CARE HOMES FOR OLDER PEOPLE
Alexandra House 23 Euston Road Great Yarmouth Norfolk NR30 1DZ
Lead Inspector Hilda Stephenson Unannounced 11 April 2005 8.00am 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alexandra House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Alexandra House Address 23 Euston Road Great Yarmouth Norfolk NR30 1DZ 01493 859641 01493 859707 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Pru Garvan Mr R Sidney Shunmuganathan Nallathamby Care Home 25 Category(ies) of DE Dementia - 25 registration, with number of places Alexandra House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Twenty-five (25) Older People who suffer from dementia may be accommodated. Date of last inspection 15 November 2004 Brief Description of the Service: Alexandra House is a care home with nursing providing accommodation and care for up to 25 older people with dementia. The home is situated within Great Yarmouth, close to the town centre and seafront. The accommodation is on four floors with nine single and eight shared rooms, some have en-suite facilities. The communal rooms consist of three lounges and one dining room. There is a small garden and patio surround the building, with car parking at the rear. Alexandra House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over two and a half hours during the busy early morning period to include the breakfast meal. A partial tour of the premises took place, care plans, policies and procedures and staff rotas were examined. Nine of the ten staff, twelve of the twenty four residents were spoken to. The premises were found to be clean and tidy with no unpleasant aroma, with residents who were up looking well cared for. What the service does well: What has improved since the last inspection?
The Manager has implemented all the requirements from the previous inspection within the stated timescale, including staffing recruitment issues, training, and recording all accidents in line with the new legislation. The Proprietors have increased the amount of hand washing facilities on each floor to reduce the risk of cross infection.
Alexandra House Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alexandra House Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Alexandra House Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 & 5 A clear admission procedure is in place to provide care and support through an unsettling process. EVIDENCE: Written documents are provided for all prospective residents and relatives prior to admission including details of staffing numbers, experience and qualifications, facilities and social activities. The Manager encourages relatives to visit if prospective residents are too frail, although an invitation goes to residents as a priority even if the time spent is towards the individual’s personal preference. The Manager or Deputy Manager generally visits prospective residents to assess their nursing and mental health needs with clear written details for staff. The home offers all residents a trial period to settle in with a review of their care after that time, this can vary depending on the individual case. Alexandra House Version 1.10 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 &10 Health and care needs are identified, reviewed and are met by staff who are knowledgeable and have a good understanding of the residents needs. EVIDENCE: Each resident has a written care plan in place for staff to follow to cater for there individual needs. The written records are reviewed each month to ensure the care is monitored. To enable staff to gain a deeper understanding of their residents a life story, or a history of there past lives should be included with these records. The trained nurses compile the care records either with the co-operation of the resident or their close relative. Occasionally, a visiting CPN or Psychiatrist monitors the care and mental health needs to ensure that residents continue receiving the correct treatment or medication. Alexandra House Version 1.10 Page 10 It was observed that residents were treated very well by the staff, with one resident stating ‘the staff are kind’. The home has a variety of lounges for residents to spend the day, but can stay in their own rooms if they wish. The staff visit each resident on a regular basis to ensure they are safe, it was seen that staff continue to knock on bedroom doors and speak in a friendly polite manner, taking into account residents who have lost the ability to communicate verbally, and adapting to ways they can communicate. Alexandra House Version 1.10 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 & 15 Social activities are well managed taking into account group and individual interests with meal times included as a sociable event. EVIDENCE: Two staff organise activities during each afternoon within the dining room leaving one member of staff to talk to those who prefer their own company or cannot manage group gatherings. One resident prefers ‘to read my daily paper and watch the racing’. The activities range from craft work, jigsaws, quizzes, reminiscence, music and sing-alongs to chatting or exploring different ways to communicate for those who are frail. Staff take residents out for a walk to the seafront during the warmer weather. The meals are organised over two sittings with those having their lunch at the first sitting usually continue to have a first tea. The breakfast appeared appetising with a variety of dishes served with staff assisting those who required help with their meal in a discreet and dignified manner. The staff monitor the weight of those who require a high level of nursing to ensure they maintain their health for as long as possible. Alexandra House Version 1.10 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The home has a satisfactory complaints system in place to ensure that residents and relatives views are listened to and acted upon. EVIDENCE: The home has a complaints procedure in place to follow for investigating all residents and relatives concerns. There were no complaints received during this inspection when speaking to twelve residents. Although, during the visit two residents expressed their wishes in an agitated manner, staff attended to them immediately. The care records showed that this was usual practice for those residents who were being monitored for agitation as part of their condition of dementia. The complaints procedure displayed in the front porch needs updating, it contains the correct telephone number but not the correct Commission. Staff appeared knowledgeable when questioned about the different forms of abuse within care homes and have attended the Adult Protection training, explaining that residents are allowed to express themselves and staff understand the depth of agitation that some communication problems can cause for residents, which was evident during this visit. Alexandra House Version 1.10 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,25 & 26 The overall quality of the furnishings and décor is very good. EVIDENCE: The home is situated on four floors with a small number of bedrooms on each floor except the ground floor where the communal areas are situated. The three lounges are colour co-ordinated to assist residents by jogging their memory with a colour. There is a variety of furniture provided with several soft reclining chairs for some residents who cannot move themselves to allow a change in their sitting position. The bright dining room has a small patio area leading off it for those residents who wish to sit out during the summer months. This is the only small enclosed outside area the home offers. The garden both front and rear of the building overlooks the road or park and is not enclosed. The gardens are reasonably maintained. Alexandra House Version 1.10 Page 14 The interior of the home is free from clutter to enable residents to walk freely around the ground floor corridor, the majority of residents appear to sit in the lounge areas although, staff stated that ‘occasionally a resident will stay in their room’. During this busy part of the morning when this inspection took place the home continued to remain clean and tidy with no unpleasant aromas. The Proprietor has taken seriously the risk of cross infection and has added hand rubs for staff on each floor to reduce the risk of cross contamination and improve standards of cleanliness. Alexandra House Version 1.10 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Sufficient numbers of staff were on duty to meet the residents needs. EVIDENCE: The home has a core team of staff consisting of the Manager, Deputy Manager and team of nursing staff who are supported by a team of care staff. One of the Proprietors is usually at the home during the day and both take turns to be ‘on call’ with the senior management team. The rota’s indicated that one nurse, four car staff, one bed maker, one laundry assistant and one cleaner were on duty during this visit. The Proprietor was cooking for the day. There are one nurse and four care staff in the evening reducing to one nurse and two care staff overnight. The home currently has a vacancy for a trained nurse. Alexandra House Version 1.10 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 The resident’s interests and welfare are looked after. EVIDENCE: The home has satisfactory health and safety measures in place with adequate policies and procedures for both residents and staff. All care records and policies are stored in the office and are available for daily use. Confidential records are secure within the Proprietors office. The home has satisfactory fire, recording of accidents, risk assessments and care records in place. Two care plans were seen during this visit and consistent reviewing had been undertaken. The residents whose records were seen were not able to communicate easily, although both appeared to be comfortable and well looked after. Alexandra House Version 1.10 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 x x x x 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x x x x x 3 3 Alexandra House Version 1.10 Page 18 No 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 16 Regulation 22 Requirement The complaints procedure displayed in the front porch must be updated. Timescale for action Immediate 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 7 Good Practice Recommendations The Manager should obtain residents life stories to enable a more holistic approach when organising social events. Alexandra House Version 1.10 Page 19 Commission for Social Care Inspection 3rd Floor Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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