Inspection on 28/07/09 for Angelus Nursing Home

This is the latest available inspection report for this service, carried out on 28th July 2009.

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

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

Other inspections for this house

Angelus Nursing Home 04/12/07

Angelus Nursing Home 26/06/07

Angelus Nursing Home 11/12/06

Angelus Nursing Home 14/08/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Angelus Nursing Home 24 - 26 Merton Road Southsea Hampshire PO5 2AQ Lead Inspector Mick Gough Key Unannounced Inspection 28th July 2009 10:00 DS0000066729.V376906.R01.S.do c Version 5.2 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 homes for older people 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. Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 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 Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Angelus Nursing Home Address 24 - 26 Merton Road Southsea Hampshire PO5 2AQ 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) 02392 715298 02392 715 297 angelusnursing@btconnect.com Cherry Garden Properties Ltd Miss Teckla Madho Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 31. Date of last inspection 8th August 2008 Brief Description of the Service: The Angelus Nursing Home is registered to provide nursing care and accommodation for up to thirty-one older people. The home is located in a residential area of Southsea within easy reach of local shops and public transport bus stops are located close by. The property consists of two older houses combined to form one home. Accommodation is provided in fifteen single bedrooms and eight twin rooms. A total of twelve bedrooms (nine single and four twin) have en-suite facilities. Bedrooms are located over the three floors and are all accessible via a passenger lift. The home provides a range of communal rooms and there is level access to an enclosed rear courtyard style garden. Cherry Garden Properties Limited owns the home and weekly fees are dependant on the type of room and level of care required. Full details of fees are available from the home. Angelus Nursing Home DS0000066729.V376906.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 1 star. This means the people who use this service experience Adequate quality outcomes. This report details the evaluation of the quality of the service provided at Angelus Nursing Home and takes into account the accumulated evidence of the activity at the home since the last key inspection, which was carried out in August 2008. The inspection took into account the homes Annual Quality Assurance Assessment (AQAA), which arrived when we asked for it and was completed satisfactorily. The AQAA is a self assessment tool that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Prior to the site visit we sent out surveys to service users, staff and health care professionals to obtain their views on how the home was meeting the needs of service users. We received responses from seven users of the service. One negative survey was returned and this stated that the person was unhappy with some staff and comments received back stated “they spend all their time chatting at reception” and “ I am fed up with Soup and sandwiches at teatime”. The other 6 responses from service users were all positive and comments included; “ Good communication with next of kin” “ the home is well run and caring” “ I am very please with all they do for me” “staff are always very helpful and available” and “ I have nothing to worry about I am well looked after”. Four staff members returned surveys and these were all generally positive with comments such as: “the home puts the residents first” “ the home ensures that service users attend all relevant appointments”. When asked what the home could do better staff told us “More staff would enable us to spend time with the service users” and “More staff as we always seem to be rushed”. One survey was returned by a health care professional who told us “Nurses will always call our service if any advice is needed for clinical support or to resolve any concerns, they ask for training updates, particularly for any new staff”. Included in the inspection was an unannounced site visit to the home, which was conducted by two inspectors from the Care Quality Commission and the visit took place on the 28 July 2009 between 0945 and 1545. For this visit we involved 9 users of the service and 5 members of staff and 5 visitors to the home who we spoke with on the day of the visit and this provided us with information about the home. Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 6 Other evidence for this report was obtained from reading and inspecting records, including pre admission assessments, plans of care, training and recruitment records and records relating to health and safety and quality assurance. We looked at how the home deals with any complaints and issues regarding the protection of vulnerable adults. We also looked at some of the homes policies and procedures. Throughout our time in the home we also observed the interaction between staff and users of the service. We were assisted through the visit by the manager of the service. The home is registered to provide support for 31 residents and at the time of the inspection there were 25 people living at the home. What the service does well: The service has robust recruitment procedures in place and staff only start work at the home once all recruitment checks have been undertaken and this provides protection for service users. We observed staff interacting with service users and we saw that people are treated with respect and their right to dignity maintained. Those service users we spoke to told us that staff listen and act on what they say. The daily routines in the home are flexible and service users are able to make informed choices. There was good evidence in care plans to show that service users were able to make their own decisions wherever possible and this allows service users to be in control of their lives as much as possible. The visiting routines at the home are flexible and family and friends can visit at any time. Visitors we spoke with told us that they are made welcome at the home. The home employs an activities co-ordinator and she works 5 days a week and provides a range of activities for service users, she ensures that those service users who stay in bed are stimulated and spend time with all of the people who live at home. What has improved since the last inspection? The front of the home has been maintained to a good standard and there were hanging baskets which service users had helped to plant and these provided a welcoming entrance to the home. The manager of the home has demonstrated her fitness to manage the home and was registered with the Care Quality Commission in February 2009. The home has changed the medication storage arrangements and this has resulted in medication being stored at suitable temperatures. Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 7 The home has provided staff with the training they need to ensure that staff are able to support service users appropriately. The health and safety arrangements in the home have been improved and all servicing and testing of fire equipment is carried out and this provides protection for service users and staff. Some areas of the home have been redecorated and service user’s rooms are decorated as they become vacant. What they could do better: 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. Angelus Nursing Home DS0000066729.V376906.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 Angelus Nursing Home DS0000066729.V376906.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. 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. Potential new residents have a needs assessment undertaken prior to moving into the home and this allows the home, the resident and their relatives to see if the home can meet the resident’s needs. The home does not provide intermediate care. EVIDENCE: A copy of the statement of purpose/service user’s guide was on display in the entrance hall. These documents provide relevant information in a written format for people or their representatives. A sample of the standard terms and conditions of admission was included in the service user’s guide. The person in charge explained the homes admission procedure and the preadmission Assessment’s for two people admitted shortly before the inspection visit were viewed. We discussed admissions with care staff and with Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 10 some people who live at the home. We also looked at the service user’s guide and other information available to prospective service users or their relatives. The person in charge stated that if an initial inquiry from either social services or from a person or their family indicates that the home would be able to meet the persons needs the home will invite the person or their relatives to visit the home to view the facilities and room available. A comprehensive pre-admission assessment is completed including and where Appropriate, members of the persons family and professionals are involved. Copies of social services assessments were seen in care plan files viewed and we also viewed discharge information from the hospital. The pre-admission assessments viewed had been completed by the registered manager and contained information about the persons needs and this enables the home and the prospective service user to make a decision on whether the home is able to meet the individuals assessed needs. Following admission the home had completed further assessments including relevant risk assessments such as for nutrition, falls, pressure areas, manual handling and specific health or behaviour needs. Equipment identified in the pre-admission assessment was seen in people’s bedrooms. It was not possible to discuss admissions with the new people whose assessments were viewed; however discussions with care staff confirmed that they felt they had enough time to meet peoples needs. People living at the home tend to be long term, however the home could provide respite or short stay accommodation if a suitable room were available. The registered manager stated that the same admission procedures would be used for respite or short stay admissions as for long-term admissions. One of the admissions viewed was for a person initially admitted for short term care. The home does not provide intermediate care. Angelus Nursing Home DS0000066729.V376906.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. 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 health, personal and social care needs of residents are contained in an individual plan of care, however care plans do not always provide all of the information required and are not in sufficient, accurate and up to date to ensure that peoples needs are being met. This and some poor practice puts people at risk of not having their health and well being protected. The home has medication policies and procedures in place but service users are not receiving their medicines as prescribed by their GP and this is putting service users at risk. EVIDENCE: Four care plans were viewed, two for people recently admitted to the home and the others for people who have been living at the home for a longer time. Other care plans were viewed to obtain specific information we wished to consider. We discussed with staff how care needs are met and observed staff in communal areas. Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 12 The care plans follow a comprehensive format and are individualised, written in plain language, however they do not always provide sufficient detailed information as to how a persons needs should be met. Care plans are written by one of the homes qualified nurses who are then also responsible for reviewing care plans and risk assessments on a monthly basis. Plans were seen to have been reviewed on a monthly basis but these reviews did not always identify that all assessments and guidelines were up to date. Care plans contained forms for people to sign to confirm that they had agreed to the care plan. Those for the newer people had not been signed. It was not clear from care plans if these had been discussed with or agreed by the service user or their relative. Care plans seen contained relevant risk assessments and management plans including; nutrition, manual handling, falls, bed rails and any individual risks. Risk assessments viewed appeared appropriate to the persons needs and had been reviewed monthly or when risks changed. Although all files viewed had manual handling guidelines in place one did not have the safer handling of people risk assessment completed and this was seen blank in the persons file. The same assessment had been completed for a person in October 2006 and had not been updated although other information in the care plan evidenced that the person’s needs had changed since admission. Some care plans identified a need for additional pressure relieving equipment due to a high risk of people developing pressure injuries. We looked in the people’s bedrooms and saw that they did have pressure relieving equipment on their beds and chairs. Some of the equipment used provides a variable degree of pressure relief depending on the persons weight. We looked at the pressure settings for this equipment. One mattress was set at the highest setting (8) and the person’s care plan stated the setting should be between 2-4. We informed the manager about this and she stated that the mattress was not working correctly and that if it was turned to 2-4 then it did not provide any pressure at all. This was demonstrated to the inspectors and when turned down the mattress lost all pressure. The home must not use equipment that is not functioning correctly. Another air mattress in use was set at 2 and the persons care plan stated that it should be set at 3-4. Not setting this equipment at the correct setting placed people at risk of developing pressure sores. The home undertakes nutritional risk assessments for people and there was evidence that people are weighed monthly. The home has scales suitable for people who are unable to stand. One of the care plans viewed was for a person who had been seen by a dietician and supplements had been prescribed. The dietician had most recently visited in May 2009 and a letter was in the person’s file detailing changes to the supplements the person now required. This Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 13 information had not been updated onto the person’s nutritional care plan. It was noted that the person had a different supplement juice drink beside the bed and this was not the type that was prescribed by the dietician. We looked in the cupboard where supplement drinks and foods are stored. We found one box of supplement mousse that was out of date and that the person for whom all the remaining supplement mousse had been prescribed was no longer receiving them. The registered manager arranged to have these destroyed. We found a container of food supplement in one of the lounge dining rooms. It was not clear form the person’s care plan if this was still required, however it had been dispensed in May 2009 and stated that it should be used within one month of opening. There was no date on the container to show when it had been opened this means that people are being put at risk of not receiving an appropriate nutritional intake. Some people required thickened fluids. In no care plans viewed was there any individual and specific guidelines as to how thick the fluids should be. In discussion with care staff they stated that they add the same amount of fluid thickener to all drinks for anyone who required thickener. One container of named thickener was seen in each lounge/dining room. Care staff confirmed that the same container of thickener may be used for more than one person and not kept solely for use for the person for whom it had been dispensed. One person who was prescribed thickener remained in bed and had a bottle of high supplement juice beside her along with two lidded cups of orange squash. The person’s supplement drink remained in its original container and this did not allow for any thickener to be added. The lidded cups of juice did not appear to have thickener added and we found no thickener in the room. This was reported to the registered manager during the inspection who stated she would look into this. Thickener was prescribed on medication sheets and had been dispensed for named people. The home must seek guidance from the speech therapists team as to the consistency of fluids that is required for anyone prescribed thickener and this information must be included in care plans. These people are currently being put at risk of choking from poor care practice. The home maintains a record of the fluid intake for some of the people who live there. These were viewed and also contained information about changes of position that people had received. The forms appeared to be well completed by night staff however there were gaps in the recording of changes of position and fluid intake during the day. One record viewed recorded that a person had not changed position between 02.20 am and 15.35 and then not again until 20.45 on the day prior to the inspection visit. This also recorded that the person always drank 50, 100 or 200 mls of fluid. The fluid chart had not been added up to give a daily total and did not record when fluids had been refused. Another chart viewed recorded regular changes of position during the night and small amounts of fluids given by the night staff however by 12.30 on the day of the inspection there had only been one recording for fluids being given this being 30 mls at 8.50 am. Again previous days fluid charts had not been totalled. The lack of adequate recording meant that it was not possible to know Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 14 when the person was last given fluids and this put people at risk of dehydration. Records were available to demonstrate that people have access to a range of services such as GPs, Opticians and Chiropodists. Records and discussions with people who live at the home confirmed that health professionals are consulted when necessary. During the inspection visit manual handling equipment was seen in use by care staff. Appropriate techniques were observed and the person’s dignity was preserved throughout the transfer. Following the previous inspection the home was required to ensure that all medication was stored correctly and securely. Since the previous inspection the home has moved the medication storage cupboard to a larger cupboard. The arrangements are appropriate and secure. The home has arranged with general practitioners that daily medication is given at 11am which has reduced the very long morning medications rounds and ensures that medications that must be given at more frequent intervals can be given at the time they are prescribed. We looked at the medication administration records for the peoples whose care plans had been viewed. We found that these had been well completed with no gaps in the recording. Medication is only administered by the homes qualified nurses. We noted that it had been recorded on one medication administration record sheet that a person had been refusing all their tablet and liquid medication. There was no information in the persons care plan about the action the home had taken in respect of the continuing refusal re the medication. The registered manager stated that the persons GP was aware that the person was not taking their medication but this had not been recorded. On the same Medication administration sheet there was a dietary supplement prescribed but this was not being given. The registered manager stated this had been discontinued but that the pharmacist has not removed it from the pre-printed medication sheets. There was no indication on the medication sheet that this was no longer required. Inadequate recording puts people at risk of not receiving the care that they need. We noted that two people are prescribed medication that must be given weekly. One person had received this four times in three weeks and the gap between administration was only 6 days, having been given on the 9th, 15th, 21st and 27th July and the chart indicated that it was again due on the 2nd August. We audited this medication which was not in the blister (pre-dispensed packs) used by home for most medications. Four tablets had been dispensed on the 2nd July; the medication record sheet stated that four had been administered however one was remaining in the box. There was no date on the box to say when it had been first used so it is possible that a tablet from a previous pack had been given during the month. However the person has been placed at risk by not receiving their medication as prescribed on a weekly basis. Another person was prescribed the same medication again on a weekly Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 15 basis. The medication administration records for this person had been completed to show that this was administered on the 21st July and would next be given on the 29th and then on the 4th August. We looked at the arrangements for the storage of medications that must remain at cooler temperatures and these were stored correctly in a fridge with daily recordings of temperatures. We also looked at the arrangements in respect of controlled medications and these were also appropriate with records maintained. We observed part of the morning and lunch time medication administration round and the procedures used were appropriate. Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 16 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. 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 home provides a range of activities for service users, which meets their expectations and the recreational interests of service users at the home are provided for. Service users are able to maintain contact with family and friends and visitors are welcome at any time. Service users are supported to exercise choice and control over their lives and are provided with a balanced diet at a time convenient to them. However the home is not effectively managing the needs of people who have specific requirements in relation to their fluid and nutritional intake. EVIDENCE: The home employs an activities co-ordinator and she works at the home in the afternoons five days per week. She has only been employed at the home for a short time and has arranged a number of activities for residents and there is a weekly activities plan and these are displayed on an activities board. Activities include, hand massage, manicures, reminiscence sessions, cards, painting, musical movement, CD’s, DVD’s and videos. She has organised service users to be involved in planting the hanging baskets at the front of the home and she told us that she has some bird feeders that she is getting service users to Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 17 decorate and these will be placed in the garden. She has arranged shopping trips and also a trip to the local theatre. For those residents that stay in their rooms she reads to service users, plays cards or just has a chat. The activities co-ordinator is making a life book for some of the residents with pictures of the past and this includes family photos. Service users we spoke with told us that the activities co-ordinator was very good and one service user told us “we went to the local shops and it was lovely” Visiting entertainers also call at the home every fortnight and the varied range of activities provide stimulation for the service users. Those residents spoken to were happy with the activities provided, some stated that they preferred not to be involved but were happy relaxing and watching what was going on. The home has a visiting policy and there are no restrictions on visitors and this enables service users to keep in touch with family and friends. The home maintains a visitor’s book and this showed that people feel able to visit at any reasonable time. The home has a small quiet lounge on the first floor that could be available for private visits if required. We had the opportunity to speak with 5 visitors to the home and 3 of those spoken with were very happy with the care provided and said that there relatives were happy and content. Two visitors told us that they felt that staff were not doing enough for their friend and felt that more staff on duty would help because they felt that staff were always very busy. All visitors told us that they were made welcome and staff were friendly. Residents spoken to confirmed that they are able to make informed choices and were able to control their own lives as much as possible. Care plans contained good information about service users choice and contained information about service users likes and dislikes, one care plan stated that the person did not like the communal environment and requested to stay in their room and this was respected by staff, another has agreed to go to a theatre trip but on the day of the trip she decided that she would rather stay at the home. We observed staff and residents interacting and they got on well together and this was confirmed by both residents and staff members we spoke with. We observed residents being consulted throughout the day from the choice of TV channel to what they wanted to drink. Staff spoken to said that they always ask residents what they want and would always respect their wishes and views. Staff were observed speaking to residents appropriately using their preferred form of address, also knocking on resident’s doors before entering. Residents are encouraged to bring some of their own possessions into the home and those rooms seen had been personalised. This enabled residents to have familiar possessions in their rooms. The home operates a 4 week rolling menu, which is changed regularly and resident’s likes and dislikes are taken into consideration. A record of food eaten by residents is kept, however the fluid intake of some residents is not accurately recorded and the amount of thickening agents needed for some residents was not recorded in their plan of care. We were told that 5 Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 18 residents require pureed meals, we observed the cook preparing the lunch and pureed food was done individually to provide colour and textures that could be enjoyed On the day of the inspection the lunch time meal was corned beef hash with fresh vegetables or poached fish and mashed potato. We were told that the kitchen assistant goes round and consults resident’s and tells them what the choice of main meal is residents choose what they like and we were told by the cook the he would provide an alternative if the choices available was not to their liking. We saw that one resident who had initially requested the corned beef for lunch was asked by their friend if they would like something else and she chose to have the fish and this was provided for her. Her friends told us that she can not remember what she has ordered and it would be better if staff asked her what she wanted just before the meal was served. We spoke to the manager about this and she told us that she would get staff to check with this particular service user shortly before the meal was served. Meals are served in the dining room at the home, although some residents have meals in their rooms. We observed the lunch at the home and care staff were supporting service users with their meal and this was relaxed and not hurried. We were told that breakfast was porridge, cereals and toast, and 2 service users have a cooked breakfast. Lunch was the main meal of the day and tea is served at 1700 to 1715 and this is normally soup, sandwiches and a hot snack type meal such as egg on toast. We were told that staff have access to the kitchen whenever the cook is not on duty and are able to make snacks or sandwiches for service user if they request something to eat. We saw drinks being served through the visit and service users we spoke with were happy with the food provided. Records within care plans included weight charts and nutritional assessments and service user’s benefit from a varied and balanced diet. Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 19 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. 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. There is a simple, clear and accessible complaints procedure, which includes timescales for the process and any complaints are logged and responded to appropriately. The homes policies and procedures help protect users of the service from any form of abuse. However some care practices may put people at risk of not receiving the care that they need. EVIDENCE: The homes complaints procedure was on display in the hallway. Evidence recorded within the homes complaints log demonstrated that people’s complaints are recorded and taken seriously. We were told that there had been 9 complaints made to the home since the last visit and these had all been appropriately investigated and responded to. Service users we spoke with were aware of how to make a complaint and told us that they would speak to a member of staff or to a relative. Those visitors we spoke with were aware of how to make a complaint and the homes polices and procedures were clear and allowed service users to raise any concerns they may have. Staff at the home receive training on adult protection as part of their induction and staff members spoken to said that they would report any concerns to the manger or the senior nurse on duty. All staff received Adult Protection training from an outside training organisation and there was a notice displayed at the home reminding staff of their responsibility to attend refresher training on Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 20 Adult Protection that had been arranged for August 2009. The home has a whistle blowing policy and also a copy of the Hampshire Adult Protection procedure and these together with the homes policies and procedures provide protection for service users. However there are some care practices that are putting people at risk. Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 21 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. 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. Residents live in a safe and generally well-maintained environment and have access to reasonably comfortable indoor and outdoor facilities. Residents have the specialist equipment they require to maximise their independence and the home was generally clean, pleasant and hygienic, however the laundry area of the home is in need of refurbishment to protect service users and staff from any cross infection. EVIDENCE: During our visit to the home we had the opportunity to look around the home including bathrooms, toilets, the three lounges, dining area, kitchen, rear courtyard garden as well as a number of bedrooms. All areas of the home were clean and there were no unpleasant odours. All bathrooms and WCs had hand washing facilities and soap with paper towels. Hot water temperatures were checked in bathrooms and WC’s and these had thermostatically controlled Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 22 valves which kept water at a suitable temperature and protected service users from scalding. Water temperatures were checked each week by the handyman and a record of temperatures was kept. Service users we spoke with were happy with their bedrooms and also the communal areas, although some service users told us that they do not use the communal areas as they prefer to stay in their rooms. The home supports some people with high physical care needs and many of the beds within the home were seen to have pressure-relieving mattresses in place. We checked pressure settings on some beds and not all of these were set at the correct level. (please see health and personal care section of this report for more details) The home has a range of moving and handling equipment and these were stored around the home. The home employs domestic staff to carry out cleaning around the home and the premises were clean and generally well maintained and provided a pleasant environment for service users. One visitor to the home told us “the staff only clean when I get on to them” However the people who returned surveys and those spoken with on the day of the visit were generally happy with the home, comments from service users included: “I am very happy here”, “Staff are very kind” “my room is very nice” The Laundry at the home is situated in the basement. The door leading to this is fitted with a keypad entry system, as there are steep steps immediately inside the door. Although this door was kept secure throughout the inspection, the code to the keypad was displayed above the lock and it is possible that someone could open to door and this could result in a fall, this was discussed with the homes manager who agreed to move the key code number. The home employs a laundry assistant who works 25 hours per week and she launders all of the service users clothing. Bed linen is sent out twice per week to an outside laundry company. There were 2 industrial washing machines and 2 industrial tumble driers and the laundry assistant collects laundry from bathrooms each morning. Any soiled items are placed in Red bags. There was suitable protective clothing available including aprons and gloves. We saw that the laundry area was very dusty and was in need of refurbishment, the walls were not readily cleanable and there was flaking plaster coming from the ceiling. There was one sink in the laundry area and this was not able to be used for hand washing of any clothing as the handyman used this sink to clean paint brushes. Hand washing of clothing was carried out in a bucket and there was no sink for staff to wash there hands. Floor surfaces are not impermeable and surfaces were not easily cleanable. The lack of hand washing facilities and the fact that laundry surfaces were not easily cleanable presented an infection control hazard and did not protect service users and staff from cross infection. Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 23 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. 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 home has sufficient staff on duty to ensure service users receive the support they require. Staff were found to be well motivated and competent to do their jobs and service users are protected by the homes recruitment procedures. The home provides training for staff to enable them to carry out their roles. EVIDENCE: On the day of the visit we looked at the staffing levels for the day of the visit and this showed that between 0800 – 1700 there are two Registered General Nurses (RGNs) plus 4 care staff on duty, between 1700 - 2000 there is one RGN plus 3 care staff and between 2000 – 0800 there is one RGN plus 2 care staff on duty who are awake throughout the night. These numbers are complemented by domestic staff and cooks and also the homes manager who works flexibly at the home 45 hours per week. Staffing numbers were discussed with the manager and she stated that she felt that, staffing levels were sufficient with the current number of residents but that staffing numbers would be kept under review. 2 visitors to the home who we spoke with told us that they felt that more staff were required as the call bells seemed to be constantly sounding, however service users spoken to said that they felt that staffing levels were adequate and comments received included “the staff are Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 24 very good” “I get all the help I need” “I am well looked after” and “they do anything I ask them to”. The home employs a total of 15 care staff and has 8 members of staff who have a minimum of NVQ2; We were informed that the home would support staff to obtain National Vocational Qualifications. Recruitment records were seen for 3 members of staff and these contained all of the required information including application form, 2 references, photo, declaration of offenders, birth certificate, Criminal Record Bureau and Protection of Vulnerable Adults checks, work permits and Nursing and Midwifery Council Pin numbers where appropriate. We found that the recruitment practices were robust and this helps to protect service users. Staff training records were looked at and staff files contained training certificates and there was also a training log which showed what training had been completed. After each training session staff complete an evaluation sheet and this gives staff the opportunity to comment on the content of the training course and informs the manager if the training has been beneficial and this enables appropriate training to be accessed. Records seen showed that staff have received training in first aid, food hygiene, moving and handling, fire, infection control, adult protection, medication, H & S, dementia awareness, diabetes, tissue viability, continence, managing diversity, palliative care practise, supervision, COSHH and challenging behaviour. We also saw notices displayed in the home to inform staff of their responsibility to attend refresher training in Infection control and POVA in August 2009. A suitable induction programme is in place, and this was based on skills for care guidelines and staff were expected to complete an induction workbook which is signed off by their supervisor. Staff spoken to confirmed that they receive appropriate training in order to carry out their care tasks and staff who completed surveys told us that training at the home was good. Staff are paid to attend training and the training provided by the home ensures staff has the skills and knowledge to provide support to service users. Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 25 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. 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 home is managed by a person fit to be in charge and has been registered by the Care Quality Commission. However the manager has not fully embedded good practice in all areas of care in the home. The home has a quality assurance system in place but this is not currently developed to support the running of the home in the best interest of people living there. Systems are in place for the safekeeping of resident’s personal spending money and the health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: The home has a manager who has demonstrated her fitness to manage the service and was registered with the Care Quality Commission in February Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 26 2009. She informed us that she continues to update her skills and knowledge and had recently completed a course in deprivation of liberty and she is also undertaking a degree in Dementia studies. However there are some areas of poor practice regarding the care plans and health needs of residents that the manager must address. Service users who we spoke with had no concerns about the management of the home and told us that the manager was very approachable. The home has a Quality assurance system and there are regular staff meetings and Regulation 26 visits are carried out each month by the registered providers. Staff received regular supervision and we saw that surveys are sent out to service users, relatives, staff and visitors and the home collates responses. Although the views of these people are sought there was no evidence that the home responds and takes action regarding any concerns that are raised. The manager told us that the menu at the home had been changed as a result of a previous survey but there was no record of this so it was not possible to see if the quality assurance system was working effectively and this needs to be followed up at the next visit to the service to see that the views of service users and other interested parties are taken into consideration. The home does not manage any service user’s finances; they do however keep some personal spending money for some service users. This money is kept in separate wallets in the homes safe and there were records of any monies spent with receipts available. We checked the balances for 2 service users and these were found to be correct and the procedures used with regard to service user’s money protects them. The home has a fire risk assessment for the building which was completed in February 2009 and the fire log book was inspected and all required recording and testing had been carried out. Certificates were seen for annual tests of equipment and these were all in date. Fire equipment was last tested in May 2009; Private electrical equipment in November 2008, passenger lift in February 2009 and the gas safety certificate was issued in December 2008. All staff received training in Health and safety and the homes policies and procedures help protect service users and staff. Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 27 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13 Requirement Timescale for action 01/10/09 2 OP15 16 3 OP9 13 The registered person must ensure that all service users have a clear plan of care that sets out in detail the action which needs to be taken by care staff to ensure that all aspects of the health and personal and social care needs of service users are met. This will ensure that staff have the information they need to provide the care and support that service users need and in the way they prefer. The registered person must 01/10/09 ensure that service users are provided with sufficient and appropriate fluid and nutritional intake. They must also ensure that accurate records are kept. This will ensure that service users receive in adequate quantities, suitable, wholesome and nutritious food. The registered person must 01/10/09 review the medication practices in the home and particular attention must be paid to: Ensuring that all medicines are given at the dose and frequency the doctor has prescribed and DS0000066729.V376906.R01.S.doc Version 5.2 Angelus Nursing Home Page 29 ensure that complete and accurate records of all medicines given to people are kept. This will ensure that people in the home receive the medication that has been prescribed for them. 4 OP26 13 The registered person must make arrangements to prevent the spread of infection in the home Readily cleanable surfaces in the laundry area together with suitable hand washing facilities will help protect staff and service users from any cross infection 05/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@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). 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. Angelus Nursing Home DS0000066729.V376906.R01.S.doc Version 5.2 Page 31 - 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!