CARE HOMES FOR OLDER PEOPLE
Alexandra Lodge Care Home 2 Lucknow Drive Mapperley Park Nottingham NG3 5EU Lead Inspector
Joanna Carrington Unannounced Inspection 2nd December 2005 09:30 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 Care Home DS0000002185.V269663.R01.S.doc Version 5.0 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 Care Home DS0000002185.V269663.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Alexandra Lodge Care Home Address 2 Lucknow Drive Mapperley Park Nottingham NG3 5EU 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) 0115 9626580 0115 9626580 Mr Samuel Cofie-Cudjoe Mr Joseph Crentsil, Mrs Mercy Cofie-Cudjoe Mrs Glenys Ann Saxelby Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Alexandra Lodge Care Home DS0000002185.V269663.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th June 2005 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 DS0000002185.V269663.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over four hours on the 30th November 2005. This was the home’s second statutory unannounced inspection for this inspection / financial year. The main method of inspection was called ‘case tracking’ which involved selecting three residents and tracking the care and support they receive through the checking of their records, discussion with their relatives and observation of care practices. Staff were not spoken with as part of this inspection and neither were residents due to the confusion and communication difficulties that they experience. The focus of the inspection was to follow up requirements and recommendations set at the last inspection and to assess the remaining key standards that must be assessed at least once over the year. Therefore, this report should be read in conjunction with the previous report. Altogether four relatives and a GP were spoken with. The manager was not present, however the owners, Mr and Mrs Cofie-Cudjoe were available during the inspection for discussion and feedback. What the service does well: What has improved since the last inspection?
Alexandra Lodge Care Home DS0000002185.V269663.R01.S.doc Version 5.0 Page 6 There is now a receipt held on residents’ files evidencing that a contract has been signed and retained by the resident or their representative as well as to say they have received a copy of the Service User Guide. This is good practice. The file containing the Nottinghamshire Adult Protection Policy and Procedures was seen stored on a shelf that is accessible to all staff, important in case action is required following an allegation. There has been significant improvement with notifications being made to the Commission. All deaths are now being notified, which is important so that the Commission can monitor and regulate the service. There is now a fire risk assessment for the home and the required fire alarm testing is undertaken, to ensure the promotion and protection of the health, safety and welfare of both residents and staff. What they could do better:
The home is not registered to admit older people diagnosed with dementia. This registration category only applies to admissions. As long as the home is still able to meet the needs of residents that develop dementia then this is acceptable. However, what could be done better is assessing the suitability of the home for people with dementia, in order to ensure that all needs of residents continue being met. The complaints procedure needs to be utilised better, as a way of assuring residents and their representatives that their concerns and complaints are in fact welcomed, as a means for improving the service, and that their complaints will be acted on. More detail on care plans for support with personal care is required, otherwise it is difficult to determine whether an individual’s needs have increased or changed, and consistency with care and taking into account preferences cannot be guaranteed. Staff must not commence employment until the return of a satisfactory Criminal Record Disclosure (or at least a POVA first check, with staff supervision). This is for the protection of all residents. This was an issue at the last inspection therefore is a very serious concern, as this requirement (and the law) is still not being complied with. If this practice does not improve then taking enforcement action will be considered. Alexandra Lodge Care Home DS0000002185.V269663.R01.S.doc Version 5.0 Page 7 A system for monitoring and reviewing the quality of care, based on the views of residents and their representatives needs to be implemented. For the protection of residents safety then fire drills must be carried out every six months. A fire drill is now well overdue. 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 DS0000002185.V269663.R01.S.doc Version 5.0 Page 8 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 Care Home DS0000002185.V269663.R01.S.doc Version 5.0 Page 9 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): 2, 3 and 4 Prospective residents are assessed before they move to the home and residents sign a contract on their admission. The registered person must ensure that necessary action is taken when it becomes questionable that the home remains suitable in meeting all the needs of individual residents. EVIDENCE: For all three residents that were case tracked both the home’s own assessment and the placing authority’s community care assessment were on their files, and this information has formed the basis for each residents’ care plan. In addition to the pre-admission assessment along with the monthly review of care plans a dependency assessment is carried out, which helps to identify whether a higher band of funding needs to be requested from Social Services. Alexandra Lodge Care Home DS0000002185.V269663.R01.S.doc Version 5.0 Page 10 When residents at the home develop dementia the registered manager must regularly assess whether the environment and service is able to continue meeting specific needs around their dementia. Please refer to Standard 18 for evidence relating to meeting the needs of existing residents. It was recommended at the last inspection that a copy of the signed Statement of Terms and Conditions be kept on each residents file. Instead of this a signed receipt to say that the resident has signed and retained this document and has been supplied with a copy of the Service User Guide is now held on file. This is good practice, as it ensures that all residents and their relatives have all of the necessary information about the home. Alexandra Lodge Care Home DS0000002185.V269663.R01.S.doc Version 5.0 Page 11 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 and 8 The health care needs of residents are met but in care plans more detail on the personal care needs of residents is required. EVIDENCE: As like at the last inspection it is still apparent that the health care needs of residents are well met. All health-related appointments including visits from district nurses, doctors and chiropodists are recorded, monthly nutritional assessments are carried out and there are ‘Care Charts’ in place for monitoring weight, general health and also to ensure hair and nails are regularly attended to. There are care plans in place for necessary action for the prevention / treatment of pressure sores. The GP spoken with reported that she has not had any issues with the quality of care. Personal care needs are identified in care plans but for the three residents case tracked there was not enough detail on how support with personal care is given. For example, on one resident’s assessment it states that this person can wash their top half whereas on the care plan all it says is “full personal care”. More detail will help in determining an increase in needs but also in providing consistency with support that takes into account individuals’ preferences.
Alexandra Lodge Care Home DS0000002185.V269663.R01.S.doc Version 5.0 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 the following standard(s): 14 Residents are helped to exercise some choice and control in their lives and contact with family and friends is promoted. EVIDENCE: Staff were observed communicating with residents in a respectful manner and were giving residents choices with afternoon drinks. Daily notes indicate that there is always choice with whether individual residents want to participate in activities. The relatives of one particular resident confirmed that when they visit there are times when this resident will choose to stay in the lounge or will be spending time alone in his room. This resident chooses to go to church every Sunday by getting picked up by volunteers at the church, which is still very important to him. All visitors spoken with said that they are always made to feel welcome when they visit their relative in the home. Alexandra Lodge Care Home DS0000002185.V269663.R01.S.doc Version 5.0 Page 13 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 Promoting the use of the Complaints Procedure is required, to ensure that issues are addressed and that residents feel their concerns are listened to, taken serious and acted upon. The Nottinghamshire Adult Protection Policy and Procedures must be adhered to at all times. EVIDENCE: The file containing the Nottinghamshire Protection of Vulnerable Adults Policy and Procedures was seen on a shelf that is accessible by all staff, which was made a recommendation at the last inspection. Since the last inspection Social Services have conducted an investigation in accordance with the Protection of Vulnerable Adults Policy and Procedures. This was following a complaint made to Social Services by relatives about the care and treatment of their relative, a resident with dementia. Further to the investigation a case conference was held involving Social Services, the owner of the home and the Commission. The outcome at the case conference was that the allegation of mistreatment was disproved. This resident’s behaviour, as a result of their dementia was becoming more difficult to manage. All of the necessary records and care plans were in place and some earlier attempts had been made at involving specialist professionals in further assessment. The main issue, however, was more to do with whether the environment remained suitable for meeting this residents needs. The individual concerned has since moved onto a more appropriate placement.
Alexandra Lodge Care Home DS0000002185.V269663.R01.S.doc Version 5.0 Page 14 The main lesson learned from this situation was that when relatives pass on concerns, which in this instance they claimed to have done on a few occasions, then the use of the Complaints Procedure should be encouraged for documenting concerns and for following these things up. This provides assurance to both residents and relatives that they are being listened to, and that necessary action will be taken. There is already an appropriate complaints procedure in place, which is displayed in the entrance of the home. It transpires that due to illness, there had been previous admissions to hospital for this particular resident, for which these incidents should have been notified to the Commission. As part of Social Services investigation there was a record of an incident in which the resident concerned had displayed inappropriate behaviour against another resident, which should have been notified to the Commission and also to the Adult Protection Unit. Alexandra Lodge Care Home DS0000002185.V269663.R01.S.doc Version 5.0 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 the following standard(s): X None of these standards were assessed on this occasion. EVIDENCE: Alexandra Lodge Care Home DS0000002185.V269663.R01.S.doc Version 5.0 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 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): 29 Residents are still not protected by the current recruitment practice within the home, which is of serious concern. EVIDENCE: At the last inspection it was found that staff are commencing employment before the return of a satisfactory Criminal Record Bureau disclosure. At this inspection the file for a newly appointed member of staff was looked at. This member of staff commenced employment before the return of her POVA First check and the full CRB disclosure is still pending. Starting a new member of staff on a CRB from a previous employer or college is not permitted. In accordance with the Care Home Regulations 2001 a new CRB check is always required. A registered person may allow a new member of staff to start work at a care home as long as a POVA request, (as part of CRB application) has been applied for. Where a registered person permits a new worker to start work before the CRB check has been received he must appoint a qualified and experienced “staff member” to supervise them and as far as is possible ensure the “staff member” is on the same time as new worker. The rota shows that the new member of staff is not being supervised and there is no record of a supervision programme available on this member of staff’s file, which is also required. Another immediate requirement was issued over this matter. If recruitment practice has not improved at the next inspection then legal advice will be sought and consequently enforcement action may be taken.
Alexandra Lodge Care Home DS0000002185.V269663.R01.S.doc Version 5.0 Page 17 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): 33, 37 and 38 Implementing a quality assurance system based on the views of residents is required. There is significant improvement with the notification of incidents to the Commission. Although there has been some progress with action necessary for protecting the health, safety and welfare of residents further improvements to fire safety practice is still required. Alexandra Lodge Care Home DS0000002185.V269663.R01.S.doc Version 5.0 Page 18 EVIDENCE: There is already a Policy and Procedures for monitoring and reviewing the quality of care at the home. The policy states that a quality audit should be undertaken quarterly that considers all aspects of the home; housekeeping, catering, care of residents and administration. There are also feedback questionnaires for residents and their representatives. The owner admits, however that this process has not been undertaken for a long time, and is now well overdue. This is required. Since the last inspection the home is now notifying the Commission of all deaths. As already mentioned under Standard 18, other notifications to the Commission such a serious illness or serious injury of a resident, (as specified under Regulation 37 of the Care Home Regulations 2001) are required so that the home can be effectively regulated. The home now has its own fire risk assessment and the fire log showed that all necessary fire system tests, in accordance with Fire Precautions legislation are now being undertaken. Fire drills are still required. The last fire drill was in July 04. To ensure the safety and protection of residents and staff these are required every six months . Alexandra Lodge Care Home DS0000002185.V269663.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X 2 1 Alexandra Lodge Care Home DS0000002185.V269663.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? yes 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 OP3 Regulation 12, 14 Requirement Ensure that individuals’ assessment of needs is kept under review and where needs change and/or increase that subsequently the home is able to make proper provision for the health and welfare of service users. This is ongoing. Ensure that there is a detailed plan on how support with personal care is given. Use the Complaints Procedure for considering concerns and complaints made to the registered person by a service user or person acting on the service user’s behalf. Ensure that notifications to CSCI and The Adult Protection Unit are made in accordance with the NCPVA Policy and Procedures. Ensure that staff are not confirmed in post until the return of a satisfactory CRB disclosure, and that if staff commence employment before the return of a CRB then this is only on return of a POVA First check, and that the new member of staff is
DS0000002185.V269663.R01.S.doc Timescale for action 31/12/05 2. 3. OP7 OP16 15 22 30/03/05 31/01/05 4. OP18 13(6), 37 31/12/05 4. OP29 19(1)(b) 09/12/05 Alexandra Lodge Care Home Version 5.0 Page 21 5. OP33 24 6. OP38 13(4)(a) 17(2) supervised by an appropriately skilled and experienced staff member. This is an outstanding requirement, and the second time an immediate requirement has been issued, therefore if practice does not improve then enforcement action will be considered. Ensure that the system for 30/03/05 reviewing and monitoring the quality of care, (which provides for consultation with service users and their representatives) is implemented at the home. Ensure that in accordance with 31/12/05 fire safety regulations fire drills are conducted every six months. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2. Refer to Standard OP7 Good Practice Recommendations 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. 3. OP18 Alexandra Lodge Care Home DS0000002185.V269663.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park 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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