Care Home: Alexander Court Care Centre

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What the care home does well The registered provider has in place, good quality assurance systems to ensure that the service is monitored and developed. Despite the challenges faced during the replacement of the registered manager, the organisation worked diligently in aspiring to provide a good standard of service at Alexander Court Care Centre. Complaints were handled robustly and in line with regulation. Residents and their relatives were very pleased with the improvement in the quality of the activities provided. They were also complimentary about the staffing efforts, naming staff not only from the clinical team, but also reception, administration and maintenance. Relatives and residents were very pleased with the care and support with regards to; `End-of-Life` care in the home. Residents reported that food was better with more choices available. The home was clean, hygienic and free from offencive odours despite its size and the range of complex needs that were provided for. What has improved since the last inspection? All forms of medication including insulin were appropriately stored. The quality of food provided was better, taking into consideration the diverse needs of the residents. Staffing deployment had improved to ensure that residents received prompt and timely attention at peak times for example - meal times, and during activities. Staffing recruitment was more robust, ensuring that an audit trail of appropriate references was maintained for all staff. What the care home could do better: The registered persons should ensure that more of the care staff are supported to acquire at least and NVQ Level 2 in Care or Health and Social Care. This should be in line with the minimum requirement of fifty per cent. Key inspection report Care homes for older people Name: Address: Alexander Court Care Centre 320 Rainham Road South Dagenham Essex RM10 7UU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Stanley Phipps     Date: 2 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Alexander Court Care Centre 320 Rainham Road South Dagenham Essex RM10 7UU 02087090080 02085937584 alexander@schealthcare.co.uk www.schealthcare.co.uk Southern Cross (LSC) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Kaleechurun Daby Type of registration: Number of places registered: care home 82 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of people who can be accommodated is: 82 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 20) Physical disability - Code PD (maximum number of places: 12) Dementia - Code DE (maximum number of places: 50) Date of last inspection Brief description of the care home Alexander Court is a purpose built care home providing nursing care for 82 adults. The home is registered to care for three different service user groups. People who are over Care Homes for Older People Page 4 of 28 Over 65 0 20 0 50 0 12 Brief description of the care home the age of 65 years and physically frail or who have a diagnosis of dementia and people who have a physical disability. The home is operated by Southern Cross Limited a company, which operates similar homes across the country. The home is situated in Dagenham and has good access to local facilities and transport links. The home is divided into five separate units and all rooms have en suite facilities divided into 5 units. Accommodation is in single bedrooms with en-suites and a passenger lift services all floors. The fees for the home are between £544.00 and £1100.00 per week. A copy of the Statement of Purpose and Service User Guide to the home is made available to both the resident and their family. A copy of both these documents and the most recent inspection report are available at the main reception and on request. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection of the service which was carried out on the 25/11/09. At the time of the visit, the newly registered manager Ken Daby and his deputy were available to assist with the process. Detailed discussions were held with; both managers, nursing and care staff, the activity coordinator, kitchen and laundry staff, and the administrator. A number of residents and visiting relatives were also spoken to about the services provided at Alexander Court Care Centre. Observations were carried out on; various practices, to include clinical and activities with an emphasis on the quality of interactions between the management, staff and, residents and their relatives. An assessment was carried out on: the building and facilities to include the laundry and main kitchen, activities, medication practices, all records required by regulation to include - care plans, risk assessments, staffing recruitment/rosters, medication, health and safety,complaints, maintenance, incidents/accidents, complaints/compliments, Care Homes for Older People Page 6 of 28 staff training and, residents financial records. The inspection also considered information provided through Regulation 26 monthly provider reports, Regulation 37 reports on significant events affecting residents welfare, surveys returned by residents/relatives and information provided in the Annual Quality Assurance Assessment (AQAA) document provided by the registered manager. Comments from external professsionals were also considered as part of compiling this report. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 28 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to benefit from having a pre-admission assessment carried out to determine the suitability of Alexander Court Care Centre in meeting their needs. This assessment forms the basis of delivering their care and support. Alexander Court does not provide intermediate care. Evidence: From the five care plans sampled, detailed assessments were in place for each of the residents. They were carried out initially by the registered manager and the deputy who have the skills and expertise to so do. Where possible residents and/or their representatives were involved in this process to ensure that every opportunity was given to capture the diverse requirements for each of the individuals concerned. The information captured at this stage is used to develop and inform a care plan for each resident. A lot of emphasis is placed on assessing the specialist needs of residents whether it be dementia sufferers, someone with a physical disability or individuals with Care Homes for Older People Page 11 of 28 Evidence: end-of-life needs. In most cases and where appropriate information from the placement authority is obtained, which also helps to gather as full a picture as possible, of each of the residents needs. The assessment process undertaken ensures that residents are admitted on the basis that their needs could be met at Alexander Court Care Center. Intermediate care is not provided at Alexander Court. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to have their personal, health and social care needs detailed in a care plan, which is used by staff to deliver their individual objectives. They get good support with their health care and are treated with dignity and the utmost respect by the management and staff. Residents and their relatives were extremely pleased with this, along with the support given with End -of- Life care. Evidence: From the care plans sampled, they were found to be comprehensive and detailed covering the personal, health and social care needs of residents. It was noted that there were improvements around the social care component of the care plans, which could be supported from the fact that activity plans were in place for the residents. Care plans were updated and reviewed monthly and this included changes that arose out of hospital admissions. All care plans were devised from the assessments carried out on each resident. The standard of care planning is maintained through weekly audits (five per week) undertaken by the homes management. Residents and relatives were very pleased the care planning process in the home. Care Homes for Older People Page 13 of 28 Evidence: There were health care records for each resident in the home and various samples were assessed for example: dementia care, tracheostomy care, diabetic and pressure sore care. The information held was again, very detailed, with clear actions and records in place to demonstrate how the home was meeting individual residents needs. In discussion with two senior nurses from two separate units, their knowledge and understanding of the care provided to an individual in one case with a tracheostomy, and another with Dementia, indicated that they understood what was required to maintain the health and well-being of the individuals concerned. Where external input was required for example; referrals for specialist interventions from the psycho-geriatrician or speech and language therapist, staff acted in a timely manner to promote the health of the residents concerned. There was evidence of the involvement of the tissue viability nurse, the palliative care nurse, dietitian, opticians, chiropodist, dentist and the diabetic nurse specialist. Monitoring charts such as: blood glucose, weight, turning, pain and fluid intake/output charts were effectively maintained. One relative commented: The staff monitoring of my mums pain is exceptional and it is very reassuring seeing her comfortable even at this difficult stage of her life. A key aspect of promoting residents health care is the support provided with medication and staff were guided by an updated policy and procedure. The staff responsible for medication were appropriately trained and kept updated with frequent refresher training. Staff interviewed were very knowledgeable of the drugs they were administering in relation to each resident. The storage of medication of medication on all areas was appropriate including the storage of insulin and controlled drugs. Controlled drugs were audited on a daily basis with monthly external audits on all medication carried out by BOOTS (Medication Supplier). The administration of medication was observed on Bluebell and staff practices were clinically sound. Throughout the inspection residents were observed engaging with staff at various points in time. On all occasions, staff demonstrated sensitivity and respect during their interactions with residents. They were observed encouraging and reassuring residents without compromising their privacy and/or dignity. Their levels and quality of interventions were supported by having effective and updated risk assessments in place for each resident, along with a sound induction and training programme. The feedback received from residents and their relatives was very positive in this area. Residents and their relatives do benefit from a service that caters extremely well for their full range of needs including, during their final moments. In this respect a number of End-of-Life plans were in place and used by staff as working tools in Care Homes for Older People Page 14 of 28 Evidence: promoting comfort and peace to residents and their relatives. On the day of the visit there were up to three deaths in the home and the staffing engagement with relatives and the residents was exemplary. The Liverpool Care Pathway model was the tool used in providing end-of-life care and staff demonstrated a good understanding of its application. A number of compliment cards were viewed on a file at the home, commenting on the support, dignity, comfort, sensitivity and understanding that was provided by the management and staff at the home. This is a strong area of the homes operations. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to enjoy activities that are suited to their cultural, social and religious interests. They are also supported to maintain their friends and family networks, and are supported to exercise choice and control in their lives. Improvements in the management and presentation of meals now ensure that residents nutritional needs are met in a manner that is best-suited to them. Evidence: At the time of the visit an activity coordinator was responsible for the delivery of activities in the home. It was clear that a well-established programme was in place for group participation, with good arrangements in place to stimulate those residents that were less able to operate in groups. The designated activity room remained wellequipped and a large number of residents were observed happily engaged and stimulated in a group activity that they had chosen. A log of activities was maintained with pictures to support the wide range of resident-engagement in activities and this included regularly planned visits by professional entertainers. The concept of themed activities continued and now featured: a Caribbean night, an Italian night, a Mexican night and a Cockney night. From the pictures seen residents were indeed enjoying their experiences with the arranged activities. Films are still Care Homes for Older People Page 16 of 28 Evidence: quite popular in the home and there was evidence of outdoor trips e.g. day trips to Southend. A range of garden furniture has been purchased to encourage residents wishing to sit out in the garden. Festivals were also celebrated to include a summer fete and Halloween. Birthday celebrations were held for residents and friends and families are usually invited to take part. It was positive to see life stories being developed, as this enabled staff to be more intricately involved in supporting residents in their activities. From observation, it was noted that residents rights were promoted. There were various avenues for consultation to ensure that a satisfactory balance is maintained in promoting residents choice, safety and freedom. They included: risk assessments, relatives and residents meetings, residents reviews and opportunities to meet with the manager on a daily basis or as necessary. As such, residents regardless of their differences were able to use and enjoy the facilities in the home without compromising either safety or their independence. This could further be evidenced by the fact that some residents actually go out to church, while others enjoy services internally, which also includes receiving the holy communion. Residents also have access to a beauty therapist who comes in once per month. Good systems were in place to enable residents to take control over their lives. There was a general improvement in the way in which meals were determined and presented, since the last inspection. It was noted that residents now have up to three choices for their evening meal. There was a better deployment of staff to ensure that residents were not left waiting around for their meals. Meals including special diets were more attractively presented and residents and their relatives informed that the quality of the food provided had improved. Staff were observed supporting residents in a sensitive manner with their meals. Residents also had access to smaller food portions and pictorial menus were used for individuals with specialist communication needs. The dining areas were clean and well-presented and on visiting the main kitchen, it was noted that a clear system was in place to provide for the specialist dietary needs of residents. Food storage and the hygiene in the kitchen was good, as were health and safety practices adhered to by the catering staff. The head cook demonstrated an understanding of the residents needs and sound arrangements were in place to ensure that food supplements were available to those residents with concerns related to: weight-loss, a diminished appetite or reduced food intake. There was a good supply of fresh fruit and vegetables with hot and cold drinks widely available to residents. Ninety-six per cent of the feedback received from residents and their relatives was positive about meals in the home. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives have access to a complaints procedure and feel assured that their concerns and/or their complaints would be looked into. Sound protocols and practices were in place to ensure that they are protected from the risk of harm or abuse. Evidence: The complaints log was examined and it detailed each complaint, the action taken and each outcome. At the time of the visit, only one matter was outstanding in that a response from the complainant was being awaited. It was noted that concerns were also recorded in the central log. An updated complaints policy and procedure was in place and widely available to all residents and their relatives. Staff spoken to understood their role in supporting residents to complain should they be unhappy with any aspect of the service, The registered manager used complaints as part of quality assuring the service. Both written and verbal feedback received from residents indicated that they knew how to complain. There was evidence that staff did have safeguarding training, including refresher training. An updated safeguarding policy was in place and available to all staff. The inspector spoke with various levels of staff, all of whom demonstrated a sound understanding of their role in safeguarding vulnerable adults. Residents are also safeguarded through the robustness in staffing recruitment and rigorous health and safety practices in the home. There was one safeguarding matter outstanding at the Care Homes for Older People Page 18 of 28 Evidence: time of the visit, which was reportedly unsubstantiated. Residents have been generally free from the risk of harm from abuse. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ar Alexander Court Care Centre, residents live in an environment that is welcoming, clean, accessible, comfortable and maintained in line with their needs and expectations. Evidence: A tour of the building was undertaken, including some of the bedrooms by the invitation of residents and/or their relatives. The environment was in a satisfactory state of repair and residents were observed at different points safely accessing it, with or without staff support. Improvements had been planned for the Dementia units (Daffodil, Blossom,and Jasmine), with regard to colour schemes. However, signage and appropriate pictures were in place on these areas. The overall quality of furnishings in the home, was satisfactory. It was noted that only one relative indicated that her mothers room could be better maintained. A maintenance officer remains in place to deal with minor repairs and a maintenance and redecoration plan was in place for the home. On the day of the inspection the home was clean and free from offensive odours. The laundry area was assessed and found equipped with facilities suited to meet the demands placed on it. Dedicated laundry staff were in place to look after the laundering needs of residents. There was evidence that they had appropriate training in health and safety, which included the handling and storage of chemicals to carry out Care Homes for Older People Page 20 of 28 Evidence: their roles. A good supply of Personal Protective Clothing e.g. masks, gloves and aprons was in stock and available for use. Health and safety signs were appropriately displayed throughout the home including the laundry area, which had appropriate floor coverings. Hand washing facilities were widely available to staff and the home did comply with the Water Supply Regulations 1999. There were no concerns raised either by residents or their relatives about the laundry services provided by Alexander Court Care Centre. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the benefit of receiving services from a staff team that is suitably trained, skilled and appropriately deployed to work with them. Improvement in recruitment practices now ensure that residents do not come into contact with staff that may be unsuitable to work with them. Evidence: The staffing roster was examined and from all indications, the levels and numbers of staff on duty were generally sufficient to meet the residents needs. At the time of the visit, up to five additional staff were going through the recruitment process i.e. two trained staff and three carers, as part of increasing the staff pool. There was a better deployment of staff at mealtimes and during activities, which residents and their relatives were very happy with. The registered manager and his deputy worked well to ensure that residents needs were kept under review, particularly in relation to those on the specialist units i.e. Dementia, and Young Physically Disabled. The overall impact on residents included a lower incidence of: falls, safeguarding issues, concerns about staffing levels, and an improved level of satisfaction in relation to the response time to call bells. Staff training records were examined and as an organisation, Southern Cross Limited demonstrated a clear commitment to staff training and development in providing a good service. A training and development plan was in place, which included all layers Care Homes for Older People Page 22 of 28 Evidence: and levels of staff including clinical and ancillary staff. Clinical staff had key training such as: moving and handling, fire safety, safeguarding adults, nutrition, medication, pressure area care, infection control, food hygiene and nutrition. More specialist training was provided in areas such as; Diabetes, Palliative Care, End-of-Life Care, Dementia Care, naso-gastric feeding and the Mental Capacity Act. It was encouraging to see both the care and maintenance staff receiving training in the safe use of bed rails, as this would enhance residents safety where they are used. At the time of the visit just under fifty per cent of the care staff had achieved an NVQ Level 2 in Care. The registered persons should ensure that more staff are supported to undertake this training to comply with the minimum requirement of fifty per cent, which is also more likely to improve the quality of service they provide. Residents and their relatives were generally pleased with the skill and expertise of the staff group in delivering the service. The files of four of the most recently recruited staff files were examined to determine the robustness of Southern Cross recruitment practices. There was an improvement in that where a verbal reference was taken appropriate documentation was in place to support this. Staff spoken to, confirmed that they had a face to face interview and completed an application form as part of their recruitment. Staff were not recruited to the service without:satisfying robustness checks in their right to work in the United Kingdom, undergoing a Criminal Records Bureau and a Safeguarding of Vulnerable Adults(SOVA) first check, and for nursing staff - having their statement of entry and PIN number validated by the Nursing and Midwifery Council. All staff were also subjected to a detailed induction and the completion of a satisfactory probationary period. These measures are in place to ensure that the most suitable staff are employed to deliver the service. The skill mix of the staff team remains diverse both in terms of gender and ethnicity. Although the staff diversity did not accurately reflect that of the resident group, the staff team including the activity coordinator and the administrative staff were wellaware of the diverse needs of the residents. Most of the feedback received was very complimentary of the staffing impact on the service which included inputs from: the receptionist, the administrator, the care staff, catering and the maintenance officer. Residents and their relatives were confident that the guidance, supervision and direction of the staff team provided a good service at Alexander Court Care Centre. Two of the areas that stood out in terms of meeting diverse needs were in activities, which included the celebration of religious festivals, and End-of-Life support. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite changes in management, sound systems remained in place to ensure that the service is run in the best interests of residents. Good quality assurance, and financial systems also ensure that the service is developed and, residents safeguarded. Health and safety policies and practices make Alexander Court Care Centre a safe place to live and work. Evidence: At the time of the visit the registered manager Mr ken Daby was in post. His appointment though recent, seemed to have had a positive impact the registered persons plan to drive up standards in the home. Despite the fact that he was experienced and qualified to carry out his functions, senior management support was put in place to ensure improvements in the home. Mr Daby did have an understanding of the diverse needs of the resident group and throughout the inspection maintained a good rapport with relatives, residents and all layers of staff. He also demonstrated a commitment to improving customer care, and feedback received from residents, their relatives and external agencies was positive. More importantly, the staff team Care Homes for Older People Page 24 of 28 Evidence: appeared motivated and on board in improving the service. There was a number of quality assurance systems in place to monitor and improve the service. One such system was the Regulation 26 monitoring visits that were not only regular, but followed up routinely by senior management, as a way of improving the service. Residents surveys were also carried out and care review outcomes were used as a measure of progress, particularly by placing authorities. Care plans, financial, medication, and internal audits, along with the monitoring of complaints/accidents/ incidents also effectively served to improve outcomes for residents living at Alexander Court Care Centre. Staff meetings and staff supervision were regular and a development plan was in place for the service. The inspector examined the financial records held by the administrator for residents, and found that they were well maintained. A good audit trail was in place for monies used with receipts held for the movement of funds from personal accounts. The actions were in line with the financial policies and procedures of the organisation. Computerised records were also held and they too were found in order. The administrator had a sound understanding of the systems used and from the assessment carried out, the inspector was satisfied that residents financial interests were safeguarded. Her work was subject to regular audits carried out by senior staff in the organisation, which adds to the safeguards already in place. Secure facilities were available for storing residents monies and valuables. The feedback received from relatives about the administrators input was very positive, which by extension reflects the organisations commitment to safeguarding residents. An updated health and safety policy and procedure was in place and widely available to all staff. Health and safety practices were of a good standard, which was a result of regular internal and external health and safety monitoring in the home. Health and safety training formed a key part of staff induction, with refresher training provided as appropriate. Staff spoken to had a good understanding of their role in promoting safe practices in the home. A wide range of health and safety records were examined relating to: gas/electric, Legionella, risk assessments, fire safety, emergency lighting, lift and hoist maintenance and servicing, accidents/incidents, portable appliance testing, wheelchair maintenance and fridge/freezer temperature monitoring. It is fair to conclude that the health and safety systems and practices in the home ensured that Alexander Court Care Centre remains safe and fit for purpose. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 28 The registered persons should ensure that a minimum of fifty per cent of the care staff pool, acquire at least an NVQ Level 2 in Health and Social Care, or Care. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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