Alexander House Care Home Service

Alexander House Care Home Service Main Street Crossgates KY4 8DF Inspected by: (Care Commission Officer) Type of inspection: Marion Neil Unannounced Inspection completed on: 11 December 2008 1/15

Service Number Service name CS2007165398 Alexander House Service address Main Street Crossgates KY4 8DF Provider Number dummy Provider Name SP2003001615 Kingdom Homes Ltd Inspected By dummy Inspection Type Marion Neil Care Commission Officer Unannounced dummy Inspection Completed Period since last inspection 11 December 2008 7 Months dummy Local Office Address Largo House, South Suite, Carnegie Avenue, Dunfermline, KY11 8PE dummy 2/15

Introduction Alexander House is registered to provide 24-hour care for a maximum of 44 people. Alexander House offers long term residential care and nursing care for older people. Alexander House was first registered as a care service in December 2007. The home is laid out on three levels with all rooms being spacious, well fitted out, and all having en-suite facilities. Each floor has an open plan lounge/dining room with comfortable chairs in the lounge area. Each bedroom has a telephone and television point. Four of the rooms can accommodate couples. Additional facilities include 2 rooms where relatives and visitors can prepare refreshments e.g. a cup of coffee, and a room dedicated to hairdressing. Outside the home, there is ample car parking. At the front of the home there is a large open garden space with shrubs and walk ways. Raised flower beds also feature in this garden. Mrs Sharon Adams is the registered manager and is responsible for the supervision of staff and day to day running of the Home. Based on the findings of this inspection the service has been awarded the following grades: Quality of Care and Support - 3 - Adequate Quality of Management and Leadership - 3 - Adequate This inspection report and grades represent the Care Commission s assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. Please refer to the care services register on the Care Commission s website (www.carecommission.com) for the most up-to-date grades for this service. Basis of Report The purpose of the unannounced inspection visit was to follow up any Recommendations and Requirements made at the previous inspection visit. The inspection plan for this service was decided after a Regulation Support Assessment (RSA) was carried out to determine the intensity of inspection necessary. The RSA is an assessment undertaken by the Care Commission Officer (CCO) which considers complaints activity, changes in the provision of the service, nature of notifications made to the Care Commission by the service (such as absence of a manager) and action taken upon requirements. The CCO will also have considered how the service responded to situations and issues as part of the RSA. This assessment resulted in this service receiving a low RSA score and so a low intensity inspection was required. The inspection was based on the associated National Care Standards, and took account of the Regulation of Care (Scotland) Act, 2001, Scottish Statutory Instruments 114. This service will receive a number of inspections over the year 08/09. The inspection visit was carried out by Marion Neil and Aileen Scobbie, Care Commission Officers (CCOs) on the 9 January 2009. 3/15

During the inspection visit, evidence was gathered from a number of sources including: A review of a range of policies, procedures, records and other documentation including the following: Service Users personal plans Audits of Accidents and Incident records Complaints records Registration certificate and staffing schedule Public liability insurance Minutes of meetings held by the Care Home with service users and their families Questionnaires used by the Care Home to gather the views of service users and their relatives Discussions with: The manager One of the nurses The activities coordinator Two service users Observation of staff practices. In detailing the evidence for this report, the Care Commission Officers took account of the Action Plan submitted to the Care Commission after the previous inspection visit. The Fire (Scotland) Act 2005 introduced new regulatory arrangements in respect of fire safety, on 1 October 2006. In terms of those arrangements, responsibility for enforcing the statutory provisions in relation to fire safety now lies with the Fire and Rescue service for the area in which a care service is located. Accordingly, the Care Commission will no longer report on matters of fire safety as part of its regulatory function, but, where significant fire safety issues become apparent, will alert the relevant Fire and Rescue service to their existence in order that it may act as it considers appropriate. Further advice on your responsibilities is available at www.infoscotland.com/firelaw. Action taken on requirements since last Inspection An Action Plan was received from the service. This detailed how they were going to take forward actions to meet the Requirement (1) and Recommendations (1), (2) and (3), all of which are fully reported on in the body of this report. Comments on Self Assessment This had previously been submitted, prior to the previous inspection visit. View of Service Users The two service users who spoke to the CCOs were, overall, satisfied with the care they received. View of Carers 4/15

There was no opportunity to seek the views of carers at this inspection visit. 5/15

Quality Theme 1: Quality of Care and Support Overall CCO Theme Grading: 3 - Adequate Statement 1: We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service Strengths The findings in this section are based on Quality Statement 1.1. Following discussion with the manager, the service's own questionnaires and an examination of the documents detailed below, the service was found to have a good performance in relation to this statement. The Care Commission examined minutes of committee meetings involving service users and their families. These committees were now established. The minutes confirmed that the manager had continued to encourage service users and their relatives to participate in improving the quality of the service. She was using questionnaires to seek the views of service users and their relatives. The questionnaires used were a general one and one on catering. It was envisaged, the manager stated, that these will be carried out bi-annually. An Activities Committee had been established. Members included a service user, a relative, the manager and the activities coordinator. Monthly activity reports were now in place along with daily evaluation of activities. Commendably, a relative is assisting the care home staff to fundraise. Funds raised in this way will be used, the manager stated, for activities. This would, she confirmed, increase the variety of activities, trips and outings. It was noted that a suggestion box was in place in the foyer, providing additional opportunities to families to make suggestions. The CCOs examined the care homes record of complaints. The complaints procedure was robust, with evidence that concerns raised were addressed by the manager. The complaints records showed that detailed outcomes had been recorded for each concern raised. The organisation had a participation strategy in place. The manager confirmed, through discussion, that implementing the participation strategy was ongoing. The ongoing development of this strategy would, she stated, ensure that service users and relatives were consulted, informed and given appropriate opportunities to comment on their care. Based on the findings of this inspection, the service has been awarded the grade detailed below, for this Quality Statement. Areas for Development The manager should now continue to develop the care home's participation strategy. CCO Grading 4 - Good Number of Requirements 6/15

0 Number of Recommendations 0 Statement 5: We respond to service users' care and support needs using person centered values. Service Strengths The findings in this section are based on Quality Statement 1.5. The following Requirement was made at the previous inspection visit: Requirement (1) Care plan documentation must be personalised, informative and detailed and adequately record essential information. All information recorded must be signed and dated. The documentation must reflect up to date care needs and how these will be met. Adequate time must be allocated to staff to ensure the delivery of care whilst the care plan development is being carried out. This is in order to comply with the Regulation of Care (Scotland) Act 2001, Scottish Statutory Instrument, 2002/114 Regulation 4 (1)(a) Welfare of users; Scottish Statutory Instrument 2002/114 Regulation 5 (1) (2) (b)(c)(d) Personal Plans. Discussion with the manager, the assistant operations manager, along with an examination of associated records, provided good evidence that a significant amount of work had been carried out to meet this Requirement. The sample of care plans reviewed by the CCOs on the day of the inspection visit were found to be accurate, informative and contained essential information. Minutes of staff meetings showed that staff were routinely reminded about their responsibilities to completed care plans appropriately. A system for auditing care plans on a regular basis was in place. The manager stated that she was now carrying out regular audits of 3 to 4 care plans per month. Findings from this audit were raised with individual staff in one to one supervision sessions. The recently appointed assistant operations manager had responsibility for auditing records throughout the organisation's care homes. On the day of the inspection visit she was present in Alexander House, completing an audit of care plans and associated records. She was auditing a 25% sample of the care home's care plans. She stated that this audit should link into improvement of the care planning process. Based on the findings of this inspection, the service has been awarded the grade detailed below, for this Quality Statement. Areas for Development The findings of the audit of care plans by the assistant operations manager was shared with the CCOs. This confirmed the CCOs findings from reviewing care plans on the day. It 7/15

showed that there were still some discrepancies in the care plans (eg not all parts of the care plans were signed and dated.) The assistant operations manager confirmed through discussion that no action had taken place yet to rectify the discrepancies, as the audit was still ongoing. She also confirmed that a robust feedback system had been developed to ensure that any discrepancies would be rectified. She stated that this would contribute to the development of the care home's quality assurance systems. Almost all parts of the Requirement (1) had been met. A Recommendation (1) is made. CCO Grading 3 - Adequate Number of Requirements 0 Number of Recommendations 1 8/15

Quality Theme 2: Quality of Environment Overall CCO Theme Grading: 0 - Not Assessed 9/15

Quality Theme 3: Quality of Staffing Overall CCO Theme Grading: 0 - Not Assessed 10/15

Quality Theme 4: Quality of Management and Leadership Overall CCO Theme Grading: 3 - Adequate Statement 1: We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service Strengths The findings in this section are based on Quality Statement 4.1. Progress on Recommendation (3), made at the previous inspection visit, are reported under this quality statement. Recommendation (3) It is recommended as good practice that the Senior Managers and the Manager develop and use a quality assurance system and undertake a quality assurance process which involves service users, carers, staff and stakeholders. This will enable the quality of the service to be assessed. National Care Standards, care homes for older people, Standard 5, Management and staffing arrangements, (2), (4) and Annex B. This Recommendation had now been met by the service. When reporting on the service's progress, evidence reviewed by the CCOs for quality statement 1.1, along with discussion with the manager and an examination of records associated with this recommendation, was taken into account. The service was found to have an adequate performance in relation to this statement The manager, as previously stated had developed the service's participation strategy by establishing committees for service users and for relatives. These, along with the service's own questionnaires, the suggestion box and the robust complaints procedure, provided good opportunities for service users and carers to express their views. The service had a development plan. Ongoing development and implementation of the service's participation strategy and quality assurance systems eg implementing the service's audit calendar, were in place. Based on the findings of this inspection, the service has been awarded the grade detailed below, for this Quality Statement. Areas for Development An examination of the service's quality assurance file showed that it was intended that service users should be given the opportunity to participate in the selection process for new care staff. CCO Grading 11/15

3 - Adequate Number of Requirements 0 Number of Recommendations 0 Statement 4: We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide. Service Strengths The findings in this section are based on Quality Statement 4.4. Progress on Recommendation (1) and (2), made at the previous inspection visit, are reported under this quality statement. Recommendation (1) It is recommended as good practice that the Manager develops and implements robust, systematic staff supervision, for all staff, with effect from June 2008. National Care Standards, care homes for older people, Standard 5, Management and staffing arrangements, (4) and best practice guidelines references in National Care Standards, care homes of older people, Annex B. Recommendation (2) It is recommended as good practice that the Manager now implements Kingdom Home's audit systems, and ensure that cognisance is taken of the information these audits provide, to influence and up date the procedures in Alexander House. National Care Standards, care homes for older people, Standard 5, Management and staffing arrangements, (1) and (4) and Annex B. Both of these Recommendations had been met by the service. Evidence to support this was gathered from discussion with the manager, the activities coordinator, observation of staff practice and discussion with 2 service users. The CCOs also examined records associated with these recommendations. The service was found to have an adequate performance for this quality statement. The CCOs reviewed the evidence provided by the manager which showed that staff supervision was in place. It was being carried out on a regular basis. One to one supervision led, where needed, to an "action plan." This provided the staff member with the opportunity to address any issues raised, eg absenteeism or lateness. Each staff member had an individual development plan. A staff member who spoke to the CCOs, confirmed that - "... good training opportunities; good staff team; (I) feel supported and the residents come first." 12/15

There was clear evidence that the service was now using a robust audit and quality assurance system. Some of the systems were part of the service's ongoing development plan eg follow-up meetings and action plans from audits carried out by the assistant operations manager. However, the following were found to be in place: 1) Appointment of assistant operations manager, with initial responsibility for audits of all aspects of the care service 2) Calendar of audits in place for the manager 3) Regular supervision and support for the manager 4) Robust complaints procedure 5) Comprehensive auditing system, linked systematically to the service's quality assurance systems The continued use and development of these systems would contribute to an ongoing process of quality assurance for the service. Based on the findings of this inspection, the service has been awarded the grade detailed below, for this Quality Statement. Areas for Development The manager should continue to develop and implement the systems identified above. CCO Grading 3 - Adequate Number of Requirements 0 Number of Recommendations 0 13/15

Regulations / Principles National Care Standards 14/15

Enforcement There has been no enforcement action against this service since the last inspection. Other Information On the day of the inspection visit the CCOs reviewed documentation and records associated with the inspection in the service's internet cafe. During this time there was significant noise and vibration from the laundry, situated next door. A review of the laundry showed that the washer/driers were suitably situated away from the far away wall from the internet cafe, on a plinth. However, it was clear that the noise and vibration would impact adversely on the service users whose room was next door to this wall. In discussion at feedback, the manager and Director of Operations confirmed that this issue would be noted and addressed through the environmental audit that was due to take place the following week. It was agreed that measures to dampen the vibration and reduce the noise of the washer/driers would be explored by the service. This is an area for improvement. Requirements No Requirements were made following this inspection visit. Recommendations Recommendation (1) It is recommended as good practice that all records relating to service users should be signed and dated by the member of staff completing them. National Care Standards, care homes for older people, Standard 5.1 and 5.2, Management and Staffing. Marion Neil Care Commission Officer 15/15