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Inspection on 10/10/07 for Alexandra Nursing Home

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

This inspection was carried out on 10th October 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

People living in the home express a good level of satisfaction with the care they receive; "It is a pleasant place to be", "The carers are very kind" were just some of the positive comments made to the expert by experience. The physical environment of the home is generally good and is currently being improved further with redecoration of corridors, lounges and dining areas on the dementia unit.

What has improved since the last inspection?

An intensive programme of staff training has been undertaken in response to concerns raised with the home by the CSCI and requirements made following the inspection of the 20th August 2007 and whilst it is recognised that the quality of some of this training may have been compromised by the need to plan and complete it within the timescale set by the CSCI, it has achieved the objective of providing all care staff with the basic skills that they require to care appropriately and safely for the people living in the home and gives a good base on which further training can be built. Work on redecoration of the dementia care unit has now commenced, which will improve the environment for people living and working in it.

What the care home could do better:

The proposed basic dementia care training that was planned has not yet taken place, in part it is recognised because of the priority that was rightly given to addressing serious deficiencies with the level of basic training for staff. This is now an urgent priority as significant weaknesses in the standard of some of the dementia care practices in the home were found in this inspection, and this is adversely impacting on the care experience of people with dementia living there. People living in the home are not always able to exercise genuine choice over some of the most basic routines in the home, for example the time they choose to get up or go to bed. There is some evidence that the operational requirements of the home and the convenience of care staff have taken unreasonable priority over the wishes and preferences of people living in the home and receiving care.

CARE HOMES FOR OLDER PEOPLE Alexandra Nursing Home 46 Alexandra Road Hemel Hempstead Hertfordshire HP2 5BP Lead Inspector Jeffrey Orange Unannounced Inspection 10th October 2007 07:50 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.V352822.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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.V352822.R01.S.doc Version 5.2 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 alexandra@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Limited Manager post vacant 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.V352822.R01.S.doc Version 5.2 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 20th August 2007 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 have some level of dementia. 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 (CSCI). Weekly fees range from £383 - £845 (not including registered nursing care contributions). These fees were current at October 2007. Additional charges apply for hairdressing, chiropody, private dentistry, newspapers and personal toiletries. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over the course of one day, beginning early in the morning so that the routine of the home could be observed as people living there were being helped to start their day. Three inspectors were present during all or part of the inspection, together with an “Expert by Experience”. Experts by experience are people whose knowledge about social care services comes directly from using services and who, because of this, some people living in a care service may feel more relaxed speaking to than to an “inspector”. During this inspection two hours were spent by one inspector looking in depth at the care being given to a small group of people. These observations were followed up in discussions with the manager and examination of records. This inspection follows an unannounced inspection on the 20th August 2007, which took place in response to concerns raised with the CSCI about staff training. The current inspection provided an opportunity to monitor the progress made by the home in meeting any requirements made at that time as well as to review key records, speak to people living and working in the home and to discuss future plans for the service with the manager. What the service does well: What has improved since the last inspection? An intensive programme of staff training has been undertaken in response to concerns raised with the home by the CSCI and requirements made following the inspection of the 20th August 2007 and whilst it is recognised that the quality of some of this training may have been compromised by the need to plan and complete it within the timescale set by the CSCI, it has achieved the objective of providing all care staff with the basic skills that they require to Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 6 care appropriately and safely for the people living in the home and gives a good base on which further training can be built. Work on redecoration of the dementia care unit has now commenced, which will improve the environment for people living and working in it. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 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.V352822.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1.3. (Standard 6 does not apply to this home) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are only admitted to the home once their needs have been assessed and it is clear that they can be adequately met. The Service User Guide does not yet provide people considering moving into the home with sufficiently clear information about fees to enable them to make a well-informed decision. EVIDENCE: Those care plans seen for people who have recently moved into the home identified their care needs and set out how they would be met. “This place is wonderful”… “They saved my wife’s life because of the attention they gave her” were some of the positive comments made about the way care staff are felt to meet the needs of people living in the home. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 9 Despite previous assurances that it would be done, the home’s Service User Guide still does not include the required information about fees and how they may differ if a third party is paying all or part of the costs involved in living in the home. This means people considering the home cannot make a genuinely well-informed decision. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 10 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. 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. People who live in the home have access to the healthcare services they require both within the home and in the local community. Care plans provide staff with the information they require to recognise and meet the health, personal and social care needs of people living in the home. The home has a comprehensive medication policy and the standard of medication practice is generally good providing for the safety and wellbeing of people living in the home. The way that care is provided for people living in the home with dementia does not always demonstrate appropriate respect for them. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 11 EVIDENCE: Care plans contain a satisfactory level of information about the healthcare needs of people living in the home and how they are reviewed and met. Care plans seen included details of the involvement of a range of healthcare professionals with people living in the home, including doctors, dentists, chiropodists, nutrition and other specialist health services. The records for administered medication, including those for controlled drugs, were seen to be well completed and accurate. During the observation carried out on the dementia care unit some examples of poor care practice were seen which did not show appropriate respect being given to people receiving care, for example moving people without warning and with no explanation or communication as the process was carried out. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 12 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. 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. Whilst people who live in the home have an increasingly varied choice of meaningful daytime activities, this does not always provide suitable stimulation for those people with dementia. People who live in the home have the opportunity to develop and maintain important personal and family relationships. People living in the home are not always able to exercise a reasonable level of choice over the routines of daily living. EVIDENCE: Details of the basic framework of weekly activities is clearly displayed in the home, along with an increasingly frequent and varied programme of additional events. Some people living in the home felt that they had communication difficulties with members of the activities team that made their participation less successful. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 13 During the observation of the dementia unit there was little significant or appropriate stimulation offered. People living in the home confirmed that they are able to have visitors and that their visits are encouraged by staff. The visits to the home by a local school were particularly welcomed, the children were said to be “very polite” and “it is nice to mix with young people” was another comment made. Meals were observed throughout the home, the atmosphere was reasonably calm and unhurried and in general people who needed help were seen to be receiving it in an appropriate way. Comments made about the food provided were in general very positive. On one unit where breakfast is served at 9am, lunch was served at 12 noon, which may be too soon for some people on that unit. Concerns were raised by a number of people at the way they are required to get up or go to bed earlier than they would ideally like. “They get you up” said one person who was woken, washed and dressed at 5.30 am and who was still waiting for her breakfast at 7.50 and said that “I am very hungry”. Several people living in the home indicated that they went along with getting up and going to bed earlier than they would like because “It helps the carers, and they are very busy”. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that they are able to express their views and concerns in a safe and understanding environment, without any fear of repercussions from doing so. Staff have the necessary training to enable them to recognise what is abuse and to know what to do if it is seen or suspected. EVIDENCE: Staff confirmed that they have received recent training in safeguarding and this was confirmed from training records seen. Most although not all staff spoken to confirmed that they understood what “whistle-blowing” was and how they could make use of its provisions if they had concerns about any activity in the home that was adversely affecting people who live or work there. The home has a complaints policy that is publicised in the home and service user documentation. Surveys of people living in the home in the recent past have confirmed a high level of awareness of and willingness to use the home’s complaints procedure. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 15 Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19. 24. 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that meets the specific needs of the people who live and work there. The home is comfortable and clean and there is a programme in place to maintain and improve the décor, equipment, fixtures and fittings. People who live in the home are encouraged to personalise their own bedrooms, so that these reflect their own tastes and interests. EVIDENCE: Work on redecoration of the home was being undertaken during this inspection and plans for future improvements, including a new sensory garden, were seen. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 17 On the day of this inspection the home was clean and tidy without any noticeable unpleasant smells. The home has been successful in obtaining grant funding through the Local Authority for an additional ten profiling beds. Rooms of people living in the home that were seen (at their invitation) provided evidence that they have been able to bring a variety of furniture, pictures and ornaments into the home to make it reflect their interests and preferences. Some concerns about a shower room on Jasmine unit that was said to have been out of action for some time and a problem with lights in some bathrooms, together with some marked and worn floor coverings in the housekeeping area of the home were raised with the inspector. These concerns were raised with the manager and evidence was provided and assurances given, that they were all being dealt with. This will be monitored in future inspections. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home generally receive a good level of personal care, however at specific times the numbers of staff on duty are not adequate to provide care to people living in the home in the way and at the times they prefer. Staff do not currently have the skills necessary to consistently provide the highest standard of care for people with dementia. The home’s recruitment practice is sufficiently robust to protect people living in the home from the employment of unsuitable people to care for them. EVIDENCE: Staff spoken to were generally very supportive of the manager and positive about the training they receive. Some members of the staff team again indicated that they were under pressure at key times to complete tasks. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 19 One service user for example complained that she has to wait “a long time” for someone to come into the lounge at lunchtime to see if they were all right before being able to be taken to the toilet. A number of people voiced the opinion that they were “got out of bed quite early” and although this did not “suit some of them” they all said “they realised it was done to help the day staff who were really busy and have lots to do” Three major training sessions were taking place throughout the day of the inspection and training records seen confirm that previous significant shortfalls in the provision of some important routine staff training has now been addressed. There were several examples seen of a poor standard of care on the dementia unit, including that relating to moving and handling practice and staff interaction and understanding. Some staff however were seen to be providing good care and demonstrated a better understanding of how to meet the care needs of people with dementia. Unfortunately they were very much in a minority and also did not receive the encouragement and support of all their peers. This “conflict” was mentioned by people living in the home that had noticed it and it was reported to the manager following the inspection. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The fitness of the current manager has not yet been established and confirmed as required through registration with the CSCI. Staff do not currently receive adequate supervision support. Lack of realistic choice in some key areas does not support the view that the home is always run in the best interests of people living in the home. The health and safety of service users and people living in the home is adequately protected and people living in the home can be confident that their financial interests are being safeguarded. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 21 EVIDENCE: At the time of completing this report the manager has not had his fitness to become registered manager of the home confirmed through completion of the registration process with the CSCI. Supervision records seen, and staff spoken to, indicate that individual staff supervision has not consistently taken place as frequently as it should. This may affect the effectiveness of staff and the standard of care practice experienced by people living in the home. People living in the home are, or feel themselves to be, restrained from exercising choice in some key areas such as meal times and times for getting up and going to bed. Maintenance and financial records previously seen have established that there are satisfactory systems in place and records kept to provide protection for people who live and work in the home. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 22 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 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 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 5&6 Requirement The home’s Service User Guide must be revised so that it meets the requirements of Regulation 5(1)(bb),5(1)(bc) & 5(1)(bd). Of the Care Homes Regulations 2001 as revised. The manager must ensure that the dignity of all people using the service is respected at all times. Activities staff must be encouraged to improve their verbal communication skills so that people living in the home can get the maximum benefit from the hard work that is put in providing the activities programme for them. Activities for people with dementia must be reviewed to ensure that adequate and appropriate stimulation and meaningful activities are available to them throughout the day. People living in the home must be given explicit opportunity to exercise choice over their daily DS0000044528.V352822.R01.S.doc Timescale for action 30/11/07 2 OP10 12(4)(a) 10/10/07 3. OP12 16(2)(n) 31/12/07 4. OP14 12(2&3) 30/11/07 Alexandra Nursing Home Version 5.2 Page 24 routines without being under any pressure to conform to a particular pattern or routine. Preferred times for getting up and going to bed must be reviewed, recorded and thereafter kept under review to give the opportunity for them to be changed if the person living in the home wishes to. The manager must review staff 30/11/07 rotas to ensure that sufficient staff are available at key times of peak activity in the home. The manager must ensure that 31/12/07 those staff providing care to people with dementia have the necessary specific training and skills to meet their care needs appropriately. Staff supervision must meet the 10/10/07 requirements of the National Minimum Standards. 5. OP27 18(a) 6. OP30 18(c)(i) 7. OP36 18(2) 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 OP15 Good Practice Recommendations Menus should include a vegetarian option and other alternative options available should be noted. Meal times should be reviewed to ensure that they are not unreasonably close to one another. Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alexandra Nursing Home DS0000044528.V352822.R01.S.doc Version 5.2 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!