Inspection on 19/01/09 for Alexandra House

This inspection was carried out on 19th January 2009.

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

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

Other inspections for this house

Alexandra House 01/03/10

Alexandra House 29/03/07

Alexandra House 01/03/06

Alexandra House 03/08/05

Alexandra House 04/01/05

Alexandra House 03/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Alexandra House 2 - 4 Lord Street Southport Merseyside PR8 1QD     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Claire Lee     Date: 2 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Alexandra House 2 - 4 Lord Street Southport Merseyside PR8 1QD 01704543715 01704543828 sharon.watson@bon.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sharon Louise Watson Type of registration: Number of places registered: BEN - Motor & Allied Trades Benevolent Fund care home 56 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Service users to include up to 56 OP of which 6 can be PD The service should employ a suitably qualified and experienced manager who is registered with CSCI Date of last inspection Brief description of the care home Alexandra House (BEN - Motor and Allied Trades Benevolent Fund) is a registered care home run by a charitable organisation. The registered manager is Ms Sharon Watson. The home provides fifty six places for nursing and personal (residential) care for residents. Included in this number the home can accommodate up to six young physically disabled. Respite/day care is offered for up to six non-residents a week. The home is situated in the town centre close to local amenities. Alexandra House is a large building and consists of two units. The nursing unit has twenty eight beds (including 6 Care Homes for Older People Page 4 of 31 Over 65 56 0 0 6 Brief description of the care home for the young physically disabled); the unit for personal (residential) care has twenty eight beds. The five beds on the ground floor accommodate residents who require general nursing. The home has fifty two single rooms and two double rooms; none of the rooms are en-suite. Six rooms on the top floor are small flats and residents accommodated in these rooms receive minimal personal care. All areas of the home are accessible by the use of a lift, chair lift and stairs. The home has suitably adapted bathrooms and a very good standard of equipment to assist those who are less independent. A call system with an alarm facility operates throughout the building and the home is subject to an ongoing programme of maintenance and redecoration. The charge for accommodation ranges from 394 pounds to 714 pounds a week per resident. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced and it took place over two days for a duration of fifteen hours. Forty eight residents were accommodated at this time. A partial tour of the premises took place and a number of care, staff and health and safety records were viewed. All they key standards were assessed and discussion took place with the manager regarding previous requirements from the key inspection in March 2009. These have been met. During the inspection five residents were case tracked. This means their care files were examined and their views of the home obtained. This was not to the detriment of other residents who also took part in the inspection. Interviews were conducted with eight staff, two relatives, a health care professional and eight residents to gain their Care Homes for Older People Page 6 of 31 views of the service. Have your say satisfaction forms were also sent out prior to the inspection. A number of comments received from the interviews and surveys have been recorded in this report. People accommodated at Alexandra House wish to be called residents and this term is used in this report. Previous reports by the Commission for Social Inspection were displayed in the home for residents to see and local contact details were also available. The last key inspection was conducted on 29th and 30th March 2007. What the care home does well: The staff provide an excellent standard of care to the residents. They ensure the health and social care needs of the residents are respected and understood. There are systems in place to ensure residents receive the right level of support and that it is given in accordance with residents wishes. The staff have worked hard so that care plans are unique to the individual and residents are able to make their own decisions. Staff support residents in taking risks in their daily lives to keep them safe and well. Residents said they were pleased with the standard of care they received. Comments included, You cannot fault the care, I have the help I need and I find everything really good. Staff were found to be responsive to changes in residents health. Looking at care files and discussion with residents confirmed that staff contact health professionals for advice when needed. This helps to keep the residents in good health. A resident said, The staff will always get the doctor if I am not well. Staff treat the residents on an individual basis and respect the fact that some may need more support than others. Care plans seen focused on what residents could do for themselves and what they needed help with. The care and support they provide respects residents rights and wishes and good information was provided in the care plans with regard to this. For example, preferred meals, activities, personal care, time of getting up or retiring at night. Excellent social activities are arranged for residents and there is a dedicated team of staff who work in the therapy department to organise the social arrangements. This includes a physiotherapist assistant who works along side a contracted physiotherapist. The physiotherapist attends the home to provide guidance on exercises regimes to hep residents with their independence. The therapy department has suitable equipment to provide this and throughout the home there are special beds, mattresses, cushions and moving and handling aids. These had been provided for residents who were frail and who needed to spend long periods of time in bed. Residents said the social programmes in the home were excellent and that there was so much going on and to choose from. Activities include bingo, quizzes, music, entertainment, relaxation, massages, lie back relaxation, outings in a minibus and film shows. At the time of the inspection lots of residents were taking part in a quiz and they said how much they enjoyed it. A resident said, The staff make it so much fun and it keeps us active. There was plenty of laughter and the staff took time to ensure everyone joined in if they wanted to. A breakfast club has been started and the staff take a small number of residents out for breakfast to a local restaurant. This is by invite only so that all residents who are well enough can take part over a period of time. This and the matrons coffee mornings have proved to be very popular. Feedback regarding the food was very good and the menu showed that residents are offered an excellent choice of meals. There is plenty of variety and attention is paid to providing what the residents want. The kitchen is well staffed and meals are served by two waitresses. Residents meet in the dining room for lunch or if preferred they can stay in their own rooms. Lunch was a very sociable occasion and residents commented on how nice it is for everyone to get together. Care Homes for Older People Page 8 of 31 There were good numbers of staff on duty to meet the care needs of the residents. Staff receive training to provide them with the skills and knowledge to undertake their job role and staff interviewed said they receive a lot of support from the management team. The manager is committed to providing this support to make sure residents receive good care. Their wishes are taken into account and this enables them to live their daily lives in a way they prefer. Comments included, The staff are very good and they are willing to do that bit extra. The staff have also been trained in end of life care and have achieved awards for their expertise in this field. The views and opinions of the residents are respected and listened to. This ensures their expectations are being met. Residents and relatives take part in regular meetings either on an informal or formal basis and they are also given satisfaction surveys to complete. In 2008 the staff achieved a 97.7 satisfaction rate as part of an external quality award. Changes are made as a result of listing to the residents For example, extended meals times, introduction of privacy signs when residents do not want to be disturbed and a monthly newsletter which keeps residents up to date with what is going on in the home. The staff are also looking to provide more resident input into the entertainment. A resident meeting was conducted at the time of the inspection and the residents were given plenty of time to ask questions to all the heads of department. This included the operations manager who was visiting. The management team are actively involved with running the home and there are systems in place to check that the residents receive a consistently high standard of care in safe surroundings. The safety of the residents is paramount and services and equipment are subject to regular contracts and tests to ensure everything is working correctly. Residents praised the staff in relation to this and comments included, You could not have better and The matron is very good indeed, there is nothing to complain about. What has improved since the last inspection? What they could do better: Residents agreement to the plan of care should be updated to reflect a change in date when their care needs are reviewed. Handwritten entries on the medicine charts should be recorded by two staff members to ensure accuracy. Staff training files should be updated to provide details of past training as evidence of their learning and development. Care Homes for Older People Page 9 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are given sufficient information to help them decide whether they wish to take up residency. The staff also assess their needs to ensure they can provide the care and support they require. Evidence: There is a good system in place to introduce prospective residents to the home with written information on the service and also the completion of a care needs assessment for each resident. Information regarding Alexandra House is provided in a Service Use Guide and Statement of Purpose. These documents were on display in the main entrance hall for people to read. The information provided was found to be informative and described the terms and conditions of residency and what it is like to live at the home. Other information displayed included awards achieved by the staff for the care they given Care Homes for Older People Page 12 of 31 Evidence: and also positive feedback from residents regarding how satisfied they were with the service. The staff complete an assessment for each resident and the assessments seen showed details of their medical needs and what they can and cannot do for themselves. Equality and diversity had been looked at in relation to recognising and respecting individual choices and wishes, for example, religion, diet, daily routine and family involvement. The AQAA reported on the interdenominational services that are held in the homes chapel every two weeks so that residents from a number of faiths may attend. A resident and relative commented on how welcome they were made to feel when they arrived at the home and that settling in had been made easier by the kind staff. They found the welcome they received reassuring. Standard 6 was not assessed as intermediate care is not provided at Alexandra House. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are very well met and their care is provided in a manner that protects and respects their privacy and dignity. Evidence: Five resident care files were case tracked and it was evident that the staff were providing a good standard of care and support to the residents. Details of this were written down in a plan of care to meet their health, personal and social care requirements. Other supporting care documents, for example risk assessments for moving residents safely, assessing diet and weight, or looking after residents vulnerable skin were also completed. Staff had been provided with information on how to give the care following consultation with the resident. The plan of care was unique to the individual and had been discussed with each resident to gain their understanding and agreement. Systems were also in place to review the care thus making sure the information recorded was accurate and relevant. Residents sign to say they are happy with the plan of care and as part of the review it would be beneficial to Care Homes for Older People Page 14 of 31 Evidence: ask them to sign again if there has been any change. Care practices in the home reflect an understanding of respecting the residents gender, age, religion and disability and preferred wishes. Staff interviewed were able to describe in good detail the care they give and the reasons behind the nursing intervention that may be needed to keep residents safe and well. Special beds and cushions were seen in residents rooms for those who need to spend long periods of time in bed. This helps to monitor and protect their skin. Any medical conditions that arise had also been recorded in a short term care plan as part of providing the necessary care. Detailed records were seen where a resident had been admitted to hospital as part of monitoring their treatment. Records showed visits by doctors and other medical professionals, for example, district nurses (for residential residents), skin specialist nurses and dieticians to promote and keep residents well. The AQAA reports that residents benefit from a weekly GP round and a link nurse who has regular contact with the hospice. The hospice provides support for residents at the end stage of their life. Records seen and talking with staff confirmed they write up the daily care they given and any change in condition is always reported. There is also a key worker system where by care staff taken on responsibilities for a number of residents and summarise the care they give over a period of time. These records also gave a general overview of the care with emphasis on social arrangements which the residents had taken part in. A staff member said, I write up the care I give to make sure everyone is aware of what has happened. With regards to the standard of care received, residents made the following comments, The care and help is excellent, I could not want for more, Very good care indeed, The girls are just brilliant and Caring in all senses is excellent. Staff were observed to assist residents with different aspects of care in a friendly and professional manner. Good communication was evident and they gave help and advice to residents in a pace that suited them and also in private when required. Medicines were being given to residents according to their prescriptions. A number of residents were receiving support to manage their own medications if they preferred and if they were able; others were given out by trained staff. Residents who wish to take charge of their medications can do so following the completion of a risk assessment by a trained member of staff. This is to ensure this is the right decision for the resident and that they are able to take them safely. Policies and procedures and completion of medicine charts evidenced that medicines Care Homes for Older People Page 15 of 31 Evidence: were being well managed and regular checks had been undertaken by the deputy manager to ensure full compliance with storing, administering and disposal of medicines. Discussion took place with the manager regarding recording two staff signatures for hand written entries on the medicine charts. This practice should be considered to ensure accuracy. Observations and feedback from residents and relatives confirmed that the staff were polite and helpful. Attention was paid to making sure everything was right for the residents and time was taken to explain care procedures. There was plenty of equipment and aids available to promote the residents independence and residents said that the staff ensured their privacy was not compromised in anyway when receiving care. Whilst walking round the home, residents appeared smartly dressed and very relaxed and comfortable with the staff. A resident said, The girls make sure I wear what I want as I like to decide. Staff were seen to knock on bedroom doors before entering and the manager has introduced a privacy sign, which residents can request to be placed on their door when they do not wish to be disturbed. Residents interviewed said the staff addressed them with their preferred name as a matter of respect. Staff were seen to help residents with their meals in an unhurried manner and respected the fact that some residents may need longer to enjoy their meals. Extra time has been allocated at lunch to enable this to happen following a request made by a resident. This demonstrates that staff listen to what is important to the residents. The staff provide a very good standard of care for residents who are dying and the care needs and wishes of the residents and their family are recorded in specialist care plans. This helps to ensure dying and death are dealt with in an open and sensitive manner. Staff were seen to respect the cultural and spiritual needs of residents who are approaching their end of life. Staff receive training and are accredited for end of life care in the community by the Gold Standards Framework in conjunction with the National Health Service. They have achieved a commendation for their work in 2008. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy a very good quality of life and are involved with a wide range of stimulating activities both in the home and local community. Evidence: Residents benefit from a very good standard of social arrangements in the home. They are encouraged to take part in and enjoy a lifestyle that is stimulating and also respects their wishes. The routine is flexible and if the residents wish to join in with different activities this is encouraged. The home has a very well equipped therapy department with designated staff. The therapy department includes equipmnent for rehabilitation and also crafts, hobbies, games, massage, relaxation, cooking and music. A number of residents have rehabilitation programmes and these are instigated by a physiotherapist who is contracted to the home. There is also a phsyiotherapist assistant to oversee the programme each day. The activities plan was displayed on all floors and one to one sessions are arranged for residents who would prefer to stay in their rooms. A quiz took place in a lounge at the Care Homes for Older People Page 17 of 31 Evidence: time of the inspection and this was well attended. There was plenty of laughter and fun all round. The breakfast club is popular with the residents and this is by invite only to ensure everyone can take part over a period of time. The residents preferred activities are discussed with the therapy staff on admission and they do their best to ensure these can continue or to provide support with new hobbies. There were photos on display of recent events such as Halloween and residents said that the staff make everything good fun. A small number of residents are very independent and they go out each day. The staff encourage this and assist them to be involved in all areas of daily living, for example shopping, and visiting family and friends. If a resident has a car then they are able to park it at the home. The home has a chapel and regular services are held so that residents can practice their chosen faith. A regular hairdressing service is also provided each week. Comments from residents regarding the activities included, The therapy department staff in the home are particularly good at arranging activities. Full marks to them, The massages are just perfect, I like the relaxation, what more could you want and The quizzes are good for stimulation which is important. A Tree of Life has been designed in the lounge to commemorate residents who have died and a resident commented on what a lovely, caring gesture this was. Visitors were seen at various times of the day and made welcome by the staff. They are asked to sign in and out of a visitors book for security purposes. A relative commented, The staff are very nice and always have time for a chat. Residents confirmed that they can maintain social contact with friends and relatives within the privacy of their own room. Residents were complimentary regarding the standard of the meals. The menu showed that they receive well balanced meals with lots of variety. It is based over four weeks and subject to change according to what the the residents would like. The chef enjoys home baking and cake making is a specialty. A resident said, The cakes are wonderful. Meals are served in the dining room or in residents rooms if preferred. The dining room tables were attractively laid and the meals were served by waitresses. The waitresses were unhurried in their approach and paid attention to how the food was presented. Staff were on hand to assist residents with their meals and the help given was sensitive and not intrusive in anyway. Mealtimes are flexible and there are two sittings at lunch time. Residents who go out from the home, said it was no problem for meals to be saved until they returned. Additional refreshments are offered throughout the day and information on what Care Homes for Older People Page 18 of 31 Evidence: residents would prefer to eat had been recorded in their plan of care. This is to ensure that meals are served to their liking and in accordance with medical need. A small number of residents have cooking facilities in their bedroom as they are accommodated in hostel rooms. This enables them to have meals with other residents but also to do some light cooking. Comments from residents regarding the meals included, Like a hotel, I cannot fault it, Lovely meals, plenty of fresh vegetables, We always get delicious cakes, I think it is first class and It is so nice to have company over lunch and enjoy a good, hot meal. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by the complaints and safeguarding procedures which are understood by the staff. Evidence: A complaints procedure was available for the residents and complaints received had been recorded in a complaints book. This means that residents who live in the home can easily access information on what to do if they are unhappy and staff are reminded of how to support them if they wish to complain. A staff member said, We have policies and procedures to follow up any complaints and a line of people we are able to speak to. Over the last twelve months the manager has received one complaint and records showed that following an investigation the complaint was upheld. The Commission for Social Care Inspection have not received any complaints regarding the service. Residents interviewed and feedback from surveys confirmed residents were happy with everything in the home and had no hesitation in speaking with the manager if at all worried. The staff had received training in how to respond to suspicion or evidence of abuse and safeguarding procedures were on file to help protect the residents. Staff interviewed demonstrated a good knowledge of what to do should they witness an Care Homes for Older People Page 20 of 31 Evidence: alleged incident and how it should be dealt with. A staff member said, I would always report anything I was unhappy about. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable, clean, well maintained and safe home. Evidence: Alexandra House is divided into two units. The residential unit is on the second floor and the nursing unit is on the ground and first floor. The five beds on the ground floor accommodate residents who are more independent. The home has a spacious entrance hall with plenty of information for residents to read and there is an intercom for security purposes at the main door. CCTV cameras view external areas only. Whilst walking round the home, the lounges, dining room, therapy department, laundry room, kitchen, a number of bedrooms and bathrooms were seen. The standard of furnishings and fittings was of a good quality and time has been taken to make the accommodation feel homely. There were plenty of pictures, ornaments and comfortable chairs and coffee tables situated on all floors. A relative said, The bedroom is fine and we have brought lots of things in from home which we are pleased about. Likewise a resident said, My room is just how I like it. A maintenance person is responsible for keeping the home in a good state of repair and there is an ongoing programme of decoration. Since the last inspection some bedrooms have been decorated and plans are in place to continue with this Care Homes for Older People Page 22 of 31 Evidence: programme. Bedrooms seen had pleasing colour schemes, comfortable beds and each resident had a call bell to ring for assistance. Residents spoken with were pleased with their bedrooms and also the spacious lounges and dining room which they enjoy spending time in. The large lounge is used by the therapy team for activities and also meetings. There is ramp with hand rails to the front entrance all areas of the home are accessible by a passenger lift and a chair lift. The AQAA reports that plans for the home include a ramp to the second floor to allow accommodation to residents requiring a wheelchair. The manager is also looking to refurbish the ground floor toilets. A corridor on the ground floor nursing unit should painted as the paint has become scuffed over time. The manager said this would be included in the maintenance plan for the home. Bathrooms are equipped with aids to help the residents and they were found to be clean with no unpleasant odours. A special shower rooms had been installed in one bathroom. Residents interviewed said that there was plenty of hot water to enjoy a bath. There are plenty of hoists and hand rails to help residents with their independence. The AQAA confirmed that policies and procedures were in place for monitoring standards of hygiene in the home. The staffing rota showed that there are good number of domestic staff on duty to keep the home clean. A resident reported, The domestic staff are very helpful and willing. There is also a small laundry room for residents who wish to launder their own clothes. Records seen evidenced that the home has been visited by a fire officer to ensure fire regulations are adhered to. An environmental inspection also resulted in the staff receiving a rating of four stars in 2008. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive care and support from staff who have the skills and knowledge to support them correctly. Evidence: The AQAA and the staffing rota showed that good numbers of staff were employed to provide care and support to the residents. A resident said, There are plenty of staff to help you and they are willing to do that bit extra. The management team comprises of a registered manager, deputy manager, two deputy care managers and a care manager. The care manager is in charge of the residential unit and is accountable to the registered manager. A full compliment of staff work with the management team and this includes registered nurses (for the nursing units), carers, domestic, laundry, administrative, catering and maintenance staff. At the time of the inspection the registered manager and deputy manager were on duty. They work closely with the staff and also have designated supernumerary hours for the completion of managerial work. Two registered nurse and seven carers were on duty for the nursing unit and the care manager and four care staff were on duty for the residential unit. Staff receive training in National Vocational Qualifications (NVQ) in care as part of the development of their role. The AQAA showed that over 50 care staff have achieved a NVQ in care. The home is an accredited training centre for NVQ and a number of staff Care Homes for Older People Page 24 of 31 Evidence: are NVQ assessors and internal verifiers for teaching purposes. There is a rolling programme for NVQ in care and housekeeping. This demonstrates a commitment to learning by the staff. A staff member said, The staff are treated very well and there is plenty of ongoing training. Feedback from the surveys and interviews with residents and relatives was positive regarding the care and support provided by all staff. Staff were seen to help residents with personal care and this was carried out in a professional and caring manner. Good communication was evident and staff took part in a hand over at each shift and had access to communication books for passing on relevant information. Residents made the following comments regarding the staff, Very good care, The staff are excellent and I like the staff, no problems. Recruitment of new staff was found to be robust to ensure they were suitable to work with vulnerable residents. Staff records evidenced that all the necessary records required prior to employment were in place. This included police checks and references. The AQAA reports that there is a recruitment policy and equal opportunities statement to ensure staff are recruited fairly and without discrimination. Examination of staff records and talking with staff confirmed that they have a full training programme to ensure they have the skills and knowledge to care for the residents safely. New staff receive an induction, which is compliant with Skills for Care Common Induction Standards. Training records should be brought up to date to reflect courses undertaken to evidence a record of achievement. Some staff also require training in infection control and food hygiene. This was discussed with the manager and future training dates for moving and handling, infection control, fire, first aid and food hygiene were arranged for the next twelve months. Other courses attended by staff include end of life care, dementia care, equality and diversity, management development and drug awareness. The manager talks to staff about equality and diversity to ensure their is an understanding of respecting a residents rights and wishes with regard to sexuality, religion, culture and belief. Plenty of learning material was available for the staff to read with regard to caring for the older person and there was guidelines on clinical care. Staff made the following comments regarding employment and training, The staffing levels are good, Checks had to be verified prior to commencing employment and Induction interesting and informative. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Alexandra House is very well managed with systems, policies and procedures to ensure the health and safety of staff and residents living there are promoted and protected. Evidence: The registered manager is Ms Sharon Watson and she has many years experience as a manager and has completed the necessary NVQ in management. She is also a registered nurse. Staff and residents were complimentary regarding her management style. The following comments were received from the staff, Very approachable, I feel it is very well run home and All residents needs are met to a very high standard. From the residents, I see the matron most days and think the home is well run and All the managers work well together. There is a good management structure in the home and an operations manager was visiting at the time of the inspection to attend the residents meeting. The manager confirmed that senior management are supportive and visit regularly. A staff member Care Homes for Older People Page 26 of 31 Evidence: said, I think it is an excellent company to work for and I am impressed with the care and overall service the residents at Alexandra House receive. A visiting health professional commented on the very good communication that exists and the staffs commitment to providing consistent, good care. The views of the residents and relatives are sought through regular meetings, daily communication and satisfaction surveys. Regular residents meetings include topics, such as provision of food, meals and activities. This helps to ensure the home is run in their best interests and they can communicate or give their views or opinion of the home. Surveys sent out last year gave an overall satisfaction of 97.7 for the service and those received by the Commission for Social Care Inspection were also complimentary. A resident meeting was held at the time of the inspection and this was well attended. Residents were able to prepare their questions in advance of the meeting and could discuss the home with the various head of department. Minutes were also provided of previous meetings and as previously stated suggestions have been taken on board at the request of the residents. The AQAA reports that the newsletter introduced gives details of forthcoming events and general information about the home. As part of assessing the quality of the service a senior manager completes regular visits to the home and a monthly report is published of their findings. This is called a Regulation 26 report and the one seen was detailed. It recorded audits that are carried out if any complaints are received or if any accidents have occurred. Accident forms seen showed the nature of the accident and what action was taken by the staff to ensure residents safety. The AQAA confirmed that health and safety policies and procedures were in place and that maintenance and associated records were up to date. Spot check of the fire, gas, and electric certificates confirmed this. Fire records showed regular tests of fire prevention equipment to ensure resident and staff safety. Staff said they hear the fire alarm being tested each week as part of checking the fire systems. Assessing risks was well managed and action had been taken to follow up on any issue that had affected the health and safety of the residents. This was seen in relation to resident care plans and the environment. An annual development plan shows what the home would like to achieve in the future and this document was available for residents to read. Staff have achieved Investors in People award and also an external award for the service they deliver. The manager continues to demonstrate a commitment to show that everyone has a understanding of residents needs in relation age, disability and culture. The care is Care Homes for Older People Page 27 of 31 Evidence: centred round each individual with emphasis on respecting residents rights and making them feel safe. Administrative staff are on hand to provide support with residents finances. These were found to be well managed to protect their financial interests. Records and receipts were seen of their transactions and how money had been spent. The finance department is audited by the organisation to ensure all financial procedures are adhered to. Staff interviewed and records seen showed that regular supervision is ongoing to help with their job role. Annual appraisals are also arranged. A staff member said, I receive support and supervision of my work. It was evident that the staff are given opportunities for their continual development. Policies and procedures for safe working and risk management were viewed. These had been reviewed regularly to ensure they were in accordance with current legislation and best practice. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Residents agreement to the plan of care should be updated to reflect a change in date when their care needs are reviewed. Two staff should record handwritten entries on the medicine charts to ensure accuracy. Training files should evidence dates of courses undertaken to evidence a record of their level of achievement. 2 3 9 30 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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