Inspection on 02/11/05 for Alexandra House [Newquay]

This inspection was carried out on 2nd November 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 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 [Newquay] 08/03/10

Alexandra House [Newquay] 06/01/09

Alexandra House [Newquay] 15/01/07

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 Unannounced Inspection 2nd November 2005 08:45 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.V253908.R01.S.doc Version 5.0 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.V253908.R01.S.doc Version 5.0 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.V253908.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users to include one named person outside the normal age category of the home. Total number of service users not to exceed 36 Date of last inspection 5th April 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.V253908.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 2nd November 2005 over five hours and was carried out as an unannounced inspection. Care plans, staff records and policies and procedures were inspected with the assistance of the registered manager. One of the registered providers was at the home during the course of the inspection. Due to the high dependency levels of the service users limited conversations took place. It was noted that a number of visitors were in the home during the course of the inspection and the staff were observed to be very welcoming to them. What the service does well: What has improved since the last inspection? Since the inspection of the 5th April two mornings of administrative support have been provided to assist the registered manager. During the course of the inspection the manager stated that this support is a big help in assisting with the administration of her duties for example photocopying. Alexandra House DS0000060351.V253908.R01.S.doc Version 5.0 Page 6 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. Alexandra House DS0000060351.V253908.R01.S.doc Version 5.0 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.V253908.R01.S.doc Version 5.0 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 the following standard(s): 1,2,3,4 and 5 The home’s combined statement of purpose and service user guide are good and provide service users and prospective service users with details of what the home provides helping an informed decision about admission to the home. The registered manager 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. The recommendation of the last inspection report (5/04/05) has been addressed. Each service user is provided with a contract of care that details the terms and conditions of their placement. It is recommended that the bedroom that the service user occupies is identified on each contract. Alexandra House DS0000060351.V253908.R01.S.doc Version 5.0 Page 9 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 manager a qualified nurse will undertake this assessment (preferably a registered mental nurse). The home employs both registered 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. Six staff have recently undertaken dementia awareness training and more staff are due to do this via a local college. Alexandra House DS0000060351.V253908.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 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 but one good practice recommendation is made as a result of this inspection. 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. The care plans have a separate record of medical interventions such as general practitioner 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 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 community Alexandra House DS0000060351.V253908.R01.S.doc Version 5.0 Page 11 psychiatric nurses as required. The home appears to have a good working relationship with these 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. The home is presently in the process of updating it’s medication policy and procedure to take into account recent good practice recommendations. The medication system being used is bottles rather than a “blister” system which the registered manager states is more suitable for the home due to the regular medication updates and changes. The nurses complete the medication administration records and it was noted that there were some gaps in the signature boxes which should be addressed. An audit of the controlled medication was found to be satisfactory. During the course of the inspection service users were noted to be treated with respect and dignity by all the staff on duty. The home has in place a good practice policy and procedure on death and dying to guide staff which includes important information on privacy and dignity related to this sensitive area. Alexandra House DS0000060351.V253908.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The home provides the service users 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 offered at all meals. EVIDENCE: Social care needs of the service users are identified in care planning documentation and a diary is kept of the social activities that take place in the home. The diary evidenced that during October 2005 there had been a trip out from the home to the Blue Reef Aquarium and “cream teas were enjoyed by all”. This trip out (and others) are a credit to the staff at the home as the dependency levels of the service users are high. Ball games had also taken place in October as had one to one interaction with the service user to include nail care. The hairdresser was in the home on the day of the inspection. Visitors were noted to be in the home during the course of the inspection and it was also noted that they were welcomed into the home by the staff. Alexandra House DS0000060351.V253908.R01.S.doc Version 5.0 Page 13 Documentation 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 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. Cakes are home made and special diets are catered for as are liquidised meals. 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 and has recently 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 with their meals where required and some visitors were also involved with their relatives in these tasks. Alexandra House DS0000060351.V253908.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 16,17 and 18 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 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 their own records of any complaints received, of which there have been none. All staff are given documentation in their induction training on the rights of the service users living in the home. The home are presently updating their adult protection policy and procedure to take into account recent good practice guidance on cot sides. Information on whistle blowing is included in the policy and procedure. When staff receive their induction training they are given a copy of the “No Secrets” adult protection policy and procedure. Ten members of staff have received adult protection training at the local social services department and more staff are due to attend. There are plans for all the staff to ultimately receive this training. Alexandra House DS0000060351.V253908.R01.S.doc Version 5.0 Page 15 Alexandra House DS0000060351.V253908.R01.S.doc Version 5.0 Page 16 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 the following standard(s): 22,23 Improvements to the premises continue and are ongoing to the benefit of the service users and the staff. EVIDENCE: Service users are provided with specialist equipment where there is an assessed need. This includes for example pressure relieving equipment to include hoists, cushions and mattresses. A recent improvement has been made to increase the space in a bathroom at the home which now also has a new bath and specialist hoist. Bedrooms are personalised and individual in presentation. Decoration of the bedrooms is ongoing and where a bedroom is shared, suitable screening has been provided for privacy. Alexandra House DS0000060351.V253908.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 and 30 Staffing levels are appropriate to meet the needs of the service users. Recruitment procedures are satisfactory and staff training is good. 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 care to the service users in the morning there are six care staff. The home has it’s own bank staff to cover for staff holidays and sickness. The registered manager has a good understanding of recruitment procedures. Staff files sampled contained two written references and fully completed application forms as well as criminal records bureau checks and contracts of employment. Staff training is good at the home. All staff have an individual training record sheet in place which evidences that statutory and good practice training is taking place. A college visits the home every week to monitor and deliver training to the staff. This training includes dementia awareness which has apparently been very successful. Night staff are all included in the training that is taking place at the home. The statutory moving and handling training is undertaken by the registered manager. Fire drill training is up to date for all staff members. Alexandra House DS0000060351.V253908.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32 and 38 The registered manager is supported well by the registered providers. The ongoing improvements in the home are to the benefit of the service users and the staff. 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 in approximately one year. It is anticipated that the new manager will undertake this training or have already obtained the qualification. One of the registered providers is involved with the external and internal maintenance of the home and the other visits the home regularly to help with some of the administrative functions in the running of the home. Alexandra House DS0000060351.V253908.R01.S.doc Version 5.0 Page 19 It is noted that the statutory requirement for staff supervision has been met as has the statutory requirement for reviewing the quality of care being provided in the home. The majority of the service users are unable to manage their affairs and records are in place where individual accounts are kept and held. Alexandra House DS0000060351.V253908.R01.S.doc Version 5.0 Page 20 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 3 3 3 3 N/A 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 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 x x x 3 3 x x x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 x 3 x x x Alexandra House DS0000060351.V253908.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP32 Regulation 24 Requirement The registered person shall establish and maintain a system for enabling staff to inform the registered person and the Commission of their views about any matter to which this regulation applies Timescale for action 31/12/05 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 OP2 OP9 Good Practice Recommendations To add on to the contract of care the bedroom number that the service user is occupying. To ensure that all medication administration records are completed accurately at all times. 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