Care Home: Alexander Family Nursing Home

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What the care home does well All the verbal feedback we received from the people who use the service and staff that work there was in the main very positive about the home. Typical comments made by one person who lives there included - `I cant say there’s anything particularly wrong with the place’, ‘if I wasn’t happy here I would soon let them know’, and ‘it’s a pretty good place to live really and staff normally let me do my own thing’. All the people who use the service we spoke with at length told us they could always choose what they ate, what time they got up, what they wore, and when they went out. They also said most of the staff who worked there were good listeners and knew what their likes and dislikes were. For example, one person who uses the service told us the chef was aware they didn’t like a particular vegetable and made sure they never served them it. This understanding of the wishes of the people who use the service has been helped by the fact that the home continues to experience relatively low rates of Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 staff turnover, thus ensuring the people who live there receive continuity of care from lots of experienced staff who are familiar with their needs and preferences. We agree with the statement made by the proprietor in the homes AQAA that the place has a ‘homely atmosphere as opposed to an institutional one’. The physical layout and interior décor of this purpose built home makes the entire place look and feel very spacious, comfortable, and above all homely. Its chalet style design lends its self well to non-institutional ‘small’ group living. All the staff we met during the course of this two day visit, which included a domestic cleaner and a maintenance man, were observed interacting with the people who use the service in a very kind, respectful, and professional manner. The atmosphere in the home remained extremely relaxed and congenial throughout this inspection. What has improved since the last inspection? All the requirements and good practice recommendations we made in the services last inspection report have been met in full within the agreed timescales for action. The vast majority of outstanding requirements we made in the homes previous report pertained to staffs poor medication recording practices. We found evidence that showed us staff authorised to handle medication in the home (i.e. the duty nurses) have significantly improved their practise and now keep more up to date and accurate records of all the medicines, creams, and dressings used in the home. The homes staff recruitment arrangements have all been improved as required in its last report. All the personal files kept in respect of the homes three most recently employed members of staff contained all the relevant information and checks the service is legally obliged to carry out. As recommended in the homes last report a number of the people who use the service who do not have any direct family involvement in their care were given the opportunity to apply for an independent advocate to represent them. The range of social and recreational activities the people who use the service now have the opportunity to participate in has also improved in the past year as recommended in the homes last report. The people who use the service are engaging in a lot more meaningful and stimulating activities, both within the home and in the wider community.Alexander Family Nursing HomeDS0000019070.V378591.R01.S.docVersion 5.3 What the care home could do better: All the positive comments made above notwithstanding the proprietor and all the duty nurses we met acknowledge the service is far from ‘perfect’ and that there is room for further improvement. In this report we have made six new requirements and seven good practice recommendations for the provider to implement: To ensure all the people who use the service and/or their representatives are made aware of the current range of fees the provider charges for services and facilities provided the homes Guide must be revised to make it more transparent and include costs. Care plans should also be revised to include more detailed information about the unique abilities and strengths of the people who use the service. All the people who use the service should have more opportunities to live their life as independently as they can and have their willingness and capacity to take greater control of their own medication and financial affairs assessed. To ensure all the people who work at the home always have the right knowledge and skills to meet the needs and wishes of the people who use the service staff must have more opportunities to refresh their training. We recommend the provider carries out a thorough assessment of its workforce’s strengths and training needs, and establish a time specific training programme to address any gaps in staffs knowledge and skills. Furthermore, we also recommend staff receive training in understanding the Mental Capacity Act and Deprivation of Liberty Safeguards. We agree with the statement made by the proprietor in the services AQAA that - ‘Over the past 12 months the home has improved its supervision systems’. However, there remains consderable room to improve the way duty nurses keep records regarding the outcome of these one to one supervision meetings with support workers. To minimise the risk of people who use the service being scalded in the bath the provider must ensure the temperature of hot water used in the home never exceeds a safe 43 degrees Celsius. Also, the privacy and dignity of the people who use the service must be respected at all times and therefore the use of CCTV cameras in the home should be restricted to external entrance areas only. Fire drills should be carried out more frequently to ensure all the staff that work there have more opportunities to participate in at least one fire practice every six months.Alexander Family Nursing HomeDS0000019070.V378591.R01.S.docVersion 5.3Finally, to ensure the service continues to improve and makes progress towards its aim of becoming an excellent rated home the proprietor must appoint a suitably experienced, qualified and competent manager to be in day to day charge of the home as soon as possible. Key inspection report CARE HOME ADULTS 18-65 Alexander Family Nursing Home Oakhurst 1 Parker Close Carshalton Surrey SM5 3HF Lead Inspector Lee Willis Key Unannounced Inspection 18 & 21st December 2009 11:45 th Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Alexander Family Nursing Home Address Oakhurst 1 Parker Close Carshalton Surrey SM5 3HF 020 8669 1111 020 8669 7070 denise.deroyparker@btinternet.com 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) Mrs Denise Deroy Parker Post vacant Care Home 18 Category(ies) of Learning disability (0), Physical disability (0), registration, with number Terminally ill (0) of places Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow service users currently residing in the home who are over the age of 65 to be accommodated until such time that the home is no longer able to meet their needs or their placement ceases. A maximum of four service users over the age of 65 may be accommodated in specified rooms on the lower ground floor. 17th February 2009 2. Date of last inspection Brief Description of the Service: Alexander Family Home is a purpose built property that offers personal support and some nursing care for up to eighteen adults of either gender. The majority of the homes beds are reserved for younger adults, although a variation has been granted to allow any of the existing service users who are over the age of 65 to be accommodated there until such time as the home is no longer capable of meeting their needs. The service can also support four additional older adults who may be accommodated in specified rooms on the lower ground floor. People who use the service may also have learning and/or physical disabilities, and/or be terminally ill. The service currently supports twelve people with various personal care and nursing needs, the majority of whom are older adults. None of these people currently require any palliative care. The service no longer has a registered manager following the departure of Lee Nah Woodman in July 2009. The manager’s position remains vacant and the proprietor is aware she needs to appoint a suitably competent person to be in operational day to day control of the home as soon as reasonably practicable. This point notwithstanding we are aware that the services proprietor, Mrs Denise Parker, remains very much involved in running the home. The home is located at the end of a narrow lane in a residential area of Carshalton and is within close proximity to a variety of local community services and facilities, including: - shops, cafes, banks, a railway station, and numerous bus stops with good links to Sutton. This detached chalet style property is built over two floors and is very homely and spacious. Accommodation comprises of five double and eight single bedrooms all with en-suite facilities. There are also assisted baths on each floor. A large opened planned dining room is located in the centre of the property, which has a kitchenette/breakfast bar built into the one corner and a balcony above. There are also two large lounges decorated and furnished to a Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 5 good standard on both the ground and lower ground floors, a separate kitchen area, laundry room, office, and a well maintained garden at the rear of the property. There is amble space for parking vehicles in the front driveway. At the time of this inspection weekly fees ranged from £550-£900. These are agreed according to the needs and dependency of the residents and would be discussed prior to admission. There may also be some extra charges payable for items such as toiletries, some activities and services such as hairdressing. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. From all the evidence we gathered as part of this Key inspection we now rate the quality of the care provided at Alexander Family nursing home as good and award it 2 stars – good service. This represents an improvement on the services previous quality rating of one star (adequate). We therefore now consider the people who live there to be experiencing good quality outcomes. We spent six and a half hours at the home spread over the course of two midweek days. On the first day we arrived just before lunch and left at 3 o’clock in the afternoon, and on the second day we arrived at 11 in the morning and stayed until half past two that afternoon. During these site visits we conversed with four people who use the service, the services proprietor, Financial Director, two out of three of the homes senior duty nurses, four support workers, the chef, maintenance man, and a domestic cleaner. We also observed the interactions between all the people who currently reside at the home and staff that were on duty at various times during the course of this inspection. This report also includes reference to documents completed and supplied by the home, such as its Annual Quality Assurance Assessment (AQAA), and those examined during these site visits (E.g. Care plans; needs and risk assessments; health care action plans; accident book; activity records; complaints log; financial balance sheets; staff recruitment, training and supervision records; quality assurance stats, fire safety records; and health and safety certificates). The remainder of this visit was spent touring the premises. What the service does well: All the verbal feedback we received from the people who use the service and staff that work there was in the main very positive about the home. Typical comments made by one person who lives there included - I cant say there’s anything particularly wrong with the place’, ‘if I wasn’t happy here I would soon let them know’, and ‘it’s a pretty good place to live really and staff normally let me do my own thing’. All the people who use the service we spoke with at length told us they could always choose what they ate, what time they got up, what they wore, and when they went out. They also said most of the staff who worked there were good listeners and knew what their likes and dislikes were. For example, one person who uses the service told us the chef was aware they didn’t like a particular vegetable and made sure they never served them it. This understanding of the wishes of the people who use the service has been helped by the fact that the home continues to experience relatively low rates of Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 7 staff turnover, thus ensuring the people who live there receive continuity of care from lots of experienced staff who are familiar with their needs and preferences. We agree with the statement made by the proprietor in the homes AQAA that the place has a ‘homely atmosphere as opposed to an institutional one’. The physical layout and interior décor of this purpose built home makes the entire place look and feel very spacious, comfortable, and above all homely. Its chalet style design lends its self well to non-institutional ‘small’ group living. All the staff we met during the course of this two day visit, which included a domestic cleaner and a maintenance man, were observed interacting with the people who use the service in a very kind, respectful, and professional manner. The atmosphere in the home remained extremely relaxed and congenial throughout this inspection. What has improved since the last inspection? All the requirements and good practice recommendations we made in the services last inspection report have been met in full within the agreed timescales for action. The vast majority of outstanding requirements we made in the homes previous report pertained to staffs poor medication recording practices. We found evidence that showed us staff authorised to handle medication in the home (i.e. the duty nurses) have significantly improved their practise and now keep more up to date and accurate records of all the medicines, creams, and dressings used in the home. The homes staff recruitment arrangements have all been improved as required in its last report. All the personal files kept in respect of the homes three most recently employed members of staff contained all the relevant information and checks the service is legally obliged to carry out. As recommended in the homes last report a number of the people who use the service who do not have any direct family involvement in their care were given the opportunity to apply for an independent advocate to represent them. The range of social and recreational activities the people who use the service now have the opportunity to participate in has also improved in the past year as recommended in the homes last report. The people who use the service are engaging in a lot more meaningful and stimulating activities, both within the home and in the wider community. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 8 What they could do better: All the positive comments made above notwithstanding the proprietor and all the duty nurses we met acknowledge the service is far from ‘perfect’ and that there is room for further improvement. In this report we have made six new requirements and seven good practice recommendations for the provider to implement: To ensure all the people who use the service and/or their representatives are made aware of the current range of fees the provider charges for services and facilities provided the homes Guide must be revised to make it more transparent and include costs. Care plans should also be revised to include more detailed information about the unique abilities and strengths of the people who use the service. All the people who use the service should have more opportunities to live their life as independently as they can and have their willingness and capacity to take greater control of their own medication and financial affairs assessed. To ensure all the people who work at the home always have the right knowledge and skills to meet the needs and wishes of the people who use the service staff must have more opportunities to refresh their training. We recommend the provider carries out a thorough assessment of its workforce’s strengths and training needs, and establish a time specific training programme to address any gaps in staffs knowledge and skills. Furthermore, we also recommend staff receive training in understanding the Mental Capacity Act and Deprivation of Liberty Safeguards. We agree with the statement made by the proprietor in the services AQAA that - ‘Over the past 12 months the home has improved its supervision systems’. However, there remains consderable room to improve the way duty nurses keep records regarding the outcome of these one to one supervision meetings with support workers. To minimise the risk of people who use the service being scalded in the bath the provider must ensure the temperature of hot water used in the home never exceeds a safe 43 degrees Celsius. Also, the privacy and dignity of the people who use the service must be respected at all times and therefore the use of CCTV cameras in the home should be restricted to external entrance areas only. Fire drills should be carried out more frequently to ensure all the staff that work there have more opportunities to participate in at least one fire practice every six months. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 9 Finally, to ensure the service continues to improve and makes progress towards its aim of becoming an excellent rated home the proprietor must appoint a suitably experienced, qualified and competent manager to be in day to day charge of the home as soon as possible. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service and/or their representatives are provided with all the details they need in order to help them make an informed judgement about whether or not the home is the right place for them and/or their loved one. No prospective service users are accepted unless their needs and wishes have been thoroughly assessed by qualified nurses at the home and they are satisfied the new referral is compatible with the existing service user group. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 12 EVIDENCE: The senior duty nurse in charge of the early shift on the first day of this inspection was able to produce a copy of the homes Statement of Purpose on request. We noticed during a tour of the premises that these documents, along with the services Guide, were kept in wall mounted boxes conveniently located outside each service user’s bedroom doors. One person who uses the service told us they were aware their Guide to the home was kept in a box just outside their bedroom and would refer to it if and when they needed too. No details about the range of fees the home charges for services and facilities provided could be located on the first day of this inspection. We spoke at length to a duty nurse and the homes Financial Director about this lack of transparency and both told us the services Guide was in the process of being up dated to include more detailed information about the range of fees the home charged for services and facilities provided. The provider is reminded information about costs should cove the provision of accommodation, food, personal care, and nursing. The service is required to notify us within 28 days of its Guide being revised to include information about the range of fees charged. The duty nurse we spoke with at length on the first day of this insopection demonstrated a good understanding of what constitutes ‘best’ practice regarding prospective new admissions. This duty nurse provided us with documentary evidence on request that showed us the home always carries out its own in depth needs assessments, obtains all the information they can about individuals from their families and professional representatives, and actively encourages the all the intersted parties to visit the home and ‘experience it first hand’. We agree with the statement made by the services proprietor in its AQAA that the policies and procedures the home has in place for assessing the suitability of prospective new admissions was something they did well. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans reflect what needs a person who uses the service has, but there is significant room to improve these documents by including more detailed information about what is important to the individual and what their strengths are. This will ensure the people who use the service receive person centred support that meets their unique personal, social, and health care needs. The people who use the service are protected by the homes arrangements for identifying, assessing, and managing risk. However, the service could do more to actively assess and support any individuals identified as willing and capable of taking greater responsibility for looking after their own medication and/or finances. This will ensure the rights of the people who use the service to live their life’s as independently as possible are promoted. Sufficiently robust arrangements are in place which enable the people who use the service to be consulted on, and participate in, all aspect of life in their home as well have an influence on how it is run on a day to day basis. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 14 EVIDENCE: We looked at the care plans for the three people who the use, which we selected to case track because of their diverse range of assessed needs. All the plans we examined in depth were relatively person centred and set out in detail what each of these individuals needs were and what specific support they each required to have them met. However, although these plans refer to the unique preferences and dislikes of these individuals in respect of the food and drinks they like and what their social interests are the documents are medical in style and could be improved by focusing more on people’s strengths and achievable personal goals. We recommend the way in which the service develops care plans should be reviewed to focus more on people’s unique strengths and abilities. All three care plans we case tracked had been reviewed in the past six weeks with all the relevant people and up dated accordingly to reflect any changes in provision. This exceeds National Minimum Standards regarding the frequency at which care plans should be revised, for which the service is commended. All the staff we spoke with about the homes keyworker system confirmed that all the people who use the service have been designated a specific member of staff to be their keyworker who they meet on a one to one basis every month. A duty nurse told us these one to one keyworker sessions have proven to be a more successful way of ascertaining the views of the people who use the service when compared to large peer group meetings. Other arrangements the home has in place to enable the people who use the service to express their opinions include; the use of independent advocates who represent two people who do not have any family involvement, and the use of quality assurance surveys left in boxes outside all the service users bedrooms. All the care plans we viewed contained detailed risk assessments and associated management strategies setting out the action staff should take in order to minimise the likelihood of an identified risk and/or hazard occurring. One person who uses the service told us staff actively supported and encouraged them to take a ‘reasonable’ risk and access the wider community without the need for staff support as they wished, which was clearly identified in their care plan as something they were capable of doing. This risk assessment, along with all the others viewed, are continually reviewed and up dated accordingly to reflect any incidents or changes in people’s needs and/or circumstances. A duty nurse confirmed that none of the services users’ willingness and capacity to take at least a degree of responsibility for looking after their own medication or finances had ever been formally assessed. This needs to be rectified and a copy of the assessment kept in everyone’s care plan. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service now have far more opportunities to participate in stimulating social and recreational activities, both at home and within the wider community. This represents a significant improvement since the services last key inspection. People who use the service with family involvement continue to have regular contact with them and those that don’t now have the opportunity to have an independent advocate represent them. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and nutritionally wellbalanced meals that meets their specific food preferences. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 16 EVIDENCE: The proprietor stated in the AQAA that service users spiritual needs and preferences will always be promoted and respected. The service demonstrated its commitment to this ethos when we noted that as stated in one service users care plan staff actively support this individual to practice their chosen Faith by regularly accompanying them to an appropriate place of worship. During a tour of the premises we positively noted that staff had put up Christmas decorations throughout the home. It was recommended in the services last inspection report the home improves the opportunities the people who use the service have to participate in more meaningful and stimulating activities. All the verbal and written feedback we received from the proprietor and staff suggested that activities was one area of practice the service had successfully improved in the past 12 months. Activity records maintained by staff showed us that a local church group, an aroma-therapist, and a jazz band had recently visited the home; staff regularly organise art and bingo sessions in the main lounge; one service user now went swimming on a regular basis at a local hydro-pool; and others had been on various day trips and outings to the coast and the theatre. On arrival at the home on the first day we observed staff supporting one service user to have their nails painted, while another we were told was watching one of their favourite situation comedy DVDs in their bedroom. It was positively noted that both the aforementioned activities could be identified in the relevant care plans as something these individuals liked to do. Furthermore, the one service user spoken with at length about activities in the home told us that although they chose not to join in with many of the activities organised by the staff they nevertheless liked the idea that they could if they wanted too. This individual went onto tell us they preferred to entertain themselves in the privacy of their own room, which staff always respected. Staff we met told us the service operates an open visitor’s policy with no restrictions placed on visiting times. One service user we spoke with at length told us that they have a spare bed in their split level bedroom, which their guests can use if they stay overnight. The proprietor stated in the AQAA that she is trying to get the families of the people who use the service more involved in the homes affairs. Progress made by the proprietor to achieve this aim will be assessed at the homes next inspection. A duty nurse told us all the people who use the service are offered a key to their bedroom when they first arrive. One person who uses the service confirmed this was the case. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 17 The feedback we received from the two people we asked about the meals served in the home was in the main very positive. Typical comments included, “the food is lovely here”, “the foods alright”, “the chef knows my likes and dislikes”, and “if you don’t like what chef prepares he’ll always make you something else if you ask”. The meals advertised on the weekly planned menus and those recorded in the food consumed log are traditionally British in style, which reflects the cultural heritage and tastes of the majority of the people who currently reside at the home. The chef and a duty nurse we spoke to at length also told us that oriental style cuisine and fish dishes were always being prepared to cater for the specific tastes of two service users, whose preference for this type of food could clearly be identified in their care plans. The meals served over lunch on the first day of this inspection looked well presented, appetising, and nutritionally well balanced. The atmosphere over lunch remained relaxed and congenial throughout the meal and we observed staff assisting several people who use the service to eat their meals in a very dignified and respectful manner. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that their unique health care needs and preferences are continually recognized and met. Overall, the services medication handling practises are good. Significant improvements have also been made in the past year to ensure staffs medication recording practices are sufficiently robust to keep the people who use the service safe. The service has developed good arrangements for ensuring the needs and wishes of services users who are terminally ill and/or dying are always respected and met. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 19 EVIDENCE: All the care plans we viewed contained comprehensive assessments of these service users specific moving and transferring needs and wishes to ensure they were supported in the way they prefer and require. One person who uses the service told they could get up, go to bed, go out, and wear what they wanted each day. The duty nurse we spoke with at length told us the service had developed a very good working relationship with a local GP’s surgery and that is was custom and practice to have a suitably qualified nurse in charge of each shift to ensure the service users physical and emotional health care needs were always met. All the health care records we sampled at random reveled staff actively support the people who use the service to attend regular appointments and check ups with all manner of community based health care professionals including, GP’s, dentists, opticians, chiropodists, and speech therapists. The duty nurse in charge of the early shift confirmed that as stated in the services AQAA none of the people who use the service had experienced pressure sores in the past year. This nurse was also able to provide us with well maintained water low charts and demonstrated a good understanding of how best to minimise the risk of pressure sores developing and good tissue viability management. Staff also maintain up to date records of all the service users’ weight, which they check at regular intervals. The duty nurse confirmed that none of the people who use the service had been involved in any accidents or sustained any serious injuries in the past year. We were made aware from the services AQAA that one service user had passed away since its last inspection. The proprietor told us one of the underlying principles of Alexander Family home was the idea that it was ‘a home for life’. Consequently, it remains custom and practice for any service users who are terminally ill or dying to be given the chance to remain in the home during their final days supported by suitably trained staff. One duty nurse we met told us they had been professionally trained in palliative care. All the service users care plans we case tracked contained details about these individuals’ wishes regarding terminal care and death. Three requirements were made in the service last inspection report regarding the homes staffs’ poor medication recording practices. We looked at all the services medication records which staff had used in the past month and no recording errors were noted where staff had failed to sign for medicines administered. Furthermore, in keeping with best practice the service maintains a separate Controlled Drugs (CD) log which two staff must counter sign together each time a CD is received into the home, administered, or disposed of. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 20 The duty nurse in charge of the early shift confirmed that as stated in the AQAA no errors had occurred with regards the handling of Controlled Drugs in the home in the past 12 months. Only qualified nurses who work in the home are authorised to handle medication on behalf of the people who use the service. All the medication records we viewed accurately reflected the stocks currently held on behalf of the people who use the service. The duty nurse told us audits on medication stocks and spot checks on staff medication practices are routinely carried out by senior staff and the owner to minimise the risk of medication errors reoccurring in the future. All the medication we looked at was safely locked away in metal cabinets which were securely fixed to a wall in the nursing station. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes arrangements for dealing with concerns and complaints are sufficiently robust and understood by staff to ensure people who use the service feel listened too and safe. Similarly, the home also has appropriate safeguarding procedures in place, which are understood by the people who work there. However, the homes security measures, although very robust, need to be reviewed as a matter of urgency as current CCTV arrangements are intruding unnecessary on the private lives and dignity of the people who use the service. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 22 EVIDENCE: The duty nurse in charge of the early shift on the first day of this inspection confirmed the service had not received any formal complaints about its operation in the past 12 months. A copy of the services complaints policy is included in its Guide and makes it clear that all complaints will be investigated and responded too within 28 days. One person who uses the service told us staff usually listen to what you have to say and if they don’t you can always to talk to the boss (i.e. the homes proprietor). All the staff we spoke with about safeguarding demonstrated a good understanding of what constituted abuse of vulnerable adults and both duty nurses we met were very clear which external agencies they needed to notify without delay if they suspected or witnessed abuse in the home. A duty nurse was able to produce a copy of the homes whistle blowing procedure and the local/host authority’s multi-agency safeguarding protocols. The proprietor was also aware that Suttons SSD’s safeguarding vulnerable adults team, the CQC, and where appropriate the police, must always be notified about any allegations of abuse that come to the homes attention. A duty nurse we met confirmed they were aware that we (the CQC) had received allegations from an anonymous source that the people who use the service were being financially abused and neglected. These allegations were fully investigated by representatives of the local authority in line with their agreed safeguarding protocols and no evidence was found to substantiate these claims. As part of the inspection process we looked at all the areas of concern raised by the anonymous source, which alleged service users were being made to wear second hand clothes, had no choice at mealtimes, did not have a formal activities program to engage in, and were having their privacy compromised through the use of CCTV cameras. All the service users we met on both days of this inspection were dressed in well maintained clothes that were appropriate for the season. Furthermore, all the clothes one service gave their promising for us to view hanging in their wardrobe looked relatively new and seem to reflect this individuals age and unique personality. As previously mentioned in this report we found evidence to suggest the homes arrangements for enabling the people who use the service to participate in more meaningful activities had significantly improved in the past year and that lack of choice at mealtimes was not an issue. However, all these positive points made above notwithstanding we agree with the concerns raised by the anonymous complaint and all the staff we met during this two day inspection that the use of CCTV cameras in all the homes communal areas are unnecessary and intrude on the daily life and dignity of the people who live and work there. We accept the proprietors point that all Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 23 the CCTV cameras currently in use inside the home are for security purposes only, but there positioning in the far corners of various communal spaces means they can be used to survey more than just the homes entrance areas. The home already uses external CCTV cameras for security purposes to cover these entrance points and should give serious consideration to restricting there use to outside only. Staff look after the majority of service user’s money and maintain up to date and accurate balance sheets of all the financial they take on behalf of the people they support. We noted that staff keep receipts for all the goods and services they purchases on behalf of the people who use the service and that their money is individually stored in a secure place. A duty nurse we met on the first day told us staffs financial practices and records are audited on a regular basis by the proprietor and financial director. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The interior decoration of the home, including its fixtures, and fittings, are well maintained ensuring the people who use the service live in a very comfortable, warm, and homely non-institutional environment. The way in which the home prevents and controls infection is sufficiently robust to ensure the people who use the service also live in a very clean and safe environment. However, the service needs to improve its arrangements for ensuring the temperature of hot water used in baths remain at a safe level at all times in order to protect the people who use the service from scalding. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 25 EVIDENCE: We agree with the statement made by the proprietor in the AQAA that the physcial layout of the home makes it ‘feel very homely, and comfortable.’ The proprietor confirmed that since the services last inspection there had been no significant changes made to the physical layout or the interior décor of the home. During a tour of the premises all the communal areas looked clean and bright, felt pleasantly warm, and smelt fresh. These areas also feel quite airey and spacious as a result of the high chalet like ceilings, are decorated to a good standard, and have been fitted out with lots of good quality furniture and soft furnishings. People with physical needs are also able to access all the homes communal areas because it has a passenger lift. We viewed two bedrooms with the permission of the people who currently occupied them. One person who uses the service told us they had enough space in their bedroom to store all their belongings, which included some furniture they had brought with them when they moved in. Both the bedrooms we saw were decorated to a good standard and in a style that seemed to match the personality of the people who currenlty occupied them. All the bedrooms have there own ensuite facilties and there is an assited bath on each floor. We tested the temperature of hot water eminating from a bath on the lower ground floor, which we found to be an unsafe 49 degrees Celsius. Records kept by staff of rountine checks they carry out on the homes hot water systems also revealled the average temperature of hot water used in this bath was 46 degrees Celsius. The services maintenance person told us this bath had been fitted with a preset thermastatic mixer valve which they agreed to adjust on the day of this inspcetion to ensure hot water used in this bath never exceeded a safe 43 degrees Celsius. The proprietor also agreed that none of the people who use the service would be allowed to use this bath until its thermastatic mixer valve had been suitably adjusted, repaired or replaced. The home employes a cleaner who keeps the place spotlessly clean and free of any offensive odours. The proprietor wrote in the AQAA that the service has an action plan to deliver best practice in preventing the spread of infection, and that all the staff that work there have received infection control training. The homes laundry facilities are sited away from any areas where food is stored, prepared, or eaten. The laundry room has its own wash hand basin and a sluicing facility. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 26 We pulled the call bell cord in the ‘Parker’ bathroom located on the ground floor and positively noted that a member of staff responded to the alarm being activated within one minute. A duty nurse we spoke with about the homes call bell system told us staff were generally very prompt at responding to warning alarms being sounded. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be sure their needs will be met because they are supported at all times by sufficient numbers of suitably competent staff. Overall, there are enough suitably trained staff working at the care home to meet the service user’s individual and joints needs, although the way the provider continually assesses and refreshes its staff teams existing knowledge and skills needs to be reviewed as a matter of urgency. The homes staff recruitment checks and vetting arrangements are sufficiently robust to ensure the risk of employing people who are not fit to work with vulnerable adults is minimised. The people who use the service benefit from being supported by appropriately supervised care staff, although the services arrangements for recording the outcome of these one to one meetings with the duty nurses needs to be significantly improved. Consistent record keeping enables anyone authorized to view them to determine whether or not staff working there are being appropriately supported by the duty nurses. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 28 EVIDENCE: All the staff we met during the course of this two day inspection were observed interacting with the people who use the service in a very kind, respectful, and professional manner. Typical comments made by one person who uses the service included - “carers who work here are generally a respectful bunch”, “I like 99 percent of them”, and “most of them listen to you and do what you ask to do most of the time”. We agree with the comments made by the proprietor in the AQAA that having low rates of staff turnover has meant the people who use the service continue to receive continuity of care from members of staff who are family with their unique needs and preferences. A duty nurse confirmed the service almost had its full compliment of staff because of low rates of staff turnover and therefore they did not have to rely on any temporary agency staff to cover staff sickness and/or leave. On our arrival on the first day of this inspection we noted that a qualified nurse who was in charge of the early shift, three support workers, a chef, and a domestic cleaner were all on duty. Weekly duty rosters sampled at random revealed that a qualified nurse was always on duty in the home both at night and during the day. All the staff we met told us having a minimum of four care staff on duty across the day, who were supernumerary to domestic staff, was enough to meet the needs and wishes of the people who used the service. The duty nurse we met on the first day demonstrated a good understanding of what constituted best practice regarding staff recruitment. The proprietor confirmed that three new support workers had been employed since the last inspection. As required in the services previous inspection report documentary evidence in the form of up to date Criminal Record Bureau and written reference checks were produced on request that proved to us all the homes most recently recruited members of staff had been thoroughly vetted and were ‘fit’ to work with vulnerable adults. We spoke to one new member of staff who told us they had received a thorough induction as part of their probationary period of employment and that they had not been permitted to work unsupervised with the people who use the service during this time. The services AQAA states that all the people who prepare meals in the home have received basic food hygiene training and that ten support workers have also received training in malnutrition care and assisting with eating. A duty nurse told us that in addition to a qualified nurse being on duty in the home at all times support workers are suitably trained to perform there care duties. The proprietor confirmed that well over 50 percent of the homes current support workers had either achieved a National Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 29 Vocational Qualification Level 2 or above in care or were enrolled on suitable course. The homes former registered manager promised us at the services last inspection that she would carry out a thorough assessment of her staff team’s competencies and training needs. We accept the proprietor’s explanation that this training needs analyses has not been carried out as promised because the home has been without a designated person in day to day control for the past six months. This assessment must be carried out to enable the provider to identify what training needs the staff team have and how best to address any gaps in peoples knowledge and skills. We did not asses whether or not the good practice recommendation made in the homes previous report about staff receiving Mental Capacity Act and Deprivation of Liberty training had been implemented. We have therefore merely repeated this recommendation at the end of this report and will look into progress made by the home to achieve this aim at its next inspection. Services AQAA states - ‘Over the past 12 months the home has improved its supervision systems for designated persons.’ Staff we spoke with about supervsion told us they had one to one meetings with a duty nurse at least once every two months or so. A duty nurse we spoke at length with confirmed this practice. However, three staff files sampled at random revealed on average that only two to three of these supervision sessions were being recorded. The provider must improve its recording of staff supervision sessions as current arrangments are very inconsistent. The home was able to produce documentary evidence on request that showed us all the senior staff (i.e. the duty nurses) and support workers have peer group meetings approximately six times a year. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 30 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are kept safe because the home continues to be adequately managed on a day to day basis by the duty nurses with on going support from the proprietor. However, for the people who use the service to reap the benefits of living in a really ‘well’ run home a suitably experienced, qualified, and competent full-time permanent manager needs to be appointed as soon a reasonably practicable. The service has sufficiently robust quality assurance systems in place which enables them to ascertain the views of the people who use the service and represent them when considering ways to improve the standard of care they provide. The services fire and other health and safety systems are sufficiently robust to keep the people who live, work and visit the home safe from avoidable harm. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 31 EVIDENCE: As previously mentioned in this report the service has not had anyone who was officially in day to day control of the home since the departure of its former registered manager in July 2009. Duty nurses we met told us they are responsible for the service while they our on shift with additional support provided by the proprietor who remains very much involved in running the home. The Financial Director told us the home was still in the process of appointing a new permanent manager, but were now in a position to start interviewing prospective candidates. The provider needs to notify us as soon as a new permanent manager has been appointed. The people who use the service and staff that work there would all benefit from having a full time manager in post who will have a better strategic overview of the home because they are the sole person in day to day charge. Staff training and development, as well as their record keeping, are two areas we would expect to see the most significant improvements made by the home following the appointment of a suitably competent manager. The proprietor completed and returned our Annual Quality Assurance Assessment when we asked for it, which tells what the service does well, has improved recently, and plans to do better in the future. Documentary evidence was produced on request that showed us unannounced monthly inspections of the home continue to be carried out by the proprietor. A duty nurse we spoke with at length told us they felt well supported by the proprietor and her fellow nurses at the home. As previously mentioned in this report one service user we met told us staff generally listen to what you have to say and you can fill out a survey about the home. During a tour of the premises we noted that copies of the aforementioned quality assurance surveys have been placed in boxes attached to the walls just outside each service user’s bedroom doors. A copy of the homes most recent fire risk assessment for the building was produced on request. The homes other fire safety records revealed its fire alarm system was being tested on a weekly basis and fire drills were being carried out bi-annually in keeping with recommended good fire safety practices. Two support workers we met told us they had been involved in a fire drill in the past six months, although the nurse in charge of the early shift on the first day of this inspection did concede that not everyone who worked there had participated in a fire drill in the past six months. This major shortfall must be rectified as a matter of urgency and we recommend fire drills are carried out on a quarterly basis. We randomly tested a number of the homes sound activated fire door release mechanisms, which were all found to be in good working order. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 32 According to the services AQAA: the premises electrical circuits; portable electrical appliances; passenger lift; portable hoists; fire detection and alarm system; fire fighting equipment; emergency lighting; emergency call bell equipment; water heating system; and gas appliances - have all been serviced or tested as recommended by the manufacturer or other regulatory body. Certificates of worthiness were made available on request in respect of the homes gas installations, portable electrical appliances, fire detection and fire fighting equipment, and electrical systems as prove that these checks had been carried out by suitably qualified engineers. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 XCHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 X 3 X X 3 X Version 5.3 Page 34 Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc No 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 YA1 Regulation 6(b) Requirement The provider must notify us when they have finalised the new most recently amended version of the services Guide, which is to include the range of fees the home charges for the services and facilities it provides. This will increase transparency within the home by ensuring the people who live there and/or their representatives have all the up to date information about fees charged for services and facilities provided, including additional costs for things not covered in the basic price of each placement. 2. YA27 13(4) The provider must ensure the temperature of hot water used in baths never exceeds a safe 43 degrees Celsius. This will minimise the risk of people who use the service being scalded by excessively hot water. 01/01/10 Timescale for action 01/03/10 Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 35 3. YA35 18(1) All the care staff that work in the home must receive up to date training in all the areas they need to carry out their duties effectively. This must include mandatory training in fire safety, moving and handling, first aid, food hygiene, and safeguarding vulnerable adults. This will ensure all the people, who work at the home have the necessary knowledge and skills to meet the needs and wishes of all the people who use the service. 01/07/10 4. YA37 8 The provider must appoint a suitably experienced, qualified, and competent (i.e. fit person) individual to be full time operational day to day control of the care home in the absence of a permanent registered manager. The provider must also notify us as soon as a new manager is appointed. This will ensure the people who use the service benefit from living in a care home that is well run by a person who is accountable. 01/03/10 Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 36 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 YA6 Good Practice Recommendations The way in which the service develops care plans should be reviewed to ensure greater emphasis is placed on the unique strengths of the people who use the service. This will ensure staff know what skills and abilities the people they support have, which will enable them to meet their needs, preferences, and personal goals through more positive individualised interventions. 2. YA9 All the people who use the service should have more opportunity to look after their own medication and financial affairs if within framework of risk they are assessed as willing and capable of doing so. A record of this risk assessment should be kept in each individual service users care plan. This will ensure the rights of the people who use the service to continue to live their lives as independently as practicable are respected and promoted. 3. YA23 The use of CCTV camera should be restricted to entrance areas for security purposes only. This will ensure the rights of the people who use the service to have their privacy and dignity respected at all times continues to be promoted. 4. YA35 It is recommended that staff training should include information regarding The Mental Capacity Act and the Deprivation of Liberty Safeguards. This will ensure the rights of the people who use the service to make informed choices about how they live their life’s are respected and not restricted unnecessarily. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 37 5. YA35 The provider should carry out a thorough assessment of the strengths of all the people who work at the home, as well as their training needs, and then create a time specific training programme to address any gaps identified in the staff team’s knowledge and skills. This will enable anyone authorised to inspect this assessment and training programme to determine whether or not all the people who work at the care home have the right knowledge and skills to perform their duties of care. 6. YA36 The way in which nurses who work at the home record the outcome of one to one supervision sessions with support workers should be reviewed as current arrangement are very inconsistent. This will enable anyone authorised to view these records to determine whether or not care staff who work at the home are being appropriately supported and supervised by their line managers/nurses. 7. YA42 Fire drills should be carried out on a quarterly basis and appropriate records kept. This will ensure all the people who work at the home, including new staff, have the opportunity to participate in at least one fire drill every six months. Alexander Family Nursing Home DS0000019070.V378591.R01.S.doc Version 5.3 Page 38 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.london@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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