CARE HOMES FOR OLDER PEOPLE
Alexandra House 1 Narborough Road Huncote Leicestershire LE9 3AN Lead Inspector
Keith Charlton Unannounced Inspection 2nd November 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Alexandra House Address 1 Narborough Road Huncote Leicestershire LE9 3AN 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) 0116 2753669 Mrs Jacqueline Ann Skubala Mr Albert Konrad Skubala Mrs Jacqueline Ann Skubala Care Home 17 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (17), Physical disability over 65 of places years of age (7) Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To be able to admit the named person of category DE named variation application number V000000223 dated 10/12/03. 1/8/2005 Date of last inspection Brief Description of the Service: This is a newly registered home for Older People.It is situated in the village of Huncote. There are local facilities nearby.Service users all enjoy the benefit of a single bedroom with toilet en suite. There is a choice of lounge/dining rooms and a good size garden to the rear.The Home has a friendly Labrador dog who provides companionship to service users. Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of the inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting two service users and tracking the care they received through looking at their records, discussion, where possible, with them and care staff and observation of care practices. This was an unannounced Inspection. The Home’s Deputy Manager was present. Planning for the Inspection included assessing notifications of significant events sent to the Commission for Social Care Inspection by the home and following up the requirements from the last Inspection Report. There have been no complaints received by the Commission for Social Care Inspection regarding the home in the past year. The Inspection took place between 09.25 and 14.00 and included looking at facilities, inspection of records and indirect observation of care practices. The Inspector spoke with seven residents, one member of staff and the Deputy Manager. What the service does well:
Care Plans are comprehensive to assist staff to deliver care that fits individual service users care needs and there is a checklist of Policies and Procedures for staff to ensure that they are read and staff records contain essential statutory checks. Service users again said that they felt safe and well looked after, thought staff were friendly, they said that their suggestions were taken up and quickly acted upon by staff and management, they liked the food and their bedrooms, visitors are welcomed by staff, they have the choice of going to the lounge or staying in their bedrooms if they choose and bedrooms are personalised and homely and their personal effects. Service users are encouraged to continue to be independent and follow their hobbies, e.g. baking, going to outside clubs and to church etc. Facilities are kept in a clean and tidy condition and decoration is of a high standard. Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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 DS0000049312.V262963.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The admission process means that needs are generally properly assessed though this was incorrectly handled on one occasion. EVIDENCE: The Home’s assessment form mirrors that of the National Standard so all essential issues are covered. The Registered Providers need to ensure that a minor variation is applied for regarding a service user outside the home’s legal registration category, needs to be swiftly made to legalise this situation. Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The individual needs and choices of clients living in the home are well met. EVIDENCE: Some service users said that they had Care Plans and were involved in reviewing them so that they met their needs. This was documented in Care Plans seen by the inspector, which also contained information as to the physical, social and medical needs of service users. Some Care Plans did not include full information as to the interests and hobbies of service users. The Deputy Manager said these would be reviewed and this information included. Service users said when they felt ill the Home would swiftly summon medical assistance - service users contacts with medical personnel were documented in Care Plans. Service users said they were satisfied with medication arrangements. Some service users take their own medication if it is assessed that they can manage this. Staff giving medication have received training according to the staff member asked. Service users said that their privacy and dignity was respected with staff knocking on doors before they entered and staff were always friendly to them.
Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 Service users living at the home have a good lifestyle. EVIDENCE: Service users said that they were satisfied with the range of activities on offer and staff came to them regarding games and quizzes and they liked it when staff had time to sit and chat with them. One service user said he would appreciate it if staff could read him crossword clues. The Deputy Manager said this is always facilitated when the service user wants this assistance. Service users can go out if they wish and one service user said he went to a shop to get his paper on a daily basis. Service users said they could attend local clubs if they wanted. A service user said she liked spending time alone and she could choose to take part in activities. Other service users said they could choose when to get up and go to bed and have additional baths if they wanted to. Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Service users views are listened to and acted upon. EVIDENCE: Service users said they felt able to talk to staff, and felt that issues are always acted on. This situation is commended. The home has a Complaints Procedure that details how to take up a complaint. A staff member was asked about the adult protection procedures, and demonstrated a very good understanding of this procedure. Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Service users were very satisfied with the upkeep and facilities of the home. EVIDENCE: Service users again said that facilities are kept clean and tidy. The home was found to be odour free. Some bedrooms were inspected and found to be homely with great deal of service users own possessions in them, and organised the way they wanted. One service user said he would like additional lighting in his room - the Deputy Manager said this was immediately followed up. Lounges were also homely and attractive. The Registered Provider has now installed a loop system to assist service users with hearing impairment. This situation is commended. Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 Staffing levels need to be reviewed to ensure that service users needs are always met. Staff recruitment checks protect the interests of service users. EVIDENCE: There has been an increase in the number of service users accommodated since the last inspection. There are two or three care/Management staff on duty during the day/evening plus a cook six days a week and a domestic worker three days week. Foe eleven service users accommodated there would be a general expectation that there always needs to be three care staff on duty in the morning period. The staff record inspected was found to be satisfactory with references and a Criminal Records Bureau/ Protection of Vulnerable Adults check in place. Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,37,38 Health and Safety systems need to be improved. EVIDENCE: In terms of Quality Assurance the Deputy Manager said that the survey results, as published in the Statement of Purpose, would be sent to the Commission for Social Care Inspection. There were some gaps in entries for food and medication records. The Deputy Manager said these would be followed up. The water temperature was taken in a first floor bathroom, which measured 48.8.c from the bath and 50.3c from the washbasin. The National Standard is close to 43c. The Registered Providers must ensure that there is a regular recorded system of checking to ensure that water temperatures ensure service users are not at risk of scalding.
Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 15 Some fire doors were wedged open. The Deputy Manager said that there is consideration at the moment that approved enclosures are fitted so that some doors can be kept open whilst at the same time preserving fire safety. An Immediate Requirements Notice was issued to immediately deal with these issues. Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 3 X X X X X X 4 STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X 2 2 Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 17 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. 1 Standard OP3 Regulation 14 Requirement The Registered Providers need to ensure that a variation is applied for the service user outside the home’s registration categories. Staffing levels need to be reviewed to ensure that all service users needs are always covered. Statutory records need to be complete. Health and Safety systems need to be improved regarding fire precautions and protection from hot water. Timescale for action 16/11/05 2 OP27 18 02/12/05 3 4 OP37 OP38 17 13 02/11/05 02/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Alexandra House DS0000049312.V262963.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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