Inspection on 03/08/09 for Alexandra House

This inspection was carried out on 3rd August 2009.

CQC found this care home to be providing an Adequate service.

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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alexandra House 30/08/08

Alexandra House 11/10/07

Alexandra House 20/05/07

Alexandra House 16/06/06

Alexandra House 28/02/06

Alexandra House 02/09/05

Alexandra House 22/04/05

Alexandra House 11/02/05

Alexandra House 04/05/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 24/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Alexandra House 2 Alexandra Road Gloucester Glos GL1 3DR Lead Inspector Ms Lynne Bennett Key Unannounced Inspection 3rd August 2009 14:00 Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra House Address 2 Alexandra Road Gloucester Glos GL1 3DR 01452 418575 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) alexandra.house@craegmoor.co.uk www.craegmoor.co.uk Cotswold Care Services Limited Mrs Jerusha James Care Home 10 Category(ies) of Learning disability (10), Physical disability (10) registration, with number of places Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning Disability (Code LD) Physical Disability (PD) The maximum number of service users who can be accommodated is 10 30th August 2008 2. Date of last inspection Brief Description of the Service: Alexandra House is a large, detached property in a residential area of Gloucester. The home has 10 bedrooms, some with en-suite facilities. There are three communal bathrooms, additional toilets, a large dining area and a separate lounge. Two of the bathrooms and one toilet have specialist adaptations such as overhead hoists and an assisted bath. One bedroom is on the ground floor. The other bedrooms are on the first floor. The home has two staircases, and a second lift has been built to improve access between floors. The home has a large back garden, which has been landscaped to make it accessible to wheelchair users. The home has a Statement of Purpose, which sets out its aims and objectives, as well as a Service Users Guide providing additional information about living in the home. These are available to current and prospective service users and to others with an interest in the home. The base fee was £1228 per week. Some additional charges are made. People living in the home are expected to pay for chiropody, haircuts and toiletries, as well as for services such as aromatherapy and reflexology. Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection took place in August 2009 and included two visits to the home on 3rd and 4th August. The registered manager had recently returned from maternity leave and was present throughout our (the Care Quality Commission) inspection. The Area Manager and Quality Assurance Manager were also present on the first day. An AQAA (Annual Quality Assurance Assessment) had been returned to us as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). We observed the care of 3 people using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these people. This is called case tracking. We also looked at staff files, quality assurance records and health and safety systems. What the service does well: What has improved since the last inspection? Eight requirements issued at the last inspection were complied with. One requirement was outstanding. Where there are restrictions on choice or freedom these are recorded with the reason for these clearly noted. People’s care needs such as changing their upper garments which were wet were being dealt with. Evidence was provided why medicine should be administered with food in agreement with the General Practitioner. Stock records were being completed for all medication kept in the home. Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 6 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to a range of information enabling them to make a decision about whether they wish to use the service. Ongoing re-assessment of people ensures that the service is continuing to meet their changing needs. EVIDENCE: The Statement of Purpose and Service User Guide were available in the home and were about to be reviewed. The AQAA stated, “We could have welcome packs set up for any potential individual which detail the facilities at Alexandra House and provide information not only in a format but also in an accessible format.” No new people had been admitted to the home since the last inspection. Previously people had been admitted after an assessment had been completed by Craegmoor and an assessment of need and care plan would be obtained from the placing authority. People wishing to move into the home would be invited for visits including overnight stays. One person was being supported to move to a new home and the changing needs of another person were being monitored. The registered manager said Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 9 that if the home were unable to meet their needs they would be supported to move to a home which was able to provide nursing care. Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Greater consistency in care planning and risk assessment will ensure that the assessed and changing needs of people are identified and they are safeguarded from possible harm. Staff must have access to the necessary information they need to meet people’s needs. EVIDENCE: The care of three people was case tracked and other files were sampled. The quality of information on people’s files was inconsistent. A manager stated that work was still in progress to further develop these plans. Some files had been reviewed with information being archived and new care plans developed. Not all information on these files had been completed. On one file there were notes indicating that this was work in progress and that these records had been reviewed but had still to be amended or completed. On another file sheets were left blank and whole sections of additional care plans and risk Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 11 assessments were missing. The registered manager located these in a box where records had been archived. Any archived records must be kept secure and accessible should they be needed in the future. During our visits the cupboard in the lounge where care plans and other information were kept was unlocked. Personal information must be kept under lock and key. One care plan indicated that a person did not have any specific religious beliefs but their ageing, death and dying care plan stated they were Church of England. A mental health/behaviour care plan indicated that additional care plans and risk assessments were in place should a person became angry but these could not be found. All care plans need to be thoroughly re-examined to make sure that all records are completed to a satisfactory and consistent standard. The format which was supposed to be in place for all people included a holistic assessment of their needs from which additional care plans and risk assessments were developed. Those in place had been regularly reviewed with an evaluation sheet providing evidence of when this had been done. It was evident that new additional care plans were being developed for some people when changing needs had been identified, such as concerns about weight loss or mobility. Staff were able to describe the care they were providing for people in respect of these new additional care plans. Annual reviews had taken place in 2008 and were being scheduled for this year. The registered manager confirmed that people were being involved in the process of reviewing their care plans. People spoke with us about their key workers and some people had signed their care plans. It was not clear how new staff would gain an understanding of people’s needs from the quality and standard of the care plans currently maintained in the home. This needs to be addressed urgently. Communication care plans indicated how to interpret people’s non verbal behaviour. Some staff had completed training in Makaton sign language and according to staff meeting minute’s further training had been requested. The AQAA indicated that this was still to be booked. Significant improvements had been made in the use of pictures and photographs around the home. A notice board in the dining room was used to display a photograph of the day’s meals. Each person had a display board in their room providing a way in which photographs indicating their activities for the day could be displayed. The registered manager showed us a collection of photographs which were being collated for this purpose. Around the home there were boxes and books with samples of photographs which could be used with people to enable them to make choices. There was evidence that any restrictions or restraints which were in place, such as the use of bed sides and key pads, were recorded. The rationale for Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 12 these was clearly noted. Best interests meetings were being held to discuss any areas of concern with the relevant health care professionals. A missing person’s procedure was in place with a pro forma describing each person in detail with a copy of a current photograph. Risk assessments for some were in place identifying hazards and indicating how these could be minimised enabling people to take risks as safely as possible. As mentioned in some files these documents were either missing or under review. A moving and handling risk assessment for one person indicated that a sling must be used when hoisting, but did not identify which sling (in this case the green sling) was to be used. Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16 and 17. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities to participate in social, educational, cultural and recreational activities are affected by staffing levels. People are supported to maintain contacts with families and friends. Some people had been put at risk by eating foods which should be avoided. EVIDENCE: Each person had an activity schedule in place indicating that some people would be supported to attend colleges and external activities alongside opportunities to participate in activities in the home. An activity log started in mid July indicated that one person had 10 activities recorded with two other people having 5 and 6 activities over this period. We sampled a two week period in June and a week in July/August. It was clear that people were not having access to activities outside of the home with any regularity. One Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 14 person’s care plan indicated the importance of ‘meaningful’ activities. During the weeks sampled records indicated they had been out to a jazz festival on one occasion. Time spent at home had either been in their room, the garden or the lounge watching television (four times), listening to music (once) or participating in karaoke (once). They had been distressed on 7 days and noted as happy on 4 days. The experience for a second person was similar although they were supported to go train spotting on one occasion. A third person had the opportunity to go for two drives, shopping, into town and for a walk as well as a cinema visit. Other people said they had been to college, horse riding and swimming/hydrotherapy. A music lady was visiting the home every fortnight and people had access to aromatherapy and manicures regularly at home. The registered manager stated that holidays were being planned with people. A community map had been produced to provide information about local resources and facilities. Staff spoken with and comments in surveys indicated problems with maintaining adequate staffing levels to be able to support people in their chosen activities. There were also problems with having sufficient drivers although staff said they had used public transport and walked to local facilities. The impact of lack of drivers was acknowledged in the AQAA which stated people were being supported to access free bus passes. Staff were planning a day trip to the seaside for two people using trains and had also walked to a tenpin-bowling centre in Gloucester the week before our visit. However staff said that staffing levels restricted the numbers of people being supported to go on external activities people requiring 1 to 1 supervision. Care plans indicated that people would be supported to help around the home with the cleaning, shopping and cooking. Staff confirmed that people were involved with the cooking and shopping. The home had various animals, a guinea pig, chickens and fish. The AQAA indicated that people would be encouraged to help to grow vegetables in the gardens. People said they kept in touch with family and friends. One person was looking forward to visiting their family and another person had been out with their family during our visits. A protocol had been introduced for opening people’s mail and supporting them to read this. People were having regular house meetings. Four had been held this year with another one planned for August. People had discussed holidays, the menus for the house, taking part in staff recruitment and selection and the use of keys or alternative technology to access their rooms. People also had the opportunity to be involved in area ‘Your Voice’ meetings and had feedback from Craegmoor’s ‘Your Voice’ divisional meetings. The home employs a cook to prepare meals. The menus were developed from people’s choices and preferences with an alternative to the main course being provided. People were observed having a tea of quiche, baked beans and Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 15 waffles and a lunch of gammon with parsley sauce, chips and peas followed by fresh fruit and ice cream. Several people had input from either a dietician or speech and language therapist with guidelines about what they should eat and what they should avoid. Two people had lists of high risk foods to avoid and were observed eating foods identified in this list both for tea and for lunch. This was discussed with the cook. Staff were observed providing drinks to people as identified in their care plans. One person’s care plan indicated that staff should sit with them and encourage them to eat slowly and take regular drinks to minimise the risk of choking. During tea, due to staff shortages, this was done by a member of staff feeding another person across the room. On the following day during lunch a member of staff provided this support from behind the breakfast bar rather than sitting with the person. This could possibly put the person at risk of harm. A care plan for one person indicated they were to have Complan twice a day but staff had indicated that they were now having Ensure drinks to supplement their diet. Environmental Health had awarded the kitchen five stars, this is excellent. The kitchen and larder were clean and records were being completed satisfactorily at the time of our visit. Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not receiving the support they need to sustain their physical health and wellbeing despite having access to a range of health care professionals and satisfactory medication systems. EVIDENCE: People’s care plans provided information about the way in which they liked to be supported with their personal care needs. One plan indicated that a person preferred male carers to help them but the other plans examined did not identify people’s preferences for support with their personal care. At the last inspection we indicated that some staff were being over familiar with people living in the home. We observed new members of staff hugging people rather than sensitively and respectfully avoiding this type of contact which other staff quite successfully managed to do. Staff were observed frequently changing one person who had a wet top. The registered manager said that they had made a referral to the Community Learning Disability Team for advice on this matter. Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 17 Minutes from a staff meeting indicated discussion with staff about how best to support people with their personal care. At a staff meeting in January 2009 staff had also discussed times for putting people to bed and that this must be in line with their care plans and reflect their personal choice. Comments from health professionals indicated their concerns that some people still were going to bed early and spending long amounts of time in bed. Night records were examined for the people case tracked which confirmed that two people appeared to be regularly going to bed before 8.00 pm but that times for the other person were flexible and were sometimes after midnight. Times for other people were sampled and found that bed times for them were quite flexible around 10.00 to 11.30 pm. Staff rotas were due to change from one 12 hr shift finishing at 8.00 pm to two shorter shifts starting at 8.00 am and finishing at 10.00 pm. A personal care plan for a person with diabetes did not provide sufficient information about the care and monitoring needed with their feet and their eyes. The registered manager said they had regular appointments with a diabetic nurse but these had not been recorded in their health care notes. The registered manager had tried to source training in diabetes but had not yet managed to deliver this to staff. Some people were at risk from developing pressure sores and although a risk assessment was on one person’s file this had not been completed. These need to be in place for all people at risk of developing pressure sores. During our visits people were observed changing into specialist chairs and having bed rest to provide pressure relief. A health and safe keeping care plan for two people indicated they had a personal exercise programme which was to be completed each day. Staff admitted that physiotherapy exercises should have been in place for 4 people but due to staffing levels this had not been taking place. Records were kept in people’s rooms where they should evidence that these programmes had been completed. Health action plans were in place although one could not be found for one person. People were having annual health checks and medication reviews. Support was being provided by the local Community Learning Disability Team and other health professionals. Staff confirmed that they had completed training in the administration of medication and that medication audits were being completed. They had also had access to training in the administration of Midazolam. Medication was dispensed in blister packs. Stock control for all medication was maintained on the administration records. Handwritten entries were countersigned by a second member of staff. Creams and liquids had been labelled with the date of opening. A homely remedy list had been signed by people’s General Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 18 Practitioner. Although the temperature had been recorded of the medication cabinet it was not being done at regular intervals. During our visits a new sheet was put in place to prompt staff to do this. Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place which enable complaints and concerns to be raised by people using the service or on their behalf. People should be safeguarded from harm or abuse by the processes which are in place. EVIDENCE: Craegmoor provide copies of their complaints procedure which is produced in a version using text, symbols and pictures to the home. This was displayed in the entrance hall. Minutes of house meetings also indicated that the complaints process was discussed with people. People said they would talk to staff if they had any concerns. The AQAA indicated that the home had received 8 complaints in the past year of which 1 was upheld. The home had a complaints file which contained copies of complaints and their outcomes. Craegmoor monitor these through their internal auditing processes. Staff confirmed they had completed training in the safeguarding of adults and those spoken with would use the whistle blowing procedure if they had any concerns about the conduct of colleagues. The home had worked closely with the local adult protection team to make sure that people living in the home were safeguarded from potential harm. Craegmoor had taken the appropriate action in line with its safeguarding/disciplinary policies and procedures. They had also provided additional training for staff in whistle blowing. Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 20 Staff had completed training in the management of behaviour which challenges and the registered manager confirmed that refresher training in ‘Primary Prevention’ was being cascaded to staff. Mental Health and Behaviour care plans for one person indicated how staff should help them to manage their anxieties and anger (it stated that not doing activities or going out would increase their anxieties). An additional anger management care plan was in place. Staff were observed supporting one person having a ‘sensitive moment’ helping them to calm down and making sure other people were safe. As mentioned the use of restrictions such as key pads and restraints such as bed sides were recorded with the rationale for these noted. Each person had a financial care plan and money management assessment in place. Staff supported people to manage their personal finances. Internal records were examined for those people being case tracked and were cross referenced with statements provided by Craegmoor who manage their money. Where parents remain as appointees for a person, an account was being forwarded to them to reimburse Craegmoor for any expenditure they had incurred. Records for one person indicated that they had paid for several meals out which replaced their lunchtime meal at the home. The manager indicated this had happened whilst the home was being managed by another manager from the organisation and that this was not normal practice. This had previously been discussed with the home and Craegmoor policy stated that people should not pay for anything which they already contractually pay for such as meals. The registered manager said they would be reimbursed. Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is safe and satisfactorily maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. EVIDENCE: The home was clean and tidy on both visits. A cleaner is employed during the week. A maintenance person is employed for day-to-day repairs and to oversee the garden. Communal areas around the home had been redecorated and house meeting minutes indicated that people had been involved in discussions about colour schemes. The day room had been refurbished and people were observed using this room to eat meals and to watch television or use an interactive game. Meetings were observed being held in the manager’s office rather than in the day room providing an environment respecting Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 22 confidentiality of information. People have access to a sensory room which staff said people enjoy using. New equipment has been bought for people to use around the house, interactive games and a television. There were plans to steam clean carpets in communal areas. People’s rooms were decorated to reflect their interests and lifestyles with good use of colour and sensory equipment. People had an inventory in place for their personal possessions and fixtures and fittings. Specialist equipment and adaptations were being provided for people after consultation with the relevant healthcare professionals. Regular checks and servicing for this equipment was in place. Risk assessments and consent forms were in place for the use of bedsides. One bathroom had been converted into a wet room and was provided with the appropriate equipment. Another smaller bathroom was being redecorated during our visit. Staff had completed infection control training. Hazardous products were stored securely and COSHH (Control of Substances Hazardous to Health) data sheets were in place. Two rooms had odours caused by incontinence. One room did not appear to have any quick or safe way to ventilate the room. Fresh air was only accessible when patio windows were opened. Another room had carpet on the floor under the bed which was likely to retain odours. Sanitary bins were in place and these appeared to be replaced at appropriate intervals. Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are inconsistent affecting the support provided to people living in the home and putting additional pressure on the team which could affect their performance. They have access to a robust training programme enabling them to develop the skills they need to meet people’s needs. EVIDENCE: There were no vacancies in the staff team at the time of the inspection although a person was on long term sick leave and another person was due to leave. Sickness absence was being managed proactively by Craegmoor. New staff were completing an induction programme provided by Craegmoor which they state was equivalent to the Skills for Care Induction Programme. This included access to the Learning Disability Qualification. The AQAA indicated that 52 of staff had a National Vocational Qualification (NVQ) in Health and Social Care. Staff spoken with had a good understanding of the needs of the people they support. As previously mentioned care must be taken to promote professional relationships between staff and people living in the home and to Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 24 respect professional boundaries. Two members of staff were observed initiating cuddles with people. Staff had been given key areas of responsibility in several areas to develop such things as activities to reflect people’s aspirations and wishes. These were still being completed during our visits. Staff indicated that there were times when the levels in the home were not appropriate to the needs of the people they support. Several said they were physically tired due to long shifts and that this affected their ability to meet people’s needs. Previously we have suggested that Craegmoor should consider staffing levels increasing to 6 per shift to make sure that people’s needs were being met. A very diverse group of people with complex needs live in the home and 3 staff were observed on our first visit trying to support them with their personal care whilst also providing activities for a group of people in the lounge. At times managers who were attending a meeting in the house needed to provide additional support to supervise people in the lounge whilst care staff attended to people’s needs elsewhere. We were told that staffing levels reflected people’s needs and their activity commitments and would be a minimum of 4 raising to 6/7 where needed. We were provided with copies of shifts worked for 1st to 14th June and examined the rota for 1st to 9th August. The latter indicated that a minimum of 4 staff had been scheduled to work a mixture of long and short shifts. On 3rd August there were 3 staff on duty due to sickness. In June there were two occasions when 3 staff were working and 4 occasions when there appeared to be only 1 waking night staff member on duty. On 3 shifts there were 6/7 staff on duty. Staff said agency staff were not used. Managers said that support might be provided from other homes but there was not evidence of this on the rotas examined which indicated when staff employed only by Alexandra House had worked. After the inspection senior management stated that staffing levels were being maintained and that additional staff from other homes and managers had supplemented shifts. Evidence of this was not provided during our visit. The registered manager stated that she had been asked to complete an assessment of needs for the people living there and we discussed the importance of completing this piece of work to make sure that people’s needs are met. The inspection indicated that staff were struggling with levels of a minimum of 4 on shift. If levels fall below the agreed level we must be notified under Regulation 37. The home will be providing care to 8 people from mid August and they will need to assess the appropriate levels of staff required to meet their needs. We should be notified of this. Two new staff had been transferred to the home from another Craegmoor home in Southern England but their recruitment and selection information was not available at the time of our visit. They had been working in the home for 2 weeks. Senior management later stated this information was in the home but the registered manager was not aware of this. No other staff had been appointed since our last inspection. People living in the home were involved in Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 25 recruitment and induction of new staff and a DVD had been produced involving one person. A training matrix was provided which had not been updated with training recently provided. Staff confirmed they had access to a robust training programme which included taught subjects and electronic open learning. Copies of certificates of courses attended were on their files. Craegmoor provides internal training at the homes and the registered manager said she also sources training with external providers. Staff meeting minutes indicated that code of conduct and Mental Capacity Act training was being arranged. Refresher training was being provided as needed. Staff files indicated that some had received supervision sessions in January, March and May but not with any regularity. Sessions had been arranged for all staff for August and September. Minutes for staff meetings held in January and April were seen. Senior management stated that supervisions and staff meetings were being held regularly and that records were available in the home. These were not seen during our visits. Staff said that morale had been really low due to changes within the home to their way of working and management. It is important at times such as these that supervision sessions and staff meetings continue at regular intervals. Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service will benefit from having a period of consistent management providing leadership and direction to the staff team which should promote improved better outcomes for service users. EVIDENCE: The registered manager has a NVQ Level 4 in Health and Social Care and the Registered Managers Award. She had just returned to the home after maternity leave. Staff spoke positively about her managerial skills and support to the staff team. In her absence several managers had worked in the home with support from senior management. The AQAA had been completed and sent to us before the deadline, although there were some inconsistencies Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 27 within this document. Several outcome areas referred to other National Minimum Standards such as discussing activities in the section for individual needs and choices instead of lifestyles. Concerns have been raised during this inspection about the ability of staff to meet people’s identified needs such as supporting them to access regular activities outside of the home and to maintain their physical health and wellbeing. Staffing levels and staff morale were both impacting on this, although staff said they were starting to feel more positive. The registered manager acknowledged the effect of this on outcomes for people living in the home. Some staff and management had completed training in the Mental Capacity Act and Deprivation of Liberty Safeguards and further training was being arranged. There was evidence that best interests meetings were being held where appropriate and the necessary assessments and records were being completed by the home. No one in the home was subject to a Deprivation of Liberty Safeguard at the time of the inspection. Information about advocacy had been provided in the home. Craegmoor have robust quality assurance systems in place which include self assessments by managers which were being completed monthly and audits by external staff. People living in the home and their relatives had taken part in a survey and a summary of their responses were examined. People from the home were involved in the Area forum of ‘Your Voice’ and had feedback from the Regional forum. Records of minutes were in the office. The Area Manager was conducting unannounced visits to the home and producing a written report each month. An improvement plan had been produced for the home by Craegmoor and senior staff had been working in the home to implement this. This appeared to be a work in progress. Systems were in place to monitor health and safety in the home. A fire inspection had recently been completed and the fire risk assessment was being reviewed in respect of night time evacuation procedures. Fire systems were being monitored at appropriate intervals. Water temperatures were also being recorded for outlets around the home. Portable appliance testing had been completed. Fridge, freezer and hot food temperatures were being recorded. Good hygiene practice was observed to be in place in the kitchen. Monthly health and safety audits were being completed. A fire door to a bedroom was being repaired during our visit but had been left without the intumescent strip overnight. Alexandra House DS0000016360.V376839.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 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 2 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 2 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 3 X 2 X 2 X X 3 X Version 5.2 Page 29 Alexandra House DS0000016360.V376839.R01.S.doc 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 15 Requirement The registered person must make sure that each person has a care plan, which has been reviewed and provides staff with the information they need to meet people’s needs. This is to make sure that people’s needs are being met. The registered person must make sure that personal records are kept securely this includes archived records. This is to make sure that personal information stays confidential. The registered person must make sure that where people have specialised diets these are provided in line with their care plans. This is to make sure people keep well and are not at risk of possible harm. Staff must be aware of their status and respect professional boundaries with people they support ie not being over DS0000016360.V376839.R01.S.doc Timescale for action 30/11/09 2. YA10 17 30/11/09 3. YA17 12 30/08/09 4. YA18 12 30/11/09 Alexandra House Version 5.2 Page 30 familiar. This is to safeguard people from possible harm or abuse. (Timescale of 2/11/08 not met. This requirement has been repeated.) 5. YA18 12 The registered person must make sure that people have access to the appropriate support and exercises to maintain their mobility or suppleness. This is to make sure people’s health and wellbeing is maintained. The registered person must make sure that where people are at risk of pressure sores the appropriate care plans and risk assessments are in place. This is to make sure that people are safeguarded from developing pressure sores. The registered person must make sure that people’s personal finances are managed efficiently. This is in respect of paying for meals which replace meals provided by the home. This is to safeguard people from possible financial abuse. The registered person must make sure that staff are employed in sufficient numbers to meet the assessed need of people living in the home. This will make sure that people living in the home receive the appropriate care and support. 30/08/09 6. YA18 12 30/09/09 7. YA23 13 30/08/09 8. YA33 18 30/08/09 Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 31 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 YA6 YA6 YA7 Good Practice Recommendations Archived care plans should be stored so that they are accessible if needed. Care plans should accurately reflect people’s identified needs. Provide additional training for staff in Makaton sign language or the Total Communication Approach. Moving and handling risk assessments should indicate which sling is to be used when hoisting people. Further develop care plans about personal care so that they more clearly reflect service users’ preferences about the gender of the person providing support. The temperature of the medication cabinet should be recorded and corrective action taken if needed. Consider ways in which the odours in rooms can be diminished. Notify CQC once the assessment of staffing levels has been completed with the minimum number of staff to be provided per shift. Rotas should evidence where staff are being used from other homes to work shifts to maintain staffing levels. Training in diabetes and tissue viability should be provided. Provide regular supervision sessions for staff and meetings to promote positive communication. Continue to implement the improvement plan for the home to improve outcomes for people. Make sure that maintenance to fire doors is resolved promptly. 4. 5. YA9 YA18 6. 7. 8. YA20 YA30 YA33 9. 10. 11. 12. YA35 YA36 YA39 YA42 Alexandra House DS0000016360.V376839.R01.S.doc Version 5.2 Page 32 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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