Inspection on 14/06/05 for Alexandra House Care Home

This inspection was carried out on 14th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Alexandra House Care Home 11/01/07

Alexandra House Care Home 06/07/06

Alexandra House Care Home 17/11/05

Alexandra House Care Home 01/11/04

Alexandra House Care Home 29/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Alexandra House Care Home Wroughton Court 191 Nottingham Road Eastwood NG16 3GP Lead Inspector Karmon Hawley Unannounced 14/06/05 10.00am 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 Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Alexandra House Care Home Address Wroughton Court 191 Nottingham Road Eastwood Nottinghamshire NG16 3GP 01773 530601 01773 710924 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) Eastgate Ltd CRH 38 Category(ies) of 38 OP registration, with number 2 TI of places Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17th March 2005 Brief Description of the Service: Alexandra House is purpose built providing nursing and residential care for older people. It is situated in a quiet cul-de-sac in the outskirts of Eastwood, close to local shops, pub, church and bus route into the centre of Eastwood and the nearby city of Nottingham. There are pleasant gardens and a car park to the front and side of the building. There are various seating areas within the home and two separate dinning rooms. Service users rooms are decorated to a satisfactory standard and are personalised. The building is accessible for wheelchair users and there is a lift to the upper floor. Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day; two members of staff, four service users and two relatives were spoken with. Three service users case files, seven staff personnel files and other relevant records were accessed with regards to care and the environment. What the service does well: What has improved since the last inspection? What they could do better: There are several areas that require improvement to enhance a quality and safe life for service users, these include care planning, staff levels and training, risk assessments, complaints and adult protection, recruitment and handling of personal allowances therefore requirements have been set with this regard. Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 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 Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 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) 3,5 Preadmission assessments and trial visits ensure that service users entering the home are assured their needs will be met. EVIDENCE: The manager carries out pre admission assessments within the community prior to placements being offered to potential service users. Appropriate sources are liaises with to ensure needs can be met. Trial visits are offered generally in the nature of respite care. Service users and /or relatives are invited to look around the home prior to making a decision. Emergency admissions are accepted, however the manager attempts to gain all required information prior to admission. One relative spoken with stated she had received all the required information prior to admission and the visiting arrangements were discussed. Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 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) 7,8,9 Assessments are sufficient in identifying needs, however care plans do not fully reflect this, consequently individual needs are not fully met. Risk assessments in use leave service users at a degree of risk. Medication procedures have improved, however further attention is required to ensure service users are fully protected. EVIDENCE: Within service users case files examined there was evidence of pre admission assessments taking place. The information gained from this assessment and others covering manual handling, nutrition and pressure area care formed the basis of the service users care plans which are based upon the daily activities of daily living. Nursing determinations were available and there was evidence that NHS entitlements are being received. Specialist services are liaised with and there are two link nurses within the home to facilitate services. There was evidence of specialist aids and adaptations in place. Risk assessments were in place however these did not highlight how the identified risk would be reduced and managed. Complex needs were not addressed in all case files and in one file observed there was no care plan or risk assessment in place. There was evidence of social profiles in place which highlighted likes dislikes and preferences. Daily records were maintained and in depth. Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 Page 10 The medication policy is unchanged since the last inspection and does not hold all the required information. Medication charts were well maintained and medicines corresponded when checked. There was no record of fridge temperatures. Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 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) 12,13,14 Activities provided are enjoyed, however these require further development to ensure service users expectations are fully met. Whilst staff work towards facilitating service users to maintain choice and control over their lives this is limited due to systems in place and reduced staffing numbers EVIDENCE: The manager is currently negotiating a budget for entertainment and recreation. Outside entertainers visit the home at present and care staff if there is time carry out activities with service users. One service user and relative spoken with expressed that the May Pole dancers that had visited were extremely enjoyable, where as another expressed he did not get the opportunity to join in activities as they are held in another room to which he sits; the manager stated this was not so and entertainment is held in both lounges. Concerns were also expressed by this service user with regards to being isolated due to the lack of staff available to meet his needs and that a buzzer is not available in the lounge, so he is unable to call for staff unless he shouts. There are no restrictions imposed on visiting, however it is requested that meal times are avoided. The visitors’ policy is displayed and the manager stated this is discussed on admission. Service users may choose who they see and if necessary staff will advocate on their behalf if they choose not to see Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 Page 12 someone. Staff expressed that a good rapport was maintained with visitors and the one visitor spoken with stated staff work really hard, they are brilliant and do their best. The social plan within case files enables choices and preferences to be acknowledged. Service users personal allowances are not kept on the premises, the manager has to phone the administrator for access, however some service users hold their own money. Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 Page 13 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 complaints procedure impacts on confidence, as it does not fully ensure complaints will be dealt with appropriately. Although some measures are in place to protect service users, these are not adequate, consequently leaving service users at a degree of risk. EVIDENCE: There is a clear and simple complaints procedure displayed, however it did not state the stages or time scales that complaints will be dealt with. The complaints book held minimal information and on discussion with the manager she had not recorded the last complaint received, as she felt it not necessary as the complaint had been dealt with at the time it was brought to her attention and resolved. There has been no further training since the last inspection with regards to adult protection, however dementia awareness training has been arranged. There is an adult protection policy in place, which is supported by the Nottinghamshire adult protection Guidelines. There are also policies with regards to gifts to staff and the handling of valuables. There is currently a large number of staff who do not have criminal records bureau checks in place. Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 Page 14 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) EVIDENCE: Not examined during this inspection. Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 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) 27,29,30 Reduced staffing numbers and a lack of mandatory training has an impact on care received thus service users needs are not fully met. Service users are placed at a degree of risk due to the homes recruitment practices. EVIDENCE: Staffing rotas were observed and there is evidence that sufficient staffing levels are aimed at, however due to an oversight in the annual leave policy and sickness there are current difficulties which has lead to a complaint being received. The proprietor and manager were aware that they were at minimal staffing levels, however the decision was taken that this was satisfactory; following the event the manager stated that it did have an impact on care received. Consequently the holiday policy has been reinforced to staff so this does not reoccur. Staff spoken with stated they are regularly short staffed which causes pressure to complete work tasks, they expressed that this has an impact on care delivered. One relative and one service user spoken with substantiated this. All registered nurse personnel files were observed, relevant checks with regards to their professional registration were in place, however there was a lack of all having two references. Within one file observed there was a concern noted with a visa, the manager is looking into this. Only a limited number of staff had criminal records bureau checks in place due to these being lost or the applications not completed. Mandatory training has not been updated since the last inspection, however five care assistant have commenced their National Vocational Qualification in Care level two and ten members of staff are due to start a dementia awareness course whist a Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 Page 16 number are doing a health and safety course through distance learning. On speaking with two staff members they discussed manual handling practices, these were out of date and two members of staff were observed to perform out of date practices. This was discussed with the manager as staff felt this was acceptable practice, the manager stated staff had been trained in this area and she would discuss these issues with them. The induction programme in use is basic and consists of one sheet of paper for tasks to complete and issues to cover. The manager stated staff are on induction for six weeks. Staff were able to substantiate they have not received the General Social Care Council Code of Conduct. Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 Page 17 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) 31,32,35 Within the short time in post the manager has demonstrated that service users are benefiting from her approach and the ethos she has implemented. Whilst service users financial interests are safeguarded there are restrictions imposed on access. EVIDENCE: The manager has now been in post for two months and is working towards improving and developing systems within the home. She is a registered nurse and ensures she remains up to date in her practices. On joining the home she wrote to all relatives stating she has an open door policy and she is approachable and available should they need to discuss any issues with her, one relative substantiated this. There is currently no budgetary restriction upon which she works; therefore none were available for inspection. Service users personal allowances are kept with the administrator, the manager has to contact the administrator by phone to access these. It may take up to two Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 Page 18 days to gain access. There were no receipts with files at Alexandra House; the manager stated these are kept with the administrator. There are records at Alexandra of amounts that are in personal allowances. The manager stated that some service users hold their own money and there are lockable facilities to ensue the safety of this. Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 1 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 1 3 3 x x 1 x x x Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 Page 20 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 OP 7 Regulation 15(2b) Requirement Service users reviews are required to reflect care received and individual outcomes. This is an outstanding requirement from April 2005 and must be addressed to avoid enforcement action. Service users care plans must accurately reflect how identified indivuidal needs will be met. Risk assessments are required to demonstrate how an identified risk will be managed. The medication policy requires updating to include keeping medication for seven days following a service users death. Adequate procedures are required to be in place to ensure the safe storage of medication. This is an outstanding requirment from April 2005 and must be addressed to avoid enforcement action. Further consideration is required to ensure the routines of the home are flexible and activities are varied to meet service users expressed needs. Futher consideration is required to ensure service users have Timescale for action Immediate 14th June 2005 2. 3. 4. OP 7 OP 7 OP9 15 (1) 13(4c) 13(2) 24th July 2005 24th July 2005 Immediate 14th June 2005 5. OP12 16(n) 24th July 2005 6. OP14 12(2,3) 24th July 2005 Page 21 Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 7. OP16 22(1,3,4, 5,8) 8. OP18 19(b) Schedule 2 13(6) 18(1a) 19(b) Schedule 2 18(c,i) 9. 10. 11. OP27 OP29 OP30 12. OP35 12(2) choice and control over their lives. It is required that there is a means of communicating with staff in each room service users have access to. The complaints policy and procedure requires up dating to ensure appropriate timescales and stages are included. All complaints received are to be recorded. All staff are required to have satisfactory criminal records bureau checks in place. Further training in adult protection is required. Staffing levels are required to demonstrate that service users needs can be fully met. All staff employed are required to have the necessary documentation in place. The responsible individual must demonstrate that staff individually and collectively have the required knowledge and skills to meet service users need. The General Social Care Council Code of Conduct is to be issued to all staff. Service users are required to have access to personal allowances without restrictions imposed. 24th July 2005 Immediate 14th June 2005 Immediate 14th June 2005 24th July 2005 24th August 2005 24th July 2005 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 Good Practice Recommendations Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Edgeley House Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alexandra House Care Home C53 C03 S26407 Alexandra House V232914 140605 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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