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Inspection on 07/04/09 for Alexandra Nursing Home

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

This inspection was carried out on 7th April 2009.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Key inspection report CARE HOMES FOR OLDER PEOPLE Alexandra Nursing Home 46 Alexandra Road Hemel Hempstead Hertfordshire HP2 5BP Lead Inspector Jeffrey Orange Unannounced Inspection 7th April 2009 07:25 DS0000044528.V375134.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra Nursing Home Address 46 Alexandra Road Hemel Hempstead Hertfordshire HP2 5BP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01442 246775 01442 216047 alexandra@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Ltd Manager post vacant Care Home 76 Category(ies) of Dementia (26), Old age, not falling within any registration, with number other category (76) of places Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home may accommodate a maximum of 76 service users requiring nursing care Within the overall capacity the home may accommodate a maximum of 5 service users between the ages of 50 and 64 Within the overall capacity the home may accommodate a maximum of 25 older service users requiring personal care Within the overall capacity the home may accommodate a maximum of 26 older service users with dementia requiring nursing care 21st August 2008 Date of last inspection Brief Description of the Service: This purpose-built care home with nursing was first opened in 1999. It consists of three floors that are connected by two passenger lifts. The ground and second floor provides accommodation to service users who require general nursing care and the first floor to service users who have some level of dementia. Each floor has its own dining room and two lounge areas. The home is built on a sloping site and the main reception; kitchen, laundry, hairdressing salon and garden lounge are located on the lower ground floor (at the rear of the building). There is off-road car parking provided both at the front and rear of the home. The home is located close to shops and other amenities including public transport. The Home has a Statement of Purpose and Service User’s Guide, both of which are available to prospective service users along with copies of previous inspection reports by the Commission for Social Care Inspection (CSCI). Weekly fees range from £578 - £636 (including nursing care contributions) for block-purchased Social Service beds. The maximum fee for privately funded beds is £995 (excluding nursing care contributions). These fees were current at April 2009. Additional charges apply for hairdressing, chiropody, private dentistry, newspapers and personal toiletries. Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection took place over the course of one day, beginning early in the morning, so that the routine of the home could be assessed as people were getting up, having their breakfasts and being helped to get ready for the day ahead. This inspection was carried out by one inspector and an “expert by experience”. Experts by experience are people whose knowledge about social care services comes directly from using services and who, because of this, people who live in care services may feel more relaxed talking to than an ‘inspector’. Where this report refers to ‘we’ it reflects the fact that it is written on behalf of the care Quality Commission (CQC). During this inspection we spoke to people who live in Alexandra Nursing Home, to visitors to the home on the day and to members of the care and nursing staff team. We had very useful and positive discussions with the management team and were able to look at a number of key records, including care plans, staff recruitment and training files. We sent surveys to a number of people who live in Alexandra Nursing Home, and their comments are taken into account in this report and were instrumental in determining what areas of the home’s operation should be specifically looked at during the site visit. This report also draws on any information we have received since the last key inspection in August 2008. This might be from comments received from people associated with the home, notifications of significant events reported to us by the home, or from other contacts with health and social care professionals involved with the home in some capacity. The home has previously sent us an annual quality assurance assessment or AQAA. (The AQAA is a self assessment document that sets out how well care outcomes are being achieved for people living in the home and also includes some statistical information, for example about complaints and staff training.) Where that information remains relevant, it has been used to inform this inspection. The home is currently in the process of completing an updated AQAA. The information it contains will be recorded and assessed and will be used in the ongoing regulation and assessment of Alexandra Nursing Home. Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 6 What the service does well: “I have found Alexandra Care Home more than satisfactory and the staff on all levels are very friendly and caring”. “I am very happy living her, I don’t have to worry about housework or cooking and there is always someone to talk to” and “I couldn’t look after my mother any better myself. It gives me peace of mind” were all comments received either on the day of the site visit as we met people living in the home or their visitors. We also received overwhelmingly positive comments in the surveys we received back from people living in the home or those responsible for them. The expert by experience noted that; “Everyone that I saw looked clean and well cared for” and “The visitors that I spoke to were very complimentary about the care their relatives were receiving”. At the last inspection we found that there had been an improvement in the standard of recording details in care plans around areas of care such as nutrition and pressure care and it is positive that this inspection has found that improvement has been sustained as this provides the basis for a good standard of care for people with more complex health and social care needs. What has improved since the last inspection? What they could do better: It is disappointing that no application has as yet been received by the commission for the registration of the current manager. This is important not only for the staff team, as it would reinforce the sense of a more permanent management approach in the home, referred to above, but it is also the way that the fitness of a person to manage a registered care service is determined. It is understood that the process of gathering the necessary information ahead Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 7 of making an application is now underway and this should be completed and an application submitted without further delay. In observing at some length the mealtime experience on one unit, it is clear that improvements could quite easily be made that would further enhance what can be for some people living in residential care “The highlight of the day”. Comments about the food in Alexandra varied quite widely and whilst there is no doubting the commitment of the chef manager and her staff team to meet peoples’ needs, there is some room for improvement in communication and feedback. Activities and the life history information content of care plans could also be improved or made more consistent, so that the care people receive and the activities that are available for them better reflect their individual needs, tastes and preferences. It was positive that in discussing these issues with the manager, we found that there was a willingness to make improvements where the need for them could be substantiated and a genuine commitment to develop and improve the care outcomes in the home for all the people living there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexandra Nursing Home DS0000044528.V375134.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 5 (Standard 6 does not apply to Alexandra Nursing Home) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering Alexandra Nursing Home as a home for themselves or someone they are responsible for can be assured that they will only be admitted once a robust and thorough process of assessment has determined that their needs can be fully and appropriately met. EVIDENCE: In October 2008 previous concerns about the registration of the home for a small number of people with learning disability were addressed by agreement between Southern Cross and the Commission and the position is now satisfactory, provided the needs of those people with learning disabilities continue to be met appropriately. Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 10 When we asked people living in the home if they had received enough information about the home before they moved in to enable them to decide if it was the right place for them 100 said yes they had. When we talked to people about the process of choosing a care home, they all told us that they had been able to visit Alexandra before making a decision and that the staff had been helpful and welcoming. One person told us that they had visited seven homes before deciding that Alexandra was the one that best suited their relative. When we asked people living in the home if they had received a contract 60 said that they had, 30 said they hadn’t and 10 didn’t know if they had or hadn’t. The home may consider it worth revisiting the admission process to ensure that any contract between them and people living in the home is clear and accessible as it is important that people are aware of the terms and conditions under which they are provided with care and accommodation. When we looked at the pre-admission assessments for some people who had recently moved into Alexandra we found that they contained the basic information, in sufficient detail for their needs to be identified and a care plan drawn up to ensure that they were met. The part of the assessment process that provides information about the social profile and life history of people being considered for admission, which is necessary for care staff to get some feeling for the individual background, interests and preferences of people being admitted was not always fully completed at the assessment stage, and this makes it harder for care staff to provide individualised care that takes this into account. Alexandra Nursing Home DS0000044528.V375134.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that they will have access to the healthcare services that they need in the home or community and that where they rely on the home to help them with their medication it will be done safely and accurately so that their health, safety and welfare are protected and promoted. EVIDENCE: “I couldn’t care for my mother any better myself” was one comment recorded which is supported by many other positive comments both by people living in the home and those responsible for them about the standard of care they experience. Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 12 When we looked at care plans we found that they were in general well completed, with evidence of regular reviews and contained the information care staff require in order to be able to identify people’s care needs and how they can be met. The review process means any changes in needs can be identified and revisions made to the care plan so that changed needs can continue to be met. There were however a few instances where one part of the care plan contradicted or was inconsistent with another and this could potentially cause some confusion for care staff or other people who need to consult care plans. The part of the homes’ care plans that include peoples ‘life history’ and which set out family background, details of significant events in their lives and their personal tastes, preferences and interests was not always fully completed and this means that care staff would not always be able to provide care, arrange activities or provide food in a way that reflects the individual and is genuinely person centred. As there were some instances where this section had been well and meaningfully completed, it suggests that work needs to be done to bring the standard of the rest of the care plans up to the same standard. When we asked people living in the home if they received the care and support they needed, 50 said they always did and 50 said that they usually did. When we asked people living in the home if they received the medical support they need, 70 said they always did, 28 that they usually did and 2 that they sometimes did as they felt that the home should provide more physiotherapy from its own resources. We saw a G.P. in the home whilst we were there, visiting a person living in the home in their own room to provide privacy and maintain confidentiality. Whilst we were in the home we observed a good standard of care being provided in a way that respected individuals and maintained their dignity. We were able to speak to the home’s ‘Dignity Champion’ who explained their role in ensuring that care given always took account of people’s dignity and rights. We were also told of work being done by the home in order to improve the care for the dying which provides both a challenge and sense of achievement to care staff and a comfort to those concerned and their relatives or carers. When we checked medication records on each of the units in the home, we found a good standard of recording and monitoring in place. No gaps were found in those records spot-checked and records for the administration and recording of controlled drugs were satisfactory. This should provide people who live in the home, and who rely on staff to assist them with their medication with confidence that it will be done safely and accurately. Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home have inconsistent experiences of the activities and food provided for them and despite the undoubted commitment of the catering and activities staff team the current level of communication about what is required is not effectively or consistently delivering activities or food that satisfy the needs of many people living in the home. EVIDENCE: When we asked people who live in the home if they liked the meals at the home, 10 said that they always did, 40 that they usually did and 50 that they sometimes did. Some comments received during our site visit were; “We had two lovely meals last week”, “It isn’t like home cooking”, “Unimaginative desserts, sauces and chutneys never offered”. “I don’t know what they do with the food here. ”When we asked people about choices some told us that there was no choice, “You Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 14 just have to eat what is given”, whilst others said that “You only have to ask if you want something”. The expert by experience saw one person being given an alternative choice as she did not like what was on the menu. When we talked with the chef we found that she was genuinely trying to find out what people living in the home want to eat and this appears on the minutes of both service user and relatives meetings. The relatives in particular were appreciative of the ‘brilliant’ Christmas dinner provided. One person said; “These include a three monthly relatives meeting to discuss any problems or worries, I find these very good”. As part of this inspection we spent from 7.45 to 8.50 on one unit observing the breakfast routine. We found that there was a shortage of staff in the dining room and that this led to people being left for long periods with no drink or breakfast. When breakfasts was served, those who had been first into the room, often because they were taken in by wheelchair, were actually the last to be served because they needed assistance. We saw that choices were given in some cases, between porridge and cornflakes and that cooked breakfasts were available. The expert by experience, in another unit stated that “In the dining room at lunchtime the food looked quite nice and was served in an appetising way. However she also noted that “the social experience was lacking” The above, very mixed picture suggests that further thought needs to be given to how people living in the home might influence the choices they are given and the way that their individual tastes and preferences can be met realistically and also that the whole mealtime experience for people living in the home needs to be monitored and audited to ensure that it is a genuinely positive experience, and not a task driven exercise. We found a commitment from all staff to improve the home’s performance in this respect, the success of this will depend in part upon training and also resources available for example in providing staff in sufficient numbers to achieve the improvements required. When we asked people living in the home if there were activities arranged by the home that they could take part in, 40 said there always were, 30 that there usually were, 20 that there sometimes were and 10 that there never were. Again, when we observed activities and spoke to activity staff, we found a mixed picture but with genuine commitment from staff to improve. One person living in the home noted; “I choose not to join in. I may be old in years, but not old in my tastes. I’m not interested in spending time with residents who are uncommunicative, or want to listen to wartime music”. The expert by experience noted that whilst the activity co-ordinator had given out quizzes to people in the ground floor lounge, no one appeared to be doing them. Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 15 Social activities and mealtimes are key elements in the daily routine of the home and people told us in both cases that their needs are not consistently being met. One service user told the expert by experience; “My family live nearby and can pop in any time, they are always made welcome”. Several very positive comments were made by relatives about the welcome they receive from care staff, and how they are made to feel, as one person put it, “part of the family”. Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that they are able to express their views and raise concerns without fear of repercussions and that any complaints they may have will be dealt with appropriately. They can also be assured that staff in the home have the training they need to recognise abuse and to know what to do if it is seen or suspected. EVIDENCE: When we asked people living in the home; “Do staff listen and act on what you say?”, 90 said yes, 10 said no. Comments received were overwhelmingly positive, including; “The staff are always helpful”, “I find the staff to be friendly and helpful” and “They are very caring”. A few less positive comments were; “Listen yes, act not always” and “Some do not take the time to listen as I have difficulty in speaking” When we asked people living in the home if they knew how to make a complaint, 99 said yes they did, with only 1 saying that they did not. When we spoke to care staff they told us that they had all received training in the safeguarding of vulnerable adults from abuse and that they knew what to Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 17 do if abuse was seen or suspected. This training was confirmed in training records seen and we were told that future ongoing training is planned. This should mean that people living in the home are well protected from abuse of any kind and that if it were to take place, it would be recognised and appropriate action taken. There is a suggestions box in the home’s reception area, together with copies of the home’s complaints policy, which means that anyone who has a comment or complaint to make should readily be able to do so. They are also able to make use of service user and relative’s meetings to make their views known. Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 21 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Alexandra Nursing Home provides a safe and comfortable environment for those people who live or work in the home. EVIDENCE: When we asked people who live in the home; “Is the home fresh and clean?” 75 said that it always was, 25 that it usually was. Comments made included “Can be too hot-but is always clean” and “The home is immaculately clean”. The expert by experience, who has visited the home previously noted that “The bathrooms I looked into had been painted and looked much Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 19 improved since my last visit” and “The whole home was clean and there were no unpleasant odours”. Where some areas of minor concern were noted, for example a loose handrail outside Jasmine dining room and a border coming away on Primrose day room and some flooring in kitchens and bathrooms needing repair, these were indicated as being included in the maintenance plan for the home, and provided that work is done in a timely fashion, the overall environment appears well maintained. We were informed that the home has obtained some new hospital beds and new mattresses to provide greater comfort for people living in the home who require them. Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can be confident that their care will be provided by a well-trained staff team with the necessary skills and expertise to meet their needs appropriately and who have been recruited following a robust and thorough recruitment process. EVIDENCE: When we spoke to staff they were noticeably more settled and upbeat than was the case at the last inspection. “Wonderful things are happening here” was one very positive comment and most care staff spoken to said that the home was undoubtedly improving and that they were benefiting from a period of relative stability in management. For example, we were told by some people who had worked in the home for over four years that in that period they had had at least three managers. Consistency of management benefits people living in the home and can enhance the care outcomes achieved for them. When we looked at training records we found that these were much improved and should ensure that care staff have the raining they need to provide a high level of care. One senior member of staff is doing an advanced dementia care Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 21 course accredited through the University of Surrey and all staff are doing some form of dementia care awareness training. This will benefit all those people in the home who live with dementia. When we asked people living in the home is staff are available when you need them? 90 said that they usually are and 10 that they always are. Comments included; “Due to personal feeding, one to one needs of some residents, staff are working flat out at meal times, and availability is scarce”, “being a dementia unit the staff have to prioritise as the residents can be quite challenging” and “sometimes they are very slow to respond to the buzzer”. The expert by experience noted that all the people in the home she saw who used their call bells were answered promptly. As we have indicated earlier, there are times, for example early in the morning at breakfast and other meal times when care staff are stretched. We noted in the last report that additional staff had been recruited at key times to help maintain a high standard of care. This needs to be monitored to ensure that the demands upon staff at key times do not cause the care outcomes experienced by people living in the home to become less good. It is certainly the case, based on the positive comments recorded earlier in this report, that care staff can be pleased that their efforts are regarded so positively by the people they care for and those who are responsible for them. “They are wonderful and caring” is a typical example of the comments received. When we looked at recruitment files for some recently recruited staff, we found that the necessary checks had been done and documentation was in place to demonstrate that the home are only recruiting suitable people to provide care to the people living in the home and this should provide those people with confidence and a sense of security. Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 35 36 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can be confident that the home is well managed and that their best interests are the basis for decisions taken. They have benefited from the recent consistent management approach, however this has yet to be confirmed through the appropriate and necessary registration of the current manager by the Care Quality Commission to determine that they are a fit person to manage a registered care service. EVIDENCE: Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 23 As noted above, following a period where there were a number of changes in manager the home is now benefiting from a consistent management approach. Whilst it is acknowledged that the current manager has made significant progress since her appointment, at the time of this report, it remains true, as was the case following the previous inspection in August 2008 that no application has yet been made for registration with the appropriate registration authority. As registration by the now Care Quality Commission is the way that an applicants’ fitness is examined and determined, it is important for people who live and work in the home for this process to be concluded in a timely way, as a matter of priority. We were told by staff and people who live in the home and those who care for them, that they feel that communication has significantly improved and that provides a more positive relationship between them and suggests that the wishes and interests of people who live in the home are taken fully into account in the running and routines of the home. The way that meal times were observed during this inspection suggests that the manager would benefit from arranging for senior staff to routinely audit and monitor the mealtime experience for people who live in the home in order to ensure it is as positive as possible for all concerned. Staff supervision records seen indicate that supervision is now taking place as required, although the schedule was only completed up to January at the time of this inspection. Staff and people living in the home benefit when staff are supported and guided through regular one to one supervision sessions with their respective line managers. The standard of record keeping seen has markedly improved, however as detailed above there is still some lack of consistency in care plans, in particular the poor quality in some cases of the personal history element, that could prove an obstacle to the provision of genuinely person-centred, individualised care. The system for the handling of money held on behalf of people who live in the home has previously been judged to be robust and subject to appropriate checks. The effectiveness of this remains the responsibility of the manager and Southern Cross. Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X 3 X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 3 3 3 Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 25 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 OP15 Good Practice Recommendations The home should obtain a copy of the CSCI report Highlight of the day and consider if the mealtime experience of people living in the home could be improved. Alexandra Nursing Home DS0000044528.V375134.R01.S.doc Version 5.2 Page 26 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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