Inspection on 26/04/06 for Alexandra Lodge

This inspection was carried out on 26th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Lodge 01/05/07

Alexandra Lodge 12/04/05

Alexandra Lodge 14/01/05

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Alexandra Lodge Wyllie Road Hilsea Portsmouth Hampshire PO2 9NA Lead Inspector Janet Ktomi Unannounced Inspection 27th April 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Alexandra Lodge Address Wyllie Road Hilsea Portsmouth Hampshire PO2 9NA 023 9266 0551 023 9265 1046 deidre.mills@portsomuthcc.gov.uk www.portsmouthcc.gov.uk Portsmouth City Council 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 Deirdre Mills Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd October 2005 Brief Description of the Service: Alexandra Lodge is a purpose built residential home providing care and accommodation for up to fifty older people. The home is situated in Hilsea, a residential area of Portsmouth. The home is owned and run by Portsmouth City Council Social Services Department and managed by Mrs Deirdre Mills. The home is arranged into four living units each with its own lounge/diner, a kitchen area, bedrooms, bathrooms and toilets. All bedrooms are for single occupancy and equipped with a wash hand basin. There is a shaft lift to the upper floor. Externally the home has pleasant gardens which are accessible to service users and adequate car parking to the front of the home. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspectors would like to thank the people who live at the home, the manager and all staff for their full assistance and co-operation with the unannounced inspection. The inspection was undertaken by two inspectors and lasted approximately eight hours, commencing at 8.45 in the morning and being completed at 5.00 p.m. One inspector spent the majority of their time with the people who live at the home and the various staff employed at the home. The other inspector concentrated on the home’s management, training and administration, viewing records and documentation including care records. A full tour of the building was undertaken. All core standards and a number of additional standards were assessed and compliance with requirements made at the previous inspection in October 2005 was assessed. The inspectors were able to spend time with many of the staff employed in the home and were given free access to all areas, records and documentation required. The inspectors had limited notice that they were to undertake the inspection, however a pre-inspection questionnaire was sent to the home and returned prior to the requested date. Service user and relative questionnaires were sent to the home with the pre-inspection questionnaire. These were distributed to service users and left for relatives to complete. Ten service user questionnaires and seven relative questionnaires were returned. Questionnaires were sent to district nurses and GPs identified as providing a service to people living at the home. Two GPs and one district nurse had responded at the time of writing this report. What the service does well: All service user and relative questionnaires returned contained positive comments about the service provided at Alexandra Lodge. Statements included ‘my father is happy, as a family we are reassured’, ‘I am very grateful that my friend is a resident at Alexandra Lodge’. Service users stated ‘I am quite happy here and the staff are very caring’ and ‘everything is pleasing’. Although the home provides a service for up to fifty people the provision of four areas each with its own lounge and dining room provides a homely, noninstitutional atmosphere. Service users are encouraged to remain active and participate in activities around the home. External outings are organised using transport available from the social services day centre located beside the home. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 6 The staff and management team were motivated and committed to ensuring service users received a quality service. The home was warm and clean, the atmosphere happy and friendly. All staff were helpful and demonstrated compassion and a commitment to the core values of dignity and rights of service users. Staffing levels appear appropriate for the service users’ needs and the manager has flexibility to increase staffing should a service user require additional support such as during ill-health or at the end of life. Service users were positive about the food provided, and this was seen to be of a good standard with choice and alternatives available at all meals. All service users spoken to were happy and satisfied with the service provided and felt their expectations have been met. What has improved since the last inspection? Following the previous unannounced inspection in October 2005 a number of requirements were made. An action plan was received from the provider’s Responsible Individual. Compliance with these requirements and completion of actions identified was assessed during this inspection. In April 2006 the home commenced the planned programme of replacing many of the windows with modern double glazed units. This was temporarily halted due to technical problems. The manager stated that the windows should recommence being replaced the week following the inspection. The manager must inform the Commission in writing that this has occurred and all identified windows have been replaced. The manager and proprietors, Portsmouth City Council, have reviewed staffing levels within the home. During the unannounced inspection, the inspectors felt that there were appropriate numbers of staff on duty within the home. The manager stated that new staff now have one week supernumerary work before being counted in the staffing numbers. Records did indicate that the home has made significant efforts to improve the care planning process although staff have yet to have training in the use of the new forms provided by Portsmouth City Council. Portsmouth City Council now provides service users who require the council to manage their personal finances with access to an individual account on which they are to receive interest. The inspector is awaiting clarification as to why personal money is initially paid into a holding account and then withdrawn by Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 7 the home’s administrator and paid into the service user’s own account. The issue of back interest has also not been clarified. What they could do better: Although service users and their relatives were happy with the service provided at Alexander lodge there were requirements made following this unannounced inspection. A service users’ guide must be available and provided to all people living in the home and prospective service users at the time of assessment or visit to the home. The new care planning process would appear to be appropriate however it does not have an individual manual handling assessment. Staff require training in the use of the new forms, the manager stated that this has been arranged. Medication is generally appropriately handled in the home, however it must always be stored in a locked facility. Staff administering medication must observe service users to ensure they have taken the medication administered before signing the record confirming that medication has been administered. Should service users not take the medication this must not be left with service users and should be recorded as refused or not required on the Medication Administration Sheet. Refused or not required medication must then be placed in secure storage and returned to the pharmacist for destruction. Staff must not commence working at the home until all the required preemployment checks have been undertaken. This includes written evidence of a POVA First check being available in the home. The home was found to be clean and free from offensive odours, however greater attention needs to be given to high cleaning and the elimination of cobwebs in high, hard to reach areas. The call bell system requires reviewing. The system relies on staff having access to bleepers that are carried on their person. There is a lack of sufficient bleepers for all staff. Paper hand towels and dispensers must be available in all bathrooms and WCs. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 8 The manager must notify the Commission in writing when the windows have been replaced. The action plan received following the previous inspection indicated that work was scheduled 2006/7 for internal refurbishment of the first floor corridors. This should be completed as soon as possible as some internal areas of the home are now clearly in need of attention. Some bathrooms are also noted to require redecoration. The responsible person must clarify the ‘holding account’ into which service users’ personal finances are initially paid and why service users’ money is not paid directly into their named accounts by the pensions and benefits agency. The issue of interest on money previously held in pooled accounts must be clarified to the Commission. A representative of the provider, Portsmouth City Council, must undertake a monthly visit to the home and complete a written report of their findings (Regulation 26 Visits). The manager stated that these visits are occurring however she does not always receive a written report following these visits. A written report must be submitted to the Responsible Individual, home’s manager and a copy sent to the Commission. The home uses the Portsmouth City Council complaints procedure. This results in complaints being investigated by a council representative not working at the home. Whilst this provides a degree of impartiality, it is essential that the manager is involved in complaints investigations and is provided with written information about the outcome of the investigation. The present system has resulted in the manager being aware that a complaint was received and investigated but not being aware of the outcome of the investigation until she requested this information several months after the investigation. Practises within the home cannot be altered to prevent further complaints of a similar nature unless the manager is aware of the issues and outcomes to inform staff practises. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. There is no written information available to service users or their representatives about the services provided at the home. All service users receive a contract. All service users are assessed prior to moving into the home, however a manual handling assessment is not undertaken. Service users, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard six is not applicable as intermediate care is not provided at Alexander Lodge. EVIDENCE: The home does not have a service users’ guide that may be provided to service users or their representatives to inform them of the services provided at the home and other important information relevant to their stay. The manager showed the inspectors a service users’ guide that had been produced by the home’s management team. This contained all the required information in an Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 11 appropriate (large type) format suitable for the majority of people living at the home. The inspector was shown fifty copies of the guide that had been placed in durable folders with the intention that one should be placed in each bedroom in the home. The manager stated that a copy could be provided to prospective service users during assessment and could be translated into other languages or formats if required. The manager stated that the service users’ guides had not been provided to prospective service users or people living at the home as she had been directed by the provider’s representative that Portsmouth City Council were producing a corporate service users’ guide for all their registered homes and service specific information would be added to the package by each home. Service users spoken with during the inspection, and information received in the comment cards received from service users and relatives prior to the inspection, indicated that they had not received adequate information about the home prior to admission. The proprietors must ensure that prospective service users are provided with written information about the home, with copies available for people living in the home. Portsmouth City Council provides service users with a contract or terms and conditions of their stay at the home. The majority of the service users who completed a comment card confirmed that they had received a contract, with three not answering this question on the form. During the inspection written terms and conditions information, signed by the service user or their representatives, were seen within individual service users’ files. Following the previous inspection a requirement was made that terms and conditions of stay must be provided to service users. This requirement would appear to have been met. The terms and conditions document stated that fees would be assessed by social services and contained information about charges for additional services that may be made. The home has recently introduced a new care planning process. This will be further discussed in the next section of the report. The manager stated that she completes the assessment part of the care plan, in conjunction with a care manager’s assessment, to determine if potential service users’ needs can be met at the home. Overall the assessment document is satisfactory, when used in conjunction with care manager’s information, however the care planning process does not contain an individual manual handling assessment and one is not carried out prior to admission. The home has not admitted many people since the previous inspection. The assessment information for a service user admitted the week prior to the inspection indicated that appropriate information had been gained to determine if the home was able to meet his needs. The service user is very independent and was out of the home during the inspection, therefore inspectors could not discuss his admission with him. The manager confirmed that she has access to information held on social Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 12 services central information systems (SWIFT) and will check information on referred people. During the inspection discussions were held with the manager about the home’s admission procedure and the levels of needs the home can accommodate. The manager stated that she would delay an admission if specific equipment was required to meet needs. The manager stated that where possible prospective service users are invited to visit the home prior to admission, with a number attending the adjacent day services or receiving respite care prior to admission to the home. If it is impossible for the person to visit the home prior to admission the manager stated that she invites their relatives or representatives to visit the home and view the proposed bedroom. During the unannounced inspection a manager from another home specialising in dementia was visiting the home to assess a service user whose needs the manager felt the home could no longer meet due to a progression of her disease. General observation of the home and people living there indicated that the home only admits people whose needs it can meet. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Once fully in use the new care planning process should identify individual service users’ needs and how these will be met, however a manual handling assessment and guidelines must be available for each service user. Staff must have training in the completion and use of the new care planning format. Services users’ health needs would appear to be met with the home clear about action it should take if it is no longer able to meet a person’s needs. Medication must be stored in a locked facility at all times. Staff must observe service users taking their dispensed medication and not leave it with service users. Service users feel they are treated with respect and their right to privacy is upheld. EVIDENCE: Portsmouth City Council has recently introduced a new care planning process for all its registered homes. Copies of the new forms were seen to have been completed for some service users, including the man admitted the week prior to the inspection. The forms contained specific assessment documents to cover Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 14 pressure areas and nutrition, however they did not have a specific assessment for manual handling of the individual. Whilst it is accepted that many of the people living at Alexander Lodge are independently mobile, others do have manual handling needs and a full individual assessment must be completed for all service users. The manager stated that where there are specific manual handling concerns they are able to access an external manual handling assessor. The care plans seen were of variable quality. The manager explained that the forms have been introduced but that key-workers and care staff have not yet received training in their completion or use. The manager stated that training was being organised and should commence soon after the inspection as the trainer had now returned from sick leave. All service users were seen to have a care plan, once staff have received training these should be more consistently completed. A requirement is not made in respect of staff training for the use of care plans as this is planned, however the manager is requested to confirm in writing that all key-workers and members of the home’s management team have undergone training. The manager must ensure that all service users have an individual manual handling assessment that states how manual handling needs can be met. The pre-inspection questionnaire detailed the names of GPs individual service users are registered with. This indicated that all service users are registered with a GP in the local area. The manager stated that service users are able to remain with their existing GP if he/she covers the Alexandra Lodge area. If the person’s GP prior to admission does not cover the home the manager arranges for them to register with a GP close to the home. Questionnaires were sent to some of the GPs and district nurses. The responses were not received prior to the inspection therefore their content could not be included during the inspection. The responses indicated that service users may not be offered as frequent a bath as might be considered appropriate. Otherwise the health professionals stated that they believed that service users’ health care needs were appropriately met. During the inspection service users did not raise any concerns about the frequency of baths and all appeared clean and appropriately cared for. The manager stated that the home is unable to access NHS dentists in the area however they have now developed links via the Health Commission with a visiting dental service who is able to treat people at the home. There is also a visiting optician, however many of the service users are able to go out to their choice of optician, if necessary with staff support. Some care staff have undertaken specific training to cut toe nails, other service users are able to access one of two visiting chiropodists for whom they pay separately. The home maintains a record of visits to/from health professionals within a separate file from the individual care plans. This is stored on a shelf in the office and not maintained in a locked filing cabinet. Information relating to individual service users should all be held within one working file such as the care plan. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 15 Comment cards received from service users prior to the inspection indicated that service users felt they usually or always received the care and support they needed. With the exception of one response, all service users’ comment cards stated that their medical needs were met. Comment cards received from relatives confirmed that they were all satisfied with the overall care provided. Service users spoken with and met during the inspection all appeared happy and appropriately cared for. No service users spoken with raised concerns about the frequency they were offered baths. One stated that staff change his bed and provide a bath regularly. During the inspection staff were observed using good manual handling techniques. Service users’ rights to privacy and dignity appeared to be fully supported. All bedrooms at Alexandra Lodge are for single occupancy and equipped with a wash basin. Service users stated that staff are all nice and caring, this was reflected in the comment cards received prior to the inspection. The manager stated that core values such as individuality and privacy are covered in Portsmouth City Council’s induction programme and reinforced during the probationary period of working in the home. The home had a copy of the Portsmouth City Council most recently revised medications policy (6th draft). Following the previous inspection a requirement was made that an appropriate number of staff are trained and competent in medication. Staff interviewed during the inspection, training records viewed and statements in the pre-inspection questionnaire completed by the manager confirmed that five senior care staff have undertaken an external certificate in safe handling of medicines as a distance learning course. An additional five staff are due to have medication administration training via an external provider soon after the inspection. This requirement is therefore being complied with. The inspectors observed some of the lunch time medication administration round and discussed the home’s procedures with staff who administer medication. At the start of the inspection inspectors were shown into the unattended, unlocked main office. On the desk was a bottle of Halaperidol. This was not stored securely and could have been taken by a service user or visitor. Whilst administrating the lunch time medications staff were observed leaving medication on tables and not observing service users taking their medication. When asked about this practise staff stated that they only do this if they consider it safe to do so. Whilst touring the home medication was noted to have been left in one bedroom. The service user stated that this had been from the night before (this was noted at about 4.00 p.m.). The medication was one Senokot in a pot and a Paracetamol tablet on her table. The service user stated that they always gave her two of each tablet but that she only took one. It was unclear where other untaken tablets had gone to. The MAR sheets would inaccurately state that the service user had received two of each tablet. One service user self administers their medication and an appropriate risk assessment had been completed. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 16 The home uses an MDS system, with multiple tablets in each blister compartment, by the pharmacist. If a service user failed to take all their medications staff may be unable to identify which tablets had not been taken, or dropped on the floor etc. Medications are usually booked into the home on the MAR Sheets, however it was noted that some medications did not appear to have been signed into the home to confirm receipt. The home has a fridge for storing medication that must be kept cool. This has a maximum/minimum thermometer and temperatures were seen to be recorded at approximately the same time each day. It was noted that insulin, which should be kept cool, had not been refrigerated but left out in a locked treatment room. The district nurses draw up a number of insulin syringes for use throughout the week and leave these for staff to take to service users who then self administer. This practise is against that identified in the most recent medications procedure for the Portsmouth City Council. This practice may be considered unsafe, as there are opportunities for syringes to be altered, either intentionally or accidentally, between being drawn up and administered. It is not clear who retains responsibility for the administration. The home must ensure that all medications are stored in appropriate locked conditions, that all medications must be recorded on entering or leaving the home, and that staff must observe service users take medication dispensed to them. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Service users find the lifestyle experienced in the home matches their expectations and preferences. Service users are able to maintain contact with family and friends as well as the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing diet. EVIDENCE: Discussions with service users during the inspection and comment cards received from service users prior to the inspection indicated that service users were able to spend their time as they wished, either joining planned group activities or spending time on their own or in individual activities. Service users are encouraged to participate around the home, with several being very involved in the home’s gardens. Another comment card confirmed that activities are organised although the respondent stated they did not wish to participate and this wish was respected. One inspector was able to talk with the home’s activities co-ordinator who is employed for twenty hours per week on a permanent contract. The activities Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 18 co-ordinator confirmed that activities are planned no more than a day in advance. There is no specific budget for activities however specific items can be requested from the manager. There are planned group activities with the activities co-ordinator stating that at the time of the inspection quizzes were popular with the current service users. The activities organiser stated that most of her focus is on an individual level with one of the assistant managers organising most of the group activities. The activities organiser stated that she has attended training with one of the carers with whom she can discuss ideas for activities. The activities organiser maintains her own file for documenting activities and who has attended. She stated that it is often the same people who attend planned group activities although she tries to encourage other people to join in. Individual rights to choose are respected. The home’s manager described how external outings are organised using the mini-bus linked to the adjacent day services, the mini-bus being available at evenings and weekends and some weekday day times. The home has two voluntary drivers, one of whom has recently retired and therefore has more time available. Outings are therefore being planned for the warmer weather, although some are undertaken in the winter such as to see the Christmas lights and Christmas shopping. The home has links with the local primary school with service users having been invited to the school’s nativity play. The returned pre-inspection questionnaires indicated that service users were very happy with the food provided at the home. The pre-inspection questionnaire contained a month’s menus which indicated that a varied nutritious menu with choices available is provided. Between meals service users are provided with hot and cold drinks. Following discussions with the service users, the home is planning to replace the biscuits provided with the afternoon hot drink with a selection of cakes. One of the inspectors observed the lunch time meal being provided to service users, this is served in the four dining rooms or the person’s bedroom if this is their choice. Staff individually ask service users what they wanted and seconds were provided. Service users spoken to during the inspection were complimentary of the food provided at the home. The home has recently purchased sit-on scales that enables all service users to be weighed if there is concern about their weight. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Written information has not been provided individually to service users as to how to make a complaint, however service users did appear aware of how to complain. The use of the Portsmouth City Council’s complaints procedure appears to remove the manager from complaints investigation and she is not provided with the results of investigations in a timely manner to enable practises with in the home to change. The home generally protects service users from abuse, however the recruitment procedure needs to ensure that new Criminal Record checks and POVA First checks are undertaken on all staff before they commence employment at the home. The arrangements to protect service users’ personal money from abuse have improved however money is still paid into a holding account and interest on money previously held in the council’s account has not been paid to service users. EVIDENCE: Responses in the comment cards returned by service users and relatives indicated that they were aware of how to make a complaint. Discussions with service users during the inspection indicated that they felt confident to make a complaint or suggestion about the service provided at the home and would do so to a member of staff or the manager. Service users are not yet provided with written information about the home’s complaints procedure, this would Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 20 ordinarily be part of a service users’ guide. The home does have copies of Portsmouth City Council’s complaints procedure that the manager states she provides to people who wish to make a complaint. The pre-inspection questionnaire stated that the home had received three complaints in the past year. The manager does not always receive complaints that, as per the council’s policy, go directly to the council’s complaints department. Whilst this will mean that complaints are investigated independently from the home, there is a need to ensure that the manager is aware of the nature of the complaint, its investigation and outcome. The inspector was shown a copy of a response letter sent approximately four months prior to the inspection to a complainant. The manager only received this after she had discussed this with the provider’s Responsible Individual the week before the unannounced inspection, she had not been provided with any information following the complaint investigation. The manager stated that she had not been involved in the investigation or the response sent to the complainant. The manager was unaware of the outcome of another complaint investigation that was handled as a complaint but may have been more appropriately dealt with as an adult protection issue. The inspector is concerned that the current procedures may mean the manager is unaware of the nature of a complaint, not involved in its investigation or response and therefore unable to alter practises should complaints be substantiated. The provider must ensure that the manager is fully involved in complaints investigations about the service and able to take action necessary to rectify any issues. The home has an adult protection policy and procedure which links to the Portsmouth City Council policy and procedure. The manager stated that the adult protection issues are included in the corporate induction undertaken by all staff and in staff updates. Previous inspections have raised concerns and requirements in respect of the homes procedures in place to manage service users personal money should they require assistance and not have a relative or representative able to support them. Portsmouth City Council has revised its procedures on service users’ personal finances and now provides an individual named account for all service users. Service users will now receive interest on any money held in this account. The home’s administrator confirmed that at the time of the unannounced inspection the home was supporting two people with their personal money. The newly set up bank account statements were seen detailing money transferred from the previous pooled account. The administrator explained the new procedure to the inspector. Service users’ pensions and benefits are paid in to a holding account. The administrator then requests the personal allowance for the service user at the end of each month. This money is paid as a cheque from the holding account and this cheque is paid into the service user’s named account. The administrator adds up the money spent by the service user e.g. hairdressing/chiropody then she will withdraw the money via a cheque from the service user’s account. The administrator was unaware of what had happened to the interest that the Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 21 service users should have accumulated from savings held in the previous pooled account or why the money is paid into a holding account instead of going straight into the service user’s named account. The inspectors understand that the provider’s Responsible Individual is looking into these issues. The Responsible Individual is required to clarify these issues with the Commission’s link inspector. The home’s recruitment procedures and records were examined and found to be inadequate to ensure protection for service users. The records for staff recruited since the previous inspection were viewed. Whilst the records contained completed application forms and two written references there was no evidence that POVA First checks had been received prior to staff commencing employment at the home. One file contained a completed CRB from a previous employer and no evidence of another check being undertaken by the council A check was undertaken by the administrator of the number on the CRB from the previous employer and this corresponded with the CRB number held on the staff record. The administrator or manager could not confirm that a new CRB had been undertaken by the council. The evidence seen would suggest that this had not occurred. A POVA First check cannot be undertaken without a CRB being undertaken. A second file contained an attachment to the application form from the recruitment department confirming that an enhanced CRB had been received. This indicated that the CRB results were received several days after the person started working at the home. No evidence that a POVA First was available in the file. Whilst the Care Standards Act 2000 (Establishments and Agencies)(Miscellaneous Amendments) Regulations 2004 do allow staff to commence working pending a full CRB being received (assuming all other checks have been completed and are satisfactory) a POVA First check must have been received. The home must ensure that all new staff have an enhanced CRB undertaken by the council, and do not commence work at the home until the POVA First has been received. Written evidence confirming that a CRB has been applied for and POVA First undertaken must be available in the home. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The home’s environment is generally safe and suitable for the people who live at the home. Areas of the home are in need of refurbishment and the replacement of a number of windows has not yet been completed. The manager must notify the Commission in writing when this work is completed. The home was found to be generally clean and free from odour although additional attention is required with high dusting. All WCs must have supplies of paper hand towels and dispensers. The home’s call bell system requires reviewing as there are insufficient personal bleepers for all staff. EVIDENCE: Both inspectors made a tour of the premises at the start of the inspection as neither had visited the home prior to the unannounced inspection. One inspector then undertook a more thorough assessment of the premises whilst meeting service users and staff. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 23 Following the previous inspection a requirement was made in respect of the internal redecoration of the upstairs corridor and the replacement of a number of windows and repainting/repair of other windows. An action plan was received from the providers indicating that the windows would be replaced by April 2006 and that the internal decoration was scheduled for the year April 2006/2007. The upstairs corridor, and other internal areas, continue to require redecoration as doors, skirting boards and walls have been damaged through general use. Carpets in the corridors have been replaced and it is a shame that the corridors were not attended to prior to this as the damaged areas detract from the new carpets and continue to create an uncared for impression. The manager stated that a window company has been contracted to replace thirty windows. They had commenced work but after a few windows had been replaced a decision was made that an additional specialist company was required to ensure safety during the replacement of windows. The manager must inform the Commission in writing when the windows have been replaced and the internal decoration has been completed. The home is generally suitable to the needs of the people living at the home and the home’s conditions (categories) of registration. Many of the people living at the home are independently mobile. The home has a shaft lift to provide access to the first floor. Shared space is provided in four lounge/dining rooms located on both floors of the home. In addition a large lounge is also available near the entrance to the home that can be used for activities groups or meetings. Lounge/diners were noted to be pleasantly furnished and service users were seen using these throughout the inspection. Kitchenette areas are provided within each dining area where hot or cold drinks may be made by service users or staff for people unable to make their own drinks. Although the home can provide accommodation for up to fifty people the number of smaller lounges creates a homely atmosphere. The home has pleasant gardens which service users are encouraged to use in the warmer weather. The manager stated that she has recently purchased three pendant buzzers for the home’s call bell system that can be used by service users who are enjoying the gardens. The call bell system in use within the home relies on staff having a bleeper held on their person. The manager stated that there are insufficient personal bleepers for staff and that some have gone missing. The call bell system must be reviewed and a system in place to ensure staff return bleepers at the end of their shift to ensure sufficient are available for the next team of care staff. Bathrooms and WCs are provided at convenient places around the home. The inspectors noted that a number of these did not contain paper towels but had hand towels. These may present an infection control risk and should not be used. Some WCs contained paper towels but no dispenser. All bathrooms and WCs must be fitted with paper towel dispensers and kept supplied with paper towels. Hand towels must not be used. A number of bathrooms were noted to Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 24 be in need of redecoration, stained ceilings and walls and holes in wallpaper. One Parker bath appeared to have retained residual water. The provider must provide a timetable for the maintenance/redecoration of these areas. The home provides the specialist equipment service users require, a range of pressure relieving mattresses and cushions were seen in use at the home. Discussions with the manager identified that she would not admit a new service user if assessment indicated that equipment not available at the home was required and she was aware of how to access equipment for people living at the home. The home has one profiling bed and the manager stated that it is soon to purchase a second. These beds support both service users and staff caring for people who have reduced mobility. Many of the home’s bedrooms were viewed during the inspection. These were seen to be individually personalised by their occupant, a number had been redecorated and had been provided with new carpets. Service users stated that they were happy with their private space. Comment cards received from service users indicated that the home is always clean and fresh. This was confirmed during the inspection although greater attention needs to be paid to high dusting with dust noted on fire bells and cobwebs in skylights. Care staff have been provided with ‘bum bags’ in which they can carry supplies of disposable gloves and antibacterial hand gel. The home’s laundry facilities are appropriate with machines capable of sluicing and washing to high temperatures when required. Laundry staff are employed and stated they have received infection control training. Soiled laundry is transported around the home in suitable lidded laundry trolleys. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home provides appropriate numbers of staff to meet service users’ needs. New staff do not always have all the required pre-employment checks. Staff receive an appropriate induction and ongoing training to meet the needs of service users. EVIDENCE: Comment cards received from service users and their relatives/representatives stated that care staff were ‘all kind and helpful’, ‘staff very caring’, ‘the staff show great patience, her key-worker is to be commended’. Service users spoken with during the inspection were equally positive about the care staff ‘staff are friendly’, ‘my key-worker (named) does a bit extra’, ‘staff great, like friends’, ‘staff good and always prompt’. Interactions observed throughout the inspection between staff and service users were warm, positive and supportive. Care staff stated they work together as a team and help each other out. The home supplied copies of duty rotas with their pre-inspection information. These confirmed the manager’s statement, and observations during the inspection, that six care staff are provided throughout the day, three upstairs and three downstairs. One is allocated to each unit with one between two units. The home employs cleaners, catering and laundry staff. In addition to care staff a senior member of staff or deputy manager is provided on all shifts. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 26 The manager stated she has flexibility over staffing budgets and is able to increase shift numbers if, for instance a service user is in need of extra support. This was observed during the unannounced inspection when an additional agency staff member had been provided to support a lady through her last days of life. Comment cards received from service users prior to the inspection indicated that they felt there were generally sufficient staff on duty. The same was generally the opinion of relatives/representatives who had completed comment cards prior to the inspection. At night three care staff and a senior sleep-in are provided. Considering the level of care needs of the service users seen during the inspection these staffing levels would appear appropriate. Pre-inspection information indicated that the home uses a high number of agency staff. This was confirmed during the inspection by service users, staff and during observation. The manager informed the inspectors that following a recent successful recruitment process (with 150 applicants) the home will shortly only have one part time care post vacant. The manager stated that she has aimed to use consistent agency staff and now has access to the council’s own staff pool. Information supplied prior to the inspection indicated that the home employs twenty-nine care staff of whom sixteen have at least level 2 NVQ. This equates to approximately 57 , in excess of the 50 required in the standards. One member of care staff interviewed stated she had NVQ level 2 and was now undertaking level 3. Following the previous inspection the home was required to ensure that copies of the following are maintained for all staff: birth certificate, passport, two written references, recent photo and certificates of training and experience. The manager and administrator confirmed that this had been undertaken although for staff who had been employed at the home for many years (ten plus years) they did not hold two written references from previous employers. The inspector accepts that after such a time delay it would be inappropriate (if not impossible) to obtain references from previous employers. The files for staff employed since the previous inspection were viewed. Two files were seen. These all contained a completed application form, work history, interview notes, health declaration, two written references, photo, contract and copies of certificates from previous employment and that undertaken whilst working at the home. The first file viewed contained a CRB from a previous employer. There was no evidence of a new CRB having been undertaken by the home. The number on the CRB from the previous employer was checked by the home’s administrator and corresponded to that listed on the council’s list and supplied to the inspector prior to the inspection as confirmation that all staff had undertaken a CRB check. As a new CRB was not undertaken a POVA First could also not have been done. CRBs are no longer transportable from one service to another as a person may have committed an offence or been placed on the POVA list since it was undertaken. The second file contained a slip of Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 27 paper attached to the application form confirming that an enhanced CRB had been undertaken, reference number and date the response was received. The inspector noted that the staff member commenced working at the home several days before the CRB was returned to the Council’s recruitment department. Again no evidence of a POVA First check was found. A POVA first check is undertaken by the CRB on receipt of a completed CRB application form and may be confirmed by e-mail by an authorised person approximately seventy-two hours following receipt of the CRB form. The POVA First check confirms that the person is not on the list held by the home office of people who are unsuitable to work with vulnerable adults. The Care Standards Act 2000 (Establishments and Agencies (Miscellaneous Amendments) Regulations 2004 allows staff to commence working within domiciliary or care homes prior to the return of an enhanced CRB check providing a full recruitment process has been undertaken and a POVA First check has been received by the employer. The appropriate recruitment checks would not appear to have been undertaken to ensure that unsuitable people do not work at the home. The home, and the council’s recruitment department, must ensure that staff only commence working at the home once all the required checks have been undertaken. Care staff stated that training was provided, including food hygiene, infection control, medication course, and NVQs at level 2 and 3. Copies of certificates were seen within staff files. Care staff stated that they felt they had sufficient skills to meet the needs of service users. The manager stated that she can identify training needs of staff and access training to meet these needs, examples being stoma care and assertiveness for managers which some of the deputy managers will be undertaking. Comment cards received from external professionals stated that they were satisfied with the overall care provided at the home. The manager described the induction process for new staff which includes a five day corporate induction off-site which covers all the mandatory induction training required. Certificates were seen in the new staff files viewed. The manager stated that new staff are now supernumerary for their first week of work within the home and are linked to an experienced carer. This will be identified on duty rotas for new staff. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The manager is appropriately experienced to manage the home, but is hampered in successfully doing so by council departments and procedures. Written Regulation 26 reports must be provided to the Responsible Individual, home manager and the Commission. The home undertakes internal quality assurance activities. The arrangements to protect service users’ personal money from abuse have improved, however money is still paid into a holding account and interest on money previously held in the council’s account has not been paid to service users. Staff are supervised approximately every two months. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 29 EVIDENCE: The home’s manager was registered with the Commission in March 2005 and prior to becoming the manager was employed in a senior position at the home. The manager is a qualified social worker, registered with the social care council and has a diploma in management. The manager stated she undertakes mandatory update training and additional training relevant to ensuring the needs of service users are met. The registered manager explained the lines of accountability within the home and with the provider, Portsmouth City Council. The registered manager is supervised by her line manager, the Responsible Individual for the provider. A number of the management elements are the responsibility of various council departments, recruitment, personnel, complaints, finance etc. The home’s manager has limited control over these departments and their procedures, however she has a legal responsibility due to her registration with the Commission to ensure that regulations and standards are met. It is the inspectors’ view the manager’s ability to manage is hampered by some of the policies and procedures of these departments and the council structures, this being evident in the requirements made in respect of the service users’ guide, care planning and lack of manual handling assessments, complaints, service users’ personal finances and recruitment. Towards the end of the inspection a senior person from the council social service department was undertaking a Regulation 26 visit to the home. The manager and her deputy confirmed that Regulation 26 visits occur every month. The file containing the reports for these was viewed. Written reports for the year preceding the inspection were only present for May 05, August 05, November 05 and January 2006. The inspection was undertaken in April 2006. Therefore only four out of twelve reports were available. Written reports are necessary to ensure that the manager and staff are aware of any action required resulting from the Regulation 26 visit. The report also identifies that the visit by the representative of the provider has been carried out in accordance with Regulation 26, in that service users, representatives and staff have been consulted with, that an inspection of the premises, its records of events and records of any complaints has been fully undertaken. The Responsible Individual must ensure that a written report is produced within a short timescale of every Regulation 26 visit with a copy received by himself, the manager and the Commission. Regulation 26 visits provide an opportunity for quality monitoring of the service. The home undertakes its own quality assurance monitoring in the form of questionnaires to relatives and service users. The results from a recent series of questionnaires were not yet available at the time of the inspection. The manager is to forward a copy of the analysed responses to the Commission in due course. The results of the surveys were discussed with the inspectors and Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 30 these corresponded to the results gained by the Commission comment cards from service users and their relatives, in that people are generally happy with the service provided at Alexander Lodge. Service user and relatives’ meetings are also undertaken with one scheduled for the morning of the unannounced inspection. The manger discussed how she intends to undertake quality assurance, with a questionnaire for service users and relatives after they have been in the home for about six weeks and then annually. The service users/relatives’ meetings will continue and the manager is to consider how external professionals’ views about the service may be gathered. Service users stated on comment cards and to the inspectors that they were able to raise any concerns or suggestions with their key worker or other staff. The inspectors were satisfied that the manager is undertaking appropriate quality assurance activities however a score of 2 has been given to reflect the lack of written reports for Regulation 26 visits. The issue in respect of service users’ personal finances has been documented in the adult protection section of this report. A requirement in connection with personal money has been made. Care staff stated that they receive supervision about every six to eight weeks. The manager explained that she supervises the senior staff with the senior staff then supervising a number of care staff. Ancillary staff are also supervised by a member of the senior team. The manager stated that written records are maintained following supervision that follows a set format and includes staff development. The list of which senior staff supervise which care staff was seen on the office wall. Overall the quality of record keeping at the home was good. As identified in various sections of this report there are some concerns in respect of record keeping. The home does not receive written reports following every Regulation 26 visit. Individual manual handling assessments are not carried out for service users as part of the care planning process. The home does not have a service users’ guide. The complaints procedure may result in the manager being unaware that a complaint has been received by the council and is unaware of the outcome of complaints in a timely manner. Staff must observe service users taking medication before signing to confirm administration. All the required pre-employment checks must be undertaken before people commence working at the home. Information relating to individual service users should all be held within one working file such as the care plan and stored within a locked facility. The home provides a safe place for service users with the exception of some practises identified more fully else where in the report. These being medication left unlocked in service users’ bedrooms and an office. Also the practises of District Nurses drawing up large numbers of insulin syringes that are then stored in the fridge (or as seen during the inspection, left in a locked room not Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 31 in the fridge). The absence of individual manual handling assessments places both service users and staff at risk. The manager is not kept informed of complaints and their investigation, and can therefore not alter practises if necessary. Paper towels and dispensers must be provided in all bathrooms and WCs. The lack of all the required pre-employment checks may place service users at risk and the lack of written reports following Regulation 26 visits may result in the manager being unaware of action the she must take following visits. Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 32 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 1 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 17 X 18 2 2 3 2 3 3 3 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 3 2 2 Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 33 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. 1. Standard OP1OP37 Regulation 5 (1) 5 (2) 5 (3) Requirement Timescale for action 01/07/06 2. OP7OP37O P38 13 (5) 3. OP9 OP37OP38 13 (2) The provider must produce a written guide to the home containing the information specified under Regulation 5. A copy must be provided to the Commission and each service user. The home must ensure that all 01/06/06 service users have an individual manual handling assessment and individual guidelines must be in place for each service user. All medication must be stored in 01/05/06 appropriate secure conditions. Staff must observe service users taking medication. The practises in respect of insulin must reflect the Portsmouth City Council’s policy and procedure. All medication must be recorded on entering the home. The manager must be fully aware of the nature of complaints, involved as appropriate in the investigation and be fully aware of the outcome of complaints at the DS0000044121.V288338.R01.S.doc 4. OP16OP37 OP38 22 (3) 22 (5) 01/05/06 Alexandra Lodge Version 5.1 Page 34 5. OP18OP35 OP37 16 (2)(l) 6. OP18OP29 OP37 OP38 19 (amended regs) 7. OP19 23(2)(b) 8. OP19OP38 23(2)(c) 9. 10 11 12 OP21OP38 OP21 OP26 OP33 OP37OP38 13(3) 23 (2)(d) 23(2)(d) 26 (4)(c) 13 OP37 17(1)(b) same time as the respondent (28 days). The responsible person must clarify the ‘holding account’ into which service users’ personal finances are initially paid and why service users’ money is not paid directly into their named accounts by the pensions and benefits agency. The issue of interest on money previously held in pooled accounts must be clarified to the Commission. Staff must not commence working at the home until all the required pre-employment checks have been undertaken. This includes written evidence of a POVA First check being available in the home. The manager must confirm in writing to the Commission when the planned redecoration and replacement of windows has been completed. The manager must review the call bell system and ensure a system is in place that staff return personal bleepers at the end of their shift. Paper towels and dispensers must be provided in all bathrooms and WCs. The provider must state when redecoration of bathrooms will be undertaken. A plan for high dusting must be implemented. A written report must be provided to the Responsible Individual, manager and the Commission following every monthly Regulation 26 visit undertaken. Information relating to individual service users should all be held within one working file such as the care plan and stored within a DS0000044121.V288338.R01.S.doc 01/05/06 01/05/06 01/08/06 01/06/06 01/06/06 01/06/06 01/05/06 01/05/06 01/05/06 Alexandra Lodge Version 5.1 Page 35 locked facility. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Alexandra Lodge DS0000044121.V288338.R01.S.doc Version 5.1 Page 36 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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. 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