Inspection on 16/06/06 for Alexandra House

This inspection was carried out on 16th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alexandra House 03/08/09

Alexandra House 30/08/08

Alexandra House 11/10/07

Alexandra House 20/05/07

Alexandra House 28/02/06

Alexandra House 02/09/05

Alexandra House 22/04/05

Alexandra House 11/02/05

Alexandra House 04/05/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Alexandra House 2 Alexandra Road Gloucester Glos GL1 3DR Lead Inspector Ms Tanya Harding Unannounced Inspection 16 and 23rd June 2006 10:00 th Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 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 DS0000016360.V300814.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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 DS0000016360.V300814.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra House Address 2 Alexandra Road Gloucester Glos GL1 3DR 01452 418575 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) Cotswold Care Services Limited Mrs Sally Elizabeth Eve Angles Care Home 10 Category(ies) of Learning disability (10), Physical disability (10) registration, with number of places Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th February 2006 Brief Description of the Service: Alexandra House is a large detached Victorian house located in a residential area of Gloucester. The home has undergone a programme of substantial refurbishment and now has 10 bedrooms, some with en-suite shower rooms, three communal bathrooms, additional toilets, a large dining area and a communal lounge. Two of the bathrooms and one toilet have adaptations such as overhead hoists and changing beds which are suitable for people with complex physical needs. One bedroom is on the ground floor as are the kitchen, laundry and a small office. The other bedrooms and bathrooms are on the first floor. The home has two large staircases and a new lift has been built to improve access from the ground to first floor for people with mobility needs. The home has a large back garden and this has been landscaped to make it accessible to wheelchair users. Alexandra House is one of three homes and a day centre in Gloucester owned by Craegmoor Healthcare Ltd. The home has a Statement of Purpose document which sets out aims and objectives of the home and the Service Users Guide to the facilities in the home. These are available to prospective service users, to current residents and their families on request. According to information about fees provided by the management team these range from £875.67 to £1389 per week. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection took place in June 2006 and included two visits to the home on 16th (10:00 to 15:45) and 23rd (10:00 to 12:30). The inspection lasted for over 8 hours during which the care of people living at the home was tracked and interactions between staff and residents were observed. The deputy manager supported the inspection and the registered manager was present during the second visit. The care of four people living at the home was case tracked. This involved looking at their records, discussing their care with staff and observing them during the visit. A number of staff were interviewed and there were discussions with the manager and deputy manager. As part of this key inspection the home received a visit on 14th June 2006 by the CSCI pharmacist inspector to carry out an audit of the arrangements for handling of medicines (Standard 20 of The National Minimum Standards – Care Homes for Adults 18 -65). This was at the request of the lead inspector to monitor progress following the pharmacist inspections in 2005. Medicine stocks and storage arrangements, Medication Administration Record (MAR) charts and other records and procedures relating to medication were looked at. The manager and two other members of staff were spoken to. The inspection took place on a Wednesday morning, lasting about four hours. What the service does well: What has improved since the last inspection? Guidance about supporting service users to get safely in and out of the vehicles is now in place. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 6 There has been a sustained improvement in the way medication is stored and handled. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 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 the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a responsible approach to ensuring that the home can meet the assessed needs of the prospective service users prior to admission. EVIDENCE: Previously there have been reservations about new people being admitted to the home. This was because there were significant shortfalls in staff training and skills base, poor bathroom facilities, a lack of specialist equipment and an unsuitable lift. The organisation has made considerable investment in refurbishing the home as noted in the last inspection report. There is a procedure for admitting new service users. The registered manager is fully involved in the decision making process as to whether the home has the facilities and staff skills to meet the assessed needs of prospective residents. The manager advised that she has been considering a referral of a service user who has complex mobility needs. She felt that until the bathing facilities have been suitably adapted to meet the needs of the person this admission would not be appropriate. This is good practice and demonstrates a responsible approach to admissions. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 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 the following standard(s): 6, 7 & 9. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some care guidance still does not correctly reflect the assessed needs of the service users and this may compromise the quality of support staff are able to offer and put people at unnecessary risk. EVIDENCE: The home has failed to meet its target of revising risk assessments and care plans for all service users within three months after the last inspection. Files for only three service users had been updated. For the majority of the service users this means that care guidance written in May 2005 remains in use. In some cases this is no longer relevant, is of poor quality and does not provide evidence of service users’ involvement. The staff team are quite new with many staff being employed for less than 12 months. Comprehensive guidance about how to support the needs of the individuals in the home is essential to ensure that the team acquires the necessary knowledge and skills and provides this support correctly. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 10 The registered manager expressed commitment to complete the necessary revisions, but stated that the lack of progress is due to time constraints. The home needs to complete the revision of all care guidance (to include risk assessments) promptly. Once this has been done the task of reviewing and revising care plans and risk assessments should be easier to undertake. Previously requirements were made about providing guidance on supporting people in and out of vehicles safely. This guidance has been developed but not for every service user as yet. To promote the safety of all the service users in the home when using transport more work is required in this area. The home has had a new lift installed and this is now in daily use. Previously concerns were raised about safety of service users when using the old lift and it was deemed unsuitable for this purpose. From discussions with staff it was evident that this is still in use for service users with mobility difficulties even though the larger lift appears to offer a much safer option. There were no risk assessments on files regarding the use of the new lift. The home is required to review the use of the old lift for transporting service users and to devise suitable care plans for people using the new lift to ensure the safety and welfare of each resident is promoted. Information about how individuals want to be supported with managing their money was not sufficiently detailed in some cases. Records of service users’ expenditure were examined and on the whole appeared to be accurately and clearly maintained. The manager advised that there are ongoing difficulties with accessing personal finances for some service users. For one person an independent advocate is being sought in order to address the issues of access. This must be resolved as quickly as possible for all service users who are experiencing these difficulties. It was not possible to effectively audit whether all service users were in receipt of the personal allowances. For some service users the home has to take money out of petty cash and then forward the record of expenditure to Craegmoor central office, where this is deducted from the account held on behalf of the service user. It is not clear which payments are made into these centrally held accounts and more transparency is required. The manager was also in the process of questioning invoices for fees which have been recently sent to two service users from Craegmoor Head office. She was concerned that there was lack of clarity as to why these fees were being requested and has noticed discrepancies with amounts shown. The manager advised that she had requested a full breakdown of the invoices and until she is satisfied that these are appropriate the payments will not be authorised. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are still unable to take full advantage of the improved transport arrangements and may be missing out on opportunities to access the community. Food served in the home is wholesome and varied although people may not have sufficient opportunity to contribute to meal planning and preparation. EVIDENCE: Staff expressed concerns about their inability to use the new minibuses to take people out. This is to do with the age restrictions on who can drive the minibuses linked to the insurance policy. Staff have to be over 25 yrs of age and in possession of the relevant licence to drive these vehicles. At the time of this visit there were just two staff who were able to drive these vehicles. These concerns were expressed in the last inspection report. It is concerning that the organisation has not taken a view on how to improve matters, leaving Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 12 staff frustrated and powerless to act in the best interest of the service users. These restrictions are clearly compromising the opportunities for service users to go out into the community. This must be addressed. Reviews of daily records for service users showed that some people did not access the community regularly. For example records for one person indicated that they went out to the day centre twice in the space of two weeks with the only other trips being to the hospital and the dentist. The relevant care plan for this person suggest that they enjoy shopping but would need support of two staff when out. The home needs to establish whether the high staffing ratio is limiting the frequency with which the person can go out. Care files seen contained plans about accessing activities and maintaining family contact. Activity planners were seen on some files, but some did not relate to the actual activities provided. For example for one service user an activity plan talked about the person going swimming, walking and to a social club one evening a week. The daily records did not provide evidence that any of these activities were taking place. Staff recognised that there was a lack of activities on offer for the residents and unanimously felt that this was because of staff shortages and not through lack of will. Discussions with staff and service users confirmed that links with families are being maintained and encouraged through visits and phone calls. The dining area was seen to be very pleasant and is used by the service users during meal times, or to have a drink and a chat to the staff. On one day of the inspection some people were seen having lunch outside on the patio. The service users were observed to enjoy this and the social interactions between staff and residents were very positive. All main meals are prepared by a dedicated cook with support staff providing breakfasts and snacks to the service users. The menus show a variety of food. There is a daily option of the main meal, but evidence in daily records suggested that alternatives are offered to service users on request. This is good practice. One person was observed to be offered a choice of what to have for their breakfast. Record of food intake are kept and provide detail about fruit and vegetables eaten. For one person a record was seen stating that the person needs extra salt on their food to maintain appropriate sodium levels. Staff spoken with were not aware of this. The deputy manager agreed to follow this matter up with the person’s GP. Staff spoken with felt that service users were not currently being involved in planning of menus, although staff would communicate to the cook about individual preferences. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 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 the following standard(s): 18, 19 & 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ health needs are closely monitored and appropriate care and attention is provided promptly when people become unwell. Service users would benefit from a more structured and consistent support for their physical needs. Lack of robust guidance around supporting people with mobility may be putting service users at risk of falls and injury. Medicines are managed safely on behalf of residents using trained staff and with regular audits carried out. EVIDENCE: Care plans about personal care were seen. For one person this contained information about the person’s preferences on how to receive this support and talked about protecting the person’s dignity and promoting independence. This is good practice. On arrival a baby monitor was seen in the entrance area, where many of the staff, visitors and residents regularly spend time. The monitor was switched on and it was possible to hear what was taking place in the service user’s room. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 14 This was seen to be compromising the person’s privacy and dignity and is not acceptable. The home needs to look for ways in which the person can be monitored more discreetly and devise a suitable protocol as guidance for staff. There was evidence that the CLDT may be considering asking the home to use video equipment to record the seizure patterns for one service user. The home needs to ensure there is a process of consultation about this matter and discuss the proposals with the Commission. Health action plans are being implemented for the service users to provide a more holistic overview of the support people need to stay well. A care plan for supporting one person with additional mental health needs did not give clear guidance about how staff should monitor the person’s emotional wellbeing. The guidance given was for staff to encourage the person to be involved in more activities if they appeared withdrawn. Records seen in the home provided evidence that prompt medical attention is sought for the service users if they become unwell. Staff advised that they would support people in hospital when necessary. A number of service users in the home have epilepsy and there had been a number of admissions to the Accident and Emergency in the past few months due to people having seizures. Following an admission the home had developed a process of closely monitoring service users with 15 minutes checks to spot any adverse effects. One person was observed to be particularly unstable on their feet and had been experiencing frequent falls, some of which have resulted in injuries. The person’s records showed that they were significantly overweight. This may be putting the person at increased risk of serious falls. Staff supporting the person with mobility may also be at risk of injury, as observed during the visit. In view of the above health concerns the home needs to consider ways of supporting the service user to maintain their independence and stay safe at the same time. There needs to be a detailed protocol describing how staff would offer support with consideration of manual handling risks. The home has a system for monitoring of weights. One service user had been advised by their GP to lose weight. The person was observed having two rounds of toast for their breakfast on the morning of the inspection, with evidence that staff were not monitoring the food intake closely and were not aware that other staff had already offered breakfast. Whilst it is good practice to offer drinks and snacks to the service users regularly, the home should ensure that they are not inadvertently putting that person’s health at increased risk. The deputy manager advised that a care plan about healthy diet and a risk assessment about mobility were being developed for this person. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 15 Information about supporting people with their mobility was examined on care files. This was not sufficiently detailed about how staff need to provide this support to make sure service users stay safe. A recent complaint investigation showed that poor guidance may have contributed to a fall and serious injury for one person and the home needs to be making every effort to prevent this from happening again. Several of the service users have complex physical needs and require regular physiotherapy exercises to keep their muscles supple and to maintain their mobility. There are exercise programmes in place for each person but staff were not sure whether these are carried out consistently and regularly. The home needs to evidence how this critical aspect of people’s health is being supported. The home should seek additional support and guidance from the Community Learning Disability Professionals so that staff can develop their skills in this area further for the benefit of the residents. There is now guidance about the use of a handling belt for one person, although this has not been incorporated into the plan of care for this individual. Care should be taken when service users are spending time outdoors. Staff should be making sure the necessary precautions are taken to protect people from adverse affects of the sun. Outstanding requirements from the pharmacist inspection on 28/06/05 have been actioned. There are a number of checking systems and audits in place to make sure medicines are managed correctly. This inspection showed these were largely effective. All staff who administer medicines have studied accredited training about the care of medicines. They have further training within the home with observation of how they handle medicines and are assessed as competent in these tasks. They also have training about an emergency medicine given bucally. There is a medicine policy and procedures in place with suitable reference information available to all staff. There are procedures in place (which the inspection showed are followed) for the supply of medicines safely during periods of leave away from the home. Medicines are stored safely and comply with the regulations. The temperature in clinic room is recorded daily. All medicines were in stock to give as prescribed. Procedures say that medicine containers must have dates written on the label when opened. This helps with checks and helps make sure medicines are used within the recommended shelf life. There were containers where staff had forgotten to do this. Some bottles were sticky and should be wiped clean after use. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 16 Administration of some lunchtime doses of medicines was observed as following safe practice in accordance with the written risk assessment. The lockable box used was showing signs of wearing out and could do with replacing. Sample audit counts of medicines compared with the records were correct indicating that medicines are given to residents correctly. Medication Administration Record (MAR) charts looked at were satisfactory. An entry is necessary in the allergy box on each chart and there were a few examples when the actual dose given to a resident was not recorded when the prescription said ‘one or two’ tablets for example. Some tablets are crushed to help the resident take the medicines. There was a care plan about this but this had last been reviewed on 30/04/05. Staff must be careful when crushing levothyroxine because of risks from inhalation or absorption of powder from the tablet. There was a risk assessment dated 22/07/05 for one resident to look after and apply some emollients but no evidence that this had been reviewed since then. Consent to medication is described in the records. Protocols for using medicines prescribed ‘as required’ are in place so that all staff know the right way to use these for the benefit of the residents. Staff were advised to be extra vigilant for signs of lithium toxicity in one resident who has been unwell recently as there are a number of medicine changes that may affect lithium. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 22 & 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are becoming more skilled in monitoring service users’ behaviours to ensure people are satisfied with the care they receive, but further work is needed to provide information about how each individual expresses concerns. Some staff have a good understanding of adult protection issues and show the commitment to reporting poor practice. EVIDENCE: The Commission has not received any complaints since the last inspection and the manager advised that a better relationship has been forged with some relatives. This is seen as good progress and a reflection of the improvements made to the quality of the service. A copy of the complaints procedure is displayed in the front entrance of the home with a ‘concerns, complaints and compliments’ book being located next to the visitor’s book (although no entries were seen in this). Observations were made during the inspection that service users appeared contented, looked well and were given the necessary support from staff. Staff were seen to be attentive towards the residents and demonstrated genuine concern for people if they were upset or needed attention. The requirement made in the last report about providing information on how people express dissatisfaction and concerns has not been addressed Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 18 consistently. Limited information was seen on files and more work is needed in this area especially for service users who have communication difficulties. Discussions with staff provided evidence that the best interests and wellbeing of the residents are at the forefront of practice in the home. This is very positive and shows considerable progress in the attitudes of staff. There was evidence that staff are now more likely to challenge poor practice immediately and to follow the correct procedure for reporting incidents which may be detrimental to the wellbeing of the residents. The majority of the staff have received training in protection of vulnerable adults. The home was advised of the training which is being offered locally to care providers by the Adult Protection Team. There was evidence that the management team is monitoring events in the home closely to ensure any reports of poor practice are investigated thoroughly for the benefit of the service users. Regulation 37 notification are being provided to the Commission as necessary. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 19 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 the following standard(s): 24, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is clean welcoming and allows flexibility of use for the benefit of the service users. Delay in provision of specialist equipment may be putting service users and staff at risk. EVIDENCE: The environment in the home has been further improved for the benefit of the service users. The sensory room has been relocated to a bigger room and with capacity for wheelchair users to get onto the floor mats and waterbed. Garden furniture has been purchased and service users were observed having a meal in the fresh air. The garden was almost completed at the time of the visit, with some additional landscaping and planting required making it more attractive. During this inspection the specialist beds for two service users were delivered to the home as required in the last report. Provision of these beds was recommended by the Community Learning Disability professionals almost 10 months ago. The delay in obtaining essential equipment is concerning. The Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 20 home is providing accommodation and support to service users with complex physical needs and has a duty to ensure the necessary equipment and adaptations are provided without delay. Staff expressed concerns about availability of hoists in the home. They advised that only one hoist has been in operation for over a month, as the second hoist was deemed unusable. This meant that service users had to wait for transfers and personal care support on occasion. Also the hoist had to be constantly transported between floors creating unnecessary delays and additional hazard. Staff were also worried about providing support to the residents if the remaining hoist developed a fault. The inspectors required for this situation to be resolved quickly and a hoist was obtained on temporary basis from the CLDT following the inspection. Since then the home has purchased a suitable hoist. As a basic minimum the home must have at least two fully operational hoists for daily use and a back up plan for obtaining a replacement hoist quickly to avoid the same situation arising. It is recommended that each service user who requires a hoist for personal care has their own, with an additional hoist for communal and emergency use. The vehicles provided for transporting people in wheelchairs have tail lifts and staff are shown how to use these informally by the maintenance person. It is recommended that this training is formalised to ensure that all staff are aware of the safety measures which need to be in place when transporting people in wheelchairs. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 21 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are supported by a dedicated team who are committed to delivering good care. Staff would benefit from quicker uptake of structured induction and access to training opportunities to further improve their skills and knowledge. EVIDENCE: There appeared to be sufficient staff on duty at the time of the inspection to assist service users with daily routines. The deputy manager was providing shift cover as a member of staff was unwell. Staff also advised that there have been some shortages due to day staff needing to cover night shifts. They felt that although five staff on shift may be adequate to support the basic needs of the residents, it was difficult to offer a range of suitable activities and community trips with this ratio. Active recruitment was in progress with interviews taking place at the time of the return visit to the home. A new shift pattern was introduced in April 2006, which resulted in staff working 12 or 13-hour shifts with the aim of providing more flexible support Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 22 for the service users. Some staff commented positively on these changes. However, some were concerned about the introduction of ‘on-call’ responsibilities for support workers, which could mean staff having to do extra hours at short notice. The inspectors plan to revisit this at future visits for further discussion. Staff rotas showed that staffing levels were being maintained for the majority of the time at between five and six staff during the day. On occasions the deputy manager and the registered manager provide shift cover for sickness. The manager felt that this may be a contributing factor to the lack of progress with administrative tasks such as reviewing of care plans and risk assessments and carrying out staff supervisions. The manager advised that there is no longer any additional administrative support for the home. Agency staff are still used, but the flexibility in bringing agency staff in has reduced due to organisation using specific agencies only. A number of staff files were viewed and provided evidence that the necessary recruitment and performance related records are being maintained. Staff advised that although people are being offered NVQ training, there had been a delay in starting this. One member of staff said that they had been requesting to start the relevant NVQ course since August 2005. There also appeared to be a shortfall in staff completing the foundation course within the recommended timescales. Evidence of induction was seen on files, although a staff member who had been in the home for about three months has not received formal induction into their role. A recommendation was made in the last report about staff being reminded to use service users’ preferred term of address. It was observed that staff regularly use terms of endearment when interacting with the residents and this may not always be respectful or appropriate. Guidance should be given to staff about more professional approaches. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 23 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is clear guidance and ongoing monitoring from the manager, resulting in better attitudes and working practices for the benefit of the residents. EVIDENCE: The registered manager had been in the home for just over 12 months and in this time had made significant progress in developing the staff team to work cohesively and in line with good care guidance. The staff commented that in the last few months the team has been working more cohesively under the guidance of the registered manager and that this has been of benefit to people who live at Alexandra House. Some staff felt that their views were not always given importance and that more praise could be forthcoming about their efforts to cover overtime hours. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 24 Many of the records regarding service users’ assessed needs and support were not seen as fit for their purpose and need to be revised in line with the person centred principles. Some records seen on personal files were not dated and may no longer be relevant. Cleaning products were seen to be left out in an area accessible to service users. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 25 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 1 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 3 X 3 X 2 X X 2 X Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard 1. YA6 Regulation 12, 14 and 15 Requirement Care plans must clearly state how each service user’s assessed needs are to be met (including personal care requirements and management of challenging behaviour). Timescales of 30/06/05, 31/01/06 and 31/05/06 not met. Provide staff with clear guidance on how to respond to challenging behaviours in the home and when out in the community. For use of any restrictive practices there must be a protocol in place in line with Department of Health guidance on restrictive physical interventions. Timescales of 31/01/06 & 31/05/06 not met. Service users must have access to their finances. There must be clear and transparent records of the care home’s charges to service users, any additional charges and the amounts paid by or in respect of each service user. These records must be available for inspection. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 27 Timescale for action 30/09/06 2. YA6 12 and 13(6) 30/09/06 3. YA7 12 and 17(2), Sch 4. 31/08/06 4. YA9 13(4) Risk assessments must provide sufficient detail about the actual risks and what specific steps / actions must be taken by staff to reduce or eliminate these. Risk assessments must be carried out for supporting service users in the community (particularly those who require mobility aids, have serious medical conditions or display challenging behaviours). These must state the numbers and competency of staff required to support the activity safely and any additional measures (such as emergency medication/mobile phones), be used to reduce risks. Timescales of 31/12/05 and 31/05/06 not met. Review the use of the old lift for transporting service users and devise suitable care plans for people using the new lift to ensure the safety and welfare of each resident is promoted. Resolve issues with transport and staffing which are compromising the opportunities for service users to go out into the community. Provide clear and accurate protocols / guidance about people’s physical and psychological health. This must include protocols for managing epilepsy, pain management and mental health needs. Timescales of 31/12/05 and 31/05/06 not met. Devise a suitable protocol for the use of the ‘baby monitor’. Consider ways in which the person can be monitored more discreetly. Consider ways of supporting a specific service user with mobility to maintain their independence and stay safe at the same time, as described in text. There needs to be a detailed protocol describing DS0000016360.V300814.R01.S.doc 30/09/06 5. YA9 13(4) 31/08/06 6. YA13 16(2) 30/09/06 7. YA18 12 30/08/06 8. YA18 12 (4) 31/08/06 9. YA19 12 (1), 13 (6) & 15 (1) 31/08/06 Alexandra House Version 5.2 Page 28 how staff would offer support with consideration of manual handling risks. Devise appropriate care plans for all service users about mobilising safely. Ensure that exercise programmes are carried out as directed by the physiotherapist. Provide guidance on files about how each service user is able to express their dissatisfaction and voice concerns. Timescale of 31/05/06 not met. Appropriate specialist equipment must be provided for to ensure manual-handling operations can be performed safely and efficiently, with specific reference to provision of hoists in the home. Chemical agents must be appropriately stored at all times. 10. 11. YA19 YA22 12(1) 22 31/08/06 31/08/06 12. YA29 23 31/08/06 13. YA42 13(6) 31/07/06 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 YA7 Good Practice Recommendations Care plans about how service users need to be supported with managing their finances should be more detailed and person-centred. There should be reference to any arrangements made with relatives / parents who may be advocating on behalf of the service user, in particular how to respond to requests from families to have access to expenditure records. This should be in line with the company policy and communicated to all involved parents and carers. Service users should be more involved in menu planning. Clarification should be obtained about the guidance for one person to have extra salt on their food. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 29 2. YA17 3. 4. YA18 YA19 5. 6. 7. 8. 9. 10. 11. YA20 YA20 YA24 YA29 YA32 YA35 YA35 Care plans about intimate care should reflect service users’ preferences with regards to the gender of the person providing support. The home should seek additional support and guidance from the Community Learning Disability professionals so that staff can offer effective support for service users with physiotherapy programmes and postural management. Complete the allergy section on medicine records. Replace the lockable container used to carry medicines around the home. A suitable area where service users can see their visitors in private (in addition to people’s bedrooms) should be provided. It is recommended that each service user who requires a hoist for personal care has their own, with an additional hoist for communal and emergency use. Staff should be reminded of best practice in addressing people by their name or a preferred term of address (if different). Address the issues raised in the text in relation to induction, foundation and NVQs for staff. The training for using tail lift on minibuses and about other safety measures which need to be in place when transporting people in wheelchairs should be formalised and recorded. Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. Extracts may not be used or reproduced without the express permission of CSCI Alexandra House DS0000016360.V300814.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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