Care Home: Alexandra House

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What the care home does well Action had been taken to comply with the requirements from the last inspection to maintain appropriate staffing levels and notify the relevant authorities of any safeguarding issues.People are offered good opportunities to take part in social activities, events and outings to meet their social needs and maintain contact with the community. The home is clean, spacious and comfortable and some areas are being further enhanced to make them more attractive. More effective systems are being introduced to monitor and improve the quality of the service. What the care home could do better: Sufficient information about people`s needs should be obtained before they move into the home to make sure their care and support can be properly planned. Staff need to make sure that care plans are kept up to date to reflect changes in people`s care needs and evaluations of plans need to be better focused. Aspects of daily care recording should clearly show how people are supported to meet their personal hygiene and continence needs. Medication records and administration is to be made fully robust to ensure people are protected by a safe medication system. Staff need greater understanding of nutrition for older people and to improve people`s meal time experience through improved care practices. More staff training must be organised that is relevant to meeting the diverse needs of the people who live at the home. Random inspection report Care homes for older people Name: Address: Alexandra House Havelock Terrace Gateshead Tyne & Wear NE8 1QU two star good 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: Elaine Malloy Date: 1 8 0 5 2 0 1 0 Information about the care home Name of care home: Address: Alexandra House Havelock Terrace Gateshead Tyne & Wear NE8 1QU 01914775117 01914774879 alexandragateshead@schealthcare.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Southern Cross BC OpCo Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 40 Number of places (if applicable): Under 65 Over 65 0 40 dementia old age, not falling within any other category Conditions of registration: 40 0 The maximum number of service users who can be accommodated is: 40 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 - maximum number of places 40 Dementia Code DE, maximum number of places 40 Date of last inspection 1 6 1 0 2 0 0 9 Care Homes for Older People Page 2 of 13 Brief description of the care home Alexandra House is a large, purpose built home in Gateshead, close to the town centre. It is built on the site of an old social club, well known in the area. It is surrounded by houses and is close to Coatsworth Road, a main shopping area. There are good transport links to the home. The home is registered to provide personal care for up to 40 older people including people with dementia. The home does not provide nursing care. All bedrooms are en-suite and for single occupancy. There are five lounges and two dining rooms over the two floors of the home. The home is equipped with aids and adaptations to help more physically dependent people in the home. A guide to the homes services, inspection reports and details of fees are available at the home. Care Homes for Older People Page 3 of 13 What we found: The inspection was carried out by: Looking at information received since the last random inspection on 16th October 2009. An inspector visiting the home unannounced on 18th May 2010. Talking to the management and other staff about the service. Getting the views of people living at the home and observing the care and supervision provided. Looking at relevant records. Checking if improvements required from the previous inspection had been made. We did not receive the Annual Quality Assurance Assessment from the home. This is a document that the provider completes to give us their view of the service and how well they care for people. We did not receive any completed surveys from people living at the home or staff. The inspection was carried out over six and a half hours. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. We found that: New people admitted to the home did not always have a thorough assessment of their care needs carried out prior to moving in and care managers had not provided assessments to the home. Care records showed that a range of assessments are used to identify peoples health and personal care needs and these were regularly updated. There was currently no assessment specific to mental health despite the home providing care for people with dementia. The management said that a dementia assessment was going to be introduced following training sessions with senior care workers. There was some good standard recording within individuals care plans that was detailed, sensitive and indicated the persons preferences, and, where applicable, matched with assessments of risk. One persons care plans examined, with the exception of pressure area care, needed updating to reflect their increased level of dependency and support required from staff. Care plans were regularly evaluated but these records were of variable quality. Some gave clear indication of whether the care plan was working but Care Homes for Older People Page 4 of 13 most evaluations were bland statements of no change or care plan remains valid. Supplementary charts relating to personal hygiene and continence were not consistently completed and therefore did not fully demonstrate that people were suitably assisted to meet their needs in these areas. Body mapping was routinely carried out to maintain records of skin integrity. Observation records were well completed for people who require more frequent checks due to risk of falls or behaviour. Care plans were in place for health care needs and these indicated appropriate input from health professionals such as the district nurse providing regular wound care treatment. Professional visitor records showed people receive visits from health care professionals including doctors, district and practice nurses, speech and language therapist, respiratory nurse, urgent care team, dentist, chiropodist, optician and attend hospital appointments. An infection control nurse visits the home and has provided training for staff. People living at the home and a relative gave positive feedback about the care and staff. Comments included, My husband is very well cared for, the staff are marvellous, I get all the help I need and good medical care, and, The carers are lovely, nothing is too much trouble for them. Senior staff only administer medication. Seniors and some care assistants have undertaken medication training. Medication records have a front sheet with the photograph of the person for identification purposes. The records examined showed some gaps where staff had not signed to verify medication was given or entered a code for the reason why it was not given. One service user had missed a once weekly dose of medication though this was marked on the administration record as to when it was due. Some handwritten directions for medication were not clear and at times included latin abbreviations. There was evidence that a prescribed nutritional supplement for one service user was regularly being refused and the deputy manager said she would follow this up. The controlled drugs register was recorded satisfactorily. Management said that medication audits were being introduced. Social profiles were recorded and people have care plans to address their social needs and interests. A full time activities co-ordinator is employed who is enthusiastic about her role and arranges a variety of daily activities, events, and outings. Details of activities and photographs of previous events were on display in the home. A minibus that is shared between other care homes in the region was being used to take people on weekly outings. On the day of the inspection some service users had been on a trip to South Shields that they said they had enjoyed. People also go out locally with staff and some had gone out to vote in the recent election. There is an activities room on the ground floor. New items were purchased the previous week to enhance the environment on the upper floor and management and the activities co-ordinator were looking towards creating areas of different interest here such as a music room. Daily activities include board games, sing-a-longs, armchair exercises, quizzes, discussion groups, one-to-ones, arts and crafts and reminiscence. A Spring Fayre, line dancing, visiting entertainers and big screen cinema events were organised. Records were kept of the range of activities provided, a summary of each persons preferred activities and charts with codes were completed to show how people have spent their time. People living at the home said there was plenty going on for them to join in with. Care Homes for Older People Page 5 of 13 Individuals nutritional needs were assessed and weights were monitored on a monthly basis, or weekly for those people identified as being nutritionally at risk. Information on peoples food likes and dislikes was available on the units and in the kitchen including special diets. Records showed that people were referred to dietitians and speech and language therapy and have care plans for their eating and drinking needs. The deputy manager meets with the cooks to discuss people who are experiencing weight loss and poor appetite. Additional calorific snacks were not provided between meals. Fruit was available in a bowl in the dining room but this was beginning to rot and it was recommended that fruit be prepared and offered to service users. Full fat milk is used however there was no butter to fortify food. The manager, who was currently absent from the home, and one care assistant only have had training on nutrition. The inspector dined with people on the upper floor at lunch time. The menu was written up on a board and lunch was a choice of braised steak or cheese and onion flan with mashed potato, sweetcorn and green beans, followed by semolina pudding. The dining tables were nicely set with coloured tablecloths, napkins, placemats and condiments. There was no salt cruet provided on the table and sauces, ketchup etc were in small plastic sachets that could be difficult for people to manage to open. Assistance was not offered to use condiments. At the beginning of the meal everyone was served cups of tea, no coffee was offered and given milk poured from a large plastic container. There was a milk jug on the table though this was not filled and no sugar bowl. A choice of cold cordial drinks was served at the same time as tea. Food was served from a hot trolley and the mealtime was unhurried. There was plenty of staff available though the extent of supervision was variable. Staff shouted across the dining room to people asking them individually which meal they wanted. The choice of meals was not shown to people as a visual aid to help them decide. One staff member was very helpful, cutting up food and verbally encouraging people and another sat with a frailer lady and helped her to eat. However another staff member at times started to feed people as she stood over them. One lady repeatedly refused the different meal options and this situation was not managed well by staff. It was noted that some people might benefit from having eating aids to help prevent food spillage and preserve their dignity. People spoken with said they had enjoyed the meal. No complaints were received about the home in the period since the last inspection. People spoken with said they did not have any concerns about the service. Staff receive training on protecting vulnerable adults from abuse during induction. Further safeguarding training was in the process of being arranged. Two safeguarding alerts had been notified promptly to the relevant authorities in the last six months, one of which had resulted in staff disciplinary action. The deputy manager and one senior care worker only have undertaken training on awareness of the Mental Capacity Act legislation. The home continues to provide a well maintained environment that is suitably equipped. People spoken with said they were happy with their bedrooms and the communal facilities. The majority of staff have completed infection control training and the deputy manager said this training was ongoing. Care Homes for Older People Page 6 of 13 Staff rotas were examined and staffing was discussed with management. The home was maintaining levels of six care workers across the waking day and three care workers at night. Care staff were allocated to the ground or upper floor units and a higher ratio of staff was deployed to work with people with dementia. External agency staff were rarely used as the deputy said the existing staff team are good at providing covering for absence. The majority of care staff have completed National Vocational Qualifications (NVQ) in care at Level 2. The staff training matrix showed a good level of core training had been undertaken including safe working practices and medication courses. However there was limited training provided specific to the needs of people living at the home such as dementia awareness, challenging behaviour, care planning, nutrition, and pressure area care. The deputy manager said she had completed a dementia facilitator course and was arranging to deliver training to groups of six staff at a time. Care planning training was organised to start later in the week. The home does not have a Registered Manager. At the time of the inspection the manager was absent. The home was being managed by a relief manager and the deputy manager, whose working hours were now in addition to the staffing levels. Senior care workers were designated in charge of the home on some shifts and they have access to an on-call system for management support and advice. The relief manager and deputy did not have any knowledge of the Care Quality Commission sending the home the Annual Quality Assurance Assessment and surveys to be completed. Quality assurance systems were examined and discussed with management. Meetings were held to get the views of people living at the home and their relatives or advocates. Books had been introduced in the dining rooms to record peoples comments on the food. A monthly newsletter was produced with information about what is happening in the home. Internal audits were being carried out on care records, accidents, weight monitoring, health and safety and catering. An area manager visits the home monthly and reports on the conduct of the service. These visits include observations, talking to residents, visitors and staff and checking records. The provider company had recently conducted a quality assurance inspection of the home. This covered the quality of care and support, environment, staffing and management and leadership and sets out recommendations for management to action. Monthly quality reports had also been introduced to monitor pressure ulcers, weight management, bed rails, accidents and incidents, medication and service user reviews. Management acknowledged that staff had not been receiving regular individual supervision. The relief manager and deputy were now taking responsibility for providing supervision and had drawn up a planned schedule. They had also started to hold head of department meetings with cooks, housekeeping, the activities co-ordinator and senior carers. What the care home does well: Action had been taken to comply with the requirements from the last inspection to maintain appropriate staffing levels and notify the relevant authorities of any safeguarding issues. Care Homes for Older People Page 7 of 13 People are offered good opportunities to take part in social activities, events and outings to meet their social needs and maintain contact with the community. The home is clean, spacious and comfortable and some areas are being further enhanced to make them more attractive. More effective systems are being introduced to monitor and improve the quality of the service. 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 Older People Page 8 of 13 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 Older People Page 9 of 13 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 7 15 Service user care plans must 18/06/2010 be revised when there are changes to an individuals health and welfare needs. To ensure that service user care plans accurately reflect current identified needs and how these will be met. 2 9 13 Staff who administer 18/06/2010 medication must complete the Medication Administration Record for each service user at the time of administration. All medication must be administered as directed by the prescriber to the service user it was prescribed, labelled and supplied for. To ensure that an accurate record of medication administration is maintained and to safeguard the health and welfare of service users. 3 30 18 All staff must be provided 18/08/2010 with opportunities to receive Page 10 of 13 Care Homes for Older People 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 training that is appropriate to the work they perform, including caring for people with dementia, challenging behaviour, care planning, pressure area care, nutrition of older people, safeguarding vulnerable adults and the Mental Capacity Act. To ensure that service users are cared for by suitably skilled and trained staff. 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 3 New service users should have a full assessment of their needs carried out prior to admission and care management assessments should be obtained. All service users with dementia should have a mental health assessment carried out to identify and monitor their psychological needs. Records of service users support with personal hygiene and continence should be consistently completed to show all assistance provided. Care plans should be evaulated in greater detail to demonstrate whether the plans are achieving or working towards the stated goals. Staff should ensure that clear handwritten directions for medication are recorded to Medication Administration Records. Service users nutritional intake should be enhanced by routinely fortifying food, providing calorific snacks between meals and regularly offering prepared fresh fruit. A review of meal time practices should be carried out to Page 11 of 13 2 3 3 7 4 7 5 9 6 15 7 15 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 ensure that service users with dementia receive appropriate support with choice of meals and drinks, and assistance with eating, including aids where necessary. 8 9 31 36 An application should be made to the Care Quality Commission to register a manager for the home. The planned schedule of individual supervision should be followed to ensure staff are suitably assessed and supported. Care Homes for Older People Page 12 of 13 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 Older People 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. 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