CARE HOMES FOR OLDER PEOPLE
Alexandra Lodge 2 Lucknow Drive Mapperley Park Nottingham NG3 5EU Lead Inspector
Joanna Carrington Unannounced 16/06/05 10.00am 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 Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Alexandra Lodge Care Home Address 2 Lucknow Drive Mapperley Park Nottingham NG3 5EU 0115 9626580 0115 9626580 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) Mr S Cofie Cudjoe Glenys Ann Saxilby CRH 19 19 Category(ies) of OP registration, with number of places Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 17/02/05 Brief Description of the Service: Alexandra Lodge is a care home registered to provide personal care and support for up to nineteen older people. The home is located in a quiet area of Mapperley Park on the outskirts of Nottingham City Centre. There are local facilities within walking distance and easy access to public transport. The home is a two-storey Grade II listed building with an added purpose built extension. The older part of the building still has many of its original features. There is one double bedroom and seventeen single bedrooms; none of the bedrooms are en-suite but assisted bathing facilities are provided. There is a stair lift available to residents who have some mobility problems. There are well maintained gardens which residents can look out to when sitting in the the large lounge. Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over four and a half hours on June 16th 2005. This was the home’s first inspection for this financial / inspection year. The main method of inspection was called ‘case tracking’ which involved selecting two residents and tracking the care and support they receive through the checking of their records, discussion with them, the care staff and observation of care practices. One of the residents case tracked was available for discussion and five visitors to the home, either friends or relatives were spoken with. Two members of staff were also spoken with and two staff files were looked at. The manager was on annual leave but the owner, Mrs Cofie-Cudjoe was present and available for discussion and feedback throughout most of the inspection. What the service does well: What has improved since the last inspection?
Mr Cofie-Cudjoe has now developed environmental risk assessments for the home, something which was identified at the last inspection. For the safety of residents and prevention of Legionella there are devices on water outlets for the regulation of water temperature and an environmental risk assessment was seen for the use of this device. Mr Cofie-Cudjoe also reports that an environmental health officer has visited to advise on this practice.
Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 6 First aid training continues for all staff on a gradual basis and staff spoken with confirmed that they have attended their first aid training. There are acceptable written Terms and Conditions that each resident signs before they move to the home. A police check was present on one of the staff files seen whereas at the last inspection these were not available at the home. 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. Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 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 Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 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) 2 and 5 Residents sign an acceptable statement of terms and conditions. There are good opportunities for prospective residents and relatives to visit and be introduced to the home before deciding to move in. EVIDENCE: Signed terms and conditions were not seen on the day of the inspection because residents or their relatives retain this themselves. One resident spoken with does recall having some form of contract. An unsigned statement of terms and conditions was looked at. This document covers all the necessary areas as outlined under Standard 2.2. It is recommended that a copy of the signed terms and conditions be kept on the respective residents’ file. This will ensure that all residents have signed one. On the day of the inspection there was a prospective resident visiting the home for the afternoon. The owner reported that this has been a gradual process for this person, to enable them to get used to the surroundings, staff and residents before moving to the home. Introductory visits are seen as important for all prospective residents, according to their needs.
Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 9 Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 There are clear arrangements in place to ensure that the social, personal care and health care needs are met including safe systems for administration of medication. EVIDENCE: The care plans seen were comprehensive covering all areas of need such as personal care, health care and social needs. They also referred to individuals’ preferences and likes and dislikes and there were risk assessments attached. It is recommended that for residents that may wonder as a result of some confusion that this is risk assessed in terms of what support is required and how to ensure that the environment and grounds are safe. One resident spoken with knew that he had a care plan and four of the five relatives said they’d had some involvement with the development of care plans. There was evidence that these plans are reviewed on a monthly basis and both members of staff spoken with feel that the plans and how they are presented make them a very useful tool in ensuring that the needs of residents are met. It was apparent from looking at the plans that the health care needs of residents well met. All health-related appointments including visits from district nurses, a doctor and regular chiropody are recorded and assessments identify when there are hearing or sight difficulties that require regular or
Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 11 specialist input. The resident spoken with talked about a health equipment problem he has been having. The experience he has recently had is described within his care plan and all subsequent action to resolve this problem has been clearly recorded. One relative that was spoken with explained how the manager had contacted her to consult on how to best support this resident with shaving. Other visitors also stated that they are always updated by either the manager or owner on the health care needs of their relatives and what appointments they may have. Residents’ weight is monitored and recorded monthly and there are good relationships with the local district nurse service. The medication system appeared to be in good order. The majority of tablets are administered using a monitored dosage system (MDS). Instructions on medication administration records (MAR) are clear and no errors were found. There are photos of residents kept on MAR sheets, which helps to ensure that residents are given the right medication. The right to privacy and dignity has been incorporated into the relevant care plans and staff spoken with stressed how promoting this right is fundamental to their caring role. Both the resident and visitors that were spoken with only made very positive comments about the commitment of staff and how they treat the residents with respect and kindness. Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 There is flexibility and choice in the day-to-day activities for residents. Contact with the local community is promoted and friends and relatives are welcome to visit residents at any time. Meals are nutritious and wholesome and are provided to residents in pleasant surroundings. EVIDENCE: All visitors spoken with said that they are always made to feel welcome by staff when they visit their relative in the home. The resident spoken with continues to go to church every Sunday by getting picked up by volunteers at the church. Relatives spoken with mentioned how the residents have had the opportunity to go to the theatre with staff. There is a Registered General Nurse employed at the home as ‘Resident and Staff Developer’. This role includes overseeing training for staff but also on identifying appropriate and preferred activities of residents. Some of the activities on offer are music, dance, board games, ball games, sewing and arts and crafts. The resident spoken with explained how he can ‘conduct his life in an ordinary manner’ by choosing what he wishes to do that day, whether he wants to be in company or on his own, when he wishes to go to bed and where he sits for his meals etc.
Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 13 Relatives spoken with are happy with the quality of meals provided. A menu is devised every six weeks and the day’s menu is also displayed on a board in the dining room. The menu plan showed that healthy and varied meals are on offer with plenty of fresh meat and vegetables. There were good food stocks seen and alternatives are always available to residents who do not want the meal that is on offer for that day. Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Residents are protected and safeguarded from abuse. EVIDENCE: There have been no incidents of adult protection or allegations made at the home. Nevertheless, both members of staff spoken with are aware having to follow the Nottinghamshire Adult Protection Policy and Procedures and know where to access this information if an allegation is ever made. On the day of the inspection the file was not where it is usually kept. To ensure staff know what to do immediately following any concern or allegation of abuse then it is recommended that staff are vigilant in ensuring this file is kept accessible at all times and stays in its allocated place. The ‘ Residents and Staff Developer’ who is a registered general nurse provides training to staff on adult protection issues including the different types of abuse and all staff are gradually attending the Age Concern course in the protection of vulnerable older adults. It is also recommended that training run by the Adult Protection Unit is also accessed, by senior staff at least, in order to clarify roles and responsibilities in accordance with the Nottinghamshire Adult Protection Policy and Procedures. Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The environment is safe, well maintained and clean and hygienic throughout. EVIDENCE: On a tour of the premises it was evident that the home is kept clean and hygienic. There are good laundry facilities available that are sited away from any areas that prepare or serve food and washing machines have a sluicing facility on them. Both members of staff spoken with demonstrated knowledge of how to control the spread of infection. All parts of the home are pleasantly decorated and there is a traditional and homely feel. Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 16 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, 29 and 30 Staffing levels and training provided to staff ensure that the current needs of residents are met. Residents are not fully protected by the current recruitment practice within the home. EVIDENCE: There are always two care assistants on each shift and in addition to this there are domestic and catering staff and the ‘Staff and Resident Developer’ also employed at the home. The resident, staff and visitors that were spoken had no concerns or complaints about staffing levels and residents getting support that they need. It is important, however, that staffing levels are regularly reviewed to ensure that they are appropriate to the needs of people living at the home. If there were a number of residents with mobility problems and needing two to one support then this would without doubt impact on the level of staffing. The ‘Staff and Resident Developer’ who is a Registered General Nurse is responsible for identifying training needs of staff. There are individual training folders for staff and certificates and a log of courses attended is kept on this file. Staff receive foundation training prior to starting National Vocational Qualification Level 2 in Care and medication training is provided both by the contracted pharmacist and also by the ‘Staff Developer’. As well as attending formal training courses there are regular briefing sessions on safe working practices, moving and handling and adult protection. Staff spoken with are happy with the level of training that they receive.
Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 17 The application form, contract and two references were present on both staff files seen. However, only on one of the files was there a Criminal Records Bureau (CRB) disclosure and proof of identification. During discussion with the manager it became apparent that the normal practice of the home is for a new recruit to start working at the home as an additional member of staff and be supervised until the Criminal Records Bureau check is returned. In accordance with Care Home Regulations, to ensure that residents are safe no person’s employment should be confirmed until there is completion of a satisfactory CRB check and until proof of identification has been obtained, with copies held on file. An immediate requirement was set at the last inspection visit as evidence that CRB checks for all staff had been applied for could not be supplied. As this is another serious concern regarding CRB checks then this has also been set as an immediate requirement. If practice does not change from this effect then enforcement action will be considered. Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 37 and 38 The financial interests of residents are safeguarded. To ensure that the Commission for Social Care Inspection (CSCI) can effectively regulate the home all deaths of residents must be notified to the Commission. Some progress has been made with the development of environmental risk assessments but the health and safety of residents will only be fully protected once a fire risk assessment is devised and all required fire safety testing is up to date. EVIDENCE: For all of the residents living at the home their relatives are the appointees. The arrangement is that relatives provide regular sums of money, which is then held securely in the office in a separate wallet for each resident. Whenever residents’ request money and when an item has been purchased all receipts are kept and all transactions are recorded. Three individuals’ money files were inspected and appeared to be in order. All of the necessary receipts were there, transactions were clearly recorded and the money in each wallet
Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 19 equated with the respective financial record. The resident spoken with said that there is always money available to him if he wants some. During the inspection it became apparent that there have been some recent deaths at the home. When the owner was asked if CSCI had been formally notified she was unaware that this is a requirement. There have been no notifications logged onto the database at CSCI, which already indicated that notifications were not being received. In accordance with Regulation 37 of the Care Home Regulations 2001 CSCI must be notified of any death of a resident. There are other occurrences, which must be notified to CSCI, as identified under Regulation 37, and these were discussed with the manager during the inspection. All staff are undertaking first aid training. Some staff have already completed the course; other staff are still due to attend. Evidence was seen indicating that electrical testing and servicing of equipment is all up to date. The owner reports that the environmental health department have given advice regarding temperature regulation devices on water outlets and a risk assessment was seen, identifying the need for such a device. In addition to this device to ensure that the temperature is being regulated at the appropriate level and that adequate hot water is provided it is recommended that the water temperature is monitored and recorded monthly. Environmental risk assessments have now been devised but fire risk assessments are also needed to ensure that residents and staff can safely evacuate the building in case of a fire. Fire test records were inspected and found to not be up to date. Testing all fire equipment is a requirement in accordance with Fire Safety Regulations. Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 3 x x 3 x 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 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x 3 x 1 2 Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 21 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 29 Regulation 19(1)(b) Requirement Timescale for action immediate 2. 37 37 3. 38 13(4)(a) 17(2) Ensure that staff are not confirmed in post and do not commence employment until the return of a satisfactory Criminal Records Bureau check. Ensuring copies are held on staff files was set as an immediate requirement at the last inspection. Given that CRB checks were seen on existing staff files, this separate issue is set an an immediate requirement but if this practice does not stop then enforcement action will be taken. Ensure that all occurences as immediate identified under this regulation, including the death of any resident, is notified to the CSCI without delay. Ensure that in accordance with 30/06/05 fire safety regulations that there are fire risk assessments in place and that required fire alarm testing and drills are up to date. Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 22 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 2 7 Good Practice Recommendations It is recommended that as well as giving the resident / relative the statement of terms and conditions that a copy of this is also retained on the respective residents file It is recommended that for residents that wander there are individual risk assessments in place identifying necessary measures for appropriate support and their safety. It is recommended that the adult protection training run by the Adult Protection Unit is accessed. Iti is recommended that the Nottinghamshire Adult Protection Procedures are available to staff at all times. To ensure residents are provided with adequate and regulated hot water it is recommended that the temperature at water outlets is monitored and recorded monthly. 3. 4. 5. 18 18 38 Alexandra Lodge Care Home C53 C03 S2185 Alexandra Lodge V233297 160605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Edgeley House Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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