CARE HOMES FOR OLDER PEOPLE
Alexandra Lodge Wyllie Road Hilsea Portsmouth PO2 9NA
Lead Inspector Clare Jahn Unannounced 12 April 2005 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 Lodge Version 1.10 Page 3 SERVICE INFORMATION
Name of service Alexandra Lodge Address Wyllie Road, Hilsea, Portsmouth, Hampshire, PO2 9NA 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) 023 9266 0551 023 9265 1046 Portsmouth City Council Mrs D Mills Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Alexandra Lodge Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 14.01.05 Brief Description of the Service: Alexandra Lodge is a purpose built residential home accomodating older persons,situated in a residential area of Portsmouth.The home is owned and run by Portsmouth City Council Social Services Department. The accomodation is arranged into four living units each with its own lounge /diner,with a kitchen area,bedrooms ,bathrooms and toilets.There is a shaft lift to the upper floor. Alexandra Lodge Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over two days. Both days were spent at the Home talking with staff, residents and relatives. The opportunity was taken to look at care records, discuss forth-coming changes with managerial staff and current practices undertaken by care staff. What the service does well: What has improved since the last inspection? What they could do better:
At present the shortage in staff has a direct effect on the home in meeting the needs of the residents. Management, ancillary and care staff, relatives and
Alexandra Lodge Version 1.10 Page 6 service users raised the current staffing levels and the issues related to the shortage of staff during the visit. Staff do not have appropriate induction or supervision and staff do not have the time to carry out their non-care tasks, such as review of care plans. The other areas identified as requiring improvement were The home needs to have available the necessary information so that residents can make an informed decision about the home and what the home provides. The current information is under review. Residents care plans need improvement. Staff need further training in assessing, planning and evaluating the care given and the written process. This needs to include nutritional status and having the necessary equipment to monitor weights. The reporting and recording of accidents and incidents needs to be improved. The process for the safe administration of medication must be improved. The concerns regarding current practice have been raised twice before and will be raised again. The provision for activities and meeting the residents emotional and social needs is not being met. The lack of activities was raised as an issue by staff, relatives and residents. It has been raised on previous occasions that the home needs a refurbishment and redecoration programme. Some of the homes communal carpets have not been replaced for 12-15 years and appear worn and discoloured. Some of the main living and dining areas have not been redecorated for 20 years. The windows need to be included in this programme for replacement and the provision for double sockets to single rooms. The homes recruitment process also requires improvement. All necessary information required prior to employment was not available for all staff. Monthly reports are not provided to the Commission as required. 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 Lodge 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 Lodge 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) 1,2,3,4,5,6, The home does not have all the information about the home available to residents and is currently unable to meet all the assessed needs of the service users. EVIDENCE: The homes’ statement of purpose and service user guide are under review but residents recently admitted had the opportunity to visit the home, make informed choices regarding colour schemes of their rooms and meet the staff. The recently revised statement of terms and conditions were not yet in circulation on the files seen at this visit. Alexandra Lodge Version 1.10 Page 9 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) 7,8,9 The residents care plans need improvement in demonstrating assessed needs and identifying actions that need to be taken and recording outcomes. The procedure for the safe handling and administration of medications needs further attention. EVIDENCE: Through discussion with staff it is clear that the current staffing levels have a direct negative effect on the standards for practice in relation to care planning and medication. Care plans did not reflect current needs, are not regularly read, referred to or reviewed accurately and did not have recorded actions to be taken to meet the identified needs of residents. Discussions with staff identify a learning and training need for care planning. Inconsistencies were seen in the recording of medications on the MARS sheet and the safe identification of residents. The current process for a duty manager to give all the medication to all service users in four different units needs review along with providing appropriate training so that more staff can undertake administration of medications.
Alexandra Lodge Version 1.10 Page 10 Key workers must have the opportunity in their working day to up date, review and discuss their resident’s care with their supervisor. Alexandra Lodge Version 1.10 Page 11 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) 12,13,14,15 The emotional and social needs of the residents are not being met and the inspector felt low staffing levels have an effecting this area. The home provides current residents with a good choice of foods EVIDENCE: Discussions with staff, residents and relatives identified that the home does not provided enough entertainment. Previously enjoyed craft classes have stopped and there are not enough staff on duty to take residents out, talk to on an individual basis or do a selection of activities. Staff felt frustrated at not having the time to talk or interact with service users and service users also felt frustrated at not being able to go out or have something to do. All service users were satisfied with the food provided. Alexandra Lodge Version 1.10 Page 12 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) 16,17,18 The homes policies and procedures, service users guide, complaints procedure will require auditing once reviewed to ensure service users are safeguarded and protected. EVIDENCE: The current information regarding the home and the complaints procedure is under review and not yet on display, but all residents and relatives spoken to knew the name of the manager and the process of reporting concerns / complaints. Staff were knowledgeable of the whistle-blowing procedure. The process for inventories of resident’s personal possessions is also under review. Alexandra Lodge Version 1.10 Page 13 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) 19-26 Improvements to the home have been made but a programme of routine maintenance and renewal to the older fabric and decoration of the premises is required with an assessment of the adaptations and further provision for rails. EVIDENCE: A number of rooms have been redecorated and refurbished with the views of the residents being considered. The window frames need attention and the carpets, walls and skirting to the communal corridors on both levels require attention. The toilet facilities need further attention for the provision for rails for persons with disabilities and further additions for double sockets are required in single rooms. Alexandra Lodge Version 1.10 Page 14 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) 27-30 The home must improve both the numbers of staff on hand within each of the four units and its current recruitment practices. EVIDENCE: The lay out of the home, being divided by two floors and into four units demands additional staffing. The processes for medication rounds, meal times, and supervision of staff need to be improved. It was clearly identified during observation of practice, discussions with residents and staff that the current level of staffing in the home is inadequate. The process for recruitment of staff must also be improved and the manager must ensure all references, forms of ID and certificates demonstrating experience and qualifications are available. Alexandra Lodge Version 1.10 Page 15 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) 32,36,33,37,38 The home does not ensure the health and welfare of the services users are protected and must improve the staffing of the units and the supervision of the staff. EVIDENCE: The homes staff supervision, induction, record keeping, opportunities for inhouse training, care planning and medication processes, time allocated for care giving and providing activities are all affected by the current staffing levels. This does therefore have a direct influence on the health and safety of the service users and the standard of care they receive. Not all residents have key workers, which causes inconsistencies in the care given. Alexandra Lodge Version 1.10 Page 16 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 x 2 x 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 x 15 3
COMPLAINTS AND PROTECTION 2 2 3 2 3 3 x x STAFFING Standard No Score 27 1 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x 2 2 x 2 x 2 Alexandra Lodge Version 1.10 Page 17 yes 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 9 Regulation 13 Requirement You are required to take whatever action you consider necessary to ensure the administration and recording of medication is accurate and that instructions given by the general practitioner are appropriately recorded and counter signed by the practioner.The medication dose and frequency ,the date ,month and year must be indicated also on the MARS sheet.Identification of the resident must be indicated in the procedure.This requirement is outstanding from the 30.06.04, 14.02.05 A plan of redecoration ,refurbishment and renewel of the physical environment must be made indicating the planned dates for action and this must be submitted to the Commission.This must include the dates of the plan to redecorate bedrooms lounges corridors communal areas including replacement window frames, carpeting and the provision of adequate electrical sockets in single rooms.
Version 1.10 Timescale for action 30.04.05 2. 19 23 14/05/05 Alexandra Lodge Page 18 3. 4,27 18 4. 29 19 5. 38 Schedule 4 (12) 23,14 6. 6 7. 8. 9 12 18(1) 16 (2) n 9. 30 18 The service must employ enough staff on each shift to meet the needs of the the service users.No fewer than two care staff must be on duty in each unit area from 7am to 9pm..This was requirement from 17/05/04 and 21/10/04 copies of the following must be maintained for all staff -birth certificate,passport,two written references,a recent photo, certificates of experience and training.This was a requirement from 17/05/04 ,21/10/04 The home must improve it current process for the recording/reporting of incidents and accidents. The home must have the appropriate equipment so 1) staff are able to monitor service users weight 2) provide appropriate grab rails so that service users with disabilities can use the toilets safely Appropriate numbers of staff are trained and competent in medication administration Appropriate activities/community events and outings are provided to meet the individual needs/preferences of service users. newly employed staff must have a period of supervised and supernummery practice when first rostered on duty so as to undertake an appropriate period of induction/introduction to their work and environment. 30.05.05 30/05/05 30.05.05 30.05.05 30.05.05 30.05.05 30.05.05 Alexandra Lodge Version 1.10 Page 19 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 38 32 Good Practice Recommendations The home holds a copy of the Health and safety in care homes book and becomes familiar with its content. The home obtains some reference material to assist staff with their care planning assessments. Alexandra Lodge Version 1.10 Page 20 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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