Inspection on 11/12/06 for Angelus Nursing Home

This inspection was carried out on 11th December 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Angelus Nursing Home 08/08/08

Angelus Nursing Home 04/12/07

Angelus Nursing Home 26/06/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Angelus Nursing Home 24 - 26 Merton Road Southsea Portsmouth Hampshire PO5 2AQ Lead Inspector Janet Ktomi Unannounced Inspection 11th December 2006 7.00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Angelus Nursing Home DS0000066729.V323173.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. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Angelus Nursing Home Address 24 - 26 Merton Road Southsea Portsmouth Hampshire PO5 2AQ 02392 715298 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) Cherry Garden Properties Limited Naila Nanji Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31), Terminally ill (6), Terminally ill over 65 of places years of age (31) Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No service user in the TI category can be admitted under the age of 55 years. 14th August 2006 Date of last inspection 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 thirteen single bedrooms and nine twin rooms. A total of twelve bedrooms (eight 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. The home is owned by Cherry Garden Properties Limited and managed by Mrs Naila Nanji. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second key inspection of the service since the current providers purchased the home in March 2006. The purpose of the inspection was to assess the home against all the key minimum standards, to follow up the requirements made at the previous inspection undertaken in August 2006 and to explore issues identified in a complaint received at the commission and an adult protection referral received by Portsmouth Social Services. The visit to the home was undertaken by two inspectors and lasted approximately ten hours commencing at 7.00 a.m. and being completed at about 5.00 p.m. All core standards and a number of additional standards were assessed. Compliance with requirements and recommendations issued after the previous inspection in August 2006 were also assessed. The inspectors were able to spend time with the nursing and care staff on duty and were provided with free access to all areas of the home, documentation requested, visitors and service users. During the visit to the home the inspectors were able to meet with and talk to many of the people who live at the home and a number of visitors. Information received about the service by CSCI since the last inspection was reviewed and the action plan provided by the home following the previous inspection was assessed. Weekly fees for the home vary between a minimum of £500 to £550 for a twin room and £550 to £625 for a single room. What the service does well: What has improved since the last inspection? The home has reviewed the written information provided to prospective service users and their representatives however there is a need to further amend the Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 6 service users guide/statement of purpose to ensure that it accurately reflects the way the home is organised and what service users can expect. Service users or their representatives are now provided with a contract/terms of admission. The home has provided adequate screening around beds in shared bedrooms. A portable screen is now available in communal areas. Care staff were observed maintaining service users privacy and dignity during manual handling procedures requiring a hoist. The home now has a dining room. Following the previous inspection in August 2006 the home was required to review its policy and procedure in respect of service users personal money. A copy of the new procedure has been provided to the Commission and is considered satisfactory. This requirement has therefore been met. Also following the previous inspection the home was required to ensure that all staff have adult protection training. The training programme supplied to the commission shortly before this inspection stated that Protection of Vulnerable Adults training is due to be provided by an external training provider in two sessions in December 2006 and January 2007. The effectiveness of this training will be assessed during the next inspection but the home is considered to have met this requirement. The home has contracted with external training providers to provide staff with relevant training including that identified by Skills for Care induction and development portfolios. Staff have undertaken moving and handling training and fire awareness training. Further training needs not included in the training programme have been identified in this report. The home has now contracted with an external provider and a comprehensive induction programme is in place, which meets the Skills for care requirements. Nursing and care staff have commenced receiving formal supervision. The home has requested visits from the local fire and environmental health officers to ensure that appropriate measures are undertaken in the home in respect of fire and environmental health. Only approved devices were seen holding open doors around the home. Generally the home was found to be cleaner than during the previous unannounced inspection. The home is trying to recruit a second cleaner. The main office was less cluttered that previously and the home has recruited an administrator who was due to commence work at the home soon after the inspection. Quality monitoring work has commenced with surveys sent to service users and relatives. A formal report has yet to be compiled. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 7 What they could do better: Outcomes for service users are generally poor, and inspectors attribute this to the lack of management and direction. The registered manager is rarely in the home, leaving the head of care to deal with the administration thereby taking her away from her clinical role. The concerns are such that a statutory requirement notice will be served, and a meeting will be arranged with the registered persons. The manager must ensure that the statement of purpose/service users’ guide contains accurate and up to date information about the services provided at the home. Assessment and care planning processes must be further developed. Nursing and care staff must receive training to meet service users needs including dementia, mental health and challenging behaviour. Suitable equipment to meet the needs of the service users is not provided, or is used inappropriately. The home has inadequate facilities in respect of bathrooms suitable for people with physical disabilities and WC’s in which moving and handling equipment may be used. Procedures for the administration and recording of medication remain poor. Service users must have access to their call bells at all times. Practice in the home results in residents not eating as regularly as they should. One resident was noted to have gone for a period of seventeen hours without food. The home is heavily reliant on tinned and processed foods, and little fresh vegetables or fruit were seen. Generally the recruitment procedure is satisfactory, but one member of staff was found to have started work without the required checks. Records of residents’ money held were not accurate. The carpet on the main stairway was ripped and presented a trip hazard. The newly appointed maintenance person was trying to tack them down to make them safe but these need to be replaced. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 8 Old furniture and items stored in the gardens and first floor lounge must be cleared and these areas made pleasant and safe for service users. There were rips to carpet on the main staircase. Bathing facilities do not meet the needs of the service users. Although the standards in respect of bathrooms only apply newly registered services the standard of at least one assisted bath (or assisted shower) to every eight residents should be considered as a guide. Health and safety procedures must be reviewed to ensure that staff take responsibility for reporting broken items, ensuring the safety of the service users and themselves. Infection control procedures are poor and do not protect service users. Staff are not adequately trained in this area. Staffing and routines are not organised in such a way as to meet the needs of the service users. The home must review the way nursing and care staff are organised and the homes routines to ensure that service users needs are met. The home is in need of a strong management presence and lacks a full time manager and administrative staff. The head of care is therefore being left to undertake all areas of the management of the home to the detriment of staff supervision and quality of care provided to service users. This is reflected in all areas, including the maintenance of records. The home should consider having one lounge as television free and provide service users with an option of which lounge they spend their time in. 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. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service users guide/statement of purpose does not accurately reflect the facilities and services provided at the home and has not been provided to all service users or their representatives. Service users are not adequately assessed prior to admission to ensure that the home has all the necessary equipment and staff training to meet their needs. Prospective service users, or their relatives/representatives have the opportunity to visit the home prior to a placement being made, however they are unlikely to be able to fully assess if the home is suitable for their relative. Service users or their representatives are provided with a written contract/terms and conditions. The home does not provide intermediate care therefore Standard 6 is not applicable. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 11 EVIDENCE: A copy of the statement of purpose/service users guide was on display in the entrance hall beside the visitors signing in book, and this appeared to be the only copy. This had been updated in September 2006 as required following the previous inspection in August 2006 but does not accurately reflect the facilities and services being provided in the home and should be further amended. The inspectors spoke with service users none of whom said that they had received written information about the home. The head of care stated that service users, or more often their relatives, are invited to visit the home prior to admission. During the inspection the head of care received a telephone call from a relative of a potential service user who wanted to arrange the admission of his relative to the home. However without accurate written information about the home it would be hard for prospective service users or their relatives to determine if the home is able to meet their relative’s needs. It would be difficult, for instance, for a relative visiting the home to appreciate that, although the home has a number of bathrooms, only one is suitable for people with a physical disability and that the majority of people in the home would only be able to use that one bath, greatly restricting opportunities for people to have a bath. The service users guide stating that ‘every service user is offered a weekly bath or shower and can have one more often if requested’. This would not be achievable with the home’s current bathing facilities. Following the previous inspection the home was required to ensure that all service users or their representatives had received a contract or terms and conditions of residency. A sample of the standard terms and conditions of admission was included in the service users guide. Files audited indicated that service users are provided with a statement of terms and conditions. This requirement has therefore been met. The inspectors viewed the pre-admission assessments of people recently admitted to the home. One viewed was incomplete with large sections of the pre-admission form not completed. Other pre-admission assessments of residents needs did not detail the necessary information in respect of mental state and cognition, social interests, hobbies, religious and cultural needs. The service users guide states that ‘the home is not permitted to admit service users with a primary diagnosis of dementia. However this is acceptable if dementia is a secondary diagnosis of old age. The home is able to meet the needs of older people with varying physical disabilities’. Whilst viewing preadmission assessments it was apparent that people had been admitted either with dementia (and behaviours which might challenge) or physical disabilities. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 12 Staff within the home have not received any specific training in relation to dementia and the home has made no efforts to provide an environment suitable for people with dementia or mental health disabilities. The home only has one bathroom suitable for people with physical disabilities. Most WC’s are too small for manual handling equipment. In the majority of bedrooms beds have to be positioned next to the wall such that staff can only support service users from one side. This greatly restricts the way staff can provide personal care and support to service users who have physical care needs. Service users with assessed needs for pressure relieving equipment recorded in care plans were noted not to have been provided with this equipment. One service user was witnessed being inappropriately transferred using a standaid when a hoist should be used due to his physical condition. The explanation given being that the hoist could not be used in that part of the lounge. The home therefore does not have the necessary environment for people with physical disabilities and the statement of purpose must therefore be amended. This will be discussed with the registered persons. All service users must be fully assessed prior to admission. The manager must be able to demonstrate the home’s capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. The environment and training of staff needs to reflect the needs of the service user group. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 13 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, 10 and 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans do not accurately reflect individual care needs or the care provided to service users. Service users health and personal care needs are not fully met. Service users are not provided with the necessary equipment to ensure that their needs are met. Residents have developed pressure sores and weight loss management is poor. The methods of administration and recording of medication administered is unsatisfactory. The home is not aware of the wishes of people in the event of their death and therefore cannot be clear that these needs will be met. Service users’ rights to privacy are now met however dignity is not always maintained due to poor care practices. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 14 EVIDENCE: The inspectors case tracked four service users and in addition viewed the records of one service user who had recently died at the home. Case tracked service users met with the inspectors and their care plans were assessed against the equipment and care provided to them. All service users had a care plan, however there was no evidence that either the service user or their representatives had been involved in the care planning process or had agreed to the care plan. The home was required following the previous inspection in August 2006 to ensure that service users or their relatives were involved in the care planning process and care plans signed to confirm this. This requirement has not been met. Care plans viewed did not reflect pre-admission assessments or the care currently being received by service users. Equipment necessary for the promotion of tissue viability and prevention or treatment of pressure injuries is not always provided. Care plans identified service users at high risk of developing pressure injuries and stated that equipment should be in use to reduce this risk. The beds of two service users whose care plans stated they required pressure-relieving mattresses were looked at and neither contained the necessary equipment. The identified service users were not sitting on the necessary pressure relieving seat cushions. Discussions with staff at the home indicated that in one instance the service user no longer required this equipment and no explanation could be given as to why the second did not have the necessary pressure relieving equipment. Care plans must be updated and they must reflect current care needs. Service users should not be admitted to the home without the necessary equipment being available. As stated in the previous section of this report the home does not meet the needs of people with a physical disability or dementia. Staff within the home have not received any specific training in relation to dementia and the home has made no efforts to provide an environment suitable for people with dementia or mental health disabilities. The home only has one bathroom suitable for people with physical disabilities. Records within this bathroom indicated that only three baths had been provided in the two weeks prior to the inspectors visit. Located around the home are a number of other baths but these are only suitable for people able to walk and step into the baths. It was obvious from the state of the baths that these were rarely used. Care staff confirmed that at the time of the inspection only one service user would be able to use the walk in baths (medic baths) and none would be able to use the step in and sit down baths. Most WC’s are too small for manual handling equipment. In the majority of bedrooms beds have to be positioned next to the wall such that staff can only Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 15 support service users from one side. This greatly restricts the way staff can provide personal care and support to service users who have physical care needs. Service users with assessed needs for pressure relieving equipment recorded in care plans had not been provided with this equipment. One service user was witnessed being inappropriately transferred using a standaid when a hoist should be used due to his physical condition. The explanation given was that the hoist could not be used in that part of the lounge. The home therefore does not have the appropriate environment for people with physical disabilities. The laundry is down a very steep flight of stairs to the basement. The door to these stairs is not locked or key coded such that service users could open the door and fall down the stairs. The home must provide a safe environment for people with dementia. The services offered by the home must be developed to support persons with dementia or other cognitive impairments, sensory impairment and or physical disabilities. The staff training programme was provided to the inspectors. This did not contain any specific training in relation to dementia or challenging behavior. Currently staff are not trained to an acceptable level so as to collectively have the skills and experience to deliver the services and care for the people living in the home. Nutritional screening is undertaken, but there is a lack of records maintained of nutrition, including weight gain or loss and indicators that appropriate action has been taken. The home does not have the appropriate weighing scales to monitor service users’ weight. The inspectors were very concerned that care staff were witnessed on several occasions to be feeding service users who were lying virtually flat in bed. This practice greatly increases the risks that service users will choke or inhale food or fluids into their lungs. Service users should be sat up in bed or out into a chair for all meals where possible. In addition to the risk, lying flat in bed reduces service users’ opportunities to feed themselves and is undignified. Discussions with care staff and observations of staff throughout the inspection indicated that care staff tend to work on their own. The majority of people living at the home have high physical care needs that would be best met by two carers at a time. Staff stated that they have to leave service users during care activity to help other carers and to find a colleague to help them such as with transfers or positioning people in bed. This reduces service users’ dignity who may be left half dressed whilst staff get or give help. There is also a risk that carers may attempt to do these tasks on their own placing service users at risk of injury. The home has a call bell system fitted in all bedrooms and communal rooms. The system is such that it can be removed from the wall and placed close to Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 16 service users without long leads trailing. Throughout the inspection service users were noted not to have been provided with their call bells. Two service users were noted to have been sat in the dining room having finished their breakfast for approximately one hour. Neither had access to a call bell. Both said they would rather be sat in the lounge in a more comfortable chair. The inspectors moved one service user in her wheelchair and informed staff that the service users wished to sit in the lounge. Service users must have access to their call bells at all times. The service user’s psychological health is not monitored regularly and preventive and restorative care therefore not provided. Staff have not received any training in relation to mental health needs such as dementia or depression in older people and none is listed as being planned on the training timetable provided by the home. The home does have records for assessing pain for effective management but these are not being completed. There is a lack of monitoring for the effectiveness and suitability of analgesia given and this is paramount for ensuring a comfortable end of life. Part of an adult protection investigation undertaken by Portsmouth Social Services included the practice of the home crushing strong slow release pain killing medication. The home confirmed that they had crushed this medication that is potentially very harmful to the service user. Alternative medication has now been sought for this service user that is in liquid format, however the practice indicates a lack of understanding of pain relieve and good medication practice. Records also indicated that service users or their relatives have not been encouraged to express their wishes about what they want to happen when death approaches and to provide instructions about the formalities to be observed after they have died. Therefore cultural and religious preferences cannot be observed. The training program shown to the inspectors indicated that care of the dying training would be provided in January 2007. The service does have a medication policy but the home’s qualified nurses are failing to adhere to safe procedures, for the recording, handling and administration of medicines. The inspectors arrived at the home at 7am. The medications due at 8am were found to have already been dispensed into plastic pots identified for different service users with a slip of paper containing the name of the individual. As required painkillers had also been placed in a plastic pot. This is considered to be very bad practice and the potential for error in administration is high. The inspectors viewed the Medication Administration Records and noted that medication in the plastic pots not yet given to service users had been signed as given on the records. Gaps were also noted on the medication administration records where there was no indication if this had been administered or not. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 17 As stated staff have been crushing medication contrary to the recommendations of the manufacturers. This practice alters the effect of the medication to the detriment of the service users health. Nursing staff have not received medications training and none is planned in the training programme supplied by the home. Whilst touring the home the inspectors noted prescription creams dispensed for one service user have been stored inappropriately and shared between service users. The name of one service user for whom the prescription cream had been prescribed by the doctor and dispensed by the pharmacist had been crossed out and another service user’s name written on in pen. These creams were noted in a basket in a shared bedroom along with other personal items and photographs. This is unacceptable practice in respect of medication management and infection control. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users have little opportunity to make choices or decisions with daily routines revolving around completing care tasks and not individual choices. Service users are provided with drinks however some service users may go for long periods between meals and some care practices around meals are inappropriate and dangerous. Visitors are welcomed at all times. EVIDENCE: Pre-admission assessments were incomplete and do not contain all the necessary information to enable individual service users expectations and preferences in respect of social, cultural, religious and recreational interests to be identified and met. Some care plans contained life histories but these were not available for all service users. Good life histories are invaluable for determining service users likes and dislikes in respect of daily life. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 19 The inspectors arrived at the home at 7am. The home organizes two care staff to start at 7am with the remaining day care staff commencing at 8 am. The two day staff informed the inspectors that their job was to ‘feed the feeders’. They reported that the number of ‘feeders’ varied but that morning they had nine. They were observed taking bowls of porridge round the home and were standing spooning porridge to service users over bedside rails when the service user was still lying virtually flat in the bed. The inspectors were able to talk with some service users who, having been ‘fed’ then lay in bed waiting for staff to get them up perhaps two or more hours later. Some were seen to return to sleep, others just lay in bed. Other service users capable of feeding themselves were seen to be provided with breakfast once they were got up. This meant that some of the remaining service users did not to get their breakfast until 10.45 am. One service user reported at 08.40. “It’s a good job I have a small appetite because I’ve had nothing”. This lady went for seventeen hours without food, finally receiving her breakfast at 10.45am. Apart from those ‘fed’ porridge at 7am service users appeared to have been provided with a choice for breakfast, some having a cooked bacon and eggs, others toast or cereal. Service users also informed the inspectors that they are provided with a choice about their lunchtime meal and were seen offered a choice of squash or water for lunch-time drinks. At the start of the inspection, when all service users were still in bed, the televisions were already on in both lounges. In one lounge there was no remote control so that service users could change television channels or turn off the television. Staff stated that it was always on this channel. One of the first service users up in the lounge commented on the high volume of the television and stated that she did not like television. As television was on in both lounges this service user had little choice but to sit in a room with a television, which she was seen to do all day. The home should consider having one lounge as television free and then providing service users with an option of which lounge they spend their time in. The home provides some activities; service users informed the inspectors that musicians visit the home. There was no information available to service users about what activities were planned for which days throughout the week. A calendar on the wall in one lounge continued to display the month of October even though the inspection took place in mid December. Out of date calendars and lack of information about activities do not help service users with memory loss. Service users are provided with little choice in respect of daily routines. The inspectors spoke with service users who were up early and some stated that they would prefer to have longer in bed whilst others who were up late stated they would prefer to get up earlier. It was not clear how it was decided who would be got up first or what order from then on. A notice on the office wall indicated that the night staff were expected to get up a certain number of Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 20 service users and listed some names although it indicated others could be got up as well if possible. Care plans contained little information about service users preferences on this matter. In addition to the current arrangements for providing breakfast being haphazard the inspectors were concerned about the range of meals provided. On the day of the visit pasta bake was the main meal at lunchtime. The cook reported that he would not be making pasta bake, as he was aware that service users did not like it. Service users confirmed that they did not like pasta bake and the main meal for most service users was an omelet, mashed potato and peas, with bread and butter pudding. At the start of the inspection the inspectors visited the kitchen. This was found to be very dirty with food inappropriately stored, such as open bacon on a top shelf of a fridge next to a lettuce with a tray of uncovered pastries below this. Food spills were noted all over the cooker and the floor, washbasin, sink and shelves were dirty. The inspectors were shown the food storage area. It was noted that there was very little fresh fruit or vegetables. A small bag containing half a dozen apples and a similar number of bananas was seen. There appeared to be a large amount of processed foods in packets or tins such as cake mixes and tinned fruit. The provision of food must be reviewed to ensure residents are receiving a nutritious diet, with meals at regular and frequent intervals, and that the menu takes into account choice and preferences. Following the previous inspection the home was recommended to consider providing a dining room or dining area. This has been provided with new tables and chairs providing seating for approximately sixteen people. Staff informed the inspectors that there are plans to replace the carpet in this area with wooden flooring when carpets around the home are replaced. During this unannounced visit to the home the inspectors were able to meet a number of people visiting the home. Visitors spoken with stated that they could visit at any time and were seen visiting their relatives in the communal lounges. The home has a small quiet lounge that could be used for private visits other than bedrooms, or if service users are occupying a twin room. This room is also used for the hairdresser on Mondays. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 21 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 poor. This judgement has been made using available evidence including a visit to this service. Service users or their relatives were neither aware of the home’s complaints procedure, nor were they aware of who the manager is. The procedure is not robust, and complaints have been sent directly to the Commission for Social Care Inspection and to Portsmouth Social Services. Care practises within the home restrict service users opportunities for choice and independence. Some care practises are dangerous and others may be considered neglectful. The home therefore is not protecting service users from abuse. EVIDENCE: The complaints policy and procedure is included within the statement of purpose and service users guide, however not all service users or their relatives were aware of these documents. Additional information is available in the home’s entrance hall although service users and visitors spoken with did not include the homes complaints procedure when asked what they would do if they had any complaints. Service users and visitors stated they would probably talk to the head of care of one of the staff. None suggested that they would talk to the registered manager and most relatives and service users were unaware of who the homes registered manager was. Issues surrounding the amount of time the registered manager is at the home will be addressed in the management section of this report, however it was clear to the inspectors that Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 22 the manager does not spend sufficient time in the home to be accessible to service users or their relatives unless a specific appointment is made. Concerns have been received regarding the service by the commission and social services, including allegations of neglectful care practice. These were considered during the unannounced inspection visit and all the areas identified in the complaint made directly to the commission were substantiated. Portsmouth social services are continuing an adult protection investigation following complaints from several sources. The home does not therefore protect service users from harm. The home does not become directly involved with service users personal finances in that it will not become the appointee for service users. However it will hold small amounts of personal money for services not covered by the fees such as hairdressing and chiropody. These were seen within a lockable cupboard in a locked office and individual money was held with records and receipts and money in separate plastic wallets. A brief audit of these was undertaken. One selected contained invoices from the manager for chiropody and hairdressing that tallied with the records and money in the wallet. The second audited contained a small amount of money and the records indicated that £10.00 had been spent on shopping but there was no receipt to indicate what had been purchased. The registered manager stated that this service user had now returned to their home and that probably the money had been spent when out shopping with relatives, however there was no evidence to confirm this. The home must ensure that financial records accurately reflect what has happened to service users personal money and any remaining money is returned on discharge. Also found in the cupboard with the money were other valuables including two watches. These were loose on the shelf, with no indication as to who they belonged to or why there had not been returned to their owners or their relatives. The registered manager stated these had been in the cupboard when the current owners had purchased the home approximately nine months previously. These should be bagged and stored securely in case someone claims them in the future. Following the previous inspection in August 2006 the home was required to review its policy and procedure in respect of service users personal money. A copy of the new procedure has been provided to the Commission and is considered satisfactory. This requirement has therefore been met. Also following the previous inspection the home was required to ensure that all staff have adult protection training. The training programme supplied to the commission shortly before this inspection stated that Protection of Vulnerable Adults training is due to be provided by an external training provider in two sessions in December 2006 and January 2007. The effectiveness of this training will be assessed during the next inspection but the home is considered to have met this requirement. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 23 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, 20, 21, 22, 23, 24 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the home has made a number of improvements to the environment in terms of redecoration and the provision of a dining room, areas of the home remain dirty, the home does not have the necessary facilities in terms of bathrooms and equipment to meet the needs of service users who have physical disabilities and no efforts have been made to provide an environment suitable for people with dementia. EVIDENCE: The inspectors had both visited the home previously so were familiar with the homes layout. The inspectors were able to tour the home unaccompanied throughout the day of the inspection. The current provider has made some improvements to the establishment and financially invested in the home but there is still some significant improvement necessary. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 24 The home comprises two semi-detached houses linked to provide one premises. A shaft (passenger) lift affords access to all areas of the home. The home is located in a residential area of Southsea, close to the sea front and local shops. Bus stops are located close by. Car parking is available in the surrounding streets. The home has two lounges and a small quiet lounge on the first floor. Communal areas were seen to have been redecorated and some new lounge furniture provided. There were carpets throughout the home, which were torn and frayed, old and worn. There were tears to carpet on the main staircase. The newly appointed maintenance person was trying to tack them down to make them safe but these need to be replaced. Care staff informed the inspectors that they are expecting new carpets to be laid soon with wood flooring in the new dining room and possibly some hallways. The registered manager informed the inspector that there had been a delay in the new carpets due to circumstances beyond her control with the carpet company, however a new company had been identified and these should be laid in the New Year. As recommended following the previous inspection in August 2006 the home now has a dining room that has been provided with new chairs and tables. Service users were seen using this facility during the inspectors visit. Generally the lounge and dining room were clean and tidy although at the start of the inspection jugs of juice and a carton of fortisip were seen in lounges which staff confirmed had been left from the previous day. Night staff should clear and dispose of any such items once all service users are in bed to ensure that they are not used the next day presenting a health risk. The home also has a small lounge on the first floor; service users could not realistically use this at the time of the inspection, as it was very cluttered with old equipment and other items such as suitcases and bags. This room could provide a pleasant quiet lounge or room for private visits and is important as nine of the home’s bedrooms are twin rooms therefore privacy for visits is restricted. This room must be cleared and made pleasant for use. The home has a courtyard style rear garden. This was seen to contain old furniture and to be quite unkempt. One of the lounges looks out onto the garden and the providers should aim to provide as pleasant a view as is possible to the garden. There is also an old sink noted in the garden, its function unclear, that further detracts from this being a pleasant place for service users. Old furniture was also noted in the smaller courtyard garden. This is not used by service users but can be seen from the dining room and should also be cleared. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 25 The homes service users guide states that it provides one bath to every six service users. The inspectors identified that the home has one bath containing a hoist suitable for people with a physical disability, two medic baths into which service users must walk, step up and turn round (hoists could not be used) and the remaining baths are standard domestic step in and sit down baths. Discussions with care staff indicated that only one service user could use the medic baths and the remaining service users would have to use the hoist bath on the ground floor. Part of the concern letter received at the commission was in respect of the home not having suitable bathing facilities and that service users did not frequently have a bath. In each bath room there was a record sheet on which staff record bath water temperatures. This indicated that in the two weeks preceding the inspectors visit only three baths had been provided in the hoist bath. The records in the other bathrooms indicated that these baths had not been used for a considerable time. The medic and other baths were found to be dirty, with dead spiders/flies and lots of dust. The home must ensure that it provides adequate bathing facilities (wet rooms or hoist baths) to meet the needs of the service users. Although the standards in respect of bathrooms only apply to newly registered services the standard of at least one assisted bath (or assisted shower) to every eight residents should be considered as a guide for this service to aspire to. Inspectors were also concerned that several WC’s were too small for moving and handling equipment to be used. It was noted that one commode stored in a bathroom had dried faeces on the seat. The floor coverings in all bathrooms and wc’s appeared dirty and were sticky to the touch. The floor coverings were old and in many places had lifted. In one en-suite bathroom the flooring did not cover the whole floor where a new toilet had been put in and the floor covering not replaced. The same ensuite bathroom had handrails to support service users however the plastic covering on the hand rails had eroded exposing sharp rusty metal. Some bathrooms/WC’s were seen to have no paper towels or liquid soap. The registered manager must undertake an audit of all bathrooms/WC’s and ensure that they are well maintained and fit for purpose without presenting a health risk to staff or service users. The home predominately provides a service to people with age related physical disabilities, however it does not have the necessary adaptations and equipment to meet these service users needs. One gentleman was being moved by inappropriate lifting equipment. Staff stated this was due to the position of his chair in the lounge area and that the hoist could not be used in this area. Staff have now received manual handling training and must only use the correct manual handling equipment appropriate for each service users assessed needs. Some residents are currently not being weighed, as the home Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 26 does not have sit upon scales. A review of the aids, hoists and assisted toilets and baths currently installed do not seem capable of meeting the needs of service user group. The registered manager must ensure an assessment of the premises and facilities is made by suitably qualified person, including a qualified occupational therapist, with specialist knowledge of these client groups, to ensure the recommended disability equipment for bathing, lifting and weighing service users is being provided. As previously stated service users assessments and care plans indicated that pressure-relieving equipment be used and this was not occurring. The home must not admit anyone for whom they do not have the necessary equipment. The provider has invested in a new call system but the handsets need to be accessible and near to service users. One service user was unable to move away from the dining area, as she was unable to reach the call bell. Service users appeared unfamiliar with the call bells and were unsure which buttons to press to summon staff. The home has thirteen single and nine twin bedrooms. The majority of these were seen during the inspector’s visit. Bedrooms are located over three floors, all of which are accessible by the homes shaft lift. The home was not specifically built as a nursing home therefore bedroom sizes vary. Unfortunately due to the lack of space in some rooms nursing beds have to be positioned against the walls and service users are not provided with bedside lockers and appropriate storage space. It is not clear how manual-handling equipment could be used in some of the bedrooms. The suitability of the rooms for their use will be further discussed with the provider. As required following the previous inspection in August 2006 twin rooms now all have adequate screening in the form of curtains to ensure privacy is maintained during personal care tasks. Bedroom doors were seen to be fitted with automatic door closure devices that will ensure immediate closure in the event of the fire alarms sounding. The action plan received from the registered manager stated that she had consulted with the fire and environmental health departments in respect of the procedures the home should undertake to ensure fire and environmental health and safety. However one door leading to the basement down very steep stairs was left open. This is a significant risk to service users who may wander. The home is clean, pleasant and hygienic in the main communal areas and free from offensive odours. There are systems are in place to control the spread of infection, in accordance with relevant legislation and published professional guidance, but this need to be improved. The manager must ensure staff practice good prevention of infection practices. Areas for concern were the sharing and inappropriate storage of prescription creams, the dirty bathing equipment and poor cleaning of commodes. The home has two sluices which were seen to be dated, worn, dirty and had an unpleasant odour. The current Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 27 flooring and surfaces in these areas require improvement so they can be adequately cleaned and maintained. Areas of the home are untidy, including the office and medication storage room and this makes it difficult to keep clean. Bathrooms and WC’s were without hand towels and soap. Staff were advised in the communication book that there was a shortage of gloves and staff should wear one and not two. In one bedroom a broken mirror on a wardrobe door presented very sharp edges. This was noted by the inspector in the morning of the inspection and pointed out to a member of staff, however at the end of the inspection nothing had been done to rectify this risk although a maintenance person had been on duty throughout the day. The inspectors left an immediate requirement in respect of this however it is of concern is that the head of care was unaware of the problem and the staff member had clearly not reported this to either the maintenance person or the head of care. In bathrooms broken light shades were seen on the floors. All staff must take responsibility for reporting broken items and ensuring the safety of the service users and themselves. Substances potentially hazardous to the health of service users (COSHH) were seen around the home in WC’S, bathrooms and bedrooms. These must be stored securely. Failure to ensure a safe environment places service users at risk and is neglect. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 28 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 poor. This judgement has been made using available evidence including a visit to this service. The home provides appropriate numbers of staff, however staff have not received all the necessary training to ensure that service users needs are identified and met. The head of care must be released from management and administration duties to ensure that service users needs are met by staff. New staff have commenced employment before all the necessary checks have been completed to ensure service users safety. EVIDENCE: The inspectors viewed duty rotas seen in the nursing office on the ground floor. These correlated to the numbers of staff on duty throughout the inspection. The home provides two qualified nurses throughout the day and one at night. They are supported by five carers in the morning, four in the afternoon and two at night. Two of the morning carers commence work at 7 am to provide additional staff at this busy time although their role seemed specific to providing breakfast to the more vulnerable service users unable to feed themselves. Nursing and care staff are supported by a chef, laundry and domestic staff. The head of care informed the inspectors that she is generally not included in the above numbers although will on occasions cover shifts as a qualified nurse when necessary. However throughout the day of the inspection it was observed that the head of care had limited time to devote to care related work Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 29 as she was constantly interrupted by telephone calls, commencing the induction for the new non care staff member and resolving other issues. The head of care was observed correcting a member of staff who was feeding a service user lying down and assisted the staff member to reposition the service user. The head of care must be able to monitor and correct staff that are providing dangerous and inappropriate care. On the day of the inspection a new maintenance person was commencing employment and the inspectors were informed that the home had recruited a part time administrator, the recruitment records for whom were seen during the inspection. The staffing levels at the home would appear appropriate for the numbers and level of needs of the service users. Although there appear to be adequate numbers of care staff to support service users there were times, as describe elsewhere in this report, when service users needs were not being met for example at and after mealtimes, in the morning when service users need to be assisted to wash and dress, supporting service users to have a bath and the provision of activities. Care staff stated that they tend to work on their own which may contribute to dangerous and inappropriate care practises. Similar issues were identified in the complaint letter to the Commission and the adult protection referral to Portsmouth social services. The home must review the way nursing and care staff are organised and the homes routines to ensure that service users needs are met. Information about staff training and qualifications was provided prior to the inspection with the home’s action plan. This stated that five care staff have NVQ level 2 and four have level 3. Two staff are undertaking level 3 training and further NVQ training at level 2 and 3 is planned for the future. Some of the care staff have overseas nursing qualifications. Following the previous inspection in August 2006 the home was required to provide a staff training programme as no training had occurred since the home was purchased in April 2006 by the current providers. This included a six month programme to commence in January 2007 for all staff based on the Skills for Care recommendations and the Portsmouth City Council personal development Portfolio. This training would be in the portfolio format supported by in house training sessions and supervision. The effectiveness, in terms of improvements in service delivery and care of service users, of training will be assessed during the next inspection. Staff have now undertaken manual handling and fire prevention training as required following the previous inspection. Further training is planned for December and January to include adult protection and terminal care, first aid (2 trained nurse), food hygiene (two care staff), Male catheterisation (two trained nurses) and Tissue Viability (two senior care staff). The training programme does not include any infection control, dementia, challenging behaviour, mental health and medication training and this must be provided for all staff. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 30 Staff have received manual handling training although the effectiveness of training must be monitored as staff were observed using inappropriate equipment when moving one service user. The head of care must be released from management and administration tasks to concentrate on improving the care provided to service users. The inspectors viewed the recruitment files for four new staff recruited since the last inspection. Overall these were satisfactory, however it is recommended that interview notes are maintained to demonstrate why staff have, or have not been appointed. Recruitment records indicated that all relevant checks are undertaken on new staff including cv, two written references and criminal records beuro enhanced check. However on the day of the inspection a new staff member had commenced working at the home. The recruitment files for this person were seen and indicated that although a CRB check had been sent the person had commenced employment prior to a POVA First check having been received. The CRB had been sent on the 6th December, this would have been received, at the earliest on Thursday7th December. The earliest a POVA check could be completed would realistically be the day of the inspection and probably later in the week of the inspection. The registered manager confirmed that she had not yet undertaken the email check that would confirm the POVA check. New employees must only commence work at the home once all the recruitment checks have been completed. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 31 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, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Registered manager is not managing the home, this is being handed down to the head of care who is unable to perform her own duties resulting in poor care being provided at the home. All records must be fully and accurately completed. Service users, visitors and staff are not safe at the home. EVIDENCE: The registered manager was contacted by the head of care early in the inspection, and arrived at the home at 4 pm, having stated that she was on her way to work in Ascot when she was contacted. The registered manager confirmed that she is only at the home one or two days per week. Discussions with relatives and service users indicated that they were unaware of who the registered manager was and all identified the head of care as the person they Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 32 would talk to. Staff confirmed that the registered manager is only in the home for limited periods of time. The Registered Manager needs to acknowledge that she must address the poor outcomes identified in this report as the accountable person. The Commission has registered her as the manager and this responsibility cannot be handed down to staff in the home in her continuing absence. The home is in need of a strong management presence and lacks a full time manager and administrative staff. The head of care is therefore being left to undertake all areas of the management of the home to the detriment of staff supervision and quality of care provided to service users. Evidence on resident’s files does indicate that some formal quality assurance work has been undertaken but there were no outcomes to be seen, as they are not being held at the premises. The manager must summarize the outcomes and forward these to the commission. Staff induction records have not been completed but are in place and staff are now under going supervision. Once the head of care is supported by adequate managerial and administrative staff she will have better opportunities to focus and develop these areas. As identified throughout this report a number of records were viewed and found to be inaccurate or incomplete. These included Medication Administration Records, care plans, service users personal financial records, service users guide/statement of purpose and recruitment records. The home must ensure that all records are fully maintained. Throughout this report numerous concerns have been identified which affect the health and safety of service users. These issues have been detailed in the relevant sections and are summarized below. • Substances hazardous to health were not being stored safely. • The staff were not handling service users in a safe manner. Dangerous and inappropriate care practices were observed. • The practices relating to the safe administration of medications were not followed. • There was a broken wardrobe mounted mirror with sharp edges unsecured. • Carpets were a fall and trip hazard and infection control procedures need improvement. • The kitchen was in a dirty and disorganized state. The home is therefore not a safe place for service users, staff or visitors. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 3 1 1 1 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 2 1 1 2 2 X 1 STAFFING Standard No Score 27 1 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X 2 2 2 1 Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 34 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 OP1 Regulation 4 (1) Requirement The manager must ensure that the statement of purpose/service users’ guide contains accurate and up to date information about the services provided at the home. A copy of the new statement of purpose and service users’ guide must be provided to the Commission and to all service users or their representatives. This was required following the previous inspection undertaken in August 2006. All service users must be fully assessed prior to admission, and no service user must be admitted unless the assessment confirms the individual needs can be met. Service users or their relatives must be asked to sign care plans and monthly reviews to confirm that they have been involved in the care planning process. This was required following the previous inspection undertaken in August 2006. DS0000066729.V323173.R01.S.doc Timescale for action 01/03/07 2. OP3 14(1) 01/03/07 3. OP7 15 (1) 01/02/07 Angelus Nursing Home Version 5.2 Page 35 4. OP7 15 (2)(b) Care plans must be reviewed and 01/02/07 updated to reflect assessed and current needs. The home must ensure that it provides all the necessary facilities and equipment to enable service users’ needs to be met, and this must be used appropriately. The environment must be safe for people with dementia. Nursing and care staff must receive training to meet service users needs including dementia, mental health and challenging behaviour. You are required to inform CSCI by the given date of the action you are taking in respect of this matter with a timescale. Medication must only be administered to the person for whom it has been prescribed and dispensed. Medication must be stored appropriately. The manager must ensure that the medication administration records are fully completed. This was required following the previous inspection undertaken in August 2006. Correct medication administration practises must be observed at all times. Service users must have access to, and know how to use, their call bells at all times. The home must ensure that service users do not go for more than five hours between meals, and must not go for more than DS0000066729.V323173.R01.S.doc 5. OP7 12 (1)(a) 01/03/07 6. OP30 12(1)(a) 01/03/07 7. OP9 13 (2) 12/01/07 8. OP9 13 (2) 12/01/07 9. OP9 13 (2) 12/01/07 10. OP22 12(4)(a) 01/01/07 11. OP15 16 (2) (i) 01/01/07 Angelus Nursing Home Version 5.2 Page 36 12 hours from the evening snack to breakfast. 12. OP15 16 (2) (i) The provision of food must be reviewed to ensure that fresh produce is provided and processed foods are limited. The manager must consult with service users to ensure that the menu meets service users choices and preferences. The home must ensure that it has a clear POVA First check on all new staff prior to their commencing work at the home. The home must ensure that financial records accurately reflect how service user’s personal money is used. This was required following the previous inspection undertaken in August 2006. The main stair carpet was torn in several places. The newly appointed maintenance person was trying to tack them down to make them safe but these need to be replaced. Old furniture and items stored in the gardens and small lounge must be cleared and these areas made pleasant and safe for service users. The home must ensure that it provides adequate bathing facilities (wet rooms or hoist baths) to meet the needs of the service users. You are required to inform the commission by the given date of the action you intend to take in respect of providing adequate facilities. 01/02/07 13. OP29 19 (9) 12/01/07 14. OP18 13 (6) 12/01/07 15. OP19OP38 23 (2)(b) 01/02/07 16. OP20 23(2) (i) 01/02/07 17. OP21 23 (2) (j) 01/02/07 Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 37 18. OP22 23 (1) (a) The registered manager must ensure an assessment of the premises and facilities is made by a suitably qualified person, including a qualified occupational therapist, with specialist knowledge of these client groups, to ensure the recommended disability equipment for bathing, lifting and weighing clients is being provided. A system must be developed to ensure breakages and unsafe fittings and equipment are reported and dealt with promptly. Liquid soap and paper hand towels from an appropriate dispenser must be provided in all bathrooms and WCs. This was required following the previous inspection undertaken in August 2006. The manager must ensure staff practice good prevention of infection practices. All staff must have infection control training. The sluices must be thoroughly cleaned and suitable hygienic flooring provided. The home must review the way nursing and care staff are organised and the homes routines to ensure that service users needs are met. The provider must ensure that the home is fully managed by the registered manager. Management responsibility cannot be handed down to the head of care. DS0000066729.V323173.R01.S.doc 01/03/07 19. OP38 23 (2) (b) 12/01/07 20. OP26 13 (3) 01/02/07 21. OP26 13 (3) 01/02/07 22. OP26 OP38 OP27 13 (3) 01/02/07 23. 12 (1)(a) 01/02/07 24. OP31 10 01/02/07 Angelus Nursing Home Version 5.2 Page 38 25. OP38 13 (4) (a) Substances potentially hazardous to health must be stored appropriately. The kitchen must be thoroughly cleaned and maintained in a clean state at all times. 12/01/07 26. OP38 13 (3) 12/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations The home should consider having one lounge as television free at least for part of the day and provide service users with an option of which lounge they spend their time in. Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Angelus Nursing Home DS0000066729.V323173.R01.S.doc Version 5.2 Page 40 - 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. 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