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Inspection on 01/11/05 for Alexandra Nursing Home

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

This inspection was carried out on 1st November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

The home has implemented a regular audit in aspects of care to ensure that the health, safety and welfare of service users are promoted and protected. All policies and procedures have been revised and updated and are available to staff for guidance.

What has improved since the last inspection?

The home has appointed a new deputy manager to assist in the day to day management of the home. The staffing level in the Dementia Unit has been increased by one. The home has a `Sensory Room` that is now open to service users. A trained member of staff always accompanies a service user who wishes to use the facility.

What the care home could do better:

The home is under new management. Staff are adjusting to the changes in procedures. Written care plans have been reviewed and they are currently being revised and updated. It is recommended that staff attend training in regards to writing care plans. Feedback received from a relative suggested that the home has not responded to a complaint within 28 days. The home manager was away at the time but she has assured the inspector that she will review the matter and improve the way complaints are handled in future. (Please see Statutory Recommendations).

CARE HOMES FOR OLDER PEOPLE Alexandra Nursing Home 46 Alexandra Road Hemel Hempstead Hertfordshire HP2 5BP Lead Inspector Yoke-Lan Jackson Unannounced Inspection 10:00 1 November and 29 December 2005 st X10015.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 Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 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. 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. Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Alexandra Nursing Home Address 46 Alexandra Road Hemel Hempstead Hertfordshire HP2 5BP 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) 01442 246775 01442 216047 Southern Cross Care Homes No 2 Limited Barbara Warner Care Home 76 Category(ies) of Dementia (26), Old age, not falling within any registration, with number other category (76) of places Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home may accommodate a maximum of 76 service users requiring nursing care Within the overall capacity the home may accommodate a maximum of 5 service users between the ages of 50 and 64 Within the overall capacity the home may accommodate a maximum of 25 older service users requiring personal care Within the overall capacity the home may accommodate a maximum of 26 older service users with dementia requiring nursing care 8th June 2005 Date of last inspection Brief Description of the Service: This purpose-built care home with nursing was first opened in 1999. It consists of three floors that are connected by two passenger lifts. The ground and second floor provides accommodation to service users who require general nursing care and the first floor is dedicated to service users who are mentally frail. Each floor has its own dining room and two lounge areas. The home is built on a sloping site and the main reception, kitchen, laundry, hairdressing salon and garden lounge are located on the lower ground floor (at the rear of the bulding). There is off-road car parking provided both at the front and rear of the home. The home is located in close proximity to shops and other amenities including public transport. Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection visits took place on 1st November and 29th December 2005. The home manager was present on both occasions. The Operations Director was present during the 2nd visit. The inspection began with general discussion with management followed by a tour of the units. Documents and other relevant materials were inspected and copies obtained. A number of service users, visitors and staff were interviewed. The home has been under new management since May 2005. Staff are adjusting to the change in management. New initiatives are being implemented. Positive feedback was received from the majority of the relatives and service users about the care given. However, a relative felt that her mother was not receiving ‘appropriate nursing care’. The matter is currently being investigated. (Please see below for details of the inspection findings). What the service does well: What has improved since the last inspection? Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 6 The home has appointed a new deputy manager to assist in the day to day management of the home. The staffing level in the Dementia Unit has been increased by one. The home has a ‘Sensory Room’ that is now open to service users. A trained member of staff always accompanies a service user who wishes to use the facility. 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. Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 7 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 Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5. Prospective service users and their relatives are given an opportunity to visit and to assess the facilities and suitability of the home. They have the information to make an informed choice. A full assessment is carried out before a prospective service user is admitted to the home. EVIDENCE: The relatives spoken to confirmed that they were given the opportunity to assess the home and a Service User Guide was given to the new admission. The home manager assured the inspector that a thorough pre-admission assessment is carried out and that the home will only admit a service user whose needs can be met. Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9. Each service user has a written care plan. Some of the care plans are inadequate and are currently being revised. There were errors made in the administration of medication. EVIDENCE: The home manager carried out an internal audit of the written care plans and found that some of them were lacking in content. The key workers, who are trained nurses, are responsible for the written care plans of the service users in their care. It is recommended that staff attend training with regards to writing care plans. The home manager recently investigated incidents a number of medication errors made by 4 nursing staff who failed to signed the Medication Administration Record (MAR) Charts. Disciplinary procedures were initiated. None of the medication errors resulted in any adverse effects on the service users. On the day of the inspection, the MAR charts were correctly completed. Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 10 Positive feedback was received from the majority of the relatives and service users about the care given. However, a relative felt that her mother was ‘not receiving appropriate nursing care’. The matter is currently being investigated. Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14, 15. The service users are given every opportunity to participate in all aspects of routine living. They are encouraged to maintain links with their family and friends. The meals provided are nutritious and choices are given. EVIDENCE: The menu was reviewed by a dietician in February 2005 and appropriate changes were made to ensure the meals provided are balanced and nutritious and choices are available. The service users interviewed were ‘quite pleased’ with the meals served. A number of service users said that they ‘would like to see more fresh fruit on the table’ so that they can help themselves as they wish. The home manager has assured the inspector that this request will be met immediately. Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. The home has a Complaints Policy and Procedure. However not all complaints have been responded to within 28 days. EVIDENCE: Feedback received from a relative suggested that the home has not responded to a complaint within 28 days. The home manager was away at the time but she has assured the inspector that she will review the matter and improve the way complaints are handled in future. The home follows the Adult Protection Procedure issued by Hertfordshire Social Services. The manager ensures that all staff are aware of the Adult Protection Procedure and the Whistle Blowing Policy. Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 23, 24, 26. Service users live in a clean and pleasant environment. The facilities provided are adequate and well maintained. The home has a ‘Sensory Room’ that is now open to service users. A trained member of staff always accompanies a service user who wishes to use the facility. EVIDENCE: The premises appeared homely and clean. On the day of the inspection, the workman was busy redecorating the bathroom on one of the floors. There is a rolling maintenance programme. The home manager confirmed that service users who require nursing care are nursed on adjustable beds (profiling beds) with appropriate mattresses in place. Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 14 Service users spoken to said that they are ‘satisfied’ with the facilities provided, including the ‘Sensory Room’ which is now in full operation. The bedrooms inspected were clean and comfortable. The items on display in the bedrooms reflected the lifestyles of the occupants. Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 30. Staff are deployed where needed to ensure the needs of the service users are being met. Appropriate training is arranged for the staff. EVIDENCE: The staff number in the Dementia Unit has been increased from 5 to 6. There is no increase in the number in the Residential and Nursing Units. The home manager confirmed that staff are deployed where needed. She and the deputy manager are both hands-on. The home manager ensures that staff receive adequate and appropriate training in order to meet the needs of the service users in their care. Arrangements have been made for 2 members of staff to attend training sessions on Wound Care. (Please see Statutory Recommendations). Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36, 37, 38. The home is under new management. Procedures are being reorganised to improve services. The health, safety, and welfare of the service users are safeguarded by the record keeping, policies and procedures of the home. EVIDENCE: The home manager (former deputy manager) has been in post since May 2005 and the new deputy manager has been in post since July 2005. Staff are adjusting to the change in management. Team working is encouraged. The home manager is currently coaching her staff to revise, update and improve the contents of the written care plans. All relevant policies and procedures have been revised and updated and these are available to staff for their guidance. Regular audits of nursing tasks such as wound care, risk Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 17 assessments, medication and other relevant services are in place. These are positive changes. Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 18 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 X 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 3 X 3 3 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 3 3 3 Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? No 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. Refer to Standard OP30 Good Practice Recommendations It is recommended that all members of staff attend training in regards to writing care plans. Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 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 Alexandra Nursing Home DS0000044528.V264242.R01.S.doc Version 5.0 Page 21 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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