Inspection on 19/08/08 for The Princess Alexandra Home

This inspection was carried out on 19th August 2008.

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

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

Other inspections for this house

The Princess Alexandra Home 11/09/07

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 27/11/2008.

CARE HOMES FOR OLDER PEOPLE The Princess Alexandra Home Common Road Stanmore Middx HA7 3JE Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 19th August 2008 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.V367071.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.V367071.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 www.jewishcare.org Jewish Care Fionnuala Baiden 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.V367071.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 72 11th September 2007 Date of last inspection 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 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 The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 5 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 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.V367071.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The unannounced inspection started at 10:10-19:20 on the 19th August and continued on the 21st August from 10:45-19:10. Our last key inspection was unannounced and took place in September 2007. The home sent us an improvement plan to tell us how it planned to meet the requirements and recommendations that were imposed on the home during that inspection. During the course of this inspection we toured part of the premises, observed care practices and looked at a sample of records. We also talked to some visitors to the home, at least eight residents and seven members of staff. When we finished the inspection we gave feedback to Fionnuala Baiden, the registered manager. An Annual Quality Assurance Assessment (AQAA) was also received from the service. This was completed appropriately and was used where possible in writing this report. We also received thirteen staff comment cards, one social and healthcare professional comment card and forty-six comment cards from residents. Some of the residents were supported by their relatives to complete the comment cards. We also had the input of Pamela Moffatt, an ‘Expert by Experience’ from ‘Help the Aged’ to help us with getting feedback about the service that the home provides from residents and visitors to the home. ‘Experts by Experience’ are people who have experience of using social care. We would like to thank all the people who contributed and supported us during the inspection. What the service does well: One person said that if he/she had to move into a home it would have to be Princess Alexandra. The home provides not only nursing and personal care but some of the services that are provided are of the same standards as those in a hotel. Jewish Care has a strong management structure that supports the care homes in meeting the aims and objectives of the organisation and of the individual homes. The care homes are also well supported by volunteers who help in The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 7 many aspects of the service that the home provides, particularly in the provision of social and recreational activities to improve the wellbeing of residents. People who are referred to Princess Alexandra have their needs assessed in a comprehensive manner and at an early stage to determine the service that they require. They and/or their representatives are provided with information about the home and about the provision of social care in general, for them to understand the way that social care is delivered and for them to make informed choices. Residents receive a variety of nutritious meals and are able to exercise choice in choosing their meals. The bedrooms of residents are generally homely, personalised and pleasant. People have the opportunity to bring their personal items to make their bedrooms homely. Residents have the opportunity to have their say about the way that the home is run. There are two-monthly residents meetings, catering meetings and yearly residents’ surveys. There are also staff and relatives surveys. The home provides appropriately trained staff in adequate numbers to meet the needs of residents. What has improved since the last inspection? There has been an improvement in the quality of the care records that are kept by the home. The assessments of needs are more comprehensive than they had been during the last inspection and care plans are formulated to address the needs of residents. These are on the whole kept up to date and reviewed as the needs of residents change. There was evidence that residents/representatives were involved in the care planning process and in drawing up risk assessments. The home has introduced a continence assessment and there was evidence that in some cases care plans were in place to address the promotion of continence and the management of incontinence. Whilst progress was noted in two units in the home, not much progress was noted in the third unit. The home has also stopped the use of incontinence sheets on armchairs for residents, as this practice was making it obvious to other people that these residents were incontinent. The home has improved the records about the input of other healthcare professionals in the care of the residents. As a result it is possible to track all the care that residents receive in the home. The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 8 During the last inspection we found that residents were brought to the communal areas after their meals and left in the middle of the room facing different directions. More consideration is now given to the dignity of residents. They are now helped to armchairs or in a position for the residents to interact with each other. Staff are more attentive to the needs of residents. They interact more with residents in the communal areas and do not spend time sitting in the office. There is a member of staff that is allocated to stay in the communal areas so that residents are not left on their own. To contribute to the security of residents’ property and valuables a record is now kept about the property and valuables that are brought into the home by residents. In the past this has not been the case. The home continues to improve the standard of the physical environment of the home. At the time of the inspection a new fire alarm system was being installed in the home. The building is relatively old and requires a lot of updating to improve the quality of the environment. This has started but there is still some way to go for the environment to be fully suited for the residents. The recruitment checks are carried out robustly to make sure that only suitably competent people are selected to work in the home. Staff receive regular supervision to make sure that they are supported in the job that they do. They also receive more training that is suitable to the job that they do. The home has developed a quality control tool that is based on the Key Lines of Regulatory Assessment (care homes for adults) of the Commission. This is used yearly to monitor the quality of the service and an action plan is produced after the audit, to address areas where improvement is required. There has been an improvement in the management of health and safety. Records that are required to demonstrate compliance with the relevant legislation and good practice were in place and there was evidence of regular checks to make sure that people who use the service are safe. The fire risk assessment and the health and safety risk assessment were up to date. What they could do better: The home has some very good care plans where the needs of residents are comprehensively addressed and others that are not so good. Good practice with regards to care plans must now be implemented for all residents who live in the home. Whilst wound care and pressure ulcers are generally managed well, records that are kept with regards to the management of pressure area care must be more comprehensive. For example photographs or wound mapping could be used to monitor progress of wounds or pressure ulcers. The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 9 Once residents have been identified as needing pressure relief equipment, the equipment must be provided without delay, to make sure that residents are not put at additional risk of developing pressure ulcers. That pain charts are used regularly as a tool in pain management to measure the effectiveness of the regime to manage pain and the effectiveness of the pain killers. To ensure the welfare of residents, the management of medication in the home must be carried out carefully to make sure that people always receive the right medication and amount of medication that they have been prescribed. Records about the management of medicine must be kept comprehensively. That the safeguarding adult procedure be used when there are suspicions or allegations of abuse. If there are uncertainties then the relevant authorities such as, the funding authority, the safeguarding adult team of the Local Borough and the Commission for Social Care Inspection, must be contacted to discuss the issues. The home must continue to improve the quality of the environment. The carpet on the first floors of the Newland and Edmond Houses is looking past its useful life and need replacing. To monitor progress with regards to the refurbishment of the home, including replacement of the carpet, a plan must be produced with appropriate timescales. A copy must be forwarded to the Commission. Whilst a few toilets and bathrooms have been updated to make these fully accessible to people with poor mobility, more need to be done in this area. There are many en-suites and many toilets/bathrooms that do not yet have grab rails in place to enable people with poor mobility access to these areas. The home should review the window restrainers that are in use in the home as these could be easily disabled by hand and as a result the windows could be fully open and people could be at risk of falling from a height. 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.V367071.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.V367071.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. People who want to move into the home receive enough information to decide if they would like to move into the home. The needs of prospective residents are assessed in a comprehensive manner before the home decides to accept a resident, to make sure that the home will be able to meet the needs of the resident, once they are admitted. EVIDENCE: Jewish Care is a charitable organisation that provides care and support to the Jewish community in London and the South-East. As a result it has a wealth of experience about managing the admission of people to care homes that are owed by Jewish Care or supporting people in their own homes. It produces many information booklets to support people in identifying the resources that are available to them as they grow old and in understanding their rights and the way social care is managed. 45 out of 46 residents who responded to The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 12 comment cards stated that they received enough information about the home to decide if it was the right place for them before moving in. The home has a comprehensive procedure about the admission of residents to its care facilities. We noted that this procedure is adhered to by Princess Alexandra and is followed by staff as required. Prospective residents who need care and/or their representatives (relative or any other person acting on behalf of the resident) normally make an application to Jewish Care to use the services that it provides. The applications are dealt with by the social workers who work for Jewish Care. Following receipt of the application the social workers carry out an assessment of the needs of the prospective resident and make a decision about the service that will be most suitable for the prospective resident based on his/her wishes or those of his/her representative’s. The manager of the care home normally visits residents to assess their needs when the residents have been identified as having nursing needs. At the same time prospective residents or their representatives receive information about the service that they wish to use and have applied for when they approached Jewish Care. Part of that information includes a service users’ guide (SUG) and a price list about the fees that are charged by the care homes that belong to Jewish Care. The SUG has in the past been assessed as a comprehensive document. We checked the care plans of three residents on the nursing units and noted that their needs were assessed either by the manager or by the deputy manager. In Newland House (the unit providing personal care) residents’ needs are normally assessed by the social workers that work for Jewish Care. Copies of these assessments by the social workers were in the care records. Discharge letters from the hospital or needs assessments that have been carried out by a local authority were also on file, if available. We were informed that the home’s contract is given to all people who move into the home to inform them of their rights and obligations. They signed the contract to show that they have agreed to the terms and conditions of staying in the home. A copy is kept in the administrator’s office. 30 out of 46 residents who sent comment cards said that they received a contract and 10 said that they have not. This might be slightly complicated as in some cases relatives may receive the home’s contract instead of residents and in other cases people who are publicly funded should also receive a copy of the contract of the funding authority with the home. It was not clear whether residents were referring to these contracts or to the home’s contract. We were informed that when residents are funded by public authorities, they are given a copy of the contract of the public authorities with the home, if one is available. The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 13 The home specialises in the provision of care and support for residents with older people needs, including nursing needs. There is evidence to suggest that management and staff in the home are familiar with the needs of older people and that residents who move into the home with these needs can expect their needs to be met. The home only accepts Jewish residents and is run according to religious and cultural practices of the Jewish Faith. The cultural and religious practices of residents are appropriately identified in care plans, providing further assurance that these needs would be met in the home. There are however a few nonJewish residents. We were informed that they practice their religion according to their choosing and that religious ministers are able to visit them to support them with their spiritual needs. These residents take the meals that are prepared in the home and choose the activities that they would like to attend. The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 14 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 content and quality of the care plans to ensure that these appropriately address the needs of residents. The healthcare needs of residents are on the whole appropriately met but the records in relation to the management of continence, pressure ulcers and pressure area care are not always that comprehensive to demonstrate how these needs are being met. The end of life care needs of residents are appropriately identified to make sure that plans can be put in place to meet these needs. The management of medicines in the home is not as robust as it should be to ensure the safety of people who use the service. EVIDENCE: We looked at five care plans. We noted that there has been an improvement in the content of the care plans. The needs of residents were on the whole appropriately assessed. The format to record the findings of the assessment of the needs of residents has been updated and a number of headings were noted including a cognitive and mental assessment, a physical needs assessment and an assessment of the social needs of residents. The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 15 The assessments of residents’ needs were on the whole appropriately completed but could have been more comprehensive. For example there were prompts to use when completing the needs’ assessment of residents. We found that not all the prompts were used which gave the impression that the assessments were not complete. In some cases information about the likes and dislikes of residents were not recorded in the section under nutrition/food. The section for sleeping did not always contain information about the time for going to bed and getting up and whether residents like to have a nap in the afternoon. However the manager said that some of these aspects/details are covered in the section ‘summary of needs and preferences’. While looking at the assessment of the needs of residents we noted that one resident did not have a physical assessment of his needs in his care record. The manager later explained that the sheet could have fallen out of the care plan. The assessments of the needs of residents also looked at the needs of residents with regards to end of life care and religious and cultural aspects of this aspect of care. All care plans that were inspected had this section completed appropriately and contained information about the wishes and instructions of residents about end of life care and funeral. The home is commended for progress that has been made in this area. Care plans were formulated to address the individual needs of residents once these were identified. We noted that on the whole care plans were appropriately written and were evaluated on a monthly basis, but there were a few areas where care plans should have been in place to address specific needs. For example a number of residents did not have a care plan to manage incontinence and promote continence and a resident at high risk of developing pressure ulcers did not have a preventative care plan in place. The home now uses a continence assessment as part of the assessment of the needs of residents. On one unit we found that this was not being used as widely as on the other units. On that same unit we looked at 2 care plans and did not find any plans addressing the promotion of continence or the management of incontinence. A resident who had a particular device to manage incontinence did not have this identified in the care plans. During the last inspection we noted that incontinence sheets were used on the armchairs of residents. This practice has now stopped as we did not see this. Out of the five care plans inspected, two did not have comprehensive manual handling risk assessments/care plans detailing the equipment to use for the various manual handling manoeuvres. This is required as not using the right equipment might result in an accident to the detriment of not only the resident but staff. The manual handling risk assessment for one of the two residents did not also reflect the fact that he/she could transfer with two staff at times and that at other times a hoist has to be used. The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 16 We found that residents experienced a good standard of personal care. Residents were clean and were dressed appropriately. Female residents had their hair done appropriately and male residents were appropriately shaved and their hair looked trimmed. The home had two residents with pressure ulcers. We were informed that the pressure ulcers were hospital acquired and that these were healing. There was evidence that the residents were referred to the tissue viability nurse as required and that appropriate action was being taken to ensure that the pressure ulcers were healing. Care plans were in place for residents who had pressure ulcers as well as wound progress notes. We however did not find pictures or wound mapping for residents who had pressure ulcers to monitor these. One resident’s care plan for pressure ulcer said ‘measure each week’, but we did not see any records of this. Staff clarified that all residents in the home were assessed for the risk of developing pressure ulcers and that care plans were in place for residents who were identified at risk. We found that a care plan was missing for one resident who was identified as being at very high risk of developing pressure ulcers. For those residents who had care plans to prevent pressure ulcers or to promote healing of pressure ulcers, we found that the items of equipment to use in bed or on the chair, were not always recorded and the repositioning regime was not always clarified. On one occasion a resident who was at high risk of pressure ulcers was referred to the primary care trust for a mattress to be made available for her, 5 days prior to the inspection. The resident had not received the mattress on the day of the inspection. This was not followed up or reported to management for appropriate action to be taken to make sure that appropriate pressure relief equipment be provided to the resident. Following the inspection, this matter was followed through and a mattress was provided for the resident within 24 hours. The care plan for a resident who had a pressure ulcer on the heel said that the heel was painful. There was a pain chart in place but the pain chart was not used regularly to review the level of pain. We did not find a care plan in place to describe the management of the pain of the resident. We found that other residents were on strong analgesics and that the pain charts were mostly used when the needs were first assessed and that these were not used regularly as a tool to manage pain. There was some equipment in the clinical room on the ground floor for resuscitation that consisted of a suction machine. We did not see mouth pieces or an ambi bag to use when resuscitating a person. We were informed that there was no resuscitation equipment that is kept on the first floor. We would recommend that the home prepares a first aid/resuscitation tray/trolley with all the necessary equipment that can be easily transported around the unit/home The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 17 in cases where first aid is required. The home should consider having such a tray/trolley in each clinical room. Residents are offered a call bell if they are able to manage one and a risk assessment is in place if they are not able to manage one. For those residents who are mobile a wireless call bell is provided. This is good practice. We looked at the management of medicines on the two nursing units and in Newland House. We noted that audits were carried out both internally and externally and training records showed that staff have had training in the management of medicines. We found that records were much better maintained than they had been in the past, but noted a number of anomalies that must be rectified to ensure the safety of residents. A resident was receiving one tablet four times daily when the instructions said to give two four times daily. The instructions for the use of cream and ointment were not always clear to describe the location and frequency of application, particularly for topical medicines that have been prescribed for pain or skin conditions. On a few occasions the medicines record charts were not always signed to show whether the medicines were administered and we did not also see codes to describe the reasons for the medicines to be omitted. While inspecting the management of medicines we found a medication error when a resident received a higher dosage of a medicine than she should have received. This was confirmed by a count of the tablets and also by the result of a blood test. Following the medication error the home took appropriate action according to its medication procedure to deal with the error. The manager stated in the AQAA that ‘We have also employed the part-time services of Jewish Cares holistic therapist who works with residents in providing end of life comfort and cognitive stimulation with other resident’s. The provision of end of life care is normally delivered to a good standard. Notices as per regulation 37 indicate that the death of residents is normally managed appropriately. There was also evidence that a few members of staff have had end of life care training and that more training is planned in this area. The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 18 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 have the opportunity to take part in a range of leisure and social activities that suits their individual needs. The home is committed to meeting the nutritional needs of residents by providing varied and nutritious meals but the meals may not always be to the taste of all people who live in the home. EVIDENCE: The home has made good progress with regards to addressing the individual social and recreational needs of residents in the care plans. The social and recreational needs were assessed and plans of care were in place to address the identified needs of residents. A ‘life history’ of the resident was also available to provide information about the background of the resident. The home normally employs a full time and a part-time activities coordinators. At the time of the inspection the full time post was vacant. However a programme of activities was still available for the home. We were informed that a volunteer had stepped in to produce the programme whilst the home continued to recruit a full time activities coordinator. We did find activities that The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 19 were arranged on a daily basis in the home, as many of the activities were led by volunteers. The home is in an enviable position where it benefits from the input of many volunteers. They not only lead on some activities but also interact with residents in groups or on a one-to-one basis. Some of the activities that take place in the home include arts and crafts, games, film shows, quiz sessions, keep fit and entertainment sessions. We noted that there was at least one entertainment session weekly. On one of the days of the inspection we noted that a volunteer gave residents tea and interacted with them. There was a small discussion about current affairs that was led by a volunteer and a volunteer manicurist was also working with residents. There was a drama session later on. We were informed that one of the lounges in Edmond House is used as a multisensory room. Feedback about this was very good. There is a programme for the use of the multi-sensory room to give all residents a chance to take part in this experience. On the second day of the inspection a Caribbean theme day was arranged in the home. There was decoration in the home to reflect the theme of the day and a lot of the meals that were provided on the day were also Caribbean. We found many people in the library, the main communal area in the home, listening to a music show following their Caribbean meals. We think that this was well organised and a number of residents said that they enjoyed their day. Residents that are accommodated in Edmond House and who are frail rely a lot on one to one activities as a lot of the activities above may not be suitable for them. The manager stated in the AQAA that the home is recruiting more volunteers to befriend and interact with these residents. The home has extensive gardens that are enjoyed by residents when the weather is nice. The weather was not that good during the inspection and we did not see residents sitting outside, but in the past we have seen many residents sitting outside. We were informed that visits by students from local colleges and schools were being arranged as part of involving the home in the local community. Outings are also arranged at least weekly in the home’s minibus, for residents to be involved in the community. According to the activities programme there are plans to go to Hyde Park, Radlet’s city Park and to the coffee shop in the neighbouring garden centre. Feedback from people who use the service suggests that the majority people are usually pleased with the activities (17 residents). 16 are always pleased The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 20 and 12 are sometimes pleased. The level of satisfaction in this area seemed to be less than other aspects of the service that the home provides. One resident said that she is not always pushed to the room where activities take place. Another said that he/she is able to choose the activities that he/she wants and a third said that he/she goes to activities when he/she feels like it. We found that relatives and visitors to the home are always made to feel welcome. They are offered drinks and are also able to have meals with the resident that they have come to see in the library area, if they give prior notice. We were informed that relatives and friends of residents are able to take the residents for outings and that the home would support this where possible. Some resident have their own phone lines while a few have mobiles to keep in touch with their relatives and friends. Other residents are able to receive and make calls on the home’s portable phone. The home offers a range of meals that are prepared according to the Jewish faith and culture. We observe lunch being served on the first day of the inspection. There were butternut squash soup, medley of fish with stir fry vegetables, angel’s steak, savoy cabbage, grilled mushrooms and sauté and mash potatoes. For desert there was a selection from fruits to apple and sultana pie. In addition to that there were additional meals for people who did not want any of the above. Feedback about the meals was most varied. Whilst to some people the above meant choice and variety to others there was not variety and choice. Some enjoyed the food and a few did not enjoy the food. For example on the day of the inspection, some people said that the steak was hard others said that it was alright. However, overall feedback about the fish medley was not good. Feedback from comment cards suggests that 24 out of 46 residents were usually satisfied with the meals, 13 were sometimes satisfied and 5 were never satisfied about the meals. 3 were always satisfied with the meals. Dinning areas on the Edmond and the Newland units were appropriately prepared and provided a congenial environment for residents to have their meals in. A few residents had their meals in their bedrooms or in the lounges. It was observed that residents who needed help with their meals were supported either by staff or by volunteers in a sensitive manner. We were informed that residents have the opportunity to make choices about their meals prior to the meals being served. We were able to observe this in practice. At times residents who did not like the food that they had chosen were offered alternatives but it was also observed that others were not offered an alternative when they did not eat their meals. The practice varied and seemed to depend on the member of staff or volunteer who served the resident. The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 21 The home has a menu for each season of the year. Residents have an opportunity to contribute and to comment about the menu in food/catering meetings that are held with the caterers and residents, albeit there have not been many of these meetings this year. Although we understand that not all people were totally satisfied with the meals we have noted the willingness of the caterers to accommodate residents’ choices and wishes. The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 22 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 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 takes complaints seriously and make sure that these are appropriately investigated and responded to within the appropriate timescale. Most allegations of abuse are taken seriously and referred to the relevant authorities as required. EVIDENCE: The complaints’ procedure is included in the service users’ guide that is offered to all residents or their representatives. The complaint procedure can also be found on notice boards in a number of areas around the home. A majority of people (39 out of 46) said that they knew how to complain, 5 said that they did not know and 2 said that there was no one to complain to. The complaint register contained complaints that have been made to the chief executive of Jewish Care and to the manager. This means that people had access to people in senior position within Jewish Care to make complaints about the service. All complaints were appropriately acknowledged, investigated and responded to within the appropriate timescale. We noted that there have been 11 complaints since December 2007. Issues raised in complaints varied from care issues to maintenance issues. Some were substantiated and others were not, but the way that judgement was reached was always clearly documented. The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 23 Since the last inspection there has been one referral to the safeguarding adult team of the Local Borough as a result of an allegation of physical abuse. This matter was appropriately referred and is being addressed. While looking at the complaints register we noted an entry about some lost items of jewellery that occurred a few months before the inspection. The manager explained the home was not sure whether this was an unsubstantiated allegation as there has been a number of things that have been reported lost by the same person and which were later found. On this occasion a judgement was made that the items that were said to be missing could have been misplaced and would be found later. The matter was recorded as a complaint but was not referred to the safeguarding adult team of the Local Borough, or the funding authority and was not reported to the Commission. The manager stated that retrospectively she should have done that. The home now keeps a record of the valuables and property that are brought by residents into the home. In the past that has not always been the case. The home has changed its policy as it is important to have a records of the valuables that resident bring into the home so that any allegations about missing property or valuables can be appropriately tracked and investigated. Training on safeguarding adult is provided as part of the induction of new members of staff and as a yearly update. We noted from training records that most members of staff were up to date with training on safeguarding adult. 12 out of 13 members of staff who responded to comment cards stated that they know what to do if a resident or a relative raise concerns about the home. The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 24 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, 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 provides a homely and clean environment. It has started with its redecoration programme, but has some way to go to raise the standard of the environment that it provides. EVIDENCE: The grounds of the home are maintained to a very good standard and residents are able to enjoy the extensive facilities that the grounds have to offer. There are large areas of lawn, mature woods, a pond and many flower beds and potted flowers. There are benches throughout the grounds and many covered areas for residents to use if they wish to sit outside. The home was clean and mostly free from odours, except for one bedroom where there was a slight odour as a result of a spillage. There was evidence that staff had shampooed the carpet to address the odour issue. The majority The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 25 of residents (29 out 46 residents) supported the view that the home is always clean and fresh, 13 said usually, 3 said sometimes and 1 person said never. The communal areas were all in an appropriate state of repair and were furnished appropriately. The focus of the home seems to be the ‘library’, a large communal area with many books on shelves, where most of the group activities seem to take place. This is also an area that is used by visitors to sit with their loved ones that they have come to see. The other communal areas in the Newland and Edmond Houses were also in good condition, appropriately furnished and used by many residents. One of the lounges in Edmond House tends to be used as the multi-sensory room for all residents to enjoy. There was evidence of ongoing maintenance and redecoration. The home started with its plan to overhaul the physical environment of the home around the time of the last inspection, in September 2007. According to the AQAA, four corridors and the surgeries in Edmond House have been refurbished. We noted that there was still a long way to go, to overhaul all the physical environment of the home. The corridors on the first floor of Edmond House have not been redecorated yet. The carpet on that floor and on the first floor of Newland House has also not yet been changed. We were informed that the carpet would be replaced as the floors were being decorated. It must be noted that we asked for the carpet to be changed during the inspection in January 2007 because at that time it looked worn and passed its useful life. The manager states in the AQAA that ‘Due to financial constraints we are unable to improve the environment as speedily as we would like to’. Bedrooms were on the whole appropriately decorated and in a good state of repair. These were personalised to a good standard and there was evidence that residents had brought personal items with them to make their bedrooms more homely. The manager stated in the AQAA that two bedrooms have been converted into en-suites. We noted that the home had carried out an audit of the environmental facilities in the home with regards to access for people with poor mobility, particularly in relation to toilets and bathroms . A few toilets and bathrooms have been refurbished, environmental adaptations have been made and disability equipment have been provided to take the needs of people with impaired mobility into consideration, but there was still improvement to be made in this area. Many toilets, including those in the en-suite do not have grab rails to promote the independence of residents with impaired mobility. The sluice areas were on the whole clean and tidy. We saw an empty urine bag in the en-suite of the bedroom of a resident, that should have been disposed of in the sluice. We also saw washing bowls on the floors of en-suite The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 26 and some urinals that would benefit from cleaning. The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 27 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 good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides appropriately trained nursing and care staff in adequate numbers to care for residents. The home ensures that robust recruitment practices are in place to protect people who use the service. EVIDENCE: There has not been any significant change in the staffing levels that are provided by the home since the last inspection. The home normally has one trained nurse and four carers during the day and one trained nurse and two carers at night for the ground floor of the Edmond House (twenty residents). There are two trained nurses and five carers for the day and one trained nurse and two carers for the first floor of Edmond House (twenty residents with nursing needs and five residents with personal care needs). There are five carers during the day and two carers during the night for Newland House. The majority of residents (25 out of 46) felt that staff are usually available when they need a member of staff and 11 stated that staff are always available when they need one. General feedback from residents and their relatives suggests that staff are helpful, nice and friendly. Residents also seem The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 28 to indicate that at times there may be a shortage of staff and that they do not get attended according to their expectations. Comments included the difficulty to find a member of staff at night and sometimes staff do not always have time to attend to them. The manager stated that the home has a vacancy of about ten carers and that some of the shifts are covered by bank staff and that a lot of the shifts are also covered by agency staff. Some permanent members of staff and residents said that as agency staff might not know residents as well as permanent staff, there might be more pressure on permanent staff to care for the residents in the home. This could explain some of the negative comments about staffing. Feedback from staff also seems to support the views above. The feedback paints a picture of ‘committed members of staff’ who ‘maintain a high standard of care’. The majority stated that most of the times there are not enough staff to attend to residents. They said that agency staff is used to maintain the numbers and that agency staff do not always know the home or the residents that well. The manager stated that the recruitment process would continue to make sure that the home is fully staffed and that she chooses staff carefully taking into consideration their competency and their possible contribution to improving the service. She said in the AQAA that ‘due to increasing levels of dependency of residents we will apply for increased care hours in the next budget to ensure that we have sufficient staff cover during busy periods of the day’. The manager reported that the home provides more staff at busy times or when residents have to go for outpatient appointments and need escorts. As a result of the above we are of the view that the home does provide adequate numbers of staff and that there may be additional pressure on current staff due to the lack of permament members of staff. This will be addressed with the recruitment of more staff. The feedback of staff about the support that they receive from management was varied. 4 said that they regularly get the support from their manager, 5 said often and 3 said sometimes. Comments included : ‘the management team delegates tasks to staff’; ‘the managers do not give enough support’; ‘staff receive regular one to one sessions’; ‘need more support from management’; and ‘they(management) shout at times’. The majority (9 out of 13) said that communication usually works well in the home and 4 said always. There is therefore some margin for improvement as communication should always work well, as far as possible. We looked at the personnel files of four members of staff. We noted that all The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 29 checks were carried out as appropriate prior to employing the members of staff. There were appropriately filled application forms, CRB checks and evidence that appropriate references were received and that checks were made about the eligibility of the applicants to work in the UK. Induction in the home consists of 10 days based at head office where staff learn about Jewish Care (the organisation) and Jewish culture. The induction also includes training in statutory areas such as fire, manual handling and safeguarding adult. 12 out of 13 staff said that induction mostly or very well covers everything that they need to know to do their job. Staff go through a probationnary period and each new member of staff is allocated a mentor who meets with him/her regularly to support him/her during that period and to monitor his/her progress. There was also evidence that staff were receiving one to one supervision at least six times a year. The home is commended for progress that has been achieved in this area. Inspection of the training records showed that most staff members were up to date with statutory training. There has also been training in clinical areas such as medication training, mental capacity and end of ife care. 11 out of 13 members of staff said that they receive training that is relevant to their job. According to the AQAA 27 out of 38 care staff have an NVQ 2 qualification in care or above. The home therefore does have more than 50 of care staff (71 ) trained to NVQ level 2 or above. The home is commended for this. The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 30 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 good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is appropriately run and managed in the interest of people who use the service and to ensure their welfare. The home has a comprehensive quality management system to monitor the quality of the service that it provides. The management of the personal money of residents is carried out to a good standard to prevent abuse. Most health and safety issues in the home are managed appropriately to ensure the safety of all people who use the service and premises. EVIDENCE: The manager has been in post for nearly two years. She has managed other care services prior to Princess Alexandra and has worked in senior managerial position within Jewish Care. She is registered and has qualifications in nursing and in management. She is supported by a deputy manager and line The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 31 management from Jewish Care. Jewish Care has a comprehensive management structure to support the care homes. There was evidence of regular staff meetings that are attended by the manager or the deputy manager. Minutes of the meetings were available for inspection. Items on the agenda included care practices, records keeping, medication and other aspects of the service that the home provides. The home has a quality assurance procedure. We were informed that a quality assurance director has been appointed to oversee quality management within the organisation. A new quality control tool has been developed based on the Key Lines of Regulatory Assessment (KLORA) from the Commission. This tool has been used on one occasion to assess the quality of the service. An action plan was produced after that audit. The manager stated that an audit using that tool will be carried out yearly. The result of the last residents’ survey was available for inspection in the form of a report that detailed the areas where people think that the home does very well and areas where it does not do so well. The report also contained a list of recommendations to address the areas that needed improvement. This is good practice. The management of residents’ money consisted of residents/representatives keeping some cash with the administrator of the home for day to day expenses. The home did not manage the social benefits of any of the residents. There were records of the receipts of residents’ money and receipts when the money was spent. We checked the accounts of two residents chosen at random and noted that records were kept comprehensively and that receipts were kept for expenditures. There was evidence of regular checks of the management of residents’ money by the manager of the home and by the administration section of Jewish Care. We looked at the records that the home keeps with regards to health and safety aspects of the service. We noted that the records were not very well kept during the early part of the year and that for the past two months there had been a considerable improvement in the content and quality of records that were kept. At the time of the inspection we found that all the safety certificates were in place and that appropriate checks on fire detectors, fire emergency lights and water temperature were carried out. We saw records to show that a number of fire drills were carried out during the day. We did not see evidence of a fire drill that took place at night. We recommend that a fire drill be carried out at night. There was evidence that the water system was maintained to reduce the risk of legionella. Lifts and hoists were also checked as required for safety. The The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 32 home had an up to date fire risk assessment, health and safety risk assessment and an emergency fire plan. We noted that most of the window restrainers of the windows on the first floor of the Edmond unit were easily disabled by hand and as a result could be fully opened. The guidance from the Health and Safety Executives states: Restrictors should be types that can only be disengaged by means of a special tool or key. (HSE, Local Authority Circular, LAC 79/6. 2007. Falls from windows in health and social care settings. Paragraph 29) As a result of the above all windows must be checked according to the home’s risk assessment to make sure that they are fitted with a type of restrainer that can only be disabled with a special tool or key as it is the responsibility of the provider to ensure the safety of residents who use the premises. The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 33 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 3 8 2 9 2 10 3 11 3 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 2 2 X X 2 x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 X 3 x x 2 The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13(5) Requirement All manual handling risk assessments/care plans must be kept up to date and must be clear about the equipment and action to take to move residents in a safe manner. In cases where residents are assessed at high risk of developing pressure ulcers a care plan must be in place to address the prevention of pressure ulcers. This must include information about the equipment to use and the repositioning regime to prevent pressure ulcer from developing. Those residents who have wounds pr pressure ulcers must have a photo or wound mapping to monitor the progress of the wounds/ulcers. To prevent pressure ulcer from developing, pressure relief equipment must be provided without delay when residents have been identified at high risk of developing pressure ulcers. That pain charts are used DS0000022938.V367071.R01.S.doc Timescale for action 31/10/08 2 OP8 17(1)(a) 31/10/08 3 OP8 16(2)(c) 31/10/08 4 OP8 12(1) 31/10/08 Page 35 The Princess Alexandra Home Version 5.2 5 OP8 17(1)(c) 6 OP9 13(2) 7 OP18 13(6) 8 OP19 23(2)(d) 9 OP22 23(2)(n) 10 OP26 13(3) regularly to monitor the management of pain of residents who have pain and are on strong pain killers, and not just when the pain is initially assessed. There must be a continence assessment for all residents and a care plan must be in place to meet any identified needs of residents. That medicines be administered as prescribed and with due care to prevent mistakes that can be detrimental to the welfare of residents. The instructions to administer medicines, including topical medicines, must be clear to make sure that staff are administering the medicines appropriately. To demonstrate that the home take issues about safeguarding adult seriously, the appropriate safeguarding adult procedure must be followed when allegations of abuse are made or when there are suspicions of abuse. The registered person must set out a plan with appropriate timescales for the refurbishment of the home, including replacement of the carpet. A copy must be provided to the Commission. Disability equipment and environmental adaptations must be provided in all areas that have been identified as needing them, such as toilets (including the en-suite) and bathrooms to meet the needs of all people who use the service. That all clinical waste is disposed of appropriately, that washing bowls are stored appropriately and that urinals are clean as DS0000022938.V367071.R01.S.doc 31/10/08 15/10/08 31/10/08 31/10/08 30/07/09 31/10/08 The Princess Alexandra Home Version 5.2 Page 36 11 OP38 13(4) appropriate. To reduce the risk of residents falling from a height there must be a review of the restrainers that are in use in the home as they must not be easily disabled by hand and must be of a type that can only be disabled by special key or tool. 31/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations All the prompts in the format for the assessment of the needs of residents should be completed as far as possible to provide as much information as possible about the needs of residents. We recommend that the home prepares a first aid/resuscitation tray/trolley with all the necessary equipment that can be easily transported around the unit/home in cases where first aid is required. The home should consider having such a tray/trolley in each clinical room. It is recommended that a fire drill be carried out at night for all staff to be familiar with the action to take in case of a fire. 2. OP8 3 OP38 The Princess Alexandra Home DS0000022938.V367071.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. 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