission had not received any concerns or complaints either. Training records confirmed that the majority of staff had been provided with training in safeguarding and whistle blowing. Those who had not received the training were due to undertake it. Environment We carried out a tour of the home and found that residents are provided with an excellent standard of accommodation. Each resident has their own self contained flat which includes a lounge, small kitchen, bathroom and bedroom. In addition, all residents have their own telephone and front door bell which rings directly to their flat so that they can receive their visitors independently. We found that all the communal areas of the home were very well maintained and nicely furnished. In addition, all the areas we viewed were clean, warm and comfortable. Staffing Prior to this random inspection we completed an Annual Service Review of the home. As part of this process we wrote to a selection of staff and asked them to take part in a survey. We received a very good response to the survey and people told us that they received the support they needed to carry out their jobs well. During our visit we noted that staffing levels were appropriate to meet the needs of residents and this was confirmed by residents we spoke to. We looked at the personnel file of one staff member and found that the home had followed careful procedures when recruiting them. Such procedures included background checks such as employment references, proof of identification and Criminal Records Bureau disclosures to help ensure the safety and wellbeing of people living at the home. We looked at training records that showed all carers are provided with training in the key health and safety areas such as moving and handling at the start of their employment. However, there was no evidence that training in areas such as working with people with dementia was offered as standard practice. We made a recommendation that training be reviewed to include additional areas such as this. We were able to confirm that well over half of the carers at the home hold National Vocational Qualifications in care at level 2 or above. Management and Administration Prior to this random inspection we carried out an Annual Service Review. As part of Care Homes for Older People Page 7 of 13 this process we asked the manager to complete a comprehensive self assessment exploring all aspects of the service provided. This self assessment was returned to us within agreed timescales and included a good level of information. The self assessment also confirmed that the manager had processes in place to monitor quality and constantly develop the service. People we consulted told us that the manager of the home was approachable and always on hand to offer guidance and support. Throughout our visit we found the manager to be cooperative and helpful. There is a health and safety policy in place at the home which is supported by a number of separate procedures including fire safety and infection control. We were able to confirm that health and safety procedures are constantly reviewed and updated. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 13 Care Homes for Older People Page 9 of 13 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 13 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The controlled drugs cupboard must be properly attached to the wall. This is to help prevent mishandling and misuse of controlled drugs. 31/03/2009 2 9 13 People must receive their 31/03/2009 medicines as prescribed and at the correct time and dose. This is because receiving medicines incorrectly can seriously affect a persons health and wellbeing. 3 9 13 There must be suitable 31/03/2009 procedures and paperwork in place for people who manage their own medication. This is to help ensure that people receive the support they need to manage their medicines safely. Care Homes for Older People Page 11 of 13 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Service User Guide should be made available in a variety of different formats so that everyone has equal access to the information. Increased guidance should be included in the care plans of people with complex needs so that carers have the information they need to provide the right level of care. Where residents are assessed as being at risk from developing pressure sores an individualised plan of care in relation to this area should be implemented. The complaints procedure should be made available in a variety of different formats so that everyone has access to the information. The core training programme for carers should include additional areas such as caring for people with dementia. This is to help ensure that carers have the skills to carry out their roles well. 2 7 3 8 4 16 5 30 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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