Care Home: Alexandra House

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What the care home does well A person centred approach to care planning is in place reflecting people`s wishes, aspirations and choices about their lifestyle and how they are supported with their personal and health care needs. People were observed choosing how to spend their time and with whom. One person was going swimming and another was on holiday in Lanzarote. People had access in their home to therapeutic activities such as massage, a sensory room and a ball pit. Comprehensive systems are in place monitoring the administration of medication. People are supported to self medicate if they wish and have completed the assessment. A range of training was available for staff, starting with an induction programme, the Learning Disability Qualification and a NVQ programme. Robust recruitment and selection procedures are in place which include people living in the home. These should protect people from possible harm. Accessible information is being provided for people including their terms and conditions and weekly menu. What the care home could do better: Recording for controlled drugs (CD`s) needs to follow best practice guidelines. Damage to the wall and radiator in the lounge need attention and sofas which are dirty or damaged need to be either replaced or refurbished. Random inspection report Care homes for adults (18-65 years) Name: Address: Alexandra House 2 Alexandra Road Gloucester Glos GL1 3DR one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lynne Bennett Date: 0 8 0 6 2 0 1 0 Information about the care home Name of care home: Address: Alexandra House 2 Alexandra Road Gloucester Glos GL1 3DR 01452418575 Telephone number: Fax number: Email address: Provider web address: alexandra.house@craegmoor.co.uk www.craegmoor.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Jerusha James Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cotswold Care Services Limited care home 10 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Conditions of registration: 10 10 The maximum number of service users who can be accommodated is 10 The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the followign categories: Learning Disability (Code LD) Physical Disability (PD) Date of last inspection Brief description of the care home Alexandra House is a large, detached property in a residential area of Gloucester. The home has 10 bedrooms, some with en-suite facilities. There are three communal bathrooms, additional toilets, a large dining area and a separate lounge. Two of the Care Homes for Adults (18-65 years) Page 2 of 10 Brief description of the care home bathrooms and one toilet have specialist adaptations such as overhead hoists and an assisted bath. One bedroom is on the ground floor. The other bedrooms are on the first floor. The home has two staircases, and a second lift has been built to improve access between floors. The home has a large back garden, which has been landscaped to make it accessible to people who use wheelchairs. The home has a Statement of Purpose, which sets out its aims and objectives, as well as a Service Users Guide providing additional information about living in the home. The base fee was GBP1228 per week. Some additional charges are made. People living in the home are expected to pay for chiropody, haircuts and toiletries, as well as for services such as aromatherapy and reflexology. Care Homes for Adults (18-65 years) Page 3 of 10 What we found: This random inspection took place in June 2010 and included a visit to the home on 8th June. The registered manager was present throughout. She had completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). The inspection focused on the requirements issued at the last inspection, case tracking two people including their medication records, examining recruitment and selection documents for two new members of staff and notification and accident records. We were also shown around the communal areas of the home. There had been no new admissions to the home for some considerable time. The home currently has two vacancies. When new people are admitted a comprehensive assessment is completed by the home and supporting information obtained from the placing authority such as an assessment of need and care plan. Visits to the home are encouraged. The AQAA stated, Craegmoor provide a thorough assessment process right through from any initial referral to the admission of a new service user. People case tracked had current copies of the Statement of Purpose, Service User Guide and their terms and conditions. These documents were produced in accessible formats and the terms and conditions was illustrated with personalised photographs of the people and the service they receive. Each person had an assessment of need which had been completed in 2010. These provided an analysis of each persons physical, intellectual, social and emotional needs. From these care plans were developed which were up to date and being evaluated each month. People had the opportunity to sign their care plans where appropriate. The AQAA stated, all service users have been given the option of holding their care plans in their rooms. Care plans clearly cross referenced to other documents such as behaviour plans, risk assessments and protocols for the use of as necessary medication. Additional care plans had been put in place and all were person centred providing a picture of how the person wished to be supported. Peoples religious beliefs were identified. Peoples preferences for the gender of staff providing their personal care were also noted. Changes to needs were identified and care plans and risk assessments promptly put in place to reflect these. Accident and incident records were being kept and monitored by the registered manager. A summary checklist was kept of all accidents and incidents. The registered manager described the response to a number of falls being recorded for one person. They were referred to their General Practitioner (GP), taken to Accident and Emergency and had a medication review. Again the relevant documentation was put in place to reflect support needed from staff to prevent the reoccurrence of falls. The MUST (Malnutrition Universal Screening Tool) had been put in place for people at risk of developing pressure sores. Where there were any restrictions or limitations these were recorded with the rationale for them indicating they were in peoples best interests to prevent harm or safeguard them. Restrictions or limitations may include restricted access to the kitchen, the use of a key pad to the front door and bed rails. A DOLS (Deprivation of Liberty Safeguard) had been completed for one person and they had been appointed an advocate to monitor this. We examined the assessment by the placing authority and the supporting documentation confirming that a safeguard was in place in the persons best interests. Risk assessments were in place minimising Care Homes for Adults (18-65 years) Page 4 of 10 identified hazards. The AQAA stated, we support service users to take risks and all risks are assessed fully and discussed, if they can be reduced, the service users are supported in order to facilitate this. People were having access to a range of social, leisure and educational opportunities. Holidays for this year had been planned. Good use was being made of photographs around the home to make information more accessible to people. This included illustrating the weekly menu and displaying photographs of the meals for the day. The home no longer has a cook and staff said people have the opportunity for greater involvement in the preparation of meals and snacks. People were maintaining contact with relatives and friends via telephone or through visits. We looked at the systems for administration of medication. Staff confirmed they complete training in the safe handling of medications. A monthly medication audit was being completed by the registered manager. The AQAA stated, medication competency of all staff in being undertaken by the registered manager to ensure that poor practice is not evident in the administration of medication. Medication administration records (MARs) were being completed satisfactorily. Each person had a medication profile with a current photograph, which identified any allergies, their medication regime and included protocols for the use of as necessary medication. Liquids and creams were labelled with the date of opening. The temperature was being monitored and recorded for medication cabinets and fridges. The home had the most recent copy of the British National Formula in place. The home had been advised by the pharmacy to store one medication as a Controlled Drug (CD) and they had a CD register in place. We discussed best practice in relation to recording in this register and sent the home our current guidance. People have been assessed to self medicate. One person was being supported by staff to administer their medications. Staff explained the process which included keeping medication for a week, securely in the persons room. Homely remedies are kept by the home and their use has been authorised by the GP. For people who have their medication dispensed covertly in food, protocols and authorisation by the GP were in place. We walked around the home with the registered manager. There had been some improvements since our last visit including removal of a breakfast bar in the dining room increasing the floor space, tidying of offices and purchase of individual chairs for people. The AQAA commented, the service aims to provide a clean, airy and homely atmosphere. Service users are encouraged to personalise their rooms and their environment, and there is artwork displayed in the day room that service users have produced themselves. We noted that there was considerable damage to the walls in the lounge and to the radiator cover. The registered manager said this had been reported. One sofa was stained and dirty and the base of the other sofa was broken. Peoples rooms had been decorated reflecting their lifestyles with some pleasing sensory environments. People also had access to a lounge with ball pit and a sensory room. Gardens were accessible and well maintained. Bathrooms were clean and specialist adaptations and equipment had been provided. The laundry although compact was clean and tidy. Personal protective equipment had been provided and good infection control procedures were seen to be in place. The AQAA stated, all staff have all the relevant checks completed prior to employment. One service user has requested to be involved in the recruitment and selection of staff and this has already started. We examined files for two new members of staff and a file for one person which was unavailable at our last visit to the home. Each file had a Care Homes for Adults (18-65 years) Page 5 of 10 checklist indicating when documents had been requested and when they had been returned. Application forms had been completed providing a full employment history. References had been obtained prior to employment and requested the reason for leaving their former employment. There was evidence that an ISA (Independent Safeguarding Authority) check had been completed for each person and that a CRB (Criminal Records Bureau) check had been received prior to employment. Proof of identity including a current photograph had been obtained and kept on file. Where staff had visas these were being monitored with a copy of the original visa kept on file. The registered manager confirmed that staff completed an induction during their first week of work which was equivalent to the Skills for Care Common Induction Standards. They also had access to the Learning Disability Qualification and could then progress onto NVQ (National Vocational Qualification) awards. Eight requirements had been issued at our last inspection and we found that these had been complied with. These were in relation to care planning, maintaining records for peoples personal care and health needs and ensuring staffing levels were sufficient to meet peoples needs. What the care home does well: 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 set out on page 2. Care Homes for Adults (18-65 years) Page 6 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 7 of 10 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, 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 20 13 The registered person must 30/06/2010 make sure that they keep accurate and complete records in the controlled drug record book. This is to help make sure that all these medicines are properly accounted for and people have received the correct doses. 2 24 23 The registered person must make sure that damage to walls and radiators is made good and to prevent further damage. This is to make sure that the premises are safe and kept in a good state of repair. 31/07/2010 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 24 Sofas should be replaced or cleaned but should be fit for purpose. Page 8 of 10 Care Homes for Adults (18-65 years) 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 Care Homes for Adults (18-65 years) Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 10 of 10 - 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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