Inspection on 14/06/05 for Alexandra House

This inspection was carried out on 14th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alexandra House 09/10/08

Alexandra House 17/04/08

Alexandra House 26/09/06

Alexandra House 28/12/05

Alexandra House 15/12/04

Alexandra House 22/07/04

Similar services:

Insight - Eastchurch

Southfields

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33 St John`s Church Road

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Alexandra House 31 Pollards Oak Road Hurst Green Oxted, Surrey RH8 0JL Lead Inspector Mr Devanand Ramdas Unannounced 14th 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 House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Alexandra House Address 31 Pollards Oak Road Hurst Green Oxted Surrey RH8 0JL 01883 380739 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 Myrna Noorbaccus Mrs Myrna Noorbaccus Care Home 5 Category(ies) of LD - Learning Disability (5) registration, with number of places LD(E) - Learning Disability over 65 (2) Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of persons for whom residential accomodation and personal care is provided at any one time shall not exceed FIVE (5) 3. The age/age range of the persons to be accomodated will be: 3 PEOPLE UP TO 64 YEARS & 2 OVER 65 Date of last inspection 15th December 2004 Brief Description of the Service: Alexandra House is a private care home for people with a learning disability and is located in a residential area in Oxted, Surrey. The home is within walking distance of the village shops and other amenities. The home offers accommodation on two floors and has a kitchen, dining room, lounge, laundry room, bathing and washing facilities and five bedrooms. One bedroom is downstairs. The home has transport that is used for daily activities. There is a front and back garden and parking is available to the back of the property. The registered manager is Myrna Noorbaccus. Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by one inspector over six hours. A full tour of the premises took place and staff and service users were spoken to. Care records and other documents were inspected. Feedback forms and comments sheets were left at the home for relatives, service users and other professionals. The inspector would like to thank the staff and service users for their contributions during the inspection. What the service does well: What has improved since the last inspection? What they could do better: The home must meet the requirements stated in the inspection report dated the 24th December 2004 to improve the records in respect of service users monies and the care planning in respect of ageing, illness and death. Care plans must be reviewed monthly and updated to reflect the changing needs of service users. The staff files must have all the records to do with recruitment of staff. The home must ensure proper arrangements are put in place for the disposal of domestic waste and that a gate is fixed to the wall in the back garden to maintain security. A fax machine must be installed on the premises. The home must ensure some of the documentation and records are dated and signed by the manager and the environment is regularly checked to ensure bedroom doors are not wedged open. The home must ensure that the Commission is notified when a service user is transferred to hospital. Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 6 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 H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 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 House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 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) 1,2,3,4. Service users and prospective service users were provided with sufficient information to make an informed choice about admission to the home. Assessments at the home are good ensuring service users needs are appropriately assessed. The home offers trial visits to prospective service users. EVIDENCE: The home had a Statement of Purpose and Service User Guide. They contained a lot of information about the home that included the aims and objectives, philosophy of the care and services and facilities on offer. The information was clearly written and easy to read. The procedure for admission to the home was clearly set out in the procedures manual. It was based on an initial assessment, an admission assessment and a risk assessment. Assessment covered the areas of personal care, diet, weight, sight and hearing, mobility, social and leisure interests, medications and personal safety. The inspector noted in the service user plan a joint health and social services assessment. Staff stated they had the experience and skills to meet the service users needs. The inspector noted one staff on duty had NVQ Level 4 and RMA the other had NVQ Level 2 in Care. The manager stated the home would offer trial visits to service users and also a trial period of four weeks after which there would be a review of the placement. The inspector noted this was clearly stated in the sample terms and conditions of residency. Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 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) 6,7,8,9,10. There is a care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. However, care plans must be regularly reviewed and the Commission must be notified of any serious illness of a service user in order to make appropriate decisions. EVIDENCE: The home had care plans. The inspector sampled the plans and found service users had a named key worker. The plans were dated 20th April 2005 and signed by a senior staff. The inspector noted the plans were not reviewed regularly. The inspector observed a service user had been in hospital for treatment and that the Commission was not notified. The home had regular meetings with service users and minutes were taken of the meetings. Staff stated they managed service users finances. The inspector noted a small sum of money for each service user was kept at the home but the records of monies spent were not individualised. A requirement was made in the previous report in respect of this area. The home had risk taking plans that included risk factors, consequences and interventions to reduce risk. Grab rails were fixed to the lounge and dining area to maintain personal safety of service users. The home had a policy on confidentiality. The manager was observed to respect confidentiality by discussing the needs of a service user in a private area away from others. The inspector noted personal files and care plans were locked in a Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 10 cupboard in the dining area. One service user stated he was happy at the home, liked his key worker and yellow custard. Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 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) 14,15,16,17. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. The arrangements at the home enable service users to engage in social and leisure activities. EVIDENCE: The home had a social and leisure activities programme for each service user. The inspector noted service users were in the dining area having mid morning drinks supported by a staff. They were doing jigsaw puzzles, playing with plastic bricks and looking at books. There was positive interaction between the staff and the service users. The deputy manager stated service users went on holiday last year and they enjoyed going out for drives, having a coffee or ice cream and then returning home. The manager stated service users are encouraged to keep contact with their relatives that are invited to birthdays and parties at the home. One service user stated he is visited and taken out by an advocate. The inspector noted service users moved around freely in the home. The inspector was invited by a service user to look at his bedroom. Staff addressed service users by their preferred names and one service user was observed helping the deputy manager doing the laundry. The inspector noted service users were asked what they wanted for lunch. One member of staff assisted a service user to make pancakes. The manager stated the dietician Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 12 had been consulted regarding the menu and service users had reached their target weight. The inspector observed lunchtime to be unhurried and relaxed and service users enjoying a light lunch of baked beans on toast followed by pancakes and drinks. Two service users stated they liked fish and chips. The inspector sampled the menu records and found fish and chips on the menu, weekly. Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 13 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) 18,19,21 The health needs of service users are well met with evidence of good working with other health care professionals. Personal support in the home is offered in such a way as to promote and protect service users’ privacy and dignity. Care plans did not reflect arrangements for ageing, illness and death. EVIDENCE: The deputy manager stated service users were registered with a local GP and a local dentist. The inspector noted service users were under the care of a community psychiatrist and chiropody care was provided at Oxted Health Centre. One service user was seen in private by the physiotherapist and the district nurse during the inspection. The inspector observed the deputy manager taking a service user to the bathroom that supported the service user using verbal prompts and minimal physical support. This was reflected in the care plan. Service users were observed to be smart in appearance. One service user showed the inspector his wardrobe and remarked he chose his own clothing. A requirement was made for the registered manager to record on service users care plans their wishes on how the staff would deal with their ageing, illness and death. This was not met. The manager stated he would make contact with relatives and others to seek their views in respect of this matter. Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 14 Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 15 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. The arrangements at the home ensure service users have the opportunity to express their views. Staff have excellent knowledge and understanding of Adult Protection issues that protects service users from abuse. EVIDENCE: The home had a complaint policy and a whistle blowing policy that was in the Procedures File. The home also had a complaint folder. The manager stated no complaint had been made to him about the home. The inspector checked the folder and noted no record of a complaint. One anonymous complaint was made to the Commission about the home that had been investigated. The inspector had a meeting with four staff. They stated they were aware of the complaint procedure and the whistle blowing procedure and had training on the protection of vulnerable adults. This was recorded in the staff induction files. The inspector noted a Surrey multi-agency protection of vulnerable adults policy was at the home. A copy of the complaint procedure was in the service user guide. The home had regular meetings with service users that were recorded. The inspector observed staff to listen to the views of service users. One service user wanted staff to take him out and was late for his activity due to the inspection process. It was noted that staff apologised to the service user. Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 16 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) 24,25,26,27,28,29,30 Recent investment has significantly improved the appearance of this home creating a comfortable and safe environment for those living there. The arrangements for security and the disposal of domestic waste must be improved. Staff must make regular checks to ensure bedroom doors are not wedged open compromising the safety of service users. EVIDENCE: The home is well maintained with a good standard of décor throughout. On the day of the inspection the home was found to be clean, well ventilated and free of mal odour. The furnishings were of good quality and the lighting was appropriate. The toilet, bathing and washing facilities were clean and hygienic. The home was fitted with adaptations such as grab rails to help service users to maintain their independence. The home had an emergency on call system. Bedrooms were found to be clean, well presented and personalised with family photographs, ornaments, pictures, cards, radio, and other items of personal interest. Some bedrooms had new carpets. The inspector noted one bedroom door was wedged open. The home had a laundry that had an industrial washing machine and tumble dryer. The kitchen was recently refurbished with a new cooker, fridge, freezer, and new flooring. The inspector noted the home had control of infection measures through the use of gloves, aprons and regular hand washing. The arrangement for the disposal of domestic waste was Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 17 inadequate. The manager stated the wheelie bin had been stolen and had not been replaced. The front and rear garden was in need of tidying up to make it nice for the service users. The inspector noted the home had no facility for facsimile transmission. Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 18 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) 33,34,35,36. The arrangements for the induction of staff are good with the staff demonstrating a clear understanding of their roles. However, recruitment records are incomplete and must be improved also the appraisal of staff must be completed. The staffing levels at the home are adequate ensuring service users are appropriately supported. EVIDENCE: On the day of the inspection the deputy manager and a care assistant was on duty. The manager and a senior care assistant visited the home to do the weekly house shopping. The deputy manager stated the home did not use agency staff. The manager reported he had increased the staff hours by seven hours per week to meet the changing needs of a service user. The duty roster was viewed and reflected the numbers of staff on duty. The inspector sampled staff induction files and found evidence of regular supervision. Supervision was appropriate and covered all areas of work. The inspector noted staff appraisals for 2005 had not been done. Staff files had induction checklists that were dated and signed by the supervisee and supervisor. Some files did not have job descriptions, statement of terms and conditions and photo ID. The home had the Investors in People Award dated May 2003. The deputy manager reported all staff had NVQ in Care. The inspector noted NVQ certificates were displayed in the hallway. The home had team meetings that were appropriate and well attended by staff. Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 19 Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 20 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) 37,38,40,41 The manager is supported well by the senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their role and responsibilities. Some documentation at the home must be dated and signed by the registered manager to safeguard service users’ interests. EVIDENCE: The home has an experienced manager who has a professional nursing qualification, NVQ Level 4 in Management and the RMA award. The manager stated he consulted with staff and worked alongside staff. He described his management style as leading by example. The inspector had a meeting with staff that stated the management ‘ had a friendly attitude’ and ‘informal style’. The deputy manager and a senior care staff remarked the management respected their decisions. The home had written policies and procedures that were kept in a folder. Staff remarked they were aware of the policies and procedures and used it when appropriate. The inspector noted the policies were not dated and signed by the manager. The home had up to date information on service users and records were in a personal folder that was stored securely and confidentially. Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 21 Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 22 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. 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 3 3 3 3 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 x x x 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Alexandra House Score 3 3 x 3 Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 3 x x H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 23 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 YA41 Regulation 17(2) Requirement The manager must provide individual records for service users monies spent that must be signed by a member of staff. Timescale of 31.01.05 not met. The home must record on service users care plans their wishes on how the staff will deal with their ageing, illness and death. Timescale of 31.01.05 not met. The registered manager must make adequate arrangement for containing fires by ensuring some bedroom doors are not wedged open. The registered person must ensure that the home has a fax machine. The registered person must ensure the grass in back garden is cut, the patio area is cleaned and a gate fixed to the back wall to ensure the safety of service users and staff. The registered person must ensure suitable arrangements for the disposal of general waste by providing an industrial waste disposal bin. The registered person must Timescale for action 01.07.05 2. YA21 12(10 01.07.05 3. YA29 23(4)(c) (i) 14.6.05 4. 5. YA24 YA42 16(2)(a) (ii) 23(2)(o) 01.07.05 01.07.05 6. YA42 16(2)(k) 01.07.05 7. YA41 37(1)(d) 01.07.05 Page 24 Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 8. YA34 19(4)(b) 9. YA6 15(2)(b) 10. YA41 24(1)(a) (b) 11. YA36 18(2)(a) ensure the Commission is notified without delay of any serious illness of a service user. The registered person must ensure that staff who work at the home have a recent photograph as proof of identity and that recruitment files contain a job description and the terms and conditions of employment. The registered person must ensure care plans are reviewed monthly and updated to reflect changing needs and agreed changes are recorded and actioned. The registered person must ensure all policies and procedures are signed and dated,monitored,reviewed and amended. The registered person must ensure that the annual appraisal of staff is completed. 01.08.05 01.08.05 01.08.05 01.08.05 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 Good Practice Recommendations No recommendations were made during this inspection. Alexandra House H58_s13549_Alexandra House_v220672_140605_stage4.doc Version 1.30 Page 25 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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