Care Home: Alexander House

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What the care home does well The home provides an open, relaxed and pleasant environment where residents are able to approach staff and the manager without formality. The staff, which includes the manager were seen as good listeners and it was clear they had a good relationship with residents and had a good working knowledge of the individual disabilities. The comments from the completed residents surveys sent to them by the Commission were positive and confirmed that they felt happy and comfortable in the home. What has improved since the last inspection? The home continues to look at what activities they can provide in an attempt to meet the diverse needs of the residents. At the time of the inspection they were looking at planning craft sessions and they had acquired the necessary equipment. The introduction of the homes surveys, together with residents meetings should ensure that all residents` views are known and acted upon. What the care home could do better: Care plans could be more specific and indicate the precise objectives that the home is attempting to achieve. Ensure all staff have accredited training for the management of medicines. Ensure that there is sufficient staff on duty to meet the needs of the residents. CARE HOME ADULTS 18-65 Alexander House 16 Tivoli Road The Park Cheltenham Glos GL50 2TG Lead Inspector Mr Tim Cotterell Unannounced Inspection 10 and 15th October 2007 10:00 th Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 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 Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 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 Adults 18-65. 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. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexander House Address 16 Tivoli Road The Park Cheltenham Glos GL50 2TG 01242 513525 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) Dr Ahmed Elbanna Mrs Lesley Elbanna Mrs Lesley Elbanna Care Home 9 Category(ies) of Learning disability (5), Mental disorder, registration, with number excluding learning disability or dementia (3), Old of places age, not falling within any other category (1) Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2006 Brief Description of the Service: Alexander House is a three storey period town house with accommodation for eight adults with a range of disabilities. The home is conveniently situated in Cheltenham, which enables service users to access local community facilities. Service users also have access to transport that is provided by the home and this enables them to access facilities in several other local towns. The home is staffed 24 hours a day, seven days a week. Family and friends are welcome to visit the home at any time and service users can meet them in private if they wish to. In general the service users organise their own activities, but sometimes the manager will organise trips or activities. Service users access a local College and Day Services. The weekly fees of the home are from £450 to £800 Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The inspection was undertaken over two visits by one inspector, the first unannounced and the second announced. On both occasions the registered manager was on duty. All staff on duty on the two occasions were seen and spoken to individually. All of the communal areas were seen and a number of the bedrooms. The following records were seen, personal monies, medication, fire safety, care plans and an assessment of need. A number of the residents survey forms sent by the Commission to residents were returned. All of the residents were spoken to, many were seen in the privacy of their bedrooms. What the service does well: The home provides an open, relaxed and pleasant environment where residents are able to approach staff and the manager without formality. The staff, which includes the manager were seen as good listeners and it was clear they had a good relationship with residents and had a good working knowledge of the individual disabilities. The comments from the completed residents surveys sent to them by the Commission were positive and confirmed that they felt happy and comfortable in the home. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs and wishes of the residents are fully known before admission through a thorough assessment. EVIDENCE: The home usually admits residents who have been referred by the NHS Partnership Trust who have completed an assessment and provide a plan of care. The home then undertakes an assessment of need and completes a homes plan of care, which covers all of the needs of the residents. Where residents are privately funded the home would undertake its own assessment of need. The pre admission procedure is undertaken carefully and the new resident is able to visit a number of times before any final decision is made. It was evident that the home tries to ensure that the placement will be successful by giving the new resident ample time to decide if they are going to like living at Alexander House. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Objectives of the care plans are likely to be more easily achieved where they are specific and measurable EVIDENCE: All residents have a plan of care and two were inspected. The plans are relevant and written in a clear way although not all of the objectives are measurable and the type/level of staff intervention not always clear. It may be helpful to consider a plan, which, identifies the problem, sets an objective to be achieved and finally explains the role of staff in achieving the objective(s). A number of “health” care plans produced by Gloucestership Partnership Trust were seen and the manager advised the inspector that these plans are added to into the homes plan of care. One of the homes care plans, under the mental health section, states that “staff to continue with objectives and staff intervention” however there is no specific objective or written advice about staff intervention. All plans are reviewed every six months and evidence was Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 10 seen of the updated plans. Staff spoken to had a good understanding of the problems associated with the disabilities of the residents. If tobacco/cigarettes are held by staff until some household jobs are done this must be recorded in the plan of care. The majority of residents require support in their daily lives, however there was evidence that they are able to influence what they do and where they go. One example was where one resident, subject to the weather, goes out for the day with a packed lunch and enjoys visiting other villages and towns nearby. The residents meetings provide an opportunity for residents to comment on life and services in the home, however, it has been some time since the last one was held. It is recommended that the meetings are held on a more frequently, and the frequency should be determined by the needs of the residents. Residents are able to make decisions about their lives and where necessary staff provide support and advice. Many of the residents manage their own personal monies and a number have relatives to assist. A number of the residents are able to go into town on their own and the home encourages responsible risk taking by discussing proposed trips to ensure the journey is manageable. There are some residents who like to go out but need staff support, and the frequency of trips was brought to the attention of the inspector with a number of residents saying they would like more trips into the community, which are supported by the staff. If there was a need to risk assess a particular event the home stated that they would consult the Community Learning Disability Team. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 15 16 and 17. good. This judgement has been made using available evidence including a visit to this service. The home is attempting to provide a range of activities to meet the changing needs of the residents. The support provided by staff ensures links are maintained between residents and families/friends EVIDENCE: The majority of residents are above the retirement age and whilst there are options for them about how they spend their day, they appear to enjoy a relaxed lifestyle with many spending long periods of time in the home. A number also enjoy the ability to walk in the local community and access Cheltenham town. The home has introduced a number of activities to provide stimulation eg. exercise sessions, gardening project, shopping and massages. It is now looking at introducing craft sessions. Whilst it is accepted that Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 12 residents must determine how they spend their time it was felt that for many, more opportunities during the day would be seen as helpful. The college and day centres were used but at present are not seen by some of the residents as being appropriate A number of the residents can walk into town and are able to use the local facilities independently; others require support and guidance from staff when outside the home. Where residents have friend’s/families the home provides practical support to ensure links are maintained. One resident regularly visits a friend and friends are welcome in the home. The rights of the residents are recognised and they are able to have keys to their bedrooms and the front door of the home. Whilst the home has encountered problems with this system they have continued to ensure that wherever possible, residents are able to exercise this important aspect of their independence. The home provides three main meals a day and residents were seen eating their teas on the first day. The meals appeared adequate and well presented and residents told the inspector that they enjoyed the food. Whilst there is a fixed four-week menu residents are always able to have an alternative, and after speaking to the residents and staff it was evident that the home were aware of the likes and dislikes of the residents. The kitchen is accessible to residents between mealtimes and they are able to make a drink/sandwich without asking staff. A number of residents made tea between meals and they clearly enjoyed this degree of independence. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18.19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The support provided is based on individual needs and wishes. Residents would be safeguarded when all staff have received accredited training in the management of medication. EVIDENCE: The home supports residents in a manner which responded to their individual needs and wishes and their dignity and privacy was respected. There is an individual record of all health care received and a number of records were seen. The records are held separately from the care plans and as it is possible that the two records may be related it is recommended that the system of record keeping is reviewed. The staff spoken to had considerable knowledge about the respective health care needs of the residents. The records indicated that where dentist/hospital treatment was required this was done with considerable thought and the appropriate support. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 14 At the time of the inspection there was no “self medication” and there was a record of the receipt, administration and disposal of medicines, the medication is kept in a locked cabinet. Staff have received basic training in respect of the administration of medicines, however Standard 20 (National Minimum Standards) states that staff who administer medicines should receive accredited training which includes confirmation that staff are competent. There had been an error in administering medicines by staff earlier this year and the registered manager provided additional training for the staff involved. The Inspector discussed the number of falls experienced by residents with the registered manager. It was pleasing to note that the home had already taken action to reduce the frequency. The action included, referral to the local hospital for advice and contact with the Community Learning Disability Team. In both cases causes had been identified for the falls and action taken, which to date had reduced the frequency of falls. The home appreciates that it is their responsibility to provide a safe environment for the residents. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff are good listeners and listen to any concern/complaint and would record and investigate without delay. Staff in the home treat residents in a dignified manner. The home provides a safe environment where residents are protected from abuse. EVIDENCE: The home has a written complaints policy and this indicated how complaints can be made. There is a copy of the procedure on the notice board in the entrance hall of the home. Many of the residents may have difficulty in fully understanding the written procedure and every effort should be made to ensure the procedure is clear and simple. There had not been any complaints since the last inspection. The management of personal monies was discussed and the manager advised the inspector that the only monies managed referred to the Disability Living Allowance. There is a record of the receipts and also the deductions made by the home for the cost of the transport provided. The balance of the allowances are passed in cash weekly to the residents. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 16 The Registered Manager told the Inspector that staff had received training in the identification of abuse. It is recommended that the home contacts the Training Department of Social Services (Gloucester County Council 01452 425000) to enrol for more comprehensive training which is provided by them. What is seen as abuse may change over time and it essential that staff are aware of what constitutes abuse to ensure vulnerable residents are safeguarded. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and pleasant physical environment where residents are able to access all areas. EVIDENCE: The front and rear gardens have been well maintained and the patio area at the back provides a pleasant alternative. The vegetable garden, which is at the back of the home has proved successful and it is hoped to repeat the exercise next year. All of the communal rooms were seen together with the majority of resident’s bedrooms. A number of bedrooms had been personalised and staff should be complimented on their attention to detail. The communal rooms were in good decorative condition. The lounge on the first floor was pleasantly decorated but seemed to have little use; perhaps this could be discussed with the residents to determine how it could be best used. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 18 The landing wall on the first floor has been damaged and should be repaired without further delay. In one bedroom on the first floor the lower wall/skirting board needs attention (small bedroom). In view of the growing dependency of the residents the registered manager invited an Occupational Therapist to assist and advise, and one resident now has additional equipment in an attempt to reduce/prevent further falls. One resident was unclear about which call bell to use, as there were two in his bedroom. The home must ensure that residents are aware of the call bell and given further advice about how and when they can be used. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32.34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home should review the needs and wishes of the residents to ensure there are enough staff on duty, specifically at some points during weekends. EVIDENCE: The registered manager who is one of the joint providers was on duty during the two visits. All of the staff who were on duty during the two visits were seen and spoken to individually. Staff were seen as competent and caring and had a good relationship with the residents. There is considerable flexibility for residents about what they do and staff were seen as supporting and guiding rather than attempting to direct. The inspector was advised that not all staff have completed the accredited training for the administration of medicines although the basic Monitored Dosage System training had been done. It is essential that all staff who manage and administer are seen as competent. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 20 The home accommodates residents who may have a mental disorder and or a learning disability and it is recommended that the registered manager seek the advice of the NHS Partnership Trust in an attempt to identify appropriate training for staff. The details of a recent appointment were seen and the required documents were inspected. There is a standard application form, references are taken up and a completed criminal disclosure was seen. It is recommended that the reference request forms include a brief description about Alexander House and of the position sought by the applicant. The registered manager advised the Inspector that during the day there were usually two support staff but at times this would increase to three. During the night one member of staff was “sleeping in””. However the staff rota supplied by the home indicated that on three weekends out of four (weeks 2/3/and 4) there was only one member of staff on duty during the period 08:00-20:00. The weekends are periods when everyone is at home and there is little organised activities in the community (e.g. day centres and colleges). In the circumstances the home should review the needs of the residents at this time to ensure needs and wherever possible wishes are met. One of the aims of the home is to provide more trips out and for this to happen at weekends will have implications for staffing. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37.39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well run and resident’s views are sought and wherever possible influence the practice of the home. Health and Safety matters are treated with importance and ensures the safety and wellbeing of the residents. EVIDENCE: The home has undertaken a number of surveys and at present they are only addressed to the residents who are asked to comment on a range of issues, which affect their daily lives. One of the topics of interest from the last survey referred to comments on the food provided and the home has responded to the wishes expressed. It recommended that the survey, which is undertaken annually, is also sent to relatives, friends and other health care professionals. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 22 The home was found to be run in an effective way and it was evident that the registered manager supported residents to comment on how they would like the services of the home to be provided. It was evident that the registered manager who is also one of the registered providers had a good knowledge of the needs and wishes of the residents, and was making great efforts to provide a caring and comfortable environment. Health and Safety issues have been addressed and there is a record of the independent tests to the fire equipment. Staff have also recently completed a days fire training which resulted in certificates of competence for staff, a number of the residents were also involved in the training. There is a fire procedure and staff have regular drills to include practicing leaving the home. It is recommended that day staff are instructed in fire procedures every six months and night staff every three months. Íf the fire procedures include a “stay put” procedure this is not seen as being appropriate, and in the circumstances you are requested to discuss the procedures with the Fire and Rescue Services to ensure that the policy and procedure of the home is seen as appropriate. Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 24 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA35 Regulation 18 Requirement Timescale for action 31/03/08 2. 3 YA33 YA42 18 23 The Registered Person must ensure that all staff have appropriate training in the management of medicines. The Registered Person must 30/12/07 review staffing levels to ensure individual needs are met. The Registered Person must 30/12/07 ensure that the fire procedures are appropriate and effective and consult with the Fire and Rescue Services. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Gloucester LO 1210 Lansdown Court Gloucester Business Park Brockworth Gloucester GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Alexander House DS0000016359.V345668.R01.S.doc Version 5.2 Page 26 - 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. 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