Inspection on 05/07/07 for Alexandra Nursing Home

This inspection was carried out on 5th July 2007.

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

Other inspections for this house

Alexandra Nursing Home 23/06/08

Alexandra Nursing Home 16/01/08

Alexandra Nursing Home 04/07/06

Alexandra Nursing Home 06/12/05

Alexandra Nursing Home 11/03/05

Alexandra Nursing Home 19/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Alexandra Nursing Home 370 Wilsthorpe Road Long Eaton Nottingham NG10 4AA Lead Inspector Jo Wright Key Unannounced Inspection 08:45 5th July 2007 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.V340192.R02.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.V340192.R02.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) Limited 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.V340192.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. BUPA Care Homes (BNH) Limited is registered to provide nursing, personal care and accommodation at Alexandra Nursing Home to service users whose primary care needs fall within the following categories :Old age, not falling within any other category (OP) 40 Physical Disability (PD) 3 - this relates to named persons listed under the conditions of registration Admission of one named person in the application received on 19/11/04 under the category Physical Disability (PD) Admission of one named person in the application received on 29/12/05 under the category Physical Disability (PD) Admission of one named person in the application received on 16/01/07 under the category Physical Disability (PD) The maximum number of persons to be accommodated at Alexandra Nursing Home is 40 4th July 2006 2. 3. 4. 5. Date of last inspection Brief Description of the Service: The Alexandra Nursing Home is a purpose built care home registered for 40 people. The building provides a modern and pleasant environment for residents and the accommodation is provided across two floors. There is a passenger lift and staircase access to the first floor facilities. There are two spacious lounge/dining areas, one with access to an octagonal sun lounge/conservatory. There is a landscaped garden to the rear of premises, which is accessible to residents. The majority of bedrooms are single occupancy, with three double bedrooms provided for residents wishing to share. All bedrooms are equipped with ensuite facilities. Information about the service is provided through the Statement of Purpose and Service User Guide, both of which were made available to residents. Information provided on 05/07/07 stated that the fees for the home were £305 to £630 per week, depending on the level of care required. A top up fee of between £30 and £50 was also in place, and residents/relatives were responsible for paying for services such as hairdressing, chiropody, private physiotherapy and occupational therapy. This information was included on the contracts and terms and conditions. Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was part of the key inspection for this service. One inspector carried out the site visit over 2 days. During this visit, time was spent speaking with residents, relatives and staff, and observing the daily routine within the home. The records for three residents were looked at in depth, as well as records relating to the general running of the home. Communal areas, bathrooms and a small number of bedrooms were viewed. Information received prior to the inspection was used to inform areas to look at during the site visit. 8 completed resident surveys were returned and the information within the surveys has been incorporated into the relevant sections of the report. What the service does well: What has improved since the last inspection? What they could do better: The recent instability in the management has affected the overall running of the service. The acting manager has identified areas that require attention and was taking action to address the issues. Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 6 The standard of record keeping in key areas relating to residents, such as care planning and medication, was poor. This means that residents are at risk of their health and personal care needs not been met, and staff unable to evidence the care and support that they are providing. Care plans need to provide staff with sufficient information to deliver appropriate care to meet individuals needs. The administration of medication and associated record keeping must improve to ensure that people receive their medication as prescribed. Systems must also be in place to ensure that prescribed medication is always available in the home. Issues and concerns raised by residents and relatives need to be dealt with in a manner that ensures that they feel reassured that their concerns have been listened to and acted upon. All staff need to receive training on the safeguarding procedures. The ongoing recruitment of staff needs to continue. Residents comments included ‘staff are there anytime’, ‘availability of staff is dependent on staffing levels’, ‘long delays in answering call bell’, and ‘home appears short staffed’. Additional staff have been recruited and were receiving their induction training at the time of this site visit. The acting manager reported that recruitment was ongoing as additional staff were still required. In addition the care staff team also needs to receive training towards National Vocational Qualifications, to ensure that staff have the necessary skills and knowledge to meet peoples needs. 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.V340192.R02.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 DS0000002132.V340192.R02.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, 2 and 3 (Standard 6 is not applicable in this service) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient Needs Assessment information ensures that needs of the people using the service are identified and met. EVIDENCE: People living at Alexandra Care Home were provided with a copy of the Service Users Guide in their bedrooms. The acting manager reported that prospective relatives were encouraged to read the Welcome Pack when they viewed the home. The majority of surveys completed by residents indicated that everyone had received enough information about the home before they moved in so they could decide if it was the right place for them. Several people commented that the home was chosen because of location. Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 9 Comments from relatives and the manager supported that people do not come to live at Alexandra Care Home unless a member of staff had visited them, and assessed that the home was able to meet the person’s care and social needs. Additional information about the person’s needs was also obtained from care management, if the person’s care was funded in this way. Information from other health and social care professionals was also made available. Since the last inspection, new documentation has been introduced called Quest. Information supplied by the provider prior to the inspection described this ‘as a personal plan which includes pre admission assessment than evolves into a set of care plans’. It was also reported that all qualified staff received training about the new documentation. The documentation had been completed for the three residents whose care was looked at in depth during this site visit. Post pre and post admission information was recorded and the scoring system completed. Although the amount of additional information recorded depended on the member of staff completing the documentation, there was always sufficient information available to enable staff to identify individuals’ personal and health care needs. There was little written evidence to support that residents were actively involved in their assessments. The written contract and terms and conditions of residence were on file. The fees at the time of admission were included. This means that residents have the information they need about the service they will receive and how much it will cost them. Everyone who completed a survey confirmed that they had received a contact. Alexandra Nursing Home DS0000002132.V340192.R02.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 poor. This judgement has been made using available evidence including a visit to this service. Lack of concise care planning may result in residents needs not being met. Poor staff practice in relation to the implementation of medication systems leaves residents vulnerable of not having their health needs met. EVIDENCE: Care planning documentation was not adequate and did not provide staff with sufficient information to meet the individual needs of residents. With the exception of plans of care for night time care, the care plans lacked detail and did not instruct staff on how to deliver care that met individuals needs and preferences. In addition, qualified staff were not using the documentation in the way that it was designed. They had not completed a nutritional risk assessment and care plan for a resident who was identified as at risk of losing weight, even though the scoring system and the instructions clearly directed them to do this. Although information had been recorded in the daily logs, care plans were not being reviewed on a regular basis. There was no written Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 11 evidence to support that the residents or relatives had been involved in planning or reviewing their care plans. However, a discussion between a qualified nurse and relative indicated that some relatives are encouraged to record information in the care plans. Risk assessments had been completed for the residents whose care was looked at in depth during this site visit. However, a number of these risk assessments not been reviewed or updated as appropriate since they had been written. Staff were observed using equipment such as the hoists appropriately and explaining to people what they were going to do prior to carrying out the task. Referrals to and input by health and social care professionals were poorly recorded in care files. Discussion with staff supported that they do seek advice as required, although comments in the surveys indicated that sometimes families prompted the referrals rather than staff themselves. Information available prior to this site visit, such as complaints, safeguarding referrals and the resident surveys did not support that all residents and relatives were satisfied with the care and services being provided at Alexandra Care Home (See Complaints and Protection Section). Several complaints have been received about the general level of care provided, and comments made in the surveys indicated that people do not always feel that they receive the care and support they need, although they felt this may be due to poor staffing levels. Residents and relatives did not feel that all staff listened to them and acted on what they said, in particular when they asked to be taken somewhere ie the toilet, they were told they would have to wait. However, staff practice that treated people as an individual was also observed. One resident was having a hot drink outside of the ‘drinks round’, and a member of staff who brought the drink asked the resident if they would also like a biscuit. Another member of staff was observed offering the same resident a damp cloth so they could wipe their hands and face when they finished. Medication practice was poor and placed people at risk of not having their health care needs met. Audits undertaken by the Quality and Compliance team of the organisation had highlighted issues in this area, and an action plan to improvement practice had been put in place. A ‘near miss’ medication error recently resulted in a safeguarding adults referral, and part of the action plan proposed by the company following the investigation was to assess the competency of qualified staff in relation to medication administration. At the time of the assessment all staff were assessed as competent although findings of this site visit would suggest otherwise. Staff had not maintained an acceptable standard of medication administration following this assessment. Residents were not receiving their medication as prescribed, either because it was out of stock; medication charts had not been signed to say that medication had been given, medication was given ‘as required’ rather then four Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 12 times as day as prescribed or it was not possible to audit the records against the monitored dose system, as they did not correspond. A number of residents had medication in both the monitored dose system and boxes/bottles in the medication trolley and it was not clear which supply was in use. Systems to check for errors when hand writing entries had not been followed, as a number of hand written entries had only been signed by one member of staff. In addition, the amount of medication recorded as available in the controlled drugs (CD) register did not correspond to the actual amount in the cupboard. Staff had recorded that they had destroyed a quantity of medication on 01/05/07 yet it remained in the cupboard. Despite staff regularly going to the CD register and the cupboard to administer other medication, this error appears to have gone unnoticed. Alexandra Nursing Home DS0000002132.V340192.R02.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): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ wellbeing may be affected by the limited range of social and recreational activities. EVIDENCE: Information provided prior to this site visit stated that the activity organiser post was vacant, and staff were delivering the activity programme. This was not supported by the comments made by residents, as the majority of residents who completed questionnaires stated that activities were sometimes provided. However, the acting manager had taken action to address this issue, by arranging for the activity organiser from another home to visit three afternoons a week. A list of activities was on display and a copy had also been given to resident. Activities were observed taking place during this site visit. The manager was interviewing for the vacant position at the time of this site visit. Little information about residents interests or hobbies was recorded in residents care files. Comments from residents, staff and observation supported that the routine within the home was flexible. People were able to use all areas of the home as Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 14 they wished, and remain in rooms if they wished. However, comments in surveys indicated that more use could be made of the garden area. Visitors commented that they were able to visit at any time, and this was observed throughout the visit. Residents commented that they were encouraged to remain as independent as possible, whether in relation to their care, going out of the home or managing their own finances. Comments from residents and information within the surveys indicated that not all residents were satisfied with the meals provided. Comments in the surveys included not high quality, not enough fruit’, ‘breakfast often very late, almost go into lunch’, ‘teas lacking imagination and variety, soup and sandwiches, not fresh fruit’ and ‘meals are very good’. Comments made by residents included ‘used to be asked what we wanted off the menu’, and ‘little choice of vegetables and usually cold’. The acting manager was aware of a number of issues relating to food, including that staff had not been offering residents the ‘Night Bites’ which ensured access to food 24 hours a day. The acting manager had already delegated a member of staff on each night shift responsibility for offering all residents supper and recording any food eaten in their care file. On the second day of this site visit the acting manager had reintroduced asking residents what choice they would like from the menu, and placed fresh fruit in the communal areas for residents to help themselves, with plans for staff to offer fruit to residents in their rooms as part of the drinks rounds. The acting manager stated that she planned to meet with residents and relatives to discuss changes in relation to mealtimes. Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. Despite concise complaints procedures being in place people do not always feel that they are listened to and their concerns acted upon. The lack of up to date staff training around safeguarding adults procedures may result in residents not being protected from harm. EVIDENCE: The complaints procedure was accessible to people living at the home and visitors. The majority of people who completed the surveys knew who to speak to and how to complain, although 2 people commented that they were not aware. Information provided prior this site visit indicated that 16 complaints had been received by the management during the previous 12 months, although no information was included about how many of these complaints were upheld. The acting manager acknowledged that a number of these complaints had been upheld. The ongoing issues raised in complaints does not support that people always feel listened to or that their concerns are acted upon and resolved. Comments in the surveys included ‘had cause to write to home manager, regarding care, issue was in part resolved’ and ‘had issues with this home’. The acting manager acknowledged that there have been issues recently relating to the management of complaints. As a consequence the acting manager has taken a Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 16 proactive approach, and goes around the home asking residents and relatives if they are satisfied with the care and services provided and dealing with issues as they arise. All complaints are recorded and information related to investigation was in place. All staff receive training on safeguarding adults as part of their induction programme, although this does not include specific training on the local authority procedures. There was evidence to support that staff do report unacceptable practice and the management of the home report incidents through the safeguarding adults procedures to lead agency and through regulation 37 reports. Staff spoken with were aware of safeguarding procedures and how to report internally and externally. Despite robust recruitment procedures and staff training, complaints and safeguarding adults referrals about the same issues continue to be made. The acting manager reported that there are systems in place for all incidents and complaints to be reported the head office each month. It would appear that this system has not been as effective as it should be prior to the acting manager taking up post. Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable and safe environment that meets their needs. EVIDENCE: All areas of the building were reasonably maintained, and there was evidence to support ongoing investment in fixtures and fittings. Information provided prior to this site visit indicated that plans were in place to purchase two specialist beds and the acting manager reported that these were on order. Residents confirmed that they were enabled to personalise their rooms if they wished, and evidence of this was seen during the site visit. The garden area was well maintained and the addition of a ramp from the dining room has facilitated easier access to the garden area for people with restricted mobility. Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 18 Bathroom and shower areas continue to be used for storage of times such as wheelchairs and hoists, which potentially restricts resident access to these areas. The acting manager reported that a number of carpets had been identified as requiring cleaning. The ground floor and first floor lounge carpets were cleaned overnight at the time of this site visit, as well as a number of bedroom carpets. It was reported that all of the easy chairs in the communal areas were due to be professionally cleaned the week after this site visit. The majority of people who completed the surveys were satisfied with the cleanliness of the home. Several people commented had they had raised issues about the cleanliness of the room, but that these had been dealt with appropriately. Systems were in place for laundering of personal clothing. The laundry area was well-organised and dedicated laundry staff responsible for washing and ironing of clothing. Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. The incomplete permanent staff team means that residents are not always supported by staff with the necessary skills, knowledge and experience to fully meet their needs EVIDENCE: Information gathered through the surveys, comments from residents, relatives and staff, and complaints indicated that people using the service considered that staffing levels were not always sufficient to meet their needs. The planned staffing rotas did not support this, and regulation 37 notifications were submitted on occasions when staffing levels could not be maintained due to unforeseen circumstances. Comments included in the surveys and made in person included ‘staff are there anytime’, ‘availability of staff is dependent on staffing levels’, ‘long delays in answering call bell’, and ‘home appears short staffed, and lack of NVQ trained staff’. Information provided prior to this site visit demonstrated a reliance on agency and bank staff to maintain staffing levels. Efforts had been made to increase the number of permanent staff employed at the home. Additional qualified and care staff had been recruited. Care staff were observed attending their induction training and working supernumerary Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 20 under supervision at the time of the site visit. Ongoing recruitment was also taking place. Less than 25 of care staff had achieved a National Vocational Qualification in care. The acting manager reported that a group of staff will start this training later in the year. A full audit of staff files had taken place, to establish what training had been completed. This information had been used to develop a training matrix, and training and development plan for the staff team. The training matrix highlighted that a number of staff required mandatory training, and training dates were in place. Newly recruited staff confirmed that they had attended induction training prior to commencing their employment as well as ongoing. The management had already identified that training of new staff must be more closely monitored by setting timescales for completion of aspects of learning. As the induction programme in place is linked to Skills for Care training, timescales for completion should be place. However, this links with the lack of regular supervision of staff. Robust recruitment procedures were in place, and required pre employment checks were in place in the files seen. However, confirmation of the registration status of a qualified number of staff was not on file. The member of staff in question stated that the registering authority had run out of registration cards. However, the registration status of qualified staff must be checked with the registering authority and not reliant on site of the card. This system is in place at Alexandra and did not appear to have been used for this member of staff in question. Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 21 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Ongoing staffing issues means that the service can not always be run in the best interest of the residents. EVIDENCE: People using the service and staff have experienced a period of instability in relation to the management of the home. The previous manager resigned her post in June 2007 following a short period when she was unavailable for work. A decision was made that the Regional Support Manager would take on the responsibilities of the acting manager until a replacement manager had been recruited. The acting manager commenced this role three weeks prior to this site visit. Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 22 Comments made in the surveys and through complaints indicate that people using the service do not feel that the service has been run with their best interests in mind. The annual customer satisfaction survey carried out for 2006 (analysis of the results has recently been made available) raised similar issues to those raised in the Commission’s surveys and through this site visit. The provider has developed an action plan to address these issues. The acting manager had planned a resident/relative meeting on 17/07/07 to enable twoway communication between the people using the service and the management of the home. The company is aware of the need for continuous improvement and has developed a Quality and Compliance team to monitor and improve quality of care and services provided as its services. The Regional Manager had already identified issues through the weekly Regulation 26 visits. This has resulted in the Regional Quality and Compliance Team carrying out a full audit of the service and putting an action/improvement plan in place. Systems were also in place for weekly/monthly auditing and reporting by the home manager. These systems have been less effective recently due to the instability in management. Satisfactory systems were in place for safe keeping of residents monies. Staff were not provided with regular supervision. This is reflected in the ongoing issues around the standard of care delivered, poor standard of care planning and administration of medication practices. Mandatory training is provided for all staff, although as previously stated the records do not evidence that all staff have received this training (See Staffing Section). Information provided prior to this site visit indicated that all equipment had been serviced or tested as recommended by the manufacturer or other regulatory body. Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 23 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement All people using the service must have an up to date, detailed care plan. This must direct staff on the delivery of care in line with the individuals assessed needs. This will ensure that people using the service receive person centred support that meets their needs. People using the service must receive their medication as prescribed. This will ensure that people receive the correct levels of medication. Systems must be in place to ensure that the amount of controlled medication recorded in the register and the amount available is the same. This will ensure that any discrepancies in amounts are identified and investigated promptly. Staff must receive training on abuse and safeguarding adults procedures. This will ensure that residents are protected from harm. The staff team must have the required skills and knowledge to DS0000002132.V340192.R02.S.doc Timescale for action 31/08/07 2 OP9 13(2) 03/08/07 3 OP9 13(2) 03/08/07 4 OP18 13(6) 30/09/07 5 OP27 18(1) 30/09/07 Alexandra Nursing Home Version 5.2 Page 25 6 OP29 19 7 OP36 18(2) 8 OP38 18(1) deliver appropriate care to the people using the service. This will ensure that staff have a better understanding of the care the people using the service require. Evidence that the registration status of qualified nurses has been checked with the registering authority must be on file. This includes on employment and on renewal. This will ensure that only qualified nurses with a current registration work in the home and protect people using the service from harm. Staff practice must be supervised to ensure that the care they are providing is appropriate to meet the needs of the people using the service. Provide all staff with mandatory training with evidence to support that this had taken place. This will ensure that people using the service are cared for by staff with the appropriate skills and knowledge. 03/08/07 31/08/07 30/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations People using the service should be involved in completing their assessment of needs and care plans, so they are able to identify with staff activities where they require assistance, and activities that they are able to manage themselves. Care plans should be reviewed and evaluated on a monthly basis with the resident and/or representative. DS0000002132.V340192.R02.S.doc Version 5.2 Page 26 2 OP7 Alexandra Nursing Home 3 OP8 4 OP9 5 OP9 6 OP12 7 OP15 8 9 OP18 OP19 10 OP28 This will ensure that care plans are kept up to date and reflect any changes in the persons condition and residents receive the care that they require. Referrals to health and social care professionals should be recorded in each resident’s care file. This will ensure that staff are kept up to date with any changes in the persons condition and residents receive the care that they require. Systems should be put in place to ensure that supplies of medication are available for people using the service at all times. This will ensure that people receive their medication as prescribed. Staff should follow the systems in place to check for errors when hand writing entries on the medication records. This will ensure that errors are noted and rectified prior to a medication error occurring. Residents hobbies and interests should be recorded in their care files. This would enable staff to provide activities in accordance with individual’s preferences. Participation in activities should be recorded to support that their social needs are being met. Residents preferences in relation to food should be obtained and the menus reviewed accordingly. This will ensure that people are offered a choice of meal each day that takes into account their collective preferences. Staff should attend training provided by the local authority on safeguarding adults procedures. Adequate storage facilities should be provided for items such as wheelchairs and hoists, so they can be removed from the bathroom areas. This will enable residents to have access to the full range of bathing facilities provided at the home. 50 of care staff should be qualified to National Vocational Qualification Level 2, so that staff have the necessary skills and knowledge to care for people using the service. Alexandra Nursing Home DS0000002132.V340192.R02.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 DS0000002132.V340192.R02.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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