Inspection on 06/02/06 for The Princess Alexandra Home

This inspection was carried out on 6th February 2006.

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

The inspector 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 19/08/08

The Princess Alexandra Home 11/09/07

The Princess Alexandra Home 16/01/07

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 Bernard Burrell Unannounced Inspection 6th February 2006 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.V282976.R01.S.doc Version 5.1 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.V282976.R01.S.doc Version 5.1 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 Ms Gaby Wills 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.V282976.R01.S.doc Version 5.1 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 12th July 2005 Brief Description of the Service: Princess Alexandra Home is registered to provide residential and nursing care accommodation to up 72 elderly people, including one respite bed. The home is a large detached property set within extensive grounds in North Harrow. The home offers two rooms suitable for couples and the rest of the rooms are single occupancy, many with en-suite facilities. There are several communal rooms including lounges, dining areas, a library, an activities room, two medical consulting rooms, four lifts and a multi-faith prayer room. Kashrut is strictly observed and is overseen by a Jewish Cares Shomer (religious) supervisor. The home has been in private ownership since 1952 but had a change of ownership in 2002 when it was taken over by Jewish Care. The new owners made a commitment of continued care to all existing service users and at the time of this inspection, the home still had non-Jewish residents. The home continues to respect and value the needs of all its residents. Special needs and diets plus individual preferences are catered for. Planning permission has been approved by the local council for Jewish Care to redevelop the site to include nursing, dementia and residential day care services. The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out in one day with input from the staff, deputy manager, residents, relatives, health and social care professionals. The inspector spoke to several residents and gained invaluable information about their varied experiences of life at the home. The inspector examined various staffing files, administrative, general maintenance and operational records as part of the inspection process. In addition, the deputy manager provided updates about the range of services and upgrading work being undertaken since the last inspection visit. The home had a core of permanent staff, many of whom have been working at the home for several years. There was plan to recruit more bank staff to supplement the current permanent staffing cover. The home does not use agency staff. The inspector was satisfied the home continues to offer satisfactory levels of services to the residents as well as meeting their individual and collect care needs. Work is still ongoing to replace the care plan system to make each one more person centred but progress continues to be slow in this area. The home has a multi-faith prayer room that meet the diversified religious needs of its residents. What the service does well: The majority of residents reported that they felt most of the staff working at the home are committed to providing care that meet their individual needs and preferences. Some reported that they felt staff members enabled them to develop their independence, choice and the promotion of their dignity. The weekly operational meeting at the home incorporates workers from the various units. This is helping to build a unified staff team and the development of their knowledge, awareness and understanding of the operation of the home and the needs of the residents. Residents are supported to exercise individual choices, where they spend their time, the activities they engage in and where they choose to have their meals. The home has cultivated and encouraged good communication links and open forum with the residents, their relatives and other stakeholders. The Resident’s and Relatives Forum are held regularly and provide the opportunity for open The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 6 discussion and debates about issues at the home and those concerning residents. The home has a transparent and effective complaints system that appeared to be working effectively to the benefit of residents and other stakeholders. The management is also actively encouraging residents and their relatives to utilise the complaints procedure. A good range of training and professional development opportunities are available to staff, including mandatory training in key health and safety matters such as adult protection, safe care handling and lifting, food hygiene and the NVQ qualifications. Staff are well supported by each other and senior managers and there was good supervision planning system in place. The home has adequate procedures and monitoring systems in place to help promote health and safety of residents and all who work at the home. Appropriate risk assessments are carried out and reviewed regularly. In addition, the home has a well resource and administrative staffing team, including a range of leisure and social activities to interest residents. What has improved since the last inspection? Improvements have been made to the physical environment of the grounds around the home, including the walk/drive ways. New carpets have been installed in various areas of the home. At the time of this inspection visit, the home was undergoing extensive upgrading and rebuilding work in several areas, including redesigning of the reception area. Improvements and installation of carpet have been made to the main walkway leading from the library to the kitchen, dining and other areas. In addition to the work stated, access for people using wheelchairs has been improved by widening the doorway leading from the reception to the library, lowering the threshold between the library and the patio and the erection of a new ramp from the garden room (previously the smoking lounge) to the patio. The social care coordinator who covered this post during the long-term absence of the previous post holder has recently been appointed to this post, which she shares with another member of staff. In addition to a varied programme of activities that includes theatre outings and relaxation sessions, a ‘night club’ has been running on Thursdays with an active involvement from young volunteers who engage some 15-20 residents who attend this popular evening activities. The review of the medication for each resident is now carried out every 6 months by the GP. The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 7 The former smoking room has been upgraded and is now used as a relaxing area by residents. The end of life issues and palliative care have improved since the last inspection. There are now active links being formed with local palliative care team, including the Motor Neuron Society and palliative care team. A new policy has been developed to address some of the concerns raised by relatives of residents at the home. At least 50 of the care support staff have now completed the NVQ training, this is supplemented by the introduction of additional training programmes, including understanding dementia and motor neuron disease. What they could do better: The manager should continue to ensure that the work being undertaken to improve the care planning system is kept under regular review to help ensure they are more person centered and reflect the daily experiences of each resident. The provider must ensure that more effective measures are put in place to help improve the general security of residents’ and staff personal properties and minimise the incidence of theft at the home. The provider must ensure work is carried out to minimise the clutter in the kitchen areas and provide additional and safe storage for durable food products. More effective monitoring by the management is needed on the night and weekend shifts to help ensure all staff are performing their duties and responsibilities responsibly. The manager and staff must ensure that all residents who have visual or other severe physical or mental health difficulties or problems are listened to, treated with respect, equality and compassion at all times. The manager must also ensure that staff breaks are planned and managed in ways that do not compromise the care and support offered to residents. The manager must ensure that all residents receiving incontinence care receive regular monitoring and review of their care in this area. The manager must also ensure that referrals for incontinence service are made on time to the relevant professional agencies. Relatives must also be kept fully updated of progress or problems relating to this area of care. The manager should ensure that the end of life issues are addressed and plans are put in place to manage these with dignity and open communication and updates to all concerned. Please contact the provider for advice of actions taken in response to this The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 9 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.V282976.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. The home has adequate and updated information, systems and procedures in place that are used to carry out appropriate care needs assessments plus enable prospective residents to make informed choices whether to move in or not. EVIDENCE: The inspector examined a number of printed booklets and leaflets and was satisfied they provided invaluable information and guide to prospective residents. These included a service users’ guide, statement of purpose, relatives’ handbook, introduction to Jewish Care and a guide about preparing and paying for residential and nursing care. The inspector was informed that the service users’ guide would soon be available in audio format to meet the needs of people with visual impairment. The inspector had discussions with several residents about their initial experiences when they were planning to move to the home. Each resident reported satisfaction with the admission procedures and the fact they were invited to visit the home, spend time meeting residents and staff plus experience some of the activities on offer, including meals. The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 11 The assessment records examined by the inspector indicated that the management of the home carries out its own pre-admission needs and dependency assessments for each prospective resident. This is in addition to assessments provided by placing authorities such as hospital discharge units and social workers/care managers. There was evidence to verify that relatives of residents also make input and contribution in the assessment process. A formal letter is sent to either the prospective resident, their next of kin or placing authorities about prospective admission. The following documents are also sent to prospective residents: copies of the relatives handbook, service user’s guide, property, money and valuables disclaimer, weekly menu, home staffing structure, calendar of activities, laundry service explanation and disclaimer. In addition, when a new resident moves to the home, they meet with an assigned key worker who assists with completing the ‘Getting to know you’ form. This aims to gather more personal and biographical information about each new resident. Some of this information is then incorporated into care planning. The inspector was satisfied that new residents are therefore provided with adequate information about the services, facilities and support systems to help them make informed decision about whether their needs can be adequately met at the home. The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9,10, The resident’s benefit from good care support from staff plus access to a range of medical and nursing care services. Many residents are proactive in monitoring their health care needs and medication administration. EVIDENCE: There were recorded health and nursing care assessments for each resident at the home. These included risk assessments, details of prescribed medication, health and nursing care guidance for care workers and nursing staff, plus details of medical appointments. The inspector noted that a new format of person centered care planning has being developed for each resident and at least 85 percent of residents had the new format at the time of this inspection. When this exercise is completed, it should enable more comprehensive and up to date health and social care information for all residents. The inspector also noted that there were good examples of carers adapting care practice to meet changing needs of residents. However, this area will need on going monitoring to help ensure this practice becomes standard. The deputy manager informed the inspector that changes to residents care plans The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 13 are discussed and agreed with the managers, staff, relatives and medical professionals. Four general practitioners (GPs) provide a weekly surgery at the home plus a 24-hour call out service. Residents also have the choice of remaining with their own GP or transfer to a GP assigned to the home when they move in. The home also has services provided by a visiting physiotherapist, chiropodist, optician and dentist. Other specialists such as dieticians and tissue viability nurses are also available to residents. These are all NHS services, but residents have the option to make their own arrangements to consult private practitioners. There was evidence of staff training in a range of health care matters, including manual handling, prevention of falls, Parkinson disease, MRSA, medication administration and various NVQ level courses. The CSCI pharmacy inspector carried out an inspection at the home in July 2005. The findings indicated the homes’ medication policy was available in each clinical area and covered areas of good medicine management and practice. The home also had a policy on self-administration of medication for those residents who self-medicate. They also had lockable cupboards to store their medication plus risk assessments were in place. At the last inspection, the administration of medication was found to be generally satisfactory and several shortfalls were identified. During this inspection, the deputy manager updated the inspector about the changes in medication administration that have taken place, including reorganisation of the ordering and auditing system. The managers and senior nursing staff are now carrying out better monitoring of the administration of medication, including checking the signatures of nursing staff on the MAR charts. Medication is also reviewed by the GP every six months. A pilot project has also started with the local Primary Care Trust (PCT) relating to offering more effective palliative care treatment and services. The feedback received, indicated that more effort is needed to help ensure that all residents receiving incontinence care receive regular monitoring and review of their care in this area. Relatives must also be kept fully updated of progress or problems relating to this area of care. The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 14 The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The residents live a varied, fulfilling and culturally rich lifestyle at the home and in the local community. The resident’s benefit from variety and choices in the meals provided and reflective of Jewish culture, traditions and customs plus the dietary needs of some residents. EVIDENCE: The inspector spoke with several residents and received feedback from many others about their experiences and views of life at the home. The inspector also received a number of written feedback from social and medical professionals, plus relatives of residents. The inspector also examined minutes of the relatives and residents’ forums and meetings. The inspector also had discussions with the deputy manager and some staff about the range of cultural, social and recreational activities offered to residents. The findings indicated a general level of satisfaction among residents with their life experiences at the home. Most residents reported that their expectations have been partially to fully met and they continue enjoy many of the activities offered, including ones that are reflective of individual interests. Among the comments received included: “we would like to say how happy we are with the care our relative is receiving. Thank you very much for all your kindness to her care.” Another relative wrote: “ I do not have a lot of The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 16 experience of old age homes, but in my humble opinion, this must be a model home- it is warm, caring and homely. I am sure there can be no better home to look after my mother.” The resident’s and relative’s meetings are held each month and are well attended. The recordings of the minutes showed that a range of issues have been discussed, including: catering, health and safety, attitude of a few care staff to residents, recruitment of volunteers, evening and social clubs, budgets and fundraising, refurbishment and general maintenance, arrangements for visitors and provision of adequate staffing cover to all areas of the home. At the time of this inspection, the social care coordinator who covered this post during the long- term absence of the previous post holder was recently appointed to this post, which she shares with another member of staff. In addition to a varied programme of activities that includes theatre outings and relaxation sessions, a ‘night club’ has been running on Thursdays with an active involvement from young volunteers who engage some 15-20 residents who attend these popular evening activities. Among the social and cultural activities on offer at the home are: outings, day trips, VE Day celebrations, church and Shabbat services, film shows, quiz games, talk and relaxation classes, library facilities and personal grooming. The feedback received from relatives of residents indicated that they are pleased good effort is being made by the management and staff to cultivate and maintain links in the Jewish and wider communities. The inspector’s discussions with some residents indicated many are independent in exercising choices and leading semi-independent lives at the home. Most residents reported they felt valued and respected by most staff and that their views are listened to. Those residents with more high dependency needs received additional support from care staff, relatives, volunteers and other stakeholders. However, a few relatives and residents reported they were unhappy with the attitude, lack of commitment and mannerism of a few staff, especially those on late and night shifts. The planning for the menu and catering continues to be discussed at various forums/meetings and has generated changes that included a new salad bar plus training for the catering staff in understanding and preparation of Jewish and kosher meals. The inspector was impressed with the range of dishes offered to residents on the day of this inspection. Some residents reported they were generally satisfied with the quality and presentation style of meals. The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The views and concerns of the residents, their relatives, advocates and next of kin are listened to and taken seriously by the management. The home’s complaint policy and procedure guidelines are transparent with appropriate systems in place to deal with complaints. EVIDENCE: The home had an up to date complaints policy and procedural guidelines with full details about its usage. The inspector noted there were additional notice posted at various places at the home giving information about resident’s right to complain and how the should go about this. The notice informed residents of the various external agencies where complaints and concerns can be referred; included the CSCI, police, Jewish Ombudsman at the Board of Deputies of British Jews, primary care trusts and local authority adult protection departments. The home maintains a complaints logging system that is kept under review and updated. The inspector was satisfied that the recorded complaints examined were dealt with according to the home’s procedural guidelines with satisfactory investigation and outcomes. The residents who spoke to the inspector indicated they use the residents’ meeting and relatives’ forum to register their views, concerns and general complaints. There were examples of complaints made about the quality, choices and taste of foods. The Food Quality and Standards Executive officer visited the home, had meetings with the residents and offered the necessary support and training opportunities to the catering staff to help improve the problems. The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 18 The inspector also received a few written responses from the relatives of residents on matters relating to consistency in the duty of care among some night and weekend shift work staff. There were also written information in the feedbacks received by the inspector relating to concerns about the management of incontinence, medication review and a few staff who are reportedly ‘abrupt, heavy handed and insensitive’ when interacting with some residents. The training records examined plus discussions with the manager and some staff indicated training has been offered in adult protection issues. This is in addition to the appropriate pre-employment checks undertaken when new staff are recruited to work at the home. The inspector also noted that disciplinary meetings have taken place between management and staff relating professional conduct. Information received by the CSCI and records examined by the inspector during this and previous inspections, indicated the incidents of thefts continue to be a problem at the home. They involved the stealing of the personal items from the rooms of few residents and staff. The manager reported that the police have been notified in each case. The management have advised residents they can take the preventative options of locking their rooms when they are out and keep valuables in the lockable facility in their rooms. The main security safe has also been offered to residents as a preventative option. The management has also advised relatives that personal loss of valuables is not covered by the home’s insurance and that personal insurance policies can be taken out by individual residents to cover losses. The management and provider are also exploring the possibility and legal implications of installing surveillance cameras at key locations inside the home. The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 25, 26 Various areas of the home’s internal and external environment have undergone major improvements to enhance the physical appearance and comfort plus maximise the safety for residents, staff and visitors. The overall appearance of the home was clean and pleasant. Work is still needed to modernise and expand the kitchen area and storage facilities. EVIDENCE: The inspector met with the home’s maintenance manager at the last inspection visit. He gave a detail update about the areas identified in a site review inspection carried out in March 2005 by Jewish Care. The report identified 25 areas as needing upgrading and repairs, including refurbishment of the reception area, asbestos remedial work, repair work to the main dining room and roof, new alarm systems to doors and conversion of smaller rooms into larger ensuite bedrooms. In addition to the work stated, access for people using wheelchairs has been improved by widening the doorway leading from the reception to the library, The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 20 lowering the threshold between the library and the patio and the erection of a new ramp from the garden room (previously the smoking lounge) to the patio. During this inspection visit, the inspector also noted that renovation and upgrading work was on schedule. Refurbishment and new carpets have been carried out to several resident’s bedrooms and the main corridor leading from the library to the kitchen and dining areas. Several residents commented to the inspector about their satisfaction with these improvements. The inspector was of the view, the improvements are helping to enhance the overall look of the home and provide better comfort for residents and visitors. The inspector noted that the kitchen areas was still cluttered and storage space for food items continue to be limited. A number of the equipment in the kitchen were also dated and needed replacement. The inspector noted that good effort has been made to improve residents care where needed, including securing assistance and equipment from external professional and care support agencies such as occupational therapy departments. The inspector noted that records for fire safety and other electrical and environmental checks were carried out with review timescales. There was notification posted about health and safety meetings planned for 2006. The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29,30 The home is managed and operated by managers and staff who have the competences, appropriate skills, experience and supervisory support. There were appropriate recruitment policy and practices in place that help to ensure the protection of residents. . However, more effective monitoring is needed of the performance of all staff, including the night and weekend shift staffing. EVIDENCE: The deputy manager provided evidence of the staff allocation for each shift. At the time of this inspection, personal and nursing care is provided over 24 hours daily by a team of nurses and care assistants. Personal residential care is provided in Newland House and personal care with nursing is provided in Edmond House. All communal areas are accessible to residents of both houses. A senior nurse and carer supervised each shift and the deputy manager has overall supervisory monitoring responsibility. The deputy manager provided the following statistical information regarding work allocation. There are 9 carers during the morning shift, in the nursing units 5 on 1st floor and 4 on the ground floor), this has been lifted since 1st April to 10 – 5 up and 5 down) in the afternoon there are 8 carers in the nursing unit – 4 on 1st floor and 4 on the ground floor. Since January 2006, new staff attend a 2 weeks induction training which includes topics ranging from health and safety, care issues to literacy and Jewish way of life’. The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 22 The deputy manager stated that both he and the registered manager carry out period monitoring checks during the night periods. He also indicated that there are plans to recruit a permanent senior worker to manage the weekend and night shifts. The inspector reviewed the home’s recruitment policies, procedures and training records. The evidence indicated satisfactory procedures are in place to help ensure that only staff with the appropriate professional experience and skills are recruited. There were evidence of relevant references including employment, CRB checks and Nursing and Midwifery Council (NMC) verification taken up for each for each staff, including volunteers. The Home is also registered with the NMC for providing supervised placements for oversees nurses. One nurse has completed her adaptation and another is due to finish in August. Each new staff is given induction across all shifts led by an experienced carer or nursing staff. Each new staff is also given a 12 weeks probation before permanent confirmation of their employment. Supervision is also offered to each staff every two months. There were examples of a range of training programmes on offer to staff, including NVQ, health & safety, manual handling, adult protection, care planning, administration of medication and other relevant areas related to their roles and responsibilities. The inspector had discussions with several residents plus received feedback from many others. The overall view was that they are satisfied that most staff are committed to providing them with good quality care and support. The keyworker system also helps residents to feel their individual care needs and concerns can be addressed individually, promptly and satisfactorily. There were recorded evidence of staffing issues and disputes being managed professionally and in line with the policy and procedural guidelines of the home and Jewish Care. The managers have undertaken to have joint staff meeting involving the night and day shift staff. It is hoped this exercise will help to address the problems identified in complaints from residents, their relatives and external professionals. It is also hoped this meeting will help to plan more effective, consistent and responsive approaches to the delivery of care. The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35, 36,37,38 The home is being managed properly with sound leadership, support and guidance from the manager and deputy manager. There were good examples of operational practices that help to promote and safeguard the welfare, health and safety of residents. EVIDENCE: The home is managed appropriately by the manager and deputy manager. Both of whom have relevant professional experience in residential and nursing care. Additional support is also received from senior nursing and care support staff and managers from the parent organisation, Jewish Care. The residents, staff, relatives and external professionals who communicated with the inspector, gave examples of what they view as positive practices and approaches at the home. They listed issues such as supervision, training, public forums and meetings. Staff also reported they felt supported and are able to carry out their roles and responsibilities with confidence. The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 24 At the last inspection, the administrator provided written evidence of the home’s accounting and financial matters, including the management of resident’s money. These appeared to be in order with appropriate accounting systems, checks and monitoring. Residents who are self-funding received contracts and Jewish Care have corporate contracts with several local borough social services departments. There were also individual contracts arranged with other local authorities. The financial documentation reviewed by the inspector showed that the families of about 30 residents have power of attorney over their financial matters. At the last inspection, about 4 residents were managing their financial matters independently, 3 residents had solicitors and over 60 residents had their pension accounts managed by their relatives. Most residents have personal accounts for hairdressing, newspapers and other expenses. These are kept topped up by their families who receive statements of expenditure on a regular basis from the home. Jewish Care also makes available to each resident or their relatives/next of kin a written explanation of charges as part of the terms and conditions of residency at the home. There was recorded evidence of adequate programme of supervision for each staff. The deputy manager also gave satisfactory verbal information to the inspector of how the supervision and appraisal system works. In addition, the inspector reviewed minutes of the home’s operational business meetings held between August and December 2005. The information recorded indicated comprehensive discussions and planning took place. These involved matters relating to general maintenance, health and safety issues, nature of care support received from staff, staff recruitment, activities for residents, risk assessments and individual and communal residential matters. The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 25 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 4 3 3 3 4 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x 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 3 3 x 3 x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 x 3 3 3 3 3 The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP18 Regulation 10,12,13 Requirement Timescale for action 30/04/06 2 OP28 10,12,13, 18,22,23, The provider must ensure that more effective measures are put in place to help improve the general security of residents’ and staff personal properties and minimise the incidence of theft at the home. 30/04/06 The manager must ensure that more effective monitoring is carried out on the night and weekend shifts to help ensure all staff are performing their duties and responsibilities responsibly. The manager must also ensure that staff breaks are planned and managed in ways that do not compromise the care and support offered to residents. The manager must continue to ensure that all residents receiving incontinence care receive regular monitoring and review of their care in this area. The manager must also ensure that referrals for incontinence service are made on time to the relevant professional agencies. 30/04/06 4 OP8 12 The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 27 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 7 Good Practice Recommendations The manager should continue to ensure that the work being undertaken to improve the care planning system is kept under regular review to help ensure they are more person centered and reflect the daily experiences of each resident. The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Princess Alexandra Home DS0000022938.V282976.R01.S.doc Version 5.1 Page 29 - 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. 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