CARE HOMES FOR OLDER PEOPLE
Alexandra House 1 Narborough Road Huncote Leicestershire LE9 3AN Lead Inspector
Keith Charlton Unannounced 1 August 2005 09:30 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 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 House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Alexandra House Address 1 Narborough Road Huncote Leicestershire LE9 3AN 0116 2753669 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) Mrs Jacqueline Ann Skubala Mrs Jacqueline Ann Skubala Care Home 17 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (17), Physical disability over 65 of places years of age (7) Alexandra House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11/2/2005 Brief Description of the Service: This is a newly registered home for Older People.It is situated in the village of Huncote. There are local facilities nearby.Service users all enjoy the benefit of a single bedroom with toilet en suite. There is a choice of lounge/dining rooms and a good size garden to the rear.The Home has a friendly Labrador dog who provides companionship to service users. Alexandra House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection; the Registered Providers were present. Planning for the Inspection included reading the Pre-Inspection Questionnaire completed by the Deputy Manager and looking at the service history. There have been no complaints received regarding the home in the past year. No Comment Cards have been received from service users or relatives. The Inspection took place between 09.35 and 14.50 and included a tour of the building, inspection of records and direct and indirect observation of care practices. The Inspector spoke with six residents, one member of staff and the Registered Providers. What the service does well: What has improved since the last inspection? What they could do better:
To ensure that only service users within the categories for which the home is registered are admitted, in order to show compliance with the Care Standards Act. A cooked breakfast, could be offered throughout the week, which would offer greater choice to service users
Alexandra House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 6 A loop system could be installed this would benefit service users with a hearing impairment. Ensuring that staff read all the service users care plans and the policies and procedures would improve the service provided to service users. If policies and procedures were put in place for emergencies and crises, this would ensure that staff take the appropriate action if these instances were to arise. Ensuring that water temperatures are kept to close to 43c Fahrenheit would ensure that the risk of scalding to some service users is minimised. 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. Alexandra House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Alexandra House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 A thorough admission process means that needs are assessed prior to admission into the home, ensuring that these needs can be met EVIDENCE: The assessment form currently in use mirrors the National Minimum Standard so that all essential issues are covered. The Registered Providers said that admissions are monitored closely to ensure compatibility with existing service users. The Registered Providers must ensure that only service users within the categories for which the service is registered, are admitted as there has been the admission of a service user who is registered blind person a minor variation must be made to make this situation legal. Alexandra House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 10 Service users are treated with respect and offered choices. EVIDENCE: Service users stated that they were satisfied with their privacy and dignity being protected e.g. staff always knocked on doors before entering rooms, they could maintain their independence as much as possible as staff did not take over tasks that they could perform, they were asked as to how they would like to be addressed and that they thought that staff were friendly and respectful. Service users have the choice of going to the lounge or staying in their bedrooms. Service users also said that staff were welcoming and friendly towards visitors. Alexandra House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 Service users benefit from being provided with a quality, well-balanced diet. EVIDENCE: Service users all stated that the food was generally of good quality and that they had a choice. They appreciate when the food is home cooking from fresh ingredients (though this was not the case on the day of the inspection the Registered Provider said that these were only for a minority of occasions). A nutritional assessment tool is included in individual care plan to ensure that dietary needs are met. The Registered Provider stated that cooked breakfasts are restricted to weekend for health reasons although if service users wanted an egg this would be prepared. A service user with sight difficulties was assisted sensitively with their food and an adapted plate is provided to ensure that food did not spill. One service user requested having tripe and onions occasionally; the Registered Provider said this request would be followed up. Alexandra House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The provision of an open culture around complaints ensures that service users are confident that their concerns would be acted upon. EVIDENCE: The home has a sound complaints procedure; this has been amended to state that the complainant can go to the Commission for Social Care Inspection at any stage. No complaints have been made to the Commission for Social Care Inspection regarding the home. Service users stated that they thought that if they complained that the management would listen to them and the issue would be rectified. Alexandra House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 Service users benefit from facilities, which are well maintained and take their needs into account. EVIDENCE: Service users stated that they are very satisfied that the facilities are kept clean and tidy and that they could bring in their personal possessions. Bedrooms were inspected and found to be clean, odour free and homely with a great deal of service users own furniture, pictures, ornaments etc which made the rooms very much their own – this is commended. Lounges are also very homely and attractive; there is now a large screen TV in a lounge so that service users can watch satellite sports programmes. The Registered Provider said that the issue of installing a loop system to assist service users with hearing impairment would be again explored. Alexandra House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 Staffing levels and pre-employment checks protect the welfare of service users. EVIDENCE: The staffing levels are appropriate in order to meet service user needs. There was discussion with the Registered Provider regarding staff working sixty hours per week. The provider stated that these incidences would decrease once the occupancy levels in the home increases. Staff records were inspected and found to be largely satisfactory though there was no photo identification (e.g. copy of passport) for the two records seen the Registered Providers said this would be followed up. Alexandra House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,38 The service users and staff benefit from a well managed home. EVIDENCE: In terms of Quality Assurance there is evidence that the Registered Providers have consulted service user regarding different issues. The Registered Providers now need to publish service user and stakeholder surveys (the timescale for implementation in the last inspection report was 22/9/04) to ensure that those views are open to prospective service users. Service users are able to control their own monies if they are able to do so. The Registered Providers have a number of Risk Assessments for safe working practices but this could be widened to incorporate further risks. The water temperature was taken in a first floor bathroom, which measured 46.6.c from the bath and 48.3c from the washbasin. The National Minimum Standard recommends that it is close to 43c. The Registered Providers must ensure that
Alexandra House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 15 there is a regular recorded system to ensure that water temperatures are checked to ensure service users are not at risk of scalding. A requirement was made to deal with this situation immediately. The pre inspection questionnaire completed prior to the inspection stated that staff had received health and safety issues including moving and handling, fire, food hygiene and first aid training in the past twelve months. This was confirmed by speaking with a member of staff Alexandra House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 2 x 3 x x 3 Alexandra House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 17 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 3 Regulation 14 Requirement The Registered Providers need to ensure that service users are admitted within the categories for which the home is registered with the Commission fo Social Care Inspection. The Registered Providers must publish service user and stakeholder surveys (the timescale for implementation in the last inspection report was 22/9/04). The Registered Providers must ensure that there is a regular recorded system to ensure that water temperatures are checked to ensure service users are not at risk of scalding. Timescale for action 1/9/05 2. 33 24 1/10/05 3. 38 13 1/8/05 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. 2. Refer to Standard 15 19 Good Practice Recommendations It is recommended that service users are offered a cooked breakfast, seven days a week A loop system in lounges would assist service users with
C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 18 Alexandra House 3. 35 hearing impairment. To ensure that staff read all the service users care plans and the policies and procedures of the service. Alexandra House C51 C501 S49312 Alexandra House V241624 010805 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection 5 Smith Way Grove Park Enderby Leicestershire LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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