Inspection on 11/09/07 for The Princess Alexandra Home

This inspection was carried out on 11th September 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Princess Alexandra Home 19/08/08

The Princess Alexandra Home 16/01/07

The Princess Alexandra Home 06/02/06

The Princess Alexandra Home 12/07/05

The Princess Alexandra Home 03/03/05

The Princess Alexandra Home 14/09/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Princess Alexandra Home Common Road Stanmore Middx HA7 3JE Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 11th September 2007 10:00 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 The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Princess Alexandra Home Address Common Road Stanmore Middx HA7 3JE 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) 020 8950 1812 020 8421 8202 Jewish Care vacant post Care Home 72 Category(ies) of Old age, not falling within any other category registration, with number (72) of places The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Maximum of 40 persons over the age of 65 in need of nursing care. Maximum of 32 persons over the age of 65 requiring personal care. Date of last inspection 5th June 2007 Brief Description of the Service: Princess Alexandra Home is a large detached building set within extensive grounds in Stanmore, North Harrow. It is situated off Common Road and is easily accessible by car and by public transport. For those people who use public transport, it is noted that the home is found a couple of minutes walk from the main road. There are good parking facilities within the grounds of the home. The home consists of an older central building, which used to be a house. Extensions have then been constructed on either side of the main building to make what is now Princess Alexandra. On the left of the main building (when facing the front of the home) is Newland House which accommodates twentyseven residents requiring personal care. Two of the bedrooms are double bedrooms, but the rooms are mostly used as single bedrooms except in circumstances when couples want to share these facilities. On the right of the main building is Edmond House which accommodates twenty residents requiring nursing care on the ground floor, twenty residents on the first floor also requiring nursing care and five residents requiring personal care on a mezzanine floor. The mezzanine floor is reached by a small set of stairs, which is also served by a chair lift. All the houses are served by lifts and all parts of the home are accessible by some form of lifts. There are several lounges in the home, some of which are in the central building and others in Edmond House. There is a dining area in Newland House and a main dining area in the central part of the home. The home also benefits from a library, an activities room, a number of nurses stations and clinical rooms, and a multi-faith prayer room. Connection between the two houses is only through the ground floor. Princess Alexandra has been a care home since 1952 and was acquired in 2002 by Jewish Care. The home now admits only Jewish residents, but as there were non-Jewish residents prior to 2002 in the home, Jewish Care has made a commitment to continue caring for them. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 5 The home is run taking into consideration the Jewish practices and faith. For example the home observes the Sabbath and provides Kosher food. NonJewish residents who live in the home are aware of these practices. The home is currently managed by Fionnuala Baiden with the support of a clinical manager. The home has a team of nurses and care workers to care for the residents. There are also admin support staff and ancillary staff. All the hotel services in the home are contracted out. The home charges £795 for personal care and £1025 for nursing care and has a mixture of publicly funded and privately funded residents. Some residents who are publicly funded have to make a third party contribution (top-up fee). At the time of the inspection there were sixty-six residents in the home. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This report contains the findings of the unannounced inspection which took place on Tuesday 11th September from 10:00-20:00 and on Wednesday 12th September 10:00-15:00. I visited the home again on Wednesday 26th from 11:15-13:00 to look at some records that I have not had the opportunity to see. The findings in this report are based on an inspection of a sample of records, observation of a few care practices, meal times and a tour of some of the premises. I also had a conversation with the manager, some members of staff, and some residents and visitors to the home. I was able to check the management of medicines in the home and for compliance with past requirements imposed on the home during the inspection of January 2007. The manager also kindly provided a copy of an Annual Quality Assurance Assessment (AQAA) as part of the inspection process. As part of CSCI methodology for inspection, Penny Wright, an ‘Expert by Experience’ visited the home to talk to residents, visitors and members of staff to find out what it is like to live in the home. I am grateful to all residents who spoke to Penny Wright and to me to share their experiences of living in the home and to all visitors who also spoke to us. I would also like to thank the manager and all the staff for their support and assistance during the inspection. What the service does well: The home provides information and an opportunity to ask questions to all prospective residents and/or their representatives about the service to enable them to make an informed decision about using the service. There are good systems in place to ensure that residents’ needs are appropriately assessed and that they are kept informed about the progress of their application of moving into the home. The home is very well supported by the Jewish community and by volunteers. They take an active role in supporting residents, in arranging social and recreational activities for residents and interacting with residents. Residents therefore have good opportunities to take part in a number of activities according to their wishes and needs. The facilities with regards to meals provision in the home are very good. Mealtimes are looked at as proper social occasions where residents are encouraged to visit the dining areas and to engage with each other or with The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 7 members of staff. A range of meals is offered to residents, from which they can choose. The communal areas of the home are appropriately furnished and decorated to make these areas pleasant and welcoming. Bedrooms of residents are also maintained and personalised to a good standard. The home is on whole clean and free from odours. The home provides appropriate staffing levels of nursing, care and ancillary staff to make sure that the needs of residents are being met. The induction, which is given by the organisation, is of a good standard. The organisation is willing and is committed to address requirements that have been made by the Commission, and to raise the standard of the service that it provides. What has improved since the last inspection? Progress has been made in many areas where the standard was lacking. However as the manager stated the progress has not been to the extent that she would have wished. There were a number of reasons for this such as the difficulty in recruiting a clinical manager to support her in improving the standards in the clinical areas. She also identified issues with regards to the level of training of staff, the existing culture among staff and issues with regards to literacy, all of which are being addressed. The progress noted with regards to records keeping on the nursing unit showed that the manager has been successful in implementing some change and it is anticipated that further progress and improvement will continue. With the support of the clinical manager and staff being made aware of their practices and of the need to comply with minimum standards and legislation, the momentum to improve standards should continue. As a result the home was able to demonstrate to some extent that it is able to meet the needs of the residents who are accommodated in the home. A procedure has been drawn up to make sure that residents who come to the dining area do not wait for long periods before they receive their meals, but the procedure should be consistently applied for it to be effective. The home has decided to introduce a form to record the valuables and property that are brought in the home for residents. This was requested following the last inspection as without a proper record of residents’ valuables and property it is not possible to ensure that they are being protected from financial abuse. The provision of training, such as infection control and end of life care has improved to meet the requirement imposed on the home during the last The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 8 inspection, but the requirement has not been fully met as a significant number of staff still have to receive that training. The redecoration of the home has been approved and decorators had just finished one corridor and were in the process of decorating another corridor. The manager stated that all the corridors in home would be eventually decorated. There was evidence that the home was looking at the provision of toilets for people with poor mobility. One of the refurbished toilets was seen and it was noted that there was a lot of space to support residents when they need to use the toilet. The management team has been consolidated with the appointment of a care manager to focus on clinical areas and on staff training. There is therefore some reassurance that issues in the home will now get addressed and dealt with as appropriate. What they could do better: The contract/statement of terms and conditions should be signed by residents/representatives to show that they have received and agreed to these. While there has been an improvement with the assessment of the needs of residents, the format used did not cover all the needs of residents. For example the physical needs of residents, such as eating, sleeping, sexuality, breathing and dying were not fully assessed. Care plans on Newland House were also not updated as and when required and were not reviewed at least monthly. Evidence must be kept that care plans and risk assessments are drawn up and reviewed with residents or their representatives. Although the home seems to be well supported by healthcare professionals, who offer their services to Jewish care, records were lacking to show that residents were regularly seen by healthcare professionals such as the dentist and the optician. Care plans and risk assessments on manual handling must be more comprehensive to include the equipment to use and the action to take for the manual handling of residents and to prevent inappropriate lifting techniques. When residents are brought back to the lounges in wheelchairs after their meals, they must be placed appropriately and not placed all of them together facing different directions. Residents must be offered their call bell unless there are risks to residents, which are appropriately recorded. Progress must continue to ensure that medicines management in the home promote the safety of residents based on good practices. There has been some progress with addressing the arrangements, which might have been made about the funeral of residents, but the perspectives of The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 9 residents/relatives and their fears and concerns about the future and end of life care were not always recorded. The recruitment process could be more comprehensive by ensuring that appropriate references are received for prospective employees and that all gaps in the employment history are explored at the point of the interview. The home must continuously strive to have 50 of its care workers trained to NVQ level 2 or above. For the home to monitor and improve the quality of the service that it provides, there must be a quality control system based on selfassessment/audit or one that is externally carried out. A few requirements are repeated from the last inspection with regards to health and safety. These must be met to demonstrate the home’s commitment to the health and safety of residents, visitors and all people who use the premises. 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. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 10 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 The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 11 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): 1-4 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and their relatives receive all the information that they require to enable them make an informed decision about moving into the home. Residents’ needs are appropriately assessed to ensure that the home will be able to meet their needs. The home is, on the whole, able to care for residents that are accepted. EVIDENCE: Residents and their relatives are offered a service users’ guide (SUG) and a range of other booklets containing relevant information with regards to issues about moving into a care home. Examples are “A guide to family or third party contributions” and “A guide to preparing and paying your residential and nursing care”. Information is also offered to residents and their relatives about the range of fees charged by the home. The manager said that the SUG was in the process of being reviewed and will be updated by the end of September. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 12 Residents moving into the home are funded in a number of ways. Some are privately funded, others by the PCT and local authorities. Those residents who are publicly funded may have to pay a ‘top-up’ fee when admitted to the home. Contracts/statements of terms and conditions are offered to residents who are privately funded or those who pay a top-up fee. Residents who are fully publicly funded received a copy of the contract/terms and conditions of the placement in the SUG but they do not always sign to show that they have received a copy and agreed to it. Prospective residents who are referred to the home are first directed to the social workers who work for Jewish Care. The home accommodates only Jewish residents and most people wishing to move into the home have to complete an application form. The application forms are processed by the social workers who then visit the residents for an assessment of their needs. If the residents require nursing care, they are then assessed by a trained nurse who may be the manager or the care manager of the home. A format for the assessment of the nursing needs was seen and was found to be comprehensive. I looked at the pre-admission assessment of at least two residents. Copies of the assessment completed by the social workers were on file. However the pre-admission assessment of two residents did not contain the nursing assessment. I was told that the residents did have an assessment of their nursing needs. I noted that since the last inspection there has been some progress with regards to the ability of the home demonstrating that it can meet the needs of the residents who are accommodated in the home. This report will show that while there has been some progress in the home, more improvement is required to fully demonstrate the ability of the home to meet the needs of residents. For example while the assessment of the needs of residents has improved at the point of admission, there was still more work to be completed in this area. Similarly care plans on the nursing units have improved. They are more comprehensive than they have previously been and are kept under review. The care plans on the units for personal care have however not improved to that extent. The manager stated that now that the home has a care manager the home has started making improvement in these areas. The nursing units were the first to benefit from sustained input to ensure improvement in all areas. This will continue and will cascade to the units for personal care. The cultural, religious and ethnic needs of residents who are accommodated in the home are addressed to some extent in care records. Some contained a good standard of information for example with regards to the level of practice of the residents but others did not. As a result of the above, I concluded that on the whole residents’ needs are being met in the home. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 13 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): 7-11 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. There has been an improvement in the standard of care records but some of these were not always comprehensive to fully describe the action to take to meet the needs of residents to make sure that residents’ needs are being fully addressed. Records were not always comprehensive to fully demonstrate that the healthcare needs of residents are being met. The arrangements in place for the funeral of residents are addressed in care records but the concerns and fears for the future and the perspectives of residents/relatives about end of life care still need to be addressed to make sure that the needs of residents in this outcome area are being met. There has been improvement in the management of medicines but a few issues still need to be addressed to ensure that the safety of residents. EVIDENCE: The care plans of six residents were inspected. As mentioned earlier there has been some progress with improving the standard of the care records, particularly on the units for nursing care. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 14 A format for the assessment of residents’ needs was now in place in the home. This was used more consistently on the units for nursing care than on the unit for personal care. The assessment consisted of three forms: one for the admission assessment, one for the social/recreational/spiritual needs and one for the emotional/mental wellbeing assessment. From these forms it was noted that there was some lacking with regards to the assessment of the physical needs of residents such as eating and likes and dislikes, sleeping, sexuality, dying and breathing. Care plans were in place when the needs of residents have been identified. Again care plans were more comprehensive than they have been during the last inspection, particularly on the nursing units, where the care plans were regularly reviewed. These were not so comprehensive on the units for personal care and were not always reviewed monthly. In a few instances the care plans did not clearly describe the action that need to be taken to meet the needs of residents. Care plans for residents who are diabetics said that hyper and hypoglycaemia should be prevented but the care plans did not contain information about how these are to be recognised. A resident who had pain in his knees did not have a care plan addressing this need and the care plan and manual handling risk assessment has not been updated to address the fact that the mobility of the resident had changed. Risk assessments were in place to manage the safety and healthcare needs of residents. These were generally reviewed monthly except on the unit for personal care. Once risks were identified care plans were also put in place to manage the risks. These included manual handling, nutritional, waterlow and falls risk assessment. A continence assessment was not in use in the home to identify residents who would benefit from support in this area of care with a view to promoting continence. It was noted that there were incontinence sheets on most chairs in the lounges of the Edmond House. The use of incontinence products must be discreet to uphold residents’ dignity and must be used according to an individual need assessment. Residents had manual handling risk assessments and care plans to manage the moving of residents. These were completed for most residents, but the equipment to use, such as the hoist and the sling and the actual manual handling manoeuvres to move residents were not always described. On one occasion I observed how a resident was lifted using a through arm lift by two members of staff in the lounge. Care plans had a section to record the involvement of residents/representatives in care plans. These were noted not to have been completed. The manager said that residents/representatives are involved at all times in the care of the residents. Relatives were observed talking to members The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 15 of staff about the care of residents, but it was not very clear to what extent they were involved in drawing up and in reviewing care records. Residents in the home presented as clean and appropriately cared for. I was informed that there were five residents in the home with pressure sores. Inspection of the records of two residents with pressure ulcers showed that appropriate records were being kept with regards to the management of the ulcers. Photographs were in place for one of the residents but not for the other resident who has been in the home for about three weeks. Care plans were however in place which address the management of the ulcers. There was also evidence that the GP and the tissue viability nurse was involved in the management of the ulcers. Pressure relief equipment is in use on the beds and in the chairs of residents who are at high risk of developing pressure ulcers or for those who already have pressure ulcers, but these items of equipment are not always described in the care records of residents. Healthcare professionals and GP records in the care plans showed that residents were seen by the GP when that was required. The records of some residents on the nursing unit showed that they have been seen in the past year by the optician but not by the dentist. Records on the Newland unit did not show that residents were regularly seen by the optician or the dentist. The manager stated that residents are at times seen by physiotherapists and occupational therapists who offer their services to Jewish Care. Residents who were on antibiotics on the two nursing units were monitored and care plans were in place to manage their condition. I also observed how they were being monitored by the care and nursing staff. I noted in Newland House, that the standard of records kept about the management of residents who were not well such as when they were on antibiotics or when they were in pain, was not so good. I observed that residents were on most occasions addressed with respect and in an appropriate manner. However there were some observations, which raise some concerns about the way residents were cared for. These included residents who were not offered a call bell, residents who were wheeled after breakfast and left in the lounge in Edmond House facing different directions, some facing sideways, others with their backs against the wall and others facing the wall. One resident was left in a bathroom without supervision while she shouted for help. Care records contained information about the arrangements that have been made with regards to the death and funeral of residents. This is good practice. There was however some lacking with regards to including the perspectives of residents/relatives about end of life care and their concerns and fears for the future in the care records. It was noted that some members of staff had The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 16 received some end of life care training some days after the inspection started and that the training need to be cascaded to as many members of staff as possible. Medicines management on all the units was inspected. Medicines were stored in clinical rooms, which doubled as nursing stations. Storage of medicines was on the whole safe. Fridges temperatures were monitored regularly and all liquid medicines and ointments/creams were dated when they were opened. The management of controlled medicines in the home was also to a good standard, except that the full signatures of nurses were not always recorded in the controlled medicines book, as per a previous requirement. It was noted that in cases where residents were on variable doses of medicines, that the amount of medicines administered were not always recorded. The instructions on creams and other topical medicines were not always that clear about the location to administer the medicines. The amount of some medicines received in the home were not always recorded and there were a few omissions in signing the medicines charts or when codes were not used to describe the reason for the medicines not to be administered. The codes used for one medicine when that was not administered suggested that it was out of stock on two occasions for about two days. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 17 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): 12-15 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are offered a range of social and recreational activities to choose from, according to their needs. The records with regards to this aspect of care have also improved, although there is room for further improvement to fully guarantee that the needs of residents would be met in this outcome area. A variety of nutritious meals are provided in sufficient quantity to residents to meet the nutritional needs of residents. EVIDENCE: I noted that the home has made some improvement in the standard of records about the assessment of the social and recreational needs of residents. There was a form ‘getting to know you’, to complete about the life of residents and about the social and recreational needs of residents. Care plans were also in place for some residents to address these needs, but a few residents did not have a care plan to address this aspect of their care. The home has a number of volunteers who visit the residents to support them with social and leisure activities. There is a club on Thursday evenings and young volunteers from Transage Volunteer Agency visit residents for one to one interaction. Other volunteers visit the home to play music for the The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 18 residents. There are plans to develop a cinema area in the library for residents to enjoy. I observed a number of activities during the inspection, some were led by the volunteers in the home and others by the activities coordinator. I was able to observed a multi-sensory session, a quiz session, and one-to-one interaction. The home has extensive grounds which are available for all residents and their relatives /friends who want to make good use of it. A significant number of residents were seated in the patio areas, where there were marquis/gazebos to protect residents from the sun/rain/wind. They were seated in groups and there were some volunteers who sat with them, to chat to them and to lead conversation. The home caters mostly for residents with the Jewish Faith and therefore all the Jewish religious practices, festivities and celebrations are observed in the home. The second day of the inspection coincided with the eve of the Jewish New Year and the home was getting ready to celebrate this event. There are 9 residents in the home from other religious faiths who have been in the home prior to Jewish Care taking over the home. I was informed that these residents have the opportunity to practice their religions and observe their faiths, as there is a minister, who regularly visits them. All dining areas were prepared appropriately and in a congenial manner. Two tables in the dining room of the Newland House have been placed in the garden lounge to create more space in the Newland House dining room, which was previously somewhat overcrowded. A few other residents who preferred not to go to the dining area had their meals in the lounge of the Edmond House. Lunch was observed in the dining area of the Edmond unit. There was potato and onion soup, Angel steak, grilled haddock and tomato and herb sauce, stuffed tomatoes with couscous, grilled mushrooms, savoy cabbage, potato wedges and mash potatoes. There was also some side salad for those who wanted it. There were also a variety of choices for deserts. I observed residents being asked about what they wanted to eat by members of staff. Some residents said that they always wait a long time before they are served. This is a concern that they have previously voiced to the manager who has responded in the AQAA and stated that the problem would be resolved by numbering the dining tables and allocating a member of staff to each table. On the day of the inspection the allocation has not been carried out and therefore the same issues persisted with regards to residents having to wait for their meals. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 19 It was noted that members of staff assisted the residents who needed support with their meals in an appropriate manner. There was a senior person in the dining room to monitor the mealtimes and to make sure that everything runs smoothly. Relatives were encouraged to eat with residents when possible. There were tables and chairs in the library for this purpose. Residents also received cakes and biscuits, which were all ‘homemade’ with their tea when this was served . There were jugs of water and juice in many areas to ensure that residents are offered drinks as required. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 20 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): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People can be confident that complaints are taken seriously and are appropriately dealt with by the service. The home has appropriate procedures, which it follows to safeguard residents from abuse. EVIDENCE: The complaints procedure was available in the service users’ guide and on notice boards in a number of areas. Residents spoken to, said that they would talk to the manager if they had any concerns. Residents also had contact with their relatives and friends who generally monitor the wellbeing of the residents. There have been 8 complaints since the last inspection. All were appropriately acknowledged, recorded and responded to. Concerns raised included waiting a long time to be served for lunch, staff not following care plans such as the likes and dislikes of residents and not doing hourly checks as required, lack of disabled access toilets and one complainant said that there was a lack of compassion on the part of some staff. The complaints were all upheld and it was noted that the home took all the complaints seriously and dealt with these in an open and transparent manner. There were attempts to address the complaints to prevent similar concerns from being raised again. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 21 The home has had two allegations of abuse since the last inspection. These were all referred to the relevant authorities according to the policies and procedures for safeguarding people and investigated within this context. Appropriate action was then taken by the home to deal with these matters as required. It was noted that all new members of staff have training in abuse and safeguarding adults as part of their induction and that they have yearly updates in these areas. During the last inspection it was noted that the home does not keep a record of all valuables that are brought into the home by residents. The home asked residents/representatives to sign a disclaimer, which removed the responsibility from the home in case of losses of the valuables and property. At the time I argued that to monitor residents’ belongings and valuables and to prevent them from being the victims of possible abuse, a record of the valuables and property that are brought by residents/representatives would be helpful. The manager stated that the organisation has plans to start the recording of all residents’ valuables and property that are brought into the home for monitoring purposes. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 22 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): 19, 21,22, 24 and 26. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has some very good facilities, but some areas require redecoration and modernisation to ensure that the home is fully suited to meet the needs of residents who are accommodated there. EVIDENCE: The home is situated in a leafy area of Stanmore and in extensive grounds, which are covered with mainly mature trees and shrubs. There are also large areas of lawn and a pond. The grounds of the home are well maintained and offer the opportunity for residents and their visitors to enjoy, go for walks or just sit under the many trees or marquis/gazebos in the grounds, as was observed during the inspection. The home requires ongoing maintenance because of its size and it age. There is a maintenance team, which comprises of a maintenance manager and a The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 23 maintenance man. Some of the maintenance work is also contracted out to another company. The inside of the home was clean and free from odours. Some areas were very well maintained but other areas were in need of improvement. The reception areas and the communal areas were on the whole maintained and decorated to a good standard. However the corridors on the nursing units and on the residential unit looked like they would benefit from redecoration. Carpet areas which were worn and identified as needing to be replaced during the last inspection have not yet been replaced. The manager stated that there are plans to renovate the corridors areas of the home, which were described as ‘shabby’ in the AQAA. The plan is to decorate one area and then move to the next area until all the corridor areas are decorated. I was able to observe that one corridor has been redecorated and that another corridor was in the process of being redecorated. The corridor, which has been redecorated, looked bright, modern and pleasant. I was informed that most of the bedrooms of residents are en-suite with a toilet and washbasin. In addition to these there are bathrooms, showers and toilets over the home. A number of the bathrooms and toilets, including the ones in the en-suite of many bedrooms, did not have handrails and some of the baths were against the wall and not particularly suited to be used with people who have poor mobility. Some of the communal toilets are also too small to enable people with poor mobility to use these. At the time of the inspection one toilet in the reception area was being converted to provide full access to wheelchair users. It was noted that two toilets on the first floor did not have a wash hand basin. Because of the number of toilets, which do not have handrails, and bathrooms, which do not seem conducive to the care of people with poor mobility, an assessment of the premises by an occupational therapist must be considered. A number of bedrooms of residents were seen. They were all decorated to a good standard, maintained and personalised. Furniture and fixtures and fittings were also of a good standard. Some residents had brought in some items of furniture and personal possessions to make their rooms homely and personalised. Some bedrooms were noted to have beautiful views over the grounds of the home. A balcony on the first floor also provides residents with an opportunity to enjoy the views over the grounds of the home. All areas of the home are accessible either by lift or by chair lift. There are five bedrooms on a mezzanine floor, which is accessible from the first floor of the Edmond House by a small set of stairs and chair lift. These areas accommodate residents who require personal care. A chair lift has also been fitted to a set of stairs on the Newland unit, as an additional safeguard should the lift on the Newland unit break down. There are plans to improve resident’s access to the garden by constructing a footpath. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 24 There are sluices on each unit. These were kept tidy and free from obstruction. Other areas such as bathrooms and toilets were also kept clean and tidy. Plans for the future include the creation of a multi-purpose room which can be used for physiotherapy, craft, multi sensory sessions, pampering and meetings on the ground floor, a glasshouse to be erected in an area that residents can access, a home cinema system to be installed in the library for residents to enjoy films and the purchase of new garden furniture. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 25 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): 27-30 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides staff in appropriate numbers to ensure that the needs of residents are being met. Recruitment procedures were not carried out as thoroughly as they could have been to ensure the safety of residents. Staff receive good induction training from the organisation and progress has been noted with the provision of training in a wider range of topics to make sure that they are competent to care for the residents. EVIDENCE: There are 5 members of staff on duty during the day for the 25 residents accommodated on the Newland unit and at night there are 2 carers. The first floor of the Edmond unit is staffed by 5 care staff and a trained nurse and at night by a trained nurse and 2 care staff. The ground floor of the Edmond unit accommodates 20 residents and is staffed by 4 care staff and 1 trained nurse during the day and 1 trained nurse and 2 carers at night. There is one additional trained nurse who is a ‘floater’ in Edmond House. The home also employs support staff in appropriate numbers. There are 2 activities coordinators, an administrator and a manager’s PA. The manager and her deputy are supernumerary. All other ancillary staff are provided by Eurest, a company to which hotel services has been contracted out. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 26 The home benefits from a number of volunteers including those from Jewish Care and Transage Volunteers Agency. They are engaged mostly in the provision of activities, interacting with residents in a group or one-to-one basis and pampering of residents such as with manicuring. Some are voluntary drivers to run errands for the home. However none of the volunteers are involved in the direct provision of care. The personnel files of four members of staff were inspected. These were all kept safely in locked filing cabinets. There was evidence that appropriate application forms were completed and that all staff received induction and were offered a contract/statement of terms and conditions when offered employment. The right of applicants to work in the UK was confirmed in the records. It was however noted that two employees had one professional reference each and testimonial references dated prior to the person applying for the jobs. Two employees had gaps in the employment history. There was no evidence that the gaps had been explored at the point of interview. Jewish Care has a comprehensive induction package that is provided to all new employees at the head office. New members of staff spend ten days for induction and are supernumerary. At this point care staff also start the common induction standards as per Skills for Care, the training organisation for the social care sector. During induction members of staff receive all the statutory training including training on abuse and an awareness of Jewish culture and religion to support in caring for Jewish residents. The AQAA showed that out of 68 care staff 22 have an at least an NVQ level 2 qualification in care and 9 are in the process of studying for one. As a result the home does not have 50 of its staff trained to at least NVQ level 2, but progress being made to meet this standard is noted. The manager stated that a few members of staff have also left which has affected the percentage of staff who are trained to NVQ level 2. Training records were seen. There were individual training records and these were kept up to date. A matrix was also kept for training in statutory areas to make sure that all members of staff are updated as and when required. Staff were mostly up to date with fire training, manual handling training and PoVA training. Health and safety training is covered as part of the induction, but there has been little update in these areas. Food hygiene is also addressed during induction, but there was evidence that the home has started to provide this training for staff. It was noted that staff also received an introductory training in dementia care. I was informed that some infection control training and end of life care training was provided by the operations manager but not all care and nursing staff have yet received these training. It is also recommended that the training, which is provided in the home be externally accredited to make sure that the training is evidence-based and according to The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 27 best practice in these areas. The manager has also identified customer service as one of the key priorities for staff training. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 28 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): 31,33,35 and 38 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home now has a management team, strong enough, to make sure that the service is able to meet its stated aims and objectives. The home has a quality assurance system but does not yet have a quality control tool based on self–assessment to enable it to monitor the quality of the service that it provides. Residents’ personal money is managed to a good standard to safeguard them. A few issues are noted with health and safety, which need to be addressed to ensure that all people who use the premises are as safe as possible. EVIDENCE: The manager has now been in post since October 2006. She has been registered for another service previously and has had many management posts in the past including that of service manager. She is a trained nurse and was in The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 29 the process of completing the registered managers’ award. She has also applied to be the registered manager of the home and her application is in the process of being dealt with. During conversation with the manager, it was noted that she was clearly aware of her role in the home and gave a fair description of where the home was with regards to improving the service. She has identified a few factors, which have prevented improvement from happening at the pace that she would have wanted. She described these factors during the inspection and in the AQAA. Now that she has a care manager to support her, improvement is likely to gather momentum. This was noted on the Edmond unit where care records were of a much better standard than on the Newland unit. The home has a quality assurance procedure. It carries out customer satisfaction surveys. The results are normally analysed and short reports are produced summarising the findings of the surveys. The manager stated that there has been a poor response following the survey, which was carried out this year and that a report has not yet been produced while she waits for more questionnaires to be returned. The home does not yet have a system of audit for the regular self-monitoring of the quality of the service that is provided by the home based on a systematic cycle of plan-action-check-review using an objective, consistently obtained and reviewed method (such as a professionally recognised quality system). I was informed that the organisation was in the process of developing such a tool. The management of residents’ money continues to be of a good standard. There is one residents’ bank account and each resident has individual records of the balance of money, which is held with the home. I was informed that the home does not act as agent for any residents and does not collect any benefits on behalf of residents and that a small sum of money is kept for residents’ day-to- day expenses. It was noted that records and receipts for expenditures were kept, as appropriate for each resident. Health and safety records showed that fire detector tests were on the whole being carried out weekly. Emergency lights test were not being carried out monthly as required. Fire drills, including one for night staff were carried out in the home. A fire risk assessment was being carried out at the time of the inspection by an external consultant. It was noted that the health and safety risk assessment has not been updated since 2004. The home has been provided with a fire emergency plan format to be used and adapted for the home. This has not yet been done. The home has a certificate to show that the water system was maintained and monitored for the prevention of Legionella. Water temperature records at exit points such as in bedrooms of residents and bathrooms were however not The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 30 available at the time of the inspection. LOLER certificates for the lifts were last carried out in February and were due in August. There was no evidence that these have been carried out. These are required to be carried out every six months or ‘at intervals laid down in an examination scheme drawn up by a competent person’, according to guidance from the Health and Safety Executive (http:/www.hse.gov.uk/pubns/indg290.pdf ). A copy of the wiring certificate was not available for inspection. The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 31 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 2 X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 14(1,2) Requirement Timescale for action 31/12/07 2 OP7 15(1) 3 OP7 15(1) The registered person must ensure that all residents have a comprehensive assessment of their needs, which is kept under review (Repeated requirement-timescale 30/06/07 not met). Care plans must set out in detail 31/12/07 the action which needs to be taken by care staff to ensure that the identified needs of residents are met. Care plans must be reviewed at least monthly or more often if the needs of service users change (Repeated requirementtimescale 30/04/07 not met). Evidence must be kept to show 31/12/07 that the care plans have been drawn up and reviewed with service users and /or their representatives (Repeated requirement-timescale 30/04/07 not met). To ensure the safety of residents the manual handling risk assessments and care plans DS0000022938.V344014.R01.S.doc 4 OP7 13(5) 30/11/07 The Princess Alexandra Home Version 5.2 Page 33 5 OP8 12(1) 6 OP8 17 7 OP9 13(2) 8 OP9 13(2) must describe the equipment to use and the manual manoeuvres to carry out when moving residents. The manual handling manoeuvres used in he home must conform to good practice and promote the comfort and safety of residents. The manager must continue to ensure that all residents receiving incontinence care receive regular monitoring and review of their care in this area. (Repeated requirementtimescale 30/04/06 and 30/04/07 not fully met). A continence assessment must be used while assessing the needs of residents for the promotion of continence and management of incontinence. The use of incontinence sheets on the chairs of residents must be reviewed to take consideration the individual needs of residents and the need to ensure the dignity of residents. To demonstrate that the healthcare needs of residents are being met, records must be kept to show that residents are regularly seen by healthcare professionals including the dentist and optician. The instructions on creams and other topical medicines must be clear about the location to administer the medicines. Medicines must be recorded accurately when received in the home and when administered. If not administered the correct endorsement must be used. If a variable dose is prescribed then the actual dose administered must be documented DS0000022938.V344014.R01.S.doc 30/11/07 31/12/07 30/11/07 30/11/07 The Princess Alexandra Home Version 5.2 Page 34 (Repeated requirementtimescale 11/06/07 not fully met) 9 OP9 13(2) Full signatures must be entered 31/10/07 in the controlled drug register (Repeated requirementtimescale 11/06/07 not fully met) To demonstrate that residents’ rights are upheld and that they are treated with dignity and respect at all times: • They must be offered their call bell unless there is a risk assessment in place • They must be placed in an appropriate position in the lounges after meals and not placed facing different directions • That they are not left unsupervised and on their own in places such as bathrooms, particularly if they are prone to shouting That the perspectives of residents/relatives with regards to end of life care and their fears and concerns of residents for the future be included in the care records. Staff must be provided with palliative care/end of life care training (Repeated requirement-timescale 30/06/07 partly met). The social and recreational needs or the life history of residents must be completed. Care plans addressing the identified needs must be in place (Repeated requirement-timescale 30/04/07 partly met). The registered person must ensure that the carpet, which is DS0000022938.V344014.R01.S.doc 10 OP10 12(4)(a) 31/10/07 11 OP11 15(1,2) 31/12/07 12. OP11 18(1)(c) 31/03/08 13. OP12 16(2) (m,n) 31/12/07 14 OP19 23(2)(d) 31/03/08 Page 35 The Princess Alexandra Home Version 5.2 15 OP22 OP21 23(2)(a) 16 OP28 18(1)(c) 17 OP29 19(1) 18 OP30 18(1)(c) 19 OP33 24 worn, is replaced as soon as possible and according to a planned strategy for refurbishment (Repeated requirement-timescale 30/06/07 not met). The responsible individual must consider an assessment of the premises, including toilets and bathrooms by a person trained to do so, such as an occupational therapist, to make sure that the home is maximising its potential with regards to the care of people with impaired mobility. The registered person must ensure that the home has 50 of its care staff trained to at least NVQ level 2 as soon as possible (Repeated requirement-timescale 31/08/07 not met). All members of staff must have appropriate references before they are offered employment and all gaps in the employment history must be explored at the time of the interview. The registered person must ensure that all care and nursing members of staff have health and safety training, infection control training and food hygiene training. She must also consider providing training in clinical areas according to a comprehensive training and development plan based on the individual profiles of each member of staff (Repeated requirement-timescale 30/06/07 partly met). The registered person must have in place a quality assurance system based on a systematic cycle of plan-actioncheck-review reflecting the aims DS0000022938.V344014.R01.S.doc 31/03/08 31/08/08 31/12/07 31/03/08 31/03/08 The Princess Alexandra Home Version 5.2 Page 36 20 OP38 23(4) 21 OP38 13(4) 22 OP38 13(4) 23 OP38 13(4) 24 OP38 13(4) and outcomes for service users. To ensure that residents, visitors and staff are protected, an up to date fire emergency plan must be available in the home for inspection. Emergency light test must also be carried out monthly. The home must have an up to date health and safety risk assessment to make sure that people are safe on the premises. A copy of the electrical wiring certificate must be made available for inspection to demonstrate the safety of the electrical wiring system in the home. To maintain the safety of the lifts there must be thorough examination of all the lifts, including chair lifts, every six months or ‘at intervals laid down in an examination scheme drawn up by a competent person’, according to guidance from the Health and Safety Executive. Evidence must be kept in the home to show that the water temperature is being monitored at water exit points to which residents have access, on at least a monthly basis, to ensure that the temperature of the water is safe. 31/12/07 31/12/07 31/12/07 31/12/07 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000022938.V344014.R01.S.doc Version 5.2 Page 37 The Princess Alexandra Home 1 Standard OP2 2 3 OP7 OP8 4 OP15 5 OP30 It is recommended that a representative of the service provider and the service user/representative sign the terms and conditions to show the service users/representatives have received and agreed to these. The format for the assessment of needs of residents should be reviewed to ensure that all the needs of residents are appropriately addressed. That the equipment in place to provide pressure relief for residents be recorded as evidence that residents are receiving appropriate pressure relief according to their needs. That the procedure that the home has developed to make sure that residents do not wait for a long time before they are served their meals, be put in place in a consistent manner. It is recommended that some of the key training, which is provided in the home be externally accredited to make sure that the training is evidence-based and according to best practice in these areas The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 The Princess Alexandra Home DS0000022938.V344014.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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