Inspection on 06/01/09 for Alexandra House [Newquay]

This inspection was carried out on 6th January 2009.

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

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

Other inspections for this house

Alexandra House [Newquay] 08/03/10

Alexandra House [Newquay] 15/01/07

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 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Alexandra House [Newquay] 11 Alexandra Road Porth Newquay Cornwall TR7 3ND     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michael Dennis     Date: 0 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Alexandra House [Newquay] 11 Alexandra Road Porth Newquay Cornwall TR7 3ND 01637877508 01637859869 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Morleigh Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 36 Number of places (if applicable): Under 65 Over 65 36 36 dementia mental disorder, excluding learning disability or dementia Additional conditions: 0 0 Three (3) service users outside the age category of 65 years and over. Total number of service users not to exceed 36 Up to six beds can be used for non nursing service users. Date of last inspection Brief description of the care home 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 and dining area with lovely views across the beach. The majority of bedrooms are for single occupancy with five double bedrooms. There are Care Homes for Older People Page 4 of 27 Brief description of the care home some bedrooms that cannot be accessed with the shaft lift. These are identified in the statement of purpose document. There is a garden to the rear of the property. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The key inspection took place on the 6th January 2009 over 7 hours and was carried out as an unannounced inspection. The Head Nurse and Head of Care were on duty during the course of the inspection and one of the registered providers and manager attended for part 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 the Annual Quality Assurance Assessment was returned to the Commission. Care Homes for Older People Page 6 of 27 During the course of the day case tracking took place with four service users. Due to the high dependency levels of the service users limited conversations took place. A number of staff were spoken with throughout the course of this inspection. They were able to verify the evidence gathered from the written records. The home is at full capacity with a waiting list. Whilst working at a work station adjacent to the main lounge we had the opportunity to observe client and staff interaction which proved to be attentive and positive. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes 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. The manager and other senior staff undertake assessments of all new service users prior to admission to the home to ensure that the care needs of the individual can be Care Homes for Older People Page 10 of 27 Evidence: met. 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. All service users have contracts of care and everyone is given the opportunity to visit the home prior to admission if they so wish. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users health, personal and social care needs are being met by the 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 has recently changed its care planning format and each service user has a comprehensive care plan in place. Some information for care planning has been gathered from relatives or 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 visits and hospital appointments. Risk assessments are included within the care planning process. Good daily records Care Homes for Older People Page 12 of 27 Evidence: support the care plans. The care plans are reviewed on a monthly basis. We suggest that more information should be available to indicate that goals set and interventions listed are followed through indicating the achievements and results. 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. 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. 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. It is strongly recommended that where hand written entries are made to the medication administration records, these should be accompanied by two signatures to avoid the possibility of error. The controlled drugs register was also inspected to include an audit of drugs held and 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. Observation of staff interaction with service users was seen to be positive. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. Fancy dress parties are held to celebrate special occasions. 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. Care Homes for Older People Page 14 of 27 Evidence: 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 or 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. 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 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 and 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 has recently taken place. A small number of deficits were identified and we were informed that steps have been taken to remedy these issues. The manager is fully aware of the importance of good nutrition for the service users that she has responsibility for. Care Homes for Older People Page 15 of 27 Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 and service user guide. The home is keeping good records of any complaints they receive. Outcomes of complaints are managed effectively. The home has in place adult protection policies and procedures to guide staff on safe practice. 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. The manager has 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 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 Care Homes for Older People Page 17 of 27 Evidence: be reported. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 been improved which will allow opportunities for service users to be supervised by care staff in the warmer weather. 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. Care Homes for Older People Page 19 of 27 Evidence: Cleaning staff are employed every day of the week. 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 but has been improved with the purchase of an industrial washing machine and two dryers. The amount of laundry at the home is large due to the high dependency levels of the service users. Some new furniture has been purchased and new carpets laid in certain areas as required. We considered the best use of space is utilised given the age of the building. There were no pervading odours. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 manager and head of care. To deliver the care to the service users in the morning there are six care staff on duty. The home has its 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 manager has 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. All staff have an individual training records sheet in place which evidences that Care Homes for Older People Page 21 of 27 Evidence: 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 70 of the staff have an NVQ 2 qualification in care with more staff due to commence these studies. Induction training is delivered to all new staff. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The 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 manager has a lot of care experience and is qualified, holding an NVQ 4 in care, an NVQ5 in Operational Management and the Registered Managers award. The manager is on call at all times when she is not working at the home. She regularly undertakes training and has attended adult protection training. 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 Care Homes for Older People Page 23 of 27 Evidence: 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 are then 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. The records indicated that all staff receive supervision at appropriate time intervals. 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 annual quality assurance assessment. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 7 9 The care plans should demonstrate progress made to the stated interventions planned and goals set Two signatures should accompany all hand written entries made to the medication administration records Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!