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Inspection on 23/07/09 for Alicia Nursing Home

Also see our care home review for Alicia Nursing Home for more information

This is the latest available inspection report for this service, carried out on 23rd July 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Alicia as a whole provided people with a homely environment with sufficient and suitable equipment and facilities for the various groups of residents. The home understands the importance of having enough information when choosing a care home. The Statement of Purpose was clear and colourful and set out the objectives and philosophy of the service. Admissions were not made until a full assessment of needs has been carried out on a prospective resident. Care plans were person centred and where possible were agreed with the individual. On the whole plans were written in detail, were easy to understand, and covered all areas of the care provided. The home appropriately sought the support of external health professionals, including opticians, continence and other specialist nurses, speech and language therapists and GPs. The home had a range of equipment to meet the care needs of the residents. Staff understood the care and emotional support needed for residents. Medication administration in the home was managed well, promoting health and reducing any risks to residents. This was supported by management and senior staff regularly auditing all aspects of the medication systems. Many residents were able to access the attached day centre where they enjoyed a full and stimulating range of activities. There were also activities for those who choose not to be in a group and the home planned trips out for the residents. Residents were free to come and go from the home and to keep up with previous friendships. Food was prepared on site and was served to resident where they wanted, for example in the day centre, their bedroom or one of the dining rooms. Residents said that the meals were "good" and they had a choice each day. There was sufficient well-trained staff to meet the assessed needs of the residents. The home`s recruitment policies and practices supported and protected the residents and it was clear that the staff team had the necessary experience and qualifications to meet the assessed needs of the residents. The employer demonstrates that they were proactive and had a very good understanding of equality and diversity throughout the recruitment, induction and training process. Whenever possible a resident was involved in the staff recruitment process and in other decisions about the home. he home was well managed. The Home Manager had many years experience, which was directly relevant to her role as manager of the home

What has improved since the last inspection?

The home has a continual programme for improvement. Since the last inspection many areas have been redecorated and a new wireless call system has been installed. The system is also connected to other safety devices such as pressure mats and door openers to alert staff to falls etc.

What the care home could do better:

In Atwell unit we were concerned that a care plan written to support a person with epilepsy was very sparse. We discussed this at feed-back and were told that the problem with the detail in some of the care plans had already been identified and a lead person employed for the unit. At the time of writing we had been provided with an updated epilepsy care plan which included all the information we considered necessary to ensure continuity of care. We therefore did not make a requirement but only a recommendation that all care plans were reviewed.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Alicia Nursing Home 33-35 and 109-115 Marsh Road Luton Bedfordshire LU3 2QG Lead Inspector Sally Snelson Key Unannounced Inspection 23rd July 2009 10:00 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alicia Nursing Home Address 33-35 and 109-115 Marsh Road Luton Bedfordshire LU3 2QG 01582 560500 01582 561574 karen@apexcare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Apex Care Homes Limited Mary Mukangwa Tengenesha Care Home 68 Category(ies) of Dementia (68), Learning disability (68), Mental registration, with number disorder, excluding learning disability or of places dementia (68), Physical disability (68) Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD Dementia - Code DE Mental disorder, excluding learning disability or dementia - Code MD Learning disability - Code LD The maximum number of service users who can be accommodated is: 68 19th September 2007 2. Date of last inspection Brief Description of the Service: Alicia Nursing home is situated on the Marsh Road in Luton close to a variety of local amenities such as shops, places of worship and public houses. The home provides accommodation over three floors within one building, over two floors in another building known as Wingfield unit and in a new addition further down the road known as Atwell. For operational purposes each floor provides its own style of care for a particular group of service users. Attached to the home is a day centre that is staffed to provide activities for any of the residents who wish to attend Monday to Friday. The care staff can open this centre at weekends or in the evenings. The home has a small-enclosed garden with parking space for staff and visitors. The home is close to the M1 and the A6 and is on a bus route. Leagrave railway station is easily accessible. The fees for this home vary from £590.30 per week, to £1527.00 per week, depending on the funding source and the needs of the resident. If a higher staff ratio is required due to the assessed needs of the resident, fee levels will be above this figure based on the additional staffing costs. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was carried out in accordance with the Care Quality Commission (CQC) policy and methodologies, which requires review of the key standards for the provision of a care home for older people, but because of the wide age range across the various units the key standards for adults have also been given consideration. The methodology took account of residents’ views and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. Sally Snelson and Louise Trainor undertook this inspection of Alicia. It was a key inspection, was unannounced, and took place from 10.00am on 23rd July 2009. Mary Tengenesha the registered manager was present for the inspection. Feedback was given throughout the inspection and at the end. During the inspection the care of four people who use the service (residents) was case tracked in detail. This involved reading their records and comparing what was documented to what was provided. In addition to sampling files, people who lived at the home, visitors, and staff were spoken to, and their opinions sought. During the inspection we also had a tour of the premises and spent some time in the communal areas of the home, observing the care practices and interventions that were carried out. Any comments received from staff or residents about their views of the home, plus all the information gathered on the day was used to form a judgement about the service. The inspector would like to thank all those involved in the inspection for their input and support. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 6 What the service does well: Alicia as a whole provided people with a homely environment with sufficient and suitable equipment and facilities for the various groups of residents. The home understands the importance of having enough information when choosing a care home. The Statement of Purpose was clear and colourful and set out the objectives and philosophy of the service. Admissions were not made until a full assessment of needs has been carried out on a prospective resident. Care plans were person centred and where possible were agreed with the individual. On the whole plans were written in detail, were easy to understand, and covered all areas of the care provided. The home appropriately sought the support of external health professionals, including opticians, continence and other specialist nurses, speech and language therapists and GPs. The home had a range of equipment to meet the care needs of the residents. Staff understood the care and emotional support needed for residents. Medication administration in the home was managed well, promoting health and reducing any risks to residents. This was supported by management and senior staff regularly auditing all aspects of the medication systems. Many residents were able to access the attached day centre where they enjoyed a full and stimulating range of activities. There were also activities for those who choose not to be in a group and the home planned trips out for the residents. Residents were free to come and go from the home and to keep up with previous friendships. Food was prepared on site and was served to resident where they wanted, for example in the day centre, their bedroom or one of the dining rooms. Residents said that the meals were good and they had a choice each day. There was sufficient well-trained staff to meet the assessed needs of the residents. The homes recruitment policies and practices supported and protected the residents and it was clear that the staff team had the necessary experience and qualifications to meet the assessed needs of the residents. The employer demonstrates that they were proactive and had a very good understanding of equality and diversity throughout the recruitment, induction and training process. Whenever possible a resident was involved in the staff recruitment process and in other decisions about the home. he home was well managed. The Home Manager had many years experience, which was directly relevant to her role as manager of the home. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1,2,3,4,6 Quality in this outcome area is good. The home understands the importance of having enough information when choosing a care home. Admissions are not made until a full assessment of needs has been carried out so that prospective residents and their representatives can be sure their needs will be met. This judgement has been made using available evidence including a visit to this service. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home provided a statement of purpose that included all the information required by the National Minimum Standards. It was clear and colourful and set out the objectives and philosophy of the service. The same information was provided in a service user’s guide. The guide detailed what the prospective residents could expect and gave details of the accommodation, the staff team, and how to make a complaint. Photographs made the Statement of Purpose and the Service Users Guide acceptable to all. Copies of previous inspection reports were available within the home. Also on display were useful contact details, such as advocacy, bereavement and safeguarding services. Each resident had a contract that was signed by them, or on their behalf, as soon after admission as possible. The care record’s of the four residents whose care was being looked at was examined and this determined that the manager or the head of the particular unit had carried out a full needs assessment prior to the person coming to live in the home. The assessment ensured that the home had the facilities and experience to meet the needs of a prospective resident and formed the basis of the care plan programs put in place to meet the identified needs. We were disappointed to find a recent pre-admission assessment had not been signed and dated by the head of the unit. We were told that this person had left and the new head of the unit was aware of the need to ensure all documentation was completed but had yet to do so. It was clear that the staff team had the necessary experience and qualifications to meet the assessed needs of the residents. See staffing section of this report. The home did not provide intermediate care. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7, 8,9,10. Quality in this outcome area is good Care plans were person centred and where possible were agreed with the individual. On the whole plans were written in detail, were easy to understand, and covered all areas of the care provided. Medication administration in the home was managed well, promoting health and reducing any risks to residents. This judgement has been made using available evidence including a visit to this service. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 12 EVIDENCE: Four residents with a range of specific personal and health care needs were selected for their care to be ‘tracked’ through the inspection process. The personal and health care needs included mobility, communication, mental and physical health needs, continence and medication. Care plans were reviewed on a regular basis and updated to meet changed needs. Care plans also provided the evidence that the home sought the support of health professionals outside of the home, including opticians, continence and other specialist nurses, speech and language therapists and GPs. The home had a range of equipment to meet the care needs of the residents. On the whole care plans continued to provide staff with clear written guidance as to how care needs were to be met and this ensured consistency of care. Care plans were person centred and where appropriate were produced in a word format and also in a picture format called All About Me. However we were concerned that a care plan in Atwell unit, written for epilepsy was very sparse. It stated – ‘has seizures that last 10 – 20 seconds – he may drop, if it lasts more that 1 minute call 999’. We would have expected to see information about how the staff should manage and support him through this. This, like the unsigned documentation in this unit, had identified the need for a learning disability lead. The service had recently appointed someone into post who had also already recognised the need for some care plans to be written in more detail and the need to introduce health action plans. The day following the inspection we were sent a care plan for epilepsy, which had been written in the detail we expected to ensure that this person’s health needs would be met correctly. In addition to plans that described how care was to be delivered the care files detailed the likes and dislikes of the resident and information about their life including family details. They also included risk assessments for areas such as nutrition, tissue viability and moving and handling. These had all been regularly reviewed. Relatives had given consent for bed rails to be used as part of the prevention falls. Staff spoken with understood the care and emotional support needed for residents. This was observed to be offered sensitively, caringly and promptly. We met with the relatives of a resident and they said that they were very satisfied with the care given to their family member and praised the staff at the home, “they do all they can to keep her happy” we were told. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 13 Procedures were in place for the safe administration of medicines that ensured staff safely administered medication to residents. Medication records were accurate and it was possible to correctly reconcile all the medications held in the home. Management regularly audited all aspects of the medication systems. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP12,13,14,15 Quality in this outcome area is excellent. Many residents were able to access the attached day centre where they enjoyed a full and stimulating range of activities. This judgement has been made using available evidence including a visit to this service. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 15 EVIDENCE: Discussion with residents and staff and observation determined that many of the residents had the opportunity to participate in a variety of activities in the home, particularly in the day centre. Residents told us about a recent trip to a zoo and a Bar-B-Q; photographs displayed in the home confirmed their enjoyment. The home had its own minibus which was used for local activities such as shopping trips and lunch outings, but a purpose built ‘jumbalance’ was hired for longer trips. The jumbalance meant that people with higher physical needs could also access the excursions. Many of the residents were helping staff to provide a 100th birthday party for one relative. A banner had been made in the day centre. In the day centre there was a designated activities coordinator who planned trips and indoor activities of craft and visiting musicians. At the time of the visit residents were enjoying a quiz and some karaoke. A resident in the Atwell unit had regular visits from his wife who was able to stay overnight with him. Residents stated that they could have visitors in the home at any time; they and visitors confirmed that they were always made very welcome. One visitor said that she is always offered refreshments when she visits her mother. She confirmed that she could have a meal, with her mother, in the home if she chose to do so. The home was located in a residential area and worked to forge positive relationships with their immediate neighbours. Throughout the inspection we saw evidence that residents made decisions about how they spent their time and when they got up and went to bed. Some residents spent time away from the home and went out with friends. One resident explained to us how he was able to continue his hobby of following horse racing. Residents said that the meals were good and they had a choice each day. On the day of the visit the lunch provided was of beef steaks or chicken fillet with cabbage mixed vegetables and mashed potatoes, extra gravy and sauces were offered at the table. Mealtimes were a relaxed and unhurried and assistance was given appropriately where required. Music was playing in the background and it in the dining areas it was very much a social occasion with good interactions from staff. We saw people being offered a light alternative if they did not want a main meal. Menus were on display in the dining room and where necessary picture cards helped residents make choices with food. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 16 The kitchen at Alicia had been inspected by an officer from the local environmental health and awarded five stars. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 22, 23 Quality in this outcome area is good. The people living in this home could be sure that any complaints would be responded to within stated timescales. Policies and procedures for the protection of vulnerable adults ensured that staff were fully aware of their role and responsibility in protecting the people who lived in the home from abuse or possible harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Policies and procedures relating to the management of complaints gave clear guidance to staff, residents, relatives and other visitors to the home. The complaints procedure was clearly displayed throughout the home. Complaints made to the home since the last inspection had been correctly investigated and responded to, and no complaint has been made directly to the commission in that time. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 18 The policies and procedures for responding to allegations of abuse continued to provide guidance to staff to follow and support them to manage an allegation of evidence or abuse. The staff worked well with the local safeguarding team. One of the directors of the home is presently Chairman of the Providers Subgroup of the Luton Safeguarding of Vulnerable Adult’s Board. She sits as a member on both the Luton and Bedfordshire Safeguarding Board representing home providers. Training records examined showed that staff had attended training on the protection of vulnerable adults (POVA), the mental capacity act and understanding deprivation of liberty since the last inspection. The training also included information on whistleblowing. Despite this, in the absence of the home manager a head of a unit had not completely followed the process and there had been a reporting delay. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19,26 Quality in this outcome area is good. This home continued to provide people with a homely environment with sufficient and suitable equipment and facilities for the various groups of residents. This judgement has been made using available evidence including a visit to this service. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 20 EVIDENCE: In the last year the service had added to the registration a property which they had previously owned and used as a care home, known as Atwell. This property was in the same road and had been adapted and upgraded to provide accommodation for up to seven people with a learning disability and the possible effects of early-onset dementia. We focused our tour of the environment on this area of the home. We were given permission by a resident to view his bedroom. It had been furnished with many personal processions and the furnishing indicated the football team he supported. The room had his photograph on the door and he had an ensuite toilet and washroom. He had a double bed so that his wife could stay over occasionally. Communal space at Atwell was provided on the ground floor and bedrooms over two floors. Communal rooms consisted of a lounge, kitchen, dining room, utility area with laundry facilities etc, and a large conservatory. On the day of the inspection the home was very clean, homely and well maintained, with a smell of home cooking throughout. The rest of Alicia was also clean and tidy and had been adapted with aids and adaptations, for example walk in showers, ramps to the garden and appropriate hand rails. There was an on-going plan for improvement and redecoration throughout the building as a routine and as necessary. At the time of the inspection bathrooms and toilets were being upgraded and made more cheerful. Any room, when vacated by a resident, was redecorated. The home had recently installed a wireless call system that was linked to other alarms such as pressure mats and doors as needed. This system provided alarms that were more portable and could be moved around the bedroom, or the home, with a resident. Where necessary the alarms were larger and brighter to help with identification. Throughout the home the gardens were safely enclosed and well maintained with some areas of raised flowerbeds. Residents were aware of the smoking restrictions within certain parts of the home. There were satisfactory policies and procedures in place for the prevention of the risk of the spread of infection and care practice observed were supporting these. Adequate supplies of aprons and gloves were available in areas were infection control was necessary. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29,30 Quality in this outcome area isgood. There was sufficient well-trained staff to meet the assessed needs of the residents. The homes recruitment policies and practices supported and protected the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager confirmed that sufficient staff were employed to meet the assessed needs of the resident. The manager stated that she has the flexibility to increase staffing levels where necessary and currently she was advertising Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 22 for two qualified nurses but staff were prepared to cover these vacancies in the short-term. Throughout Alicia there were qualified nurses on duty at all times. Staff were encouraged and supported to complete NVQ level 2 or above training. The staff training records showed that a considerable amount of training had been provided over the last year both internally and externally. Many of the senior staff had a train the trainer qualification and would train and update on particular areas. The manager kept a robust training matrix that identified the training needs of each staff member. The personal records of four members of staff, including two who had recently been employed were assessed as part of this visit. All of the records contained all of the required information including application forms, two written references for each person and details of a completed Criminal Records Bureau(CRB) checks, (original CRB documentation was held at the head office). There was evidence that the correct checks had been carried out before a staff member commenced employment. All new staff had a period of induction and there skills and knowledge were assessed during this period. The employer demonstrates that they were proactive and had a very good understanding of equality and diversity throughout the recruitment, induction and training process. One of the residents told us about his role during staff interviews. Some staff had training such as makaton (sign language) skills to enable them to communicate effectively with all residents. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP31,32,33,35,36,37,28 Quality in this outcome area is good. The home was well managed and run in the best interests of the residents. This judgement has been made using available evidence including a visit to this service. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 24 EVIDENCE: The Home Manager had many years experience, which was directly relevant to her role as manager of the home. In addition to being a Registered General Nurse, a Registered Mental Health Nurse and holding the Registered Managers Award she had a mentoring and support qualification at degree level and had recently completed a postgraduate qualification in clinical leadership. The manager continued at times to work on the floor at weekends to be alongside the residents and staff. One member of staff said, “we are so lucky to have Mary, she is fair and knows so much about everything”. Apex care had a process for reviewing the quality of the standards of care and services offered by the home and the quality assurance tool used was based on seeking the views of residents and other stakeholders on the service provision. The quality assurance provided a development plan for the service. In addition the manager carried out audits of areas of the care provided, for example medication, care plans, finances. The home had been awarded a nationally recognised award by Investors in People. Structured resident’s and relative’s meetings were held. The feedback and the views of people were taken seriously to help meet their individual needs. Accounting and financial procedures in the home were managed appropriately, with the home only managing small amounts of resident’s personal monies and encouraging residents to be responsible for their financial affairs where appropriate. All staff had a supervision contract and were regularly supervised by a senior. The manager managed staff supervision and ensured that every member of staff would have the required six sessions in a year. Health and safety checks were routinely carried out including checking of fire alarms and hot water temperatures. We did note that in the Atwell unit the water temperatures were not recorded for each individual bedroom. Fire safety records were examined and found to be up to date and confirmed fire alarms are tested weekly. Staff were trained regularly in fire training, moving and handling, risk assessment, first aid, COSHH, infection control and food hygiene which promoted safe working practices. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 3 21 X 22 3 23 X 24 3 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 4 32 3 33 4 34 X 35 3 36 3 37 3 38 3 Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP38 Good Practice Recommendations Care should be taken that exact detail of how care should be provided is recorded as part of care plans. Water temperatures should be recorded at all exit points. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Alicia Nursing Home DS0000017661.V376645.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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