CARE HOMES FOR OLDER PEOPLE
Alexandra House 2 - 4 Lord Street Southport Merseyside PR8 1QD Lead Inspector
Mrs Claire Lee and Mrs Margaret Van Schaick Unannounced Inspection 10:30 29 and 30 March 2007
th th 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 DS0000017218.V328105.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000017218.V328105.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Alexandra House Address 2 - 4 Lord Street Southport Merseyside PR8 1QD 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) 01704 543715 01704 543828 sharon.watson@bon.org.uk BEN - Motor & Allied Trades Benevolent Fund Mrs Sharon Louise Watson Care Home 56 Category(ies) of Old age, not falling within any other category registration, with number (56), Physical disability (6), Terminally ill (5) of places Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 56 OP and up to 6 PD The service should employ a suitably qualified and experienced manager who is registered with CSCI 1st March 2006 Date of last inspection Brief Description of the Service: Alexandra House (BEN - Motor and Allied Trades Benevolent Fund) is a registered care home run by a charitable organisation. The registered manager is Mrs Sharon Watson. The home provides 56 places for nursing and personal (residential) care for residents. Included in this number the home can accommodate up to 6 young physically disabled. Respite/day care is offered for up to 5-6 non-residents a week. The home is situated in the town centre close to local amenities including shops, churches, cinema, pubs, restaurants and public transport. Alexandra House is a large 5-floor building and consists of 2 units. The nursing unit has 28 beds (including 6 for the young physically disabled); the unit for personal (residential) care has 28 beds. The palliative care unit closed on 8th December 2006 and the 5 beds accommodate residents who require general nursing. The home has 52 single rooms and 2 double rooms; none of the rooms are en-suite. The 6 rooms on the top floor are small flats and residents accommodated in these rooms receive minimal personal care. The rooms on the top floor have cooking facilities and as the needs of the residents change, the rooms are being converted in to standard residential rooms. All areas of the home are accessible by the use of a lift and stairs. There is a chairlift on the residential unit and ramp for wheelchairs at the main front entrance. The home has suitably adapted bathrooms and a very good standard of equipment to assist those who are less independent. Residents’ benefit from a therapy room, hairdressing salon, their own laundry room and a chapel for worship. 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 £180.00 - £645.00 a week per resident. Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over two days for duration of eleven hours and forty nine residents were accommodated at this time. It was an unannounced inspection and on the first day of the site visit two inspectors were present. A partial tour of the premises took place and a number of the home’s care, staff and health and safety records were viewed. Discussions took place with thirteen residents, four staff, one of the home’s administrators and the registered manager. During the inspection six residents were case tracked (their care files were examined and their views of the home were obtained). This process was not carried out to the detriment of other residents who also took part in the inspection process. An interview also took place with a relative. All the key standards were inspected and also a previous requirement from the last inspection in March 2006 was discussed. Satisfaction survey forms “Have Your Say About …” were distributed to a number of residents and relatives prior to the inspection; fifteen surveys were returned. Comments included in the report are taken from the surveys and also during the site visit. A pre inspection questionnaire was completed by the manager prior to the site visit to provide information regarding the establishment, the service provided and personnel details. What the service does well:
Alexandra House presents with a very warm, welcoming and friendly atmosphere. A number of staff have worked at the home for a long period of time and it was evident that the home has a committed staff team who deliver good standards of care to the residents. Residents and relatives were complimentary regarding the level of care and support they receive. Comments from residents and relatives include: “I don’t think you would find anywhere better, not here in Southport anyway” “My mother could not be better look after” (relative) “We all get very good care” “The home is just lovely” “Can only say I am pleased I made the decision to come here. It has made life much easier” “Very special place” “Cannot fault the home”
Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 6 The care files contain relevant information regarding the resident’s individual health and social care and all care plans are subject to review to ensure the information is recorded accurately and to reflect any change in care. Residents and/or relatives are involved with this process and a relative said, “The staff at Alexandra House always keep my mother and myself informed about everything”. Through discussion and observation it was evident that residents were treated respectfully and the home ensures good standards of privacy and dignity. Staff were observed assisting residents in a discreet sensitive manner with their lunch and also ‘do not disturb’ signs are placed on bedrooms doors when residents are resting or staff are carrying out a nursing procedure. This ensures residents are not disturbed. The home’s routine was relaxed and based around the wishes of the residents; this was discussed in relation to meal times and time of retiring at night. Visitors were seen popping it at various times of the day and a relative said, “When I go to Alexandra House which is every other day at a different time, everybody has a smile and you always feel part of a big family”. Residents are offered a good range of social activities including, ‘Take Your Pick’, musical entertainment, quizzes, bingo and massage. The home now has a minibus for outings with designated drivers. A therapy department is situated in the basement and therapy staff work closely with the residents to ensure they can continue to enjoy their social interests and also to take part in rehabilitation programmes where appropriate. A physiotherapist conducts assessments for different programmes. The therapy department is well equipped and feedback from residents was positive regarding its use. Therapy staff arrange social activities in the afternoon and residents said the quizzes are great fun. An activities list for the week is displayed for residents to view. A number of residents are fairly independent and go out each day into to Southport; one resident went on holiday last year. Residents were very complimentary regarding the food and the menu offered a good variety of wholesome meals. Snacks and hot drinks are available at any time. Residents interviewed said they are consulted with regard to any change in the menu to ensure it is to their liking. Silver service is provided in the dining room by catering staff and the tables are attractively laid for each meal. The home has an excellent standard of equipment to assist residents with limited mobility and this includes moving and handling aids, special baths, beds, pressure relieving mattresses and physiotherapy equipment in the therapy department. Staff receive moving and handling training to ensure they have the knowledge to transfer residents safely. The lounges and dining room are pleasantly decorated and although the standard of furnishings in some bedrooms does differ residents interviewed were pleased with their rooms. Bedrooms seen had personal items belonging Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 7 to them and they appeared ‘homely’ in appearance. A resident said, “I am quite happy with the size of my room and have all my belongings with me”. New staff are recruited via robust recruitment practices to protect the residents. Staff commence employment once two written references have been received and a CRB (Criminal Record Bureau) enhanced disclosure has been obtained. Staff have access to a good standard of training in safe working practice areas, courses include infection control, first aid, food hygiene, moving and handling, fire prevention and health and safety. Residents interviewed said that the staff were good at their jobs and appeared happy in their work. One resident stated the home has “Very nice staff”. The manager also ensures staff attend courses relevant to the care of the older client and for caring for residents who are terminally ill. The home has two nurses who act as link nurses with the hospice and the home is highly efficient in caring for residents who are terminally ill or dying. At the appropriate time residents’ care needs and wishes are recorded on a clinical pathway for the dying. The paperwork is very detailed to ensure a consistently high standard of care is given with the support of the resident’s GP and family. A high percentage of staff are qualified to a National Vocational Qualification (NVQ) Level 2 and above in care. Residents and relatives are asked for their views of the service and completed survey forms evidence satisfaction for the service. Through discussion with residents it is apparent that many attend the regular residents meetings where they are able to participate freely. A resident commented on the fact that the manager listens to their views and takes on board suggestions. Through observation, discussion with the residents and staff it is evident that the overall management of the home is efficient and residents receive a high quality service. The manager works closely with the staff and senior management to ensure care standards are maintained and that the home’s policies and staff training programme promotes the health and safety of residents and staff. What has improved since the last inspection? What they could do better:
Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 8 The manager must complete a risk assessment for each resident who wishes to administer their own medicines. This will ensure they are able to take their own medicine safely and understand the risks involved. Recommendations are made within the main report regarding the recording of further details for the care needs’ assessment and wound care for residents on the nursing unit. This will provide staff with more details when planning their care. Risk assessments are completed for the use of bedrails and the resident and/or their relative’s agreement and consent should be sought, as this is a form of restraint. The basic induction for care staff who have past experience in care should include further details regarding care practices to ensure they have a better understanding of care delivery in the home. The induction should be signed and dated on completion to keep the record accurate. The home is decorated to good standard however scuffed skirting boards on the corridors on the first and second floor should be painted. New wallpaper in these areas would also brighten up the home thus improving the overall appearance for the residents. 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. The summary of this inspection report can be made available in other formats on request. Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 9 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 DS0000017218.V328105.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are given sufficient information regarding home to enable them to decide whether the wish to use the service. Pre admission assessments help ensure that the home can meet the needs of the residents. EVIDENCE: The home’s Statement of Purpose has been updated to reflect the closure of the palliative care unit in December 2006. The Statement of Purpose is on display in the main hall and is given to prospective residents and their families. There are also other brochures regarding the home on display in the main hall for residents to view. A resident said the information was very useful when choosing the home. Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 11 Residents have an individual care record and assessment information is obtained by the manager, care manager and/or qualified member of staff prior to admission. Assessment seen were for residents on both units. The assessments on the residential unit contained sufficient information regarding the residents’ health and social care needs to ensure their care needs could be met. One resident on the nursing unit was accommodated from out of the area and a care management assesmsent was on file from the relevant authority. On the nursing unit it would be beneficial to record more details of residents’ personal care needs as they will require more assitance from staff due to the nature of their condition. A new assessment has been drawn up for residents who require short term care and this template could also be used for assessing residents who require long term care. The manager stated that this would be implemented to help improve the assessment process. Standard 6 is a key standard to be assessed however the home provides long term care only and does not provide intermediate care. Some of the residents have lived at the home for a number of years. Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs are addressed in care plans and medicines were given in accordance with the home’s policy thus ensuring they were administered safety. Residents are treated with respect and dignity and the home provides care and support in a sensitive way for those residents who are at the end stage of life. EVIDENCE: Six care files were viewed as part of the case tracking process (three files of residents on the residential unit, three files of residents on the nursing unit). The care files are accessible for staff, they are organised and the information is easily read. Residents and/or their relatives are involved with the drawing up of the care plans and information is reviewed regularly to ensure accuracy and report any changes in care provision. The care plans include key areas - skin, nutrition, personal hygiene/well being, sleeping, spirituality, expressing sexuality, pressure area care, mobility, risk taking/ falls, communication, and
Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 13 social involvement. Residents are also involved with the drawing up of their care plan for end stage of life to record their final wishes. One care file contained details of wound care and it was difficult to follow the progress of the affected site as the care plan and wound care chart did not reflect the same information. Following discussion with the manager the records were amended. A more detailed wound care chart would be beneficial for monitoring the progress of the affected site as part of the ongoing management. The care files contained assessments for nutrition and residents are weighed regularly to monitor weight gain or loss. An assessment is completed for the use of pressure relieving equipment and aids for residents whose skin may be at risk from breaking down. Moving and handling assessments record the equipment to be used to transfer residents safely and the number of cares to assist with this task. A risk assessment is also completed for the use of bedrails; agreement and consent should be sought from the resident and/or relative where possible, as bed rails are a form of restraint. The risk assessments seen had the signature of the nurse completing the form. A care file was viewed for a resident who is receiving specialist-nursing intervention with support from the hospital. The care file evidenced visits by the relevant external health professional and the daily record sheet gave a good account of the ongoing care. Staff interviewed were knowledgeable regarding the strict nursing protocols required for caring for the resident. Residents can see their GP when they want and staff accompany them on appointments from the home. Residents interviewed were pleased with the care they received and felt that the staff did a good job. Several residents when interviewed were unsure as to the details of their plan of care however were more than happy for the staff to organise the care for them. A relative said, “I feel that Alexandra House does everything well, they could not be better to my mother, they look after her very well”. The home cares for residents who are at their end of life. Staff provide care, comfort and support for residents who require an end of life pathway. The home implements the Gold Standards Framework for caring for residents with palliative (terminal) care needs. One resident was receiving care in accordance with The Vigil, which is for residents who have advanced progressive diseases with non reversible deterioration. The care file evidenced that the necessary paperwork had been completed in accordance with a pathway for the dying which replaces the general care documentation. The home instigates this at the appropriate time with the agreement of the resident’s doctor and family. Good staffing levels ensure the resident receives one to one care when needed. The home has strong ties with the hospice and two members of staff are designated link nurses between the hospice and the home. Residents are able to live and die in the place of their choice with the full support of the home.
Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 14 The medicine trolleys seen were locked when not in use and at the time of the site visit medicines were being administered in accordance with the home’s policy and procedure. A list is kept of staff signatures for those responsible for medicine administration and staff attend a medicine awareness course as part of their ongoing training. Residents can administer their own medicines if they wish however the home must complete a risk assessment to ensure each resident is able to take their own medicines safely. A disclaimer is signed by residents to say they wish to undertake this practice. A number of medicine charts were seen and staff signatures were evident for medicines administered. At the time of the site visit advice was sought from the Commission’s pharmacist regarding the recording of dressings for wound care. The manager was informed that if a wound care dressing was not signed for on the medicine chart then the date and change of dressing is to be recorded in the resident’s plan of care. This will ensure the care plan is updated regularly and will give an accurate record of the treatment. Staff were observed to be respectful in their general approach towards the residents and had time to sit and chat with them. Several staff members were observed assisting residents with various aspects of personal care and with choosing what they would like to eat at lunch. The help was given in a sensitive quiet manner. Staff did not appear rushed in any way when helping residents and were seen knocking on bedrooms doors before entering. A resident said, “The girls are always polite in everything they say and do”. To respect the resident’s privacy a sign is placed on the resident’s bedroom door when they are resting or when staff are undertaking a nursing procedure. The resident is then not disturbed. The home was offering a day care service to four people at the time of the site visit. People who attend for day care receive personal care from the staff and are able to have their meals with the residents and attend the therapy department. Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are able to exercise choice and control over their lives and are offered a choice of well balanced and nutritional meals. EVIDENCE: The home had a very pleasant atmosphere and residents interviewed were pleased with the social arrangements and routine in the home. The routine was discussed in relation to meal times and time of retiring at night. Residents had no problems with this and said that staff always tried to accommodate their wishes. A number of residents are able to go out independently and enjoy the freedom the home offers while others stay at the home. Staff work hard to ensure social interests are stimulating and it was evident through discussion with residents that they enjoy a full lifestyle. An outing was recently arranged to the Botanic Gardens; the home now has its own minibus with designated drivers fro trips out.
Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 16 The home has a very well equipped therapy department with moving and handling equipment, a special bed for physiotherapy, light therapy for stimulation and a microwave for cooking. The home employs a physiotherapist to assist with rehabilitation programmes and the department has its own staff including a staff physiotherapy aid. The therapy staff encourage residents to take part in a good range of social interests and hobbies either in the department or in one of the lounges during the afternoons. One resident attends a stroke club as part of her rehabilitation therapy. The activities are advertised all around the home and they include, ‘Take Your Pick’, music, quizzes, bingo, films and massage. The home also has a hairdressing salon and chapel for residents to enable them to worship. A resident confirmed that services are held at the chapel and on occasions therapy staff arrange a Songs of Praise service. The car park to the side of the building has been converted into a paved patio area/garden and a number of residents said they were looking forward to using it in the warmer weather. The garden has wheelchair access. Comments from residents regarding the activities include: “We have something on every afternoon” “I can go out when I want and went to London last year” “I think the therapy girls do very well with treatment and activities” “”The social side is good” “I like to go shopping in Southport” Visitors were seen popping in at various times of the day and they were able to spend time with their relative in the lounges or in the bedrooms if preferred. A relative said, “You can come in any time, no one minds at all”. Residents are able to personalise their bedrooms with small items of furniture, ornaments and photographs. A number of bedrooms evidenced this (with the resident’s permission). The rooms seen were pleasant and ‘homely’ in appearance. The residents were involved with the choice of carpet on the landings when it was replaced. Residents and relatives attend regular meetings to enable them to give their views regarding the home and minutes were seen for a number of recent meetings. To promote independence residents have their own laundry room, which enables them to care for their own laundry if they wish. The meals continue to be of a high standard. A copy of the menu was provided with the pre inspection questionnaire and it was on display in the home for residents to view. The menu is based over four weeks and the main meal of the day is served at lunchtime; two hot meals and vegetarian option are available at this time. There are two sittings at lunchtime and residents are
Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 17 offered silver service. Catering staff were observed to be very polite when serving the meals. Dining room tables were attractively laid for lunch and residents were able to choose whom they sat with. Residents said the food is always good and served nicely by the staff. Snacks and drinks are available at any time and the chefs prepare special diets if needed. Pureed foods are served in an attractive manner to preserve the colour and taste. Any changes made to the menu are undertaken following consultation with the residents and the menu is also checked by a dietician to ensue the balance and nutrition is satisfactory. Comments from residents regarding the food include: “Like a hotel” “Always good food” “Fish is always excellent” “You can have what you want” “Lovely food” “Not too big portions” Environmental health records seen were up to date and kept in line with the latest guidance to ensure the ongoing protection of the residents. Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives have confidence that their concerns will be dealt with. Abuse policies and procedures are in place to protect the residents. EVIDENCE: The home’s complaint procedure is made available to residents and relatives and it is also on display. Two residents did say however that they were not aware of the written procedure but they had no ‘grumbles’ and would speak to Sharon (manager) if they were worried. The manager said that the complaints procedure would be discussed at the next residents’ meeting to ensure residents are familiar with the content. One resident said, “I feel confident that I would be listened to always”. Through discussion with staff it was evident that they knew what to do should a resident wish to complain and that the home welcomes any suggestions to improve the service. The complaint log was viewed and two complaints have involved the police. No further action is being taken at this time. One complaint is ongoing with the organisation and the Commission are aware of the nature of the concern. The home has dealt with the complaint at Chief Executive level to ensure it has been investigated in full. The home has an abuse policy and also Sefton and Liverpool’s Guide for the Protection of Vulnerable Adults. The staff training record evidenced abuse awareness training and staff interviewed had an understanding of how to report an alleged incident.
Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,20,21,22,24,25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in pleasant, safe, well equipped, comfortable and well-maintained surroundings. EVIDENCE: Alexandra House is a large house comprising of two units. The residential unit is on the second and top floor, the nursing unit on the first and ground floor. The five beds on the ground floor are accommodated by residents who are less dependent on the staff. The home has a large spacious entrance hall with an intercom for security purposes at the main door. CCTV cameras view external areas of the home. There are a number of brochures and the Statement of Purpose on display in the main hall. Visitors are asked to sign in and out for security purposes.
Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 20 The home has a large dining room and one large lounge on the ground floor. There is also one small lounge on this floor, which is often used for private interviews or as a ‘quiet’ area. The residential unit has a small lounge and this is used for cosy television and video evenings. Small kitchens are on all floors for residents’ and staff use; the flats on the top floor have their own cooking facilities. In the basement there is a hairdressing salon, chapel and also therapy room. The therapy room is used daily and is well equipped to enable residents to enjoy social activities and rehabilitation programmes. A resident said, “The therapy sessions are really good”. A number of bedrooms were viewed and some are decorated to a very good standard. Others have adequate furnishings. Residents had personal items, pictures, ornaments and photographs and they can also bring in their own furniture if they wish. Room 304 and 107 have old bedside cabinets, which should be replaced due to their age and general wear and tear. This was brought to the manager’s attention and arrangements made to replace them. Residents are able to lock their rooms if they wish and a call system with an alarm facility is available in the rooms. The bathrooms are well equipped with aids to assist residents who have limited mobility. Residents can choose to have a bath or shower and hot water temperatures are recorded to ensure the hot water is delivered at a safe temperature. Records seen were current. The home offers a very good standard of equipment including a variety of hoists, slings, handrails, raised toilet seats, assisted baths and pressure relieving equipment, mattresses and chairs. One room had a pressure mat next to be a resident’s bed to monitor the resident’s movements at night as they may be at risk of falls. Staff interviewed said that the home had plenty of equipment to meet the needs of the residents. The home is subject to an ongoing programme of maintenance and refurbishment. The home is decorated to good standard however scuffed skirting boards on the corridors on the first and second floor should be painted. New wallpaper in these areas would also brighten up the home thus improving the overall appearance for the residents. Double glazed windows are being fitted this year as part of the maintenance programme. The home was clean and smelt fresh. Sufficient numbers of domestic staff were on duty to ensure a good standard of cleanliness was maintained. Staff had access to gloves and aprons and infection control procedures were being adhered to thus minimising the risk of infection. The home has a large clean, organised laundry room and also a smaller laundry room for residents to use if they wish to launder their own clothes. Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 21 A fire risk assesmsent of the building is in place and emergency lighting is provided throughout. The emergency lighting is subject to a full maintenance contract and records evidenced an ‘in house’ test of the equipment each month to protect the welfare of the residents. Comments from residents regarding the overall environment include: “I have a nice bedroom” “I have everything I need in my room” “The home is spotless” Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28, 29 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are appropriately trained and experienced staff employed so that residents feel supported and that their needs are understood and met. The home’s recruitment policy is robust to protect the residents. EVIDENCE: The staffing rota for the week of the inspection was seen for both units and also for the beginning of April 2007. Sufficient numbers of staff were on duty to provide support and care of the residents. The care manager was in charge of the residential unit and a registered nurse for the nursing unit. The registered manager was also on duty. Two members of the care staff are assigned to the five bedded unit on the ground floor during the day. Staffing levels are good to reflect the needs of the residents and residents said that staff are always around to help. Both units have a deputy manager and a facilities manager oversees the general maintenance, domestic, laundry and catering side of the home. The facilities manager is also a chef. Care staff have a key worker role whereby they are appointed extra responsibilities for a number of residents. Senior care staff are appointed as team leaders to give support to less experienced staff. The home has four domestic staff, a housekeeper, laundry assistance, chefs, catering staff and kitchen porters.
Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 23 The home is an accredited training centre for NVQ and 68 staff have NVQ Level 2 or above. A number of staff are NVQ assessors and internal verifiers for teaching purposes. Three staff are undertaking an NVQ in housekeeping and one staff member has an NVQ in hotel management. Staff interviewed were pleased with the NVQ training provided and the support they receive with their studies. Five staff files were viewed to establish the training given and to evidence recruitment practice in the home. Recruitment practices are robust to protect the residents. Files for new staff evidenced a completed job application forms, two written references and a CRB enhanced disclosure. Staff are given a handbook when they start and also receive a contract and job description. The home employs oversees staff to reflect diversity within the staff team and a staff member said that the manager and staff had been very helpful when starting work in a new country and improving her spoken English. All staff receive training in safe working practices – moving and handling, infection control, health and safety, first aid and food hygiene. A rolling training programme ensures staff have the skills and knowledge to care for the residents and improve outcomes for them. A member of staff said “I was not allowed to use any moving and handling equipment until I had received the training”. Some care staff are undertaking a Macmillan distance-learning course in palliative care and others have attended the hospice for palliative training. Registered nurses also have qualifications in palliative care and the deputy manager is a link nurse with the hospice. Other courses are also accessed and these include diabetes, continence management, Parkinson’s Disease, Dementia, appraisal and supervision training, Indian head massage, dealing with difficult people, medication awareness, computer training, falls and report writing. The home has a varied training programme, which enables residents to receive care from a team of staff who have the necessary skills, knowledge, commitment and experience to meet their needs. The home are having an awards ceremony in recognition of the training undertaken by staff. There are two types of induction for new staff. A very detailed induction is given to staff who have no or less experience in a care setting or who have not undertaken any NVQ training. A ‘basic’ induction is given to staff who have previous care experience and have an NVQ in care. The format for this basic induction is a checklist and is being changed to include more detail of the home’s care practices. The induction should be signed and dated on completion to keep the record accurate. Comments from residents and relatives regarding the staff include: “I don’t think you would find anywhere better, not here in Southport anyway” “My mother could not be better looked after” (relative) “We all get very good care” “The staff are just wonderful” Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 24 “I would say the staff are excellent, very well trained both day and night staff” (relative) “The staff are Alexandra House are trained and I do not have any worries about them” (relative) “They have lovely staff” “Very friendly people” One “Have Your Say” form returned by a resident reflected some concerns and one of the inspectors met with the resident to clarify the issues. The manager was advised of the outcome of the meeting and further discussions took place with the manager to resolve any issues. No further action is being taken at this time and the resident is satisfied with the service. Staff interviewed were pleased with communication in the home and said they can contribute their views at meetings and on a day to day basis with the management. Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,32,33,35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home and administration of the home is based on openness, understanding and respect of resident’s views and wishes. The health and safety of the residents is protected by the home’ policies and procedures. EVIDENCE: The registered manager is Mrs Sharon Watson and Mrs Watson has many years experience as a care manager. Mrs Watson has completed the Registered Manager’s Award and is an assessor for NVQ. Through observation, viewing home records and discussion with staff, residents and relatives it was evident that Mrs Watson is highly competent to run the home and works closely with staff to maintain and develop good standards of care for the residents. Mrs Watson maintains robust practices with regard to recruitment,
Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 26 an excellent standard of staff training and implements research based care practices for residents to protect their welfare. Residents and staff made the following comments regarding the manager, “Good”, “Really helpful”, “Always has an open door, “You can ask her anything”, “Always available for a chat” and “Sends time with the residents”. A care manager, two deputy managers and a full compliment of staff support Mrs Watson in her role. All staff receive individual supervision to discuss their professional development and any concerns they may have. Staff interviewed said they were supported in their role and that the overall management of the home was very organised. Staff also receive an annual appraisal and a list was seen for personal identification numbers and expiry dates for the registered nurses. This check is undertaken as part of their fitness to practice safely. Residents at the home have varying needs, some more complex than others. It was evident through observation and discussion with staff that they confident in delivering high quality outcomes for residents with regard to their individual care needs and, for example, gender and belief. Policy documents are being reviewed to reflect equality and diversity within the service and staff are going to attend a course on this subject through Age Concern. Residents have a care plan for recording ‘expressing sexuality and spirituality’ to ensure their individual wishes are recorded and respected by staff. Residents and relatives are asked to complete satisfaction survey forms regarding the service. Survey forms from September 2006 reported positively regarding the service and any negative comments had been picked up by the manager and addressed. The home has a local independent external quality award, which is awarded annually and senior management conduct a twicemonthly visit to the home and record their findings in line with Regulation 26 of the Care Standards. The report for February 2007 was seen and found to be satisfactory. Each month the manager completes a quality check of a number of care files and medicine charts from both units to ensure care needs are reflected in detail and that medicines are administered safely. The home has Investors in People and the manager is looking to review and include more detail for the home’s annual development plan in April 2007. The home has a finance department and efficient systems ensure residents’ monies are protected. Finance staff are responsible for monies held on behalf of a number of residents. Individual records were seen and these evidenced balance totals, expenditures, receipts, staff and or resident signatures. The finance department is audited by the organisation to ensure the home fulfils the requirements of the residents. The home’s accident book was viewed and recent entries recorded in detail the nature of the incident and any action taken. Accidents are monitored in the home with emphasis on falls and their cause. Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 27 The home has policies and procedures in place to help protect staff and residents. A policy was seen for abuse, confidentiality, equal opportunities and recruitment. Maintenance contracts are in place for a number of services and equipment. Safety checks are carried out and a current certificate was seen for the gas, electric, lift and moving and handling hoists. Staff receive fire training and the equipment is subject to an annual maintenance contract. Fire alarms are tested weekly and a fire drill was conducted in February 2007. Staff interviewed were aware of the procedure to be followed in the event of a fire. Ongoing maintenance of the service protects the welfare of the residents. Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 28 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 4 X 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 3 X 3 Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13 (2) Requirement Staff must complete a risk assessment for each resident who wishes to administer their own medicines. This will ensure they are able to take their own medicine safely and understand the risks involved. Timescale for action 30/05/07 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. 2. 3. Refer to Standard OP3 OP8 OP8 Good Practice Recommendations The nursing assessment should contain further detail regarding personal care to ensure staff have the information needed to care for the residents. The risk assessment should evidence the resident’s consent and agreement to the use of bed rails, as this is a form or restraint. A resident’s care plan and wound care chart should reflect
DS0000017218.V328105.R01.S.doc Version 5.2 Page 30 Alexandra House 4. OP19 5. OP30 the same information to ensure the resident receives the care they need and reflect the current treatment. The home should look to introduce a more detailed wound care chart for recording purposes to help with this process. Scuffed skirting boards on the corridors on the first and second floor should be painted. New wallpaper in these areas would also brighten up the home thus improving the overall appearance for the residents. The basic induction for care staff should include further details regarding care practices to ensure they have a better understanding of care delivery in the home. The induction should be signed and dated on completion to keep the record accurate. Alexandra House DS0000017218.V328105.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 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
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