Inspection on 30/08/08 for Alexandra House

This inspection was carried out on 30th August 2008.

CSCI 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 03/08/09

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 08/11/2008.

CARE HOME ADULTS 18-65 Alexandra House 2 Alexandra Road Gloucester Glos GL1 3DR Lead Inspector Ms Lynne Bennett Key Unannounced Inspection 30 August and 2 September 2008 10:45a th nd Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alexandra House DS0000016360.V367842.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alexandra House DS0000016360.V367842.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 Manager post vacant Care Home 10 Category(ies) of Learning disability (10), Physical disability (10) registration, with number of places Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th October 2007 Brief Description of the Service: Alexandra House is a large, detached property in a residential area of Gloucester. The home has undergone a programme of substantial refurbishment and now 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 changing beds. 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 reported to be approximately £1300 per week although this is negotiated on an individual basis. 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.V367842.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. A random inspection had been carried out in April 2008 to check on progress towards meeting requirements issued at the last inspection. Two additional requirements were issued but the report noted some general improvements to the service being provided. This inspection took place in August and September 2008 and included two visits to the home by us (The Commission for Social Care Inspection) involving one inspector and a visit by an expert by experience. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with us to help provide a picture of what it is like to live in the home. Surveys were returned to us from three people living in the home, two members of staff and two healthcare professionals. Time was spent talking to and observing all people during the visits, talking to seven members of staff about the care they provide and observing the practice of all staff on duty. The manager was present throughout. A selection of documents were examined including care plans, financial and medication records, health and safety systems and staff files. The registered manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). 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. What the service does well: The home is spacious and provides adaptations where needed to meet the diverse range of needs of people living there. The Expert by Experience commented, “The building was totally wheelchair accessible and they are doing work on the shower room to make it more accessible. I was shown the snooze room’ which I thought was alright.” Appropriate support is provided to enable the people living in the home to stay in contact with family and friends. People living in the home are offered a nutritional and healthy diet. There is a good framework for handling concerns and complaints, helping to ensure that people feel listened to. People living in the home are being involved in the induction Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 6 of new staff. One person was involved in a DVD and they told the Expert by Experience, “I really enjoyed doing it.” The Expert by Experience also said “ I spent about an hour talking to …. She told me she likes living in the home and she likes the staff very much. They treat her with respect. She likes her key worker, who was with us most of the time.” Health and safety is well managed in the home, promoting the wellbeing of staff and service users. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alexandra House DS0000016360.V367842.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.V367842.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have access to information about the service they receive that is produced in a format appropriate to their needs. Satisfactory admission arrangements are in place that includes an assessment of people’s needs. Ongoing re-assessment of people will ensure that the service is continuing to meet their changing needs. EVIDENCE: The Statement of Purpose and Service User Guide had been reviewed in August 2008 and copies had been forwarded to us. People had a copy on their personal files. The Service User Guide had been produced in a format appropriate to people’s needs using picture, text and symbol. There had been no new admissions since the last inspection. The home had an admissions policy and procedure in place with evidence on files examined that comprehensive assessments and admission information had been obtained prior to the person moving into the home. Discussions with staff confirmed that people’s changing needs were being monitored and wherever possible specialist adaptations and equipment provided to ensure they could remain in the home. Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have some say in their day to day lives and as a person centred approach is adopted within the home will have an increasing role to play in the planning of the care and support they receive. Further improvements to the records maintained will ensure easy access to information and a consistent approach. EVIDENCE: The care for three people was case tracked which included looking at their person centred plans, observing the care provided and talking to staff about their individual needs. Each person had a person centred plan in place with a prompt for key workers to sign and date. This had not been completed for one person. Each care plan had an evaluation record in place; this had been completed for one person providing evidence of the review of care plans but not for the others. The manager confirmed that annual reviews were being Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 10 held with input from the placing authority. Two people had copies of recent community care assessments and care plans on their files. Staff confirmed that they had been booked to attend person centred planning training. Once completed this should impact on the quality and consistency of care plans. Care plans were in place for a range of holistic needs covering people’s emotional, physical, intellectual and social wishes and desires. These had prompts for staff to link with specific care plans or risk assessments. They had not been completed for one person. There were some good examples of care plans being cross referenced to other documents providing the reader with an overall picture of the care being provided. For instance a care plan for eating and drinking indicated the way in which support was needed to ensure the person did not choke, this in turn referred to the risk assessment and guidelines that had been developed with the Speech and Language Therapist. Another care plan referred to how staff should support a person during “sensitive moments” and although other documents such as a risk assessment and additional care plan were in place the care plan did not direct the reader to these. Staff had a good understanding of how to support this person and were clearly following guidelines indicated in the care plan. The additional care plan stated, “Staff are to understand me and my sensitive moments” but did not provide clarity on what might trigger these and what to avoid. By searching through other care plans it was possible to find reference to how staff could divert this person. The use of the prompts would have made this process easier – including making reference to which section these documents could be found. Communication care plans were in place which provided a guide to people’s verbal and non verbal communication. Some people use Makaton sign language and their care plans indicated which words/signs they used. Some staff confirmed they have had training in this area. The AQAA stated that the Speech and Language Therapist had been contacted to provide additional training for staff. It also stated that more work needed to be done in relation to this area, increasing the use of photographs and pictures around the home. Another care plan indicated that the person would point to objects when offered a choice enabling them to make decisions about what to drink or eat or wear. This was observed during the visit. Any restrictions on people such as restricted access to the kitchen were recorded with the rationale for this. Staff should remember to include the reasons for the keypad on the front door and star keys on some doors in the home. Some people were also wearing belts in their wheelchairs and comfy chairs to prevent them from falling or slipping out of the chair. The rationale for this also needs to be recorded. Such restrictions or restraints need to be recorded in line with the principles of the Mental Capacity Act and with Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 11 reference to the forthcoming deprivation of liberty safeguards. See also Medication Standard 20. People had a financial care plan and risk assessment detailing the support needed. Financial records were examined and found to be satisfactory. Further detail could be documented on the copy kept in the home providing an explanation of what the expenditure actually was. A query about two items logged, as “Gifts” could not be quickly explained. Receipts were being kept within the home and could be cross-referenced with the financial records. Each person had an individual account managed by Craegmoor. There was evidence that they were in receipt of interest for their accounts. Regular auditing of these accounts was apparent both by the home and Craegmoor. A range of risk assessments were in place which had been drawn up from hazards identified in care plans. Most had been signed and dated with evidence of regular review. The AQAA identified improvements for the next twelve months, “ For staff to understand the responsibility of enabling service users to take risk in line with risk assessments and risk management. Service users where possible are given the chance to make informed choices and any essence of risk to be explained.” Records for one person appeared to be contradictory stating in one document that they were not to be disturbed at night and in another risk assessment that they needed reassurance if agitated during night, with regular checks. The manager stated that the latter risk assessment related to a period of time when they were ill. Information should be archived when no longer relevant. There was a missing person’s folder in place with a current photograph of each person and an individual pen picture. Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15,16 and 17. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home make choices about their lifestyle, and will be supported to develop life skills. There are increasing opportunities to take part in social, educational and recreational activities and keep in touch with family and friends. People have a nutritional diet and their diverse needs are catered for. EVIDENCE: The range of activities being provided both within and outside the home had considerably increased since the last key inspection. To some extent this was because staffing levels were being maintained at a minimum of five per shift but also because of the impact of the new management team. The AQAA stated, “Activity Timetables in place which are service user specific and activity planners in place to show the activities that they have undertaken and any comments” and “Service user led staffing and activities have greatly improved Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 13 within the home. Service users have access to greater opportunities for days out, concerts etc.” Timetables had been produced in a mixture of photograph, symbol and text. Each person had a record of what activities they had completed or where they had refused. Comments from healthcare professionals confirmed this, “Have introduced more activities to provide variety to client’s daily routine” also commenting “could provide more variety to those individuals who are less able to express their wishes.” During the visits people had a barbeque with friends and family, went shopping or train spotting and for lunch out, had individual aromatherapy sessions and used the sensory room. People were observed choosing where to spend their time and with whom. Daily diaries indicated that people had been to the cinema, theatre, and trips to London, Bristol and Cardiff. They were also using local facilities such as bowling, the pub, horse riding and swimming. Staff confirmed that people would be resuming college courses, hydrotherapy sessions and social clubs in September. Some people also attended a day centre. The Expert by Experience, spent time with one person and reflected that they said they were supported in activities, and planning a holiday abroad. She noted that one person spent time in front of the television although appeared to be asleep. This had been discussed with staff and they said that he chooses to be in the lounge and staff would ask if wished to spend time in the sensory room, dining room or garden. He was observed going out and spending time in the dining room during visits. It is important that assumptions are not made that this is what he would like to do, and records confirm when he was being offered alternatives. One person particularly enjoyed going to visit Gloucester Cathedral and others have a Church of England background. The manager stated that they were exploring opportunities for people to go to church on a Sunday. People said they were busy planning holidays for later in the year and were looking forward to these. Some were going abroad and one person had chosen Butlins. A person was observed helping prepare the evening meal. The AQAA identified that the manager would like to “Give greater autonomy to service users, i.e. where can they be more independent, keys to their rooms, making their own drinks, taking their own laundry downstairs.” Care plans provided information about “important people in my life” and there was evidence that people were being supported to maintain contact either through telephone calls or visits to the home or their friends and relatives. Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 14 Several relatives visit the home on a regular basis and one commented on the recent improvements within the home. The AQAA stated “A food comments book is in place for the Team Leader to record what meals the service users enjoy and what they do not enjoy in order to provide a more specific menu to cater to their tastes and needs.” New menus had been put in place involving people’s choices and although there was one main meal offered the cook confirmed that alternatives would be offered where needed. Some people were on soft diets and needed support to eat their meals. This was being provided. Meals appeared to be freshly prepared and fresh vegetables were in evidence. A water dispenser had been installed in the dining room providing people with access to filtered water. People were observed being offered drinks and snacks throughout the day. One person was being supported to manage their caffeine intake and this was recorded in their care plan with the reasons for this. Other drinks were available as an alternative. Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Greater care and thought needs to be given to how staff can be more responsive to people’s personal care needs. Further safeguards are needed to ensure that systems for the administration of medication are robust and protect people from possible harm. EVIDENCE: People’s preferences for the way in which they would like to be supported were recorded in their care plans. This included specific items such as what clothes they liked to wear, what cosmetics they liked to use and how they liked to be supported with their personal care. Although staff indicated that people’s preferred gender of staff was provided to support them with their personal care, this had not been identified in their care plans. People’s routines appeared to be flexible, with people deciding when to get up and go to bed. On the first visit to the home, one person was still in bed at 11.00 am (it was a Saturday) but staff explained that they had been feeling unwell. They were fast asleep. On the second visit to the home they were up much earlier. Daily diaries for another person also indicated that they often Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 16 get up to have breakfast and then return to bed. It would be helpful if records indicated whether this was due to their emotional state (they can at times become depressed) or for other reasons. One member of staff commented that this person often retires to their room due to boredom and could be encouraged to participate in activities. During the visits staff were observed to talk to people respectfully. One person liked to ask people for a cuddle and most staff appeared to have strategies in place to avoid doing this whilst respecting the person’s wishes. Some staff were observed responding by giving a cuddle. This was clearly inappropriate and a blurring of professional boundaries. Staff also need to be aware of and take responsibility for people’s appearance. The following issues were noted during the visits: • • One person was wearing slippers without a sole on one foot two people were observed wearing t-shirts for a considerable length of time with spilt drinks down them (the manager pointed this out at one point and asked staff to address this) • one person had a dirty face which needed cleaning, the manager again asked staff to do this • people were observed having their face wiped with paper towels (tissues or wet wipes would be more gentle on the skin). One person’s care plans indicated that they were at risk of pressure sores and noted the equipment they had in place including a mattress and alternative chairs. Physiotherapy exercises were needed for some people and detailed instructions including the use of photograph were on their file. People were observed being supported to use alternative chairs or lie on a mat to stretch out. This is good practice. Each person had a Health Action Plan in place as well as individual care plans indicating the support needed to promote their health and wellbeing. Good records were being maintained of appointments with a range of healthcare professionals. People appeared to be having appointments with their doctor, dentist, optician and chiropodist. One person had a hearing test and others were going to a weight clinic. The Community Learning Disability Team regularly visit the home but had previously had concerns that their recommendations were not being implemented. They commented “there has been an improvement, responses have been appropriate when concerns have been raised.” They indicated that staff appeared familiar with clients needs following protocols and that recording had improved. Documentation for people with epilepsy was in place including records of seizures, protocols for administration of ‘as necessary’ medication and risk assessments. Staff confirmed they had completed training in the Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 17 administration of ‘as necessary’ medication and talked through emergency procedures. Systems for the administration of medication were examined. Staff confirmed they completed training in the safe handling of medication and then had an internal assessment prior to administering in the home. During the visits one member of staff was shadowing another member of staff giving out the medication. There had been a concern raised to the manager about the administration of medication prior to our visit that had involved medication being put into pots resulting in the wrong medication being given. We had been informed by the home and a notification forwarded to us. The home were investigating and taking the appropriate action. Staff talked through the procedure for administering medication and described correctly the way in which it should be done – giving the medication directly to the person then signing the record. During our inspection of medication it was noted that several tablets had been taken from the monitored dosage system at the end of the month indicating that some tablets had been spoiled. There was no record on the medication administration record noting when this had happened. Staff found this medication locked away in envelopes with a record of the date, what had happened to the medication and the signature of staff, ready to be returned to the pharmacy. This was in line with the medication procedure. The AQAA identified future plans for auditing medication on a regular basis by team leaders and then monthly by management. This would be good practice. Protocols for some people indicated that medication was being given covertly with food. Records indicated that this had been done in the best interests of people living in the home and that the Community Learning Disability Team had been involved in this process, although they had not signed the records. These documents need to be reviewed in line with the principles of the Mental Capacity Act annually in a multi disciplinary forum. It was noted that recommendations from the previous inspection had been implemented and that temperatures of medication cabinets were being monitored daily, handwritten entries were being countersigned and an up to date signature list was in place. Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable complaints and concerns to be raised by people using the service or on their behalf. Safeguards are in place to protect people from possible harm or abuse. EVIDENCE: The home has a complaints policy and procedure, copies of which were provided to each person living in the home. The DataSet stated that the home had received 5 complaints that had been dealt with by the home and Craegmoor following the organisations procedures. Full records were kept on file with copies of the outcome of the complaint. The AQAA commented that improvements in the next twelve months would include, “Service user and family questionnaires to be sent out regularly feedback encouraged from professionals so that if there are areas of concern then these can be worked on.” Staff confirmed that they had completed training in the protection of vulnerable adults and those spoken with had a good understanding of their roles and responsibilities in identifying and challenging poor practice. They had confidence that the manager would act upon any concerns they may have and would not tolerate poor practice. The manager stated that further training was to be arranged and was informed about training with the local adult protection team. Mental Capacity Act training had been scheduled for staff for later in the year. Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 19 Staff confirmed that they received training in Crisis Prevention Intervention, a low arousal approach to the management of challenging behaviour. Staff were using Antecedent Behaviour Consequence (ABC) charts to monitor incidents in the home. Daily notes examined made reference to incidents but did not always refer to these charts, although on one occasion this was done. This is good practice. Staff discussed how they support people who may have “sensitive moments” or self-harm, reflecting what was recorded in people’s care plans. Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,29 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is safe, clean 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 free of odours during both visits. A cleaner was employed during the week and staff were observed to be cleaning areas over the weekend. A maintenance person was employed for day-to-day repairs and to oversee the garden. He stated over the winter areas of the home would be redecorated. There were some ongoing concerns with a link from a sink in one small room that was being used for aromatherapy during the visits. Staff said that this was being looked into but the leak could not be found. The floor and carpet were wet. Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 21 The Expert by Experience commented “The garden was really nice and big. They had 4 chickens, 1 rabbit and 1 guinea pig.” Comments received from healthcare professionals indicated concerns about access to a meeting room that promotes privacy and confidentiality. Often the day room was being used, which provides sufficient space but was also needed for access to the first floor via the lift. Since the last inspection the sensory room had been fully fitted out and was being used by people during the visits. 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. The manager had plans to convert a bathroom into a wet room. The laundry had been redesigned to ensure that soiled and clean clothing were kept separately in colour-coded baskets. One washing machine was out of action waiting for repair. Hazardous products were stored securely and COSHH data sheets in place. Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 and 35. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are met by a competent staff team, who have access to a mainly satisfactory training programme that needs to ensure staff have knowledge about the diverse needs of people living at the home. People have been put at risk by unsafe recruitment processes although recent improvements if sustained will protect people from possible harm. EVIDENCE: There had been significant changes to the staff team since the last inspection with new members of staff joining the team that was now fully staffed. Staff spoken with indicated that this had a positive effect on morale and maintaining a minimum of five staff on shift. A number of people living in the home often require 2:1 support and previous inspections had recommended that the home considers a minimum of six staff on shift. The rota indicated that at times this was the case. Staff said that they had discussed concerns about shift patterns with the manager who was accommodating their individual needs. Some staff had chosen to work 12-hour shifts and others to work 8-hour shifts. The manager said that this also gave her some flexibility when drawing up rotas. Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 23 New staff said they had completed an induction programme that included a corporate induction and an induction with the home. One staff member commented they felt that a one-day induction at the home had been rather brief. The manager said Craegmoor had introduced a new induction programme that was equivalent to the skills for care induction requirements. Staff confirmed that the NVQ programme was now in place and one member of staff said they had completed their NVQ in Health and Social Care at Level 2. The DataSet confirmed that 21 of staff have a NVQ and another 21 of staff were working towards their awards. Staff spoken with had a good understanding of the needs of the people they support. Overall staff appeared to have developed positive relationships with people although as mentioned in Standard 18, more vigilance was needed by some staff to attend in a timely fashion to the personal care needs of people. One person living in the home reflected to the Expert by Experience that, “she likes the staff very much. They treat her with respect. She likes her key worker, who was with us most of the time.” The Expert by Experience also thought “the staff are very friendly and did a lot of things with the residents.” The recruitment and selection files for three new members of staff were examined. A central human resources department was processing applications and then forwarded all records to the home. It was apparent that staff were not being appointed until two references had been obtained and either a pova first or Criminal Records Bureau check was in place. The following issues were noted: • a full employment history was not being obtained – there were gaps in employment for one person between 1978 and 2001 and for another between 1999 and 2003 • on two files, where people had worked previously in care the written reason for leaving had not been obtained from these employers. For example one person had worked for one service between 2001-2006 and there was no reference from this employer. • Criminal Records Bureau checks were still in place dating back to 2005 and these must now be destroyed. Details of these checks had been noted on staff files. Staff files contained evidence of people’s identity and a current photograph. References requested the reason for leaving former employment. Copies of certificates of training courses previously attended were on file. A training matrix was being maintained electronically and this confirmed that staff were having access to mandatory training with refresher training where needed. Staff confirmed that they had completed food hygiene recently and fire, health and safety and Mental Capacity Act training had been arranged. Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 24 Additional training had been provided to include sensory deprivation, autism, epilepsy, administration of Midazalom and training on Scleroderma (a condition of one person living in the home). Further training specific to the needs of people living in the home such as diabetes and tissue viability should be put in place. The manager stated that some staff had completed training in diabetes but found it did not give them the information they needed. Training in this area was being sourced. Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are benefiting from a manager who is providing clearer direction and leadership. By ensuring robust recruitment and selection procedures are in place she will safeguard people from possible abuse. Effective quality assurance systems are in place involving people. Systems are in place to maintain and monitor the health, safety and welfare of people. EVIDENCE: The AQAA stated, “The new manager has been in post since February 2008. The manager has been employed by Craegmoor for nearly 2 years and had management experience of 5 years. The manager has both the NVQ Level 4 in Health & Social Care and in the Registered Managers Award.” The manager was going through our registration process at the time of the inspection. She Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 26 stated that she was taking part in Craegmoor’s professional development programme. Staff said that she was open and approachable and a positive role model. She stated that since starting at the home she has chosen to spend a signficant amount of time working with staff to provide her with an overview of people’s needs and the service being provided. The manager needs to make sure that recruitment and selection procedures within the home are more robust and that all information required by us has been obtained before appointing staff. The AQAA was supplied to us within the required timescales and contained information about her plans to improve the standards of care within the home. Craegmoor have a robust quality assurance programme in place which involves regular audits of the home producing reports with action plans for the managers. The AQAA indicated, “Service user meetings are taking place. Craegmoor Your Voice forum is being utilised within the home. One of our service users took part in the Craegmoor DVD for Your Choice with their permission and permission of their parents. The service user was awarded for their participation and invited to the DVD launch on 23rd July 2008 at Holiday Inn Gloucester and they took pride of place of on the front cover of DVD.” Minutes of service user meetings were available in the home and provided comment on the service and planning for holidays. Although as indicated by the Expert by Experience these were not produced in a format appropriate to all people’s needs. Health and safety systems within the home were delegated to key staff and records were observed to be well kept and regularly maintained. Records examined included: • • • • • • Fire checks – equipment, drills and training Water temperatures Fridge and freezer temperatures Hot food temperatures Legionella testing and flushing of water outlets Environmental risk assessments. The fire risk assessment for the home was dated April 2007 and this should be reviewed. Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 27 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 CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 26 27 28 29 30 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X 3 X X X X X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 STAFFING Standard No Score 31 X 32 3 33 3 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000016360.V367842.R01.S.doc 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Alexandra House Score 2 3 2 X 2 X 3 X X 3 X Version 5.2 Page 28 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 YA7 Regulation 17 (1) a. Sch. 3 (3) (q) Requirement Where restrictions on choice and freedom are imposed there must be clear documentation of the rationale and resultant guidance along with appropriate assessment and consideration of issues around capacity, consent and best interests. (This has been repeated from the last inspection. Progress observed in some areas.) Staff must be aware of their status and respect professional boundaries with people they support ie not being over familiar. This is to safeguard people from possible harm or abuse. People’s personal care needs must be addressed in a timely fashion so that they are not left in discomfort. This is to make sure that their personal needs are met. Where medication is given to a person covertly i.e. in their food, documents must be in place providing evidence that this has been agreed as in their best DS0000016360.V367842.R01.S.doc Timescale for action 02/11/08 2. YA18 12(5) 02/11/08 3. YA18 12(4) 02/11/08 4. YA20 13(2) 02/11/08 Alexandra House Version 5.2 Page 29 6. YA20 13(2) 7. YA24 23(2) 8. YA34 19. Sch. 2 (6) interests. This is to safeguard people from possible harm. Medication administration records must be correctly completed to provide a stock record of all medication. This is to protect people from possible harm due to errors. The leak identified must be attended to before further damage is done to the room. This is to make sure the environment is fit for purpose. Ensure that there is a full employment history for all people working in the home. (This is repeated from the last inspection.) 02/11/08 02/11/08 02/11/08 9. YA34 19 Sch 2(4) Where a new member of staff had previously worked with adults or children, the reason why they left this employ must be obtained in writing. This is to safeguard people from possible harm. 02/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Care plans should be signed and dated. Evaluation records should be completed to provide evidence of the review of care plans. Prompts linking care plans to specific care plans and risk assessments should be completed, including reference to the section they are to be found. 2. YA7 Revise documentation in care planning files dealing with DS0000016360.V367842.R01.S.doc Version 5.2 Page 30 Alexandra House issues around capacity and consent so that it is compatible with the principles of the Mental Capacity Act. Staff should have input about the Mental Capacity Act as soon as possible. 3. YA7 Take forward plans to introduce more of a ‘total communication’ approach in conjunction with professionals in the community. Use these strategies to promote decision-making and empowerment of service users. Records that are no longer relevant should be archived. Further develop care plans about personal care so that they more clearly reflect service users’ preferences about the gender of the person providing support. Record in daily records possible reasons for people returning to bed – illness, depression or mood. Use alternatives to paper towels when wiping people’s faces such as tissues or wet wipes. Implement regular medication audits to ensure safe working practices are in place. Consider how meetings can be held in areas/room where privacy and confidentiality can be upheld. Take forward plans for staffing levels to be a minimum of six per shift. Training in diabetes and tissue viability should be provided. Minutes of meetings should be produced in a format appropriate to people’s needs. The fire risk assessment should be reviewed. 4. 5. YA9 YA18 6. 7. 8. 9. 10. 11. 12. 13. YA18 YA18 YA20 YA24 YA33 YA35 YA39 YA42 Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alexandra House DS0000016360.V367842.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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