Inspection on 16/01/08 for Alexandra Nursing Home

This inspection was carried out on 16th January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Alexandra Nursing Home 23/06/08

Alexandra Nursing Home 05/07/07

Alexandra Nursing Home 04/07/06

Alexandra Nursing Home 06/12/05

Alexandra Nursing Home 11/03/05

Alexandra Nursing Home 19/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Alexandra Nursing Home 370 Wilsthorpe Road Long Eaton Nottingham NG10 4AA Lead Inspector Helen Macukiewicz Unannounced Inspection 16th January 2008 09:15 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 DS0000002132.V355595.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 DS0000002132.V355595.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra Nursing Home Address 370 Wilsthorpe Road Long Eaton Nottingham NG10 4AA 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) 0115 946 2150 0115 946 2094 EDGESU@BUPA.COM www.bupa.com BUPA Care Homes (BNH) Ltd Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (3) of places Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. BUPA Care Homes (BNH) Limited is registered to provide nursing, personal care and accommodation at Alexandra Nursing Home to service users whose primary care needs fall within the following categories :Old age, not falling within any other category (OP) 40 Physical Disability (PD) 3 - this relates to named persons listed under the conditions of registration Admission of one named person in the application received on 19/11/04 under the category Physical Disability (PD) Admission of one named person in the application received on 29/12/05 under the category Physical Disability (PD) Admission of one named person in the application received on 16/01/07 under the category Physical Disability (PD) The maximum number of persons to be accommodated at Alexandra Nursing Home is 40 5th July 2007 2. 3. 4. 5. Date of last inspection Brief Description of the Service: The Alexandra Nursing Home is a purpose built care home registered for 40 people. There is a passenger lift and staircase access to the first floor facilities. There are two spacious lounge/dining areas, one with access to an octagonal sun lounge/conservatory. There is a landscaped garden to the rear of premises, which is accessible to residents. The majority of bedrooms are single occupancy, with three double bedrooms provided for residents wishing to share. All bedrooms are equipped with ensuite facilities. Information about the service is provided through the Statement of Purpose and Service User Guide, both of which were made available to residents. Information provided on 16/01/08 stated that the fees for the home were £491.50 to £915.50 per week, depending on the level of care required. A copy of the Inspection report is kept in the foyer. Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This Inspection was unannounced and lasted eight and a half hours during one day. Computer held records of all contact between the Home and the Commission for Social Care Inspection since the last Inspection were also referred to in the planning of this visit. During this Inspection discussion with people who use the service and their relatives took place. Time was spent in discussion with the Manager and staff. Four residents care files were looked at in detail and their care was examined to see how well records reflect care practices within the home. Relevant records belonging to the home were also examined such as complaints and policy documents. A brief tour of the home took place including some bedrooms. An ‘expert by experience’ assisted with the inspection process. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The ‘expert by experience’ was present for 4 hours and spoke with eight service users and three visitors. Her findings are incorporated into the report. What the service does well: There is good information about the home for prospective residents. There is a good level of basic information in care files so staff have a good understanding of the needs of residents. Reviews of care are regular. Relatives said that staff are good at keeping them informed of events. Relatives said that the medical care is good and one said ‘(named the resident) seems well looked after and cared for, they get regular treatment from the chiropodist and dentist’. Residents and relatives who gave an opinion all said the laundry service was good. Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Registered nurses need to ensure they are working to their professional guidelines when recording information on care records. There needs to be greater involvement of residents in decision making. Better recording on medication administration sheets is needed. Residents would benefit from more social care and activities within and outside the home. There was mixed feedback from residents about the food and this is an area where further consultation between staff and residents is needed, to ensure the food meets everyone’s needs. There was evidence to suggest the home is not resolving issues that have been the subject of complaints. The complaints procedure is not known to all residents and visitors, which means their rights are not fully upheld. Many of the bedrooms had some degree of damage to the paintwork or décor. Some carpets were stained, bathrooms lacked homely features and some areas of the home, including one unoccupied bedroom contained a noticeable urine odour. Staffing was one of the main areas that residents and relatives wanted to give their opinions on, and where they felt improvements could be made. Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 7 Residents comments included ‘when you ask for something its usually wait a minute’, or ‘I’m very busy I can’t do it now’. There were also some examples whereby staff are not working to the homes’ stated aims when caring for residents. BUPA continues to maintain a system for self-audit and continuous improvement. However, this has not succeeded in preventing recurring concerns by residents and relatives about care issues. One matter relating to heath and safety was noted. There was some hand gel and sanitiser that was incorrectly stored. 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 DS0000002132.V355595.R01.S.doc Version 5.2 Page 8 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 DS0000002132.V355595.R01.S.doc Version 5.2 Page 9 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 and 3. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have enough information to ensure they choose a home that can meet their needs. EVIDENCE: A copy of the most recent Inspection report was seen in the foyer as you walk through the door. Some relatives had read this. The information about the home (Statement of Purpose and Service Users Guides) was seen in all bedrooms that were visited. There was also a copy in the foyer. The Manager said this has been updated since the last Inspection to reflect current staffing arrangements. Relatives said they had seen this. Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 10 New documentation has been introduced for staff to record their pre-admission assessment of the resident. The files that were seen all contained a fully completed admission assessment that was in sufficient detail to ensure staff had a good understanding of the person’s needs. Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 11 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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People do not always receive the care they need in a dignified way. Gaps in the recording of medicines means that there is potential for peoples’ wellbeing to be adversely affected. EVIDENCE: Four care files were seen for people currently living in the home. New documentation is in place, which is standardised across all BUPA homes. This ensured that all the required basic information was in place in those files seen. Qualified staff have received training on the new systems and there are plans to train care staff on the same. All care files showed some evidence of consultation with residents and/or their relatives although they were not routinely asked to sign the records to say they had been involved in, and agreed to their plan of care. There was Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 12 insufficient evidence in the documentation to support that residents are fully involved in decision making about their care. One resident spoke of not being consulted before the position of their bed had been changed. Another spoke of not being offered a choice about whether or not they had a bath without supervision. One resident said they hadn’t seen their care plan. Files recorded all formal contact with relatives to update them about the residents’ care and any changes that have occurred. Relatives said that staff are good at keeping them informed of events. The care documentation, like the assessments, had been updated and was very easy to follow. All residents’ files contained a plan of care. This showed identification of peoples’ needs, reviews of care and updates. Risk assessments in areas such as falls prevention, continence, nutrition and skin care were all in place and again, there were reviews recorded. There was a record of all visits by the G.P., chiropodist, dentist and optician. Relatives said that the medical care is good and one said ‘(named the resident) seems well looked after and cared for, they get regular treatment from the chiropodist and dentist’. Qualified nurses have to comply with their own guidelines, set by their governing body, the Nursing and Midwifery Council (NMC). In most care files there were some recording errors that did not meet these guidelines such as not signing and dating entries or updates to information and not signing and dating changes to care information. BUPA have an internal audit system for regularly checking care documentation and completed ones were seen. In most care files there was a record of the person’s preferred daily routines. All visitors who were asked said that staff treat their relative with respect and that privacy is maintained. This was supported by the comments from residents themselves. However, there was some feedback and observations that showed that the dignity of people has been compromised by the current staffing arrangements within the home. (for more detail see the staffing section of this report). A system for regularly checking medication records had been introduced and BUPA have an early warning audit system where they look at medication records monthly. There were records to prove that all qualified staff had a competency assessment in drug administration. However, both of these had not been effective in identifying or preventing errors in the recording of medication. Some medication had not been signed, or had a coding system applied, so it was unclear as to whether the resident had received their prescribed medication. Some new medications or changes to medications had been hand written onto medication charts without a date, or second signature Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 13 to confirm that the information was accurate, and in one case, without any signature. The manager had picked up some of these errors through the internal audit system and had taken appropriate action to ensure this did not happen again, and to ensure the safety of the residents themselves. Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 14 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 12-15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to choose how they spend their day but their lifestyle is affected by the lack of social care and planned activity. EVIDENCE: The activities co-ordinator for the home left employment last year. The Manager had documentation to support that she is in the process of appointing a new person to fulfil this role for 35hours/week. In the mean time both the administrator and the manager have been organising events such as a Christmas party and, on the day of the Inspection, an organist. Some residents were happy to occupy themselves with knitting, newspapers and crosswords; one resident spoke of going to the pub several times a week on their own. Other residents spoke of being bored. One visitor said their relative had complained of being bored at times. One resident said that staff haven’t the time to spend sitting and chatting and they would like this. On the day of this Inspection, many residents spent most of the day asleep in the Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 15 conservatory with little stimulation from staff, who were busy undertaking direct care duties. The manager was aware of these current issues and hoped these would be resolved with the appointment of the activities co-ordinator. In the care files there was a completed life history sheet and space to fill in a preferred daily routine, although the latter section had not been completed in one file. Social care needs were written into residents’ care plans. Peoples’ individual cultural needs were identified within care plans. The life history sheet details any cultural needs and specific dietary or religious requirements. The staff mix reflects the diversity within the group of residents. Residents said they could do what they want during the day with minimal restrictions. Relatives confirmed that people are assisted to fill in postal votes during parliamentary elections. People had access to a telephone, there was a pay phone in the foyer, and some had their own telephones in their bedrooms, or mobile phones. Peoples’ food preferences were stated in care files. There was some variation in residents’ views about the meals they receive. One resident said ‘the foods good enough for me’ another said ‘they sometimes run out of things, you don’t always get what you order on the menu’ but went on to say ‘food varies but most of the time there is a choice’. One relative said ‘the kitchen staff are excellent- they will change the menu if needed; they will accommodate (named the resident) needs’. One resident said the menus were ‘too rich in fat and cream’. Three residents said that there were insufficient fresh vegetables and fruit on offer. One visitor and two residents stated that the ‘dinners were not palatable’. Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 16 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): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are kept safe in the home, although a lack of knowledge about how to complain means visitors cannot provide full advocacy for residents and some residents’ rights are not fully upheld. EVIDENCE: The complaints procedure is kept in the foyer. This tells people who they should contact within BUPA if they have any concerns that cannot be dealt with by the staff at the home. Complaints are monitored monthly by BUPA. A record of all complaints that had been received since the last Inspection was seen. There were eight in total. These appeared to have been resolved to the satisfaction of the complainant and there was a record of what action the home had taken as a result. Minor concerns were documented in residents care documentation, and again, supported the action that the home had taken. Complaints related to staffing shortfalls, use of agency staff, not getting baths regularly and people asking to be taken to the toilet regularly. Quite a few of these areas were highlighted as current concerns by relatives and residents Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 17 during this Inspection, suggesting that the home has not fully resolved some of these issues. Some residents knew how to complain; one said ‘if I wanted to complain I would see the manager’. Some relatives also knew how to complain, one said ‘I can talk to the manager, she will listen and do her best to sort it, she will do what she can’. However, three visitors and three residents did not know how to make a complaint. There is a BUPA safeguarding adults policy, although the policy seen in the home was the Derbyshire Safeguarding policy, which the regional manager said that staff prefer to use. Adult protection alert forms were also available to staff. The staff training matrix showed that most staff have had safeguarding training, and the manager said the rest were booked on courses in the near future. All staff who were asked, said they had received this. Documentation showed that staff had responded correctly to any safeguarding issues that had arisen. Care files showed that residents or relatives had signed to agree to the use of bed rails. The BUPA regional manager, present for this Inspection, stated that the Manager and Deputy have received mental capacity act training through Derbyshire Social Services. The deputy manager has been trained as a trainer and is due to cascade the training to all staff. Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 18 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current standard of accommodation does not promote the dignity of the people who live there. EVIDENCE: A walk around the accommodation took place. A resident led this tour. There was plenty of nursing equipment about. Bedrooms contained some of the residents’ personal possessions, photographs and small items of furniture. Many of the bedrooms had some degree of damage to the paintwork or décor. Some carpets were stained, bathrooms lacked homely features. Some areas of the home, including one unoccupied bedroom contained a noticeable urine odour. One relative had also commented on the odour, which they felt had improved recently. Another said ‘they do their best to keep things clean and Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 19 tidy, but this place is desperately in need of refurbishment’. One resident stated, ‘rooms could be cleaner. However, another said they thought the home was clean. The dining room carpet needed cleaning. Residents and relatives said that there are locks for bedroom doors if needed, or a lockable space within bedrooms if not. The Regional Manager and Quality and Compliance Officer for the Home said that a total refurbishment of the building was planned for this year, including new carpets, furnishings, curtains and bathrooms. They said that residents would be given the option to change rooms at this time, depending on availability, and also would be able to choose the colour scheme from a range of options provided by BUPA. There was equipment in the laundry for cleaning soiled clothes. Residents and relatives who gave an opinion all said the laundry service was good. Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 20 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 to 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Failures in the delivery of care through staffing arrangements means that people have their dignity compromised. EVIDENCE: There has been a large recruitment of staff since the last Inspection; use of agency staff has decreased so residents receive more care from people they see regularly. Staffing rotas showed that generally there were one or 2 nurses and 4 or 5 care staff on each shift, 1 nurse and 2 care staff on nights. Sickness absences were recorded and some staffing shortfalls have occurred as a result, where Agency staff cover could not be achieved. Staffing was one of the main areas that residents and relatives wanted to give their opinions on, and where they felt improvements could be made. Residents comments included ‘when you ask for something its usually wait a minute’, or ‘I’m very busy I can’t do it now’, ‘there is a high turnover of staff’, ‘the staff situation is dreadful really’ and ‘you have to wait too long for the commode at night’. Residents also said ‘you don’t get a chance to get to know Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 21 the agency nurses’. They also spoke of the attitude of some staff not being as good as it should. Comments were ‘when you are talking to them they turn around and walk away, I know they are busy but it makes you feel small’, ‘I ask them to close the door at night and they leave it open’ and ‘some are good, some are not’. One resident complained that one staff member was always bad-tempered and did not join them in conversation. This made them more anxious. Most relatives also said that they thought there were not enough staff around. They accepted that there had been a high turnover of staff lately, and that the manager was trying to recruit more staff. They had also been given the chance to air their views about this issue at relatives meetings. One relative said ‘the manager seems concerned and says she is addressing these things’. The lack of continuity of care caused by the high turnover of care staff was also raised as a problem. Times when staffing was worse were reported as weekends, night time and early evenings. Examples where relatives said this had affected care were ‘I have visited in the evening and found my relative with a cold cup of tea, they need help to drink’, ‘sometimes they have been so late bringing tea trays to rooms I have had to fetch it myself’, ‘I saw up to 16 people waiting in wheelchairs to be put in comfortable chairs on that weekend - they do seem to be getting better but weekends seem chaos’ and ‘the use of agency staff puts more pressure on staff and you can’t be confident things will get done’. Other issues raised by relatives were people not being assisted out of bed early enough in the morning, not enough bathing of residents, people waiting a long time to go, or to be assisted off the toilet and the fact that the staffing problems seem to have gone on for a long time, getting better then happening again over a period of several months. The pattern of complaints seen in the complaints file and care files also supported this view. One resident was seen during the Inspection calling for 56 minutes for staff to assist them to the toilet, this compromised their dignity. Staff also reported that they are under pressure and need more people to help. Comments included ‘we are sometimes one or two staff down’ and ‘it means people have to wait longer at the table’. It was their perception that numbers of residents determined staffing numbers. The manager also spoke of providing more staff as new admissions were planned. There was a system to monitor dependency levels of residents but this did not seem to have as much direct influence on staffing levels. Recruitment files for four newly appointed staff were seen. These showed that the home is following correct recruitment procedures to ensure the safety of residents. One relative described recently appointed staff as ‘better quality’. Record of supervisions seen, these discussed care issues and training needs. Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 22 There was a rolling programme for adult protection training and the staff training matrix showed that most other mandatory training had been done. A poster advertising forthcoming training was on display. Skills for care induction standards booklets were used when staff first start, including a separate one for ancillary staff. A completed one was seen. Staff also go through a BUPA distance learning package. They are also given a BUPA employee handbook. This then moves on to the skills for care foundation standards and NVQ level 2. Staff said they had been on training in areas such as safeguarding adults, infection control and fire safety. They spoke of a training booklet they had completed. 20 care staff have NVQ2 or above out of a total of 46. This is less than the recommended minimum number. The manager stated that the next set of training is February and she intended to book some staff on this. Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 23 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 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management systems have not ensured that people’s needs are fully met. EVIDENCE: A new manager has been in post since August 2007. She has applied to be registered with the Commission for Social Care Inspection. She completed a Registered Managers Award in May 2006. She has recently been awarded the BUPA new manager of the year award. She had ensured that all the requirements of the last Inspection had been attended to. However, issues relating to staffing have not been fully resolved since the last Inspection and Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 24 have impacted on the overall quality of care within the home and outcomes for people using the service. Visits by the registered provider take place monthly. Residents knew the visitors, which supported that they are consulted during visits. The monitoring forms used were seen for November and December 2007, and included consultation with staff and residents. BUPA continues to maintain a system for self-audit and continuous improvement. This system includes consultation with people who use the service. However, this has not succeeded in preventing recurring concerns by residents and relatives about care issues, which impact on the overall quality of life people experience at the home; preventing medication errors which impact on the safety of residents, or preventing gaps in the recording standards of registered nurses. Therefore in some areas, internal quality measures are only providing adequate outcomes for people using the service. Both residents and their relatives said they are happy with the system for handling personal allowances and that a monthly statement is provided. Money kept in behalf of residents is kept in interest paying accounts and relatives confirmed that the resident themselves receives the interest payments. Accident records were kept and audits of these were seen. Fire records were up to date in log book including weekly testing. A Full audit of the home took place monthly using an early warning tool. This includes health and safety issues. Chlorination records for the water supply dated 5/9/07 were seen. Where checked, fire equipment had an up to date service history displayed. One matter relating to heath and safety was noted. There was some hand gel and sanitiser that was incorrectly stored. Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 25 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 X 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 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 X X X X X x 2 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X x 2 Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 26 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. 1. Standard OP7 Regulation 15(1)(2) Requirement People who use the service must be consulted about their care and the care plan must be able to support this. Staff must ensure that all medications administered are signed for, and that there are no recording errors on the medication administration record. This is to ensure the safety of people using the service and to ensure their well being is not affected through poor practice. People living in the home must be provided with a range of activities and social interests must be supported. There must be an effective complaints procedure, which is well communicated to ensure people living in the home have their rights upheld and are safeguarded. All parts of the home must be kept clean and reasonably decorated to ensure the environment promotes the dignity of people who live there. DS0000002132.V355595.R01.S.doc Timescale for action 31/03/08 2. OP9 13(2) 31/01/08 3. OP12 16(2)(m)( n) 22 31/03/08 4. OP16 29/02/08 5. OP19 23(d) 01/09/08 Alexandra Nursing Home Version 5.2 Page 27 6. OP27 18(1)(a) 7. OP27 18(2) 8. OP33 24 9. OP38 4(c) Staffing at the home must be sufficient to ensure that care needs are met and that the dignity of people living there is not compromised. Supervision of staff must be effective in ensuring all work professionally and that communication with people using the service promotes wellbeing. The registered person must ensure that the system for reviewing and improving the quality of care provided in the home, including the quality of nursing, is effective. The registered person must ensure hazards to the safety of people who use the service are identified and eliminated through the correct storage of cleaning products. 31/03/08 29/02/08 31/03/08 29/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP15 OP28 Good Practice Recommendations Qualified nurses should comply with their professional guidelines when record keeping. People living in the home should be consulted about their satisfaction with meals and changes to the catering services made where needed. Over 50 of staff should be trained to national vocational qualifications level 2 in care. Alexandra Nursing Home DS0000002132.V355595.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG 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. 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