Care Home: Alexandra Nursing Home

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What the care home does well Residents were assessed to make sure their needs could be met before they came into the home.Residents said staff were kind and treated them well. Comments from residents and relatives included "I am quite happy", "Very good care, good staff", "They`re all great, wonderful", "the carers know you better than you know yourself", "care staff are like friends to Mum, always talking and having a joke with her to get their jobs done" and "Mum is looked after very well always being talked to, turned and made a fuss of. She ... cannot move so I am very pleased". Care plans were generally detailed and gave a good overview of what each resident needed help with. Residents said they saw their GP`s when they needed to and arrangements were made for visits from the podiatrist, optician, dentist and other health care professionals. One resident said, "If you tell staff anything is wrong they go for the nurse right away" and another said, "All hospital appointments are taken care of and the dentists and opticians call out for checks". Residents were positive about the food provided and said they had a choice at each mealtime. All residents who returned surveys confirmed that they knew how to make a complaint if they needed to do so. Most people said they had nothing to complain about but said the manager was very approachable and easy to talk to. The Alexandra provides a clean and comfortable environment for people to live in, although there were some ongoing maintenance issues that were being addressed. Comments about the home included "cleaners clean every day and change your bedding" and "the place is homely, clean and well decorated". Many of the rooms are spacious and bright, with large windows and lovely views over the park. 53% of care staff are trained to at least NVQ level 2. Records showed that staff were encouraged to undertake training in a variety of topics so they had the skills and knowledge to care for people properly. What has improved since the last inspection? At the last key inspection five requirements were made and, of these, four had been met at this inspection. Since the last inspection staff had worked on making the assessments of prospective new residents more detailed and this means that people can be sure that staff understand what help they need and are confident they can provide the necessary care.Several new carpets have been fitted in various rooms and on the staircases. New windows have been installed and a substantial amount of decoration has been completed. Medication procedures and practices had improved. What the care home could do better: To fully protect residents, recruitment procedures need to be improved to ensure appropriate references are received before staff start working at the home. This requirement was also made at the previous inspection. Activities and opportunities for social interaction are provided by the home but could be expanded on. Further consultation with residents about their preferences and expansion of the key worker system may help to identify ways in which this area could be developed. Although the manager regularly checked how staff were performing and whether the correct procedures were being followed, an accurate record was not always made of how shortfalls were addressed. In the same way the record of complaints and the response to residents` surveys and meetings did not clearly show how comments or suggestions were acted on or used to improve services in the home. A recent health and safety inspection by Oldham MBC identified some environmental and training needs that must be met. The Commission for Social Care Inspection (CSCI) will seek confirmation that these have been dealt with. CARE HOMES FOR OLDER PEOPLE Alexandra Nursing Home 71-75 Queens Road Oldham Lancashire OL8 2BA Lead Inspector Mrs Fiona Bryan Unannounced Inspection 26th February 2008 09:30 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 Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra Nursing Home Address 71-75 Queens Road Oldham Lancashire OL8 2BA 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) 0161 627 2970 0161 627 2015 Cherry Garden Properties Ltd Sarah Jane Beswick Care Home 35 Category(ies) of Dementia (35), Old age, not falling within any registration, with number other category (35), Physical disability (35) of places Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with Nursing - code N, to people of the following gender:- Either; whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP; Dementia - Code DE; Physical Disability Code PD. The maximum number of people who can be accommodated is: 35. 31st August 2006 Date of last inspection Brief Description of the Service: The Alexandra Nursing Home is situated on Queens Road, less than half a mile from Oldham town centre. The home has a total of 35 beds and provides nursing care, personal care and care for service users with mild forms of dementia, as long as they do not require the input of psychiatric nurses. The home is owned by Cherry Garden Properties Limited, which is a private company. A registered manager is responsible for the day-to-day running of the home. Fees for accommodation and care at the home range from £345 to £449.26 per week. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. Accommodation at the home is provided over three floors, all served by a passenger lift. There are a total of 25 single rooms, with ten of these having en-suite facilities, and a further five double rooms for service users wishing to share. In addition, the home provides three lounges, three dining rooms and assisted bathing and toileting facilities. The home is located in the Alexandra Park district of Oldham and is well served by local bus services. It directly overlooks the park offering lovely views from the garden. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection, which included a site visit, took place on Tuesday 26th February 2008. The manager was not told beforehand of the inspection visit. All key inspection standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with people who live at the home, the manager and other members of the staff team. Three people were looked at in detail, looking at their experience of the home from their admission to the present day. A tour of the building was conducted and a selection of staff and care records was examined, including medication records, employment and training records and staff duty rotas. Before the inspection, surveys were sent out to residents and relatives, asking what they thought about the care at the home. One relative and eight residents responded and their comments have been considered and included in the report. We sent the manager a form called an Annual Quality Assurance Assessment (AQAA), which asks them to tell us what they think they do well, what they have improved upon and what they need to do better and this was returned to us before the site visit. We felt that the manager had tried hard to be objective about how the home was performing. What the service does well: Residents were assessed to make sure their needs could be met before they came into the home. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 6 Residents said staff were kind and treated them well. Comments from residents and relatives included “I am quite happy”, “Very good care, good staff”, “They’re all great, wonderful”, “the carers know you better than you know yourself”, “care staff are like friends to Mum, always talking and having a joke with her to get their jobs done” and “Mum is looked after very well always being talked to, turned and made a fuss of. She … cannot move so I am very pleased”. Care plans were generally detailed and gave a good overview of what each resident needed help with. Residents said they saw their GP’s when they needed to and arrangements were made for visits from the podiatrist, optician, dentist and other health care professionals. One resident said, “If you tell staff anything is wrong they go for the nurse right away” and another said, “All hospital appointments are taken care of and the dentists and opticians call out for checks”. Residents were positive about the food provided and said they had a choice at each mealtime. All residents who returned surveys confirmed that they knew how to make a complaint if they needed to do so. Most people said they had nothing to complain about but said the manager was very approachable and easy to talk to. The Alexandra provides a clean and comfortable environment for people to live in, although there were some ongoing maintenance issues that were being addressed. Comments about the home included “cleaners clean every day and change your bedding” and “the place is homely, clean and well decorated”. Many of the rooms are spacious and bright, with large windows and lovely views over the park. 53 of care staff are trained to at least NVQ level 2. Records showed that staff were encouraged to undertake training in a variety of topics so they had the skills and knowledge to care for people properly. What has improved since the last inspection? At the last key inspection five requirements were made and, of these, four had been met at this inspection. Since the last inspection staff had worked on making the assessments of prospective new residents more detailed and this means that people can be sure that staff understand what help they need and are confident they can provide the necessary care. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 7 Several new carpets have been fitted in various rooms and on the staircases. New windows have been installed and a substantial amount of decoration has been completed. Medication procedures and practices had improved. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 8 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 Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents and their representatives have the information needed to choose a home that will meet their needs. EVIDENCE: A statement of purpose and a service user guide are available in the home and copies are given to all new and prospective residents. These documents provide all the information required for people to make a decision about coming to live at the home. Three residents were case tracked. Two had assessments completed prior to admission. The third had an assessment completed several days after admission and an overview assessment from Oldham Social Services had been faxed to the home nearly a month later. The manager said all the information for this person had been discussed over the phone and there had been a delay in getting the actual paperwork. The manager said it was normal practice to Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 10 visit a prospective resident prior to their admission to undertake an assessment and ensure the service would be able to meet their needs. An actual visit had not been possible in that particular case. All the assessments were very detailed and provided information about each resident’s abilities, the reason for admission and what care staff would need to provide for them. Intermediate care is not provided at The Alexandra. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The health and personal care residents receive is generally based on their individual needs and residents are treated with respect and dignity. EVIDENCE: Three residents were case tracked. Care plans were in place for all of them that had been developed from information gained during the assessment process. Care plans had been reviewed monthly but were not always updated with advice or information from other health care professionals. For example, it was recorded that a blood test for one resident had shown low potassium levels and the GP wanted them to eat more potassium rich foods, such as bananas and oranges, but this advice was not transferred to the care plan and may therefore have been overlooked. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 12 Risk assessments for falls, moving and handling, pressure sores and nutrition had been undertaken for all the residents. Some of these had not been evaluated for the effectiveness of the planned interventions. This, on occasion, led to incorrect information, which contradicted details elsewhere in the care files. For example, one resident’s risk assessment stated that they had to be transferred by hoist, but their updated care plan showed that their mobility had improved and they were able to transfer using a turntable. Mental health needs had been addressed where necessary but plans to address social care needs were often lacking. Apart from these anomalies care was generally planned, reviewed and recorded well. Care plans were, for personal and health care, in the main, person-centred and gave a good overview of what help each person needed. Residents had all been weighed monthly. Several residents had put on significant weight since their admission, which staff should be aware of and seek advice about, as major weight gain may affect residents’ mobility and general health. Records showed that residents had seen opticians, dentists, GPs and podiatrists and had attended hospital out patient appointments. One resident with diabetes was being monitored properly and her treatment adjusted appropriately. Residents said they were well looked after and treated with kindness and patience by staff. One resident said, “It is wonderful. I was very poorly when I first came here and if it hadn’t been for them I’d be dead. They’re all great”. Staff had a good knowledge of residents’ care needs and were able to describe peoples’ preferences and daily routines. Staff reported that there was a handover at the start of every shift to ensure they had up to date information about the residents’ conditions. Comments from residents and relatives in the surveys that were received included “I have been given my treatment regularly”, “If you tell staff anything is wrong they go for the nurse right away”, “Mum is looked after very well, always being talked to, turned and made a fuss of. I am very pleased” and “care staff are like friends to Mum always talking and having a joke with her to get their jobs done”. In response to the question “do you always receive the care and support you need”, one resident had replied “and more besides”. Examination of a small sample of medicine administration records showed that staff were following the correct procedures and no issues were identified in relation to the management of medicines within the home. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents are able to make some choices about their lifestyle but further consultation is needed to ensure that all residents’ social, cultural and recreational expectations can be met. EVIDENCE: Although an activity organiser is employed at the home for 35.5 hours per week, no activities programme was advertised around the home and residents said little was provided in the form of organised social events and leisure activities. One resident said staff had taken her for an occasional walk in the park across the road and several said they were visited regularly by family members who sometimes took them out. Some residents went to see the Blackpool Illuminations. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 14 It was reported that games of cards and dominoes were organised in the afternoons and some residents had gone out one evening with staff to play bingo. One resident said he went to the park independently and went shopping with staff, but the majority seemed to spend most of the time watching television. One resident said she preferred to spend time on her own and stayed in her room out of preference. One of the care files of the three residents that were case tracked contained a social profile, giving interesting information about the person’s childhood and family relations. Social profiles were not available for the other two residents. Daily records contained little information about how residents had spent their time, mainly confirming that medicines had been given, the resident had eaten well and so on. Residents said they got up at the time of their choosing and routines were relaxed. An example of the flexibility of staff was observed when a resident who normally had a bath on Tuesday mornings received visitors, so her bath was postponed until later when her visitors had gone. One resident said staff took her to her room at about 6pm and she got ready for bed and watched television. She said she went to her room as she felt isolated in the lounges, as everyone else had gone to bed. There was no evidence of evening events within the home that may stimulate residents and encourage them to socialise and stay up later. Although one resident’s assessment stated that she was a practising Catholic no arrangements had been made for her to receive communion or be visited by a priest. The manager said she would sort this out. The manager had recognised in the AQAA that providing activities that were stimulating was an area that could be improved. The home does have a key worker system but staff said it needed updating. A review of this system and further development of the key worker role could help staff to identify people’s social preferences and meet them according to their individual strengths and abilities, especially for those that do not wish to or are not able to join in with group activities. The day’s menu was displayed on whiteboards outside each dining room. Lunch on the day of the site visit was continental lamb chops or sausages, mashed potatoes, peas and carrots, followed by spotted dick and custard. Tea was black pudding and tomatoes or sandwiches, followed by mandarins and cream. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 15 Menus run over four weeks. A cooked breakfast was provided for those that wanted one. One resident said his eggs and bacon were always “cooked to perfection”. Typical food for the main meal of the day included casseroles, pies, fish, roasts, lasagne, spaghetti bolognaise, pasta, curry and scampi. Lighter meals at teatime included sandwiches and hot options, such as beans on toast, soup, hot dogs, fish cakes, crumpets, burgers and potato cakes. On some occasions, a hot option was not provided and residents were offered a salad instead. Residents said the food was good and that the chef was very accommodating; if they did not like either of the two options on the menu they could ask for another alternative. For example, one resident said she did not like sandwiches or black pudding and was having soup for tea. Most residents on the first floor were served their meals in their rooms or stayed in the lounge and had trays on small tables next to their armchairs. There was only one table in the dining area so a maximum of four residents could sit at the table even if more wanted to. Consideration should be given to ensuring that seating at tables is available so residents have the opportunity to use mealtimes as social occasions. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are able to express their concerns, are protected from abuse and have their rights protected. EVIDENCE: The complaints procedure is displayed in each hallway of the home. 100 of the residents and relatives who returned surveys said they were aware of how to make complaints. One resident on the day of the site visit said there was nothing to complain about and therefore she did not know how to complain. Another resident said, “They try to sort me out with what I like”. A record of complaints received had been maintained. Two complaints had been logged since the last inspection. However, although the manager was able to say what action had been taken, this was not clearly recorded and there was no record of the final outcome. Since the last inspection one concern raised by a member of staff had been investigated by the safeguarding team. No evidence was found of any form of abuse. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 17 Staff were aware of the procedures to follow should they suspect abuse as most of them had completed internal training. Some staff had also undertaken training in dealing with challenging behaviour. It was recommended that the alerter training provided by Oldham MBC be accessed so that staff are familiar with Local Authority procedures. Similarly, the safeguarding policies and procedures written by Oldham MBC should be freely accessible to all staff. The manager said they were currently kept in her office, which is locked when she is not there. It was suggested that these were kept in the nurses’ office and all staff made aware of where they were and encouraged to read them. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home provides a pleasant, comfortable environment for people to live in but some maintenance and improvements need to be made to ensure it meets with health and safety requirements. EVIDENCE: A tour of the home was conducted. The home was clean, tidy and free from any unpleasant odours, with the exception of one lounge. A member of staff shampooed the carpet whilst the inspection was in progress. Residents spoken to said they were satisfied with the cleaning and laundry services. 100 of residents who returned surveys said the said home was always or usually fresh and clean. Comments included “cleaners clean every day and change your bedding”, “the place is homely, clean and well decorated” and “clean and well run”. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 19 A number of residents’ rooms were viewed and all were personalised with small items of furniture, mementos and items of interest to the residents. Rooms were a good size and many were light and airy with large windows, looking over the park. On the second floor a lounge has been allocated for residents wishing to smoke. The smell of smoke was drifting into the hallway and the room smelt strongly of cigarettes. A health and safety inspection conducted by Oldham MBC took place on 18th January 2008, which identified the need for mechanical ventilation/extraction in the room and this needs to be organised. It was also identified that the roof was leaking, causing water damage to two residents’ rooms and part of the hallway. Also, a bath chair was in a state of disrepair and needed replacing. These issues need addressing to comply with the requirements made to meet Health and Safety regulations. The manager said that work was starting to repair the roof on Thursday, 28th February. It was also reported that new carpets had been fitted in various rooms and on the staircases, new windows had been installed and some rooms had been redecorated since the last inspection. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Staffing levels may not always be consistent with the demands of delivering the service and recruitment procedures are not always followed, which could put residents at risk. EVIDENCE: At the time of the site visit 31 people were living at the home. It was reported that during the week there were usually one nurse and five carers on duty all day, and at weekends there were one nurse and six carers. This was because the manager was also at the home during the week and spent some of her time delivering care, so an extra carer was provided on the days she was not working. Examination of the staff duty rotas for weeks commencing 18th February and 25th February 2008 confirmed these staffing levels; some days an extra nurse was on duty in place of a carer. Residents said they did feel that staffing levels were too low sometimes, one saying, “Enough staff? I don’t think so, although they never say but from what I see – they are sometimes too busy. If you buzz they don’t always come – they come as soon as they can but you have to wait”. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 21 A resident who returned a survey said, “they are very busy” and a relative commented “Sometimes the carers are a little understaffed on my mum’s floor because of so many people immobile and need at least two people (are needed) to help each client at the home”. The manager acknowledged that staff levels were sometimes “borderline”. The daily routine and work practices were observed and it was noted that staff on the first floor did appear to struggle at lunchtime, as two were trying to serve residents sat in the dining room, those who stayed in their rooms and feed several residents. One carer took two pureed meals out of the hot trolley to cool down but they were left on the side for at least ten minutes and the plates were virtually cold by the time staff were able to take them and start helping the residents to eat. It is recommended that staffing levels are reviewed and consideration should be given to increasing them at busy times of the day and to ensure that there are sufficient staff to meet residents’ social care needs. 53 of the care staff at the home had successfully completed NVQ training to level 2 or above. Two staff personnel files were examined. As stated at the last key inspection the application forms only requested details of the applicant’s last two employers. This meant that one person had not provided any employment history before 2006 and the other had provided a five-year employment history. A note had been made on the file of the former that they had been asked about their employment previous to the dates given and the manager was satisfied with the information given. However, the application forms should be amended so applicants are requested to supply details of their full employment history. One person had started working at the home before their CRB was applied for and before a POVA check had been made. This person only had one reference on file, although a second had been sent for twice. The manager had decided to start the new employee, as she already knew her. However, robust recruitment procedures must always be followed for anyone employed at the home. Training records showed that staff had received training in a variety of topics, including moving and handling, dealing with challenging behaviour, fire safety, dementia, management of urinary sheaths, food hygiene, caring for people with dysphagia and general foot care. One carer said she was looking forward to some training in palliative care later this year. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The attitude of the manager and staff is open and inclusive, which provides a positive atmosphere for people living in the home. EVIDENCE: The manager is registered with the CSCI and has successfully completed an NVQ level 4 in management. Staff and residents said the manager was accessible and approachable and they had confidence in her ability to manage the home. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 23 Not all of the residents spoken to were aware that residents’ meetings were ever held but minutes provided evidence that meetings had been held in November 2006, February and September 2007. These showed that residents had been asked to make suggestions and comments about how the home was running. Surveys were also available that had been completed by residents and relatives. Some were not dated, so it was unclear how old they were and how relevant the feedback was. Although they could be anonymous, some residents had signed them. However, it was clear that some residents had been helped to fill the surveys in, although there was no information as to who had helped them. The manager said she thought staff may have helped them and a discussion was held about the validity of surveys that are completed with the help of staff and whether residents would feel entirely comfortable about giving their opinions. A few residents and relatives had made comments, but most had just answered multiple choice questions. Where comments were made, there was no evidence of what had been done in response or if any feedback had been given to the resident or relative about their suggestions. Staff said they had handover sessions at the start of every shift when day-today issues were discussed. There was also evidence in staff personnel files that staff had received supervision. Staff said they felt they worked well as a team and liked working at the home. A representative of the company had undertaken internal audits and random samples of documentation had been reviewed. The home has ISO 9001:2000 accreditation and last had a surveillance visit in March 2007. This visit identified that internal audits had been carried out but did state that although action was often undertaken to correct areas of non-conformance reports were not updated to record what had been done. Evidence of this was still apparent, for example, in the records of complaints and how they were managed. Maintenance records were up to date and showed that regular checks were made of the building and equipment but Oldham MBC had required some action to be taken as a result of their Health and Safety inspection, such as training for the manager so she can act as the moving and handling facilitator in the home, improved health and safety risk assessments, infection control measures to be implemented where residents shared hoist slings, and some staff needing up to date training in fire safety awareness. Staff said they had enough equipment to do their job safely and were seen to be working using safe working practices. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 24 The manager returned the AQAA promptly and provided clear, relevant information about what changes had been made and where they still needed to make improvements. Since the last inspection no notifications have been sent to the CSCI under Regulation 37 of the Care Homes Regulations 2001. The manager said that very few reportable incidents had occurred in that time but was not aware of some of the issues that were reportable. A discussion was held about the types of incidents that were notifiable under the regulations. Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19 Requirement To fully protect residents,two references must be obtained for all new employees prior to their employment. (Timescale of 31/10/06 not met). In addition CRB and/or a minimum of a POVA check must be received for all new staff before their employment starts. Requirements made as a result of the health and safety inspection conducted by Oldham MBC must be complied with to ensure residents are safe. Notice must be given to the CSCI, without delay, of any occurrence listed under Regulation 37 of the Care Homes Regulations 2001 so that we can be sure that any significant event that occurs is appropriately dealt with. Timescale for action 31/03/08 2 OP38 23 30/04/08 3 OP38 37 15/03/08 Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 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 2 Refer to Standard OP7 OP8 Good Practice Recommendations All risk assessments should be reviewed and updated regularly to reflect residents’ changing abilities and needs. Advice and information from other healthcare professionals should be transferred on to the resident’s care plan so it will not be overlooked and will be carried out appropriately. The key worker system should be further developed to maximise person centred care and assist in meeting residents’ social, cultural and spiritual needs. Consideration should be given to rearranging the seating arrangements at meal times, to ensure that a pleasant and social dining experience is facilitated for residents. When complaints are recorded in the complaints record and dealt with, details should be added to confirm what action was taken and whether the complainant was satisfied. Staff should attend the formal training in safe guarding adults run by Oldham MBC and a copy of the Local Authority procedure should be easily accessible for staff so they have contact information and advice if they need it. Staffing levels should be kept under review and should take into account the dependency of residents and busy times of the day such as meal times. Application forms for new employees should request sufficient information about the candidate’s employment history. Quality monitoring tools such as resident meetings or surveys should be used to demonstrate that feedback from residents and staff is being considered and incorporated in to the development plans for the home. Where the manager has taken steps to improve or change the service as a result of feedback or her findings in audits, this should be recorded to demonstrate how improvements are managed. 3 4 5 OP12 OP15 OP16 6 OP18 7 8 9 OP27 OP29 OP33 Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alexandra Nursing Home DS0000066180.V358876.R01.S.doc Version 5.2 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!