Inspection on 19/03/09 for Alexandra House Care Home

This inspection was carried out on 19th March 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Alexandra House Care Home 03/05/06

Alexandra House Care Home 05/09/05

Alexandra House Care Home 11/04/05

Alexandra House Care Home 15/11/04

Alexandra House Care Home 08/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Alexandra House Care Home 23 Euston Road Gt Yarmouth Norfolk NR30 1DZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Hilda Stephenson     Date: 1 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 22 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 22 Information about the care home Name of care home: Address: Alexandra House Care Home 23 Euston Road Gt Yarmouth Norfolk NR30 1DZ 01493859641 01493859707 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs. Pru Garvan,Mr. R Sidney care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Twenty-five (25) Older People who suffer from Dementia may be accommodated. Date of last inspection Brief description of the care home 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. A small garden and patio surround the building, with car parking at the rear. 25 Over 65 0 Care Homes for Older People Page 4 of 22 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The unannounced key inspection of this service has been carried out by using information from previous inspections, written information provided by the proprietors, some residents and their relatives as well as others who work in or visit the home. This unannounced visit took place during the day on the 9th March 2009. Both proprietors, the acting manager and deputy manager were in attendance during most of the day. Prior to the inspection the proprietors provided a completed Annual Quality Assurance Assessment giving details of what the homes strengths and weakness were and how these could be adapted to improve care for the residents who live there. During the inspection a tour of the premises was undertaken, staff practice was observed, records and files were read and checked and residents and their visitors Care Homes for Older People Page 5 of 22 consulted. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 7 of 22 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 22 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 22 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides clear information about its services to people thinking about coming to live there. People have their needs assessed and are given a contract which clearly tells them about the service they will receive. Evidence: There has been no change to the Statement of Purpose or Service User guide since the last inspection. It is well written and clearly presented and available for prospective new residents and their family. A detailed contract was in place for the resident who was most recently admitted to the home containing the service provided by the home. Details of the initial assessment were seen in the files inspected which included personal, social and mental health care needs. The proprietor visits all new residents and jointly compiles the care records with the acting nurse manager. Care Homes for Older People Page 10 of 22 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of dignity and respect are put into practice. Evidence: The staff continue to improve its care planning. All care plans inspected were of good standard, were up to date and person centred. Falls risk assessments were in place as are other assessments of need and risk. Evidence of good health care support was seen. The care plans contained detail of health, social and mental health care needs, including the activities of daily living. Life history work is being undertaken to help the staff to provide a service that reflects peoples wishes and needs. Evidence of how staff implement nutritional needs of residents especially those who are most vulnerable are in place. Care plans and risk assessments are reviewed by the nurses on a monthly basis or when needs change. Medication is administered by the qualified nurse on duty. Two of the medication records of the residents were checked and found to be in good order. Evidence that medication is audited and checked was seen. Care Homes for Older People Page 11 of 22 Evidence: Staff were observed treating residents with respect and courtesy at all times. One visitor was spoken with who confirmed that this is consistent practice. Screening is in place in the shared rooms to ensure individual privacy during personal care. Care Homes for Older People Page 12 of 22 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices in their daily lives. A range of activities are available and visitors are warmly welcomed into the home. Evidence: Residents have a choice of lounges, one has a television, the second has a television but is used to show specific films and the third is a quiet room for reflection and resting. The majority of arranged activities are held in the dining room during the afternoon. A programme of entertainers is in place and information regarding a forthcoming raffle arranged for March 09 was displayed. Some of the residents were involved with making home bakes and selling raffle tickets. People living at the home said they were able to bring in their own personal possessions when they moved in which went towards helping them settle in. Comments from visitors showed that the proprietors and staff team always welcomed them into the home. The meal times are arranged over two sittings for the main lunch and tea time meals. Both the proprietors take it turns to cook the meals and employ an extra member of staff to cook and serve teas. The meal during this visit was lasagne, chicken or ham served with mashed potato, carrots and peas. A choice of three desserts was also offered. The lunch time was seen Care Homes for Older People Page 13 of 22 Evidence: to be a sociable event for residents with those residents who required assistance with their meal were helped in a discreet manner. Inspection of the kitchen found it to be clean, tidy and had good quality food items in place. The proprietor spoke of the refurbishment of the dining room, treatment room and drinks room, when the dining room would be temporarily moved to the lower ground floor next to the kitchen. It was recommended that the proprietors employ a temporary cook while they were undertaking this as the one of the proprietors would be fully involved with the refurbishment and would not be able to cook as well. Care Homes for Older People Page 14 of 22 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a good complaints procedure and are protected by a trained staff team. Evidence: The acting manager stated that there have been no complaints since the previous inspection. Through discussion with residents, visitors and staff no concerns or complaints were highlighted during this visit. Evidence of staff training in adult protection and whistle blowing was seen. Care Homes for Older People Page 15 of 22 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained environment, which is homely and comfortable. Evidence: The home itself is comfortable, well maintained and tidy. The proprietors stated that during the past year that eight bedrooms had been decorated, the front porch window had been replaced, new carpets had been replaced on the stairs and hallways and that there was now a hoist on each floor. Two of the shared rooms were to be used as single rooms reducing the overall number of residents. Staff files and fire records were in place and found to be satisfactory. Care Homes for Older People Page 16 of 22 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are available in sufficient numbers to look after people living at the home. Evidence: Inspection of the staff rotas, observation during this visit and discussion with residents and visitors demonstrated that there are enough staff on duty to meet the needs of the residents. Both proprietors are also in attendance during the day. The acting manager and deputy manager provided evidence that ten of the care staff currently or had already achieved the NVQ accreditation, with the deputy undertaking the leadership and management level 3. The proprietors had also encouraged some of the domestic staff to undertake NVQ training in infection control which should be commended. Evidence also showed that nursing staff attended training to enable them to keep up to date in line with their professional body. The deputy manager showed copies of recorded staff supervision sessions and staff spoken to stated these were beneficial. Care Homes for Older People Page 17 of 22 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is generally good. However, there are lapses in quality assurance. Evidence: The registered manager has left the home since the last inspection and there is an acting manager in post whose role is confined to the direct welfare of the residents. The proprietors remain in daily contact with the home and manage the majority of the management tasks. They still have not formalised the quality assurance system as yet even though they obtain feedback from relatives about the home, the proprietors explained how difficult it is to involve the residents as most have dementia. By obtaining feedback from visitors, and visiting professionals this would go a long way in helping them plan for any changes for the future. This requirement is ongoing. Money is not generally held on behalf of residents with the majority receiving assistance from their relatives or legal professionals. Care Homes for Older People Page 18 of 22 Evidence: Staff files showed that health and safety training is undertaken at regular intervals. The maintenance records were in place and found to be satisfactory. Care Homes for Older People Page 19 of 22 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 20 of 22 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 31 8 The registered proprietors must register a manager to manage the home. . 18/06/2009 2 33 24 To introduce a formal Quality Assurance process, and feedback to the people who use the service. . 18/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 15 The proprietors should consider employing a temporary cook while the refurbishment of the dining room is carried out. Care Homes for Older People Page 21 of 22 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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