Inspection on 29/09/06 for Alexandra Nursing Home

This inspection was carried out on 29th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 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 05/06/09

Alexandra Nursing Home 18/01/06

Alexandra Nursing Home 09/08/05

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

CARE HOMES FOR OLDER PEOPLE Alexandra Nursing Home Moorland Road Poulton Le Fylde Blackpool Lancashire FY6 7EU Lead Inspector Christopher Bond Unannounced Inspection 10:00 29 September 2006 th 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 DS0000064333.V304741.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 DS0000064333.V304741.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra Nursing Home Address Moorland Road Poulton Le Fylde Blackpool Lancashire FY6 7EU 01253 893313 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) Alexandra Nursing Home Limited Mrs Pat Nixon Care Home 40 Category(ies) of Dementia (7), Old age, not falling within any registration, with number other category (31), Physical disability (2) of places Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered to accommodate a maximum of 40 service users to include; Up to 31 service users in the category OP (Old Age, not falling within any other category) Up to 7 service users in the category of DE (Dementia) Up to 2 service users in the category of PD (Physical Disability) over the age of 60 18th January 2006 Date of last inspection Brief Description of the Service: The Alexandra is a listed building and stands in its own grounds on the outskirts of Poulton-le-Fylde. The main building is most attractive and contains many of its original features, including wall and ceiling paintings, stained glass windows and a broad open staircase leading up from the hallway. The gardens are well managed and there are lots of places for residents to sit out in good weather. The main railway station is quite close and bus services run from close by. There are plenty of parking spaces close to the home and within its grounds. There are local shops not far from the home as well as places of worship and other amenities. The building has a lift and some of the bedrooms are en-suite. The home is registered for 40 residents, there are 7 residents who have dementia and a specific area has been set -aside for this purpose. Other residents have general health problems or physical disabilities and trained staff are available at all times to assist with their needs. At the time of this visit, (29/09/06) the information given to the Commission showed that the fees for care at the home are from £416.50 to £524.50 per week, with added expenses for hairdressing and chiropody. Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over a total of 6 hours. A tour of the home included bedrooms, lounge and dining areas, and bathrooms. All areas were clean, hygienic and pleasantly furnished. The residents’ personal files and care plans were examined. Care staff records were also looked at. Safety certificates for the home were also examined. Residents, and care staff were also spoken to during this inspection. The lunchtime meal was also sampled. What the service does well: This is a service where the residents are looked after well. The manager and the owner of the home both run the service effectively and professionally. They show great enthusiasm for ensuring that the home is run in the best interests of the residents. The service provides a clean, homely and comfortable environment for its residents. Residents were complementary regarding the service they receive and the facilities available. Care records are professionally written and informative. Care plans are updated and reviewed on a regular basis to ensure that the standard of care remained constant. The care staff work well as a team and show a good understanding of the needs of the people living at the home. Almost all of the care staff either have a nationally recognised qualification in care or are working towards this. Over 50 of the staff are now qualified. Daily routines for the people living within the home are flexible and the residents’ personal routines and lifestyles are respected. Mealtimes are relaxed and unrushed. Menus showed that there was plenty of choice. The food that was being cooked on the day was nutritious and appealing. Several of the residents spoke of how much they enjoyed the cooking at the home. The building itself is in attractive surroundings and the interior of the home contains many original murals, paintings and features. Many of the residents who were spoken to commented on the pleasant surroundings within the Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 6 home. One resident said, “ This is a lovely place to live. I feel ‘special’ living here.” The manager of the home had been in charge for only a few months but had begun her role well. The Commission for Social Care Inspection had registered her as manager in June 2006. She had commenced a nationally recognised management qualification and hoped to complete this soon. This will mean that she will be better qualified to manage the home successfully. What has improved since the last inspection? 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 DS0000064333.V304741.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Thorough admittance procedures and careful assessment ensures that the home can meet people’s needs. Written information provided to prospective residents is good enabling an informed decision about admission to the home to be made. EVIDENCE: The home’s Statement of Purpose and Service Users Guide is a set of written information that tells people about the care service that is offered, who the manager and staff are, and what the resident can expect if he or she decides to live at the home. This has been reviewed and updated. Each resident had been given a copy of this information. Two of the residents were able to confirm that they had been given this information. There was a Service User Guide in each of the bedrooms ensuring that information about the home is accessible to all service users. Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 9 Each of the residents had been assessed before coming to live at the home so that a decision could be made as to whether the home could care for them properly and address their specific needs. There was a copy of this assessment on each of the residents’ personal information files. . Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents health and social care needs are met, and people are treated with dignity and respect at this home. Residents are supported and protected in their daily lives. EVIDENCE: All of the residents had an extensive plan of care that documented all of their daily needs and how the home would address these needs. This was a Nursing Home and some of the residents had quite complex needs. The trained nurses and care staff added information to the plans on a daily basis and each plan was reviewed every month so that information could be updated and appropriate action taken. The monthly review included updating information on bathing, mobility, nutrition, continence, and moving and handling needs. The inspector looked at twelve of the care plans and there was enough information in each of these plans to show that the care needs of the residents were being dealt with properly and appropriately. Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 11 An accredited assessment tool for the care and prevention of pressure sores was being used at the home, and reviews were held monthly and recorded. This meant that people were less likely to develop pressure sores because the care staff were constantly monitoring their condition. Preventative aids were also available within the home. One of the residents commented, “They look after me really well here, I don’t feel that I could be in a better place.” Eight visitors to the home were also spoken to and all of them commented on how well the home dealt with the needs of their relatives. One visitor said, ”The care here is excellent.” There were some very good examples seen of the care staff addressing residents politely and courteously. Some of the residents were being supported to move from the dining room through to the lounge and help was being given appropriately and respectfully. None of the residents were responsible for their own medication. Systems were in place that ensured that medication was handled correctly and professionally. The records of all the people who received medication were seen and there were no concerns. Each resident had a photograph attached to his or her record sheet to help with identification. Only trained staff gave out the medication. There was evidence that the pharmacist visited the home to advise on medication issues. Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents enjoy planned and stimulating activities. Friends and family are made welcome within the home, which helps to maintain positive relationships. Mealtimes are planned and unhurried and residents’ preferences are respected. EVIDENCE: The care plans held some good information about the social, cultural and religious needs of the residents. This meant that the care staff were aware of what interests people had and what hobbies and pastimes they enjoyed. There were lots of planned activities within the home to help ensure that the residents were entertained and kept active. These included bingo, sing-alongs, days out to places of interest, shopping trips, coach trips and parties. Several residents were spoken to during the inspection and all of them said that there was always plenty to do. Some of the residents were enjoying Tai Chi exercise and massage from a trained practitioner when the inspectors arrived. An entertainer arrived in the afternoon and the residents enjoyed singing along to the old tunes. Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 13 The home had a separate Dementia unit. There were specialist activities available for the residents in this unit. These included reminiscence sessions and special games and pastimes. Some of the residents had special boards in their rooms where old family photographs were displayed. This helps the residents to retain important memories. The care plans also held lots of information about important events in residents’ lives. This helped the care staff to communicate effectively. There were several visitors to the home during the inspection. All of those who were spoken to said that they found their visits to be a positive experience and that they were made to feel very welcome. Visitors were given refreshments and offered privacy. One of the visitors commented, “It’s nice coming here because they make my mother and I feel special. I come at different times and I’ve never seen anything that worried me. It’s a nice, cheerful place.” There was information on the notice board in the hallway about the local Advocacy service. This service helps residents to have a voice when there are no relatives to look after their interests. There was a residents committee that met regularly and minutes of these meetings were kept and displayed. The inspectors were able to sample the meal that was served. This was enjoyable and nutritious and very well presented. The dining area overlooked the garden and the dining tables were properly and attractively set in attractive surroundings. The care plans held evidence that special diets were catered for. One of the residents said, “They have been marvellous in helping me manage my Diabetes.” All of the residents that were spoken to said that they thought the food was generally very good and that they looked forward to meal times. The chef was spoken to and she confirmed that fresh vegetables were always served and that a balanced diet was very important to the health of the residents. There was a list of birthdays in the kitchen and special arrangements were made to help the residents celebrate. The Fylde Coast does not have a large population of differing ethnic minorities and cultures. The manager was aware of what action to take to ensure that everyone was treated equally. There were residents that enjoyed religious followings on a Sunday. Every effort was made to ensure that they either went to church or were visited by a priest or vicar. Sometimes they had communion. This information was recorded on the care plans. Two of the residents were able to say that the home made every effort to ensure that their religious belief was followed. Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Complaints are treated seriously to ensure that the residents’ rights are protected. Residents were safeguarded from harm by good staff awareness and appropriate training. EVIDENCE: There were policy documents for the staff to read about how to recognise and report suspected abuse. All of the staff that were spoken to said that they had a good awareness of this important issue and knew what to do if they were not happy about something they had seen. The manager was aware of her responsibilities and knew whom to contact should abuse be suspected. There had been two recent concerns raised about the home and the manager and owner of the home had appropriately and respectfully dealt both of these. All of the staff that were spoken to said that they knew what to do if someone was unhappy about the service. The complaints procedure was displayed in several parts of the home. The manager was aware of her role regarding the complaints procedure and how complaints can be used as a quality tool to ensure that the home is run in the best interests of the residents. Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 15 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 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents are provided with a comfortable, clean and hygienic environment and bedrooms were personalised. This means that residents will feel at home with their belongings around them. EVIDENCE: A tour of the home showed that the general environment was very good; furnishings were very comfortable and aids and adaptations were in place to help with the residents’ mobility and personal toilet and bathing needs. The overall feeling in the building was that it was homely. Residents and visitors stated that they felt at home. Bedrooms were personalised and comfortable and several residents were able to say that they were happy with their rooms. All of the rooms had photographs, books, ornaments and other personal items within them. One of the residents commented, “I’m very happy. They moved the furniture around in my room to make it personal.” Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 16 The house was in a very attractive setting, with extensive gardens. The hallway to the home was decorated with ceiling murals and there was a wide, open staircase with stained glass windows. The manager clearly took the maintenance and cleanliness of the home seriously. The home was well maintained throughout and maintenance tasks were dealt with quickly so as not to inconvenience residents. The home was also clean and hygienic. There were no unpleasant smells. The housekeeping staff were spoken to and it was clear that any accidents were dealt with quickly and appropriately. Some of the rooms were shared and the care staff spoke of their responsibility to ensure that everyone had privacy. There were screens available to maintain dignity. Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 17 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good recruitment practices meant that residents were protected from unsuitable staff working in the home. Staff were caring and competent in their roles. EVIDENCE: There were enough trained staff and care staff on duty during the inspection to ensure that the assessed needs of the residents were adequately dealt with. The staff rotas showed that staffing was good and that there were plenty of staff on each shift to ensure that people were being properly looked after. One resident said, “The staff are busy but they always have time to sit and talk with us.” Staff records showed that new carers had been properly checked before starting their jobs. This helped to make sure that the residents were safer. There was a good induction process to help ensure that new care staff were competent before commencing their role. Three of the care staff were spoken to and all said that the training in the home was beneficial to their work. Some staff had achieved a national qualification in care (National Vocational Qualification level 2 or 3). Others Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 18 would be commencing this training shortly which would bring the total amount of trained staff to well over 50 . This means that the staff are well trained to perform caring tasks. Training records showed that appropriate and frequent training was taking place. The home had a specific staff training area. Another care organisation used these facilities frequently and staff from the Alexandria were invited along. The home also organised core safety training such as health and safety, fire safety, first aid, food hygiene and moving and handling. Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 19 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, 32, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are protected and safeguarded by good management practice and a well maintained home. EVIDENCE: Good records were being kept of safety checks within the home. These showed that professionals were checking the lift, electric and gas equipment and the fire alarm system regularly. This helped to ensure that the residents lived in a safe home. The manager of the home had been in charge for only a few months but had begun her role well. The Commission for Social Care Inspection had registered her as manager in June 2006. She had commenced a nationally recognised Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 20 management qualification and hoped to complete this soon. This will mean that she will be better qualified to manage the home successfully. The matron ran the home well and had the respect of all of the care staff that were spoken to. It must also be added that the owner of the home visited the home daily and showed great enthusiasm in ensuring that the home was run in the best interests of the residents. Some of the residents had small amounts of money held by the home. This was held very securely and was safeguarded by good recording and checking. Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 21 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 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 3 3 3 3 4 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP36 Good Practice Recommendations Staff should receive regular, recorded, formal supervision. Alexandra Nursing Home DS0000064333.V304741.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 DS0000064333.V304741.R01.S.doc Version 5.2 Page 24 - 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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