Inspection on 11/04/06 for Alexandra Park Home

This inspection was carried out on 11th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Alexandra Park Home 10/06/08

Alexandra Park Home 21/05/07

Alexandra Park Home 12/12/05

Alexandra Park Home 16/05/05

Alexandra Park Home 13/09/04

Alexandra Park Home 04/05/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

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

CARE HOMES FOR OLDER PEOPLE Alexandra Park Home 2 Methuen Park Muswell Hill London N10 2JS Lead Inspector Karen Malcolm Key Unannounced Inspection 11th April 2006 09:10 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 Park Home DS0000010757.V288468.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 Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Alexandra Park Home Address 2 Methuen Park Muswell Hill London N10 2JS 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) 020 8883 5212 020 8343 7459 Mr David Weston Mr David Weston Care Home 15 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (15), Old age, of places not falling within any other category (15), Physical disability over 65 years of age (8) Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Limited to 15 people of either gender who fall into the category of old age (OP) and who may also have a mental disorder (MD(E)) and of whom no more than 8 people may be accommodated on the ground floor may also have a physical disability (PD(E)) One specified service user who has dementia may remain accommodated in the home. The home must advise the regulating authority at such times as the specified service user vacates the home. 12th December 2005 Date of last inspection Brief Description of the Service: Alexandra Park Home is a care home for fifteen older people some of whom may have mental health problems, up to eight people may be accommodated on the ground floor may also have a physical disability and one specified service user who has dementia. There are nine single bedrooms and three shared rooms. No bedrooms have en suite facilities, although there are a number of toilets plus two bathrooms. Alexandra Park Home is not purpose built and comprises of a large converted house with an extension on the ground floor. The home is situated in a quiet residential area of Muswell Hill and is not far from local shops, other amenities and Alexandra Park. Transport links are very good. The home’s stated aim includes that ‘residents right are at the top of our care philosophy. We will advance the rights in all aspects of the home and encourage our residents to take part fully in decision-making’. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. The current scales of charges are from: - £390 to £550 per week. This information was submitted to the Commission for Social Care Inspection (CSCI) in October 2005 via the home’s ‘Pre Inspection Questionnaire’ (PIQ). Other additional charges include, hairdressing, chiropody, newspapers and magazines. Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over approximately nine hours. Upon arrival the senior carer who was in-charge greeted the inspector. Also on shift there were another carer, the cook, a domestic assistant and a student carer on placement. Later during the inspection the deputy manager arrived at the home, and supported the senior carer throughout the rest of the inspection. The registered provider/manager was on holiday at the time of this inspection. The inspector was informed that thirteen service users were in the home and two service users were in hospital. The inspector was also informed, that one service user had recently returned from being in hospital the day before the inspection, after spending approximately four months there. The inspection process involved, the inspector speaking to three service users and three members of staff, touring of the building, sampling five service users care plans, observing staff with service users in day to day running of the home and examining their policies and procedures. Service users spoken to, express their satisfaction with the quality of care offered by the home and, were happy living there. One service user was asked to have their say. The outcome was that “the cook is smashing, the manager is grumpy sometimes, but aren’t we all”. The service user likes mixing with people and listening to music, and if they have any complaints they will tell the manager or staff. The inspector would like to thank the deputy manager, care staff and service users for their time, patience and co-operation during the inspection process, which was positive and open. What the service does well: The manager is also the registered provider. The staff and the service users spoken to stated that they found the manager very down to earth, flexible, a great source of knowledge, very pleasant and a kind person. It was evident during the inspection that, the inspector found these traits to be a true reflection. Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 6 Alexandra Park Home has a relaxed and homely atmosphere, and the quality of care provided was found to be very good. Many of the service users have lived in the home for a number of years, and stated that they are happy living there. The home offers shared bedrooms, as well as single bedrooms, all of which are comfortable and homely. The service users are provided daily, with a varied choice of foods, which are well balanced and nutritious. The management team and the care staff have a good rapport with the service users. There are opportunities for service users to participate, in leisure activities and maintain contact with families and friends. What has improved since the last inspection? What they could do better: This inspection has identified twenty-eight areas of improvement and nine recommendations. Five of which have been restated from the previous inspection report. Two of which were Immediate Requirements relating to one specific service user’s care plan that was not in place. The second related to notification of illness, hospital admittance or any other events pertaining to the health and safety of a service user, who reside in the home. While it’s evident that the staff are experienced and competent, the home has failed to ensure that service users needs are consistently being supported, recorded, reviewed, monitored and up-dated appropriately. It is therefore required that the registered person submits an action plan to the Commission for Social Care Inspection (CSCI), which describes how they will address these matters. The summary of the findings is that the registered manager needs to monitor and review regularly entire home’s service users care plans policies and Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 7 procedures. The complaints and abuse policies both need reviewing and updated, to be in line with current procedures. Record keeping is generally good, however, it was evident they all need reviewing regularly. Once all the policies and procedures are reviewed, it is good practice to date each one. A requirement for all care staff to undertake mental health awareness training was made. Information held on each service user’s file with regards to death or a serious illness occurring, needs to be reviewed with each of the service users, to ensure that all the areas regarding individuals’ care and wishes have been addressed appropriately. It is also required that the manager reviews with care staff how complaints, especially verbal communication, are addressed and recorded. This can be either discussed in a team meeting or through training. Risk assessments were not updated when a change to individual’s healthcare needs occur. The registered manager must address a number of maintenance issues that were identified during the inspection. The main concern is the lack of appropriate communal bathing facilities in the home. The registered person is to consult with the environmental health officer with regards to this. The laundry door does not close effectively, one service user’s bedroom door was found to be propped open, one of the round tables in the lounge was wobbly and unsafe and the lounge/dining room walls need repairing. The ramp at the front of the home is to be made safer for wheelchair access and the patio areas need addressing. Staffing records were not inspected at the time of this inspection, due to the manager being on holiday. However, the staffing level between 8am and 9am needs to be reviewed to ensure adequate staffing is in place and on each shift at least one named qualified first aider should be indicated on the rota. A number of the outcome groups under ‘Management and Administration’ were not inspected. However, the home’s equal opportunities policy was checked and it was clear that this policy must be amended to coincide with the current changes in legislation. Also the registered manager is to ensure that all care staff abides by the Health & Safety at Works Act 1974 especially when mopping the floor. The registered person is to update the current certificate in place regarding the Data Protection, as this has now expired. The recommendations addressed in the table at the back of this report are deemed good practice. Any unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. Please contact the provider for advice of actions taken in response to this inspection. Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 8 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alexandra Park Home DS0000010757.V288468.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 Park Home DS0000010757.V288468.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&3 The home’s Statement of Purpose and Service User guide is poor and does not provide sufficient information for prospective service users to be clear about the services that the home provides to meet their needs. Service users prior to moving into the home are assured that their needs will be met, therefore receiving appropriate care to meet individual’s care needs. However, service users cannot be confident that this is consistently monitored appropriately in all cases. EVIDENCE: Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 11 Currently the home is fully occupied. The home’s Statement of Purpose and Service User’s guide were both examined. It was evident from the findings that both documents needed to be amended and updated to cover all the elements as set out in Regulation 4(1)(c) & 5, Schedule 1 of the Care Homes Regulations 2001. It was also recommended by the inspector that the deputy manager should ensure that the Statement of Purpose and Service User guide are both user friendly and are produced as a selling tool for the home. Areas such as service users care and what the home provides on a short term and long-term basis should be reflected in both documents. Two service users have been admitted into the home since the last inspection. The inspector spoke to one of the two service users. It was evident from the discussion that the service user was content and happy living at the home. Prior to any prospective service user being placed in the home, the placing authority submits to the registered manager, an assessment of needs regarding the specific service user. The registered manager also completes his own assessment to ensure that the suitability of the prospective service user matches the home ethos, and that their care needs can be individually met by the home. Evidence of assessments completed was present on each service user’s file. One specific service user, who had moved into the home in December 2005, did have in place assessments completed by both parties. However, no care plan regarding the individual’s day-to-day care was on file. This has been addressed further in this report under ‘Health and Personal Care’. At the previous inspection it was required that the registered person notifies the CSCI of the specific service users who have dementia and have recently moved out of the home. Prior to this inspection, the registered person submitted a letter to the Commission, with the names of the service users who have currently moved out of the home. The home’s certificate has been amended to reflect the changes. At present the home’s Conditions of Registration has one specific named service user recorded. In discussion, with the deputy manager and one of the senior carers during the inspection, it was evident, that at least four service users, who reside in the home, are now diagnosed with dementia. No notification has been submitted to the Commission nor has the registered manager discussed this issue with the lead inspector, and nor has the registered person submitted an application to the Commission. Therefore at present the registered person is in breach of their Conditions of Registration. It is therefore advised, by the inspector that the registered person must cease to admit any other service users in the home a clinical diagnosis of dementia. For those service users have a currently are diagnosis with dementia, an application for variation must be submiited to the Commission as a matter of urgency. Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 12 All service users’ contracts of care from the placing authority and the home were in place. The home does not provide intermediate care. Alexandra Park Home DS0000010757.V288468.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, 10 & 11 Care plans are in place; however the registered manager has failed to ensure that service users’ health, personal and social care needs are recorded and monitoring consistently. Therefore the care staff are unable to support service users appropriately in the home. Service users are confident that their privacy and dignity is respected and upheld within the home. Therefore service users feel comfortable and safe. Service users are also confident that their wishes with regards to death are respected by the home. However, service users are not fully confident that all their wishes have been addressed. Therefore, service users may feel vulnerable that a sensitivity issue regarding their care may not be addressed appropriately. EVIDENCE: Five care plans were examined. The findings were that a number of care plans were not signed or dated; it was difficult to establish from the finding whether or not individuals were consulted with regards to their care. Each file examined had a different care plan and Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 14 monthly reviews format in place. While monthly review were completed, these were not always done consistently. A number of files did not have a current photograph of the individual. Daily records were completed. However, guidance on what information is to be recorded needs to be in place to ensure information regarding individuals’ daily care was not omitted. It was evident that risk assessments were not up-dated when a fall or accident occurs. Service users’ care needs, that are complex such as depression, mental health problems or smoking obsession, did not have a record on the specific individual’s care plan. Four of the five care plans examined were in place. The specific service user, who care plan was not in place, was discussed at length with the deputy manager and the senior carer during the feedback session at the end of the inspection. The concerns were: • No care plan of care was in place • The specific service user had moved into the home in December 05, and admitted into hospital on 24th December 2005. No notification had been made to the Commission • The specific service user has history of specific mental health problems which is not documented fully • No risk assessments were in place • The specific service user has recently (10/04/06) returned to the home from hospital, however, no information with regards to this was on file • No assessment was in place regarding whether the home could manage the service users care needs since returning from hospital • The deputy manager and the senior carer informed the inspector that the consultant at the hospital had stated that the specific service user was on a trial visit to the home. If within this period the service user falls ill, the home is to immediately admit the service user back to hospital. No notes regarding this information were recorded on the individual care plan or daily notes on how this is monitored or supported. Due to the concerns regarding this specific service user and the appropriate care an Immediate Requirement was issued on the day relating to this. It was also evident that none of the carers have undertaken any mental health training, with regards to ensuring service users with mental health care needs, within the home are appropriately supported. At the previous inspection it was required that the registered person updates each of the seven service users risk assessments, whose bedrooms are on the first floor, with regards to accessing the stairs. It was also required that the registered person consults with relevant professionals and update individual’s mobility risk assessments. It was evident from this inspection that this was not completed. However, the deputy manager stated that a referral has been made to the relevant professionals in regards to this. Although verbally the inspector was informed that a referral had been made, there were no records Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 15 on file in supporting of this. Therefore this requirement is restated in this report. The deputy manager stated that four specific service users are deemed independent within the home. They are able to support themselves with personal care and one service user goes out daily for a walk to buy their newspaper. The front door is key coded and the service user has been given the code, to ensure that the individual is able to come and go independently. The specific service user, when asked confirmed this. It was advised that the specific service user’s risk assessments must include a section on all the areas of their independence. Also the specific service user’s last review dated the 8/11/05, did not contain a list of the attendees. Healthcare records have improved since the previous inspection. Each service user has a named GP who is local to the home. The deputy manager informed the inspector that two service users were in hospital at the time of this inspection. No notification had been made to the Commission with regards to this. The deputy manager stated that she was unaware of the process to follow with regards to notification of incidents. An Immediate Requirement was also issued relating to this. The deputy manager stated that all service users have recently undertaken a medical review. The accident and incident booklet was examined. Since the previous inspection, there have been nine recorded incidents resulting in service users falling. One service user was admitted into hospital as a result of a fall. Medication procedures were examined. Recording, storage, handling, disposal and administration of records were all in good order, this has much improved from the previous inspection. This was commended to the deputy and senior carer during the feedback session. The only area of concern regarding medication, relates to the medication policy. The medication policy was last updated and reviewed by the home in 1997. The inspector observed lunchtime medication. It was observed and fed back to the carer that one service user’s medication was left on the table in a medication pot, whilst the carer when to get a jug of water. It was observed by the inspector that service users are treated with respect and the dignity they deserve. Service users that the inspector spoke with said the staff were very good and were sensitive when providing personal care. They also stated that staff always knock on the door before entering their rooms. Staff interviewed were able to give examples of how they provide care in a dignified manner and with regard to the service user’s privacy. On the files examined, except one, had information regarding individuals’ wishes in the event of their death. However, it is also recommended that Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 16 information regarding individuals’ wishes if they become terminal ill be recorded alongside this information. It is also good practice to review these sensitive issues with each service users regularly, to ensure that the information recorded remains accurate and if any changes or any additional need to be made this can be updated. Alexandra Park Home DS0000010757.V288468.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 & 15 The home has made adequate improvement on meeting individual service users with regards to social activities. Therefore service users social needs are appropriately and meaningful met. However, this could be further improved with more planned activities. Service users maintain good family contact. The meals are good offering choice, variety, and catering for special needs. However, service users with visual impairment or those who are confused at times may not always remember or see what is written on the menu board. Therefore mealtimes could be confusing and not a time of enjoyment and contentment. EVIDENCE: At the previous inspection there were no issues raised under this section. Service users have the opportunity to exercise their choice in relation to leisure, social activities and cultural interests. There was written evidence that service users can choose from a range of activities, either facilitated by staff or by the activity person. Service users confirmed that they go out shopping and visit another local residential home for planned activities. They also confirmed that they have a choice of meals. Although one service user did state, that they were not aware of what was being provided until the meal is on the table. Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 18 This was addressed with the deputy manager. The menu board was on a wall near the entrance to the kitchen above a service user’s armchair. The menu board in place was deemed small and the information recorded was small in size, and in parts unreadable. It was advised that this must be printed in larger letters to assist service users, as a number of the service users have Dementia and visual impairment. The menu board should be removed from its current position to an accessible position for all to see. The activity person provides in house activities once a week and also works between Alexandra Park Home and another residential care home locally. Evidence of each visit is recorded in the activity file. Upon reading the file it was evident that the activity person has completed a number of courses within the last year including Dementia Care. The last recorded activity session undertaken by the service users was on 14/03/06. The recorded information stated the numbers of service users who participated in the specific activity. It was advised by the inspector that an activity programme be in place and displayed. The deputy manager stated that the home does provide different cultural activities for service users, when they arise. A poster of St Patrick Day events was on file. The deputy manager also informed the inspector that all forthcoming events are always disseminated verbally to service users personally, such as the Easter party being held at another home close to Alexandra Park Home. The home has a policy regarding encouraging social contact. There was evidence from the visitors’ book that service users regularly see friends and family. One visitor was visiting during the inspection. The deputy informed the inspector that service users could see visitors in private if they so wish. For those service users who wish to smoke, the home provides a smoking room on the ground floor. The manager deals with two service users financial affairs. The rest is managed either by the placing authority or individual family and friends. It was not evident from the five files examined who manages their personally monies. At the previous inspection it was recommended that the manager improve the accounting system. However, due to the manager being on holiday at time of this inspection the inspector was unable to inspect service users financial documents. There was evidence of personal possessions in service users rooms. All care plan files, are kept locked in a filing cabinet, which is stored in the main hallway area. However, it was advised that the filing cabinets are removed and relocated to a more suitable safe place. The cook has been working at the home for a number of years and has a good understanding of the requirements of service users. The kitchen was clean and met with the requirements of a recent environmental health inspection. It was observed that service users, who need additional support with eating, were Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 19 supported appropriately during mealtimes. Care staff supporting service users sat beside the individual in an appropriate and non-threatening way. The meal presented looked appetizing and the portion sizes were reasonable. Service users spoken to seemed happier with the home and meals provided. The inspector observed four service users during the inspection. One service user felt slightly hot in the lounge area and started undressing. One of the carers intervened and spoke gently to the specific service user. The service user was then supported to their bedroom. Two-service users were having a discussion about the headline news in the local paper. One service user was being supporting with eating by a student carer. The deputy manager gave the student carer support and advice with regards to the correct ways to support individuals with feeding. One service user was sweeping up after lunch with a dustbin and hand brush. The findings from the obervation period were very positive. Service users in the home are treated with dignity and respect in a sensitive way. Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 20 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, 17 & 18 The home has an adequate complaints system with some evidence that service users feel that their views are listened to. However, this is not consistent. Therefore service users cannot be assured that verbal complaints are at all times listened to and acted upon appropriately by the home. Service users legal rights are protected. This is deemed good, ensuring that individual’s rights are maintained. Service users are protected from abuse. However, the home’s policy on abuse needs to be in line with the local authority’s procedures, to ensure all parties follow the same procedures, if an allegation or suspicion of abuse is reported, EVIDENCE: The complaints policy and procedure is in place however, like the other policies and procedures in place this needs reviewing. Service users that the inspector spoke with said they had no complaints about the care they received but said they would talk with the manager if they did have a problem. One service user complained to the inspector about the rice pudding dessert, being served at lunch. They complained that there was no sugar in it. The deputy manager overheard the conversation and rectified the matter straight away by offering the service user another dessert with sugar, which the service user accepted. Complaints were discussed with the deputy and the senior carer and it was evident that verbal complaints regarding food are addressed straight way. However, no record is made. It was advised that the manager must find appropriate ways of ensuring that all complaints by service users, Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 21 especially verbal communication are recorded and acted on by the manager and the staff team. All service users are registered to vote. The deputy informed the inspector that the manager takes service users to the local polling station or ensures that service users have a postal vote if so required. The abuse policy and a copy of the local authority’s adult protection procedures were in place. However, this policy like a number of other policies on file needed updating and amending. Alexandra Park Home DS0000010757.V288468.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, 21 & 26 The home is adequately decorated, therefore providing service users with a pleasant environment in which to live. However, there are a number of maintenance issues, which need addressing in the home. EVIDENCE: The home is well maintained and decorated to an adequate standard. The home has a large lounge/ dining area, which is in need of redecorating. The plaster behind the wallpaper has blown in places, needs of addressing. There is also a small smokers lounge. The home meets with the current requirements in terms of communal space. There are four toilets and two bathrooms. However, there is no bath or shower in the lower ground floor purpose built part of the home, where three service user bedrooms are located. When a service user requested a bath they have to walk down the corridor into the lounge/dining room off the conservatory to access a bathroom. Although this is the only bathroom on the ground floor, this is not adequate. It is advised the registered person look at Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 23 ways of increasing the number of bath or shower rooms for service users to access, as at present the inspector is of the view that this is not adequate in a home that support sixteen older people. All bedrooms were found to be homely and to the personal taste of each service user. However, in one of the service user’s vanity unit, a large first aid box was found. It was advised that this must be removed. The patio area between the main building and the purpose built lower ground floor was inspected. The patio tables and chairs were found to be old, dirty and some were broken. A number of pot plants in the front and back of the home were either dead or in need of some tender loving care. The paved area in the patio area needed some attention as they had weeds and moss growing on them. The whole areas look untidy and messy. It was advised that the garden paved area be addressed. The clinical and domestic waste was found to be open and exposed, this must be cornered off and secure. The washing line in the patio areas was inappropriately placed and will need removing. At the previous inspection it was required that the wooden portable ramp placed at the front entrance to the home was not suitable and is unsafe. It was advised that the registered person consult with the relevant professional to obtain support and advice on the correct ramp that could be used. At present there is one wheelchair service user residing in the home. A requirement was made relating to the registered person, completing an environmental and fire risk assessment of the home. Both requirements were not addressed at the time of this inspection, therefore both will be restated in this inspection report. The lounge door has a Dorguard in place, which is activated by the fire alarm. However, one service users, bedroom door that is located off the hallway area, was found to be propped open, at the request of the service user. This specific service user’s bedroom door must have a self-closing device fitted or the door must be kept shut at all times. The dining room is set out with one main large dining table, two smaller round tables plus a number of armchairs for each service user. One of the round tables was found to be wobbly and unsafe, this was the table being used by the only wheelchair person in the home. The service users filing cabinet is stored in the hallway, in the interest or security or confidential information this must be addressed. The laundry room is narrow and small, storing a washing and large industral dryer. The laundry room is off the hallway area and is next to one of the service users’ double bedrooms. The laundry door was inspected at the last inspection and a requirement was made. It was identified that the door was not closing effectively. The outlet pipe for the dryer was exposed in the front garden area and this also needs addressing. Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 24 The infectious control policy is in place, however this needs to be amended to include sections on MRSA, HIV and appropriate and safe storage for clinical waste. The skylight in the toliet on the ground floor, in the purpose built section is in need of cleaning. Alexandra Park Home DS0000010757.V288468.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): 28 & 30 The registered person has ensured that the skills mix of staff meets service users needs. However at certain times of the day service users could be place potentially at risk of harm, due to the number of staff on duty. The registered person has ensured that all staff are trained and competent to do their jobs appropriately, this is good. EVIDENCE: The inspector was unable to inspect the care staff personnel records due to the manager being on holiday at the time of this inspection. Requirements relating to staffing records have been restated in this report and will be inspected at the following inspection. The rota was shown. In discussion with the senior carer it was evident that there is always two carers on shift. However, between 8am and 9am there is only one care, plus the cook on duty. The senior carer stated that the cook is always willing to give a helping hand during this period until the carer arrives at 9am. The senior carer also stated that handover is completed 10 minutes before each shift ends and the next shift starts, however, this was not reflected in the rota seen. Copies of past rotas were kept on file. Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 26 Records of staff meetings were in place. The last recorded minutes on file were in July 2005. The deputy manager and the senior both stated that they have had a number of staff meeting after this date. A Copy of the draft employee’s handbook was shown to the inspector. Discussion of what was needed to ensure individual rights were addressed was discussed. It was evident at this inspection that the carers were more knowledgeable about individuals service users and their care needs. Information with regarding to the care planning system was explained, by the senior carer on duty. This was impressive and commended by the inspector. The deputy manager informed the inspector that a number of staff have completed their NVQ level 2 and 3 in care. The manager has a D33 Advance Management in Care and all staff are supervised monthly. The care staff spoken to confirm this, however, appraisals are overdue. The staff team within the home is made up of various nationalities. At the previous inspection a Criminal Records Bureau (CRB) for the student on placement was required. At these inspection copies of student CRB’s were kept on file. One student stated that the care in the home is excellent, this was reiterated to her by one of the service users thanking one of the carers for their support and care. Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 27 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, 32, 34, 35 37, & 38 There is good leadership and a line management arrangement is in place. The registered person has adequately ensured that service users, are appropriately safeguarded by the home’s policies and procedures, record keeping and health and safety. However, due to the lack of monitoring and reviewing process in place, this has not always been kept up-to-date, therefore potentially placing service users’ at risk. EVIDENCE: The home is managed by the registered provider/manager. The registered provider/manager is responsible for no more than one residential care home. The deputy manager informed the inspector, that over the years the manager has taken a number of training courses to ensure that his knowledge, skills and competence of managing the home are kept up to date. However, due to manager being on annual leave the inspector was unable to inspect these Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 28 documents. The line of management accountability within the home is clearly defined. The deputy manager and the care staff during the inspection were open and transparent about the services they are providing for the service users. The service users whom the inspector spoke to confirmed this. Policies and procedures in the home are kept in the office, which is accessible to all staff. However, a number of policies and prcedures examined needed reviewing and amending to include aims and objectives. Many of the doucments on file were produced a number of years ago and have not been reviewed since. It was also evident that a number of the policies were statements and didn’t address the solution with an aim and objective. This was discusssed with the deputy and the senior carer. It was therefore advised that the policies and procedures file must be reviewed and updated accordingly. Equalities and diversity was discussed with the deputy manager and senior carer. The equal opportunities policy on file, upon reading it was only a statement. It was advised by the inspector that tha homes policy must reflect with the current changes in Law with regards to equalities and diversity. Health and safety certificates were checked and are in place. The cleaner was observed after lunch mopping the vinyl flooring near the conservatory area. However, no signage to indicate ‘wet floor or cleaning in progress’ was evident. Last recorded fire drill was 6/04/06. Recorded on the file was the names of all the care staff on duty, however it also only indicated service users were present. It was reccomended as good practice, that the names of the service users should be listed on the information recorded. It was reminded that on each shift there must be at least one qualified first aider and this should be clearly indicated on the rota in place. Generally record keeping within the home was good. However, record keeping update, montoring and reviewing was found to be poor, especially with regards to policies and procedures and care plan information not being updated and in one case no information recorded. This has been addressed in the outcome group relating to ‘Healthcare and Personal’ In view of the fact that the registered provider/manager wasn’t available at the time of this inspection. The Standards relating to Quality Assurance, financial procedures, supervision, service users finance was not inspected. A copy of the Data Protection Act certificate was on file. However, it had expired at the time of this inspection. Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 29 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 2 18 2 2 X 2 X X X X 2 STAFFING Standard No Score 27 X 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 2 2 X 2 2 Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 30 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 OP8 Regulation 37 Requirement Timescale for action 13/04/06 2. OP7 It is therefore required that the registered person submit a notification notice under Regulation 37 to the CSCI giving specific time and detail of why each service user was admitted into hospital. This must be either faxed or posted to the CSCI by 13 April 2006. Immediate Requirement 18/04/06 17(1a)Sch Therefore it is required that the 3.3m&15 registered person must have in place by Tuesday 18 April 2006 a care plan for the specific service user ensuring all the areas covered under Standards 3 & 7 with regards to service user’s care and health needs are addressed. A copy is to remain on file and a further copy to be submitted to the CSCI either by fax or post no later than the specified date above. Immediate Requirement The registered person must have in place clear and precise guidance for care staff on how the specific service user, who Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 31 has recently been admitted back to the home from hospital, is to be supported by staff during this trial period of placement. The information recorded must include: Guidance for care staff with trigger points Daily concise records What action is to be taken, if service user becomes ill And any emergency procedures 3. OP1 4&5 Sch 1 The registered person must amend and ensure that the home’s Statement of Purpose and Service Users’ Guide cover all the elements as specified in Regulations 4 & 5 and Schedule 1 of the Care Homes Regulations 2001. The registered person must cease to admit any other service users into the home with a clinical diagnosis of dementia. 20/05/06 4. OP3 12(1ab) 14(12) 20/05/06 5. OP7 17(1)(a) Sch3.3n The registered person is required to ensure that where a service user is thought to have developed dementia during their long-term stay at the home, assessment information is obtained which will form the basis of an application for variation to registration conditions. The registered person must 30/05/06 ensure that risk assessments are updated on individuals’ service users care plans any changes to individuals’ health or care needs this must be update. A record of falls must be kept respect of each service user. This must be monitored and reviewed accordingly. Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 32 6. OP7 7. OP7 8. OP7 9. OP7 The registered person must update the specific service user’s current review notes dated 8/11/05 with the names of the attendees. 17(1a)Sch The registered person must have 3.3m recorded in each service user’s care plan guidelines for care staff when supporting individual service users who have may have a complex health issues such as depression or smoking obsession to ensure the correct care and support is being given. 17(1a)Sch The registered person must 3.2 ensure that a recent photograph of each service user is on individuals care file. 16(2n) The registered person must ensure that the specific service user’s care plan reflects the service user’s needs such as independence, activities and accessing the key code for the front door. 14(2a) The registered person must update each of the service users risk assessments whose bedrooms are on the first floor, with regards to accessing the stairs. Copies of the updated risk assessments must be kept on file and updated accordingly when any changes occur. The registered person must consult with relevant professionals mobility risk assessments regarding the specific service users who bedrooms are on the first floor. Copies of each completed assessments are to be kept on file. (Previous timescale of 30/01/06 not met.) The registered person must ensure that each service users is DS0000010757.V288468.R01.S.doc 30/05/06 30/05/06 30/05/06 30/06/06 10. OP7 15 30/05/06 Page 33 Alexandra Park Home Version 5.1 11. OP9 13(2) 12. OP15 17(2)Sch 4.13 consulted, with regards to drawing up their care plans and that they are signed by the service user wherever capable and or their representative on their behalf. The registered manager must ensure that the current medication policy is updated to reflect current legislation. The registered person must ensure that the menu plan board displayed in the lounge/dining area is legible for service users with visual impairment. The registered person must ensure all the care staff undertake mental health awareness training. The registered person must ensure that all care staff are aware of the Health & Safety at Works Act 1974 procedures. The registered person must purchase ‘wet floor’ signs. The registered person must ensure that all care staff have the opportunity to meet and discuss issues relating to care practice and service users needs at least once a month. Records of the meeting/s held are to be kept on file. The registered person must find appropriate ways of ensuring that all complaints by service users, especially verbal communication are recorded and acted on. The registered person must ensure that the abuse policy is updated and is in line with the local authority’s procedures. 30/05/06 30/05/06 13. OP30 18(1c)(i) 20/06/06 14. OP38 13(4) 30/05/06 15. OP30 18(2) 30/05/06 16. OP16 22 30/05/06 17. OP18 13(6) 30/05/06 Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 34 18. OP21 16(2j) The registered person must consult with the local environmental office with regarding to increasing the bathing facilities in the home. An action plan addressing this matter must be submitted to the Commission The action plan is to include future plans. The registered person must ensure that the: • • Patio area is to be addressed The pot plants in the front entrance and in the patio area are to be replaced The cobwebs in the toilet on the ground floor are to be cleaned The lounge/dining room wall is repaired and redecorated The outlet pipe for the dryer must be covered with an appropriate safety netting The wobbly round table in the lounge/dining area must be replaced or repaired The first aid box being stored in one of the double bedrooms vanity unit must be removed. The cabinet in the hallway must be removed. 30/06/06 19. OP19 13(4)&23 (2cdl) 20/07/06 • • • • • • 20. OP19 13(4a)(b) &23 The registered person must ensure that all fire doors are able 30/06/06 to effectively self –close at all times and are not wedged open. Magnetic door hold or a release mechanisms must be fitted to Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 35 any fire doors in the home that young people/staff members routinely prefer to leave open for extended periods of time during the day or night. Alternatively the registered person must consult with the London Fire Emergency Planning Authority (LFEPA) fire officer with regards to leaving fire doors inoperable and ensuring that the LFEPA are satified with this arrangement. 21. OP19 13(4) & 14(2ab) The registered person must consult with the a Occupational Therapist regarding installing a suitable and safe ramp to be positioned at the entrance to the home for service users in wheelchair/s to access the home safely. The current portable wooden ramp in place must be removed as this is deemed a hazard. (Previous timescale of 28/02/06 not met.) 22. OP37 17 The registered person must review all the policies and procedures in the home. The registered person must update the Data Protection certificate. The registered person must complete an environmental risk assessment that includes a fire risk assessment. This is to be reivewed annually. (Previous timescale of 28/02/06 not met.) 25. OP28 18(1) The registered person must review the staffing levels between 8am and 9am daily and ensure adequate cover in the 30/05/06 30/06/06 30/06/06 23. OP34 DP Act 30/06/06 24. OP38 13(4) 30/06/06 Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 36 home at all times. 26. OP35 17(2)Sch 4.9 The registered person must keep an accurate record of individual’s personal monies kept. A detail account of income and expenditure are to be kept and must be available for inspection. (Previous timescale of 28/02/06 not met.) 27. OP26 13(4) The registered person must ensure the laundry door is a fire door and is able to close effectively. (Previous timescale of 28/02/06 not met.) 28. OP26 13(3) The registered person must ensure that the infectious control policy is update in line with current legislation. 30/05/06 30/05/06 30/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations It is recommended by the inspector that the registered person should ensure that the Statement of Purpose and service user guide are user friendly and a selling tool for the home and the organisation. Areas such as service user care and what the home provides on a short term and long-term basis should is reflected in the document. It is recommended that the registered person should have in place clear and precise guidelines for care staff on how to complete the daily logs. It is recommended that the registered person should review the current service users profiles and care plans to DS0000010757.V288468.R01.S.doc Version 5.1 Page 37 2. 3. OP7 OP7 Alexandra Park Home 4. 5. 6. OP37 OP27 OP11 7. 8. 9. OP7 OP11 OP15 ensure that are consistent and follow the same formats. It is recommended that all policies are dated, and signed on review to evidence that a review has taken place at least annually. It is recommended that the registered person should have recorded on each care staff shift pattern, allocated time to complete a proper handover. It is good practice for the registered person to consult with each service users at least yearly their wishes with regards to death or a serious illness occurring. If any changes are made this is to be amended on the individual’s care plan. It is recommended that the registered person have clear and precise guidance notes are in place to assist care staff when completing the daily log. It is good practice to discuss and record on individual service users their wishes with regards to any terminal illness that may occur. The registered person must reposition the menu board. In a more suitable and accessible place for service users to read at their own leisure. Alexandra Park Home DS0000010757.V288468.R01.S.doc Version 5.1 Page 38 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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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