Inspection on 16/01/07 for The Princess Alexandra Home

This inspection was carried out on 16th January 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 11/09/07

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 Unannounced Inspection 16th January 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.V325614.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.V325614.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 Manager post vacant 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.V325614.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 6th February 2006 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 service users 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 service users requiring nursing care on the ground floor, twenty service users 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 service users, but as there were non-Jewish service users prior to 2002 in the home, Jewish Care has made a commitment to continue caring for them. The Princess Alexandra Home DS0000022938.V325614.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 service users who live in the home are aware of these practices. The home is currently being managed by Fionnuala Baiden. The deputy manager’s position is vacant. The home has a team of nurses and care workers to care for the service users. There are also admin support staff and ancillary staff. All the hotel services in the home are contracted out. The home charges £706 for personal care and £935 for nursing care and has a mixture of publicly funded and privately funded service users. Some service users who are publicly funded have to make a third party contribution (top-up fee). At the time of the inspection there were sixty-seven service users in the home. The Princess Alexandra Home DS0000022938.V325614.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 key unannounced inspection which took place on Tuesday 16th January 2007 from 10:00 to 19:00 and on Friday 19th January from 10:00 to 16:30. The findings are based on the inspection of a sample of care, personnel, training and health and safety records, touring of some of the premises, observing care practices in the home and conversation of the inspector with some service users, visitors to the home and the manager and some of her staff. This report contains a significant number of requirements and recommendations compared to the report following the inspection in February 2006 when there were three requirements and one recommendation. The current manager took her post in November 2006. The home has not had a manager and a deputy manager from about August 2006 to about November 2006. The current manager is however aware of the current deficits and areas where improvement is required. She provided the inspector with a copy of an action plan for team leaders and trained nurses and an improvement plan for the home, that she has produced to address the issues that she has identified since she has been in post. These issues are very similar to the ones contained in this report. In this endeavour she will need the full support of the organisation, all her staff and service users and their relatives. What the service does well: The home has good procedures for the assessment of the needs of service users prior to them being offered a place in the home. Service users and their relatives are offered information about the services that are provided by the home and other information that are useful when people move to live into a care home. This includes information about the range of fees charged by the home Service users or/and their relatives are given a statement of the terms and conditions of the placement and a contract for those who are privately funded or who pay a third party contribution. The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 7 Good resources are available in the home for the provision of activities including a full- time social care coordinator and a part-time social care coordinator. Volunteers also run a number of activities sessions. The home benefits from a number of volunteers who help in enhancing the quality of life for the service users. It was noted that they were involved in a number of activities with service users and were seen on many occasions interacting with service users. There are good systems in place with regards to the provision of meals in the home and the monitoring with regards to whether service users were satisfied with the meals that are provided. Dining rooms are prepared to a good standard to provide a congenial environment for service users to have their meals. The home provides a homely environment and service users have the opportunity to bring their personal belongings in the home. There is a commitment and willingness from the provider to ensure that the home provides a high quality environment for service users who are accommodated in the home. Ancillary and support staff is provided in good numbers to ensure the smooth running of the home and to ensure that care and nursing staff are supported in doing their job. The home has good systems in place with regard to managing service users personal money, including audit checks. The home is now being run by an experienced manager. She has identified the issues that needed addressing in the home and has prepared an action/improvement plan based on her findings which reflects the findings of the inspector in this report. The manager was convinced that staff in the home require more training to ensure that the required improvement could be sustained. The home has good systems in place with regards to the consultation and involvement of service users and their representatives in the management of the service. Satisfaction questionnaires are sent quarterly and reports with action plans are prepared to summarise the findings of the satisfaction surveys. There was evidence that the organisation and the home take health and safety issues seriously and that quick actions are taken to address any health and safety issues that are identified. The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: While service users or their representatives sign a contract/terms and conditions of the placement when the service users are self funding or when they pay a top-up fee, it is recommended that copies which are offered to service users who are publicly funded are also signed and kept on file as evidence that they have received a copy. The needs of service users once admitted into the home must be comprehensively assessed, recorded and kept under review to ensure that appropriate care plans can be put in place to meet the needs of the service users. Without this there is no guarantee that the needs of service users would be met. Care plans were formulated to address some of the needs of service users, without a holistic assessment. Service users were therefore viewed as a set of needs rather than from a person centred perspective. Care plans must also be formulated and reviewed with service users or their representatives within an agreed timescales or when the needs of service users change. All service users in the home who have needs with regards to continence must have a care plan dealing with the promotion of continence or the management of incontinence. Service users must also be weighed at least monthly as part of the monitoring of their nutritional status. Comprehensive records must be kept with regard to the management of pressure ulcers in the home. The wishes and instructions of service users with regard to end of life care and death were not always comprehensively addressed in care records. While there was evidence of activities in the home, it was noted that these were provided by the volunteers in the home and by the social care The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 9 coordinator. There was little evidence of the involvement of nursing or care staff in the promotion of social and recreational activities. The records with regards to the assessments of social and recreational needs of service users were poor and care plans were not always in place to address these needs. The carpet in some areas of the home such as the first floor of the Edmond and House and in some bedrooms must be renewed. The provision of bath, shower rooms and toilets could be reviewed to ensure that these are accessible and provided in adequate numbers for service users accommodated in the home. The staff teams must be better organised to ensure the smooth running of the units and the appropriate supervision of service users at all times. The home has strong recruitment procedures but it was noted that one member of staff from the four personnel files inspected, did not have evidence on his/her personnel files that he/she was allowed to work in the UK. There has been some training in the home, and the home must now ensure that training is provided in health and safety, food hygiene and infection control as well as in clinical areas which would be determined by the training profiles of staff. The home does not have 50 of care staff trained to NVQ level 2 yet. The findings in this report suggest that there is a risk that the needs of service users might not be met. As a result the responsible person must, either by training and supervising staff or otherwise, ensure that staff have the skills and experience to deliver the services and care which the home offers to provide. While the home has a quality assurance procedure and systems in place to get feedback of users of the service, their relatives and members of staff, the home does not yet have a quality system based on self-assessments and internal audits. The resident’s handbook states on pg8 that ‘Jewish Care takes all reasonable steps to look after resident’s property’. While it is also clear that Jewish Care is not liable for the property, valuables and money of service users, it is not clear how the organisation would look after the property of service users without knowing what service users have in the first instance by keeping an up to date list of property and valuables that has been brought in by service users or their representatives. On the first day of the inspection, the inspector noted that there were no restrainers on some windows. This issue was rectified on the second day of the inspection, but the home’s own health and safety risk assessment should be able to identify such issues. The inspector would like to thank all the service users and visitors who spoke to him and the manager and all her staff for a kind welcome to the home and for their support and cooperation during the inspection The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 10 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.V325614.R01.S.doc Version 5.2 Page 11 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.V325614.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users receive a range of information about the service that the home provides, but the fees are not yet available in the service users’ guide. Service users have on the whole an assessment of their needs prior to admission. Once admitted, service users do not have a needs assessment for care plan purposes. The home did not demonstrate conclusively its ability to meet the needs of service users who are accommodated in the home. EVIDENCE: The inspector had access to a range of literature which is provided to prospective service users and their relatives to understand issues with regard to admission of a person into a care home. There was also an opportunity of service users and their relatives to ask questions about this process when they met with representatives of Jewish Care during the assessment of the service users needs or when the service users or their representatives visit the home. The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 13 Amendments to the Care Homes Regulations 2001 require that information about the fees charged by the home be included in the service users guide. This information was not provided to the inspector at the time of the inspection, but was later produced to show that this information is provided to prospective service users. The inspector noted that contracts and terms and conditions were available on files for service users who were self-funding. There was also a special contract for service users who paid third-party fees or top ups. Other service users who were publicly funded received the terms and conditions of the placement in a special admission pack. They however did not always sign to say that they had received the terms and conditions of the placement. Jewish Care is a charity to support Jewish people who require care. Referrals of people who require care are made through an application to Jewish Care, where social workers appointed by Jewish Care process the application. Decisions are then made about the nature of the care required after an assessment of needs by the social workers. Some of the people who have been referred may then be eligible for care (personal or nursing) and are then placed on a waiting for a care home close to where they live. Arrangements are also made by the social workers with regard to funding. In cases where the service users require nursing or where the social workers are not sure whether nursing care is required, the manager of the home assessed the service users. The care records of a service user who was recently admitted to the nursing unit was inspected to look at the pre-admission assessment. The inspector was unable to locate the preadmission assessment on the care records of the service user on the unit where she was accommodated, but a copy of the preadmission assessment was available with the social worker who carried out the assessment. The manager stated that the service user was admitted as an emergency and she therefore was unable to assess the service user’s nursing needs, and that in general all service users who require nursing needs have an assessment of their needs. Part of the care plan from the previous place of stay was available on file, but the inspector concluded that these were not comprehensive enough to provide information about the nursing needs of the service user. The inspector therefore concludes that in this case the needs assessments of the service user was carried out by the service provider but he recommends that the needs’ assessments of prospective service users be always available on the units where the service users are accommodated and that a comprehensive assessment of the nursing needs be also carried out. The inspector also noted that service users’ needs’ assessment, once service users were admitted to the home, were not in place. There was no format in the care records to use for the needs’ assessment and some members of staff queried the need to have a comprehensive assessment of needs, as according The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 14 to them there were care plans already in place. However without identifying the needs of service users to ensure that care plans can be formulated, there is no guarantee that these needs would be met in a holistic way. It seemed that service users were viewed as a set of needs rather than from a person centred perspective. Other basic information about service users was also missing such as the likes and dislikes of service users with regard to food, aspects of communication and aids for communication if any were required, the time to go to bed and to get up and information about the mobility of service users and aids in use. The manager showed the inspector a comprehensive format that should have been in use to record the assessment of needs of service users but for some reasons these have not been in use in the home. A number of other observations and findings of the inspector, which are included in this report, showed that the registered person did not demonstrate comprehensively the ability of the home to meet the needs of the service users who are accommodated in the home. For example the needs of service users were not always identified by carrying out a comprehensive assessment of the needs of service users, comprehensive care plans were not always in place to address the needs of service users, there was little evidence of consultation with service users and their relatives about the care plan, medicines’ management in the home was not of a good standard, there was a lack of supervision of service users in communal areas, there little evidence of appropriate pressure area care and the assessment of the social and recreational needs of service users was poor. As a result the responsible person must either by training and supervising staff or otherwise ensure that staff have the skills and experience to deliver the services and care which the home offers to provide. The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans did not always address the needs of service users and did not always describe the actions that need to be taken to meet the needs of service users. There was little involvement of service users and of their relatives in the care planning process. Some healthcare needs of service users were not always addressed in a comprehensive manner. Care records did not contain comprehensive information about the end of life care of service users taking into consideration the wishes, instructions, cultural and religious beliefs of the service users. Medicines management in the home was not carried out as safely as it should have been. EVIDENCE: Care records were kept in nursing offices/stations which were available in each house. These were in the main in good order. As mentioned in the previous section care plans did not contain a needs’ assessment. There were plans of The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 16 care but these did not always describe the actions to take to meet the needs of service users. In some cases care plans were not in place even when service users had obvious needs. According to the progress notes of one service user, the latter was depressed and needed motivation. She however did not have a care plan about this need. Another service user who had a respiratory condition did not have a care plan in place to address this need. Inspections of care records showed that these were not always reviewed on a monthly basis or when the needs of service users changed. It was noted that there were gaps in the dates of the review and evaluation of care plans. A number of risk assessments were in use in the home. There was a waterlow pressure sore risk assessment, nutritional risk assessment, falls risk assessment and manual handling risk assessment. Again these were not always reviewed on a monthly basis. A number of service users were cared for in beds which had bed rails. It was noted that risk assessments were not in place for service users who require bed rails and that bumpers were not always in use to prevent injury and entrapment. There was little evidence in care plans about the involvement of service users and their relatives in drawing up and in reviewing care plans and risk assessments that are produced by the home. There was evidence of six monthly care reviews after admission, and then yearly reviews, by social workers, where the service user or their relatives were involved. The inspector was informed that the Jewish Care social workers were mostly responsible for carrying out care reviews at specified period of times, except for service users from one Local Authority where the social workers from that Local Authority were responsible to carry out the care reviews. One service user who was asked about her care plan does not recollect having seen her care plan or been asked about it. The relative of another service user however was aware of the care that her mother needed, but it was not clear if that was because of her involvement with the home or because of the consultation of staff with her about the care plan. There was however no evidence in the care plan of that service user, that her relative had been involved in drawing up and reviewing the care plan. Inspection of daily progress notes showed that entries about the personal and nursing care provided to service users were not made in their care plans on each shifts or on a daily basis to give an indication of the condition of the service users and events which have taken place on that shift. In one case there were no entries for five days out of the nine days that a service user had been admitted into the home. The same service user did not yet have a set of plans of care to address her needs. The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 17 The home also uses an elimination sheet to record the elimination of service users. This sheet was not completed comprehensively to make this a useful document. In some cases this has not been completed for periods of more than seven days and therefore wrongly indicating that service users may not have passed stool for that period of time. There was also duplication with the elimination sheet and the daily record sheet. All service users were clean and appropriately dressed, except for a service user who was wearing ankle socks which were tight and therefore made an indentation around her already oedematous leg. Records were not always kept about the baths/showers of service users and it was therefore not always possible to say whether service users were having regular baths according to their care plans. One service user who was identified to have one bath a week has not had a bath in a period of eighteen days. The home uses a continence assessment in cases where service users have been identified with incontinence. However a care plan was not always in place to address how continence would be promoted and how incontinence would be managed. It was noted that a few service users in the home had catheters in place to manage incontinence. There was however a lack of catherisation packs, gel to use for catherisation and sterile gloves in cases where service users may need to be catherised such as when a catheter is blocked or in cases of acute retention of urine following advice from the GP. Service users’ nutritional status was assessed by the use of a nutritional assessment and weights. It was noted that service users were not always weighed monthly as a way of monitoring their nutritional status. Four out of the five care plans inspected did not contain monthly weights of service users. A number of service users were on antibiotics because they were unwell. Records of a service user who had not been well showed that there was a lack of monitoring of her vital signs when she was unwell and that there was no care plan in place to address her acute illness. There was one service user in the home with pressure sore at the time of the inspection. He has been in the home for a number of years. There was evidence that the service user was seen by the Tissue Viability Nurse. The care plan however did not have comprehensive records about the pressure sore and it was therefore not possible to say whether the pressure sore was healing. There were no photos, no regular wound assessment records and no care plan in place. There was a care plan about skin care but not specifically about the management of the pressure sore. That care plan said to use pressure relieving mattress but did not describe the pressure relief equipment in use in the home, to enable a person reading the records to make a decision as to whether the equipment provided was suitable for the service user. The service user however did have a mattress replacement in place which was confirmed verbally by the nurse on duty. The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 18 Records showed that service users were seen by the relevant healthcare professionals and that staff in the home referred service users through the GP to the relevant healthcare professionals when that was required. There was evidence that the optician, chiropodist, tissue viability nurse, continence nurse and dietician visit the home. Medicines management on the ground floor of the nursing unit was inspected. The home uses a monitored dose system to manage medicines. It was noted that a number of medicines, which required a date of opening to be identified, such as liquid antibiotics and eye drops, did not always have such a date. Medicines were also not always signed when administered and codes were not always used to describe the reasons when medicines were not administered. On one occasion a medicine was signed as given but the medicine was still in the blister pack. Some medicines did not have clear instructions with regard to administration. For example the instruction on the label for one topical medicine said to ‘administer as directed’ and for paracetamol, for one service user, said to administer 1 gram as required but did not say how often this should be administered. The medicines’ fridge temperature was recorded daily, but it was noted that the actual temperature as recorded, has been around 12 degrees centigrade for at least a week. No action seemed to have been taken with regards to checking the temperature with another thermometer or reporting that the fridge was not working properly. The latest BNF shown to the inspector was dated September 2003 and the inspector therefore recommends that a more up to date medicines reference book be made available. The management of controlled medicines was in the main good, except that on one occasion there was only one signature instead of the two, which were required, in the controlled medicines’ register. The inspector noted that members of staff were using insulin pens to administer insulin to one service user. Insulin pens are for self-administration and are not for professional use due to the increased risk of needle stick injury while replacing the needle. The use of pen injection devices by healthcare professionals, such as for insulin, must be reviewed in line with guidance from the Medicines and Healthcare Products Regulatory Agency on these equipment with regard to the risk of needle stick injury (See MDA/2005/009). On the first day of the inspection, it was noted that the home did not have an adequate supply of single use lancing devices for blood sugar testing as per MDA/2006/066. This was rectified on the second day of the inspection when a new supply had been ordered and received. Care plans of service users did not always have clear information with regard to the end of life care, death and arrangements/instructions/wishes of service The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 19 users or their representatives with regard to these aspects of care. The home accommodates mostly Jewish service users, some of who may have different level of practicing their faith (for example some may be more orthodox than others). There were also a few service users from other faiths. It was also noted that service users’ care plans did not always take the religious and cultural aspects of the life of service users into perspective. The home informs the Commission of all deaths in the home. These are in the whole managed appropriately. It was however noted that staff in the home have not had ‘Palliative care/End of life care’ training , from which they would benefit, particularly in cases where decisions are required to be made for the service users within the multi-disciplinary team. The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a range of activities with the help of volunteers. There was little evidence of care staff in the provision of social and recreational activities and records did not always address the social and recreational needs of service users in the form of a life history or biography. Service users have the opportunity to choose from a range of nutritious, varied and appropriately prepared meals. EVIDENCE: The home has one full time and one part time activities coordinators. There is also a large number of volunteers who visit the home and engage in some form of activities with service users such as reading to individual service users, book reviews, creative craft, quizzes, tea and chat, manicuring, taking service users out and generally helping out. The home has a range of resources to enable the provision of activities in the home. There is a multi-sensory machine which can be wheeled to communal areas or to the individual room of service users. The home has also recently provided two computers for service users to learn to use or to use to search the web or to keep in contact with distant realtives by email. There is also a Thursday evening club for service The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 21 users, where they have the opportunity to engage with each other and the people who run the club. During the course of the two days inspecting the home, it was noted that there was little involvement of the nursing and care staff in the provision of social and recreational activities. Inspection of care records showed that there was practically no information about the recreational and social needs or the life history of service users on file. Care plans were not always in place to address the social and recreational needs of service users. The inspector was able to appreciate the outside facilities that the home provides, which are enjoyed by service users and their visitors when it is warmer. There are pathways among the extensive lawns, a small lake and wooded areas. Other service users can sit on a terrace area and enjoyed the view. This is accessed through the garden lounge, which has a beautiful view on the outside of the home, hence the name of the lounge. Conversation with service users confirmed that outings are arranged. The home has a mini bus which is used to take service users out. One service user stated that she is able to go to cafes and have meals outside the home. Other service users are taken out by their relatives. The inspector observed that many service users were visited by their relatives. The visitors were well received into the home and members of staff seemed to know them well. They were offered beverages and supported in meeting the service users in the bedrooms of the service users or in the communal areas. Some service users had their own phones to contact their realtives/friends or to receive calls. There were public phones in the home which provided privacy to whoever wanted to use them. There were also cordless phones which service users who were confined to their beds could use to make and receive phone calls. The home has a small multi-denominational area which is used for praying and religious ceremonies. In the afternoon of the second day of the inspection, which was a Friday there is a religious ceremony was held prior to the Sabbath as per the Jewish faith. The inspector was informed that representatives of other religions also visit service users who were not Jewish. This was confirmed by a service user who was from a different faith. The inspector observed lunch being served to service users. Lunch consisted of carrot and coriander soup, roast chicken with a wine and mushroom sauce or pan-fried hake with a tomato sauce, mash potatoes, diced roast potatoes, courgettes and cauliflower. There was also a salad bar. For desert there were peach fool and fresh fruits. Service users who were able to express themselves confirmed that they were asked about their choices. All food is prepared in the home according to Jewish culture. Most service users and visitors spoken with The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 22 by the inspector stated that service users were pleased with the meals and one service user who was not Jewish said, that she enjoys the food. The home has a well-equipped kitchen and it was well maintained. There is an adequate number of catering staff. They are also responsible to serve all the food to service users, visitors and staff in the home. It was noted that care staff and a few volunteers assisted some service users with their meals where necessary and in an appropriate manner. The home has a catering manager who monitors the standard of meals provided in the home. There was evidence that service users were asked about the quality of the meals and that their comments were recorded to help in improving this service. The inspector was also informed of the existence of a food forum in the home, with representatives from service users, management and catering and which meets every month to discuss the menus and meals provided in the home. This is good practice. The home has two dining rooms, one on the Newland unit and a much bigger one on the Edmond unit. It was noted that these were prepared to a good standard and provided a welcoming and congenial environment for service users to have their meals. Service users on the Newland unit were not restricted to the dining room on that unit and could also go to the main dining room on the Edmond unit. The home provides a facility for service users to eat with their relatives/friends. Relatives/friends purchased their food and this is served in the library where tables are set. Service users can then enjoy their meals together with their relatives and friends. There was a provision of drinks in all the lounges which service users could make use of, if they wanted a drink. Fresh water was also provided in all the bedrooms of service users. This is good practice. The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 23 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): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and are appropriately dealt with. The manager and her staff are aware of the action to take to deal with suspicions and allegations of abuse. The system in place for the management of the property and valuables of service users does not seem to be comprehensive. EVIDENCE: The home has a complaint procedure which was seen in the service users’ guide and on notice boards in several areas of the home. The manager or the person in charge of the home in the absence of the manager, are also available on site to deal with complaints that might be made by service users or visitors to the home. Service users stated that they would contact the person in charge of the shift if they had any concerns. Relatives/visitors of service users were also clear that they would speak with the team leaders if they had any concerns and would approach the manager if necessary. The inspector was able to observe how one visitor raised concerns with a member of staff, who took the matter seriously and said that she would address the issue. There have been nine complaints since April 2006. These have been appropriately recorded and there was evidence that there have been investigations and that responses have been provided to complainants to The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 24 address the complaints. It was noted that five of the complaints were about staff. The abuse procedure in the home was not seen on this occasion. Training records and conversations with members of staff showed there has been training on abuse and on safeguarding adults. On the whole staff were aware of the steps to take if abuse is suspected or alleged. In the past there has been concerns about possessions of service users disappearing. The manager informed the inspector that since April 2006 there has been one incident when a small sum of money was missing, but there has not been any jewellery or valuables missing. There was a requirement during the last inspection that effective measures are put in place to prevent thefts of the property, valuables and money of service users and staff. The inspector noted that the home did not always make a record of possessions and other valuables that are brought by service users into the home. The manager explained that the home is not responsible for the valuables of service users and that service users or their representatives sign disclaimers about any property, money or valuables that are brought into the home. Service users and their representatives are also encouraged to take private insurance for all personal possessions. Service users are actively discouraged from bringing large sums of money into the home and to bring only a small sum of money for small expenses which are most of the time handed over, to be kept in the safe, but property and valuables are normally kept in the bedrooms of service users or are worn by the service users. Some service users enjoy wearing their jewellery as part of their body image, sexuality and identity and the home promotes that. The statement of terms and conditions does make clear however that money, jewellery, work of arts, furs and rare books are not covered by the home’s liability insurance. While it is appreciated that the home does not keep a list because the list may be difficult to keep up to date as new belongings/possessions are brought for service users or removed from the home, it does say in section 4.2 of the terms and conditions that ‘residents are required to provide a detailed list of all personal possessions brought… in the home’. It also says that ‘under no circumstances can the proprietor accept liability for loss of any item of a residents’ personal possessions that has not been properly recorded on the resident’s list of personal possessions’. The Care Homes Regulations 2001, schedule 4(10) does require that a list is kept of all furniture brought into the home. There is therefore an inference that a list is kept of the possessions of service users that are brought into the home. Keeping a list does not necessarily infer liability, but is rather a reflection of good practice in monitoring service users The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 25 possessions in the home. The list also acts as a point of reference in case there is a dispute of what has been brought into the home and to enhance security. The disclaimer form that is used in the home does not mean that a list should not be kept for monitoring purposes. In view of the above the registered person should consider reviewing its practices with regard to recording the possessions that are brought into the home by service users or their representatives. . The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 26 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While the home provides a warm and homely environment, there were a few issues which needed addressing, to ensure that the environment was fully suitable for the accommodation of the service users. EVIDENCE: The home is located in a quiet area of Stanmore, off Common Road. People who visit the home by public transport have a small walk from the main road through the grounds of the home before they get to the building where service users are accommodated. The extensive grounds around the home and the car park areas were maintained to a good standard. Due to the age of the building the home requires ongoing and sustained maintenance work. The home employs a maintenance manager and a maintenance man for this purpose. There was evidence of ongoing The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 27 maintenance work. The inspector was able to observe the redecoration of a bedroom which was vacant on the day of the inspection and the replacement of the carpet and some of the fixed furniture which used to be in the room. The home was in the main clean and free from odours. The carpet on the first floor of both Edmond and Newland Houses and in some bedrooms was in need of renewal. The manager stated that financial resources has been identified for the development of the home and that replacing the carpet in some areas of the home has been identified as part of the redecoration programme. Some windows were also noted not to have catches and therefore did not close properly. The manager added that there was a plan to replace the windows in the home. The home has a number of communal areas. There are two lounges and a main dining area on the nursing unit. There is a boardroom, a garden lounge, a green lounge and a library in the main building and the residential wing. The inspector observed that service users had access to and were able to use all areas in the home. The main building of the home and the units, which have been added, were built at a time when there was not so much equipment, such as hoists, frames and wheelchairs, which are currently in use in the home. As a result there is an issue in the home with regards to storage space and suitability of some of the areas for the care of service users with poor mobility. The home has a number of toilets, bathrooms and shower-rooms on each floor. It was noted that a number of bathrooms had baths that were against the wall and did not provide access on either sides of the bath. There was evidence that in view of the space and accessibility some of the baths were being replaced by showers. A number of toilets were in rooms which were too small to provide access to wheelchairs users. It was also noted that a large number of the toilets did not have grab rails in place for service users with poor mobility. It is therefore required that the responsible individual conduct a review of the bath/shower and toilet facilities in the home to ensure that these are suitable for the needs of service users that the home accommodates. The communal areas and most areas are accessible to wheelchair users. The nursing home has a mezzanine area, which can be reached by a set of 4-5 stairs. The inspector was informed that this area is normally occupied by service users who are mobile. There is a chair lift to assist service users if that is required. The home has lifts in all the houses, but a number of service users raised concerns that the lift, which is situated in the Newland House, breaks down quite often and that when this happens they are not always able to go to the communal areas which are located on the ground floor. The manager stated that there are plans to fit a chair lift to a set of stairs as a back up to the lift should the latter breaks down. The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 28 Service users and their relatives have been encouraged to bring personal items of decorations and photographs to ensure that the bedrooms were personalised and homely. It was noted that some service users stayed in their bedrooms and others preferred to go to the communal lounges. On this occasion the inspector did not confirm with service users if they were offered a key to their bedrooms. The service users’ guide however does mention that keys to the bedrooms of service users can be provided if requested. There was evidence that service users’ bedrooms were being decorated as they become vacant and that furniture was being replaced as required. There were sluices with sterilisers in each house, but the inspector noted that a hoist with a sling was stored in one of the sluices. As the sluices are ‘dirty’ areas, ‘clean’ items must not be stored in the sluice because of the danger of cross contamination. The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 29 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home seems to have adequate numbers of staff on duty, the nature of the environment may require that more staff be provided to ensure that the needs of service users are met. Recruitment procedures were generally good. Staff receive training in some of the statutory areas but would benefit from more comprehensive training to ensure that they are fully competent to care for the service users. EVIDENCE: Newland House accommodates twenty-five service users requiring personal care and is staffed by five carers during the day and by two carers at night. It is run as a whole unit. Edmond House is divided into two floors which is each run by a team of staff. The ground floor accommodates twenty service users requiring nursing and is staffed by a trained nurse and four carers during the day and by one trained nurse and one carer at night. The first floor of Edmond House provides accommodation for twenty service users requiring nursing and five service users (accommodated on the mezzanine) requiring personal care. It is staffed by a trained nurse and five carers during the day and by a trained nurse and one carer at night. There is also a senior nurse on duty who supervises the nursing units. The manager is supernumerary. The deputy manager’s post was vacant and there was evidence that the manager has been The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 30 actively recruiting for the post. While the numbers of staff provided by the home would have been adequate for a purpose built home and units, the manager and staff stated that the extensive layout of the building and of some of the units make the current staffing level difficult to work with. For example the ground and the first floors of Edmond House are interlinked by a number of long corridors and it would be difficult to know what is happening on one side of the corridor if a member of staff is on the other side. The home also employs support staff to assist in running the home such as social care coordinators, maintenance persons, receptionists, an administrator and the manager’s PA. All ancillary services are contracted out and therefore the contractor provides the catering and cleaning staff in the home. Jewish Care has a number of volunteers who dedicate themselves to helping others within their own community. The home is therefore in a fortunate position where there are volunteers to assist where possible. There are for example drivers who run errands and people to help with activities. From his observations and from talking to service users, visitors and staff, the inspector concluded that there seemed to be a culture in the home where care and nursing staff tend to provide personal or nursing care to service users and leave social and recreational activities to the social care coordinator and volunteers. It was noted that most of the time, service users were left without adequate supervision in the communal areas. One service user was observed with her legs over the arms of her chair in an uncomfortable position with no members of staff in the lounge. At the time the inspector counted three members of staff in the office and two in the clinical room of the ground floor. On another occasion the inspector observed four out of five members of staff on one unit having a lunch break together. In the past there have been observations that staff tended to have their breaks together and leaving service users unattended. There is a requirement from the last CSCI inspection that the manager monitors staff working over the weekend and night duty and the planning of staff breaks, to ensure that the care and support offered to service users is not compromised. The complaints register also showed that members of staff were a major source of complaints in the home. As a result of the above the registered person must review the way that staff teams are organised to ensure the smooth running of the home and the health and safety of service users at all times. The manager stated that she has started the reorganisation of the staff teams and has designated staff teams for each floor of the Edmond House, which would be run by a trained nurse each. Four staff personnel files were inspected. These contained all the records as required by schedule 2 of the Care Homes Regulations 2001. There were appropriate application forms in place which had been completed appropriately. References were available and CRB checks have been completed before new members of staff were allowed to work in the home. It was also The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 31 noted that all volunteers have had CRB checks before they were able to work with service users. One member of staff did not have an up to date permit to work in the UK. Jewish Care normally provides a two weeks induction period for all new staff, which is run once every month. There were some new members of staff in the home and they had already started to work in the home without the two weeks induction period. The manager stated that they have had an induction in the home and would attend the next induction which has been arranged by Jewish Care. She added that the common induction standards are provided to new members of staff when they attend this induction. The home did not have a training and development plan in place based on the assessment of the individual training needs of each member of staff. The manager stated that she plans to develop one. There was evidence of some training having been arranged such as fire training, manual handling training and PoVA training with which most members of staff were up to date. There were also some members of staff who have attended dementia training and managing continence training. There was however a lack of evidence to show whether staff have had training in health and safety, food hygiene and infection control. Training in clinical areas such as pressure area care, tissue viability, managing service users with strokes, bereavement and end of life care, was also lacking. The home has about forty-seven carers and out of these twenty have completed at least an NVQ level 2 qualification in care and fourteen were in the process of studying for this qualification. As a result the home does not yet have 50 of its care staff qualified to NVQ level 2 in care. The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 32 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is experienced to run the home but she would need more managerial support to improve the standards of service that the home provides. The management of personal money of service users is carried out to a good standard. While there are some systems in place to monitor the quality of the service that the home provides, there is not yet a quality control system based on selfassessment. Although a few issues were noted which could compromise the health and safety of service users, the home does take health and safety issues seriously EVIDENCE: At the time of the inspection the home did not have a registered manager. The inspector was informed that the previous manager left the home in September The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 33 and that the deputy manager also left around the same time. A new manager has been in post since the end of October 2006. She has managed a number of care homes and has occupied a number of management posts for Jewish Care. Conversation with her showed that she was aware of the issues in the home, which needed addressing. A copy of an action plan for team leaders and staff nurses and a copy of an improvement plan for the home, that the manager has drawn up were provided to the inspector. While it is noted that the ‘turnaround’ process of the home might have started, the manager would require the support of the service provider, all members of staff, the service users and their relatives to continue with her improvement agenda. The manager must however be registered as soon as possible. She stated that she has a post-graduate qualification in nursing and was in the process of starting the Registered Manager’s Award. The home has a quality assurance procedure. At the heart of the quality system is feedback from staff, service users and their relatives, and visitors to the home. The satisfaction questionnaires are sent every three months and the service provider uses a third party to analyse the satisfaction questionnaires and to prepare a report. Regulation 26 visit is another quality control measure in use in the home. Jewish Care also has a quality and excellence department which develop standards for the inspection of ancillary/support services. These are normally carried out by volunteers and reports are produced. These are open documents. The report following a recent inspection was available for viewing at reception. While all the above are important part of a quality control system, the inspector noted the absence of audits/controls 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). These could explain the reason for the existence of so many care and care plan issues which have not been picked up and addressed in the home. The management of personal allowances in the home was inspected. The inspector was informed that the home does not act on behalf of any service user. Small amount of money were kept for individual service users to pay for daily expenditures and receipts were kept for most of the expenditures but it was also possible to track expenditures made on behalf of service users in cases where a receipt was not always available such as with the provision of newspapers when a bulk receipt is provided. Inspection of the records kept showed that good records were in place and that the management of personal money of service user was of a good standard. It was noted that the home had a PAT testing certificate, gas safety certificate for all the equipment which uses gas and LOLER certificates for the hoists. A chlorination certificate for the water system was also available in the home. At the time of the inspection the certificate for the Electrical Wiring Certificate was being renewed. The inspector was however unable to see a LOLER certificate The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 34 for the lifts. There was also evidence of ongoing maintenance of equipment such as the call bell system and the laundry equipment. On the day of the inspection staff were not clear of the 1st Aider on duty in the home. It is required that a 1st Aider be identified for each shift in the home. A number of first floor windows in the bedrooms of service users and in the corridors of the Newland House did not have restrainers in place. As a result the windows could be fully opened and thus posing a risk to service users. The manager was informed of the above on the first day of the inspection and on the second day of the inspection she stated that all the windows that did not have a restrainer in the Newland House now have one in place. The inspector was informed that the home has a health and safety risk assessment in place. The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 35 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 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 2 2 X 3 X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 x x 2 The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 36 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 OP3 Regulation 14(1,2) Requirement Timescale for action 30/04/07 2 OP4 10(1) 3 OP7 15(1) 4 OP7 13(4,7,8) The registered person must ensure that all service users have a comprehensive assessment of their needs, which is kept under review. The responsible person must, 30/06/07 either by training and supervising staff or otherwise, ensure that staff have the skills and experience to deliver the services and care which the home offers to provide. Care plans must set out in detail 30/04/07 the action which needs to be taken by care staff to ensure that the identified needs of service users are met. That a comprehensive risk 31/03/07 assessment is carried out and recorded for each service user who requires bed rails. The risk assessment must be agreed by the service user/representative. and must be kept under review. Bumpers must be used to prevent the service user from injuring himself/herself on the bedrails as per the risk assessment. DS0000022938.V325614.R01.S.doc Version 5.2 The Princess Alexandra Home Page 37 5 OP7 15(2) 6 OP7 17 7 OP7 17 8 OP7 15(1) 9 OP8 12(1) 10 OP8 17(1)(a) 11 OP8 12(1) 12 OP8 12(1) Care plans must be reviewed at least monthly or more often if the needs of service users change. The registered person must consider that an entry is made on every shift in the progress notes of each service user to record the care that has been provided to the service user and any event that has taken place on that shift. That plans of care are produced within a clear identified period of time from the point of admission to address the needs of newly admitted service users. Evidence must be kept to show that the care plans have been drawn up and reviewed with service users and /or their representatives. 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 not fully met). The registered person must ensure that appropriate records are kept about the pressure sores of service users including photos, regular progress updates about the sores and care plans addressing the management of the sores. Service users must be weighed at least monthly to assess their nutritional status. A note must be made when this is not possible. There must be appropriate monitoring of the vital signs of service users when they are acutely ill, with records kept. Short-termed care plans must DS0000022938.V325614.R01.S.doc 31/03/07 28/02/07 28/02/07 30/04/07 30/04/07 31/03/07 28/02/07 28/02/07 The Princess Alexandra Home Version 5.2 Page 38 13 OP8 12(1) 14 OP9 13(2,4) 15 OP9 13(2,4) 16 OP9 13(2,4) 17 OP9 13(2,4) 18 OP9 13(2,4) 19 OP9 13(2,4) 20 OP11 15(1,2) also be drawn up to address the acute illness of service users. The registered person must review the stock of equipment that may be required for the catherisation of service users such as the supply of sterile gloves, gel for catherisation (e.g. instillagel) catherisation packs There must be clear instructions on the medicines sheets and the labels of medicines with regard to the dose of medicine to administer and the frequency and route/location of administration. All medicines must be signed when administered and codes must be used where necessary to describe the reasons for service users not receiving the medicines. The registered person must ensure that all medicines, which require a date of opening to be identified such as liquid antibiotics and eye drops, have such a date recorded. The medicines’ fridge temperature must be within a range of 3-8 degrees centigrade as far as possible and ideally within 3-5 degrees centigrade. There must be two signatures in place in the controlled medicines book when a controlled medicine has been administered. The use of pen injection devices by healthcare professionals, such as for insulin, must be reviewed in line with guidance from the Medicines and Healthcare Products Regulatory Agency on these equipment with regard to the risk of needle stick injury (See MDA/2005/009) The registered person must ensure that the arrangements in DS0000022938.V325614.R01.S.doc 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 30/04/07 Page 39 The Princess Alexandra Home Version 5.2 21 22 OP11 OP12 18(1)(c) 16(2) (m,n) 23 OP18 13(4), 17(1)(a) 24 OP19 23(2)(d) 25 OP21 OP22 23(a,j) 26 27 OP26 OP27 13(3) 18(1)(a) place and the instructions/wishes of service users or their representatives with regards to end of life care and death are recorded, taking into account their culture, ethnic background and beliefs. Staff must be provided with palliative care/end of life care training. The social and recreational needs or the life history of service users must be completed. Care plans addressing the identified needs must be in place. As part of the measures to help improve the security of service users property, valuables and money, to minimise the incidence of theft at the home, it is required that the registered person consider keeping a list of all property and valuables that are brought into the home by service users and that this list is kept under review and updated as required. The registered person must ensure that the carpet which is worn is replaced as soon as possible and according to a planned strategy for refurbishment. The responsible individual must conduct a review of the bath/shower and toilet facilities in the home to ensure that these are suitable for the needs of service users that the home accommodates. He must also ensure that these are accessible to service users with poor mobility. The registered person must ensure that ‘clean’ items are not stored in the sluice. The registered person must review the way that the staff DS0000022938.V325614.R01.S.doc 30/06/07 30/04/07 31/03/07 30/06/07 31/03/07 28/02/07 28/02/07 Page 40 The Princess Alexandra Home Version 5.2 28 OP28 18(1)(c) 29 OP29 19(1) 30 OP30 18(1)(c) 31 32 OP31 OP33 9 24 33 34 OP38 OP38 13(4)(c) 23(2)(b,c) teams are organised to ensure the smooth running of the home and to ensure that service users are supervised appropriately. 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. All members of staff must have evidence in their personnel files that they are allowed to work in the UK. 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. The registered manager must be registered as soon as possible. The registered person must consider introducing a quality assurance system based on a systematic cycle of plan-actioncheck-review reflecting the aims and outcomes for service users. The registered person must ensure that there is an appointed person for 1st Aid on each shift. The registered person must ensure that there are up to date LOLER certificates for the Lift as per the Lifting Operations and Lifting Equipment Regulations 1998. 31/08/07 31/03/07 30/06/07 30/06/07 30/06/07 31/03/07 31/03/07 The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 41 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 OP2 Good Practice Recommendations 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. It is recommended that the needs’ assessments of prospective service users be always available on the units where the service users are accommodated and that a comprehensive assessment of the nursing needs be carried out by a nurse for all prospective service users who require nursing care. That the use of ankle socks for service users with oedematous legs be reviewed as they may impair circulation. It is recommended that records are kept about the baths of service users to demonstrate that they are having baths, according to their care plans. It is recommended that a more up to date medicines reference book, such as the latest BNF be made available in the home. Care staff should be involved in the provision of social and recreational activities in the home. A review of the staffing level should be carried out taking into consideration the layout of the building and the units. 2 OP3 3 4 5 6 7 OP8 OP8 OP9 OP12 OP27 The Princess Alexandra Home DS0000022938.V325614.R01.S.doc Version 5.2 Page 42 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.V325614.R01.S.doc Version 5.2 Page 43 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!