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Inspection on 10/05/06 for Alexandra Nursing Home

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

This inspection was carried out on 10th May 2006.

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

Those service users and their relatives spoken to were in general very positive about the standard of care experienced in the home. "I am treated very well here" was one typical comment made by a service user. The standard of record keeping seen was at least adequate and sometimes good and the manager appears committed to raising the average standard to that of the best.

What has improved since the last inspection?

The recent appointment of a new manager has meant that the period of transition and change previously experienced by service users and staff has continued.

What the care home could do better:

The consistency and safety of the services provided to service users would be improved if the home`s very comprehensive policies and procedures, for example in the recruitment of staff and provision of appropriate staff training, were always fully implemented. This inconsistency is reflected in the outcome judgements made in several areas, which could otherwise be good.

CARE HOMES FOR OLDER PEOPLE Alexandra Nursing Home 46 Alexandra Road Hemel Hempstead Hertfordshire HP2 5BP Lead Inspector Jeffrey Orange Key Unannounced Inspection 10th May 2006 08:30 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.V293852.R01.S.doc Version 5.1 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.V293852.R01.S.doc Version 5.1 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 www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Limited 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.V293852.R01.S.doc Version 5.1 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 1st November 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 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 building). There is off-road car parking provided both at the front and rear of the home. The home is located close to shops and other amenities including public transport. The Home has a Statement of Purpose and Service User’s Guide, both of which are available to prospective service users along with copies of previous inspection reports by the Commission for Social Care Inspection. Weekly fees range from £383 -£750 (not including registered nursing care contributions). These fees were current at April 2006. Additional charges apply for hairdressing, chiropody, newspapers and personal toiletries. Alexandra Nursing Home DS0000044528.V293852.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection started at 8.30 a.m. and provided an opportunity to observe the operation of the home from breakfast through to the afternoon. This report includes information received from discussions with service users and relatives, the manager and staff, from records inspected during this visit and also information about the home received since the previous inspection in November 2005. The home is again in a period of transition, following the recent appointment of a new manager. There are a number of changes that have already been made, with others being introduced. Progress will continue to be monitored by the Commission for Social Care Inspection using information obtained throughout the coming year from a variety of sources, including further visits to the home. The manager and her staff were very open and co-operative throughout this inspection. What the service does well: What has improved since the last inspection? The recent appointment of a new manager has meant that the period of transition and change previously experienced by service users and staff has continued. Alexandra Nursing Home DS0000044528.V293852.R01.S.doc Version 5.1 Page 6 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.V293852.R01.S.doc Version 5.1 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.V293852.R01.S.doc Version 5.1 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 3 4 (Standard 6 does not apply to this service) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the information provided to prospective service users is sufficient and appropriate and the pre-admission assessment appears robust and comprehensive, the standard of specialist dementia care provision requires improvement. EVIDENCE: A number of staff on duty on the Jasmine dementia unit had not been given adequate training in dementia care. It was not clear that the activities programme on the dementia unit had been based on the specific individual needs of those service users with dementia and reflected current best practice. Alexandra Nursing Home DS0000044528.V293852.R01.S.doc Version 5.1 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 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans, when completed fully provide a good record of the medical needs of service users and how they are being met. Social care needs are less fully recorded and sometimes it was not possible to easily track how needs were being met. It is acknowledged that a review of care plans is currently under way and this has led to some improvement in overall standards. Medication procedure when fully complied with is satisfactory and should provide for the safe administration of medication. Some improvement is required in the recording of medication for return and in the monitoring of medication held for use as and when required by service users. Service users are able to access the community health and social care services they require, for example dentistry, general practice and chiropody. Service users are generally treated with due regard to their dignity, a recommendation about female service users dress has been made. EVIDENCE: Alexandra Nursing Home DS0000044528.V293852.R01.S.doc Version 5.1 Page 10 The standard of care plans seen was generally adequate. The standard remains variable, with some of those recently reviewed being good and others less so. In one case it was not possible to determine if a care plan goal for an immersion bath at least weekly had been achieved consistently. Records for the return of medication on one unit were not being completed at the time the medication became surplus, which would make an accurate audit difficult. Two of the amounts of medication held for use as and when required by service users were not accurate, one being more than shown and one less. A service user was seen being taken for a routine hospital visit and care plans include good evidence of the involvement of community health services. Several of the home’s female service users had either bare legs or were wearing “pop socks”. Where this is routinely the case, it should be recorded in the care plan and must only be as a matter of choice by the service user or for a medical/treatment reason, not simply for the convenience of staff. Alexandra Nursing Home DS0000044528.V293852.R01.S.doc Version 5.1 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): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current activities programme provides a good basis for further development to increase the person centred approach discussed with the manger and specifically to take full account of current best practice in the provision of activities for people with dementia.(Please see requirement made under Standard 4) Service users are able to build and maintain contacts with families and friends in the community and in the home. Although the CSCI report “Highlight of the Day” about improving meals for older people in care homes was on display, it is not clear how far this has been reflected in care practice as it refers to the organisation of mealtimes and the environment in which meals are taken. (Rather than just nutritional considerations). There are several things which could be addressed to make the experience for both service users and staff more positive and enjoyable, for example appropriate music, décor, presentation of tables and food and the amount of time service users have to spend in the dining area prior to meals actually being served. Alexandra Nursing Home DS0000044528.V293852.R01.S.doc Version 5.1 Page 12 EVIDENCE: An activities programme was on display in each unit and the home has a dedicated Activities Organiser. One activity session was observed on the dementia care unit. Several family and visitors were spoken to and they were positive about their access to the home and the care they saw there. Breakfast and lunch were observed on the dementia unit in particular. Staff had not read the CSCI report “Highlight of the Day?” although a copy was prominently displayed in the dementia unit. Alexandra Nursing Home DS0000044528.V293852.R01.S.doc Version 5.1 Page 13 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 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints policy and procedure is in place, notices are prominently displayed in the home about this and also setting out the whistleblowing policy for staff and others. However, not all staff spoken to were familiar with the whistle blowing policy of the company. EVIDENCE: Policies and procedures have been seen previously and notices are prominently on display throughout the home. Those members of staff asked what they understood by abuse and whistleblowing policies and procedures did not all have a full understanding of these concepts, although it should be covered in their induction programme. There is currently a potential adult abuse investigation being carried out, the home have co-operated in this process. Alexandra Nursing Home DS0000044528.V293852.R01.S.doc Version 5.1 Page 14 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 20 21 24 25 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home provides the number and size of facilities for service users that are required and adequately maintains the premises, although there are some specific areas that require attention to bring them back up to standard. There is a good range of communal and bathing facilities although in some cases these could be made much more attractive and pleasant to use. Not all fire doors, that do not have automatic closures fitted, are kept closed as they should be but are propped open using furniture or other objects. EVIDENCE: Alexandra Nursing Home DS0000044528.V293852.R01.S.doc Version 5.1 Page 15 There are several areas where water damage has affected the home’s décor. Some areas of wallpaper and paintwork are badly worn and now require attention. Some lights were left malfunctioning throughout the inspection. Bathrooms were cluttered with odd slippers, dirty bowls, and coat hangers and could generally benefit from being looked at through the eyes of someone for whom a weekly bath should be another highlight of their life in the home. The doors to the garden day room and staff room, although labelled as fire doors to be kept closed at all times, were propped open at the outset of the inspection. Alexandra Nursing Home DS0000044528.V293852.R01.S.doc Version 5.1 Page 16 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 29 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The numbers of staff appear to be adequate for the current service user group, with additional staff being allocated to the dementia care unit in recognition of the demands placed upon staff by the needs of that client group. However the need for at least an intermediate level of specialist training in respect of dementia care, whilst recognised has not yet become a reality. The recruitment policy and procedure of the home, if followed in full, would adequately provide for the safety of service users, however it is not. EVIDENCE: Not all staff providing care to service users on the dementia unit have received appropriate specific training in dementia care.(Please see requirement made under Standard 4) Three of the staff recruitment records seen did not include two references, taken up before the applicants started work. Staffing levels were seen to be in line with previously agreed levels and were appropriate for the numbers and dependency of service users. In talking to service users and their relatives, no adverse comment was made about staffing numbers. Alexandra Nursing Home DS0000044528.V293852.R01.S.doc Version 5.1 Page 17 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 33 35 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The two issues of improper use of fire doors and failure to implement the home’s recruitment policy, together with the fact that the home’s manager is not yet registered have influenced this judgement. From discussions with the manager during the inspection and provided that the health and safety issues noted are appropriately addressed, it is expected that this situation will improve as there are some positive changes already being made in the home following the appointment of the new manager, building on some other positive changes introduced by her predecessor. Alexandra Nursing Home DS0000044528.V293852.R01.S.doc Version 5.1 Page 18 EVIDENCE: Although the manager holds a variety of appropriate nursing, social care and management qualifications and has wide experience in management of health and social care settings, she is not yet registered by the CSCI and no application has yet been made. See previous evidence in respect of fire doors and recruitment records. The home’s quality assurance procedure includes service user’s and relatives’ forums as well as manager surgeries. Alexandra Nursing Home DS0000044528.V293852.R01.S.doc Version 5.1 Page 19 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 X 3 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 3 2 X X 3 2 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 1 Alexandra Nursing Home DS0000044528.V293852.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? N/A 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 OP4 Regulation 18 Requirement Where staff are to provide care to those with particular needs arising from, for example, dementia, they must be provided with adequate and appropriate training to enable them to meet those needs in a way that takes account of current best practice. The programme of activities available for service users must take account of their specific needs and draw on current best practice for example in respect of activities for those with dementia. The manager must ensure that an accurate record is kept of medication kept and administered by the home on an as required basis. The manager must satisfy herself that all staff have an adequate understanding of issues around adult abuse and that they are familiar with the home’s policies in respect of abuse and “whistle blowing” Fire doors that are not fitted with approved self-closing devices DS0000044528.V293852.R01.S.doc Timescale for action 10/05/06 2 OP4 16(2)(n) 10/05/06 3 OP9 13 10/05/06 4 OP18 13(6) 30/06/06 5 OP19 13(4)(a) 10/05/06 Alexandra Nursing Home Version 5.1 Page 21 6 OP29 19 & Schedule 2 must not be propped open by other means. All the information set out in schedule 2 (as amended) must be obtained in respect of each person working in the home. 10/05/06 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 OP9 OP10 Good Practice Recommendations Where medication is to be returned it should be recorded as such as soon as it becomes surplus in order to ensure that an audit trail can be clearly established if required. Female service users should not routinely be left bare legged or in short style socks, unless that is their choice or if it is necessary for medical or treatment purposes, in which case this should be recorded on their care plans. The manager should consider how the meal time routine and the meal time environment might be improved involving both service users and staff in this process. The manager should review the maintenance schedule for the home to ensure that due priority is being given to those areas of the home, identified during this inspection, that now require some more urgent attention. The manager should consider how the bathing routine and the bathing environment might be improved involving both service users and staff in this process. 3 4 OP15 OP19 5 OP21 Alexandra Nursing Home DS0000044528.V293852.R01.S.doc Version 5.1 Page 22 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.V293852.R01.S.doc Version 5.1 Page 23 - 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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