Inspection on 04/12/06 for Alexandra House [Poole]

This inspection was carried out on 4th December 2006.

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 [Poole] 08/07/08

Alexandra House [Poole] 08/11/05

Alexandra House [Poole] 07/06/05

Alexandra House [Poole] 04/01/05

Alexandra House [Poole] 14/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Alexandra House Alexandra Road Parkstone Poole Dorset BH14 9EW Lead Inspector Sally Wernick Key Unannounced Inspection 10:00 4th December 2006 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 DS0000004036.V321845.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. DS0000004036.V321845.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra House Address Alexandra Road Parkstone Poole Dorset BH14 9EW 01202 746640 01202 743627 alexandra@dorsettrust.co.uk www.care-south.co.uk Care South 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) Mrs Christine Trinder Care Home 39 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (39) of places DS0000004036.V321845.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 39 in the category OP (Old Age) including up to 20 in the category DE(E). One person under the age of 65 may be accommodated, from time to time, to receive care. 8th November 2005 Date of last inspection Brief Description of the Service: The home is situated just south of the Ashley Road in Parkstone, Poole. Ashley Road is a busy shopping centre and has a range of facilities including banks, a post office, supermarket, public houses, local public transport, etc. Alexandra House was a purpose built home, erected in 1965 and which transferred from the control of Dorset County Council to Care South in the early 1990s. The Borough of Poole currently own and lease the property. Accommodation is provided on both the ground and first floors; both have their own lounge/dining areas and a small kitchen, which is used for preparing drinks, breakfasts and light snacks. On the ground floor there is the main lounge and dining room with a central kitchen used for preparation of all meals. Toilet and bathroom facilities are to be found in various locations throughout the home. Staff have office accommodation along on the ground floor corridor. Alexandra House is registered with the Commission for Social Care Inspection to accommodate 39 residents. Including up to 20 places for those who are diagnosed with dementia. Fees range from:£425.00-£600. See the following website for further guidance on fees and contracts. http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx DS0000004036.V321845.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and began at 10.00am on Tuesday 4th December 2006. This was a ‘key inspection’ where the homes performance against the key National Minimum Standards was assessed alongside progress in meeting a requirement made at the last inspection. The registered manager assisted the inspector, as did other members of care staff. During the course of the afternoon a second inspector arrived and assisted during the site visit, which took a total of five hours to complete. Methodology used included a tour of the premises, review of records and discussions with staff. The inspector also reviewed the contact sheet for Alexandra House and documentation submitted by the registered manager in response to the requirement and recommendations made at the last inspection. A Pre-inspection questionnaire was also sent to the manager in order that information could be provided prior to the inspectors site visit. That information where relevant will be included in the main body of this report. What the service does well: Alexandra House provides a service for older people some of whom have dementia. Thorough assessments and care plans are in place for all residents and staff regularly update these. Daily notes provide evidence of the way that care is delivered and of the community health professionals who support those living at the home. All residents spoken to had high praise for the staff that are described as kind and helpful. Visitors are very welcome at the home and there is a wide range of activities to suit all residents. Two survey cards received by the commission from relatives/visitors included the following comments: “I feel the home is well run, with a very friendly happy atmosphere”. “I have found Alexandra House to be a caring home for my relative-this is due to the overall attentiveness of the registered manager and all her staff who are friendly, patient and aware of individual needs”. Medication systems are well maintained and residents were happy with the quality and choice of meals available. Residents are cared for in a comfortable setting by caring staff that has received good training. The Registered manager and her staff have the skills and experience to manage the home resulting in a supportive environment in which residents are respected and safe. DS0000004036.V321845.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. DS0000004036.V321845.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 DS0000004036.V321845.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): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good admissions procedure enables prospective residents and their supporters to make informed decisions about the home and ensure that only service users whose needs can be met by the home are offered places there. Alexandra House does not provide Intermediate care this standard therefore was not inspected. EVIDENCE: Two files of residents who had come to live at the home since the previous inspection were examined. Pre-admission assessments were detailed with strategies for managing personal and healthcare needs and files held copies of local authority assessment and care plans. Information about life at the home is provided during the admission process. Residents spoken with were unable to recall the information provided but believed that the home had provided good levels of information to assist them DS0000004036.V321845.R01.S.doc Version 5.2 Page 9 in deciding to accept the placement. Written survey forms from 7 respondents at the home indicated that 6 felt they had received enough information prior to moving into the home another found the move unsettling but added “later I realised I’d made the right decision”. Care South provides written confirmation as to the outcome of the preassessment to prospective residents and their supporters so that they can be fully assured that individual care needs can be met. DS0000004036.V321845.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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good care planning system in place to ensure that staff has the information that they need to meet the needs of residents. The health needs of the residents are well met with evidence of good support from a range of community health professionals. The medication at the home is well managed promoting the good health and well being of residents. Residents are treated with respect and their privacy and dignity are promoted at all times. DS0000004036.V321845.R01.S.doc Version 5.2 Page 11 EVIDENCE: Three care plans were examined all were of a good standard. They followed on from the assessments made by the home, were easy to read and were full and informative about the needs of the resident and of how the home was to meet them. Information in the care plans was up to date with plans being reviewed monthly. Records evidenced and daily notes support regular liaison and referral to G.P’s, district nurses, community psychiatric nurses, occupational therapy as well as opticians, dentists and chiropodists. Risk assessments are carried out for each resident and appropriate steps taken to minimise any risks identified. Residents spoken to during the course of the inspection said the level of care and support that they received from staff was “very good” other comments included “ I’m very pleased to be here” “staff are very helpful could not ask for more” “help is always there you only have to ask” “marvellous” “really wonderful” “staff are excellent” and “they treat you with respect”. One resident commented that the home “ always support me in my independence”. A local chemist supplies the home with medication and carries out audits on the storage and administration. The medication was securely held within the home. None of the residents fully self medicated although some people did retain control of certain items. Records were kept to identify when these items were given to individuals. Temperature sensitive medication was stored in a dedicated fridge a record of operating temperatures was kept. A brief audit of four residents showed the records matched the stock held. Items with a short shelf life were dated when opened. All items seen during the visit were in date. With the medication records were copies of the residents’ photographs to help ensure that the medication was administered to the correct individual. Where hand written additions or amendments were made to the record a second person checked the entry to help reduce the risk of transcription errors. The home had a secure cabinet for storage of controlled medication. There was a controlled drug register. Senior staff, assessed as competent, managed the medication. The organisation had a medication policy and was available to the staff. Staff were observed throughout the inspection to be treating residents with courtesy, patience, kindness and respect. DS0000004036.V321845.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 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lives are enhanced by the activities on offer at the home, the choices made available to them and the social opportunities afforded by spending time with other residents, the staff and family and friends who are able to visit at a time that is individually suited. Residents are helped and encouraged to exercise choice in their daily lives at the home. The meals are good, nutritionally varied and served in a pleasant environment. EVIDENCE: The home has a dedicated activities co-ordinator who has received specific training in the care of dementia and whose day is divided to promote and support activities for all residents. The activities programme in place meets the needs of the most fragile service users and the more active and includes: games, music, hand and nail treatments, cookery and quizzes. Each Tuesday staff and residents gather for a sing-along and there is a wide range of fete’s, raffles and sponsored activities to raise money for the resident’s amenities fund. A regular newsletter keeps residents and their supporters informed of life DS0000004036.V321845.R01.S.doc Version 5.2 Page 13 in and around the home, good use is made of the garden in warmer months and there are a variety of trips out. Residents spoken to said there was a wide range of activities and always something they were able to do. In response to the written question Are there activities arranged by the home that you can take part in? Seven respondents indicated “Always” with added comments including: “every week there is something to enjoy” and “I select things I like to do”. Visitors are welcomed at the home at times that are suited to residents and written survey forms received by the commission from three supporters indicated that they are able to visit at any time and see their friend/relative in private if they wish. When people move into the home they and their families are asked about what the resident likes to eat and menus are based around known likes and dislikes and on providing a good wholesome diet. Residents confirmed that they enjoyed the meals at the home some of the comments received include: “very varied and most enjoyable” “good but plain” “usually good” and “very good”. The registered manager stated that where residents following nutritional assessment are not maintaining optimum health steps are being taken to introduce a different range of tasty nutritional snacks and to encourage smaller meals over increased periods. This is one example of the home’s good practice and the inspector will look forward to seeing the results of this at the next inspection. DS0000004036.V321845.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 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 formal complaints procedure allowing residents and visitors to express their concerns. Adult protection procedures are in place to deal with allegations of abuse for the protection of the residents. EVIDENCE: Since the last inspection two complaints had been investigated in the home with improvements introduced. Information on the complaints procedure was included in the information given at admission. There was a copy on the hallway notice board, which was accessible to visitors and residents. Staff were trained in adult protection procedures and those spoken to confirmed that they would know what action to take if they had any concerns. A copy of local “No Secrets” guidance is available to staff, as is the home’s procedure. Written responses received from residents indicated that in six out of seven cases all would know who to speak to if they had a complaint. One resident commented that they disliked having to explain potential concerns to carers and indicated it would be helpful if when requested staff referred enquiries directly to the manager. DS0000004036.V321845.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Alexandra House provides a well-maintained, comfortable, safe and homely environment for residents to live in. The home is kept clean and there are no unpleasant smells, making daily life for all in the home more pleasant. EVIDENCE: The home had a maintenance record for the safety equipment used in the home. The premises were maintained to a reasonable standard in line with a previous recommendation. Since the last visit a number of the windows had been replaced with double glazed units. On the first floor all windows had restricted openings. In one bedroom the new window did not close fully and needed adjustment. This was pointed out to the manager who agreed to rectify the problem. DS0000004036.V321845.R01.S.doc Version 5.2 Page 16 None of the radiators in the home had been covered so the topic was included in the individuals’ risk assessments. In some rooms where a risk was identified the hot pipes had been lagged to remove the risk. A requirement to take appropriate action to comply with Dorset fire service (lock to front door) has been actioned The home was clean, pleasant and hygienic throughout with good laundry facilities. Staff are trained in infection control procedures. All of the residents spoken to were happy with the levels of cleanliness within the home. In some bathroom areas communal towels were in use in order to limit the risk of cross infection it would be good practise for the home to introduce paper towels in these areas. DS0000004036.V321845.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff are sufficient to ensure that the assessed needs of residents are met. Robust recruitment procedures are in place to ensure the protection of residents living at the home. There is a programme of formal training designed to improve and develop staff knowledge and skills for the benefit of people living at the home EVIDENCE: Throughout the inspection it was clear that there were sufficient numbers of staff on duty and staff rotas confirm this. One resident said that the staff were “always available if help was needed” and “help is there you only have to ask”. Another commented that it was “sometimes difficult to get hold of senior staff”. The staff team is stable with a reduction in reliance on agency staff and to the home’s credit more than half hold National Vocational Qualifications at or above level 2. Robust recruitment procedures are in place and good staff files evidenced that. DS0000004036.V321845.R01.S.doc Version 5.2 Page 18 Records are kept of training that staff undertake. These records showed that staff have access to a good range of training and receive their regular mandatory updates. Induction is delivered in line with skills for care and one member of staff spoken to confirmed that induction was both thorough and relevant. As the home specialises in dementia care all of the staff team have access to in-house training although this is only following their three-month probationary period. Given the specialised nature of this work it would be good practice for staff to receive training at the induction stage and enhanced training in this area to ensure that they are able to meet the needs of the resident group. DS0000004036.V321845.R01.S.doc Version 5.2 Page 19 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 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the experience and qualifications to run the care home in the best interests of the residents. The views of residents and other interested parties has been regularly sought in order to identify and prioritise improvement although this is not always reported back to service users and other interested parties. Residents are assured of sound management of their financial interests. The health, safety and welfare of service users and staff are promoted and protected. DS0000004036.V321845.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager has managed Alexandra House for a number of years and has completed the Registered Managers award. Regular training is undertaken by her to ensure she is able to maintain and develop both her knowledge base and skills. Care South has a system of monthly visits by head office staff in order to monitor standards in the home; reports of visits are forwarded to the Commission. Quality Assurance surveys for Alexandra House have been gathered through residents, relatives, staff and other healthcare professionals. The results of these are aggregated and incorporated into an annual development plan for action by the registered manager. Results of these surveys however are not currently provided to service users and their supporters so they are not aware of outcomes or the steps to be taken to improve quality of life for those living at the home. The home does not manage the finances for any of the residents who are all assisted by family, friends or legal representatives. The home has an accident reporting procedure. The records seen were all numbered to allow the system to be audited. Senior staff that monitored for trends reviewed all accident reports; this had resulted in a referral for community healthcare attention. Safety in the home is well managed. Records showed that the fire safety system, precautions and staff training were up to date. All agency staff received basic training before their first shift in the home; however, it was not clear from the training records if they received refresher training. Records were maintained for the servicing and testing of hoists and lifting equipment used in the home. Staff carried out audits of water temperatures to ensure that the thermostatic mixing devices on the baths were operating correctly. Contractors also carry out annual inspections of water quality. DS0000004036.V321845.R01.S.doc Version 5.2 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 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 x 17 x 18 x 3 X X X X X X 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 3 X 3 X 3 X X 3 DS0000004036.V321845.R01.S.doc Version 5.2 Page 22 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. Refer to Standard OP26 Good Practice Recommendations In order to reduce the risk of infection it would be good practice for the home to introduce paper towels in communal bathroom and toilet areas. It would be good practice for the providers to ensure that in a specialised care home such as Alexandra house all staff receives both induction and enhanced training in dementia care to demonstrate that they are able to meet the needs of the resident group. The Registered manager/providers should continue to develop quality assurance methods based upon seeking the views of service users and other interested parties, to ensure success in achieving the aims and objectives of the home. The outcomes of which should be provided to supporters and service users in a format, which can be easily understood. 2. OP30 3. OP33 DS0000004036.V321845.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000004036.V321845.R01.S.doc Version 5.2 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!