CARE HOMES FOR OLDER PEOPLE
Alexandra House 2 - 4 Lord Street Southport Merseyside PR8 1QD Lead Inspector
Mrs Margaret Van Schaick Unannounced Inspection 1st March 2006 09:20 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 House DS0000017218.V280760.R01.S.doc Version 5.1 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 House DS0000017218.V280760.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Alexandra House Address 2 - 4 Lord Street Southport Merseyside PR8 1QD 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) 01704 543715 01704 543828 BEN - Motor & Allied Trades Benevolent Fund Mrs Sharon Louise Watson Care Home 56 Category(ies) of Old age, not falling within any other category registration, with number (56), Physical disability (6), Terminally ill (5) of places Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Service users to include up to 56 OP and up to 5 TI and up to 6 PD Maximum no. registered - 56, of which up to a maximum of 28 PC (personal care) and up to a maximum of 28 N (nursing). The service should employ a suitably qualified and experienced manager who is registered with CSCI Room 208 to be temporarily registered as a nursing bed Date of last inspection 3rd August 2005 Brief Description of the Service: Alexandra House (BEN - Motor and Allied Trades Benevolent Fund) is a registered care home run by a charitable organisation. The registered manager is Mrs Sharon Watson. The home provides 56 places for nursing, residential and palliative (terminal) care residents. Included in this number the home can accommodate up to 6 young physically disabled. Respite care is offered for up to 5-6 non-residents a week. The home is situated in the town centre close to local amenities including shops, churches, cinema, pubs, restaurants and public transport. Alexandra House is a large 5-floor building and consists of 3 units. The nursing unit has 28 beds (including 6 for the young physically disabled); the residential unit has 28 beds and palliative care unit 5 beds. There are 52 single rooms and 2 double rooms; there are no en-suite facilities. 6 of the residential rooms on the top floor are small flats. They have cooking facilities and as the needs of the residents change, the rooms will be converted in to standard residential rooms. All areas of the home are accessible by the use of a lift, stairs, chairlift on the residential unit and ramp for wheelchairs at the main front entrance. The home has suitably adapted bathrooms and a very good standard of equipment to assist those who are less independent. Residents’ benefit from a therapy room, hairdressing salon, their own laundry room and a chapel to worship. A call system with an alarm facility operates throughout the building and the home is subject to an ongoing programme of maintenance and redecoration. Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over one day and lasted 8 hours. This was the second unannounced inspection carried out this year as part of the regulatory requirement for care homes to be inspected at least twice a year. As part of the inspection process some areas of the home were viewed including residents bedrooms. Care records and other nursing home records were inspected. Discussion took place with the registered Manager, deputy Manager, domestic services Manager, assistant care Manager and administrative clerk and one to one interviews with a registered nurse, a physiotherapy aide and one care staff. Several residents were also spoken with. Two of the residents were interviewed on a one to one basis and one other resident and their visitor were interviewed in privacy also. This enabled the inspector to gain their views on how the home is run. What the service does well:
Alexandra House is a care home that is run for the benefit of the residents who live there. Following discussion with residents it is apparent that they feel that they are very involved in what is going on in the home, which gives them a sense of belonging. Without exception residents spoken with were very complimentary about the staff and management at the home. One resident commented, “staff are very, very pleasant, I’m very happy with the new matron, Jan (deputy) is excellent, she is particularly cheerful, they are a good team together”. Residents were also particularly pleased with their surroundings and felt very comfortable. Residents’ comments include “it’s five stars” and “I’m very happy about living here, we are well looked after, it’s nice and warm and cosy”. Care files are well maintained and evidence regular reviews of care with residents interviewed confirming their health care needs were met effectively and professionally. Residents are able to live their lives as they please with staff enabling residents where needed to exercise their choices. One resident stated, “we go out when we wish and come and go as we please”. The home ensures any minor concerns residents raised are investigated and resolved, which is recorded in the ‘grumbles book’. This is good practice and evidences residents views are listened to. Residents who attend the residents Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 6 meetings commented “they are very good, you can complain, bring things out into the open and we keep in touch with everything”. The home has an ongoing plan of improvement and areas viewed showed a high standard of cleanliness, furnishings and decoration, which ensures residents, are living in a comfortable and well-maintained environment. Residents’ comments included “it’s spotless, you couldn’t ask for a cleaner home” and “I’ve brought in lots of my furniture and my room is lovely and personalised”. The home is motivated to providing a good standard of training, which ensures staff are qualified to meet the residents needs. One resident stated, “the care is excellent”. One staff member stated “the training has been very good”. The home has exceeded the standard expected for a minimum of 50 of care staff to be trained to NVQ level. At present the level in the home is 72 . Through discussion with palliative care staff it is apparent that they have confidence in their ability to meet the residents needs. Staff interviewed stated “the training has been very good”, our GP’s are very supportive to our unit and we have plenty of equipment to support the unit”. Quality assurance measures are in place to ensure residents’ views are listened to and action taken where necessary. Through discussion with residents it is apparent that many attend the regular residents meetings where they are able to participate. The inspector viewed the minutes of the most recent meeting. Detailed financial records are kept to ensure residents are protected. What has improved since the last inspection? What they could do better:
Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 7 The residential unit need to ensure two staff signs all medication returns. Staff files need to be updated to evidence most recent training. 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 DS0000017218.V280760.R01.S.doc Version 5.1 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 House DS0000017218.V280760.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed as Standards 2 and 3 were met at the previous inspection. Standard 6 is not applicable. EVIDENCE: Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 7,9 Care files are well maintained and evidence regular reviews of care with residents interviewed confirming their health care needs were met effectively and professionally. EVIDENCE: Standard 7 was met at the previous inspection and recommendations regarding the key worker system have been carried out. Key workers are now documenting their input in care file records. Three residents care files were viewed. One care file was selected from palliative care, residential care and nursing care. Care plans evidenced care needs/problems with individual care planned and outcomes in place. The care plans showed regular reviews and updates with dates and signatures in evidence. Care files evidence baseline observations, regular nutrition scores, waterlow assessments (tool for measuring pressure risk) manual handling assessments with hoist and sling used identified, signed resident agreement, GP visits and other multi disciplinary team visits, weight, daily reports, risk assessments and self medication agreements in place. Aberdeen (medication) records were checked on the residential floor and records show fairly good housekeeping. Isolated missing signatures were evident. With regard to medications that are prescribed as one or two tablets to be given, there is not enough space below each staff signature to show if
Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 11 one or two items are administered during medication rounds. The home should contact the pharmacy to arrange that this be amended so that staff are able to identify if one or two medications are given. Auditing of these medications would be made easier also. The medication returns need to be witnessed with two staff signatures in place as discussed. Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 14,15 Residents are able to live their lives as they please with staff enabling residents where needed to exercise their choices. EVIDENCE: Residents interviewed stated that they were able to personalise their bedrooms with small items of furniture, ornaments and photographs. During the inspection process the inspector was able to (with residents permission) view some of the bedrooms, which showed homely surroundings individual to the residents who lived there. Residents also stated “I like living here, with my own furniture, it’s nice and warm and cosy”. Another resident stated “ I have brought lots of my furniture with me and my bedroom is lovely”. Residents interviewed stated, “we have regular residents meetings, which are very good, you can complain, bring things out in the open”. “We keep in touch with everything that’s going on, it’s easy to talk with the new managers, and they are very good”. One resident stated, “we go out when we wish, come and go as we please”. Staff interviewed also confirmed that residents are able to have choice in how they manage their lives. One of the residents interviewed stated “I wash my own clothes in our residents laundry and I don’t use the hairdresser here, I go out to my own hairdresser”. One resident stated
Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 13 “five of us went out to a local café for breakfast, with help from some of the staff”. Advocacy information is available to residents where needed. Standard 15 was assessed and met at the previous inspection but one of the residents had commented, “they would like more home cooked puddings”. This has been addressed and the new menu format evidences additional home baked puddings. Residents interviewed confirmed this. Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 16 The home ensures any minor concerns residents raise are investigated and resolved, which is recorded in the ‘grumbles book’. This is good practice and evidences residents views are listened to. EVIDENCE: Standard 16 and 18 were assessed and met at the previous inspection. A discussion took place at the previous inspection with regard to the residential unit commencing a ‘grumbles book’, which has been implemented. The book was viewed and evidences minor issues raised by residents, which are addressed and resolved to their satisfaction. Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 19,25 The home has an ongoing plan of improvement and areas viewed showed a high standard of cleanliness, furnishings and decoration, which ensures residents are living in a comfortable and well-maintained environment. EVIDENCE: Standard 19 was assessed and met at the previous inspection but a recommendation was made to include bedroom 208 in the decoration programme. This has been carried out. Standard 25 was also assessed at the previous inspection with one requirement raised to fit a window restrictor to the bedroom window in room 207. This requirement has been carried out also. During this visit the inspector viewed many areas of the home including a few of the residents bedrooms. The home has a high standard of cleanliness throughout the areas viewed including public areas and the therapy department. Residents were also very pleased with the high standards of cleanliness in the home. Residents’ comments included “the home is spotless, we couldn’t live in a cleaner home, it’s five star” and “the home is beautifully looked after and clean”. One resident had requested a larger room during the
Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 16 previous inspection and this has now been accommodated. CCTV cameras are now in place around the outside of the home. Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29,30 The home is motivated to providing a good standard of training, which ensures staff are qualified to meet the residents needs. EVIDENCE: The home is an accredited training centre for City and Guilds NVQ training in care. One care staff is training to level 2 NVQ and six training to level 3 NVQ. 16 care staff already have achieved level 2 NVQ and 20 care staff are qualified to level 3 NVQ. The home also has 8 NVQ assessors and 2 internal verifiers. This standard has been exceeded and percentage of staff trained to NVQ level is 72 at present. The home places great emphasis on facilitating staff training. New care staff follow an induction programme as confirmed by staff that were interviewed and documentation included in staff files. Standard 29 was assessed at the previous inspection and a requirement made with regard to all staff having their CRB (Criminal Records Bureau) checks at enhanced level has been carried out. An up to date list of CRB checks is in place and staff files evidenced enhanced checks. Staff files viewed during this inspection visit also evidenced all other pre employment checks are in place. The training programme has been set up for the year, yet training attended by staff has not been fully evidenced in staff files. Staff interviewed stated, “training has been very good”. Staff discussed the training provided to meet the needs of the residents in the palliative care unit. The staff agreed that the
Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 18 support and training provided has enabled them to meet the varying and sometimes complex needs of residents admitted to the unit. Following discussion with staff it is apparent that they have confidence in their ability to meet the residents needs. One of the care staff interviewed commented, “training is excellent, and we are provided with all the mandatory training”. Formal staff supervision is carried out two to three monthly with supervision files evidencing such. One staff member stated, “the supervision is helpful”. Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality assurance measures are in place to ensure residents’ views are listened to and action taken where necessary. Detailed financial records are kept to ensure residents are protected. EVIDENCE: The registered manager has been appointed to this position since May 2004. She has many years experience in a senior position in the caring sector and has attended training and further study to provide her with the necessary skills to manage Alexandra House including the registered managers award. Feedback from residents about her management skills has been positive and comments include “the new manager is easy to talk to” and “I am very happy with the new matron”. Staff comments include “I find the new manager easy to approach, we are given time, she listens to staff” and “we have staff pamper days, half an hour each with all staff encouraged to participate”. Residents meetings are held on a regular basis and minutes of the most recent meeting
Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 20 (February 2006) were viewed. 22 of the residents attended this meeting. Residents interviewed also confirmed any concerns of theirs are raised and action is taken where needed. An external quality assurance scheme is carrying out questionnaires six monthly with results published. Policies and procedures have been updated and are available in draft form. The inspector was able to view this. The documentation with regard to new staff induction and foundation training was viewed also. This record will ensure all new staff are trained to the standard thought necessary to meet the needs of the residents in the home. Staff meetings are held on a regular basis with minutes held. These include night staff, day staff, therapy staff and trained staff. Letters have been sent out to relatives with questionnaires included and a relatives meeting has been set up but there was a poor turnout at the most recent. The home has individual records of all financial transactions that take place in regard to residents’ finances. Records were viewed and evidenced detailed information with regard to bills paid, receipts for goods bought, hair, chiropody and newspaper payments. Some residents have signed where able on receipt of personal allowances or cash. Some residents receive help and assistance from therapy staff when shopping for items. Their records evidence receipts and signatures of all transactions. Records show that the residents’ clerk audits the monies weekly. Residents’ valuables are listed and records are kept. Residents or their relatives where agreed need to have a copy of items kept on their behalf. Standard 38 was assessed at the previous inspection with one requirement made to ensure temperatures of hot foods and fridge/freezer temperatures are made daily. Records viewed during this visit evidence these are carried out. Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 21 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 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x 3 X X X X X 3 X STAFFING Standard No Score 27 X 28 4 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 House DS0000017218.V280760.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13 (2) Requirement The Registered Provider must ensure that all staff responsible for the administration of medication on the residential unit sign immediately after administering the prescribed medication. Timescale for action 03/04/06 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 OP9 Good Practice Recommendations The inspector strongly recommends that two staff signatures be recorded on return of medications from the residential unit. Alexandra House DS0000017218.V280760.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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