Care Home: Alexandra Lodge Care Home

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What the care home does well Potential new residents benefit from a pre- admission assessment that allows for only those who needs can be met, being admitted to the home. The health needs of residents are well met with evidence of good multi disciplinary working taking place. Staff provide personal support to residents in such a way that promotes and protects residents privacy and dignity. Residents benefit from an activities calendar that is arranged according to their choice. Residents experience mealtimes that are unhurried, whilst all meals are home cooked with an alternative option being available for each mealtime. Residents can be assured that there is an efficient complaints procedure in place and that the homes processes and staff training should protect residents in the event of an allegation of abuse. The location and layout of the home are suitable for its stated purpose. All areas of the home are accessible to residents. Residents experience the benefits of a staff team that have the necessary skills and experience to the meet their needs. Staff training is on going and is appropriate to the level of needs of current residents. The management and administration of the home is good, with evidence of consideration being given to residents and/or relatives opinion at all times. What has improved since the last inspection? Following consultation with the residents, a programme of group or individual activities, to provide opportunities through leisure and recreational activities has been provided to residents. Residents have been consulted regarding their social and leisure interests, a programme of activities has been implemented to provide residents with opportunities for exercise and physical activity, taking into account the needs of each resident, to maintain, as far as possible, their physical well-being and mobility. Reviews of the menus have been conducted to introduce more variety into the daily meals, particularly, the tea time sandwiches, providing residents with more choices. The fridge containing medications is now kept ice free and the temperature is checked daily to ensure that any medicines kept in the fridge are maintained at their proper storage temperature. What the care home could do better: There were no Requirements or Recommendations for good practise made as a result of this inspection. Key inspection report Care homes for older people Name: Address: Alexandra Lodge Care Home 2 Lucknow Drive Mapperley Park Nottingham NG3 5EU     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: Rebecca Shewan     Date: 1 6 0 6 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 23 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 23 Information about the care home Name of care home: Address: Alexandra Lodge Care Home 2 Lucknow Drive Mapperley Park Nottingham NG3 5EU 01159626580 F/P01159626580 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Samuel Cofie-Cudjoe,Mr Joseph Crentsil,Mrs Mercy CofieCudjoe care home 19 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 19. The registered persons may provide the following categories 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 Dementia over 65 years - Code DE(E). Date of last inspection Brief description of the care home Alexandra Lodge is a care home registered to provide personal care and support for up to nineteen older people, including people with dementia. Located in a quiet area of Mapperley Park, on the outskirts of Nottingham City Centre, there are local facilities within walking distance and easy access to public transport. The home is a two-storey Grade II listed building, with an added purpose built extension and a well-maintained Care Homes for Older People Page 4 of 23 Over 65 19 19 0 0 Brief description of the care home garden. The older part of the building still has many of its original features. There is one double bedroom and seventeen single bedrooms; none of the bedrooms are ensuite but assisted bathing facilities are provided and there is a stair lift available to residents who have some mobility problems. Fees charged are the same for people funded by social services, or privately funded, at £392 per week, with residents paying for extras, such as hairdressing (£4), Manicurist (£5) and Complimentary Therapy (£4). Potential new residents and/or their representatives find ut about the service by word of mouth, from placing authorities, from healthcare professinals and by contacting the home direct. Care Homes for Older People Page 5 of 23 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: This unannounced inspection took place during the morning and afternoon of the 16th June 2009. The homes Annual Quality Assurance Assessment (AQAA), incident reports and previous inspection reports, held by the Care Quality Commission, were read before the inspection. The inspection of the home took five and a quarter hours. Records such as care plans, staff files and medication records were also viewed. Eighteen service users (known as residents) were accommodated at the home at the time of the inspection. A tour of the whole home was undertaken and the Registered Manager, a cook, one relative and two residents were spoken with. The Care Quality Commission also conducted surveys of both residents and staff, the responses to which were positive in all aspects of care, provisions, training and staff support. Care Homes for Older People Page 6 of 23 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 Care Homes for Older People Page 7 of 23 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 23 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 23 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 home has processes in place for assessing potential new residents with services being offered to only those residents whose needs can be met. Evidence: The homes Registered Manager carries out pre- admission assessments. Copies of care management assessments from the placing authority are obtained, where these exist. The Registered Manager addresses any issues, which are highlighted within this assessment. Documented records are maintained of all correspondence with the placing authority. Records inspected showed that pre- admission assessments are carried out on all new and potential residents. Documentation relating to the most recent admissions to home were viewed and found to have been completed fully and conducted with the involvement of the resident and/or their representatives (where applicable). Intermediate care is not provided by this home. Care Homes for Older People Page 10 of 23 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 are offered a good provision of health care and personal support by the home. All care is administered in way that protects residents privacy and dignity. Medication procedures ensure that medication are stored and administered safely. Evidence: Care plans and risk assessments were sampled and it was evidenced that these were comprehensive, detailed in content and covered all aspects of residents needs/risk. Care plans are written to allow the assessor to gain a good overview of individuals medical, mental health, social and personal care needs and provide the assessor with a clear overview of the Residents current needs, limitations and required assistance. Residents involvement in the care plan review process was also evident. Care plans are reviewed on a monthly basis and are updated to accurately reflect any change in Care Homes for Older People Page 11 of 23 Evidence: needs. Residents are registered with one GP from a local Health practice or one of two other local surgeries. District Nurses, provide continence advice and attend the home as needed and are accessed directly by the staff of the home. Domiciliary Dentist and Opticians attend the home and private appointments to local opticians are also supported. Access to audiology, physiotherapy, Occupational Therapy and the Dietician are sourced via the GP. The home has a Chiropodist who attends the home every six weeks and as required. The home has good links to the Community Mental Health Team- the Dementia Outreach Team. The home has good procedures in place for the monitoring and recording of all drugs administered and those entering and leaving the home. The stores for medication were viewed and these were found to be maintained in a clean and orderly manner. It was evidenced that the previous inspection Recommendation that the fridge containing medications is kept ice free and the temperature is checked to maintain any medicines kept in the fridge at their proper storage temperature has been met in full. Staff were observed providing personal support to residents in such a way that promoted and protected their privacy and dignity. It was observed that residents bedroom doors were knocked before staff entered them and that residents were called by their preferred choice of address. Care Homes for Older People Page 12 of 23 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 provides a range of social, cultural and recreational facilities, including specialist diets to residents. Residents choice and wishes are respected. Evidence: It was evidenced that the previous inspection Requirement that you must develop and implement, following consultation with the residents, a programme of group or individual activities, to provide opportunities through leisure and recreational activities to provide residents with mental stimulation, paying particular attention to residents who have elements of dementia has been met in full. Residents have been consulted regarding their social and leisure interests. The Registered Manager reported that there is not a published list of activities in place, due to the staff of the home developing an activities programme based upon residents preferences and learning new activity skills. A member of staff has been appointed to conduct activities and has accessed a local group called City Art to attend the home for ten weeks. During this ten week period City Art will conduct once weekly activities and teach staff the skills needed to conduct activities, after the course is complete. Care Homes for Older People Page 13 of 23 Evidence: There is a Motivational Class held twice a month, which promotes safe exercise for residents. Therefore the previous inspection Requirement that you must develop and implement a programme of activities to provide residents with opportunities for exercise and physical activity, taking into account the needs of each resident, to maintain, as far as possible, their physical well-being and mobility has been met in full. Residents have currently declined the offer of Holy Communion, however this can be arranged if their wishes change. Discussions with the Registered Provider/Registered Manager highlighted that although the current residents had similar religious beliefs, the home would welcome any potential new resident who has special cultural/religious/spiritual beliefs and would make provision to accommodate their needs. The management of the home believes in promoting an equal and diverse culture among staff and residents. Outings such as trips to lunch with relatives and visits at weekends with relatives are positively encouraged. Residents, where able, are encouraged to attend the local shops and town. Contact with family and friends is positively encouraged with visitors being able to attend the home at any time and in accordance with the residents wishes. Menus are planned with residents input. The homes menus are devised on a weekly basis. All meals are home cooked with an alternative option available for each mealtime. Meals can be taken in the residents bedroom or in the communal dining room. Medical, therapeutic or religious diets are provided as needed. Drinks and snacks are available at all times. The meal served during the inspection was ample in quantity and attractively presented. The lunchtime meal was observed to be unhurried. Menus were observed and were found to offer a good variety. The tea time meal has been reviewed and there is now a buffet style sandwich platter on offer, along with soup and a hot snack. Therefore the previous inspection Recommendation that reviews of the menus to introduce more variety into the daily meals, particularly, the tea time sandwiches, would provide residents with more choices has been met in full. Care Homes for Older People Page 14 of 23 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. Residents benefit from a robust and efficient complaints procedure, whilst the homes procedures, processes and staff training should protect residents in the event of an allegation of abuse. Evidence: The home has an established complaints procedure in place. The home has received no complaints in the past twelve months. Residents spoken with and survey responses highlighted that they would know how and who to complain to. Both CRB and Protection of Vulnerable Adult (POVA) checks are carried out on all new and existing staff. Staff have attended training in the Safeguarding of Vulnerable Adults within the last twelve months. This was evident from the staff files that were viewed. There have been no Safeguarding Alerts raised by the home in the last twelve months. Staff have ready access to the Multi Agency Procedures for Safeguarding Vulnerable Adults. Care Homes for Older People Page 15 of 23 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. The home provides accommodation for residents that is safe, and well maintained, whilst infection control procedures are adhered to at all times. Evidence: The location and layout of the home are suitable for its stated purpose. The home is well maintained and all areas of the home, including the garden, are accessible to residents. The home has an ongoing plan of refurbishment in place. People living in the home benefit from sensory stimuli and clear signage of facilities such as toilets and bathrooms. The home has an infection control policy in place and staff are trained in infection control procedures, staff training records viewed confirmed this. There is a daily cleaning schedule in place. On the tour of the premises it was observed that bars of soap for communal use and used gloves were evident in the homes toilet and bathroom areas. An immediate requirement was made and it was evidenced that all such products/items had been removed prior to the conclusion of the inspection. Care Homes for Older People Page 16 of 23 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 home has a staff team that have the necessary skills and experience to the meet the needs of current residents. Evidence: A competent staff team, sufficient in number, meets the residents needs. There is a staff rota in place, which details staff hours of working and job designations. The home has a permanent staff team of the Registered Manager, three Senior Carers, eleven Care staff, two Cooks and nine Support Workers (Domestic, Laundry, teatime/breakfast Assistants, Kitchen Assistants and a Float). The management of the home are committed to training staff in National Vocational Qualification (NVQ). Three care staff are NVQ, level 2 or above, trained in care and six Carers are currently completing the NVQ level 2 or 3, in care training. The Cooks are trained to NVQ level 2 in Food and Catering and four Domestics are trained to NVQ level 2 in cleaning. Staff recruitment files were viewed and it was evidenced that these files contain all items required under the Care Homes Regulations 2001. Therefore the previous inspection Requirement that all staff records contain evidence of identification, to confirm the eligibility of the person to work there and to protect the residents has Care Homes for Older People Page 17 of 23 Evidence: been met in full. The home has an Equal Opportunities policy in place and is an equal opportunities employer. Training records were observed and it was evidenced that the staff induction training is conducted in line with Care Skills Sector guidance. Mandatory training consists of Skills for Care Induction and foundation programme, Moving and Handling, First Aid, Safeguarding Vulnerable Adults, Managing Challenging Behaviour, Infection Control, Fire Safety, Health and Safety, Mental Capacity Act, Deprivation of Liberties and Medication. Additional training is also provided in other subjects that arise from changes in residents needs. Care Homes for Older People Page 18 of 23 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. Residents experience the benefits of a home that is well managed and administrated. The health, safety and welfare of residents and staff are protected at all times. Evidence: The Registered Manager of the home is also one of the Registered Providers, has owned the home for eighteen years and has been registered as Manager for five years. The Registered Provider/ Manager is a Registered General Nurse and Nurse Prescriber and has qualifications in Health Visiting. She has also achieved the Leadership and Management Award. Survey responses and residents and relatives spoken with, said that the Registered Manager is friendly, approachable and always takes concerns or comments seriously. A formal quality monitoring system is in place. Annual residents questionnaires are conducted, the results of which are correlated and published. Other stakeholder and Care Homes for Older People Page 19 of 23 Evidence: relative questionnaires are also conducted on an annual basis. Regulation 26 visits are not currently required as the Registered Provider/Registered Manager is in the home five days a week. Regulation 37 incident reports are sent to commission. Staff meetings are held every month. The Registered Manager reported that minutes are maintained of all meetings held. Residents meetings are no longer held, at the request of residents. Residents have asked for daily informal meetings with staff and/or the manager. The Registered Manager reported that she is in the process of devising a means of recording such discussions. The home does not take any responsibility for many of the residents finances and most residents have family, friends or representatives who protect their financial affairs. Petty Cash accounts are maintained for many of the current residents, detailed accounts of which are maintained. Two staff sign for all transactions. All monies are kept locked in the homes safe, in secure individual money bags. The homes AQAA, observations made on the tour of the premises and records viewed provided evidence that fire drills, fire alarm testing and fire equipment checks, health and safety checks and water checks had been carried out. Care Homes for Older People Page 20 of 23 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 21 of 23 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 22 of 23 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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