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Inspection on 23/01/06 for Queen Alexandra Hospital Home

Also see our care home review for Queen Alexandra Hospital Home for more information

This inspection was carried out on 23rd January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has high standards and provides a safe environment for residents to enjoy. Care plans are clear and provide staff with the information, which they need to meet the needs of the residents. Residents, who are able, are encouraged to retain an independent lifestyle, accessing local communal facilities and maintaining relationships Staff are well trained and staffing levels are reviewed regularly to ensure that the changing needs of residents can be met.

What has improved since the last inspection?

Since the last visit to the home the building project has been completed which has increased the number of single bedrooms available to 36 and has provided a new occupational therapy unit, physiotherapy unit and additional communal space. A programme of redecoration of bedrooms in the original part of the home has begun and future plans to update the facilities in the original building are being discussed.

What the care home could do better:

Medication practices do not ensure effective monitoring of medication, which could result in the wrong doses of medication being administered. Regular maintenance checks should be undertaken on any self-releasing door guards. The home has established security systems in place but these should be regularly reviewed to protect residents.

CARE HOMES FOR OLDER PEOPLE Queen Alexandra Hospital Home Gifford House Boundary Road Worthing West Sussex BN11 4LJ Lead Inspector Mrs D Peel Unannounced Inspection 23rd January 2006 06.30 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 Queen Alexandra Hospital Home DS0000024198.V279473.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. Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Queen Alexandra Hospital Home Address Gifford House Boundary Road Worthing West Sussex BN11 4LJ 01903 213458 01903 215419 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) Queen Alexandra Hosptal Home Limited Mrs Valerie Walker Care Home 60 Category(ies) of Physical disability (60), Physical disability over registration, with number 65 years of age (60) of places Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 4 females in the above service user categories may be admitted. Date of last inspection 16th August 2005 Brief Description of the Service: Queen Alexandra Hospital Home is situated in a residential area of Worthing with local shops and other amenities within walking distance. The seafront and beach are close by. Residents living at the home are ex-servicemen or women and have chosen the home because of its connections with the armed forces. The home has recently completed a major new building project, which has increased the number of single bedrooms available at the home to 36 and provides a new occupational therapy, physiotherapy unit and further communal areas. A second phase of improvements is planned for the existing building to improve the accommodation and facilities at a later date. Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over 4.5 hours on the 23rd January 2006 and was carried out by a Regulatory Inspector and a Business Relationship Manager. This was the second visit to the home this year and it was carried out to complete Queen Alexandra Hospital Home’s annual inspection programme for the year 2005 required by the Care Standards Act 2000. The inspectors arrived at 6.30 am to meet the night staff who had cared for the 53 residents on the Sunday night and to find out how residents needs are being met by staffing levels at night. The care records of six residents were inspected during the visit along with other records, which showed how care needs are to be met. Staff were spoken with informally and the Registered Manager and Responsible Individual on behalf of the organisation, were available at the home to assist with the inspection process. During the visit a tour of the home took place with all communal areas, and a proportion of private accommodation being visited. An inspector joined residents for breakfast and residents were spoken with informally throughout the morning. What the service does well: What has improved since the last inspection? Since the last visit to the home the building project has been completed which has increased the number of single bedrooms available to 36 and has provided a new occupational therapy unit, physiotherapy unit and additional communal space. A programme of redecoration of bedrooms in the original part of the home has begun and future plans to update the facilities in the original building are being discussed. Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 6 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. Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 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 the following standard(s): 3,4,5 Residents are assessed prior to moving into the home to make sure that the home can provide a care plan which residents or their families know will meet their needs. Prospective residents, their relatives and friends have an opportunity to visit the home to look at the facilities available and assess its suitability before moving in. EVIDENCE: The records of seven residents were viewed at this visit to the home. Records showed that senior staff at the home assess residents before they move in. Residents are then offered a trail period to see if the resident, their families and staff feel that they can meet the individuals needs. Residents spoken with referred to visits to the home before moving into the home. For some this had been a number of respite visits before moving in permanently and for others short visits to the home with family and friends had assisted them to make a decision about which home they wanted to live in. In some cases where residents had been too poorly to visit the home or had lived too far away they had relatives visit on their behalf. Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The care planning system gives clear information to assist with all aspects of health, personal and social care needs. Records are in place to monitor the health care needs of residents to make sure that any signs of residents being unwell are recognised. Medication practices do not ensure effective monitoring of medication, which could result in the wrong doses of medication being administered. EVIDENCE: Care plans examined at this visit had been developed from an initial assessment carried out prior to residents moving into the home. Clear information is provided to staff to enable them to meet the needs of the residents in all aspects of heath, personal and social care. Care records are updated regularly on a computerised system, which also alerts the relevant named nurse to review aspects of the care plan. Care records showed that the physical health of residents is regularly monitored, including weight and dietary needs. Residents confirmed that they have access to the normal NHS services and on the morning of the visit a doctor was visiting the home to carry out a surgery. Medication procedures are in place to protect residents from the mishandling of medicines however on this occasion it was noted that sometimes hand written Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 10 changes to medicine doses on Medication Administration charts are not always clear and could not be referenced to the prescribers most recent directions. Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 The home encourages a flexible lifestyle for residents allowing those who are able to exercise choice and some control over their lives. EVIDENCE: The inspectors arrived at 6.30 am so that they could look at the routines and flexibility of the home at this time of the morning. A few residents were already up and some residents were in the process of being assisted to get up by staff. The residents spoken with who were already up and about were of the opinion that it was of their preference that they got up early and one resident said that he would get up earlier but it might disturb others. Some residents stayed in bed until later in the morning and confirmed after they had got up that it was their choice to get up later. One resident spoken with had chosen to have breakfast in his room because he didn’t feel well. One resident spoken with said that they liked to go to bed late and that staff were able to accommodate this whilst another residents said that he would like to go to bed later but didn’t think he could. Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Residents are protected by the homes adult protection procedure and staff have attended training in how to protect vulnerable adults. EVIDENCE: Since the last visit to the home the manager has responded to an adult protection alert in accordance with the homes own Adult Protection Procedure and the West Sussex Multi-Agency Policy for protecting vulnerable adults from abuse. This incident is still under investigation, CSCI have no further involvement in this investigation. Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,23,24 Queen Alexandra Hospital Home is in a good location, which enables residents to have access to the local community. The property is well maintained but areas of the older building are in need of updating and redecoration to ensure residents comfort. The home has provided more single bedrooms to offer privacy to residents who have made a choice to have single accommodation. EVIDENCE: Since the last visit to the home the building project has been completed and is now occupied by residents on the upper floor and the physiotherapy unit and occupational therapy unit on the ground floor. All bedrooms in the new building have en suite facilities and the additional bathrooms and toilets are modern and are well equipped with aids and adaptations to maximise independence. The older building bathrooms and toilets are in need of upgrading with the exception of some facilities in the ward areas. The next phase of the upgrading of the home will include upgrading and relocating the out of date facilities. Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 14 The number of single bedrooms available at the home is now 36 and in the remainder of the home there are fewer residents sharing accommodation. On the day of the visit there were 17 residents sharing bedrooms. Those residents moving to the new single bedrooms have begun to personalise their rooms but in the remaining accommodation residents sharing rooms have limited areas to make their own. The new single rooms meet the National Minimum Standards for Older People with regard to individual accommodation. Residents spoken with confirmed that they had been offered a choice about moving to the new accommodation and some residents had declined the offer because they preferred to share. Others commented that they felt isolated not sharing accommodation. Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, The staffing numbers are set at level, which allows residents assessed needs to be met EVIDENCE: There is qualified nursing staff working at the home all day and night supported by well trained care staff. Each of the three units has named staff assigned each day and night. The night staff spoken with at this visit felt that they were able to meet the current residents needs but did comment that they felt better equipped when there were three qualified nurses on duty at night across the three units. Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 16 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): 33,37,38 The majority of the homes record keeping ensures that residents rights and best interests are protected. Alexandra Hospital Home provides an environment, which promotes the health, safety and welfare of residents and staff. EVIDENCE: Residents meetings are held at the home and the minutes of the last meeting were viewed on the notice board in the lounge. Residents say that they usually see the manager around the home on most weekdays and know that they can talk to their named nurse or key worker if they have a problem or are not satisfied with some aspect of their care. The Responsible Individual on behalf Queen Alexandra Hospital Home is based at the home and provides CSCI with monthly reports. In addition to the statement of purpose and service user guide the home has produced an information file, which is available in the new entrance to the home. Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 17 Although Queen Alexandra Hospital Home has a quality assurance system in place the manager confirmed that residents have not been formally surveyed recently to seek the views of residents to see if they feel that the home is meeting its aims and objectives and Statement of Purpose of the home. All records viewed at this visit with the exception of medication records were in good order. Security of the home and maintenance of self-releasing door guards were discussed with the manager and responsible individual. No other health and safety issues came to the attention of the inspectors at this visit. Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 18 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 X 4 4 3 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 4 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 3 3 3 2 2 x x STAFFING Standard No Score 27 3 28 X 29 X 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X 2 2 Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action 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. 3. Refer to Standard OP37OP9 OP33 OP38 Good Practice Recommendations Hand written changes to medication or doses on the medication record charts should be referenced to the current prescribes directions. Resident’s anonymous quality assurance surveys should be carried out annually. Security systems should be regularly reviewed to protect residents and staff working at the home. Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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. Extracts may not be used or reproduced without the express permission of CSCI Queen Alexandra Hospital Home DS0000024198.V279473.R01.S.doc Version 5.1 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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