Inspection on 23/06/08 for Alexandra Nursing Home

This inspection was carried out on 23rd June 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Alexandra Nursing Home 16/01/08

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Alexandra Nursing Home 370 Wilsthorpe Road Long Eaton Nottingham NG10 4AA Lead Inspector Steve Smith Unannounced Inspection 23rd June 2008 10:55 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.V366600.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.V366600.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 Manager post 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.V366600.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 The maximum number of persons to be accommodated at Alexandra Nursing Home is 40 16th January 2008 2. 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 areas, one with access to an octagonal sun lounge/conservatory. A separate dining room is also available. There is a landscaped garden to the rear of premises, which is accessible to those staying in the Home. The majority of bedrooms are single occupancy, with three double bedrooms provided for those wishing to share. All bedrooms are equipped with ensuite facilities. Information about the service is provided through the Statement of Purpose and Residents Guide, both of which are made available to people staying in the Home. Information provided on 23 June 2008 stated that the fees for the Home were from £463.77 to £675.00 per week, depending on the level of care required. Details of previous inspection reports can be found at the Home, or on the Commission for Social Care Inspection’s website: www.csci.org.uk Alexandra Nursing Home DS0000002132.V366600.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 that people who use the service experience Adequate quality outcomes. The focus of inspections, undertaken by the Commission for Social Care Inspection (CSCI), is upon outcomes for people and their views of the service provided. This process considers the Home’s capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that needs further development. This inspection visit was unannounced and took place over a period of approximately 10 hours. In order to prepare for this visit we looked at all of the information that we have received, or asked for, since the last key inspection of the Home, which took place on 16 January 2008. This included: The ‘Annual Quality Assurance Assessment’ (AQAA). This is a document completed by the Registered Providers of the Home that focuses on how well outcomes are being met for people using the service. What the service has told us about things that have happened in the service. These are called ‘notifications’ and are legal requirements. The previous ‘Key Inspection Report’, and the results of any Other Visits that we have made to the service in the last 12 months. Relevant information from Other Organisations, and what Other People have told us about the service. Surveys returned to us by people using the service, from the relatives of those staying in the Home, and from the staff working in the Home. For this inspection of the service the Commission’s Residents questionnaire (a ‘survey’ mentioned above) was sent to 10 people staying in the Home, and 7 were returned. Ten questionnaires were also sent to relatives of those staying in the Home, and 2 were returned. Ten questionnaires were also sent to staff, and again only 2 were returned. During this visit to the Home ‘case tracking’ was used as a system to look at the quality of the care provided. This involved the sampling of a total of four peoples records, being a cross-section of people staying in the Home. Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 6 Discussions were held with those people, if they were able, together with a number of others, about the care and services the Home provided. Their care plans and care records were also examined, and their private bedrooms and communal facilities were seen. Discussions were also held with any relatives that were visiting during this visit to the Home. In addition, discussions were held with the Manager of the Home about its general operation. Discussions were also held with staff about the arrangements for peoples care, and also about the staffs recruitment, induction, deployment, training and supervision. What the service does well: What has improved since the last inspection? What they could do better: The following issues were found to be outstanding from the inspection reported completed in January 2008, and so need to be urgently addressed: Those people staying in the Home, with the ability, need to be shown their plans of care, and to be enabled to sign the record. All nursing staff need to sign the Medication Administration Record (MAR) sheets after distributing medication to people staying in the Home. An improved range of social interests and activities needed to be provided for those staying in the Home. The decoration and cleanliness of the Home needed attention. Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 7 Staffing levels need to be appropriate to the needs of those staying in the Home. At least 50 of care staff need to be trained to NVQ level 2 in Care. Many aspect of the Quality Assurance programme need to be address in the Home. All care staff need to be supervised at regular intervals of time. In addition to the above the following issues need to be addressed. The statement of purpose and Residents Guide need to be improved, and to ensure that they apply to this particular Home rather than to the companies homes in general. A copy of the Home’s statement of terms and condition of residency needed to be supplied to all those people sponsored by Social Services Dept. Nursing staff needed to record more accurately when additional medication was stated as needed by Doctors for those staying in the Home. All care staff need to receive induction training when first employed in the Home. Mandatory training was required by a large number of those working in the Home, in Moving and Handling, Fire Safety, First Aid, Food Hygiene, and Infection Control. 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.V366600.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.V366600.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, 2, 3 & 6. The quality in this outcome area was Adequate. This judgement was made using available evidence including a visit to this service. Potential Residents and those people already staying in the Home were not provided with sufficient information in the statement of purpose and Residents Guide. EVIDENCE: The Registered Providers had provided a statement of purpose for the Home together with a very limited Resident’s Guide, which were seen in the bedrooms visited during this visit to the Home. The statement of purpose had been completed by the Registered Providers, with little reference to this particular home. The Residents Guide was very poorly completed with little of the required information within it for use by people staying in the Home. This was discussed with the Manager, who had only been in post 3 weeks, was aware of these limitations in the above documents and said it was her intension to improve both documents in the near future. Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 10 People who commented on the admission process said that they were satisfied with the information they received, but have been disappointed in recent times on the operation of the Home – ‘When I came here it was very good, but the last 2 years has gone down hill a lot’ – and – ‘I have been here 6 years and it was a really nice home when I came here. It has altered a lot and is not nice now.’ When staff were asked about the information they were given about those staying, they said, in the questionnaire, - ‘Yes, information regarding resident care is available in their care plans.’ The records of four people were examined during this visit. A copy of the contract, if purchasing their care privately, was found in each file, although for those people who were funded with the assistance of Social Services Depts no statement of terms and conditions of residency were available. The new Manager was aware this, and again said it was her intension to correct this in the near future. When new people were admitted to the Home, the Manager was provided with a summary of the needs of each person, completed by the Social Services Dept Care Manager supporting that person, copies of which were seen. The Manager also assessed all people sponsored by Social Services Depts. If the person was self-funding from the outset, the Manager completed her own summary of needs, which were also seen during this visit. This was confirmed by the Annual Quality Assurance Assessment completed by the Manager. In it she wrote – ‘No Service User is admitted to the home before having their needs assessed by a qualified person, we offer the potential resident the opportunity to come and view the home themselves. … For all residents there is a trial period from admission, so that they retain the choice to decline if they are unhappy.’ Standard 6 does not apply to this Home. Alexandra Nursing Home DS0000002132.V366600.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 & 10. The quality in this outcome area was Adequate. This judgement was made using available evidence including a visit to this service. Plans of care were not appropriately completed to record peoples health and personal care needs. A robust system of recording the distribution of medication were also not in place to ensure that peoples wellbeing was not adversely affected. EVIDENCE: To help assess Standard 7, the Resident’s Plan of Care, the records of four people staying in the Home were examined, for the purpose of case tracking. The medical records and records maintained by nursing staff were found to be very well completed, providing all the necessary information to staff. However, the following issues were found to need addressing. In the records seen, people staying in the Home were not able to see their plans of care. Two people were spoke with about this and they said about the plans of care – ‘No, don’t get to see that at all, (I have) no idea about it’ – and – ‘I have never been shown it.’ Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 12 The assessments undertaken prior to the admission of a new person to the Home were seen. These were poorly completed with little detail provided to enable staff to undertake the care needed. An assessment completed by the new Manager was seen, and this was completed in good detail. Six monthly review of care of all people staying in the Home were not provided by the staff of the Home. In one person’s file a review undertaken by the local Social Services Dept was seen, but this would not address all of the needs of the person staying in the Home. Staff were observed talking and assisting those staying with meals in the dinning room and in the lounges. This was seen to be done very positively, with a relaxed atmosphere, which was enjoyed by the people staying in the Home. The records of peoples health needs were observed and a good record was found to be maintained. The Annual Quality Assurance Assessment stated that the Home used ‘Quest’, which provided personal plans that formed a basis for assessment and an holistic approach to care. All medication and the method of distributing it to people staying in the Home was examined. This showed that a well maintained record was kept. However, the following issues needed to be addressed: A review of many of the Medication Administration Record (MAR) sheets was undertaken and a number of signature gaps were found. The vast majority of entries on the MAR sheets were typed by the pharmacy. However, a number of entries were hand written by staff. These were late entries that occurred as a result of a Doctor’s visit, but these were found not to have been completed correctly. They should all have been signed by two staff, to ensure they were correctly completed, they should have been provided with the date the medication was to start and stated the Doctor who authorised the medication. All seven people returning the Commission’s questionnaire said that they received good medical attention at all times. Discussion was held with people about life in the Home. They said that staff were very good at listening to their views on how they liked to be cared for and staff would carry out their wishes. They also said that their care needs were always met with dignity and respect. As a result, they felt very safe in the Home, and appeared to have a strong sense and appearance of well being. One person said, when asked if staff did things the way the person wanted – ‘I do everything myself and just ask staff if and when I need it. But they would Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 13 do it my way, I would make sure of that’ – and – ‘They respect me, I would say something if they didn’t, no problem. But as yet I have not had to do this.’ Another person said that ‘Staff are helpful and good, but they have to much to do’ – and – ‘The majority of staff are very helpful.’ However, in the questionnaires sent to people staying in the Home people had a different view – ‘There are never enough (staff) to help me’ – and – ‘Over the past year I’ve been here the care has been hit and miss. There has been a distinct lack of staff…’ – and – ‘Sometimes they are very busy due to staff shortages.’ This shortage of staff was an issue commented upon by all people staying in the Home who chose to make a statement, in person or on paper in a questionnaire. All staff were observed to be very caring in their dealing with people, and spoke to them in a caring manner. The Manager’s Annual Quality Assurance Assessment stated that ‘In the last three months there has been a change of managers, and it is nice to see that the (staff) team is now stabilising. They have requested additional support and with this they have identified specific training requests, which indicates a level of security and stability.’ Alexandra Nursing Home DS0000002132.V366600.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, 13, 14 & 15. The quality in this outcome area was Adequate. This judgement was made using available evidence including a visit to this service. Peoples preferred lifestyles were respected by the Home, although insufficient activities were provided to meet peoples interests and needs. All people staying in the Home were given a wholesome and appealing diet in pleasant surroundings. EVIDENCE: People staying in the Home were asked about the activities provided. Those spoken with said such things as – ‘Now, nothing is provided for us. In the past we had games, quizzes, allsorts of things. Now we just watch TV, it is not right’ – another person said – ‘I play darts and bowls in my bedroom. There is ball throwing in the lounge occasionally, some church services, and a singing group comes about three times a year. There are no trips out from the Home.’ In the past the Managers of the Home had tried to recruit Activities Coordinators, and in the past 2 years or so there have been approximately 4 Coordinators. However, they all left within just a few weeks. The Annual Quality Assurance Assessment, provided by the Home’s Manager, said that she needed to develop an activities programme, hoping to do this with help of another newly appointed Activities Coordinator. Her Assessment Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 15 also said that in the next 12 months she was planning to provide trips out for people staying in the Home, which would include pub lunches, garden and large house visits and at least one seaside trip. People said that they decided when they got up and went to bed, saying things like – ‘I decide. I often don’t go to bed ‘till 4.00 am, I love to watch the sport on the TV. Mind you I am also often up at 5.00 or 6.00 in the morning, but I often sleep in the afternoon!’ – and – ‘Yes, I can go to bed when I want and get up when I want.’ People also said – ‘I can have a shower every morning if I want, I do it myself’ – however, another person said – ‘We used to be able to have a number of baths a week, but now I only get 1 a week, and sometime less than 1. Staff have to help me with my bath.’ People staying in the Home said that relatives and friends were able to visit at anytime, and could always be seen in private. ‘They come in here, my bedroom, always’ - and – ‘Oh yes, we use my bedroom or the vestibule of the Home, it is private there.’ The staff spoken with also said that relatives could visit at anytime. It was said that those staying could chose where they wanted to see their relatives, in one of the lounges, or in the person’s bedroom. One person said that – ‘I go out about 3 times a week usually. A friend picks me up and we go to the pub to play dominoes. I usually get back at about 12.00 midnight. I also sometime go to the market to get some bits and bobs I need.’ Another person said – ‘Some people go out, but I don’t. We used to have the library around to lend books, but not lately.’ Peoples were asked how staff respected the privacy of their bedrooms. One person said - ‘They knock and wait for my to say ‘come in’, always’ – while another said – ‘They knock on the door and walk in; no never have they waited for me to say ‘come in’’. People staying in the Home were able to say that the Home provided good meals and that a choice was available at breakfast, dinnertime and teatime meals – ‘A choice is at every meal, meals are good here, you can get to much if you’re not careful!’ – and – ‘Oh yes, a choice is provided at every meal.’ Staff also confirmed this. People staying and staff said that drinks and snacks were always provided between meals, and that people could also ask for additional drinks at anytime. Mealtimes were never rushed, which was witnessed during this visit to the Home. Staff were also seen to assist people with meals, which was done in a caring and helpful way. The Annual Quality Assurance Assessment, provided by the Manager, also said that an excellent choice of meals was provided, including a ‘Nite Bites’ menu, which provided a late evening choice of meal/snack. Two staff were also asked, when people needed assistance to managed their meal, how many people they might help at the same time. Both staff said that Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 16 people were seated at tables so that they could assist two people, sometimes more, at the same time, if this were needed. The dinning room was well laid out, with the days menu on each table. However, a choice of meal was available at all meals throughout the week, except for the lunch time meal on a Wednesday and Sunday. On these days only one meal was listed. Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 17 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 & 18. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Complaints made to the Manager were addressed to meet peoples needs. The protection policies and procedures provided meant that people staying in the Home were protected. EVIDENCE: One person said that if he had a complaint to make – ‘I’d see the Manager, but I have never had to do this yet.’ Another said – ‘I would tell one of the carers.’ Of the seven questionnaires completed, 4 people said they knew how to make complaints, but three said that they did not know. However, this was not an issue that the 7 people chose to expand upon. The 2 relatives who replied to the questionnaire sent to them said that they knew how to make a complaint, but again didn’t chose to expand on their answers. The Manager’s Annual Quality Assurance Assessment said that the company’s complaints procedure could be found in the foyer of the Home, along with forms in which to make a written complaint, if this was preferred to a verbal complaint. The Commission had not received any notice of complaint since the last visit to the Home, in January 2008. However, the Home had received 6 complaints since January 2008. These were reviewed and found to have been addressed in a positive manner. Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 18 Good procedures were seen for both written and verbal complaints. The Registered Providers complaints procedure detailed that all complaints would be responded to by the Manager within 24 hours, and that an initial response to the complainant would be made within 72 hours days and all complaints would be addressed with 28 days. The Registered Providers had a Safeguarding Adults procedure that included a ‘Whistle Blowing’ policy, which staff said they were aware of, and had received training about. This meant that a procedure was in place to allow staff to inform the Manager of any inappropriate actions by other staff. The Manager, being new to the Home, was not sure whether the Home had copies of the Public Interest Disclosure Act of 1998, or the Dept of Health’s policy called ‘No Secrets’. The Manager confirmed that all allegations and incidents of abuse would be promptly followed up and that all actions taken would be recorded. Staff said that they understood that people staying in the Home might, on occasion, show anger and aggression, and described the training they has received on the best way to resolve these situations. The Manager said that a policy was available to staff stating that they could not benefit from Residents wills, which was also understood by the staff, with whom discussions were also held. Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 19 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, 20, 21,22, 23, 24, 25 & 26. The quality in this outcome area was Adequate. This judgement was made using available evidence including a visit to this service. The Home was well maintained throughout, providing all people staying in the Home with a safe, comfortable environment in which to live. EVIDENCE: The Annual Quality Assurance Assessment, produced by the Manager said that the Home was clean and well maintained. The Assessment also said that the Home was a ‘non-smoking’ home, and that this was explained to new people prior to admission. A tour was made of the public areas of the Home, and included the four bedrooms of the people whose care was reviewed at the time of this visit, plus other bedrooms, chosen at random. The public areas of the Home was appropriately decorated throughout, the lounges and dining room were pleasant to sit in and were provided with Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 20 necessary items for those staying. However, all bedrooms, on each floor, were decorated in the same style, providing no individuality at all. The bedrooms also looked very plain, and were dowdy in appearance, with few, sometimes no, pictures provided on the walls. Four of the seven people who completed questionnaires said that the Home was always fresh and clean. However, three of those staying were less than happy, saying – ‘…at times there is a distinct smell of urine. The home is looking tired and in need of … funding…’ – and – ‘Could do a lot better, e.g. commodes are not always clean. The whole place needs decorating etc. Beds are not made properly, sometimes left anyhow. Rooms should be left tidy, but this isn’t so’ – and – ‘My curtains are hanging down (not attached to the curtain track) and the carpet is dirty. The cleaning staff do their best, but most things need replacing.’ The bedrooms seen provided good space and provision for each person, and the Registered Providers had provided appropriate furnishings in almost all locations seen during this visit. Toilets were easily available to all people staying in the Home and were clearly marked. A ‘staff call’ system was also available throughout the Home. The Home had appropriate sluicing facilities, and laundry was washed at appropriate temperatures. In the Annual Quality Assurance Assessment the Manager wrote that refurbishment of the Home was due to take place in the autumn, and that a planning meeting for this was to take place at the end of July 2008. However, the following points needed attention: The door to the toilet, just outside the downstairs lounge did not lock. Bathroom 3, a shower bathroom, was also being used as a store for plastic boxes and continence wear. As a result the bathroom was not at all inviting to people who may need to use it. All of the bedrooms visited were large bedrooms, but only one chair had been provided and not two comfortable chairs, as recommended by the Commission. Inappropriate notices were provided on the internal doors of at least three bedrooms; one was on the outside door to the bedroom as well. The notices read, ‘Nil by mouth’, ‘Do not shave (name of person staying)’ and ‘Pads for (person staying) – Daytime super (yellow), nighttime extra Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 21 blue.’ This information should be supplied at ‘staff handovers’, together with regular reminders, if necessary, and not posted on the doors of bedrooms. Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 22 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. The quality in this outcome area was Adequate. This judgement was made using available evidence including a visit to this service. Care staff were not consistently trained to ensure that people staying in the Home had their needs met. Inconsistent staffing levels also had the potential to affect peoples well being. EVIDENCE: The staffing rotas were examined for the 4 week period from the 23 May to the 19 June 2008. This appeared to show that staffing varied considerably. Across this period 2 nursing staff were supposed to be on duty in the morning and 2 in the afternoon/evening, but this varied from this target to 2 in the morning and just one on a number of afternoon/evenings shifts. Care staff were aimed at providing 5 staff on duty in both the morning and afternoon/evening shifts. However, although this target was generally achieved, it did vary. A number of shifts were staffed at 4 in the morning and 3 in the afternoon/evenings, and 5 in the morning and 4 in the afternoon/evenings. Night staffing was provided at 1 nurse and 2 care staff each night. The questionnaires sent to those staying in the Home were not complimentary about staffing. Examples of what people chose to say included – ‘There are never enough people to help me’ – and - I ‘Do not always get a response’ when I call for staff’ – and – ‘Often short staffed as carers do not stay very long. New carers are set on each week, no continuity’ – and – ‘Again delays Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 23 due to staffing levels.’ However, one person said – ‘There is always someone when I call them.’ In the Annual Quality Assurance Assessment the Manager had written that, since her arrival in the Home, she has recruited an additional 8 staff, plus three more staff transferring from other BUPA homes. During this visit to the Home, the Manager said that these people were due to begin work in the near future. At the time of this visit to the Home it was found that under 50 of care staff had a qualification of at least NVQ level 2 in Care; 8 out of a total of 22 care staff, 36 . Of the two staff spoken with, one had her NVQ level 2 in Care and was wanting to begin an NVQ level 3 in Care. However, the other member of staff had an NVQ level 1 in Care, but had not as yet been put forward to begin her NVQ level 2 in Care. She had worked in the Home just over 12 months. The records of two new staff employed during the past 12 months were examined to see whether the Manager had obtained all relevant information about them. It was found that all information had been obtained. One of the care staff spoken with was able to confirm that she had been given a copy of the General Social Care Council’s code of conduct and practice, although the second member of staff was unaware of this. Staff were also asked about their induction training and the number of days training they had received during the past 12 months. One member of staff said that she had had induction training and that she had received at least 3 days training in the past 12 months. However, the second member of staff said that she had not received induction training and had only received 1 days training during the past 12 months. In the Annual Quality Assurance Assessment the Manager wrote that she, as the new manager of the Home, would be ensuring that the full induction programme for new staff would always be followed. Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 24 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. The quality in this outcome area was Adequate. This judgement was made using available evidence including a visit to this service. The management arrangements at the Home were not sufficiently robust to ensure that residential and nursing care were maintained at a positive standard. EVIDENCE: The Manager was appointed just three weeks prior to this visit to the Home. She had been registered by the Commission with respect to other homes, and said that she was in the process of applying to the Commission for registration as Manager of Alexandra Nursing Home. The records of the monthly ‘inspections’ of the Home, carried out by a senior manager of the organisation, were examined and were found to be satisfactory. Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 25 The Manager was able to show the annual development plan for the Home, which was adjusted on a monthly basis. This development plan reflected the aims and outcomes for people staying in the Home. The surveys to be completed by people staying in the Home were not available, and nor were surveys carried out with the relatives of those staying in the Home nor with visiting professionals. The senior care assistance, who was spoken with, was unable to say which people she was key worker to, and said this was due to the large number of staff the various managers of the Home had appointed during this last year. The Home held a number of accounts for peoples money, with the Home ensuring that interest was paid on the money held. It was seen that this was managed effectively for those staying in the Home. However, advise was given on the amount of money it was appropriate for the Home to hold for each person. Two members of staff were asked about the formal supervision they received from the Manager or other senior staff of the Home. They both said that they received no formal supervision at all. The Manager also confirmed that supervision was not currently taking place in the Home, and she had recorded this within the Annual Quality Assurance Assessment. The training required by the Regulations was examined. This showed that training was needed in all areas, those being Moving and Handling, Fire Safety, First Aid, Food Hygiene and Infection Control. Of the two staff spoken with one said that she had received training in Fire Safety only and the second in Moving and Handling and Fire Safety only. The Manager added that additional training had been provided in Dementia Awareness, the Liverpool Pathway, the Mental Capacity Act, Medication training and Safeguarding Adults and POVA. The Manager was able to show that all accidents, injuries and incidents of illness or communicable disease were recorded and reported to the relevant government bodies. With the assistance of the Fire Service, fire safety notices were also posted in relevant places around the Home. Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 26 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 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 3 3 2 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 1 X 2 Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 27 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 Reg 4 & 5 Requirement The statement of purpose and Residents Guide must contain all of the data listed in Regulations 4 and 5 and in Sch 1 to ensure that those staying in the Home have appropriate information on the Home’s operation. A copy of the Home’s statement of terms and condition of residency must be supplied to all those people sponsored by Social Services Dept. This is to ensure that people are aware of their rights while staying in the Home. People staying in the Home must be consulted about their care, see their plans of care (if they are able) and the care plan must be able to support this. This is to ensure that people are aware of the care being provided for them, and for them to make suggested alterations if necessary. (This issue is outstanding from the inspection report dated 16 January 2008) DS0000002132.V366600.R01.S.doc Timescale for action 18/08/08 2. OP2 Reg 5 18/08/08 3. OP7 Reg 15(1)(2) 18/08/08 Alexandra Nursing Home Version 5.2 Page 28 4. OP9 Reg 13(2) When distributing medication to people staying in the Home nursing staff must always sign the Medication Administration Record (MAR) sheets on every occasion. This is to record that the medication has been given out to each person at the required dose and at the required time. (This issue is outstanding from the inspection report dated 16 January 2008) When staff have to enter additional medication on to MAR sheets as a result of a Doctor’s visit, this must always be checked and signed by two staff, state the day on which the medication is to commence and state the Doctor authorising the additional medication. This is to ensure that appropriate records are kept of the medication to be given to those staying in the Home. 18/08/08 5. OP12 Reg 16(2)(m) & (n) People living in the home must be provided with a range of activities and social interests, to provide entertainment and to encourage mental and social activity. (This issue is outstanding from the inspection report dated 16 January 2008) All care staff employed by the Registered Providers must receive appropriate induction training and be encouraged to undertake at least 3 days training a year. This is to ensure that staff work in appropriate ways at all times. Supervision of staff must be DS0000002132.V366600.R01.S.doc 30/09/08 6. OP30 Reg 18(1)(c) 18/08/08 7. OP36 18(2) 18/08/08 Version 5.2 Page 29 Alexandra Nursing Home effective in ensuring all work professionally and that communication with people using the service promotes wellbeing. (This issue is outstanding from the inspection report dated 16 January 2008) 8. OP38 Reg 13(3) Mandatory training must be & 18(1)(c) provide for the members of staff requiring Moving and Handling, Fire Safety training, First Aid, Food Hygiene and Infection Control training. This training is needed to ensure that all staff have the knowledge to meet the needs of people staying in the Home, and to ensure that the Home is run to satisfactory standards. 31/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Refer to Standard OP7 Good Practice Recommendations The initial assessments of new people coming to the Home should be completed in full detail, as undertaken by the new Manager. Formal reviews of care should be undertaken at 6 monthly intervals. Those taking part should at least include staff from the Home, the person themselves and their relatives, particularly the ‘personal representative’. The review of care should be shown to the person staying in the Home (or representative) for signature. One of these reviews, each year, could be conducted by the Social Services Dept, although the Manager should provide formal written input to the review of the welfare and care provide to the person staying in the Home. No. 1. Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 30 2. OP12 People staying in the Home should be able to have a bath or shower, at least once a week, but usually more often than once a week. Consideration should be given to providing an Activities Coordinator. Staff should be made aware of those Residents who should be encouraged, following staff knocking on their bedroom door, to invite staff into their bedrooms and those Residents who can no longer do this. 3. OP15 Staff should only be required to assist one person at a time with their meal. If necessary other people awaiting their meal should be left in the lounge, or in their bedroom, until a member of staff was able to assist them with all of their meal at one time. Meals should be kept hot to allow this to take place. A choice of lunch time meal should be available throughout each week. 4. OP16 All people staying in the Home should be reminded of the method of making a complaint, or how to voice their dissatisfaction with any aspect of the Home’s operation. A copy of the Public Interest Disclosure Act of 1998 and of the Dept of Health’s policy called ‘No Secrets’ should be available within the Home to ensure that the Manager is aware of the action to take when complaints are made about the actions of her staff. Consideration should be given to improving all of the decoration in the bedrooms of those staying. Different wallpapers could be used in each bedroom, and from a range of choices, people staying in the Home could chose the décor they preferred. The Registered Providers should also provide picture to go on the walls, and /or encouragement to those staying to provide picture from their own homes. The toilet, just outside of the downstairs lounge, must be fitted with an operating lock. The stored boxes and continence wear in shower bathroom 3 should be removed to an appropriate store room, leaving the bathroom to operate simply as a bathroom. 5. OP18 6. OP19 Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 31 All bedrooms should be provided with two comfortable chairs. The notices on some peoples doors should be removed, e.g. ‘Nil by mouth’. Staff should be provided with reminders of people needs at ‘staff handovers’. 7. OP27 The amount of care staffing should be reviewed to ensure that the needs of those staying can always be met within a reasonable amount of time. Over 50 of staff should be trained to NVQ level 2 in Care. All new staff to the Home should be given copies of the General Social Care Council’s code of conduct and practice. The Acting Manager should apply to the Commission for her position to be assessed and hopefully accepted. Surveys should be undertaken with those people staying in the Home and with their relatives, friends and professionals. The money held for each person staying in the Home should be limited to the amount recommended during the visit. Formal supervision should be provided for all care staff at least 6 times a year. Staff training must be provided, in addition to mandatory training, in all necessary areas to allow the Home to provide a complete service to the public. 8. 9. 10. 11. OP28 OP29 OP31 OP33 12. OP35 13. 14. OP36 OP38 Alexandra Nursing Home DS0000002132.V366600.R01.S.doc Version 5.2 Page 32 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. 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