Inspection on 14/08/06 for Angelus Nursing Home

This inspection was carried out on 14th August 2006.

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

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

Other inspections for this house

Angelus Nursing Home 08/08/08

Angelus Nursing Home 04/12/07

Angelus Nursing Home 26/06/07

Angelus Nursing Home 11/12/06

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 14th August 2006 09.20 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.V300129.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.V300129.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.V300129.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. New service first inspection Date of last inspection Brief Description of the Service: The Angelus Nursing Home is a registered care home providing 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.V300129.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 14th August 2006. This was the first inspection of the service since being purchased by the current owners in March 2006. The inspectors would like to thank the people who live at the home and the staff for their full assistance and co-operation with the unannounced visit. The visit to the home was undertaken by two inspectors and lasted approximately seven and a half hours commencing at 9.20 a.m. and being completed at about 4.00 p.m. All core standards and a number of additional standards were assessed. The inspectors were able to spend time with the care staff on duty and were provided with free access to all areas of the home, documentation requested, visitors and service users. Prior to the visit a new service pre-inspection questionnaire was sent to the home and returned after the requested date. External professional questionnaires were sent to people identified in the preinspection questionnaire as having regular contact with the home. Telephone discussion was held with district nurses the home identified as having visited the home, and also with district nurses who visited the home on the day of the inspectors’ visit. Comment card responses were received from two GPs. Service user and relative comment cards were sent to the home and these were completed and returned. Five service user comment cards and twelve relative comment cards were received. Information was also gained from the link inspector and the home’s file containing notifications of incidents in the home. During the visit to the home one inspector was able to meet with and talk to many of the people who live at the home and any visitors, the other inspector spent time with the head of care and viewed various documents and information identified in the report. What the service does well: The service has recruited a new head of care who is a registered general nurse with previous experience of working in a nursing home. With the exception of domestic staff the service is fully staffed and has robust recruitment procedures that should ensure that unsuitable people do not work in the home. Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 6 The new owners have commenced a programme of refurbishment of the communal areas of the home. Comment cards received from service users and their relatives were generally positive about the service. What has improved since the last inspection? What they could do better: Although the inspector found positive aspects of the service a number of requirements are made following this inspection. The home’s statement of purpose and service users’ guide must be reviewed and rewritten to ensure accurate information about the providers, management arrangements and services provided at the home are available to service users and their representatives. Copies of contracts must be held within service users’ files at the home. Care plans and risk assessments must be signed by the service user or their representative to demonstrate their involvement and agreement of the care plan or risk assessment. The home must ensure that privacy and dignity for service users is maintained at all times. Full screening must be available in all shared rooms and consideration of how dignity may be maintained when hoists are being used in communal areas. The home must consider how the doors to the WC adjacent to the lower ground floor lounge may be altered to ensure privacy for people using this facility with staff support. The home must provide more activities for service users. Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 7 The policy and procedure for service users’ personal finances must be reviewed. Receipts must be available for all money spent on behalf of service users and a checking system implemented to ensure that the correct money is in each service users’ plastic wallet. The home’s adult protection policy and procedure must be reviewed and include reference to contacting social services and the Commission for Social Care Inspection. It is recommended that the home produce a quick reference guide for staff as to the action they should take in the event of suspecting abuse of a vulnerable person may have occurred. The home must be clean at all times. An environment improvement plan must be submitted to the Commission. A staff training programme must be developed and a copy provided to the Commission. All staff must have supervision and an annual appraisal. Copies of the analysis of the quality assurance questionnaires must be made available to service users and the Commission. Paper hand towels must be present in the medication/treatment room. Medication administration records must be fully completed with no gaps (blank boxes) left. If medication is not administered as prescribed then the correct letter must be used to identify the reason why omission has occurred. Medication dispensed by the pharmacist for individual service users must not be used as stock supplies. Doors must only be held open with approved devices that will ensure the doors close in the event of fire alarms sounding. The home must consult with Environmental Health officer to ensure the correct procedures are being followed in respect of the home’s water supply and prevention of water borne infections. Liquid soap and paper hand towels must be available at all washbasins. The home must consult with the local fire officer to ensure the procedures undertaken by the home in respect of fire prevention and maintenance of fire detection equipment is appropriate. The registered manager must ensure that the office is organised such that correspondence cannot be mislaid. Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 8 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. Angelus Nursing Home DS0000066729.V300129.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.V300129.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The home must review and re-write the statement of purpose and service users’ guide to ensure that it contains correct information about the proprietors, management arrangements and services provided at the home. A copy of the contract, signed by the service user or their representative, must be held in the service user’s file. All service users are assessed by a senior member of nursing staff prior to admission to the home. The home must develop an induction and training programme to ensure that all staff have the necessary skills to meet service users’ needs. Prospective service users, or their relatives or representatives, have the opportunity to visit the home prior to a new service user being admitted. The home does not provide intermediate care therefore Standard 6 is not applicable. Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 11 EVIDENCE: A copy of the statement of purpose and service users’ guide was on display in the entrance hall of the home beside the visitors’ signing in book. The inspector viewed this document and found that it had not been updated since the home was taken over by the new proprietors. Information within the statement of purpose and service users’ guide stated the previous owner and previous matron of the home. Other information about services was also felt to be inaccurate. The manager must ensure that the statement of purpose and service users’ guide contains accurate and up to date information about the home’s management arrangements and 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. Comment cards were received from five service users. These indicated that a new contract had not been received from the new owners of the home. The inspector viewed the service users’ files in the home’s office. Some contained copies of letters requesting relatives to sign social service contracts. The inspector viewed files for people who are self funding and did not find any evidence of contracts within these files. The head of care was opening the home’s post whilst the inspector was in the office viewing staff files. One letter contained a signed contract from the relative of a new service user. The inspector read the contract that contained all the appropriate information in a relatively straightforward format. This clearly stated the fees payable and how these should be paid as well as information about notice periods etc. The head of care was very new to her position and was unsure why contracts were not held in service users’ files. The home does not have an administrator and it may be that contracts are held by the company in an office at another location. Should a service user or relative wish to clarify a contract they would at present be unable to do so. The home must hold a copy of the contract, signed by the service user or their representative at the home. The inspector viewed the pre-admission assessments of four people admitted to the home since the new owners purchased the home in March 2006. The home uses a standard form for all pre-admission assessments, completed forms being seen in care plan folders. The assessment form contains all the required sections and should enable the assessor to determine if the home is able to meet the needs of the new service user. The pre-admission assessment is completed by a senior nurse. Information was seen to have been transferred from the pre-admission assessment form to the care plans for individual service users. Information was also seen from care managers and hospital discharge summaries to supplement the home’s pre-admission assessment. The new head of care was clear that she would not admit anyone to the home whose needs could not be met, either because the home did not have the necessary equipment or staff the specific skills required. Comment cards Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 12 received from service users stated that they always or usually receive the care they require. The home was unable to supply the Commission with the requested information about staff training, either held or planned. The manager stated on the pre-inspection questionnaire that she had no information about staff training from the previous owners. However the new owners purchased the home in March 2006, the inspection was undertaken in mid August 2006 and therefore approximately five months had elapsed since the new owners purchased the home. It would be expected that staff training would have been provided in this time. Staff confirmed that they had not received training during this time. It is therefore not possible to determine if staff have the necessary training to meet service users’ needs. The head of care stated that where possible prospective service users are invited to visit the home prior to admission. Due to the level of disability of people admitted to the home this is not always possible and therefore relatives or representatives are invited to visit the home and view available rooms and facilities. The home has a block contract with Portsmouth Social Services for eight beds. The head of care confirmed that pre-admission assessments are completed for these people and the home can refuse to accept people whose needs it cannot meet. The home is registered to provide terminal care for up to six people under the age of 65 years although an additional condition exists which states that no service user in the TI category can be admitted under the age of 55 years. At the time of the visit to the home there were no service users under the age of 65 years however the home is not registered for either physical disability or dementia over the age of 65 years, its categories being old age not falling within any other category. A number of people living at the home appeared to have been admitted with either a physical disability or dementia being their main need necessitating nursing care. The Commission no longer uses the TI category and the home should consult with their link inspector to decide how their registration categories and conditions should reflect the service the home wishes to offer. Angelus Nursing Home DS0000066729.V300129.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. All service users have a care plan that identifies health and social care needs and how these should be met however GPs expressed concerns about the home and how healthcare needs are met. The home must ensure that qualified nurses and care staff have appropriate training to meet service users’ healthcare needs. Medication is appropriately stored. The manager must ensure that the medication administration records are fully completed. Medication may only be administered to the person for whom it has been dispensed. Paper hand towels must be available at all times in the medications room. Service users are treated with respect, however their privacy is compromised during some personal care and manual handling activities. Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 14 EVIDENCE: During the unannounced visit to the home a number of care plans for new and existing service users were viewed. Comment cards were sent to the home to give to service users and their relatives prior to the visit to the home. Five service user and fourteen relative comment cards were returned. The inspector telephoned district nurses identified as having visited the home and comment cards were sent to GPs with patients living at the home. Two were returned. Care plans seen by the inspectors confirmed that all service users have an individual care plan that had been reviewed every month and contained daily records of care received. Statements within care plans seen were concise and specific to enable the service users’ needs to be clearly identified and met. Care plans were seen to contain all the information required including specific risk assessments and management plans to cover pressure areas, manual handling, continence, nutrition and falls. Risk assessments had been regularly reviewed and updated. Care plans also contained information about a service users’ likes and dislikes including preference about male and female care staff. There was no indication within care plans or monthly reviews that service users or their relatives had been involved in the care planning or reviewing process. 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. Should service users or relatives decline this can be recorded on the care plans and review sheets. Service user comment cards stated that they always or usually get the care they require. Comment cards were sent to the GPs service users living at the home are registered with. Two comment cards were returned. Both GPs stated that staff do not always demonstrate a clear understanding of the care needs of service users, one stated that they had ‘some reservations’ and the other that ‘usually’ they are satisfied with the overall care provided at the home. Additional comments were made by the GPs, ‘staff are friendly but do not always seem to have a full understanding of patients’ needs, basic observations e.g. BP, pulse, temperature or blood sugars have not been taken in anticipation and records are sometimes vague’. The other GP stated ‘the standard of nursing care has not been what I would have expected over the last year, the level of medical knowledge has been less than I would expect and a low level of nursing initiative – however the majority of patients have appeared well cared for’. The inspector telephoned one district nurse identified by the home as having visited since the new owners purchased the home and was able to speak with another two district nurses who were visiting the home on the day of the unannounced inspection. The district nurses stated that they had limited contact with the home, having been consulted for advice re the management of a significant pressure injury, the home already using the dressings they would have recommended but needing to pack the wound more tightly during dressings. Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 15 The other district nurses had not previously visited the home and felt unable to comment on the services provided. The manager of the home does not have a nursing qualification and has recently appointed a head of care who is a qualified nurse with nursing home experience. The head of care had only been in post for one week at the time of the unannounced inspection. During the inspection qualified nurses and care staff confirmed that they have received little training. This was confirmed by the manager within the pre-inspection questionnaire who stated that a training programme was to be devised by the new head of care. During the inspection visit staff training was discussed with the head of care as to what should be included in the training programme. It is important that the qualified nurses have appropriate update and specific training to meet service users’ general and specific health needs. Care staff must also receive training to ensure they are able to meet service users’ needs and have an understanding of how specific conditions may affect people. The arrangements for the management of medication within the home were assessed. All medication is administered by qualified nurses and is stored securely within the home. The home uses a local pharmacy who undertook a review of the home’s medication arrangements the week preceding the unannounced visit. Medication is booked into the home by the qualified nurse on duty at the time medications arrive into the home. The medication administration records were viewed. The medication administration records were noted to have numerous gaps, where it was not clear if a prescribed medication had been administered or not. The manager must implement a system for checking that medication administration sheets are fully completed. It was also noted that although a number of service users were receiving a liquid laxative only one bottle was open and in use in the medications trolley. Additional supplies, named for individual service users, were seen stored in a cupboard. The inspector suspected that the one bottle in use was being dispensed to all service users prescribed this medication although it was labelled with a service user’s name. The head of care confirmed that this was the case as the medications trolley is too small to accommodate more bottles. The manager must ensure that medication is only administered to the person for whom it has been dispensed and whose name is on the label. The medications room has a sink however there were no paper towels available for nurses to dry their hands or to dry the plastic medication administration pots or spoons. Paper hand towels must be available at all times in the medications room to ensure that nurses are able to ensure medications pots are dry before use and that hands are washed before any activity involving medications. One inspector was able to spend most of her time with staff and service users in the communal areas of the home. Service users and visitors stated that staff were kind, caring and helpful. Staff were observed to treat service users with respect however the inspectors were concerned about some aspects of privacy within the home. The curtains that provide screening in twin bedrooms did not Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 16 always extend completely around the bed. This would result in privacy during personal care tasks when both service users were in the room (such as at night or when getting up in the morning) being impossible to ensure. The home must ensure that screening is adequate to ensure privacy and dignity. The inspectors witnessed service users being hoisted in the communal areas. The use of hoists is essential for the manual handling of many service users, however their use can compromise the dignity of service users wearing skirts as the sling’s position results in underwear being visible. The home should consider portable screens to protect service users’ dignity during manual handling techniques. One of the home’s lounges has a WC situated adjacent to the lounge. The WC has two doors however it is not possible to close these doors and manoeuvre a wheelchair and transfer a person to the toilet. During the inspection visit the inspector observed a service user being transferred onto the toilet with the doors open. The home must review the doors to this WC, it may be possible to alter the doors to enable them to close prior to service users being transferred to the toilet. The home should consult with the local environmental health officer to determine if two doors are required between the lounge and toilet as the removal of the inner door would probably resolve the problem. Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home must consult with service users and increase the quantity of activities available to service users. Service users are helped to exercise choice and control over their lives, able to maintain contact with family and friends and are provided with an appropriate diet. The home should encourage service users to eat their meals at a dining room table. This will ensure a better sitting position for eating, encourage mobility and provide opportunities for socialisation. EVIDENCE: The manager completed a pre-inspection questionnaire. This listed activities as chiropodist, hairdresser and Patey day centre. The inspector does not consider chiropody as an activity but as a healthcare need that occurs approximately every six to eight weeks. One inspector was able to talk with the hairdresser who confirmed she works in the home every Monday. The Patey day centre is a visiting service on Tuesday and Wednesdays between 10.00 and 11.00 a.m. This is part of the Alzheimers Society and organises bingo, quizzes, games such as snakes and ladders, darts, skittles and some craft activities such as Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 18 making cards. The head of care informed the inspectors that a music session has also been organised for alternate weeks. Care staff stated, and financial records confirmed, that staff take some service users out to local shops or to the sea front however this is dependent on service user health and staff availability. During the visit one inspector spent much of the day with service users in communal areas. One lounge had two televisions on throughout the day both showing different channels. This could be quite confusing and irritating for service users. Following consultation with service users the home must review the activities provided and ensure that increased activities are made available for service users, especially those who for personal or health reasons spend the majority of their time in their bedrooms. Fourteen relative comment cards were received. These indicated that relatives or visitors were always welcomed into the home, could see their relative in private, were generally kept informed of important matters affecting their relative and were satisfied with the overall care provided. During the unannounced visit to the home one inspector was able to spend most of the day in the communal rooms and witnessed a number of people visiting the home. Visitors spoken with stated that they could visit at any time and were seen visiting their relatives either in the communal lounges or service users’ bedrooms. 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. As previously mentioned staff will take some service users to local shops and the sea front with evidence being seen in the financial records of ice creams and refreshments. Service user questionnaires indicated that staff always listen and act on what service users say. One visitor commented that she sometimes finds it difficult to understand or make herself understood by some staff for whom English is not their first language which might make it a problem for her relative to make his needs and wishes known. The inspectors were able to communicate adequately with the staff on duty at the time of the inspection, however as a number of service users were noted to have hearing loss they may experience problems making themselves understood. One service user has a communication system using pictures as recommended by the speech and language therapist. Overall the inspectors felt that service users are encouraged to make choices and that these are respected by staff. The home does not have a separate dining room and although a dining style table was present in one lounge, service users were seen to be eating their main lunchtime meal in their lounge chairs with small tables put in front of them. These tables were noted to require cleaning. This reduces the opportunities for social interaction, good sitting position for eating and physical exercise that walking/moving to a dining room or dining table would provide. The home has recently recruited a new chef who was on duty at the time of the inspectors’ visit to the home. The chef stated that he is planning to review the menus and has given the service users and relatives a questionnaire to Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 19 determine their views about what should be available on the menu. The chef was aware of special diets and the nutritional needs of older people. There were no concerns about the meals provided at the home from service user comment cards or service users and relatives spoken with during the inspectors’ visit. Service users who require assistance to eat are served first and assistance provided then the more independent people are served. The inspectors observed the main lunchtime meal that appeared pleasant and well presented. Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. The home appropriately responds to complaints but must ensure that the correct information as to who to complain to is available to service users and relatives in the service users’ guide. The home’s recruitment procedures should ensure that unsuitable people do not work in the home, however the home must review its adult protection policy and procedure ensuring that it links to the locally agreed procedures. Staff must have training in adult protection. The home must implement a checking procedure to ensure that receipts (which can be written by care staff for small items such as ice-creams) and that the correct money is within each wallet. The home must review its policy on service users’ personal finances that must not be held in the company account depriving service users of interest due them. EVIDENCE: Nine of the fourteen relative comment cards and three of the four service user comment cards returned stated that they were aware of the home’s complaints procedure (one comment card was returned uncompleted and has therefore not been included in these figures). A copy of the home’s complaints procedure was noted by the inspectors on the hall wall near the home’s front door. As stated within Section 1 of this report the home’s service users’ guide must be reviewed and include the correct information about who formal complaints should be addressed to. During the inspectors’ visit to the home service users and relatives did not express any concerns or complaints to the inspectors. The Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 21 home maintains a complaints book, this was viewed by one inspector and indicated that service users and relatives are able to make complaints and that these are appropriately investigated and addressed by the manager. One inspector viewed the home’s policies and procedures in respect of adult protection. The home has a copy of the Portsmouth adult protection policy and procedure as well as its own policy and procedure. The home’s policy and procedure does not link to the Portsmouth procedure and contains no reference or direction for staff to notify the Commission or the local social services duty team. Social Services are the lead agency for adult protection and should be notified of any concerns that adult abuse may have occurred. The home must review its policy and procedure and ensure that it complies with the locally agreed procedures. As previously mentioned there would appear to have been no staff training since the new owners purchased the home in March 2006. All staff must receive adult protection training to ensure awareness of adult protection issues and the action they should take should they suspect adult abuse may have occurred. The home has an appropriate policy for gifts to staff that makes it clear the staff must not accept gifts from service users or relatives. This protects both staff and service users. This should also be included in the revised service users’ guide. The recruitment procedures should prevent unsuitable people working at the home and include POVA and criminal records bureau checks. The home’s policy and procedure in respect of service users’ personal finances must also be reviewed. The home is not appointee for any service users, however it does hold a small amount of personal cash for individual service users in a locked facility in the home’s office. Money is held individually with records and receipts within plastic document wallets, two of which were checked by the inspector. One was found to contain the correct money, however the other was missing a receipt and was fifty pence short. The home must implement a checking procedure to ensure that receipts (which can be written by care staff for small items such as ice-creams) and that the correct money is within each wallet. The home’s policy and procedure for the management of service users’ personal finances states that ‘money to be held by manager in company bank account and given to them as requested’. This must be reviewed as the holding of service users’ personal finances in the company bank account would result in service users being deprived of any interest accrued on personal money. Service users should be supported to open their own bank/building society accounts from which they may receive any interest due them. The new head of care was unsure if or what service users’ personal money is held in the company accounts. The manager must clarify this and arrange that service users receive any interest due them on personal money held in the company account. Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 22 Angelus Nursing Home DS0000066729.V300129.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The home provides a comfortable, homely environment for service users. However a number of requirements in respect of the environment are made. The home is generally well maintained but in need of redecorating and refurbishment. The home must review its cleaning programme and ensure that adequate cleaning of rooms and equipment is maintained. Liquid soap and paper hand towels from an appropriate dispenser must be provided in all bathrooms and WCs. The home must review the doors to the WC located from one lounge as these cannot be closed if staff are supporting a service user with mobility needs to use the toilet. The home must ensure that screening is adequate to ensure service users’ dignity and privacy are maintained during personal care tasks. Bedroom doors must only be held open by approved devices that will ensure automatic closure in the event of fire alarms sounding. The home must consult with the local environmental health officer to determine the measures the maintenance man must undertake to prevent the risk of water borne infections. The home must consult the local fire officer and request a visit to the home to assess the home’s fire prevention, detection and Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 24 containment procedures as well as the process that should be used to maintain these systems. EVIDENCE: Both inspectors undertook a tour of the home at the start of their visit. One inspector undertook a more detailed tour of the home whilst talking to service users, staff and visitors. The home comprises of two semi-detached houses now linked to provide one premises. A shaft (passenger) lift affords access to all three floors 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 head of care stated that the new owners are planning to redecorate and re-carpet the communal areas of the home. Some bedrooms have also been redecorated. A number of the carpets, tables and chairs within communal and bedrooms have generally seen better days. A requirement is not made in respect of these as the head of care stated that the manager is intending on replacing these as part of a refurbishment programme. The home has two large lounges and a small quiet lounge on the first floor. Service users were seen using these rooms during the inspectors’ visit. The quiet room is also used by the hairdresser on Mondays and at other times could be used for meetings if required. The home has two courtyard style gardens that are accessible to all service users as they are paved and have level access from one lounge. Furniture in communal rooms is domestic in style, however the individual tables and some chairs are in need of a thorough cleaning. The home does not have a dining room, a dining style table is provided in the lounges however it was noted at lunch time that these were not used with service users eating their main meal of the day sat in the lounge chairs. The home should encourage service users to eat their meals at a dining room table. This will ensure a better sitting position for eating, encourage mobility and provide opportunities for socialisation. The home has bath and shower facilities suitable for people with mobility needs and WC facilities located close to communal areas and bedrooms. Eight single and four twin bedrooms have en-suite facilities. As previously mentioned the home must review the doors to the WC located from one lounge as these cannot be closed if staff are supporting a service user with mobility needs to use the toilet. Some bathrooms were noted to have bars of soap on washbasins, bar soap can be a risk of cross infection. One GP also stated that Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 25 hand washing facilities need improvement. Liquid soap and paper hand towels from an appropriate dispenser must be provided in all bathrooms and WCs. Discussion’s with the head of care indicated that she would not admit new service users if the home did not have the necessary equipment to meet their needs. The home has predominately height adjustable beds with non-height adjustable beds only being used for service users who do not have moving and handling needs. During a tour of the home the inspectors noted a range of pressure reliving equipment in use on service users’ beds. Information supplied by the manager in the pre-inspection questionnaire stated that hoists, including bathroom hoists have been serviced in May 2006. As previously stated there were no training records available to indicate if staff have received training in manual handling and the use of equipment such as hoists. The home must ensure that only suitably trained staff use manual handling equipment. The home has thirteen single and nine twin bedrooms These were all seen during a tour of the home. Bedrooms are located over three floors (ground, first and second), all of which are accessible by the passenger lift. The home was not specifically built as a nursing home therefore bedroom sizes vary. Shared rooms were seen to have curtains fitted round beds to provide screening. In some twin rooms the curtains were noted to be inadequate to completely surround the bed thus privacy during personal care tasks could not be maintained if the room had two occupants. The home must ensure that screening is adequate to ensure service users’ dignity and privacy are maintained during personal care tasks. Some bedroom doors were noted to be held open by non-approved items. Bedroom doors must only be held open by approved devices that will ensure automatic closure in the event of fire alarms sounding. Discussions with the home’s maintenance man indicated that he was not fully aware of the necessary procedures he should take to prevent the spread of water borne infections. The home could not demonstrate that water is stored and distributed at the correct temperatures and that disinfection of shower heads is occurring. The home must consult with the local environmental health officer to determine the measures the maintenance man must undertake to prevent the risk of water borne infections. Although he had been completing weekly checks of the fire detection equipment the maintenance man was unclear how this should specifically be done. The records seen would indicate that he may be doing more than is necessary. The home must consult the local fire officer and request a visit to the home to assess the home’s fire prevention, detection and containment procedures as well as the process that should be used to maintain these systems. On the day of the inspectors’ visit to the home there was no cleaner. Overall the home was found to be in need of a thorough cleaning with areas of specific Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 26 concern having already been identified including the tables and chairs in communal areas and the home’s communal rooms and corridors. Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The home provides appropriate numbers of staff to meet service users’ needs however the home must ensure that domestic staff are provided in adequate numbers to ensure that the home and equipment are kept clean. Staff are appropriately recruited with all the required checks undertaken. There was no evidence of staff training and the home does not have a training programme. Staff complete an induction booklet, however the responses in some booklets seen were incorrect and there was no evidence that this had been addressed with the staff member concerned. EVIDENCE: The manager supplied copies of staff duty rotas to the inspectors prior to the visit to the home. Additional duty rotas were seen during the visit to the home. The head of care informed the inspectors that with the exception of domestic staff that are supplied by an agency the home was fully staffed with no vacancies for permanent care or nursing staff. Most of the responses from service users and relatives stated that there were generally sufficient staff on duty although at times staff were very busy. The home aims to provide two qualified nurses and five carers in the morning, two qualified nurses and four carers in the afternoon and one qualified and two carers at night. The home also provides a chef, cleaner and laundry person. The head of care stated that she works some shifts as one of the qualified nurses and has three shifts per Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 28 week for management time. The inspectors felt that the numbers of nursing and care staff provided are appropriate however the home must ensure that domestic staff are provided in adequate numbers to ensure that the home and equipment are kept clean. The home employs a total of twenty-three care staff. Information about NVQ numbers is provided on duty rotas. Nine of the twenty-three care staff have at least NVQ level 2 in care. The head of care informed the inspector that two additional care staff are undertaking NVQ level 2. Whilst reviewing the staff files the inspector identified that two of the care staff employed at the home are overseas qualified nurses however their qualifications are not recognised in England until they have completed an adaptation course. The home therefore almost meets the 50 minimum standard for care staff having NVQ level 2 or above. A requirement is not made in respect of NVQ training, however the manager must ensure that NVQ training is included in the training needs audit undertaken by the home. The inspector viewed staff files for new staff recruited since the new owners purchased the home in March 2006. The home has a thorough recruitment procedure with all files seen having the necessary evidence that all the required pre-employment checks had been completed prior to a person commencing employment at the home. The manager stated on the pre-inspection questionnaire that the new head of care would be producing an action plan to address staff training and that there was no information available about staff training. Staff spoken with stated that they had not received any training since the new owners purchased the home. New staff are linked with an experienced staff member and complete an induction booklet which covers a range of core values and practical tasks. Examples of completed books were seen. The inspector was concerned that, in both books seen, inappropriate responses had been recorded for questions covering privacy and dignity and health and safety. The head of care stated she would address these issues with the relevant staff but was not yet familiar with the induction process. The home must ensure that all staff have adequate induction and ongoing training to meet service users’ needs. Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 25, 36, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The registered manager must provide the Commission with a management structure for the home stating how management and clinical lead will be organised. There is a need to ensure that the office is organised such that important documents are not mislaid and the registered manager is aware of all correspondence coming into the home. The registered manager must undertake formal quality assurance and quality monitoring work and provide the Commission with a plan as to how this will be undertaken and a copy of the results. The manager must ensure that all staff receive an annual appraisal and formal supervision at least six times per year. The manager must ensure that records are fully maintained and stored appropriately. Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 30 The manager must ensure all requirements made previously in relation to health and safety are complied with. EVIDENCE: The home’s registered manager does not have a nursing qualification and has therefore appointed a head of care who does have the necessary nursing qualification being a Registered General Nurse. The head of care had only commenced working at the home the week prior to the unannounced visit to the home. The new head of care was unclear how management responsibilities would be divided. Discussions with various staff, service users and visitors indicated that the manager is only at the home two days per week. The head of care stated that she works five days per week, two of which are as one of the two qualified nurses on shift and the remaining three as office/management days. The home also has an acting matron, who was on leave at the time of the unannounced visit by the inspectors. The head of care was unsure how her role and that of the acting matron would link to ensure all clinical management areas were covered. The registered manager must provide the Commission with a management structure for the home stating how management and clinical lead will be organised. The home does not have any administration support. During the unannounced visit the head of care, on what should have been a day when she was working on shift, was noted to have to undertake administration tasks such as opening post and answering all telephone calls. The home has two offices, one on the ground floor which is essentially a nurses’ office and a second on the top floor which is for management activity. The management office was noted to be very cluttered with papers etc. The pre inspection questionnaire was returned very late to the Commission as the registered manager had stated that this had been misplaced and she was unaware of its arrival. There is a need to ensure that the office is organised such that important documents such as this are not mislaid and the registered manager is aware of all correspondence coming into the home. The company has an office at another location and some records such as service user contracts were not available at the home. The home was purchased by the current providers in March 2006. There was no specific quality assurance or quality monitoring systems in place at the time of the unannounced visit to the home. The head of care informed the inspector that the acting matron had attended a two day quality assurance training event the week prior to the inspectors’ visit to the home. The chef informed the inspectors that he intends to do some quality assurance questionnaires or discussions with service users to determine their views on the meals served at the home and menu options available. however the registered manager must undertake some formal quality assurance and quality monitoring work and provide the commission with a plan as to how this will be undertaken and a Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 31 copy of the results. This is especially important as the registered manager is only in the home two days per week. As registered manager she remains legally responsible for the home. The home’s policy and procedure in respect of service users’ personal finances must also be reviewed. The home is not appointee for any service users, however it does hold a small amount of personal cash for individual service users in a locked facility in the home’s office. Money is held individually with records and receipts within plastic document wallets, two of which were checked by the inspector. One was found to contain the correct money, however the other was missing a receipt and was fifty pence short. The home must implement a checking procedure to ensure that receipts (which can be written by care staff for small items such as ice-creams) and that the correct money is within each wallet. The home’s policy and procedure for the management of service users’ personal finances states that ‘money to be held by manager in company bank account and given to them as requested’. This must be reviewed as the holding of service users’ personal finances in the company bank account would result in service users being deprived of any interest accrued on personal money. Service users should be supported to open their own bank/building society accounts from which they may receive any interest due them. The new head of care was unsure if or what service users’ personal money is held in the company accounts. The manager must clarify this and arrange that service users receive any interest due them on personal money held in the company account. No staff within the home have supervision. This was confirmed by staff spoken with and the records within staff files that indicated that some qualified nursing staff had received one supervision session since the new proprietors purchased the home. There were no planned supervision sessions to be held in the near future. The manager must ensure that all staff receive an annual appraisal and formal supervision at least six times per year. Supervision must cover all aspects of practice, philosophy of the home, career development and training needs. Supervision should be provided by staff who have undertaken appropriate training in appraisals and supervision. During the unannounced inspection a variety of records was inspected. These included care plans, risk assessments, Medication Administration Records, staffing rotas, staff recruitment records, menus and service users’ personal finances. With the exception of the medication administration records that were not fully completed all records were found to be appropriately maintained. As previously mentioned within this section the manager must ensure that the office is organised such that correspondence cannot be mislaid. The manager must also ensure that copies of service users’ contracts are held with service users’ files. Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 32 Throughout this report there have been areas identified which result in concerns that the health, welfare and safety of service users, visitors and staff cannot be adequately maintained. Staff have not received adequate induction or any ongoing training in essential areas such as fire awareness, moving and handling, infection control, adult protection and there is no training planned to rectify these concerns. The maintenance man is unaware of the procedures he must take to protect people from water borne infections and the correct checking procedures of fire detection equipment. Bedroom doors were noted to be wedged open with various non-approved items (towel etc.). There are inadequate hand washing facilities (bar soap and no paper towels) in many WCs and bathrooms. Generally the home and equipment was in need of a thorough cleaning. Requirements are made in respect of all these issues. Angelus Nursing Home DS0000066729.V300129.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 2 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 2 2 2 X 2 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 2 1 2 1 Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? N/A 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 OP16 Regulation 4 (1)(2) 5 (1)(2) 6 Requirement The manager must ensure that the statement of purpose and service users’ guide contains accurate and up to date information about the home’s management arrangements and 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. The home must hold a copy of the contract, signed by the service user or their representative at the home. The home must consult with their link inspector to decide how their registration categories and conditions should reflect the service the home wishes to offer. The home must submit a staff training programme to the Commission to demonstrate that staff will receive the necessary training to meet service users’ needs. Service users or their relatives DS0000066729.V300129.R01.S.doc Timescale for action 01/12/06 2. OP2 OP37 17 (2) schedule 3 (4) Care Standards Act 2000 18(1)(a) 01/12/06 3. OP4 01/12/06 4. OP4 OP8 OP38 01/12/06 5. OP7 OP37 15 (1) 01/12/06 Page 35 Angelus Nursing Home Version 5.2 6. 7. 8. 9. 10. 11. OP9 OP37 OP38 OP9 OP9OP38 OP10 OP24 OP10 OP21 OP12 13 (2) 13 (2) 13 (2) 12(4)(a) 12(4)(a) 16 (2)(n) 12. OP18 OP38 13 (6) 13. OP18OP38 13 (6) 14. OP18 OP35 OP37 13 (6) 15. OP18 OP35 13 (6) 16. OP19OP38 23(2)(c) (1) must be asked to sign care plans and monthly reviews to confirm that they have been involved in the care planning process. The manager must ensure that the medication administration records are fully completed. Medication must only be administered to the person for whom it has been dispensed. Paper towels must be available in the medications room. The home must ensure that bedroom screening is adequate to ensure privacy and dignity. The home must ensure service users’ dignity during manual handling and personal care. The home must consult with service users and increase the quantity of activities available to service users. The home must review its adult protection policy and procedure and ensure that it complies with the locally agreed procedures. All staff must receive adult protection training to ensure awareness of adult protection issues and the action they should take should they suspect adult abuse may have occurred. The home must implement a checking procedure to ensure that receipts (which can be written by care staff for small items such as ice-creams) and that the correct money is within each plastic wallet. The home must review its policy on service users’ personal finances that must not be held in the company account depriving service users of interest due them. The home must consult the local fire officer and request a visit to DS0000066729.V300129.R01.S.doc 01/12/06 01/10/06 01/10/06 01/10/06 01/10/06 01/10/06 01/10/06 01/12/06 01/12/06 01/12/06 01/12/06 Angelus Nursing Home Version 5.2 Page 36 17. 18. OP20 OP27 OP38 OP21 OP38 13 (3) 13 (3) the home to assess the home’s fire prevention, detection and containment procedures as well as the process that should be used to maintain these systems. Communal areas and furniture must be kept clean at all times. Liquid soap and paper hand towels from an appropriate dispenser must be provided in all bathrooms and WCs. The home must ensure that only suitably trained staff use manual handling equipment. Bedroom doors must only be held open by approved devices which will ensure automatic closure in the event of fire alarms sounding. The home must consult with the local environmental health officer to determine the measures the maintenance man must undertake to prevent the risk of water borne infections. The home must ensure that all staff have adequate induction and ongoing training to meet service users’ needs. A copy of the home’s training needs audit and training programme must be submitted to the Commission. The registered manager must provide the Commission with a management structure for the home stating how management and clinical lead will be organised. The registered manager must ensure that the office is organised such that correspondence cannot be mislaid. The registered manager must undertake formal quality assurance and quality monitoring work and provide the DS0000066729.V300129.R01.S.doc 01/12/06 01/12/06 19. 20. OP22 OP38 OP24OP38 13 (5) 23(2)(c) (1) 01/12/06 01/12/06 21. OP25 OP38 13(3) 01/12/06 22. OP30OP38 18 (c) 01/12/06 23. OP31 OP32 01/12/06 24. OP31OP37 01/12/06 25. OP33 24 (1) and (2) 01/12/06 Angelus Nursing Home Version 5.2 Page 37 26. OP36 18(2) Commission with a plan as to how this will be undertaken and a copy of the results. The manager must ensure that all staff receive an annual appraisal and formal supervision at least six times per year. 01/12/06 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 OP15 OP20 2. OP18 Good Practice Recommendations The home should encourage service users to eat their meals at a dining room table. This will ensure a better sitting position for eating, encourage mobility and provide opportunities for socialisation. It is recommended that the home produce a quick reference guide for staff as to the action they should take in the event of suspecting abuse of a vulnerable person may have occurred. Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Angelus Nursing Home DS0000066729.V300129.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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