Inspection on 26/06/09 for The Princess Alexandra Home

This is the latest available inspection report for this service, carried out on 26th June 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.

Other inspections for this house

The Princess Alexandra Home 11/09/07

The Princess Alexandra Home 16/01/07

The Princess Alexandra Home 06/02/06

The Princess Alexandra Home 12/07/05

The Princess Alexandra Home 03/03/05

The Princess Alexandra Home 14/09/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Princess Alexandra Home Common Road Stanmore Middx HA7 3JE Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 10:30 26 & 30th June 2009 th DS0000022938.V376296.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 2 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 The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Princess Alexandra Home Address Common Road Stanmore Middx HA7 3JE 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) 020 8950 1812 020 8421 8202 fbaiden@jcare.org www.jewishcare.org Jewish Care Fionnuala Baiden Care Home 72 Category(ies) of Old age, not falling within any other category registration, with number (72) of places The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 72 19th August 2008 Date of last inspection Brief Description of the Service: Princess Alexandra Home is a large detached building set within extensive grounds in Stanmore, North Harrow. It is situated off Common Road and is easily accessible by car and by public transport. There are good parking facilities within the grounds of the home. For people who use public transport, it must be noted that the home is found a couple of minutes walk from the main road. The home consists of an older central building, which used to be a house. Extensions have then been constructed on either side of the main building to make what is now Princess Alexandra. On the left of the main building (when facing the front of the home) is Newland House which accommodates twentyseven residents requiring personal care. Two of the bedrooms are double bedrooms, but the rooms are mostly used as single bedrooms except in circumstances when couples want to share these facilities. On the right of the main building is Edmond House which accommodates eighteen residents requiring nursing care on the ground floor, twenty residents on the first floor also requiring nursing care and five residents requiring personal care on a mezzanine floor. The mezzanine floor is reached by a small set of stairs, which is also served by a chair lift. All the houses are served by lifts and all parts of the home are accessible by lifts. There are several lounges in the home, some of which are in the central building and others in Edmond House. There is a dining area in Newland House The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 5 and a main dining area in the central part of the home. The home also benefits from a library, an activities room, a number of nurses stations and clinical rooms, and a multi-faith prayer room. Connection between the two houses is only through the ground floor. Princess Alexandra has been a care home since 1952 and was acquired in 2002 by Jewish Care. The home now admits only Jewish residents, but as there were non-Jewish residents prior to 2002 in the home, Jewish Care has made a commitment to continue caring for them. The home is run according to the Jewish culture and practices. For example the home observes the Sabbath and provides Kosher food. Non-Jewish residents who live in the home are aware of these practices. The home is managed by Fionnuala Baiden with the support of a clinical manager. The home has a team of nurses and care workers to care for the residents. There are also admin support staff and ancillary staff. All the hotel services in the home are contracted out. The home charges £823 for personal care and £1085 for nursing care and has a mixture of publicly funded and privately funded residents. Some residents who are publicly funded have to make a third party contribution (top-up fee). At the time of the inspection there were sixty-six residents in the home. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The unannounced inspection started on the 26th June 2009 at 10:30-19:00 and continued on 30th June 2009 from 10:10-16:30. The last key inspection took place on the 19th August 2008 when the service was rated a 1 star service. During this inspection we talked to at least fifteen members of staff, twelve residents, and four visitors to the home. We looked at a sample of records that the home keeps, carried out a partial tour of the premises, observed lunch being served and some interactions of staff with residents, and randomly checked the management of medicines in the home. The manager completed an Annual Quality Assurance Assessment (AQAA) as part of this inspection that we have used to plan the inspection and to inform this report where possible. We also received nine satisfaction questionnaires from residents, two from social and healthcare professionals and nine from members of staff. We have incorporated this feedback where possible in this report. We would like to thank all people who gave us feedback about the service that the home provides and the manager and all her staff for their cooperation and assistance during the inspection. What the service does well: There is a comprehensive system in place to ensure that the needs of people, who are referred to the home for admission, are appropriately assessed to make sure that the home will be suitable for the prospective residents. Residents also receive information not only about the home but about social care in general and about funding so that they have all the necessary information to make an informed decision about moving into a care home. People who live in the home are given every opportunity to express their views and to make choices in their daily life. Residents meetings are arranged at two monthly intervals and there are other meetings where the views of residents are sought, such as the catering meetings. Residents and/or their relatives are involved in drawing up and in reviewing care plans and in making decisions about the welfare of residents. Residents are also supported appropriately for them to meet their healthcare needs. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 7 The manager is experienced and knowledgeable about running care homes. She is supported by experienced staff within the home and within the organisation to make sure that the home meets its stated aims and objectives. The catering in the home is organised relatively well and is generally flexible to reflect residents’ choices and wishes with regards to the provision of meals. The home benefits from two activities coordinators and a range of volunteers to organise and carry out fulfilling social and recreational activities for residents both inside and outside the home. The social and recreational needs of residents are also appropriately assessed and plans are then drawn up to meet the identified needs. The home has an open approach to the management of complaints. The complaints procedure is easy and simple to use and complaints are accepted in most format, whether verbally, by email or by letters. There is a robust approach to the protection of vulnerable people, as all staff receive training in this area during induction and then yearly. The management of the home keeps an active presence on the floors and monitors the care and support that residents receive. The home provides appropriate staffing levels and offers the appropriate training and supervision to make sure that staff are skilled and competent to care for residents. One resident said that ‘the home is a model to other homes’. Another said ‘I like the food and staff are friendly’. A third said that ‘there are enough cultural activities which I need’. A fourth reported that ‘the home environment is always clean and tidy’. What has improved since the last inspection? All staff that we spoke to said that there has been continuous improvement in the quality of the service that is provided to residents during the past 2-3 years. That was also the time when the current manager of the home was appointed. We are pleased to note that with the support of the organisation, she has been able to turn around the home. The standard of care records continues to improve. These generally reflect the needs of residents and contain information about the action to take to meet the needs of residents. The management of medicines has improved as compared to the findings during the last inspection and there are monitoring systems in place to make sure that the standard is maintained. The standard and the quality of the environment that the home provides has again improved. Nearly all the corridors have been redecorated and the The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 8 floorings have also been replaced. This was particularly needed in Newland House, where we noted during the last inspection that the carpet was well beyond its useful life. The home has improved the quality management system, as there is now a comprehensive annual audit to monitor the quality of the service that is provided by the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1-4 People using the 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 all people who wish to use the service, the necessary information for them to decide whether they would like to use the service. The needs of all people who are referred to the service are appropriately assessed for the home to decide whether it will be able to meet their needs. EVIDENCE: Copies of the service users’ guide (SUG) and the statement of purpose (SoP) were available for inspection. These have been updated and refreshed to contain the latest information about the service that the home provides. All people who want to be a resident in the home or to receive services from Jewish Care have to go through an assessment process. They first fill an application form. They are then assessed by social workers who work for The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 11 Jewish Care. Around the same time they receive a range of information about moving into care homes, paying for care homes placement and their rights and options with regards to receiving social care. This includes information about the home that they would like to move in. The above is confirmed by our survey when seven out of nine residents who responded, said that they received information about the home before they were placed. The other two were not sure. When residents have been identified as suitable for placement in the care home, their needs are assessed by the manager or her senior staff. The residents and/or their representatives also visit the home to find out about the services and the facilities that the home offers. In cases when residents are unable to visit the home, the representatives of the resident are always invited to visit the home to find out if the home is suitable for the prospective resident. In cases of emergency referrals, the home makes sure that the needs of the residents are assessed appropriately and requests the needs assessment of the funding authority, before accepting the resident. The representatives of the prospective residents are also invited to visit the home to decide if the home will be suitable for the prospective residents. We looked at the care records of two residents who have been recently admitted to the home and we noted that one resident’s needs were assessed by the manager and the other resident’s needs by the deputy manager. The assessments of needs of residents were on the whole comprehensively completed and there was additional information available from social services or from hospitals to enable the home decide, whether the home would be able to meet the needs of the residents. We asked if the above two residents were given the home’s contract of stay. We were informed that all residents that are admitted to the home receive a contract, including the above two residents. Our survey showed that the majority people have had a contract. For those who did not respond to this section of the questionnaire or were not sure, it could very well be the representatives of the residents that have received the contract. The home specialises in meeting the needs of Jewish residents and only admits Jewish residents. This is made clear in the SUG of the home. There are a few residents that have been in the home prior to Jewish Care taking over and who are Christians. We were informed that they are offered opportunities to maintain their cultural and religious beliefs, despite the predominantly Jewish population of the home. Staff receive a comprehensive induction and information about the Jewish culture. As a result they are quite familiar with the traditions and customs of the Jewish Culture. The cultural and spiritual aspects of the needs of residents The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 12 are on the whole appropriately addressed in the care records of the individual resident and in practice. All nine staff who responded to our survey stated that they are given up to date information about the needs of residents and that they receive support and training to do their job appropriately. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. 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 feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans generally address the needs of residents appropriately to make sure that these needs would be met. Residents are appropriately supported by nursing and care staff to meet their healthcare needs. Medicines management is on the whole, of an appropriate standard to ensure the safety of residents. End of life care is appropriately addressed in the care records of residents to make sure that these needs would be met when they arise. EVIDENCE: The care records of five residents were inspected. The assessments of the needs of residents were on the whole appropriately completed to identify the areas where residents needed support and care. Care plans were then drawn up to address the identified needs of residents. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 14 We found that the care plans were on the whole clear and contained information about the action to take to meet the needs of the residents. There were also a range of risk assessments that were used to ensure the safety of residents. Care plans and risk assessments were generally reviewed monthly but were not always updated when the needs of residents changed. The care plans and risk assessments of a resident were not updated to reflect the changes in their needs, particularly with regards to mobility and sleeping. Care plans were on the whole drawn up and agreed with residents and/or their representatives. We found that one of the five care plans had no signatures in place to show whether this had been agreed with the resident and/or their representative. We observed that three out of the five residents were on pain charts. Inspection of these showed that the pain chart for one the three residents had not used on a single occasion, when the care plan said to use the pain chart to assess pain. For the other residents, the chart was used once monthly when the care plans were reviewed. These were not used as an appropriate tool to monitor the level of pain that residents had. Residents had ‘elimination charts’ that were used to record instances when residents passed stools. The charts for at least two residents showed that these were not regularly completed to give comprehensive information about the elimination of residents. If the charts were to be believed, then the residents had not been to the toilet for more than ten days. Residents were all registered with a GP and records were in place to show the outcomes of the visits. Referrals were also made to various healthcare professionals such as the speech therapist and the tissue viability nurse. A dentist and optician saw residents for check ups and when required. Residents are also able to access the services of a physiotherapist if that is required. Seven out of the nine residents who responded to our survey said that they are always supported by staff with their healthcare needs and that they always receive the care and support that they require. Two respondents said usually to the above. A few residents in the home had pressure ulcers, and we were informed that the pressure ulcers were all healing. The care records of one resident with two pressure ulcers showed that these were being managed appropriately and that the pressure ulcers were healing. There was evidence that the tissue viability nurse had seen the resident and provided advice. We noted that the last photographs of the ulcers were dated March 09. There were no wound mappings that had also been carried out after March 09. There were however regular entries in the wound progress notes. On the day of the inspection the resident sat out for about three hours. We were informed that this was because the carpet in their room was being shampooed. It is evidence-base The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 15 practice that people with a sacral ulcer should not spend more than two hours sitting out. The home accommodates a number of residents who are quite independent and who are able to self-care to a large extent, particularly in Newland House. We noted that the care plans of the more able residents could have been more comprehensive by addressing the independent living skills. During the inspection we came across a few residents that were willing to loose weight and to take action to improve their general health and well being such as, by taking part in exercise sessions. The care records of one of the residents showed a large reduction in weight. It would have been helpful to have a plan in place to address and manage the weight loss, as too much weight loss in a short space of time can also be detrimental to residents’ health. As a result of the above we concluded that some residents in the home would benefit from health promotion and advice for them to lead a fulfilling and healthy lifestyle. We looked at the management of medicines on all the units. We noted that the standard of medicines management has improved when compared to the findings of the last inspection. The home has a system of medicines audits to ensure that the standard of medicines management is maintained. We were informed that a few residents have been assessed as able to selfadminister their medicines. The care records of one resident, who selfadminister medicines, showed that risk assessments and control measures were in place to address the risks. There were weekly checks that were recorded to make sure that residents were taking their medicines as required. In cases when there was no lockable space in the bedrooms of residents, the medicines were kept on the medicines trolley and given to residents when they were ready to take their medicines. The amount of all medicines was recorded when received in the home. However, the amount that was carried forward was not always recorded when a new medicines cycle started. As a result we were not able to relate the amount of a medicine (for thinning the blood) with what should have been in stock. We noted that the amount of another medicine was more than what should be in place, albeit by one tablet. We also observed that a few topical medicines did not have clear instructions about the location to administer these medicines. The care records contain information about the end of life care of residents and their resuscitation status. This included information about the spiritual and religious needs of residents. The information was generally received during the assessment of the needs of residents and care plans were then put in place to address end of life care needs. The home is commended for the progress in this area. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 16 The end of life care of residents is generally managed well, but we noted that one resident who required end of life care might have benefited from a referral to the palliative care service to establish the link between the resident, the home, and the palliative care service and to have the backup for getting advice and support should the needs of the resident change. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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 maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People using the 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 on the whole have the opportunity to take part in a range of social and recreational activities, both within and outside the home. The home makes every attempt to provide a variety of nutritious meals to meet the needs of residents, although this may not always be to everybody’s taste. EVIDENCE: The home has two part time activities coordinators as well as many volunteers who run particular social and recreational events. For example there are people who do manicuring for residents and others who run an evening club. Some examples of social and recreational activities are: cookery club, discussion groups, tai-chi, quiz sessions, aromatherapy, computer classes, talks by some residents, film shows and entertainment sessions. The evening club is seen by residents as something interesting and positive to be involved in. There are students from a school who take part in the evening club and who engage with residents. The film shows were described as not always a success because the cinema system is found in the library and due to The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 18 the amount of light that enters this room, people cannot always see the screen properly. For example on the day of the inspection, there was a tennis match and people could hardly see the tennis ball. We noted during our inspection that activities seemed to be concentrated to people who were more able to do things such as the people who only require personal care and live in Newland House. We discussed this with the manager and asked about the activities for the residents that are accommodated on the nursing units and who sit in the communal areas, in Edmond House. We were informed that staff normally do activities with residents and that some volunteers do aromatherapy and one to one sessions with residents. A few of the residents go the library and many are involved in communal activities such as when there is a religious celebration. One of the smaller lounges has the equipment in place, to convert it into a multi-sensory room. We however think that the home should continuously assess and review the facilities that are in place for those people who are more dependent and who are least able to express themselves. We were informed by staff that outings are arranged for residents. One resident said that they have been to a local theatre. Others said that they are able to go out with their relatives and friends. A few are able to go shopping and in the local community. For those residents who go out in the community independently, there are risk assessments in place about the ability of residents to go out or use public transport independently. These did not only promote the safety of residents but also their independence. Two out of nine residents who responded to our survey said that there could be more outings and one of them said that there could be more outings to parks, museums and the beach. The home has an open visiting policy and many visitors were observed in the home during the course of the day. Some sat outside with their relatives, others stayed in the communal areas and a few visited residents in the bedrooms of the residents. We noted that they were all offered drinks and biscuits. The home has a praying area, which is now predominantly used by residents of the Jewish faith, as the overwhelming majority of the residents are Jewish. Residents are supported with their spiritual needs and assisted to attend the many religious/prayer sessions that take place in this area. On the first day of the inspection (a Friday) there was a prayer session that was attended by many residents in the home. The library/prayer area was full. We observed lunch on the first day of the inspection in the main dining room. The dining area had been appropriately prepared for residents to have their meals. Lunch consisted of fried eggs or poached eggs or omelettes, baked beans, peas and chips. There were also mashed potatoes and roast potatoes. For desert there was rice pudding with strawberry jam sauce. Fruit salad is The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 19 always available. We were informed that there is normally a light lunch on the Fridays and that the main meal is then served for supper. Friday evening is the start of the Sabbath. For supper there was yellow pea soup, poached salmon and tartar sauce, vegetable sausages and tomato sauce. Desert consisted of cold compote and milky custard. The home provides a restaurant type service for meals. Residents choose their meals when members of staff ask them about their choices from the list of meals that are available on the day. We thought that the service was relatively good and that residents were offered choices. Some residents that we talked to commented that the service at the tables is not very good and that staff do not always listen to their full choices and make errors at times. One person suggested using a notepad to record the choices of residents. Some residents stated that they enjoy the meals but a few said that the food at times was not very good. One person, who talked to us, said that there is variety but the food is not always very tasty. Another said that ‘you cannot always please everybody’. Two residents who responded to our survey stated that the meals could be better. We however noted that people have the opportunity to express their views about the meals and are also able to make suggestions about meals in catering meetings. Minutes of these meetings were available for inspection. One person said that it always takes some time before action is taken to address any comments that they make. We noted during the inspection that the catering manager and the chef were working on a new menu. They said that they were making some changes to the menu and were adding new items after listening to residents. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 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’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16-18 People using the 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 manager and her staff take all complaints seriously and make sure that these are appropriately investigated and responded to. Similarly staff are clear about the action to take if there are suspicions or allegations of abuse. EVIDENCE: We looked at the complaints register that the home keeps. There have been eleven complaints since the beginning of 2009. The manager has made sure that all complaints were recorded in an open and transparent manner and investigated. There was also evidence that written responses were sent to complainants with the necessary apologies where it was found that the complaints were substantiated. Out of the eleven complaints, five were about the attitude/behaviour of members of staff. Out of these, two were not substantiated and three were substantiated. Actions were formulated to address the lessons to be learnt. The complaints procedure was available in the reception area, on notice boards and in the service users’ guide. We noted that the home accepted complaints that were made verbally and in writing whether is letters or via emails. Residents, who responded to our survey, stated that they knew who to contact if they were unhappy about the service. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 21 There have not been any referrals to the safeguarding adults team of the Local Borough. Our conversation with members of staff showed that they would inform the person in charge if they come across allegations or suspicions of abuse. The training records showed that most members of staff were up to date with training on safeguarding adults and abuse. In the past the manager and her staff have appropriately dealt with allegations of abuse. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 and 26 People using the 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 pleasant, maintained and personalised environment for residents to enjoy. EVIDENCE: The home is situated on a relatively large expanse of land, about 3-5 minutes walk from the main road and therefore, provides a relatively quiet and peaceful environment. The grounds of the home continue to be very well maintained and consist of wooded areas with mature trees, extensive lawns, flower beds, shrubs and bushes as well as a pond. Walkways, most of them accessible to wheelchairs, cover the grounds and offer the opportunity for residents to go for walks and to enjoy the outdoors. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 23 The building was in a reasonable condition at the time of the inspection. We were able to note that many areas of the home have been redecorated and upgraded. Nearly all the corridors have been redecorated and repainted. The carpet has also been renewed in the corridors that now provide a maintained and pleasant environment. There are many communal areas all over the home and these continue to be suitable for the residents that are accommodated in the home. The lounges in Edmond House provide adequate communal space for the residents requiring nursing care and we noted that there are appropriate seating facilities for the residents. A few residents are also taken to the library to sit with their relatives or with other residents that they have befriended. On one day of the inspection the weather was particularly pleasant and we noted that many residents sat outside. Many areas outside the home, including the patio areas have been adapted to accommodate wheelchair users and to provide shade. A number of gazebos were also observed in the garden offering shade for those who wanted to sit in these areas. There are bathrooms and toilets on each floor and since the last inspection a number have been adapted to ensure access to those with a mobility impairment and to those who are wheelchair users. Grab rails were noted in some toilets and the manager said that there are enough toilets and bathrooms to meet the needs of disabled residents. A few toilets in the ensuites do not have grab rails on either side, but the manager stated that the mobility needs of residents are assessed and that grab rails are provided if required, depending on the findings of the assessments. The bedrooms of residents that we saw were all appropriately decorated and furnished. We noted that residents have the opportunity to bring their own furniture, items of decoration, pictures and photographs. The quality of the fixtures and fittings is also of good quality and provides the evidence that the environment is well kept. The AQAA says that bedrooms are normally decorated when they become vacant in preparation for the next resident. All residents that we spoke with during the inspection said that they were satisfied with their rooms and with the environment. According to the AQAA, some of the improvements made to the environment are: new bathroom installed in nursing wing, another disabled toilet installed, refurbishment of the Drawing Room and Garden Lounge, all bedrooms have the décor updated when vacant, air conditioning installed in Library, broadband now available to residents, new furniture purchased, home cinema system installed. Improvements that are planned for the future consists of planting an area outside the Nursing Lounge to which frailer residents can have access to, refurbishing the outside wooden furniture, new blinds to be purchased for The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 24 Nursing Lounge to protect residents from direct sunlight, new curtains to be purchased for Drawing Room and Nursing Lounge and upgrading Newland House Surgery. The home was clean in all areas that we toured and there were no odours. The ancillary work/hotel services in the home are contracted to an outside company. They are also responsible for the laundering of residents’ clothes. The training records showed that most staff have had training in infection control. We also discussed the Department of Health Guidance on infection control “Clean, Safe Care” for care homes and audit of infection control. The manager stated that she is in the process of looking at a suitable tool to carry out infection control audits in the care home. All nine residents who responded to our survey stated that the home is always fresh and clean. The home is commended for progress in this area. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People using the 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 staffing levels that are provided in the home are suitable to meet the needs of residents that are accommodated in the home. Recruitment procedures are on the whole strictly complied with, to ensure the protection of people who use the service that the home provides. Staff receive the necessary training and support for them to do their job as effectively as possible. EVIDENCE: The duty rosters were inspected. On the day of the inspection there was one trained nurse and five carers during the day and one trained nurse and two carers at night on the nursing unit on the ground floor (eighteen) residents). There was one trained nurse and five carers for the day and one trained nurse and two carers for the nursing unit on the first floor of Edmond House (twenty residents with nursing needs and five residents with personal care needs). In addition there was a trained nurse who acted as a floater between the two nursing units, and the deputy manager, who is supernumerary. There are five carers during the day and two carers during the night for Newland House. These staffing levels seem to be adequate for the residents that were accommodated in the home at the time of the inspection. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 26 We noted from the duty rosters, that the home generally maintains the staffing levels as outlined in the first paragraph. The manager said that the home has a flexible approach to the provision of staff and that at busy times, such as when residents needs escorts, or when there are functions in the home, there may be more staff to care and support residents. The duty rosters showed that the home used bank or agency staff to cover the shifts when there was a shortage of permanent staff, such as when there were staff vacancies, sickness or holidays. At the time of the inspection there was a vacancy of seven carers and one trained nurse. The manager stated that she is in the process of recruiting more staff and that unfortunately there has been a shortage of suitable applicants. Six of the nine residents who sent us surveys, commented that staff are usually available when they need support, one said sometimes and one said always. Staff also said in comment cards that more permanent staff are required. All nine residents who sent surveys said that staff always listen and act on what they say. One resident said ‘I am happy here though at times I get carers who are not really caring’. This could well be linked to the absence of permanent staff and the use of temporary staff. We looked at the personnel files of four members of staff that have been recently employed by the home. We noted that all the records and checks as required by legislation were in place including, appropriate CRB checks, references and proof of identity and eligibility to work in the UK. The work history of applicants however, could have been more comprehensive to identify all the gaps and to make sure that the work history was as close to the month as possible. There was also evidence that an induction to the home had taken place for these four members of staff, as well as a corporate and structured induction at the head office. During the induction period, members of staff start the common induction standards as per Skills for Care. The administrator kindly provided us with the training records. These were up to date and showed that members of staff received mandatory training as well as other training in clinical areas to make them more competent in caring and supporting residents. There were notices of training sessions that have been planned for staff, to make sure that they were aware of these and for them to attend. Mandatory training for care and nursing staff included fire, manual handling, food hygiene, infection control, abuse and health and safety training. There was training in dementia, palliative care and phlebotomy. We noted that the organisation also provided a training called ‘Values in Practice’ which aims to promote the dignity of older people while caring for them. According to the AQAA the home has thirty-one carers out of forty-one, trained to at least an NVQ level 2 in care. This is good practice and demonstrates the The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 27 commitment of the home to the training and development of its care staff. We were informed that the organisation now aims to introduce some form of professional practice development programme and monitoring for trained nurses, to make sure that they continuously deliver a high standard of nursing care and that they are able to supervise the care and support that residents receive in an appropriate manner. The home already ensures that all nursing and care staff receive supervision every two months or six times a year, including an annual appraisal. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. 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 the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People using the 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 manager is experienced and fit to run the home. She is fully able to discharge of her responsibilities. The home has tools in place that involves the participation of stakeholders to monitor the quality of the service that it provides. The personal money of residents and their property is managed to a good standard to ensure that residents are protected as much as possible from financial abuse. Health and safety issues are taken seriously and are addressed as required to ensure the safety of people who use the premises. EVIDENCE: The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 29 The manager has been in post for about 3 years. She is a trained nurse and has the registered manager’s award. There was evidence that she has kept herself up to date by having training relevant to her job. She was able to discuss the care of the residents and thereby demonstrating a good knowledge of the residents and their needs. Staff said that she runs the home in an open and inclusive manner. The manager is assisted by the deputy manager. We noted that both kept an active presence in the home and were quite involved in the care of residents and in engaging with them. They also monitored the meal times of residents and frequently entered the communal areas of the home to see what was happening in these areas. All staff who responded to our survey stated that they do get support from management but one respondent mentioned that there is a communication breakdown at times. All residents that we spoke to said that they knew the manager and the deputy manager well and said that they would approach management if they wanted to discuss any issues. Minutes of general staff meetings, house staff meetings and unit staff meetings were seen. Staff that we spoke to also said that they have the opportunity to contribute to staff meetings. There are two monthly residents meetings. Minutes were available for inspection and action plans were drawn to address any issues that were identified. The home has a quality assurance procedure and a quality assurance system. Comprehensive surveys of residents, their relatives and staff are conducted. Results are summarised in the form of a report and the home then provides an action plan to address areas where performance was not good enough. In addition to these surveys, there are also catering surveys that feeds directly to the catering department, to provide feedback about the meals that are offered to residents, so that changes to the menu and improvement of the provision of meals can be made, where required. An audit tool has been added to the quality assurance system by the clinical governance department of the organisation. This is carried out yearly by the said department and looks at all aspects of the service that is provided by the home. The administrator was not present during the inspection and the manager was able to provide records about the management of residents’ money. We noted that the personal money of residents is managed to a good standard. Each resident has a separate record. Money is recorded when received into the home for a resident and receipts are kept for all expenses that are made for residents. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 30 The home has also introduced property sheets to record the valuables and property that residents bring into the home. Previously these were not in place. We noted that these were being filled for new residents. The property sheets therefore provide an opportunity to monitor residents’ property and valuables that are brought into the home. We looked at the health and safety and maintenance records that the home keeps. We noted that all safety certificates were in place as required, and that there were systems in place to ensure regular health and safety and fire checks. Certificates were also available to show that items of equipment were maintained and checked for safety. The home has a health and safety risk assessment and fire risk assessment. We did not see a fire emergency plan, as required by the Regulatory Reform (Fire Order) 2005. There were pieces of information that should be in the fire plan in a number of files but it would be helpful to have all the information in one ‘emergency fire plan’ that can be pulled out at any moment and that will contain all the necessary information to deal with an emergency situation when there is a fire. The manager stated that all window restrainers in the home have been replaced with restrainers that can only be disabled by a key or a special tool. The previous restrainers could easily be disabled by hand and were therefore inadequate and could have been putting residents at risks. It is for the home to have regular checks to ensure that these are in place and working appropriately. The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 31 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 32 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. 1 Standard OP7 Regulation 15 Requirement That care plans must be used as ‘live’ documents and must be updated and kept under review as and when the needs of residents change. All medicines must be administered as prescribed, otherwise the amount of medicines that is in place will not match the amount that should be in place if the medicines are administered appropriately. The instructions to administer medicines, including topical medicines, must be clear to make sure that staff administer the medicines appropriately. 3 OP9 13(2) The amount of medicines that remains after a medicine cycle has finished and that is carried forward, must be recorded to provide a clear audit trail. 31/08/09 Timescale for action 30/09/09 2 OP9 13(2) 31/08/09 The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 33 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 3 Refer to Standard OP8 OP8 OP8 Good Practice Recommendations For pain charts to be used effectively, these should be used as an active tool when residents say or observed to be in pain and not used at fixed intervals. The home should look at the issue of health promotion in the elderly and identify opportunities if, there are any. All records have to be completed properly including elimination charts, as these provide valuable information about the care and support of residents, on the basis of which decisions may have to be taken. Residents who have palliative care needs should be referred to the palliative care service in the community at an early stage to start building the relationship between these parties and to make sure that prompt access to this service is available when required. The home should assess and review the facilities and opportunities that are available for the provision of activities to the more dependent residents that live in the home, particularly those that are accommodated on the nursing units. The work history of applicants should be comprehensive and as close to the month as possible, to make sure that there are no gaps in the employment history. It is strongly recommended that an emergency fire plan be in place to address all issues that might arise as a result of a fire, and to ensure that the home is fully prepared to deal with a fire if, it happens. 4 OP8 5 OP12 6 7 OP29 OP38 The Princess Alexandra Home DS0000022938.V376296.R01.S.doc Version 5.2 Page 34 Care Quality Commission National Enquiry Line: 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). 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. 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