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Inspection on 13/04/07 for Alexandra Nursing Home

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

This inspection was carried out on 13th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Those people who live in the home who were spoken to were very positive about the standard of care that they receive as were those relatives consulted about what they see of the home; "It is a wonderful place" was one comment by a regular visitor. The way that staff provided care was seen to take account of the dignity of people receiving personal care and in speaking to members of the staff team the overall impression was of a group of people who are genuinely committed to providing a high standard of care. The quality and scope of activities available in the home was mentioned by people who live there, visitors and staff, as being an increasingly valued area of the home`s operation.

What has improved since the last inspection?

The physical environment of the home is being improved as the programme of redecoration and refurbishment continues.As noted above, the activities available in the home have been seen to improve considerably since the previous inspection and this provides people who live there more stimulation and choice in how they spend their time. There has been some additional training provided for those staff who provide care to people with dementia, which should enable staff to provide care in a more sensitive and appropriate way. The current manager has succeeded in consolidating the improvements previously made and staff morale appears to have improved.

What the care home could do better:

There are still areas of medication administration practice that are not satisfactory. The programme of refurbishment must continue so that people that live and work on all floors in the home benefit from improvements made elsewhere. Formal staff supervision needs to be improved, as it has not always taken place as frequently as it should. The major challenge faced by the home is to maintain the progress made over recent months and to take forward further improvements at a time when the home again faces a change in manger, with the unavoidable anxiety that brings, however well the process is managed.

CARE HOMES FOR OLDER PEOPLE Alexandra Nursing Home 46 Alexandra Road Hemel Hempstead Hertfordshire HP2 5BP Lead Inspector Jeffrey Orange Unannounced Inspection 13th April 2007 08:15 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.V336087.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.V336087.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.V336087.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 28th September 2006 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. Weekly fees range from £383 - £845 (not including registered nursing care contributions). These fees were current at April 2007. Additional charges apply for hairdressing, chiropody, private dentistry, newspapers and personal toiletries. Alexandra Nursing Home DS0000044528.V336087.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection began early in the morning and continued through to mid-afternoon, which provided a good opportunity to observe the operation of the home whilst people were being assisted to get up, having medication administered, having breakfast and later on lunch, taking part in activities and receiving visitors. During this visit it was possible to speak to people who live in Alexandra Nursing Home, to staff who work there and to both the local manager and a member of the regional management team. Some key records were also inspected, including those for medication and staff recruitment. In addition to any information obtained during this visit, this inspection report makes use of information received by the Commission for Social Care Inspection since the previous inspection in September 2006. The ongoing inspection record for the home will include information received from surveys of people who live in the home, relatives and associated health and social care professionals and this will be continuously reviewed as it becomes available. What the service does well: What has improved since the last inspection? The physical environment of the home is being improved as the programme of redecoration and refurbishment continues. Alexandra Nursing Home DS0000044528.V336087.R01.S.doc Version 5.2 Page 6 As noted above, the activities available in the home have been seen to improve considerably since the previous inspection and this provides people who live there more stimulation and choice in how they spend their time. There has been some additional training provided for those staff who provide care to people with dementia, which should enable staff to provide care in a more sensitive and appropriate way. The current manager has succeeded in consolidating the improvements previously made and staff morale appears to have improved. 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.V336087.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.V336087.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): Standards 1 3 4 (Standard 6 does not apply to this home) Quality in this outcome area is good. 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 home now provides better training for those staff who provide care to people living in the home who have dementia and this should improve the care they experience. The Service User Guide needs to be reviewed and revised to make sure that people considering moving into the home have clear information about fees. 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. “We have everything we need” was the comment of one person who lives in the home. Alexandra Nursing Home DS0000044528.V336087.R01.S.doc Version 5.2 Page 9 Staff spoken to and training records seen demonstrate that enhanced training in dementia has been undertaken and this, provided it is maintained and further enhanced, should improve the care experience of those who have dementia. The Service User Guide seen did not meet the revised requirements of the Care Homes Regulations although it is understood that this has now been addressed. Alexandra Nursing Home DS0000044528.V336087.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): Standards 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 generally contain a satisfactory level of information about healthcare needs and how they are reviewed and met. There is still some inconsistency in how well they are completed but the manager has made good progress in monitoring and improving the overall quality of care plans, which helps staff more effectively meet the care needs of people living in the home. Whilst the home has a comprehensive medication policy, there is inconsistency as to how medication administered on an as required basis is recorded and records are not sufficiently accurate to fully protect those receiving medication on an as required basis. Other areas of medication practice are generally good. EVIDENCE: Alexandra Nursing Home DS0000044528.V336087.R01.S.doc Version 5.2 Page 11 A visiting G.P. was spoken to during the course of this inspection and a representative of the Primary Care Trust was seen to be carrying out assessments of nursing need. Care plans seen included details of the involvement of a range of healthcare professionals with people living in the home. Care plans seen were generally well completed, although the quality of some daily notes was variable. The care plan format appears to work for the home and enables its staff to identify and review care needs satisfactorily. “We are very well looked after, if we ask for something we get it” was the comment of one person living in the home. The records of medication for administration on an as required basis were not accurate, totals of medication did not agree with the records and some records were completed each day, whilst others were completed only when medication was actually administered. The latter method is probably more satisfactory, however a consistent policy and practice should be followed in either case. The records for regularly administered medication were well completed and accurate, including those for controlled drugs and a recent inspection by the home’s pharmacy was said to have been satisfactory. Throughout this inspection visit, staff were seen to treat people living in the home with respect and in a way that ensured their dignity was protected. “They are very kind” was the comment of one person living in the home. Alexandra Nursing Home DS0000044528.V336087.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): Standards 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home have an improving choice of meaningful daytime activities according to their individual interests and capabilities, this includes 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 enabled to exercise a reasonable level of choice over daily living, including daily choices of what they are to eat. 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. People who live in the home, staff and those visiting all mentioned the improvement in activities available in a very positive way. Alexandra Nursing Home DS0000044528.V336087.R01.S.doc Version 5.2 Page 13 Several visitors were spoken to and made some very positive observations “This is a wonderful place”…”Very impressed, communication is very good”…”It’s like a family here” were some of the comments made. People living in the home confirmed that they are able to have visitors and that their visits are encouraged by staff. Meals were observed on the unit that provides care for people with dementia. The atmosphere was calm and unhurried and people who needed help were seen to be receiving it in an appropriate way. Alexandra Nursing Home DS0000044528.V336087.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. The home has an open culture and 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. The complaints procedure is displayed throughout the home and in key documents available to everyone who lives in the home. This should mean that anyone who has a comment or complaint knows where to go and who to speak to about it. Training in the area of safeguarding is provided for all staff, this should ensure that members of the staff team know how to recognise abuse and what to do if it is seen or suspected. EVIDENCE: Policies and procedures have been seen previously and are prominently displayed throughout the home. Meetings are held which both residents and their relatives or carers can attend and make comments or discuss the operation of the home. People who live in the home and people who regularly visit the home spoken with during this inspection all said that they felt able to raise any concerns with staff or the manager. Alexandra Nursing Home DS0000044528.V336087.R01.S.doc Version 5.2 Page 15 Staff confirmed that they have received recent training in safeguarding and 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. Alexandra Nursing Home DS0000044528.V336087.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): Standards 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. The improvements to the décor of other areas of the home now make the Jasmine unit rather less good by comparison. People who live in the home are encouraged to personalise their own bedrooms, so that these reflect their own tastes and interests. EVIDENCE: Alexandra Nursing Home DS0000044528.V336087.R01.S.doc Version 5.2 Page 17 Those bedrooms seen, at the invitation of the people whose rooms they were, had a variety of items of furniture, pictures and ornaments, which made them personal to the individuals concerned. “We have our own keys,” one person noted. Kitchenettes have been added to two units dining rooms, which are now called “The Copper Kettle” and the “Cat’s Whiskers” respectively, following consultation with people who use those units. The front garden of the home has been improved to give a more pleasant outlook and external bins are being relocated to address potential health and safety risks to staff using them. Lighting has been improved in bedrooms and the corridors on Primrose unit have been redecorated. New beds have been provided throughout the home and action is being taken to permanently address long-standing problems with leaks. On Jasmine unit some walls are still marked by door furniture striking them, some wallpaper is missing or torn and by comparison to the more recently decorated areas of the home, it now appears rather less attractive. Alexandra Nursing Home DS0000044528.V336087.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): Standards 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 using services are generally satisfied with the care they require to meet their needs, but there are times when they may need to wait a short time for staff support and attention. There are enough qualified, competent and experienced staff to meet the health and welfare of people using the service. Staffing rotas take account of the current level of dependency of people living in the home, but do not always allow for the ready availability of additional staff at peak times. The service recognises the importance of staff training and has recognised where additional training to that already provided is required. 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: “We just have to wait here” was a comment made by one person in a lounge in a wheelchair. Overall comments by people living in the home were appreciative of the care they receive with an expectation that there would be some delay at times in staff being able to respond to them. Staff were very supportive of the manager and positive about the training they receive. Some indicated that they were under time pressure to complete tasks such as staff supervision and care plans and all staff recognised that the dependency level of people living in the home was in general increasing and Alexandra Nursing Home DS0000044528.V336087.R01.S.doc Version 5.2 Page 19 that this, together with an increased incidence of people receiving much of their care in their bedrooms placed additional pressure on staff time particularly at key times. Additional training in dementia care is being provided, drawing on Alzheimer’s Society material and also the University of Stirling. Staff confirmed the provision of training in amongst other things food hygiene, safeguarding, infection control (a session was to take place in the week following this visit) and moving and handling. A selection of staff recruitment files for recently employed staff were seen to include the required information and evidence of checks being made to verify their suitability for employment. Alexandra Nursing Home DS0000044528.V336087.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): Standards 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. Although the manager has achieved some significant progress since her appointment over 12 months ago it has not been possible in that time to successfully complete an application to the CSCI for registration. The home now has established a consistent record of meeting relevant health and safety requirements and legislation, which provides protection for people who live and work in the home. Individual staff supervision has not consistently taken place as frequently as it should which detracts from an otherwise good record of support by the home for its staff. This has been recognised and is said to have been addressed. EVIDENCE: Alexandra Nursing Home DS0000044528.V336087.R01.S.doc Version 5.2 Page 21 The current manager has not yet provided a satisfactorily completed application for registration to the CSCI. The manager and staff confirmed that individual, one to one supervision has not consistently been taking place, although it is recognised that team meetings and group supervision does take place. Service user meeting, quality surveys, monitoring visits and a monthly home manager audit which is itself audited by the Operations Manager all contribute to putting outcomes for people who live in the home at the centre of its operations. Alexandra Nursing Home DS0000044528.V336087.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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X 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 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 3 Alexandra Nursing Home DS0000044528.V336087.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 2. Standard OP1 OP9 Regulation 5&6 13 Requirement A copy of the home’s revised Service User Guide must be sent to the CSCI within 28 days. The manager must ensure that an accurate record is kept of medication kept and administered by the home on an as required basis. This requirement has now been carried forward over two inspections in a twelvemonth period. Unless this requirement is met in full, further enforcement action will be taken. Timescale for action 31/05/07 13/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Alexandra Nursing Home DS0000044528.V336087.R01.S.doc Version 5.2 Page 24 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.V336087.R01.S.doc Version 5.2 Page 25 - 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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