Care Home: Alexandra Court

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What the care home does well Before being admitted people had their needs assessed. This helped to make sure they would receive the right care and support they needed. Information needed to support them in every day living was recorded. Residents benefited from the support of a named worker referred to as a Key worker who took responsibility for their personal care. All residents were registered with a GP and accessed local health services either in the community, or were supported by visits to the home by health care professionals. Residents who provided written comments for this inspection said they always received the care and support they needed. Comments included, The home does well with `Practically everything. They are especially good with those residents who are quite disabled.` And `Provide a good standard of care in above average accommodation. Staff are always willing to help in any way with anything and usually with good humour.` The expert by experience commented, `I did think that all the residents looked well. Good clear skin and bright eyed`. The right of residents to be treated with dignity and respect was included in staff training. Staff are commended for the care and attention given to residents appearance, and how in the course of their duties they were respectful to residents. Residents spoke very highly of the staff, and said there was never any question of their privacy being compromised. There were no unnecessary rules imposed on residents and their routines in the home were flexible. Birthdays and festive celebrations were catered for. During inspection several residents went to the `Norbreck Hotel` for a Christmas lunch they all said they had enjoyed. Visiting arrangements were very good. Residents could have visitors at any time. The catering arrangements were excellent and the standard of meals provided met with resident`s tastes, choice, and needs. Staff were observed as courteous and attentive when serving meals and assisting residents requiring support. The complaints procedure was clear which helped residents/relatives have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. This meant residents rights, safety, and welfare was promoted. The home was very well maintained, clean, and tidy and provided a pleasant for residents staff and visitors. Residents accommodation was excellent. The expert by experience commented, `I did find the home very clean, ( no odors) and comfortable. Lovely furnishings which made it feel quite luxurious`. Information received at the Commission for this inspection showed all essential maintenance had been carried out, for example electrical checks. Staff interviewed said they enjoyed their work and felt supported by management. Training was provided and a high percentage of care staff holding a National Vocational Qualification in care level 2 or above had been achieved.Residents referred to staff as being `very good`. Written comments from residents included, `It is kept clean, no smell anywhere. Cynthia and her office staff are very helpful and kind. The cleaners are good keeping it clean and tidy everywhere`. `I have no complaints. It is a wonderful home to be in`. People living and working in the home considered they were `listened to`. Quality assurance was carried out and the company holds Investors In People Award. This means staff are given opportunities to develop their caring skills, attend training, and be supported by management. And there is good organization applied in the daily running of the home. This will help to ensure the home is run in the best interests of the residents and more likely to ensure quality outcomes in all standards. What has improved since the last inspection? The controlled drugs had been attached to the wall as required at the random inspection in February 2009. Observations made of medication being given to residents showed this was done as prescribed by their GP. Records were completed and medication storage organized. How people manage their own medication was recorded and procedures were in place to ensure this is done safely. As recommended in the random inspection, increased guidance had been included in the care plans of one person with complex needs, and a reassessment of needs arranged by the manager so that carers have the information they need to provide the right level of care. Where residents are assessed as being at risk from developing pressure sores, a individualised plan of care is written. Other improvements made that were not required or recommended included: Many of the apartments over the last 12 months have been re-decorated and new carpets have been laid. Fridges have been replaced as and when required in some apartments. A fresh water drinks dispenser has been installed in the dining room for the residents to use at all times of the day. The conservatory has been repainted during the summer months. Further staff members have successfully completed N.V.Q.Level 2 as part of their staff training programme. A deputy manager has been employed. What the care home could do better: The Service User Guide should be made available in a variety of different formats so that everyone has equal access to the information. Consideration should be made to develop assessments to be more person centred. This will help make sure the care residents receive includes what they consider they need and want, and what is important to them when receiving care. Residents should have a daily living plan to support them exercise choice and control over their lives. This will help to make sure all staff will support them as they wish and require and their care will be more person centred. The complaints procedure should be made available in a variety of different formats so that everyone has access to the information. To make sure residents are fully protected staff contractual arrangements should commence on appointment to ensure staff formally agree to follow the company`s ruling regarding residents financial interests. How visitors are allowed into the home should be given consideration as the current system is not entirely safe. This is because the system used does not open apartment front doors but the main entrance door. There is a danger people enter without staff knowledge. Staff must receive the terms and conditions of their employment. This is to make sure residents staff and employer are protected. Interview notes should be taken and include clarification of the applicants employment history. This will ensure written information is correct and support the decision made to employ the applicant and demonstrate equal opportunities has been applied. Full induction training should be given to staff irrespective of their role. The manager should be given formal supervision. This will provide her with management support from the company, and support her professional development as manager. Staff should be given formal supervision more frequently and staff meetings increased. Key inspection report Care homes for older people Name: Address: Alexandra Court 110 Victoria Road East Thornton Cleveleys Lancashire FY5 3SZ     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: Marie Dickinson     Date: 0 2 1 2 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 32 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 32 Information about the care home Name of care home: Address: Alexandra Court 110 Victoria Road East Thornton Cleveleys Lancashire FY5 3SZ 01253853645 01253827397 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Maria Mallaband Care Homes (2) Limited care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code 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 - Code OP The maximum number of service users who can be accommodated is: 37 Date of last inspection Brief description of the care home Alexandra Court is a unique care establishment in that it provides 34 individual apartments, each with its own lounge, kitchenette, bathroom and bedroom. There is a spacious communal lounge area, conservatory and communal dining area, all of which are furnished and decorated to an extremely high standard. The building is set in its own very well maintained grounds and provides parking to the front area for staff and visitors. Care Homes for Older People Page 4 of 32 Over 65 37 0 2 6 0 2 2 0 0 9 Brief description of the care home The home is conveniently located for local facilities and amenities, including a library and bowling green, which are within comfortable walking distance. Care is provided on a 24-hour basis including waking watch care throughout the night. The service has changed owners and it is now part of the Maria Malliband Care Group. The registered manager is Mrs Cynthia Underwood. A service user guide is available at the home that includes information about the service including current fees. Costs range from £600-£650 per week for single occupancy apartments, and £950-£975 for double occupancy apartments. Care Homes for Older People Page 5 of 32 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: A key unannounced inspection was conducted in respect of Alexandra House on the 2nd December 2009. The inspection involved getting information from an Annual Quality Assurance Assessment (AQAA) completed by the manager.The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service, such as number of staff trained, and of essential maintenance to keep the home safe being carried out. Written comments were sent direct to the Commission prior to and following the inspection from residents living in the home. They gave their personal view about how well the service met their needs. Various topics were discussed with the manager such as plans for staff training, and Care Homes for Older People Page 6 of 32 residents accommodation. Staff on duty and residents were invited to have their say about about life in the home. The manager was given a verbal summary of the inspection outcome and invited to comment on the accuracy of the findings. An expert by experience was used in this inspection. She observed daily life and social activities in the home and looked at the living arrangements provided for residents. She interviewed several residents, a visitor and spoke to staff and the manager. She also enjoyed a meal with the residents. A written report was received of her observations made and is referred to in this inspection report. Areas identified in the random inspection carried out on the 26th February 2009, that had been required to improve were looked at for progress made. The home was assessed against the National Minimum Standards for older people. Care Homes for Older People Page 7 of 32 What the care home does well: Before being admitted people had their needs assessed. This helped to make sure they would receive the right care and support they needed. Information needed to support them in every day living was recorded. Residents benefited from the support of a named worker referred to as a Key worker who took responsibility for their personal care. All residents were registered with a GP and accessed local health services either in the community, or were supported by visits to the home by health care professionals. Residents who provided written comments for this inspection said they always received the care and support they needed. Comments included, The home does well with Practically everything. They are especially good with those residents who are quite disabled. And Provide a good standard of care in above average accommodation. Staff are always willing to help in any way with anything and usually with good humour. The expert by experience commented, I did think that all the residents looked well. Good clear skin and bright eyed. The right of residents to be treated with dignity and respect was included in staff training. Staff are commended for the care and attention given to residents appearance, and how in the course of their duties they were respectful to residents. Residents spoke very highly of the staff, and said there was never any question of their privacy being compromised. There were no unnecessary rules imposed on residents and their routines in the home were flexible. Birthdays and festive celebrations were catered for. During inspection several residents went to the Norbreck Hotel for a Christmas lunch they all said they had enjoyed. Visiting arrangements were very good. Residents could have visitors at any time. The catering arrangements were excellent and the standard of meals provided met with residents tastes, choice, and needs. Staff were observed as courteous and attentive when serving meals and assisting residents requiring support. The complaints procedure was clear which helped residents/relatives have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. This meant residents rights, safety, and welfare was promoted. The home was very well maintained, clean, and tidy and provided a pleasant for residents staff and visitors. Residents accommodation was excellent. The expert by experience commented, I did find the home very clean, ( no odors) and comfortable. Lovely furnishings which made it feel quite luxurious. Information received at the Commission for this inspection showed all essential maintenance had been carried out, for example electrical checks. Staff interviewed said they enjoyed their work and felt supported by management. Training was provided and a high percentage of care staff holding a National Vocational Qualification in care level 2 or above had been achieved. Care Homes for Older People Page 8 of 32 Residents referred to staff as being very good. Written comments from residents included, It is kept clean, no smell anywhere. Cynthia and her office staff are very helpful and kind. The cleaners are good keeping it clean and tidy everywhere. I have no complaints. It is a wonderful home to be in. People living and working in the home considered they were listened to. Quality assurance was carried out and the company holds Investors In People Award. This means staff are given opportunities to develop their caring skills, attend training, and be supported by management. And there is good organization applied in the daily running of the home. This will help to ensure the home is run in the best interests of the residents and more likely to ensure quality outcomes in all standards. What has improved since the last inspection? What they could do better: The Service User Guide should be made available in a variety of different formats so that everyone has equal access to the information. Consideration should be made to develop assessments to be more person centred. This will help make sure the care residents receive includes what they consider they need and want, and what is important to them when receiving care. Residents should have a daily living plan to support them exercise choice and control Care Homes for Older People Page 9 of 32 over their lives. This will help to make sure all staff will support them as they wish and require and their care will be more person centred. The complaints procedure should be made available in a variety of different formats so that everyone has access to the information. To make sure residents are fully protected staff contractual arrangements should commence on appointment to ensure staff formally agree to follow the companys ruling regarding residents financial interests. How visitors are allowed into the home should be given consideration as the current system is not entirely safe. This is because the system used does not open apartment front doors but the main entrance door. There is a danger people enter without staff knowledge. Staff must receive the terms and conditions of their employment. This is to make sure residents staff and employer are protected. Interview notes should be taken and include clarification of the applicants employment history. This will ensure written information is correct and support the decision made to employ the applicant and demonstrate equal opportunities has been applied. Full induction training should be given to staff irrespective of their role. The manager should be given formal supervision. This will provide her with management support from the company, and support her professional development as manager. Staff should be given formal supervision more frequently and staff meetings increased. 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 10 of 32 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 11 of 32 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. The admission process ensured peoples needs were assessed before they were admitted. Evidence: Information received at the Commission for this inspection informed us, A preadmission assessment is always completed by the Care Manager to ensure that the home can meet the clients individual needs. And Prospective clients and their relatives and friends are welcomed on visits to the home to assess for themselves the quality of care provided, and assess the suitability of the home for their individual needs. Provision is made for lunches to be served on these occasions for the prospective client and their guests enabling them to make an informed decision and take in the atmosphere of the home. Residents who provided written comments for this inspection said they received enough information about the home before they moved in. This helped them decide if Care Homes for Older People Page 12 of 32 Evidence: the home was the right place for them. One resident said her friend was in the home. I knew her, we belonged to the same Church, I am very happy for the 3 years I have been in. Records of the most recent admissions showed how admissions were planned for and managed. When someone was considering taking up residence in the home the manager had completed an assessment of their need prior to their admission. The assessment took into account and considered peoples needs, for example, health and personal care, mobility, nutritional needs and other essential information to support peoples care. Information recorded was brief. Potential risks involved in providing support had been identified. This provided staff with information to care for people safely. Consideration should be given to develop the assessment to be more person centred, therefore making sure peoples expectations is recorded. This will help make sure the care all residents receive will include what they consider they need and want, and what is important to them when receiving care. Care Homes for Older People Page 13 of 32 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 had care plans, risk assessments, and a named key worker, which supported them to ensure their health and personal care needs being met in a consistent way. Evidence: All residents who provided written comments and those spoken to during inspection, indicated that they always receive the care and support they needed at Alexandra Court. Positive comments about the care and attention they receive were made. For example they said, Provides a good standard of care in above average accommodation. Staff are always willing to help in any way, with anything, and usually with good humour. The home does well with Practically everything. They are especially good with those residents who are quite disabled. Information received at the Commission indicated there are full comprehensive care plans for each resident. And residents are treated with dignity and respect and their right to privacy upheld. They had improved over the past twelve months by introducing a new pre-admission assessment form, that formed the basis of writing Care Homes for Older People Page 14 of 32 Evidence: care plans Staff worked to a key worker system that involved having responsibility to make sure care needs were personalised for residents. This meant residents should benefit a continuation of their care and support by people they knew and trusted. Two care plans were looked at in detail and two in brief. Information seen on care plans included a basic record of peoples details, and needs identified such as personal care, mobility, communication, personal safety, medication, medical, and social. How identified needs are to be supported was generally clear. For example, the support they required when having a bath. Some elements of the care plans were good but more attention is required to being specific about the care. More detail of actual needs and personal wishes of residents for staff to know about, when providing their care is required. This will help to make the care plan person centred, and should include detail that identifies who will take responsibility to ensure needs are met, such as carers, ancillary staff, family, health professionals and management. Care plans had been reviewed and updated regularly. Care plans were not easy to follow and risk was based upon numerical scoring. There is a risk by using this method to overlook an element of need where the outcome overall score is low. The manager said all care plans were to be written using a person centred format and were currently being processed. A sample was looked at and although the format appeared to be based on a nursing model, it was good. The right of residents to be treated with dignity and respect was included in staff training. Residents who provided written comments for this inspection said they always received the care and support they needed. They considered staff listened to them and acted on what they said, and made sure they got the medical care they needed. Residents had access to health care services. All residents were registered with a GP and accessed local services either in the community, or were supported by visits to the home by health care professionals. For example this could include visits from the district nursing team for nursing intervention required such as applying dressings. Continence care appeared to be managed very well. Risk assessments were completed to ensure residents well being, for example in pressure care, moving and handling, and nutrition. The home operated a monitored dosage system for the administration of medication, which was dispensed into blister packs by the supplying pharmacist. An appropriate Care Homes for Older People Page 15 of 32 Evidence: recording system was in place to record the receipt, administration and disposal of medication. Consent for medication was recorded and demonstrated peoples wishes and capabilities to self medicate was considered. Medication given as when necessary was sufficient in detail as to when this would be given. A clear audit of medication received was kept. The record of medication administration was signed and as recommended in the previous random inspection in February 2009, storage of medication was secure. Staff responsible for administering medication had been trained. Observations were made of medication being given to residents. The expert by experience also made some observations during lunch. I did hear the staff member asking whether certain people had pain and whether they needed pain killers. Care Homes for Older People Page 16 of 32 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. The home generally provided residents with choice and flexible routines to support them to exercise control in everyday life. Visiting arrangements were very good, enabling residents to keep in contact with their relatives and friends. Catering arrangements were excellent and met with individual taste, choice, and need. Evidence: Comments from residents returned to the Commission as part of the inspection show residents thought there was sometimes activities arranged by the home they could usually join in. Although care plans did not include a daily living plan with preferred routines recorded to support residents preferences, observations showed residents appeared to have freedom of choice over their lives within their capability. Residents were seen to go out alone, have visitors, and stayed in their apartment as they chose to. The home appeared to be managed so as to avoid any institutional practice. For example the manager said residents got up when they wanted and went to bed when it suited them. One resident who spoke to the expert by experience considered she had to get up at eight. The manager said quite often residents have breakfast in bed if Care Homes for Older People Page 17 of 32 Evidence: they are not up, and all residents are served breakfast in their rooms. Residents were able to receive visitors at any time and were able to entertain their guests in private. Residents were also supported to continue with their chosen religion. This was recorded in residents assessment. Residents apartments were personalised. They were able to bring in personal belongings and arrange their rooms how they wished. Information received from the manager for this inspection said the apartments provides residents with an opportunity for semi independent living. As these skills are not assessed, this are could be developed to enhance residents quality of life experience. An expert by experience looked at quality outcomes in these group of standards as part of this inspection. This was achieved by chatting with residents, staff, the manager, and a visitor. She also made some observations of the daily routine in the home. Extracts from her report are as follows. There was a group of elderly people waiting in the hallway and it transpired that many of the residents were going out for lunch and entertainment to the Norbreck Hotel that day. The Manager and her Deputy were to go along with the residents, leaving a Senior Carer in charge of the home. I spoke with two ladies who were sitting on a settee in the hall. One lady said that she did not go today for the meal as she was breathless whilst the other lady said the Priest was calling to see her which he did each Wednesday and that was the reason she had not gone out. There was little recall of activities offered, but residents referred to their visitors. Later, one lady I sat with said she had not gone out on the trip, as she could not walk. She said that there were not recall any activities going on in the home but that people would not join in if offered. She said that she had a son and a daughter, her son living away but who visits and joins her for a meal. I did notice people chatting at their tables over lunch. The lady I sat with said that one resident walked miles each day and I must say that later, I did see her going out walking with her frame and returning alone which was manageable due to the easy access of the door into the home. The expert was informed the chef sometimes plays the piano for them which they enjoyed very much. One relative told her that more activities could be offered for the Care Homes for Older People Page 18 of 32 Evidence: residents and the whole thing needs addressing. A suggestion was made of a home mini bus to take people out to the shops, out for a coffee, garden centers etc. was made. Catering arrangements were very good. The expert by experience spoke to the chef and had a meal with the residents in the home. It was evident from her report residents are given the best with choices offered at breakfast, lunch and tea and their favorite food provided where possible. Special diets were catered for and residents enjoyed their breakfast in their rooms between 8 am and 8.30am. or earlier if required. The expert by experience enjoyed a meal at lunch time and reported, The meal was lovely, nicely served by courteous attentive staff. The evening menu included a hot meal if wanted. Dining arrangements were exceptionally good. Tables were set nicely, with condiments provided and cloth napkins for residents use. Each course of the meal was served individually to residents when they were ready, and staff gave residents time to eat in comfort. Care Homes for Older People Page 19 of 32 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 complaints procedure was available and used properly, which helped residents and other people have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. This meant residents rights, safety, and welfare was promoted. Evidence: Quality assurance is carried out at the home with residents and relatives. This is done yearly and the manager reported most people were very satisfied with the service. The complaints procedure was given to residents when they were admitted to the home. The procedure listed in the service user guide gave clear directions on whom to make a complaint to and the timescales for the process. A recommendation was made at the random inspection in February 2009 to provide the procedure in other formats such as an audio version so that everyone has access to this information. Records showed that the home had not received any complaints in the last twelve months and the Commission had not received any concerns or complaints either. A complaints recording system was in place. The manager said, people are very open and would say if they had any concern. Residents were encouraged to say what they wanted and were asked regularly if everything was all right. Residents spoken to said they had no complaints against the staff. Staff were Care Homes for Older People Page 20 of 32 Evidence: described as being very good, and obliging. Residents who provided written comments for this inspection knew who to formally speak to if they were not happy and knew how to make a complaint. Comments were made such as I have never had to make a complaint and I have no complaints. Staff working at the home during inspection said they were aware of the written abuse policies and procedures, which included whistle blowing. They knew their responsibility in this area and were confident they would report bad practice if ever the need arose. In addition to this the manager said staff training was provided regularly to ensure staff understands procedures. To fully safeguard residents, contractual arrangements for new staff should commence on appointment. This will ensure a formal agreement for staff to comply with the homes policies and procedures for example agreeing to the ruling on non-acceptance of gifts, or being involved in wills or bequests and confidentiality is in place. Care Homes for Older People Page 21 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well maintained, clean, and tidy, and provided an exceptional home from home pleasant environment for residents, visitors, and staff. Evidence: Alexandra Court is a purpose built home set in its own very well maintained grounds. It is close to local amenities and facilities such as a library and bowling green. Accommodation is provided in apartments. This includes, lounge, kitchen, bedroom and bathroom. The expert by experience looked around the home and reported, I did find the home very clean, (no odors) and comfortable. Lovely furnishings which made it feel quite luxurious. The following observations were also made. Apartments were well set out and furnished to individual taste. The lounge had a two seater settee and easy chair, fireplace with a fitting for a fire effect, and traditional furniture and furnishings. The kitchen area was off the lounge with light modern kitchen units and kettle for making tea and a fridge. The bedroom had a built in double wardrobe, good quality single drawer divan bed, and traditional furniture. The manager said residents brought their own furniture with them if they wanted. Care Homes for Older People Page 22 of 32 Evidence: Apartments are redecorated if necessary before a new resident moves in. Each apartment had an intercom system where they could allow visitors in via a phone system and a staff call system. The use of an intercom system to allow people into the home is not an entirely safe system, as people can be in the home without staff knowledge. One relative pointed this out to the expert by experience. It was thought the door should be seen by staff as the door bell is not answered and residents let in visitors un-vetted which he did not like. Bathing facilities in the apartments consisted of a bath. There is a hoist to support residents who cannot manage to bathe independently. Care plans identified residents preference, and most residents chose to use the specialist shower facility provided. There is no specialised bath facility for those who do not like a shower. The main hall was very nicely decorated and well lit with quality table lamps and furniture and clean quality carpets. There was a baby grand piano in the lounge with books on shelves and current magazines available to read. The manager said they were planning to provide a large screen television in the lounge for residents use and to encourage more social interaction. The hygiene of the home was very good. Laundry was arranged to ensure this is done to allow for each residents clothes were washed separately. The expert by experience reported, Each resident has a time and day for their washing to be done and I must say that the residents all looked clean and well cared for, as did the bedding. Care Homes for Older People Page 23 of 32 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. The numbers of staff employed and training provided should ensure residents are cared for by qualified and competent staff. Evidence: Residents who sent written comments to the Commission for this inspection considered staff were always available when they were needed. They felt they were cared for as they wanted and had medical care when needed. Residents spoken to during inspection said, Staff are very good, friendly and helpful. Rotas completed for the end of November and first week in December showed the compliment of staff was sufficient to cover all essential duties in providing care, and maintaining essential standards in the home such as hygiene and catering, with senior staff on duty at all times. Staff personnel files showed recruitment practices were generally good. This included completed application forms, interview notes taken, and references received. Character checks from Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register had been applied for. However, to make sure recruitment is a safe practice at the home, CRBs issued to a previous employer should not be used, two references must be obtained in all instances, and reference request must go to the past employer rather than work colleagues. Interview notes should be taken for all Care Homes for Older People Page 24 of 32 Evidence: applicants, and include reference to the applicants employment history. This will ensure written information to support the application is correct, and the decision made to employ the applicant demonstrates equal opportunities has been applied. On appointment new staff were not issued with a contract of terms and conditions of employment that covered their probationary period of work. There was little evidence made available to show completed induction training for all staff irrespective of their role. Staff records showed initial induction completed in one day such as fire procedures. The manager said that the reason for this was because a new training source was being used and that the providers were aware of who needed this training. Information provided for this inspection indicated 75 of care staff hold a National Vocational Qualification in care level 2 or above and the carers who do not have this are to attend the relevant courses for this purpose. Staff interviewed during the course off the inspection appeared to be knowledgeable about the needs of older people. They said they received training and enjoyed their work. There was a good team spirit and a positive atmosphere observed between residents, manager and staff. Care Homes for Older People Page 25 of 32 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. The home is managed well and run in the interests of the residents. Evidence: Information received at the Commission informed us the registered manager has achieved a National Vocational Qualification level 4 in management and the Registered Managers Award. She has many years experience of managing a residential home. A deputy care manager had been recently appointed to support the manager in day to day running of the home. Senior care assistants were delegated for each shift and staff meet together daily and have shift meetings to discuss residents and other issues relevant to their work for the day and night. The companys financial planning systems means the manager works within budgetary control. There was evidence of a continuing investment made in the home and the needs of residents always being considered. There are clear lines of accountability and the entire service is audited on a monthly basis. Reports of these visits are made. The Care Homes for Older People Page 26 of 32 Evidence: manager should also receive formal supervision. This will enable her to raise work issues formally and receive company guidance and support in all areas of her work. However it was clear the manager did place emphasis on providing quality care and improving outcomes for residents. For example there is stricter medication management, quality dietary provisions and continuing investment in the environment by the company. Quality assurance is carried out yearly with residents and relatives, and the company holds Investors In People Award. This means staff are given opportunities to develop their caring skills, attend training, and be supported by management. And there is good organisation applied in the daily running of the home. This helps to ensure the home is run in the best interests of the residents and more likely to achieve quality outcomes in all standards. The Annual Quality Assurance Assessment (AQAA) was returned to the Commission when requested. It was completed properly and provided all the information that was required. All the records required for the efficient running of the home were available to look at. They were stored securely, readily available for this inspection, and organised. Records showed staff supervision was given providing staff with an opportunity to individually express themselves, their concerns, and their plans for the future or to receive feedback on their performance. The frequency of these sessions however was not very good. The manager said this was due to the deputy being on long term sick but should improve with the support of the new deputy. Staff received appraisals. Staff meetings were not regular. Minutes of meetings held in the past were based on good practice issues to improve the service. Observations made during the inspection showed staff and management worked as a team, and were well thought of by the residents. A sample of residents monies held in the office was checked. These were found to be correct. Records of transactions made by, or behalf of residents, provided a good audit trail for accounting. Information received at the Commission indicated Health & safety throughout the home is the responsibility of the registered manager. Regular maintenance and fire safety checks were carried out this year as required. This is to ensure the home is maintained to a standard required for the safety of residents, staff and visitors. Arrangements are in place for all new for staff to have mandatory training such as fire Care Homes for Older People Page 27 of 32 Evidence: safety procedures, food hygiene and first aid training. Care Homes for Older People Page 28 of 32 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 29 of 32 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 1 29 17 Staff must formally receive 08/01/2010 terms and conditions of their employment. This is to make sure residents staff and employer are protected. 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 1 The Service User Guide should be made available in a variety of different formats so that everyone has equal access to the information. Consideration should be made to develop assessments to be more person centred. This will help make sure the care residents receive includes what they consider they need and want, and what is important to them when receiving care. Care planning should be clearer and more person centred. This will help to make sure individual needs are identified properly and support will be provided in a consistent way, and should include detail that identifies who will take responsibility to ensure needs are met, such as carers, ancillary staff, family, and management. Page 30 of 32 2 3 3 7 Care Homes for Older People 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 4 7 How care needs are identified should be reviewed, as the outcome of numerical scoring that identifies low, medium or high risk, could potentially overlook an element of need within a low score. Residents should have a daily living plan to support them exercise choice and control over their lives. This will help to make sure all staff will support them as they wish and require, and their care will be more person centred. The complaints procedure should be made available in a variety of different formats so that everyone has access to the information. To make sure residents are fully protected staff contractual arrangements should commence on appointment to ensure staff formally agree to follow the companys ruling regarding residents financial interests. How visitors are allowed into the home should be given consideration as the current system is not entirely safe. This is because the system used does not open apartment front doors but the main entrance door. There is a danger people enter without staff knowledge. Interview notes should be taken and include clarification of the applicants employment history. This will ensure written information is correct and support the decision made to employ the applicant and demonstrate equal opportunities has been applied. Full induction training should be given to staff irrespective of their role. The manager should be given formal supervision. This will provide her with management support from the company, and support her professional development as manager. Staff should be given formal supervision more frequently, and staff meetings increased. 5 14 6 16 7 18 8 25 9 29 10 11 30 32 12 36 Care Homes for Older People Page 31 of 32 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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