Care Home: Alexander Lodge

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What the care home does well The home offers a very warm and friendly atmosphere and that has been echoed in the surveys received form service users who live at the home, as well as the visitors to the home spoken to on the inspection day. Comments received included, "Alexander Lodge is a happy and caring home", "when I visit it feels like a family home, the management and staff are friendly and helpful", "I am very happy here" and "its not all posh and fussy, its like a home from home". Comments about the home also included the fact that it is kept clean there are never any smells. Service users and the surveys confirmed that meals are cooked fresh and enjoyed by service users. The home`s staff provide activities and outings, service users said there is always something to do if you want to join in, but you don`t have to. The staff at the home keep a record of outings producing a booklet with story and photos so that service users can show their families where they have been. Staff can also use these booklets for reminiscence, with service users enjoying talking about there trips out. What has improved since the last inspection? Areas of the homes environment have been refurbished and en-suites facilities seen at the last inspection which need to be finished have now been completed. The manager has a rolling programme of redecoration. The service user`s care plan documentation has improved showing service users have an active roll in there care planning. Risk assessments were seen to be in place along with the management strategy to minimise the risk. The home is now following a robust procedure when recruiting new staff What the care home could do better: There were no requirements made, but it was recommended that the manager ensures that copies of all staffs training certificates are available on file. Key inspection report Care homes for older people Name: Address: Alexander Lodge 41 Skinners Lane Ashtead Surrey KT21 2NN     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: Sally Hall     Date: 1 2 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 25 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Alexander Lodge 41 Skinners Lane Ashtead Surrey KT21 2NN 01372276052 01372813293 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Izette Aeon Davis, Mrs. Desline May Davis care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 12. The registered person may provide the following category/ies of service only: Care home only - PC 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 - OP Dementia - DE Date of last inspection Brief description of the care home Alexander Lodge is a large detached house, situated close to the local amenities of Ashtead. The home provides accommodation and personal care for up to twelve service users in the category of older people, whom may have dementia. The accommodation currently consists of twelve single bedrooms many with an en-suit toilet, dining room, a lounge with a conservatory, and appropriate laundry and kitchen facilities. A small garden is situated to the rear of the home and parking for approximately four vehicles is available to the front of the property. The fees for this Care Homes for Older People Page 4 of 25 Over 65 0 12 12 0 1 2 1 1 2 0 0 8 Brief description of the care home service are available on request. Care Homes for Older People Page 5 of 25 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: We agreed and explained the inspection process with the Registered Manager at the start of the inspection. The focus of the inspection was to assess Alexander Lodge in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. We used a varied method of gathering evidence to complete this inspection, preinspection information such as the previous report and discussion and correspondence with the registered provider was used in the planning process to support the inspector to explore any issues of concern and verify practice and service provision. The home had completed an AQAA, an annual quality assurance assessment questionnaire, which was received prior the site visit to the home. This provided us with information relating Care Homes for Older People Page 6 of 25 to what the home considers it does well. However the questionnaire was not fully completed and the service did not take the opportunity to state what they could do better, what they have improved within the last 12 months or their plans for improvement. Survey questionnaires were also sent to the home prior to the inspection for distribution to service users, staff and other health professionals, information from these have been included in the inspection report. Documentation and records were read. Time was spent reading of written policies and procedures, reviewing care plans and records kept within the home. Other areas viewed included risk assessments, pre-admission assessments, staff rota, training records and recruitment records. We identified four people who use the service for case tracking, speaking with one of them whilst assessing the available information held in the home pertaining to the care provision for them. In addition the Inspector met with the other People who use the service and their family, which gave her a good opportunity to observe the quality of care being provided by the home and understand the impact the care provision has on their quality of life. Care Homes for Older People Page 7 of 25 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. 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 8 of 25 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 9 of 25 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. Service users can be confident their needs are assessed prior to admission. Intermediate care is not provided. Evidence: Two pre admission assessments were viewed. Evidence from these demonstrated that a pre admission assessment is carried out to enable the manager to make a judgement as to whether the home will be suitable for and can meet the needs of the individual. These assessments include information gathered from care managers and health professionals. Upon admission, assessment is ongoing with the information from all the assessments informing the care planning and risk assessments. Care Homes for Older People Page 10 of 25 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. Service users benefit from being competently assessed and supported with regard to their health and personal care needs. They can be confident all their needs are recorded on care plans and risk assessments which are kept under review and include their wishes and preferences. Evidence: Three care plans were selected at random, all contained evidence of individual needs, with further evidence of regular reviews. The plans were person centred and detailed the care and support the service users would like staff to provide. The reviews are taking place and detail the changes required to meet service users newly assessed needs. There was a record written by staff daily about the care individual service users receive these cross reference with the plans of care and assessments seen. Observation through the day, conversations with service users, their families and surveys received, it was evident that staff do provide a high level of individual care. One service users said its good here because you are given time to do things for Care Homes for Older People Page 11 of 25 Evidence: your self but know staff are on hand if you want them. Risk assessments were seen in response to risks having been identified in the assessment process. This has improved since the last inspection when a shortfall in the risk assessment process was noted. Risk assessments are dated and contained review dates, with evidence of reviews evident. All the service users and their relatives spoken to confirm that their privacy is respected and a staff member was seen to knock on a service users door before entering. Observation of interaction between staff and service users throughout the visit confirmed that privacy and dignity is respected in the home and that communication between service users and staff is comfortable. The manager has undertaken the training regarding Deprivation of Liberty recently, he intends to complete the assessments for the service users in the near future, although currently he believes that no persons currently at the home have their liberty impeded. Several service users during the day said how happy they are in the home. Visitors spoken to said they were more than satisfied with the care their relative receives and praised all staff for the warm and friendly atmosphere in the home. When asked or surveyed about how people felt about the care in the home phrases were used such as, It is so homely, a real home from home. Everyone is treated as an individual, the staff are very caring. You couldnt ask for better care. The staff are so kind and helpful. Evidence was seen on individual files that the home makes arrangements for service users to see the chiropodist, doctors and other health care professionals when they need to. The home uses a pharmacy supplied MDS, Monitored dosage system, where medication is dispensed in a separate packs for each service user. We viewed the storage arrangements and some records including Medication Administration Record (MAR) sheets, however the protocols for the administration of PRN/s When Required Medication were not available. The manager stated that currently none of the service users have been prescribed PRN medication. The medication record sheets observed were completed correctly. A small audit of medication was undertaken and this was correct, showing care staff are administering and recording the medication correctly. The controlled drug arrangements were also viewed and found to meet the current requirements of the Royal Pharmaceutical guidelines regarding medication which care staff have to adhere to. Care Homes for Older People Page 12 of 25 Evidence: Care Homes for Older People Page 13 of 25 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. Service users benefit from being supported to make choices and have a range of activities available to them. Evidence: Service users are supported to live their lives as they choose. Routines are flexible. Restrictions are kept to a minimum particularly important when caring for people with dementia as walking around the home can be extremely important to some individual service users. There is a variety of activities on offer and on arrive it was evident service users were doing what they wanted with two reading the paper, one doing a cross word and three playing dominoes. Service users spoken to said there are always things to do if you want to, and a visitor came in to offer holly communion for service users who wanted it. One service user explained that she has an active role in the garden and she has enjoyed choosing and planting flowers etc. The home arranges outings, these are documented with photos and service users use them to show family and they are used as a reminiscence tool. One visitor explained that their mum never wanted to go out she does now with the home her favourite is going out for lunch. Care Homes for Older People Page 14 of 25 Evidence: There is no dedicated activity organiser with all staff supporting activities through the day. The home employs extra staff to cover outings from the home. The dining room is in a conservatory which is almost part of the garden, it is fully heated, part of the lunch time was observed, staff assisted service users as necessary and encouraged service users to finish their meals. The weekly menu appeared nutritious and the manager explained that service users had been consulted about the menu. There was a choice offered, although all service users all chose the roast pork on the day. The manager explained if they do not like what is on the menu they can have other alternatives. The home can offer meals that takes account any specialist dietary needs. Most meals are home cooked at the home. Service users spoken to after the meal said that they liked it, one said the food is always very nice, another said its Ok, if you like what you are given. However others spoken to or surveyed said the meal are freshly cooked and they enjoyed them. The dining room is well laid out with tables attractively set, with fresh flowers. Care Homes for Older People Page 15 of 25 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. The home has an effective complaints system in place and service users can be confident their complaints will be taken seriously. Service users are protected by adult safeguarding policies and procedures Evidence: The home had a written complaints procedure, which was seen. Feedback received and comments made within service users surveys confirmed they were aware of the procedure and felt free to voice their concerns. The home has received no complaints since the last inspection. Homes Policy for protecting people, the Whistle blowing procedures for staff and safeguarding adult policy were seen on file. Staff spoken to confirmed that they were awre of the procedure and their responsibility regarding this, they also confirmed they have received safeguarding training. The manager confirmed that all staff had received training and are aware that this training needs to be refreshed every three years as is good practice. Criminal Record Bureau Checks (CRB) has been obtained for all staff. The Manager is aware of his obligations with regard to ensuring the safety of service users and protecting them from abuse through a robust recruitment procedure. Care Homes for Older People Page 16 of 25 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. Service users benefit from living in a home that provides a safe, clean and homely environment internally, plus a well maintained and accessible garden. Evidence: The home provides an environment that is clean and homely, as one service user said its not all posh and fussy, its like a home from home. It does provide a rolling programme to improve the decoration, fixtures and fittings, and this was evident when walking around the home. There have been a number of improvements since the last inspection, and all the new en-suite facilities have now been completed. However care needs to be taken that seals around wash hand basins are in tact for easy cleaning and to ensure infection control. The home is small, accommodating just 12 service users, many rooms have an ensuite toilet facility. All bedrooms in the home are single, and service users are encouraged to personalise their bedrooms and choose where they sit in the communal areas. The laundry is small but has the required equipment including a washing machine with a sluice facility. The home does all the laundry personal and bedding in house. There were no unpleasant odours detected in the home during the visit. Care Homes for Older People Page 17 of 25 Evidence: The garden to the rear of the home is accessible to service users and well maintained, it has been planted to give interest all year round with the best views available from the dining area. Care Homes for Older People Page 18 of 25 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. Service users can feel confident that their care, social and emotional needs will be met by care and nursing staff in sufficient numbers who have the skills, knowledge and training to those needs. Service users can be confident that they will be protected by the homes robust recruitment policy and procedure. Evidence: The ratios of care staff to service users are determined according to the assessed needs of service users. Observations made during the inspection of the number of staff available in the home gave us the opinion that sufficient care staff were on duty to support service users to meet their personal needs and take all reasonable steps to ensure their health and safety. Staff spoken to confirmed that rotas are covered when staff are absent or taking service users on outings. Service users families talked with also confirmed that there seemed to be sufficient staff on duty when they visit. Feedback from surveys confirmed that service users are generally well supported with their needs. The staff training records indicated undertaken training. However it is important that this is kept up to date and that certificates are chased if they are not received in a timely way. From the evidence seen the staff training relating to basic courses is being undertaken. However where staff have recently come from other services their original training certificates must be seen and copied. Where there is no certificate it can not be assumed that the staff member has undertaken the training Care Homes for Older People Page 19 of 25 Evidence: successfully. The home has achieved an NVQ (National Vocational Qualification) Level 2 or above care qualification for more than 50 of care staff. Staff training is ongoing and further training is booked. The manager confirmed that the homes staff do undertake an induction which meets the skills for care and booklets were seen that staff fill in as they become competent with care provision. The staff files sampled showed that the home undertakes a robust recruitment procedure including submission of an application form detailing all previous work history, requests proof of identity and copies of some qualification certificates, seeks two written references, and confirms work status. It was evidenced that all staff have a current CRB and POVA (Protection of Vulnerable Adults) check. Care Homes for Older People Page 20 of 25 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. Service users can be confident that the registered manager has the necessary skills and experience to run the home in a way that promotes their quality of life. They can also be confident that their views and opinions effect how the home is run. Evidence: The manager has a great deal of experience managing this home over many years and he has been undertaking the RMA (Registered Managers Award) although he has not yet completed. Throughout the inspection the manager was open and assisted in the inspection. The manager has shown since the last inspection his commitment to improving standards with in the home, and many areas of improvement were seen regarding the bathing and toilet facilities in the home. The manager confirmed that there is now a rolling programme for maintenance and redecoration in the home. Quality assurance systems include daily direct observation of staff practice by the manager. The Care Homes for Older People Page 21 of 25 Evidence: manager also stated that a questionnaire survey is used annually to obtain feedback from residents who are able to complete the same. From observations of the staff and managers interactions with the service users and visitors, there was a warm and friendly atmosphere and one of openness and respect. The AQAA, (Annual Quality Assurance Assessment ) although completed and sent by the manager it did not include the dates of maintenance certificates pertaining to servicing. These were checked and most were found to be in order however this was a short fall during the last submission of the AQAA. The AQAA completion was generally poor and the manager missed an opportunity to document in full what is good with in the home, what has improved and what they hope to improve over the coming year. It also gives the manager the opportunity to explain any reasons why improvement is being hampered. The AQAA stated that service users like to have their own money available for spending when they are on visits, shopping or going to restaurants. Where the service user is able to account for and look after their own money they are encouraged to do so. Those who have difficulties in this area are supported and protected by the home. Family members are asked to leave a desired sum of money for the resident in the office. These funds are then looked after through a petty cash system. Care Homes for Older People Page 22 of 25 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 23 of 25 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 30 Ensure that a copy of all staffs training certificates are available on file Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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