Inspection on 05/09/05 for Alexandra House Care Home

This inspection was carried out on 5th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 19/03/09

Alexandra House Care Home 03/05/06

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Alexandra House Care Home 23 Euston Road Great Yarmouth Norfolk NR30 1DZ Lead Inspector Hilda Stephenson Announced 5 September 2005 9.30am 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 I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Alexandra House Care Home 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 Dementia (25) registration, with number of places Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Twenty-five (25) Older People who suffer from Dementia may be accommodated. Date of last inspection 11 April 2005 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 Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place as an announced inspection during the day on the 5th September 2005. The evidence gathered to publish this report was obtained by speaking to nine of the twenty-four residents, three visitors, proprietors, nine staff and the manager. Further evidence was obtained by checking through care records, medication records, through observation during the day and reading a sample of policies and procedures with comments received through the twelve comment cards that were returned to the office prior to the visit The home was very clean and tidy containing comfortable communal areas for residents to spend there day. The majority of the residents were either seated within the three lounges or participating in the organised activities within the dining room. Several visitors were seen coming into the home during the day. The home provides both nursing and residential care for residents who have been diagnosed with a degree of dementia. What the service does well: The home provided copies of the rota prior to this visit confirming that there is usually plenty of staff caring for residents. The home offers nursing care so a trained nurse is on duty during the twenty-four hour day. The manager is also a trained mental health nurse with vast experience in caring for residents with dementia. Both proprietors who visit and work within the home support the manager and staff. The home has a small loyal team of staff who have worked at the home for some time, who appear to spend time with the residents and have gained an understanding into their individual ways. The home has a slow turnover of staff that helps retain some form of consistency for those residents with memory impairment. Each afternoon an organised activity is arranged within the dining room for those who enjoy group meetings, some residents cannot participate in group activities and staff appear to respect this and arrange other types of stimulation. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 6 Residents appeared to be quite content within a comfortable and homely setting, being cared for by knowledgeable trained staff. The home is a large detached three-storey house surrounded by a small garden. An enclosed patio area is provided with seating with several residents preferring their meals outside during the warmer weather. The home is very well decorated with regular maintenance being carried out by one of the proprietors. What has improved since the last inspection? What they could do better: The proprietor is replacing four windows situated in four of the bedrooms so is currently advising residents and relatives about the proposed upheaval. Currently the manager is included on the rota and because the proprietors share the workload has reduced the amount of supernumerary days. The manager should be supernumerary for part of the week to the working rota to continue with his managerial tasks. The home has a low numbers of care staff achieving the recommended NVQ training and the manager should encourage the development of this training for care staff to improve their skills. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 7 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 I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 8 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 I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 9 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) 1,3,4,5 Residents are given assistance through the admission process by helpful, informative staff. 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. Generally, the details of terms and conditions are discussed with the family depending on the level of comprehension of the prospective resident. 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. Before any visit is arranged the manager receives written information from the social worker and a psychiatric assessment regarding the mental health issues caused by dementia. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 10 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. The manager again discusses the terms and conditions of residency with the family, trying to include residents who can comprehend. A random sample of these details was seen. One relative stated ‘I came to look round and saw mum’s room, and helped with the details of the admission, the manager helped me come to terms with her change of circumstances, I liked the way the staff talk to each person like an adult and not a child’. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 11 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) 7,8,9,10,11 Residents’ health and care needs are identified reviewed and are met by staff that are knowledgeable and have a good understanding of their needs. Safe procedures are in place for the administration of medicines. EVIDENCE: Residents have 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 the manager has introduced life stories, obtaining information from relatives or friends residents. This information helps staff to gain a better understanding of the residents past life and interests especially when planning activities or reminiscence and is seen as good practice when caring for those with dementia and memory impairment. The trained nurses compile the care records either with the co-operation of the resident or their close relative. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 12 Occasionally, a visiting CPN or Psychiatrist monitors the care and mental health needs to ensure that residents continue receiving the correct treatment or medication. The home has a safe procedure in place for the storage and administration of medicines. The trained nurse demonstrated the medication procedure and explained the policy. The medication including controlled drugs are administered by trained nurses who also oversees the ordering and returning of medicines, some records were seen and found to be satisfactory. The home is supported by the local GP practices and residents are encouraged to register with a local surgery. It was observed that the staff treated residents very well, with one resident stating ‘the staff are very kind and keep me right when I forget things’. The home has a variety of lounges for residents to spend the day, but can stay in their own rooms if they wish, although the manager encourages residents to continue maintaining their socialising skills. 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. The policies for the dying were read and the home can accommodate residents with different religious or spiritualist needs. Several letters and cards were seen from past visitors with one stating ‘I cannot thank the staff enough for the care and support they gave me when my father died’. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 13 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) 12,15 Resident’s social skills are maintained with individual interests developed within the organised activities. Residents are offered a varied and wholesome choice of meals. 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. The activities range from craftwork, jigsaws, quizzes, reminiscence, music and sing-along to chatting or exploring different ways to communicate for those who are frail. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 14 Staff takes residents out for a walk to the seafront during the warmer weather, and one of the residents had gone out with their family during the day. One resident stated ‘ I prefer to read rather than join in and the staff respect this’. Several residents appeared to enjoy the crafts that had been organised with staff assisting when needed. Some residents who were unable to participate were watching, with staff explaining to them what they were doing. The staff appeared knowledgeable about the skills and needs of their residents during this social time and it was observed that staff treated residents as adults with a memory impairment rather than as a child, and this practice should be commended. 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 Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 15 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) 16,17,18 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 displays the complaints procedure in the front entrance this contains the address of the Commission in case the manager or proprietor cannot assist with concerns that have been previously raised. To ensure that residents concerns are listened to, these can be raised in a number of ways, for example it was observed during this visit that one resident was rather agitated and staff tried a variety of methods to reduce and relieve the agitation of the resident in a practical and kindly manner. 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. One of the proprietors stays at the home six days a week and is in daily contact with residents and relatives. This time, the proprietor stated ‘is a good opportunity to discuss any concerns or improvements that the family wish to make to enhance the residents lives within the home’. This verbal contact is also included within the quality assurance aspect of the home. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 16 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. Adult Protection issues are also included within the induction of new staff. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 17 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) 19,20,21,25,26 Residents live in a clean, tidy and well-maintained home. The bedrooms contain residents’ personal possessions and are tastefully decorated. EVIDENCE: Alexandra House is a detached town house near to the sea front, 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 comfortable 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, although if residents wish to go outside, staff will supervise within the gardens and large park next door. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 18 The home has adequate toilet and bathroom facilities situated throughout the building, with some bedrooms having ensuite facilities. 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’. The home is cleaned on a daily basis and the laundry and personal clothes are also cleaned by dedicated staff, leaving the care staff to attend to residents. The proprietor takes infection control very seriously and has introduced handwashing measures on each floor with the introduction of hand gels to be used before entering bedrooms. The proprietors have a maintenance programme in place and have plans for the replacement of four bedroom windows. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 19 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) 27,28,29,30 Sufficient numbers of staff are on duty to meet residents’ needs with extra staff brought in to cover busy periods. Good recruitment procedures and training are in place to ensure residents are cared for and protected. EVIDENCE: Copies of the rotas were received prior to this visit indicating that one nurse, four care staff, one bed maker, one laundry assistant, one cook and one cleaner were on duty during the day, reducing to one nurse and two care staff overnight. The manager has been working as part of the rota over recent weeks due to the amount of help both proprietors offer. The manager should be exempt from part of the working rota to enable him adequate time for managerial tasks and this has been recommended during the feedback at the end of the inspection. 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. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 20 Staff files were checked and the manager ensures safe practices when recruiting new staff, ensuring they follow the homes induction-training programme. The mandatory training is carried out by the deputy manager organising training for both nurses and care staff such as first aid, food hygiene, dementia care, challenging behaviour, moving and handling and infection control. The deputy manager keeps up to date with the current trends of dementia care and these are cascaded to the staff team during the dementia training. The home is low in the numbers of care staff achieving the recommended NVQ training in care and it was recommended that the deputy manager ensures that care staff are encouraged to continue to develop their knowledge and skills with this formal achievement. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 21 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) 31,33,36,37,38 Residents are looked after within a safe environment by people who understand their individual needs. EVIDENCE: The manager has worked at the home for two years; he is a qualified mental health nurse and has a vast experience for caring for those with dementia or memory impairment. The deputy manager offers a counselling service for staff and also supervises staff on a regular basis. Staff files were seen and records contained within these confirmed that staff were included with training and supervision. Any counselling undertaken by the deputy manager is confidential and these records were not requested. Staff who spoke during this visit confirmed that it was very supportive of the management team to offer a counselling service within a stressful environment. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 22 The home is run in an ‘open and inclusive’ manner, feedback received from the numerous comment cards received prior to the inspection and comments received from the three relatives who spoke during the inspection confirmed this. A quality assurance system is in place with care reviews taking place, through staff supervision and training, with questionnaires given out to visitors and residents who can participate, as well as verbal feedback during meetings or when the proprietor speaks to relatives. Relatives meetings that have been organised in the past have diminished due to fewer numbers, so any feedback received from the poll is distributed verbally initially. A sample of health and safety procedures was checked including fire records, monitoring accidents, staff training, risk assessments and infection control which were all satisfactory. The regulatory records were also checked with no requirements from both the fire and EHO outstanding. The water, central heating and radiators, fire equipment and specialist equipment and the upstairs windows were also satisfactory. The registration and insurance certificate was valid and displayed in the entrance hall. Those residents whose records were seen some were not able to communicate easily, appeared to be comfortable and well looked after. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 23 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 4 COMPLAINTS AND PROTECTION 3 3 x x x x 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x x 4 3 3 Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 24 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 28 31 Good Practice Recommendations The manager should encourage the care staff to develop their skills by undertaking the recommended NVQ training in care. The manager should be supernumerary and not be included on the rota for at least two days of the week to allow him to undertake managerial tasks. Alexandra House Care Home I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 25 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 © 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 I55 S15609 Alexandra House V242523 050905 Stage 4.doc Version 1.40 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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