Inspection on 28/02/06 for Alexandra House

This inspection was carried out on 28th February 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 10 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 16/06/06

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 28th February 2006 09:30 Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 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.V284993.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V284993.R01.S.doc Version 5.1 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 To be appointed Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd September 2005 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 provide 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. Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors, Tanya Harding and Richard Leech and lasted seven hours. The home manager and deputy were present during the whole visit. All of the service users were seen and greeted during the day. A number of care records were examined including care plans, risk assessments and daily recordings. Several staff were spoken with and a tour of the premises was undertaken. A number of observations about how service users are supported were made at lunch- time. Examples of good practice and those where support should be improved have been noted and are described in the body of this report. This inspection was preceded by an unannounced visit on 31st January 2006, which focused on staff training. The purpose of this visit was to assess progress made towards meeting the large number of requirements from the last report. It was evident that progress has been made in a number of areas, although much work remains to be done to further improve the overall standard of care. A number of requirements could not be assessed at this visit, mainly around medication administration and storage systems and around formal supervision of staff. These have not been repeated in this report, but will be checked at the next visit. A meeting has taken place following this inspection with the representatives of Craegmoor Healthcare to discuss whether the progress achieved by the home is satisfactory in view of previous significant concerns and underperformance. What the service does well: What has improved since the last inspection? The main changes noted were with the environment. The bathroom and toilet facilities have been equipped with aids and adaptations and can now better meet the needs of people with physical disabilities. The garden has been landscaped and is accessible to wheelchair users and once completed would offer a relaxation space for service users. Greater stability has been achieved within the staff team. Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 6 Additional transport has been provided to promote access to the community. Key staff have received training in Health Action Planning and have began to implement the principles of this approach into service users’ care. Work has started on improving care plans and risk assessments although progress to date has been slow. 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.V284993.R01.S.doc Version 5.1 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.V284993.R01.S.doc Version 5.1 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): Not assessed. EVIDENCE: There have been no new admissions to the home since the last inspection in line with agreement between Craegmoor and the Commission for Social Care Inspection. The home has applied for a variation to its registration to reduce the registered numbers from 12 to 10. This is mainly due to the changes in the environment. Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 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 and 9 Shortfalls in care guidance continue to compromise the quality of support offered to the service users although steps are being taken to resolve this. EVIDENCE: Much of the care guidance written in May 2005 remains in use but some of the information here is out of date, may not correspond to the changing needs of the service users and there is limited detail of how to provide the required assistance. This means that staff may not have sufficient guidance on how to support the individuals in the way which is safe and appropriate for each person. These deficiencies have been recognised by the home and work has started to review and re-write all care guidance to make it person centred and accurate. The manager showed examples of new risk assessments and care plans which she hopes to provide for all service users within the next three months. The new format is seen as a great improvement on current care plans and its effectiveness will be monitored in future visits. It was observed that a message from a relative received by telephone was communicated by a staff member in front of several other service users and Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 10 staff. This was not seen as appropriate and should have been passed onto the service user and other staff in a way which would protect the privacy of the information. Good practice in passing information was also observed. Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 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): 13 and 17 Improved transport arrangements are in place although there are difficulties which prevent the service users from taking the full advantage of the new vehicles. Shortfalls in guidance for accessing the community safely may be jeopardising the safety of staff and service users. Improvements to the way meals are prepared and served are of benefit to the service users, although more needs to be done to promote independence in self-help skills and to develop support around safe eating. EVIDENCE: Daily records were examined for several service users. These provide information about which support is given and by whom, also information about outings and activities. These records are completed after each shift. The manager advised that three of the service users are now accessing hydrotherapy. Staff commented about service users going out into the community more, although some planned activities were not always accessed due to staffing or other events in the home. Guidance about supporting people Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 12 in the community safely needs to be improved as required in the previous report. Three service users were going out on the morning of the inspection, two to the day centre and one out for a drive. Two new minibuses have been provided for the home, both with the capacity to take up to two wheelchair users as well as seated passengers. There are some difficulties in using these buses as staff have to be over 25 yrs of age and in possession of the relevant licence to drive these vehicles. Staff spoken with were not aware of any specific guidance about safety matters when getting service users in and out of the vehicles. This requirement has been repeated in a number of reports and must be addressed to ensure consistency of approach and safety of the residents. A number of observations where made during the lunchtime meal and discussed with the home. These were around safe eating practices (see Standards 18- 21) and also about promoting self-help skills and independence. Good practice in this was observed when one person was supported to make their drink. It was clear that the service user enjoyed making a cup of tea. However, for another service user staff provided full assistance with food and drink although the care guidance on file evidenced that the person can pick up some foods and drink independently if seated in the right position. Staff should be given the right guidance which corresponds to the needs and abilities of the service user and which maximises individuals’ autonomy. Care plans for one person who requires assistance with meals were examined. These did not fully correspond to the recommendations which were made by the speech and language therapists about avoiding certain high risk foods and to be offered frequent drinks to avoid dehydration. Staff may already be taking these precautions in practice, however, without clear guidance in the care plan this would be difficult to monitor for effectiveness. It was observed that lunch was unrushed and there was good banter between staff and service users. Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 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 and 19 Systems are in place for responding to accidents and for monitoring service users health needs. The staff team may lack skills in supporting service users with physical and mobility needs and this has the potential to compromise people’s safety and wellbeing. EVIDENCE: Specialist health appointments are being arranged for one person to review management of their epilepsy. This is because the person has experienced a number of falls which could be linked to seizures. One service user had suffered a fall during which they had broken their arm. The manager advised that support guidance for this person around mobility and personal care has been amended to reflect the need for increased staff support. The person is currently being supported by two staff when mobilising. A discussion took place about service users with physical disabilities being supported when eating. The guidance in care plans about safe posture and seating must be checked to ensure this is sufficiently clear and detailed to minimise potential risks, such as choking. Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 14 There was evidence that food intake is being monitored for the service user who has on occasion refused food. However, monitoring of weight for the same person should be improved to provide a more accurate record. The manager shared her concerns about the ability of the care staff to fully meet the physical needs of the service users. This is with reference to the physio exercises and use of specialist mobility equipment. Further consultation should be carried out with the Community Learning Disabilities team professionals to ascertain the best way forward with meeting people’s needs in this area. Health Action plans are being developed for the service users by staff who have accessed the relevant training. Four have been completed at the time of this inspection. Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home continues to receive challenges to some practices through complaints and concerns raised but steps are being taken to learn from these for the benefit of the service users. EVIDENCE: The home has responded to a complaint from a health professional in January 2006. Evidence of a prompt response was seen. The manager advised that systems have been put in place to ensure that service users who attend medical appointments are supported by staff who are knowledgeable about the service users’ needs and have the right information with them. An incident during which a service user sustained a significant injury has resulted in a complaint. This was investigated by the placing authority with input from the Commission. An overview of the findings from this complaint will be forwarded to the home and the complainant. As a result of the incident additional assessments have been requested from the physiotherapist and the occupational therapist and care guidance and risk assessments for the service user have been re-written. The manager has made the Commission aware of concerns which came to her attention from a relative. The manager has provided an explanation of how the home is responding to these. An incident took place in the home in December 2005 which had seriously compromised the safety and wellbeing of a service user. The home has taken action to ensure this does not happen again. This relates to introduction of written hand-over sheets, which are completed by the team leaders and used Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 16 as a communication aid for staff to ensure all service users receive the necessary level of support and supervision. Staff spoken with said they would know who to go to with any concerns and were confident that these would be dealt with appropriately. The requirements around protocols for responding to challenging behaviours were followed up through discussions with staff. Staff were aware of which behaviour challenges some service users may present, but some were not aware of any written guidance about how to respond to these. Some staff talked about use of distraction and de-escalation techniques if a service user was displaying challenging behaviours. The Commission has requested for additional information to be gathered about an incident which took place on 10/11/05 during which a service user sustained injuries. The incident did not take place in the home and the manager advised that despite following this up, she has been unable to get any additional information about the events that day. Statements from staff and a notification of the accident have been provided. The home was also asked to provide a copy of the incident form for 02/11/05 involving a specific service user– to ensure full and complete information is available. This must be done. Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 17 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 and 30 There are significant changes to the environment which should enhance to quality of support and promote safety for service users and staff. EVIDENCE: A tour of premises was undertaken. The registered provider has invested a significant sum of money to update the facilities in the home. This has resulted in fewer bedrooms, some existing bedrooms having additional en-suite facilities provided, existing bathrooms and toilets have been redeveloped to incorporate the necessary hoisting, bathing and changing equipment. The garden has also been redeveloped and should become a valuable resource for the home and a relaxation area for the service users. A new lift has been provided and once in operation should ensure that service users can be transported safely between floors with staff support as necessary. There were numerous homely touches around the home and new furnishings and décor in some of the rooms. This has increased the feeling of homeliness and comfort. The deputy manager has made a comprehensive list of outstanding maintenance matters. She will be monitoring completion of these. A copy of Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 18 the ‘home inspection/ audit’ with details of outstanding matters has been provided to the Commission. There are plans to relocate the office closer to the kitchen and develop the space near this office in part for use by the team leaders and in part as a computer area for the service users. The formal office will then become a sensory room. Due to the environmental works the home now intends to accommodate up to 10 service users and has made an application to amend the registration. The manager advised that there have been some teething problems with ensuite shower rooms where water spray is making the floors wet. There have been some difficulties in accommodating all of the furniture in one room where the layout has changed with the addition of the en-suite shower room. This should be monitored to ensure that the service user and staff can manoeuvre safely in the room. One person needs a specialist bed for comfort and safety reasons. This advice came from the occupational therapist several months ago. The manager advised this has been requested but not yet approved by the registered providers. If the person has been assessed as needing this equipment for their wellbeing and safety the home must provided it. One service user has moved into a new room and indicated that they were very pleased with the room and the decoration. The person was looking forward to a new carpet being fitted and a new bed to be put up. One bathroom did not have a privacy lock and this needs to be provided. Discussion took place with the management team about providing a suitable area where service users can see their visitors in private in addition to people’s bedrooms, which may not always be appropriate. Cleanliness of the home is being maintained to a satisfactory standard as noted during the visit. All of the areas seen were pleasant and odour free. However, better systems need to be in place for cleaning wheelchairs as some were very grubby from food and dirt. Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 19 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 and 33 Availability of ancillary staff allows the support staff to concentrate their efforts on providing care and attention to the service users. Planned changes to how staff are deployed should allow for greater flexibility of support and better access to activities for the service users. Systems are in place for guiding staff towards carrying out their duties in a professional way and this should ensure that service users are treated with respect and dignity. There are still shortfalls in staffs’ knowledge of assessed needs and agreed care plans and this could compromise consistency and quality of care given to the service users. EVIDENCE: The deputy manager advised that large part of her role is to observe and supervise care staff in their daily work as a way of monitoring practice and ensuring that support for service users is offered in a consistent and appropriate way. It is felt that this is an important and necessary step in view that the staff team is very new and some staff continue to demonstrate lack of satisfactory knowledge of people’s needs and relevant care guidance. The manager gave an example of staff challenging discriminatory attitudes towards the service users when out in the community to promote fair treatment. Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 20 The use of endearment terms by staff when addressing the service users was noted on a number of occasions. Staff should be reminded of best practice in addressing people by their name or a preferred term of address (if different). On the day of the visit there were six care staff (including the deputy manager). There were also three ancillary staff including the cook, maintenance person and administrative assistant. The manager advised that changes to shifts have been proposed and likely to take place from April 2006. The main aim of these changes is to allow for staff to offer a more continuous support to the service users during the day. The home has been experiencing some difficulties with getting recruitment information back from the head office and this matter has been brought up to the attention of the Area manager. The policy about staff transferring has been supplied to the Commission for reference. It is felt that this is not sufficiently detailed about how any such transfer would be managed to ensure that the relevant information about the staff member was made available to the home manager. An additional visit was made to the home on 31/01/06 during which staff training records were examined. There was evidence that staff are receiving mandatory training and protection from abuse training. Additional requirements have been made about aspects of staff training and these have been responded to separately by the home. A number of staff were interviewed. These discussions provided evidence that good value base about respectful and caring approach is being promoted. There is emphasis on encouragement and non-confrontational approach when responding to difficult behaviours, expectation that staff will read care plans and raise questions which they may have in order to clarify any aspects of care. There were again shortfalls in staffs’ knowledge of care plans and care needs for the service users. Some staff spoken with showed good understanding of how service users communicate through non-verbal cues. However, some staff were not aware of a significant impairment which was detailed on file for one service user. Guidance for one service user talked about the person being able to hold their drink independently, but in observations staff did not present those opportunities to the person. Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 21 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 Stability of the management team and their commitment to promote good practice should continue to contribute to the improvements in care delivery for the benefit of the service users. EVIDENCE: Since the inspection the manager has successfully completed the registration process. The manager has got considerable experience of managing care homes. She has identified a number of areas for further development including working with people with profound physical needs. This inspection provided evidence that the home has benefited from a period of stable management. It is clear that there is still a significant amount of work to do before the home is meeting the National Minimum Standards in a number of areas. However, the Commission now has some confidence that the right steps are being taken to improve the quality of care and support for the service users. Positive feedback was received from staff about the improvements in the home, supportiveness and approachability of the manager and better Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 22 cohesiveness and motivation of the staff team. Some staff commented that the quality of care for the service users has also significantly improved. The manager advised that staff have received instruction on how to operate specialist equipment such as accessible baths and hoists. At the time of the inspection staff were awaiting for instruction in the safe operation of the new lift. The socket in one of the bedrooms had several appliances plugged in. The home should be mindful not to overload the socket in line with fire safety guidance. There were two sockets in this room. There has been an inspection by the Fire Officer and a return visit was expected to check on compliance. A door guard was missing from the fire door to the dining room on the day of the visit. This has already been noted for follow up by the home. Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 23 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 X 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 2 14 X 15 X 16 X 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 X X 3 X X X X X X Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 24 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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 and 31/01/06 not met) Ensure that care plans are understood and followed by staff and form the basis of practice. (Timescale of 30/06/05 and 31/12/05 not met) Provide staff with clear guidance on how to respond to difficult behaviours in the home and when out in the community. For use of any restrictive practices there must be a detailed protocol in place in line with the Department of Health guidance on use of restrictive physical interventions. (Timescale of 31/01/06 not met.) Risk assessments must provide sufficient detail about the actual risks and what specific steps / DS0000016360.V284993.R01.S.doc Timescale for action 31/05/06 2. YA6 12 and 18 31/05/06 3. YA6 12 and 13(6) 31/05/06 4. YA9 13(4) 31/05/06 Alexandra House Version 5.1 Page 25 actions must be taken by staff to reduce or eliminate these. (Some progress has been made) 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) which may be used to reduce risks. (Timescale of 31/12/05 not met.) 5. YA9 12 and 13(4) Robust procedures for supporting people in and out of vehicles must be implemented to ensure safety of service users and staff, as well as to protect the dignity of service users. (Timescale 02/02/05, 11/02/05 30/06/05 and 31/12/05 not met). Staff must follow safe moving and handling principles at all times. 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. Timescale of 31/12/05 not met. The guidance in care plans about safe posture and seating during meals must be sufficiently clear and detailed to minimise potential risks, such as Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 26 31/05/06 6. YA18 12 31/05/06 choking. 7. YA19 37 Provide a copy of the incident form for 02/11/05 involving a specific service user. Ensure all necessary and outstanding records are obtained for all staff working in the home. 31/05/06 8. YA34 19 31/05/06 9. YA22 22 10. YA29 23 Ensure staff are do not commence employment until full and satisfactory information is available about them. (30/11/05. Not assessed on this occasion.) Provide guidance on files about 31/05/06 how each service user is able to express their dissatisfaction and voice concerns. (Timescale of 31/07/05 not met). (31/01/06 – to be assessed at the next visit) The specialist equipment must 31/05/06 be provided for the service users. (This refers to the equipment (bed/s) assessed by the CLDT as being necessary for specific service users. ) 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 focus on the individual and give the necessary level of detail. 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 DS0000016360.V284993.R01.S.doc Version 5.1 Page 27 Alexandra House families to have access to expenditure records. This should be in line with the company policy and communicated to all involved parents and carers. 2. YA18 Care plans about providing support with intimate care should reflect service users’ preferences with regards to gender appropriate support. Staff should have allocated time to read care plans and support guidance on regular basis. The home should monitor whether the furniture arrangement in one bedroom is satisfactory to enable safe manoeuvrability and correct manual handling procedures. Further consultation should be carried out with the Community Learning Disabilities team professionals to ascertain the best way forward with meeting people’s postural and mobility needs. A suitable area where service users can see their visitors in private (in addition to people’s bedrooms) should be provided. Better systems should be put in place for cleaning wheelchairs. Staff should be reminded about sharing confidential information appropriately. Monitoring of service users’ weights should be improved to provide a more accurate record. Staff should be reminded of best practice in addressing people by their name or a preferred term of address (if different). 3. 4. 5. YA32 YA24 YA19 6. 7. 8. 9. 10. YA24 YA30 YA10 YA19 YA32 Alexandra House DS0000016360.V284993.R01.S.doc Version 5.1 Page 28 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.V284993.R01.S.doc Version 5.1 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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