Inspection on 05/04/05 for Alexandra House [Newquay]

This inspection was carried out on 5th April 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 [Newquay] 08/03/10

Alexandra House [Newquay] 06/01/09

Alexandra House [Newquay] 15/01/07

Alexandra House [Newquay] 02/11/05

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 Announced 5 April 2005 09:30 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 Version 1.10 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 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 Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: One service user under the age of 60 on admission to the home Date of last inspection 28/11/04 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 5th April 2005 over seven and a half hours and was carried out as an announced inspection. A tour of the premises took place and staff, care records and policies and procedures were inspected. Staff on duty were spoken to during the course of the inspection. Due to the high dependency levels of the service users limited conversations took place. Positive interactions were noted between the visitors to the home and the staff. Both owners were at the home during the course of the day, one working in the garden and one present during the inspection. What the service does well: What has improved since the last inspection? Staff training has considerably improved since the last inspection. A local college now visits the staff at the home weekly and a variety of training has recently taken place or is planned to take place. First aid training, fire training, moving and handling and basic food hygiene certificate training are all up to date. Dementia training is due to commence. Staff who are involved in meal preparation (including the cook) are presently undertaking a healthy eating course. Some staff have already attended adult protection training at the local social services department and six more staff are to receive this training. The new owners have spent a considerable part of their budget on reducing the amount of agency staff that had been employed in the home. Agency staff are Alexandra House Version 1.10 Page 6 now only employed when there is staff sickness. Staffing levels have increased for both the nursing and the care staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alexandra House Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Alexandra House Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 4 The homes 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. This document is displayed in the entrance hall of the home and given to each service user and their representative. It is recommended that some small additional information is included in this document for example information where the shaft lift is not available to bedrooms. 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. 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 Alexandra House Version 1.10 Page 9 health needs of the service users but also the physical needs. There are plans for staff to receive dementia care training. Alexandra House Version 1.10 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 standard(s) 7,8 and 9 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 two good practice recommendations are made as a result of this inspection. EVIDENCE: The home uses the standex care planning system and each service user has a comprehensive care plan. 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. 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 psychiatric nurses as required. 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. Alexandra House Version 1.10 Page 11 The home has in place a recently updated medication policy and procedure. The medication system is from bottles/pots rather than a `blister’ system which the registered manager stated had been considered, however due to regular medication updates she felt it would be an impracticable system for the home. Medication administration records were found to be completed appropriately but these are written by the nurses which is time consuming. It is recommended that the manager discusses this with the pharmacy to see if they can complete this task. The controlled medication is appropriately stored but one particular drug (temazepam) is not being recorded in the controlled drug register which is a good practice recommendation included in this inspection report. Alexandra House Version 1.10 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 standard(s) 15 The meals provided in the home are good with special diets catered for and a choice offered at all meals, although more written evidence is required as the service users are unable to express that they are given this choice. EVIDENCE: The home offers 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. Although a full choice is available further information is required and it is suggested this information is kept in a diary when any one has not had the main meal of the day off the menu. The cook has her basic food hygiene certificate and is now studying a healthy eating course as are staff who have meal preparation responsibilities. The more able service users take their meals at the dining end of the lounge, the more frail service users remain in their chairs. Many of the service users need feeding or assistance with their meals. An inspection of the kitchen by the district council environmental health officer took place on the 30th December 2004. The two legal requirements from this inspection have been actioned. Alexandra House Version 1.10 Page 13 Alexandra House Version 1.10 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 standard(s) 16 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 an adult protection policy and procedure in their induction training and some staff have recently had training in this area with others due to receive this. Staff are therefore 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 is keeping their own records of any complaints received and are aware they need to update their documentation from the NCSC to the CSCI. The home has recently updated it’s adult protection policy and procedure which is now comprehensive. When staff receive their induction training they are given a copy of the adult protection policy and procedure. Some staff have attended the `No Secrets’ adult protection training at the local social services department and six more staff are due to attend. There are plans for all staff to ultimately receive this training. Alexandra House Version 1.10 Page 15 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) 19,20,2124,25 and 26 Recent improvements to the premises have taken place following the change of ownership of the home and more improvements are planned. This will improve the appearance of the home externally and internally. EVIDENCE: The home is situated on a hill with lovely views over the beach. The surface of the drive has been improved and the gardens are presently in the process of being planted up. A recent ramp has been provided to the entrance of the home for wheel chair access. The home is on three levels and has a shaft lift serving the majority of the bedrooms. Many of the bedrooms have been redecorated and there are plans for more redecoration to take place. It was noted during the course of the tour of the premises that bedroom doors should not be wedged open. A discussion took place with one of the owners on the safer alternatives. Alexandra House Version 1.10 Page 16 The nurses station is directly positioned within the lounge which is excellent allowing for prompt intervention to the service users when required. The owners do have plans to increase the communal space with an extension which will be a big improvement as there is limited space for the equipment that is needed for the more frail service users. Bathing equipment is presently being improved with two bathrooms recently being converted to wet rooms/walk in wheelchair shower rooms. These facilities have been completed to a high standard. Shared bedrooms are provided with suitable screening. Service users are able to bring personal items with them on admission to the home. Radiators are guarded in the home and taps are installed with pre set valves for safe bathing. The home was clean and hygienic on the day of the inspection except for one bedroom which was discussed at the time of the inspection. Alexandra House Version 1.10 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 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) 2728,29 and 30 Staffing levels are appropriate to meet the needs of the service users. Recruitment procedures are satisfactory and staff training has improved considerably since the last inspection report. EVIDENCE: The new owners have spent a considerable part of their financial budget on reducing the hours that the home had been using on agency staff. Agency staff are only now used when there is staff sickness. More trained and more care staff have been employed. The registered manager has a good understanding of recruitment procedures. Staff files sampled contained two written references and application forms, evidence of criminal records bureau checks and contracts of employment. Staff training has improved considerably since the last inspection report. All staff have an individual training record sheet in place which evidence that statutory and good practice training is taking place. A college visits the home every week to monitor and deliver training to the staff. NVQ training is also taking place with four staff with an NVQ 2 and three more registered. Two staff are trained to level NVQ 3. Visitors to the home were noted to interact very well with the staff. Alexandra House Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,36,37 and 38 The registered manager is supported well by the new owners of the home. Between them they have improvements planned for the home which will be to the benefit of the service users. 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. A job advert has been placed for an additional manager who will eventually succeed the present registered manager when she retires. One of the owners is involved in the external and internal maintenance of the home and the other visits the home twice a week to pay bills, deal with the accounts and contracts for example. Alexandra House Version 1.10 Page 19 More work is required on evidencing that the staff are involved in the running of the home for example staff meetings. In addition more documentation is required to evidence that staff are receiving the right amount of supervision. Although documentation is detailed the number of supervision sessions needs to be increased and an overview taken of who has these responsibilities to meet the requirements of the standard. One of the owners has undertaken a monitoring system by sending out questionnaires to the relatives/service users. Where the information has been returned this now requires analysing with a view to dealing with some of the constructive points raised in the returned questionnaires. The majority of the service users are unable to manage their affairs and records are in place where individual accounts are kept and held. Maintenance records on equipment in the home were discussed and inspected during the course of the inspection. These were satisfactory. Records also indicate that fire drills and instruction is taking place regularly. Alexandra House Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 x x 3 3 3 STAFFING Standard No Score 27 3 28 3 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 2 2 x 3 2 3 3 Alexandra House Version 1.10 Page 21 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 32 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 The registered person shall establish and maintain a system for reviewing at appropriate intervals the quality of the care provided at the home. The registered person shall ensure that persons working at the care home are appropriately supervised. Timescale for action 31/08/05 2. 33 24 31/08/05 3. 36 18 31/08/05 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 1 9 Good Practice Recommendations To add information to the statement of purpose document on the bedrooms in the home that cannot be accessed with the shaft lift To contact the phamracy supplying the medication to establish if they can complete essential information on the Version 1.10 Page 22 Alexandra House 3. 4. 5. 9 15 19 medication administration records rather than the nursing staff at the home. To record the temazepam medication in the controlled drug register. To evidence any alternative meals (off the main menu) provided to the service users in a separate diary. To give consideration to a safe system to allow service users to keep their bedroom doors open without them being wedged. Alexandra House Version 1.10 Page 23 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall, PL25 4AD 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 Version 1.10 Page 24 - 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!