Inspection on 15/01/07 for Alexandra House [Newquay]

This inspection was carried out on 15th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 [Newquay] 08/03/10

Alexandra House [Newquay] 06/01/09

Alexandra House [Newquay] 02/11/05

Alexandra House [Newquay] 05/04/05

Alexandra House [Newquay] 28/09/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOMES FOR OLDER PEOPLE Alexandra House 11 Alexandra Road Porth Newquay Cornwall TR7 3ND Lead Inspector Elaine Bruce Key Unannounced Inspection 15th January 2007 08:50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000060351.V322923.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra House Address 11 Alexandra Road Porth Newquay Cornwall TR7 3ND 01637 877508 01637 859869 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Morleigh Ltd Mrs Olwyn June Hanvey Care Home 36 Category(ies) of Dementia - over 65 years of age (36), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (36) Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Three (3) service users outside the age category of 65 years and over. Up to six beds can be used for non nursing service users. Total number of service users not to exceed 36 Date of last inspection 2nd November 2005 Brief Description of the Service: Alexandra House is a care home with nursing providing care for up to 36 older people. The beds are registered to admit service users with a dementia and or a mental disorder. Alexandra House is a large property set back in its own grounds overlooking the beach at Porth, Newquay. There is car parking available in the grounds of the home. The home has a lounge/dining area with lovely views across the beach. The majority of bedrooms are for single occupancy with five double bedrooms. There are some bedrooms that cannot be accessed with the shaft lift. These are to be identified in the statement of purpose document. There is a garden to the rear of the property. Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection took place on the 15th January 2007 over 8 hours and was carried out as an unannounced inspection. The registered manager was on duty during the course of the inspection and one of the registered providers was also at the home during most of the day. Care plans, staff records and policies and procedures were inspected with the assistance of the manager and staff. Prior to the inspection a detailed pre inspection questionnaire was received as well as two relatives/visitors comment cards. The two comment cards state that “the home is doing a grand job” and that the home is “a very good nursing home, it has a friendly atmosphere, the staff are caring to the residents, and I always feel welcome.” During the course of the day case tracking took place with five service users. Due to the high dependency levels of the service users limited conversations took place. The weekly range of fees at the home is from £454.79 to £603.75 What the service does well: The dependency levels of the service users at Alexandra are high. A large number of service users require assistance with feeding and toileting and are generally very frail. Staff are therefore very busy at the home and it is a credit to the staff team that they are meeting the high care needs of the service users in the home. Staff stability at the home is good, and in addition the home does not appear to have any problems recruiting staff. Staff sickness is covered by the home’s own bank staff providing a continuity of care for the service users. Staff training is very much encouraged and valued by the manager. Training is therefore to include regular statutory and good practice training. Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s statement of purpose and service user guide documentation as well as a brochure provide prospective service users with details of what the home provides helping an informed decision about admission to the home. The registered provider assesses all service users prior to admission to the home to ensure that the home will be able to meet their care needs. EVIDENCE: The home has a comprehensive combined statement of purpose and service user guide document. The document is displayed in the entrance hall of the home and given to each service user and their representative. It is Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 9 recommended that more information is included in this documentation on diversity and equality as discussed at the time of the inspection. The registered manager undertakes an assessment of all new service users prior to admission to the home to ensure that the care needs of the individual can be met. In the absence of the registered manger a qualified RMN nurse will undertake this assessment. The home has an admissions policy and procedure in place on good practice guidance. Where a service user is funded by the local adult social care department the home has in place assessment documentation from the department. The service considers carefully the needs assessment for each prospective service user before agreeing admission to the home. The home employs both registered general mental nurses and registered general nurses with a view to having a skill mix to meet not only the mental health needs of the service users but also the physical needs. At this particular inspection it was noted that a large number of service users have high physical care needs which the home appears to be meeting well. Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service user’s health, personal and social care needs are being met by the staff and multidisciplinary staff as required. Medication is being administered correctly to the service users ensuring that health care needs are met. Staff were observed to treat the service users with respect and dignity during the course of the inspection. EVIDENCE: The home uses the standex care planning system and each service user has a comprehensive care plan in place. Some information for care planning has been gathered from relatives/representatives as the majority of the service users are unable to understand the care planning process. The care plans have a separate record of medical interventions such as general practitioner Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 11 visits and hospital appointments. Risk assessments are included within the care planning process. Good daily records support the care plans. The care plans are reviewed on a monthly basis. Many of the service users are physically very frail and several spend significant periods in bed with appropriate pressure relieving equipment in place. Specialist advice is sought from the tissue viability nurse, community nurses and psychiatric nurses as required. On the day of the inspection a professional was assessing a service user for support with swallowing problems. The home appears to have a good working relationship with health care professionals. An optician visits the home every six months and referrals to an audiologist can be made via the service users general practitioner. The service users are regularly weighed and blood pressures are regularly checked. Dressings are undertaken by the nursing staff. A discussion took place on the importance of a recognised nutritional screening tool in care planning for the service users. The manager has plans in hand for this to be implemented. Management are presently giving consideration to changing the medication system at the home, which at this time is bottles, rather than a blister system. The present medication policy and procedure is appropriate for the current medication arrangements. All medication is administered by qualified nursing staff. The medication administration records were found to be satisfactory on the day of the inspection. An inspection of the medication administration was undertaken by the pharmacy on the 10/01/07. This was found to be satisfactory. Staff were noted to treat the service users with respect, consideration and dignity during the course of the inspection in regard to toileting requiring the use of equipment for example. It was also noted that attention was given to hand and nail care during the course of the morning. Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides the service user with opportunities to meet their social care needs. Visitors are encouraged and welcomed into the home. The meals provided in the home are good with special diets catered for and a choice of food offered at all meals. EVIDENCE: Social care needs of the service users are identified in care planning documentation (daily records) and a diary is kept of the social activities that take place in the home. The home has been busy over the recent Christmas period. A yearly “trip out” is undertaken by the home which is a credit to the staff as the dependency levels of the service users are very high. Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 13 The hairdresser regularly attends the home. The staff involve themselves in painting the nails of the service users when this is appropriate. It was noted that staff have the opportunity to spend one to one time with the service users. The religious needs of the service users are met by attendance at the home (monthly) of representatives from the Church of England and Roman Catholic Church. The manager advised the inspector that celebrations of events such as Easter and Harvest Festival are celebrated around the changing seasons rather than the primary aim of religious worship. This is to ensure that all service users are involved irrelevant of their religious background. A number of visitors were at the home during the afternoon of the inspection. They are asked to sign the visitors’ book on arrival to the home. Visitors are welcome at any time and facilities are available for them to have a drink or a meal with the service user. Documentation in care planning includes information on the wishes of the service users in regard to how they spend their days at the home. This information has been gathered in some cases with assistance from relatives/representatives. The home has developed a system for displaying information and bringing attention to community events and activities. The home offers the service users three full meals a day. The menu is traditional to include fish and chips on a Friday and a roast dinner on a Sunday and a Wednesday. The main meal of the day on the day of the inspection was sausage casserole. Cakes are home made and special diets are catered for as are liquidised meals. Over half the service users at this time require liquidised meals and a large number require feeding. A full alternative choice is available in regard to the meals provided in the home and documentation is in place to evidence when this has taken place. The cook has obtained her basic food hygiene certificate qualification and has undertaken a healthy eating course, as have other staff members. The more able service users have their meals at the dining end of the lounge, the more frail service users remain in their chairs. Staff were observed to be feeding/helping the service users when required and the home also encourages relatives to be involved in this task when they so wish. An inspection of the kitchen by the District Council Environmental Health Officer took place on the 20/02/06 the requirements and good practice recommendations have been dealt with. The cook has recently attended training on new legal requirements for food safety. Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 14 In the recent quality assurance audit that has taken place very positive comments were made by relatives on the meals at the home. The manager is fully aware of the importance of good nutrition for the service users that she has responsibility for. Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure provided to the service users and their representatives in the combined statement of purpose/service user guide. Staff are provided with the knowledge and understanding of adult protection issues to protect service users from abuse. EVIDENCE: The home has a detailed complaints policy and procedure and each service user and their representative has received this in their combined statement of purpose/service user guide. The home are keeping good records of any complaints they receive. Outcomes of complaints are managed effectively. The home have in place adult protection policies and procedures to guide staff on safe practice. Information on whistle blowing is included in the policy and procedure. Whey staff receive their induction training they are given a copy of the “No Secrets” adult protection policy and procedure. The registered manager has recently attended training at the local adult social care department and there are plans for this training to be cascaded to staff. Management recognise the importance of adult protection work, and there are Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 16 plans for all staff to be trained in this area. There are a low number of referrals made as a result of lack of incidents, rather than a lack of understanding when incidents should be reported. Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements externally and internally to Alexandra House are ongoing to the benefit of the service users and staff. EVIDENCE: Access to Alexandra House is at the end of a steep drive with parking available. The views from the home over Porth beach are stunning. The upstairs lounge and dining area as well as bedrooms at the front of the house also have these views. Garden areas have recently been improved which will allow opportunities for service users to be supervised by care staff in the warmer weather. Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 18 Bedroom accommodation is available on three floors with a lift serving all levels. Bedrooms are personalised and individual in presentation. Where a bedroom is shared suitable screening has been provided for privacy. The home has a well maintained environment which provides aids and equipment for service users as required. The fact that the home is not purpose built does though make it difficult for staff to move wheelchairs and hoists around the home. Corridors are long and narrow. Cleaning staff are employed every day of the week and the cleaner on duty at the time of the inspection was spoken to. The home was found to be clean on the day of the inspection. The home has in place infection control policies and procedures to guide staff, they are also fully aware when to work with external agencies if required. The laundry is small and could be improved with the purchase of an industrial washing machine. The amount of laundry at the home is large due to the high dependency levels of the service users. Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are appropriate to meet the needs of the service users. Recruitment procedures are satisfactory and staff training is ongoing, encouraged by management and valued by the staff. EVIDENCE: There is a qualified nurse on duty at all times in addition to the registered manager who is also a qualified nurse. To deliver the care to the service users in the morning there are six care staff on duty. The home has it’s own bank staff to cover for staff holidays and sickness. During the night there is one nurse and two care staff on duty. It is noted that staff stability at the home is good and the home appears to have no problems recruiting staff. The registered manager haws a good understanding of the importance of correct recruitment procedures. The recruitment of good quality carers and nurses is seen as integral to the delivery of a good service. Staff files inspected noted two written references, fully completed application forms as well as criminal records bureau checks being in place. Staff members are provided with contracts of care. As discussed at the time of the inspection it is Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 20 recommended that risk assessments must be in place when criminal records bureau checks disclose any offences. All staff have an individual training records sheet in place which evidences that statutory and good practice training is taking place. Statutory moving and handling training is undertaken by the manager. Over half of the staff have first aid training which ensures that there is always someone on duty with this qualification. Over 50 of the staff have an NVQ 2 qualification in care with three more staff due to commence these studies. Induction training is due to be improved/expanded and dementia training is also due to take place. Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The registered manager is very experienced and knowledgeable to the benefit of the service users and the staff team. The home is delivering a very good standard of care to a group of service users who have high physical and mental health care needs. EVIDENCE: The registered manager is a registered nurse and has a lot of care experience although she has no plans to undertake the registered managers award, and has plans to retire at the end of the year. With this in mind a deputy manager Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 22 has been recruited. She will be encouraged and supported to undertake the registered mangers award by the registered providers. The registered manager is on call at all times when she is not working at the home. She regularly undertakes training and has recently attended adult protection training. She is also the moving and handling trainer for Alexandra and the other homes in the Company. The manager is highly competent to run the home. One of the registered providers is involved with the external and internal maintenance of the home and the other visits the home regularly. She was at the home for most of the inspection and was fully involved in the feedback process. A visit to the home takes place weekly from one of the registered providers at this time. The manager organises a yearly quality assurance/monitoring programme to obtain feedback from relatives and professionals on the standard of care that the home is delivering. The results of the audit have been analysed by the manager. Very positive outcomes are noted on the answers to the questions. The majority of the service users are unable to manage their affairs and records are in place where individual accounts are kept and held. The manager has support for duties such as these from a part time administrator. Health and Safety policies and procedures are in place. The testing of appliances in the home is ongoing and maintenance of equipment is ongoing with full evidence provided in the home and sent to the CSCI as part of the pre inspection information. Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 4 x x 3 Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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. 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. 3. Refer to Standard OP1 OP26 OP29 Good Practice Recommendations To include information on diversity and equality in the statement of purpose/service user guide. To give consideration to the purchase of an industrial washing machine. To draw up a risk assessment as discussed at the time of the inspection in regard to recruitment information. Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alexandra House DS0000060351.V322923.R01.S.doc Version 5.2 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!