Care Home: Alexandra House

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What the care home does well People moving into Alexandra House can be confident that staff will be able to meet their needs. This is because they are involved in a detailed assessment, before they are offered a place. The home has an experienced management team and staff are trained in meeting the needs of older people. A resident told us that Alexandra House `Provides excellent management and caring services`. People can be confident that they will be involved in planning their care so staff know how they wish to be supported and they are offered choices. Residents, relatives and staff feel Alexandra House provides a homely environment for people to live in. People can be confident they will be offered a choice of meals that they will enjoy and meets their dietary needs. People can be confident that robust recruitment procedures are in place to ensure suitable staff are employed. The management team demonstrates a positive approach to seeking the views of residents and their relatives. They make sure people are kept informed of developments and changes within the home and seek their views as to whether they are suitable or not. What has improved since the last inspection? The management and staff make small improvements to the service that they offer to residents continually. These changes may not be huge but they feel that the small things make a big difference. What the care home could do better: The management of this service has a good awareness and understanding of what they want to achieve and how to do this including involving people who use the service. Recording of the rationale for use of bed rails could be more detailed. This should include documenting the person centred aspect of the safety management including discussion had with other parties in the multi-disciplinary team. Recording regular checking of the rails and any maintenance required. Training should be implemented for all staff who use them during their work. Key inspection report Care homes for older people Name: Address: Alexandra House 1 Poyner Road Ludlow Shropshire SY8 1QT     The quality rating for this care home is:   three star excellent 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: Pat Scott     Date: 2 3 0 3 2 0 1 0 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 22 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 22 Information about the care home Name of care home: Address: Alexandra House 1 Poyner Road Ludlow Shropshire SY8 1QT 01584872412 01584879561 alexres.home@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Susan Grehan,Mrs Julie Daley,Mrs Nichola Price,Miss Jane Alexandra Gifford care home 22 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 22 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 (OP) 22 Date of last inspection Brief description of the care home Alexandra House is a privately owned care home registered to offer care and support to a maximum of 22 elderly people. The home is 2 storey building situated in a residential area within walking distance of the town centre of Ludlow. There are gardens to front and rear and these are well maintained and provide pleasant seating areas. The home offers accommodation in 18 single and 2 double bedrooms. The ground floor provides rooms for dining and sitting including a reception hall that serves as an additional informal seating area. Care Homes for Older People Page 4 of 22 Over 65 22 0 Brief description of the care home All facilities and shops are within reasonable walking distance. There is a railway station near by and a regular bus service passes on the road next to the home. Ludlow is a busy historic market town in the South of Shropshire and has plenty to offer by way of activities, entertainment and areas of interests. Care Homes for Older People Page 5 of 22 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is a key inspection for Alexandra House. This inspection site visit provided an opportunity to find out how peoples developing care needs are being met, together with the services plans for improvement. This report draws on information received from the home in their Annual Quality Assurance Assessment 2009, which is a self-assessment process that requires care services to record how well care outcomes for the people living in their service are being met as well as providing a range of statistical information about the service. We also looked at information we have about how the service has managed any complaints and responded to safeguarding referrals. We reviewed what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Care Homes for Older People Page 6 of 22 Our last key inspection of Alexandra House took place on 18.4.2007. At that time the home was given an excellent rating, which meant we carried out annual service reviews during 2008 and 2009. Annual service reviews do not involve a visit to the home but are an assessment of risk based on the information we have received and the views of people using the service. These reviews told us that people continued to express a high level of satisfaction with the service provided at Alexandra House. We gathered relevant information from other organizations such as the Environmental Health Office (EHO), Health and Safety Executive (HSE) and the Fire Safety Officer (FSO). We spoke with 3 people about their experience of care and reviewed their care plans. 5 staff/managers working at the home were spoken with and records were reviewed. One Regulatory Inspector carried out this inspection over 3 hours. Care Homes for Older People Page 7 of 22 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 22 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 22 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. People who use the service can be confident that they will have their needs fully assessed and have the opportunity to visit the home before living there. This ensures that all parties can be sure the home can meet all individual needs in the required way. Evidence: People we spoke with said that communication between them and the staff is very good and that they understood about all aspects of their care and support and choices available to them. They had been given full information about the home both verbally and written and had had the opportunity to visit beforehand. One person talked about being able to express their views and to be involved in making decisions about their care. A relative spoken with confirmed that they were always kept up-to-date with developments and fully understood the care given to their relative. Care Homes for Older People Page 10 of 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the care they receive will be based on their individual needs and support their dignity. People will be supported to have their medicines and there are safe systems in place for people who need help with this area of their lives. Evidence: Discussion with the management showed that they recognise the diversity and rights of people who live in the home. Observation of care showed that the staff maintain privacy, dignity and independence of the people in their care. Examination of care plans showed that people experience effective, safe and appropriate care and support that meets their assessed needs and protects their rights. The management has taken account of relevant research and guidance into health and social care. Nutritional and pressure area score assessments are in place. This is a proactive approach to care which identifies problems at an early stage. When changes Care Homes for Older People Page 11 of 22 Evidence: to peoples health does occur the manager makes relevant referral to other professionals, such as, district nurse, GP, social services. People we spoke with were very complementary about the staff that care for them. Comments were made such as: The staff are very kind to me and they look after me well Everything is excellent here, and managers are all ways on site and you can always speak to them The care I receive is sensitive to my needs, they appreciate I have had darker moments and have brought me back to life. We observed a very high level of personal care and attention to clothing, nail and hair care that enabled people to maintain their dignity and individual identity. People spending time in bed because of their frailty, all looked comfortable and well supported with drinks and call bells to hand. Aids to independence and prevention of pressure sores are available and in use. Basic information for the safe and appropriate use of items such as bed rails is in place. We discussed with the management the need to make the initial assessment/rationale undertaken with the district nurse to use them, more specific to the individual and those involved in their care. Records of frequent review, recording, training and checking/maintenance of the rails could be improved. One person was observed to be cared for in bed with rails in situ. She looked very comfortable and safe. People told us that Alexandra House felt like home. A resident said Staff talk to me regularly during the day and have a very healthy attitude to their work. There are good systems in place for ensuring people receive their prescribed medication safely and regular reviews are carried out to confirm staff are working to the homes polices and procedures. Staff have a positive approach to promoting the health of the people living at Alexandra House. Care Homes for Older People Page 12 of 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given opportunities to lead dignified, comfortable and fulfilling lives based on their individual preferences, abilities and choices. People are provided with a choice of meals that they enjoy and maintain their health. Evidence: Details of the activities and events taking place on a daily basis are displayed for people to see. In addition to the one to one and group activities and trips out, visiting entertainers also provide for leisure opportunities. A relative told us that staff make an Effort to stimulate and entertain residents. People told us the home was very welcoming. There are regular opportunities for residents and relatives to give their views on how the home is run. Each person living in the home has a plan of care that takes account of their individual interests, preferences and life history so activities can be matched to their individual needs. A person said Alexandra House is their home. Friends and relatives are encouraged to visit any time of the day and are made to feel very welcome. Another person said There is a lovely family atmosphere. They keep us very well informed of all aspects. Care Homes for Older People Page 13 of 22 Evidence: People are offered nourishing meals each day. We could see from our discussions with people that individual arrangements are made for people who need special diets or have particular preferences. Care Homes for Older People Page 14 of 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be protected and their individual rights supported because there is an open and inclusive atmosphere in the home and staff work in their best interests. Evidence: In several sections of this report we have identified that the manager has a very open approach to listening to residents, relatives and staff and involving them in the running of the home. This means that the home has not received many complaints and we have not been notified of any serious concerns between our inspections. People are encouraged to make complaints formally through written procedures and informally through day-to-day contact with staff. People we talked with said that they would have no hesitation in mentioning anything they are unhappy with and felt that all would be sorted out immediately. Management confirmed that staff attend regular training on protecting people from abuse. The manager has taken on board the implications of the Mental Capacity Act in making sure people act in the best interests of residents and involve them in decisions about their lives. Care Homes for Older People Page 15 of 22 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. People live in a safe, clean home, which is kept under review by the management, so that the improvements benefit the people who live there. People can be confident that there are suitable systems in place to provide them with fresh clean laundry and prevent infections spreading. Evidence: A tour of the premises showed the home is very comfortable, clean and bedrooms immaculately presented. There are some new furnishings including curtains and bedding. All the bedrooms seen were personalised and were warm and all had call alarms. One resident said she had chosen to bring her own furniture into the home to help her settle in. Care Homes for Older People Page 16 of 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a long serving staff team that have been selected for their suitability to work with vulnerable people and receive the training and supervision they need to respond to peoples diverse and changing needs. Evidence: People commented positively on the approach of staff. One person said the staff are Always pleasant and caring. The recruitment record we reviewed showed us that the manager is receiving the required criminal records bureau check and references before staff are employed. There are good records of the recruitment and interview process to show that the correct procedures have been followed. There is a training plan in place to make sure staff receive the regular training they need to stay up to date. Staff are trained in specific areas, according to their role in the home, to enable them to support the needs of older people. Care Homes for Older People Page 17 of 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident in the services provided at Alexandra House because the home is well managed and takes account of their views. There is a genuine commitment to reviewing the quality of the service provided and making sure that the health & safety systems in place to protect people living, working and visiting the home are up to date. Evidence: The management team provide effective leadership and management of the home based on providing good outcomes for the people who live there and involving their relatives. A person told us there is a genuine commitment from the management to listen to what people say about the home, ideas are acted upon and people provided with feedback. The home has a good history of meeting the required standards and providing Care Homes for Older People Page 18 of 22 Evidence: excellent outcomes for people. The management team, are very experienced, keep up to date with current best practice to ensure appropriate procedures are followed and any care intervention is based on evidence based practice. Discussions showed us that the management works to achieve excellent outcomes for the people living in the home and is open to new opportunities. Health and safety risk assessments covering the work of the home are in place and kept under review. The management keep us informed of events in the home, such as accidents and incidents. The range and frequency of notifications have not raised any concerns with us. The manager has provided dates of regular servicing of equipment and systems within the home. Care Homes for Older People Page 19 of 22 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 20 of 22 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 Care Homes for Older People Page 21 of 22 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). 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