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Inspection on 21/08/08 for Alexandra Nursing Home

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

This inspection was carried out on 21st August 2008.

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

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

The expert by experience was told "They work very hard here" and "The staff are very kind" and these comments were typical of what were very positive comments received both fact to face with people living in the home during this visit and also in the many survey responses returned to us. In general the standard of recording in care plan records, particularly in respect of some of the areas that previously gave rise to concerns, such as pressure care and nutrition is now much improved and this provides better care for some of the most dependent people living in the home. In providing additional "twilight" staffing and also putting in place additional staff to take responsibility for the admission process and setting up the care plan for new residents, the home have demonstrated a flexible and innovative approach to dealing with some key points at which staffing can come under particular pressure, which benefits people living in the home and those in the process of moving in. (However also see comments below)

What has improved since the last inspection?

The inspection in April 2008 found that there had been an improvement in some training especially that in respect of pressure care and tissue viability. It was also established that choices for people living in the home were being better recorded and acted upon and that a new menu was to be introduced. There was evidence of an improved standard of recording and care provision for those people living in the home who require palliative or end of life care. In general it was possible to confirm that improvements noted during the inspection of April 2008 have been sustained and carried forward, which is to the benefit of all people who live in the home.

What the care home could do better:

There are still times when the staff team are under pressure and people who live in the home have commented about this; "I often have to wait when I need the toilet" one person told the expert by experience and several comments were received in survey returns about call bell response times. To balance this, many of the survey responses indicated that staff were always or usually available when required. We were told by several people living in the home that activities still require further development and consideration in order to offer an appropriate range of choices for people of very different levels of ability and need. When we looked at the premises during our visit we found that there are some areas of the built environment of the home that are looking "tired" and in need of some refurbishment in order to maintain a pleasant environment for all people living in the home. We observed that some of the experiences of people living in the home during mealtimes were not as involving and positive as they could be. The overall finding of this inspection is that improvements have begun to be made and have very largely been sustained over the past five months. The home now requires a period of stability and consolidation to enable it to demonstrate that these improvements are long and not short term.

CARE HOMES FOR OLDER PEOPLE Alexandra Nursing Home 46 Alexandra Road Hemel Hempstead Hertfordshire HP2 5BP Lead Inspector Jeffrey Orange Unannounced Inspection 21st August 2008 08:00 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.V370462.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.V370462.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.V370462.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 30th April 2008 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 £420 - £611 (including nursing care contributions) for block-purchased Social Service beds. The maximum fee for privately funded beds is £905 (excluding nursing care contributions). These fees were current at August 2008. Additional charges apply for hairdressing, chiropody, private dentistry, newspapers and personal toiletries. Alexandra Nursing Home DS0000044528.V370462.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 unannounced key inspection took place over the course of one day, starting at 8 am, which enabled the early morning routine of the home to be observed and assessed. It was carried out by two inspectors and 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’. This inspection draws on any information obtained during the regulatory activity that has taken place since the last key inspection in October 2007 set out below. It also makes use of information provided to the CSCI by the home in their Annual Quality Assurance Assessment (AQAA), which they submitted in June 2008. (The AQAA is a self- assessment, which sets out how well care outcomes are being achieved for people living in the home and also contains some useful statistical information.) During this inspection visit we spoke to a large number of people living in the home, to visiting relatives and friends as well as to management and staff. We looked at some key records including those for recruitment and staff training, care plans and medication records. We also received a significant number of responses to surveys sent to people living in the home and to staff and the information these contained was used in the planning of the inspection site visit and is reflected in this report. The reason for this inspection was to monitor progress made by the home in meeting requirements set in the previous key inspection of October 2007 and the random unannounced inspection carried out in April 2008 and to assess how far the home have achieved the aims of the action plans they subsequently submitted to the Commission for Social Care Inspection (CSCI). The period since the last key inspection in October 2007 has been a very challenging one for Alexandra Nursing Home. A series of concerns were raised with the CSCI in the period from October 2007 and April 2008. Hertfordshire County Council Adult Care Services also took action under their safeguarding procedure following concerns raised with them and for a time suspended placements into the home, although these have subsequently been restarted. These concerns gave rise to local and national media interest and it has been clear from conversations with people living in the home, those responsible for Alexandra Nursing Home DS0000044528.V370462.R01.S.doc Version 5.2 Page 6 them and members of the staff and management teams that this period has been a very difficult one and has given rise to genuine anxiety. As a result of the serious concerns arising about Alexandra Nursing Home over this period there has been a sustained enhanced process of monitoring and action by regulatory, health and social care bodies. Although these agencies have attempted to co-ordinate their activity wherever possible, in order to minimise the disruption to the home, it is recognised that the process has placed some unavoidable burdens on the home’s management team. Throughout this process the CSCI have received full co-operation from the home and its local and area management and have always been given a courteous and efficient response to any enquiries or requests made of them. What the service does well: What has improved since the last inspection? The inspection in April 2008 found that there had been an improvement in some training especially that in respect of pressure care and tissue viability. It was also established that choices for people living in the home were being better recorded and acted upon and that a new menu was to be introduced. There was evidence of an improved standard of recording and care provision for those people living in the home who require palliative or end of life care. In general it was possible to confirm that improvements noted during the inspection of April 2008 have been sustained and carried forward, which is to the benefit of all people who live in the home. Alexandra Nursing Home DS0000044528.V370462.R01.S.doc Version 5.2 Page 7 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.V370462.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 DS0000044528.V370462.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): 1 2 3 (Standard 6 does not apply to Alexandra Nursing Home) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a thorough and robust assessment process in place that should ensure that only those people whose care needs can be appropriately met are admitted to the home. The Service User Guide and Statement of Purpose has been revised and now provides better basic information about the charges that apply to people considering Alexandra Nursing Home as a home for themselves or someone they are responsible for. This should assist in making a reasonably wellinformed decision, although further improvements to both content and format would be even more helpful, particularly in respect of any people who may have been admitted with a learning disability. The contractual process between people living in the home and the home could be clearer and more transparent. EVIDENCE: Alexandra Nursing Home DS0000044528.V370462.R01.S.doc Version 5.2 Page 10 “I have no concerns at all about the level of care that Mum receives” and “overall the family considers Alexandra Nursing Home to be well run and to provide good care for my father” were two quite typical comments made to us about the way people living in Alexandra Nursing Home’s care needs re met. When we looked at care plans and pre-admission assessments we found that there was a robust system of assessment in place to identify the needs of the person concerned and to set out in detail how these were to be met. We were told by the manager that an application for the variation of the home’s registration in respect of specific individuals living in the home who have a learning disability is being prepared. This will have to be reflected in the home’s service user guide and statement of purpose. It is understood that the home is not likely to seek a wider registration for the provision of this category of care in the future. We were informed that training for staff providing care for people with learning disabilities is to be put in place. The key worker for one person living in the home who has a learning disability has not yet received any specific training in learning disability. It is important that people receive care from staff who have a basic understanding of the reasons behind them requiring care and assistance and how best that can be provided. Whilst the majority of people told us they had received a contract, a significant number either said that they had not or that they didn’t know if they had. Alexandra Nursing Home DS0000044528.V370462.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): 7 8 9 10 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home have ready access to the healthcare services they need both in the home and in the local community. Care plans contain the level of up to date and relevant information that care staff need in order to recognise and meet the health, personal and social care needs of people living in the home. People living in the home are well protected by the standard of medication practice and by the training, policies and procedures that are in place and followed. People living in the home are generally provided with care in a way that demonstrates respect for them and preserves their dignity and rights. EVIDENCE: Alexandra Nursing Home DS0000044528.V370462.R01.S.doc Version 5.2 Page 12 When we looked at care plans we found that they were detailed and in general well-completed, that they are reviewed regularly to ensure that any changes in need are identified and changes made to the care plan to ensure that they continue to be met. The care plans we saw included evidence of a well-developed and effective palliative care approach where that is required. Overwhelmingly people living in the home told us that they “always” receive the medical support they need, with only three people indicating that they “usually” did. “G.P called out as and when required” and “The home’s relationships and communication with his doctors appears very good” were two positive comments received. The only reservations about healthcare were that different doctors are seen, rather than a regular one. “ The only problem is that there are so many doctors at the surgery I never see the same one twice”. One person thought a regular surgery at the home would be useful and one other that they felt sometimes families had to “suggest” a doctor’s visit to staff. When we looked at the medication records on each floor we found that they were accurate, that storage and handling were appropriate and that staff were receiving training in how medication should be administered safely in order to protect the well-being of people living in the home. People told us that staff always (95 ) or usually (5 ) listen to them and act on what they told them. One person told the expert by experience that “He is well cared for. I know he can be difficult, but the staff never complain” As we went round the home, speaking to people and observing their care being provided by staff, we saw that people were treated with respect, they were not being out-paced and that there was good and appropriate interaction between staff and people living in the home and this was confirmed by surveys returned to us; “Staff are pleasant and courteous under difficult circumstances” was one typical comment made. Minutes of the head of departments meeting held on the 21st July 2008 were seen to include discussion of dignity and how this could be maintained for people living in the home. Dignity champions have been appointed for each unit and they will have a particular role in promoting this amongst staff. Alexandra Nursing Home DS0000044528.V370462.R01.S.doc Version 5.2 Page 13 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. The provision of meaningful activities for people living in the home who have different levels of need is a challenge that is still not being fully met although it is recognised that this area of the homes operation has and is continuing to develop. People who live in the home have the opportunity to develop and maintain important personal and family relationships and this is encouraged by the home. The dining and bathing experience of people living in the home could be improved to make them more effective and pleasurable. EVIDENCE: When we asked people about the activities arranged by the home, the response was very mixed. The majority accepted that there were always or usually activities that they could take part in and this was borne out by activities programmes seen during this visit. However a significant number felt the activities were not stimulating enough and were not varied enough for people of differing levels of need and ability. “Not much to do”, “I have Alexandra Nursing Home DS0000044528.V370462.R01.S.doc Version 5.2 Page 14 difficulty with my hands, so can’t join in” “Mum has tried to mix with the resident’s and has been taken to the lounge but found the company of some “high needs” residents very distressing and preferred to sit in her room”. Someone else noted “My mother is invited to join in sessions but feels they are not differentiated for the needs of the clients” The expert by experience noted that whilst there were lists of activities on each floor for every day, they didn’t actually speak to anyone who joined in. However the expert by experience also talked to some people who had quizzes brought to them in their rooms. One person told them “I do my own exercises in my room, I prefer it to throwing and catching a ball”. However, by contrast another person told us “I like activities organised by the girl who gets us to throw balls at skittles” When we talked to the manger and saw records of recent relative’s meetings (6th August 2008) we found that the home is aware of the challenge they face and are taking steps to further improve their performance. They have also appointed a person to take specific responsibility for dementia care activities. The home have shown that they are aware of the need to improve the mealtime experience in the home. Minutes we were given of the general staff meeting and relative’s meeting, both held in August 2008 include reports of discussion about food presentation, and the relative’s meeting raised concerns about the time of meals, choice of bread and yoghourts. When we observed breakfast throughout the home, the picture was different on different floors. Jasmine unit was quite a pleasant experience, with music playing, good staff and resident interaction and a reasonably calm atmosphere. Elsewhere we found distracting noise, poor presentation of food and several people told us they prefer to take their meals in their own rooms because they find eating under these circumstances “distressing and unpleasant” The expert by experience noted that there were several comments made to them about food. “Its not cooked the way I like it” “there’s too much mince” and “ it’s not very nice but you have to eat something”. To balance this, survey returns included some more positive comments; “My mother seems to like the food” although overall very few people answered that they “always” like the food, with most answering “usually” or “sometimes” and again only a very few replying “never”. The home told us through their AQAA that efforts are being made by the chef and her staff to ascertain preferences and receive comments so that the meals in the home can be modified to reflect the wishes of people living in the home. Alexandra Nursing Home DS0000044528.V370462.R01.S.doc Version 5.2 Page 15 We saw, when we went around the home that the décor in some bathrooms is rather tired and uninspiring and does not provide the most welcoming or pleasant environment for people in the home using them. We saw as we went round the home that people living in the home were sitting in communal areas with the television tuned to programmes that would not on the face of it appear to be the most likely to appeal to them and with no evidence that they had been asked what programmes they would like to watch. Alexandra Nursing Home DS0000044528.V370462.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): 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 required training to enable them to recognise abuse and to know what to do if it is seen or suspected. EVIDENCE: Southern Cross have co-operated fully with recent serious concerns meetings held under the safeguarding process for Hertfordshire County Council Adult Care Services and have responded appropriately to any concerns raised through that process. Staff told us that they have received recent training in safeguarding and we were able to confirm this from records seen and to see also that further training is scheduled throughout the next year. People told us that they knew how to make a complaint if they needed to and we saw minutes of recent relative’s meetings, which provided ample opportunity for any concerns or complaints to be raised and recorded. We saw “Care Aware” leaflets prominently displayed in the home together with advice how to contact the local Alzheimer’s Society for advice or guidance. Alexandra Nursing Home DS0000044528.V370462.R01.S.doc Version 5.2 Page 17 There is a suggestions box in the home’s reception area together with copies of the complaints procedure so that people who want to know how they can contact the CSCI or other agencies to raise concerns. Alexandra Nursing Home DS0000044528.V370462.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): 19 21 24 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that generally meets the needs of people who live and work there and is comfortable and clean although there are now specific areas of the home that require attention in order to maintain an acceptable standard. EVIDENCE: The expert by experience noted that as they went round the home they found that “Everywhere was nice and clean with no unpleasant odours” and this view was borne out by what people told us in their answers to our survey question about cleanliness in the home. “Very clean” and “very rare that we ever have complaints in this area” were some typically positive comments received. Whilst we were in the home we found that some dining chairs were unsafe, because their joints were coming apart and we had to ask staff to make sure Alexandra Nursing Home DS0000044528.V370462.R01.S.doc Version 5.2 Page 19 they were removed from use in order to prevent possible injury to people sitting on them. We found that several areas of the home were looking “Tired” and bathrooms in particular were in need of redecoration and improvement in order to provide people using them with a more pleasant and positive experience. A bathroom on Primrose unit for example had no top to the swing top bin, walls were flaking in places, the toilet paper was almost out of reach of someone using the toilet, there was someone’s vest left in the room and it was being used to store hoists and slings. The ground floor lounge was attractive and had a new large screen TV, the top floor lounge was by comparison far less inviting with no large screen TV. We found odd cushions on some lounge chairs and one chair in the ground floor lounge had no cushion. We received very positive comments about the laundry and cleaning service in the home; “Our clothes are well cared for and come back not only clean but beautifully ironed” was one. The expert by experience noted that all the bedrooms they saw had personal things in them that “made each room individual to the person living there and gave a “homely” feeling”. Alexandra Nursing Home DS0000044528.V370462.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): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home receive a good level of personal care although at times staff are under pressure to meet their needs in a timely fashion. Staff are now receiving a more sustained programme of training to help them provide appropriate care to people living in the home and this has been reflected in an improvement in the care experience of people living in the home. The home’s recruitment practice remains robust and thorough and protects people living in the home from the employment of unsuitable people to care for them. EVIDENCE: The expert by experience noted that “although there seemed to be plenty of staff around they were all very busy and some people were still waiting to be washed and dressed” This view was supported by comments received from people living in the home; “They work very hard here” “If the staff are busy somewhere else I understand that they can’t be in two places at once” Most responded “always” or “Usually” to the question are the staff available when you need them? Although others qualified this for example “shortages of staff is a problem”. Alexandra Nursing Home DS0000044528.V370462.R01.S.doc Version 5.2 Page 21 When we asked people about call bell response times, in general they thought this was done fairly quickly although some indicated that they routinely had to wait for assistance. There was only one instance during this inspection when we found a call bell response time to be extended. The home have told us in their AQAA that they have provided additional “twilight” staff at key times, to help with times of particular pressure. It was also very positive to see the improvement in initial care planning following the introduction of additional qualified staff to deal with admissions and drawing up of the initial care plan, which is an important determinant of how well care is provided at what is often a very critical time for people entering a care service. When we talked to staff and looked at training records and had conversations with some of the home’s training providers we found that action has been taken to address the serious shortcomings found previously. This will eventually improve the care standards for people living in the home and will provide additional skills and motivation for staff. The needs of people living in the home with learning disabilities need to be met by people with the appropriate training and skills and this is not always the case, although we have been told that steps are being taken to address this. The home have told us in their AQAA that about 60 of staff are now NVQ level 2 trained. Alexandra Nursing Home DS0000044528.V370462.R01.S.doc Version 5.2 Page 22 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 in respect of Alexandra Nursing Home. Provided the schedule for staff supervision provided to the CSCI is strictly adhered to staff will receive appropriate supervision support. The health and safety of people living in the home and staff working there is adequately protected and people living in the home can be confident that their financial interests are safeguarded. People living in the home and those responsible for them are increasingly being consulted and this should ensure that in the future the home is run in their interests. EVIDENCE: Alexandra Nursing Home DS0000044528.V370462.R01.S.doc Version 5.2 Page 23 There has been no application received by the CSCI for the registration of the new manager at the time of this report. This is the latest in a series of managerial appointments to the home and applications for registration were not always finalised before the manager moved on. When we spoke to staff and people living in the home they were supportive of the new manager and the changes that have been put in place in order to improve the care provision for people living in the home. We looked at staff supervision schedules that are now in place. Currently these are up to date for permanent staff, those for bank staff are less so. This has been identified by the home in their AQAA as one area where improvement is required. We were shown copies of relatives’ meeting minutes, which were very wideranging and included consideration of communication and how it could be improved. When we looked at the way that records of financial transactions are carried out and recorded on behalf of people living in the home, we found that they were robust and accurate and provided checks and balances to protect people living in the home. Alexandra Nursing Home DS0000044528.V370462.R01.S.doc Version 5.2 Page 24 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 X X 3 2 X 3 Alexandra Nursing Home DS0000044528.V370462.R01.S.doc Version 5.2 Page 25 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 Care Standards Act 2000 Requirement To comply with the Care Standards Act 2000 the home must be registered in respect of each care category that it admits people under. This must be reflected explicitly in the home’s Statement of Purpose and Service User’s Guide. This requirement had a timescale of 05/06/08, which has not been met. Enforcement action is now being considered. Timescale for action 21/08/08 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 Refer to Standard OP15 OP21 Good Practice Recommendations The home should obtain a copy of the CSCI report “Highlight of the day” and consider if the mealtime experience of people living in the home could be improved. The home should conduct an ‘audit’ of the bathing DS0000044528.V370462.R01.S.doc Version 5.2 Page 26 Alexandra Nursing Home experience for people living in the home, involving them as much as possible, to determine what practical steps can be taken to improve it. Alexandra Nursing Home DS0000044528.V370462.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact 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.V370462.R01.S.doc Version 5.2 Page 28 - 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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