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Inspection on 08/06/05 for Alexandra Nursing Home

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

This inspection was carried out on 8th June 2005.

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

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

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

What the care home does well

One thing that this home appears to do exceptionally well is to involve relatives and friends. We rarely see so many visitors as we saw during this inspection. Visitors and service users alike were fulsome in their praise of the staff and their caring attitudes. We were especially impressed with the manner in which one of the housekeeping staff carried out her duties. The home is kept to a good standard of cleanliness. Less obvious to the visitor is the work being undertaken to improve the standards of care in the dementia unit and the high standards of record keeping.

What has improved since the last inspection?

The manager is currently working with the Hemel Hempstead Hospital`s Head Nurse to enable both parties to have a better understanding of what can be expected from a registered care home and the range of services that can be provided. Both parties should be commended on this initiative that will result in a more comprehensive service for the service users. There have been improvements to the environment in the dementia unit with more additions planned.

What the care home could do better:

There are minor decorative matters that need attention and the manager is preparing a prioritised plan to address this. Food choices should be better advertised as the alternatives written on the menu do not always show a significant choice and service users are not alerted to the fact that there are other options available. Again, the manager has this in hand and will be working with her chefs to find a way forward. We made three requirements; The use of door wedges must cease and a better way of providing access to communal areas must be introduced. Seating areas outside are virtually non-existent and the patio areas also need extending. Divan beds must be replaced by beds that are appropriate to the potential needs of service users and the staff that care for them.

CARE HOMES FOR OLDER PEOPLE Alexandra Nursing Home 46 Alexandra Road Hemel Hempstead Hertfordshire HP2 5BP Lead Inspector Robert Kittle Unannounced 8 June 2005 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 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 I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 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 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 Highfield Care Homes No 2 Limited Barbara Warner CRH Care Home with Nursing 76 Category(ies) of DE-26, OP-76 registration, with number of places Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate a maximum of 76 service users requiring nursing care. 2. Within the overall capacity the home may accommodate a maximum of 5 service users between the ages of 50 and 64. 3. Within the overall capacity the home may accommodate a maximum of 25 older service users requiring personal care. 4. Within the overall capacity the home may accommodate a maximum of 26 older service users with dementia requiring nursing care. Date of last inspection 23 November 2004 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 is dedicated to service users who are mentally frail. 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 bulding). There is off-road car parking provided both at the front and rear of the home. The home is located in close proximity to shops and other amenities including public transport. Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of Alexandra Nursing Home in the current inspection year. The inspection was undertaken by two regulation managers and was unannounced. We spoke to a number of service users, their visitors and staff. In addition, we looked at records, both on the floors where care is delivered and in the office. Finally, we inspected the building and grounds. This was a most encouraging inspection. There have been past issues about numbers of accidents (and hospital referrals) from the home, but it became evident that the cause could very well be that the home caters for some very frail people and the staff are realistic about the level of service that they can safely offer. There were only two vacancies at the time that this inspection took place and staff numbers in the home were adequate. There is a new manager in post since the last inspection took place and she has made a positive start in her new role. What the service does well: What has improved since the last inspection? The manager is currently working with the Hemel Hempstead Hospital’s Head Nurse to enable both parties to have a better understanding of what can be expected from a registered care home and the range of services that can be provided. Both parties should be commended on this initiative that will result in a more comprehensive service for the service users. There have been improvements to the environment in the dementia unit with more additions planned. Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 Page 6 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. Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4 & 5 standard 6 does not apply to this home. The home ensures that it can meet the needs of service users and prospective service users (or others acting on their behalf) are provided with clear information about the home and the services it offers. EVIDENCE: The manager confirmed that, wherever possible, prospective service users are encouraged to visit the home before deciding if they wish to stay there. However, most are admitted directly from hospital and are dependent on their relatives and social workers to make a choice for them. There is a six-week trial period for all new admissions. The manager (or a senior member of the caring staff) undertakes assessments and service users are also re-assessed before returning from a stay in hospital to ensure that the home can meet their needs. A detailed pre-printed assessment is used and information is also obtained from other health and social care professionals prior to admission to help in the decision. Without exception, service users who spoke to the inspectors were happy with their surroundings. “He knows that he is in the best place for him” was one comment received and the service user agreed. All service users are either Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 Page 9 provided with a copy of the terms and conditions or have a contract. There are copies of past inspection reports available in the Relatives Information folder which also helps a clear picture of the home to be gained. Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 10 All aspects of personal care are carried out sympathetically and with proper regard to the privacy and dignity of the individual. Care planning is maintained to a good standard so that service users needs are clearly identified and how staff are to meet these needs are recorded. EVIDENCE: Several care plans were read on each floor and all were very comprehensive and up to date. There was also evidence of service user and relative involvement in preparation and reviews of care plans. This demonstrates that individuals are as fully involved in their care as they wish (or are able) to be. Staff are realistic about whether or not the home can meet service users needs and will refer service users to hospital if appropriate. The manager is currently working with the Hemel Hempstead Hospital’s Head Nurse to enable both parties to have a better understanding of what can be expected from a registered care home and the range of services that can be provided. Better communication and understanding on both sides will result in a more comprehensive service to service users. The way that staff gave out the medication on one of the floors was observed and we noted that it was undertaken appropriately. The recording of all aspects of administration was also seen to be to a good standard. Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 Page 11 Service users and visitors that spoke to us said that the staff were attentive and gentle. We saw some excellent interaction between staff and service users during the inspection. We also saw staff knocking at bedroom doors and waiting to be acknowledged before they entered and all intimate personal care was carried out behind closed doors. Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 Service users who wish can enjoy an enhanced lifestyle and their friends and relatives are welcomed to the home. Meals appeared to be nutritionally sound although there was little in the way of choice advertised on the menus. EVIDENCE: The home has a full-time Activity Co-ordinator. It also has a consultant available to advise on dementia care. The consultant has provided training to staff and advised on the activities programme. Staff were very positive about the work undertaken by the consultant. On the dementia unit, snoozlem equipment has been ordered and will be delivered soon; bedroom doors have been repainted and will look like front doors with an identifying photograph (or picture that the room’s occupant can associate with) to help orientation; each corridor has been given a street name and the road signs have been ordered. The home also employs two chefs and three kitchen assistants. Volunteers run the trolley shop. We noted that staff were very attentive at lunchtime. However, choice of main meal was sausage or vegetarian sausage and it appeared that whilst meals are nutritionally sound, the alternatives shown on menus are often the vegetarian version. The manager said that there are always other alternatives if people ask and she is already talking to the chefs about new menu plans. For this reason, no recommendation has been made. Overall, service users were very alert and were positive about choices and social life in the home. Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 Page 13 It was also noted that two service users had been interviewed by the BBC Breakfast Time television programme in connection with the VE Day celebrations. There were an exceptional number of visitors in the home on the day of inspection. The home positively messaged encourages this contact. Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has a robust complaint procedure. EVIDENCE: There was information about how to make a complaint displayed on each public notice board and this included information about how to contact the Commission. The home has a complaints log containing details of all complaints received and action taken by the home in response. The Commission has received no complaints about the home since the last inspection took place. Some service users and some visitors were asked if they knew how to make a complaint. Most said that they would approach a member of staff or the manager. There is a copy of the County Council’s Adult Protection procedure available in the home. Members of staff that were asked were aware of what they should do if they suspected a service user was being abused (whistleblowing). Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24 25 and 26 The home is kept to good standards of cleanliness and service users are encouraged to personalise their bedrooms. Overall the home and grounds are maintained to a good standard although it was necessary to make three requirements on this occasion. EVIDENCE: The first impression of the home is that it is well maintained and kept to a good standard of cleanliness. The home deploys one member of the housekeeping staff on each floor with an extra part-time member available where needed. Many bedrooms were highly personalised, reflecting the interests and tastes of the occupant. There are some minor maintenance matters that have resulted from daily wear and tear and the manager and handyman are preparing a prioritised list of minor repairs and decorating issues. We made three requirements about the environment; There is an in-built system that enables fire doors to be kept open during the day by means of an electronic hold-open system linked to the fire alarms. Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 Page 16 However, the doors to the communal areas are not included in this system and were being held open by door wedges. This could compromise fire safety and a requirement has been made. At the last inspection, a requirement was made about grounds maintenance and extending the patio and seating areas. Whilst the grounds were neat and tidy, nothing else has been done to date and this requirement has been brought forward. One service user and their visitor pointed out that if there were more than a couple of people sitting in the garden there would be no chairs or room for them. We also saw that there are a number of divan beds provided by the home. These are relatively low to the ground and could cause a lifting hazard to staff that need to provide assistance. The service provider must obtain beds that are appropriate to the potential needs of the service users. Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 Staffing levels are adequate and staff provide a good standard of care to the service users. There are robust recruitment procedures and staff have access to a wide range of relevant training. EVIDENCE: Overall, staffing levels are maintained appropriately. The home aims to use as little agency input as possible. The availability of bank staff has dropped as three of the bank staff were adaptation students who have now obtained their PIN numbers and taken up nursing posts elsewhere. There has recently been a recruitment drive for care staff that work day shifts and four potentially suitable applicants had been identified. Staff files examined confirmed that the home follows robust recruitment procedure that protect service users as all staff are properly screened before being offer a position in the home. Although a visitor said, “The staff are very good but they are on the go all the time” and “Sometimes it takes a bit longer for people to get a bit extra attention”, on the day that this inspection took place, staff appeared to be managing well. Staff were very positive about all aspects of their training including induction into the home and routines to on going specialised training opportunities. However, the manager stated that they cannot get phlebotomy training at present. This means that a District Nurse must take blood samples and this has raised issues with the Primary care Trust. The Commission was therefore pleased to learn about the steps that are being taken to enable the home and the local hospital to work more cooperatively. Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36 and 38 The home is being managed in a professional yet caring manner. Staff have a range of policies and procedures available for their guidance. EVIDENCE: Since the last inspection took place, the registered manager has been promoted and the former deputy manager, Adele Dennis, is now managing the home. On 6 July 2005 a new deputy manager will be taking up her appointment. Both manager and deputy manager are said to be progressive and caring in their management style and the new manager has certainly begun a number of new initiatives that bode well for the future. There are systems in place for regular staff support and supervision and the organisation have provided the staff will a wide range of policies and procedures for their guidance. The area manager was present in the home whilst this inspection took place. It was noted that she was in the building to Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 Page 19 support the manager, but had sufficient confidence in her abilities that she took a passive role in the inspection process. This too is very encouraging. Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 x 3 2 3 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 Standard No 16 17 18 Score 3 x x 3 3 3 x x 3 x 3 Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? 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 19.3 Regulation 23 (2) (b) Requirement Timescale for action 31/08/05 2. 19.5 23 (4) (c) (i) 3. 24.3 16 (2) (c) The proprietor must provide details of proposed ground maintenence and plans to extend the seating and patio areas. N.B. Previous time-scales were not met. The use of wedges on fire doors 31/8/05 must cease and appropriate action taken to overcome problems for service users mobility caused by fire doors. The proprietor must provide 8/09/05 adjustable beds for service users who are receiving nusing care. 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 Good Practice Recommendations There were none made Alexandra Nursing Home I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ National Enquiry Line: 0845 015 0120 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 I52 s44528 Alexandra Nursing Home v231871 080605 Stage 4.doc Version 1.30 Page 23 - 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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