Inspection on 26/06/07 for Angelus Nursing Home

This inspection was carried out on 26th June 2007.

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 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 11/12/06

Angelus Nursing Home 14/08/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 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 08:20 26th June 2007 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.V331923.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.V331923.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.V331923.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. 11th December 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. Fees: Weekly fees for the home vary between a minimum of £525 to £575 for a twin room and £560 to £625 for a single room. Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the third 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 and to follow up the requirements made at the previous inspection undertaken in December 2006. The visit to the home was undertaken by one inspector and lasted approximately ten hours commencing at 8.20 a.m. and being completed at about 6.30 p.m. All core standards and a number of additional standards were assessed. Compliance with requirements and recommendations issued after the previous inspection in December 2006 were also assessed. The inspector was able to spend time with the nursing and care staff on duty and was provided with free access to all areas of the home, documentation requested, staff, visitors and the people who live at the home. 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 some 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. The manager completed a pre-inspection questionnaire and comment cards were received from six people who live at the home and nine relatives. The inspector contacted health professionals who regularly visit the home. What the service does well: The service has done well to address many of the previous requirements and has appointed a new experienced manager. The new manager will take over from the current Registered Manager once her induction is completed and she is registered with the Commission. People who live at the home and their relatives are happy with the care and support provided and state that staff are cheerful and meet their needs. Additional comments on relatives and peoples survey forms stated that nursing and care staff ‘treat residents with the utmost care and respect’, ‘care for all the residents with a friendly and professional manner’. Other similar positive comments about the staff were made. Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home has worked well to meet many of the requirements made at the previous inspection in December 2006 and continues to make improvements however the following repeated or new requirements are made. The registered manager is not at the home very much and has delegated some responsibilities to others but this has adversely impacted on the service, putting people who live at the home at risk. The registered manager must ensure that care plans are reviewed to ensure that they provide an accurate record of peoples current care needs and reorganised to ensure that information is readily available to nursing and care staff. The registered manager must review staffing levels especially at peak times such as mornings and mealtimes to ensure that peoples needs are met. Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 7 People must have access to, and know how to use, their call bells at all times. The registered manager must ensure that controlled medication no longer in use is destroyed following the appropriate procedures. The registered manager must ensure that all staff have undertaken all mandatory and specific training necessary to ensure that peoples needs are met. People are protected by the homes recruitment procedures however new staff are not undertaking an induction or mandatory training. All staff must have formal supervision at least six times per year and a yearly appraisal. Staff undertaking supervision of other staff must have received training to do so. 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.V331923.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are provided with relevant written information about the service. People are only admitted after a pre-admission assessment. Staff must be provided in sufficient numbers with the correct training to ensure people’s needs are fully met. The home does not provide intermediate care therefore Standard 6 is not applicable. EVIDENCE: Following the previous inspection the home was required to ensure that the statement of purpose and service users guide contained accurate and up to date information and was provided to people. The home has revised these documents and provided a copy to the Commission in April 2007. A copy of the Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 10 statement of purpose/service users guide was on display in the entrance hall beside the visitors signing in book. These documents now provide relevant information in a written format for people or their representatives. Discussions with a person who had recently been admitted to the home confirmed that he had been provided with written information about the home prior to admission. Four of the six people who live at the home who completed surveys confirmed that they had received enough information about the home prior to admission. This requirement has therefore been met. A sample of the standard terms and conditions of admission was included in the service users guide. During the previous inspection in December 2006 files audited indicated that people are provided with a statement of terms and conditions. This non-core standard was therefore not re-assessed on this occasion. The inspector viewed the pre-admission assessments of people recently admitted to the home and saw pre-admission assessments for other people in their care plans. The inspector spoke with one person who had been recently admitted to the home and discussed the admission procedure with the head of care and newly appointed manager. The home is contracted by Portsmouth Social Services to provide eight beds. The head of care and manager confirmed that they are not expected to admit people whose needs they feel they are unable to meet. The head of care undertakes pre admission assessments on all referrals. One completed survey stated that the person had been admitted in an emergency and the head of care, on her day off, had visited the person and completed the pre-admission assessment. The newly admitted person confirmed that the head of care had visited him prior to admission and asked him questions about his health and care needs. A new person was admitted on the day of the inspector’s visit and discussions between the head of care and the nurse on duty demonstrated that the head of care had completed an assessment and was aware of specific health and care needs. All care plans seen contained a completed pre-admission assessment, which indicated that the home would be able to meet the needs of the people who had been admitted. The inspector discussed with the head of care that pre-admission assessments could contain more information as to peoples abilities in respect of personal care, as general statements such as ‘needs help with personal care’ may result in care staff undertaking tasks that people can do. Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Everyone has a care plan however these need to be reviewed to ensure they accurately reflect the current care needs of people and reorganised to make them more appropriate working documents. Medication is appropriately stored and administered, however discrepancies in the volume of liquid controlled medication must be investigated and the home must ensure that medication no longer required is destroyed following the relevant procedures. People are treated with respect. Nursing and care staff must have the necessary mandatory and specific training to meet people needs. EVIDENCE: The inspector viewed care plans and discussed these with the head of care, registered manager, care staff and people who live at the home. Everyone had a care plan contained within folders and stored within the temporary nurses office. The inspector viewed four care plan folders selected randomly. The Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 12 folders contained pre-admission assessments, risk assessments, care plans, daily recordings, information about visits from health professionals and other papers. Information within the folders was not in an order that would make it easy for nursing and care staff to find or record care provided and folders contained a range of out of date and historic information which should be archived to make the folders more accessible as working documents. Care plans had been reviewed monthly, generally stating no change to needs however care plans did not necessarily reflect the current care needs of individual people. There is a need to review the care plan folders, remove historic and out of date information and reorganise care plans to make them easier for staff using care plans. There is also a need to ensure that they are reflective of current care needs and contain sufficient information as to how peoples individual care needs will be met. Some care plan folders were in a poor state of repair and should be replaced. People and relatives the inspector spoke with stated that they felt their care needs were met, with four of the six surveys received four stated that they always receive the care and support they need, one usually and one sometimes. Of the nine surveys returned by relatives seven stated that their relatives care needs were always met, one usually and one did not respond to this question. Seven of the nine relatives surveys also confirmed that the home provides the care that they expected their relative to receive. Since the previous inspection the home has reviewed the way in which staff are organised on shifts. The nurse in charge now allocates care staff, generally in pairs, to care for named people. People are provided with breakfast in bed or sat in their bedrooms and then assisted to get washed, bathed and dressed. A record of staff allocations is maintained and was seen. The manager and nurse in charge therefore know who is responsible for each person. Care staff stated they are happy with these arrangements and that they continue to support each other as necessary. The inspector noted in the qualified nurses minutes that nurses felt they were not meeting everybody’s needs especially around personal hygiene, nutrition and activities due to the numbers of very high dependency people. Discussions with relatives, people who live at the service, staff, surveys returned and observations throughout the inspection visit indicate that people’s rights to privacy and dignity are maintained. However the inspector again noted that not everybody had their call bells within reach. In the lower ground floor lounge nobody could reach a call bell. The home has provided a call system, which can be removed from the wall and placed on the person’s table or beside them eliminating the risk of training cords. The home was previously required to ensure that people have access to their call bells at all times and this requirement is repeated. Discussions with care staff indicated that consideration is given to people’s wishes when planning times for getting people up in the morning. Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 13 Care plans contained records of visits by health professionals and these indicated that a visiting optician had recently visited the home and assessed many of the people. Records also indicated that GP’s and District Nurses are contacted when required. Five of the six people who completed a survey form stated that they always receive the medical support they need. Since the previous inspection in December 2006 the home has provided training for nursing and care staff. This has included specific training relevant to peoples health needs for some staff including swallowing, dysphasia, male catheterisation, end of life care (Liverpool care pathway), first aid, continence, infection control and dementia. Although not all staff have attended all training it is positive that training is now being provided. The head of care stated that the home has been in contact with their link district nurse and additional training relevant to the needs of people has been discussed. This should include diabetes and conditions such as Parkinson’s and strokes that have been diagnosed for people living at the home. The inspector viewed medication records, observed part of a medication round and viewed storage arrangements and controlled medications with the head of care. Following the previous inspection requirements were made in connection with administration and recording procedures. The home has contacted the pharmacy and GP’s with a view to changing the times of the main morning medication round to 11.00 am, in line with new hospital procedures, such that all medication prescribed once only each day (other than that which must be given at set times) will be administered once people are awake and sat up in chairs or the lounge making swallowing easier. This will also release the nurse in charge from a long medication round to assist care staff and undertake dressings as people are assisted to bath and get up rather than people having to wait for any wound dressings. The medication administration records were viewed and found to be fully completed with the head of care stating that these are checked on a regular basis. Training information supplied stated that three qualified nurses have undertaken medications training in February 2006. Observation of the part of the lunchtime medication round showed that the nurses follow appropriate procedures. The head of care assisted the inspector to view the controlled medications held in the home. Discrepancies were noted in the volumes of liquid controlled medication in two bottles compared with the register of controlled medication. One bottle having below the recorded amount the other more than the recorded amount. The bottles had been dispensed for different people, one person was no longer at the home and the medication should have been destroyed following the correct protocols approximately seven months prior to the inspection. Additional medication that should also have been disposed of was also present in the controlled drug storage cupboard. The registered manager must ensure that the discrepancies in the liquid controlled medication amounts are investigated and must inform the commission of the outcome of her investigation. The home must ensure that controlled medications no longer in use are destroyed following the relevant procedures. Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 14 Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are now provided with more opportunities for choice and these are respected by staff. Activities are provided but staff may not always have sufficient time for afternoon or one to one activities. Meals are now provided at regular intervals however the high number of people requiring total support means that some people have a delayed mealtime. EVIDENCE: Surveys from people living at the home indicated that the home sometimes (two), always (three) and not answered (one) provided activities the person could take part in. The hairdresser visits weekly and the home has increased the organised activities it provides with three activities provided by external organisations or people per week. A member of care staff is allocated to undertake activities each afternoon, however staff identified that this does not always happen as they have a high number of people who have high support needs and therefore do not have time for activities. The home maintains records of activities in care plans. Those viewed tended to list visits by relatives as opposed to specific activities people had taken part in. The home Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 16 would support people to continue their chosen religious/cultural activities with one survey confirming this. Improvements have therefore been made in the provision of activities however the home needs to ensure that people who spend much of their time in their bedrooms are engaged in activities at some point each day. More information could be provided in care plans especially for people with Dementia about life histories and activities/choices people previously made such as types of music or television programmes enjoyed. Observations during the inspection visit and discussions with care staff indicated that people are provided with opportunities for choice and that choices are respected. The inspector observed people being offered alternatives at meal times, asked if they wanted as required medication, and care staff stated they would ask people if they were ready to get up and if a negative response was received would assist someone else then return to the first person. People spoken with confirmed that they are given choices and these are respected. Surveys received from relatives stated that they could visit at any reasonable time and were made welcome at the home. Comments also indicated that they were able to join their relative for a meal if they wished. The small lounge is currently being used as a temporary office whilst work is being undertaken on the homes reception/nurses station area. Once this work is completed this room could then be used for private visits especially for people occupying a twin bedroom. Following the previous inspection visit it was identified that people were going for prolonged periods of time between meals and drinks. The home has reorganised the way nursing and care staff are organised such that everybody who is awake and wants breakfast can have this before everyone is up and dressed. The home has employed two new chefs, one for weekdays and one weekends. The inspector met the chef who stated that he has a flexible realistic budget and is providing more fresh fruit and vegetables within meals. The food store area has been relocated to next door to the kitchen. The food store was seen and contained more fresh fruit and vegetables than previously as well as stocks of fruit juices. The chef is working to support people who require special diets and is ensuring that high calorie meals are available for people who have smaller appetites. There are a lot of people who require total support with their meals and although the lunchtime meal commenced at 12.30 some people were still having their lunch at 1.45pm. The chef and care staff confirmed that people are provided with a choice of meals and people confirmed that the food provided was good. The inspector was in one lounge/dining room and people were enjoying their lunchtime meal. A choice was also provided for the evening meal. Records of food and drink are maintained for those with a need to monitor their intake and examples were seen in some bedrooms. Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. People and their relatives are able to complain. Care practises must ensure peoples needs are met, staff have not all had safeguarding adults training and were not aware of the locally agreed procedures for reporting incidents of abuse. EVIDENCE: Four of the six surveys received form people living at the home and six of the nine relatives surveys stated that they were aware of how to complain. None raised any concerns or complaints. Surveys from relatives also confirmed that the home always responds appropriately if they had raised concerns. The inspector spoke with some relatives during the visit to the home and they stated that they were aware of how to complain and would do so if they felt it was necessary. The inspector spoke with some people who live at the home who confirmed that they would say something if they had any concerns. The home keeps a record of complaints and this was seen during the inspection. This would indicate that people are aware of how to complain and would do so. Discussions with care staff indicated that they would report any complaints made to them onto the nurse in charge or head of care. Following the previous inspection the registered manager has been identifying the days she will be at the home in the entrance hall such that people could arrange to visit on those Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 18 days if they had any issues they wished to discuss with the registered manager. The home has recently appointed a new manager who will become the registered manager once her induction is completed. The new manager will work five days per week and stated that she will make herself available at other times should people wish to see her. The new manager has undertaken training as a Protection of Vulnerable Adults trainer and stated that she will be providing training for all staff in safeguarding adults. Training information provided stated that thirteen staff attended protection of vulnerable adults training in February 2007. Discussions with care staff indicated that they were unclear about the local safeguarding adults policy but would report concerns to the head of care. A requirement is not made in respect of safeguarding adult training as the new manager is arranging this, however the effectiveness of this training will be explored at the next inspection. Since the previous inspection a safeguarding adults investigation has been undertaken in respect of injuries sustained by a person during a manual handling incident. The outcome of the investigation was inconclusive as to whether the injuries had been sustained during the use of a hoist by one person, however the correct procedure in respect of the hoist is that two people should be present and the person was therefore placed at risk by the procedure being undertaken by one person. During the previous inspection it was identified that care practises at the home were not ensuring that peoples needs were being met. As identified previously in this report changes within the organisation of staff would indicate that people’s needs are now generally being met although improvements in care plans and life histories could enhance people’s lives. During the previous inspection visit it was identified that people’s personal money held for safekeeping did not correspond to that in the records. This will be further discussed in the management section of this report. With the exception of one person personal money, which had £10.00 more than the record indicated personal money was correct and stored appropriately. The registered manager identified how the error had occurred and corrected this during the inspection. Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provider continues to invest in the environment of the home that is now more suitable to meet people’s needs. EVIDENCE: A number of issues were identified in the previous report concerning the environment. At the time of the previous inspection the home had been without a maintenance person for a period of time and numerous issues and areas requiring attention had developed. The home now has a full time maintenance person who has completed the outstanding work in respect of the environment. The inspector viewed the maintenance persons work request book and a variety of staff are identifying things that need attention, which he is completing. The new manager is now undertaking regular environmental checks and issues from these were also seen in the request book. The home Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 20 also has a part time gardener. The inspector overheard a conversation between the new manager and him by telephone with discussions to ‘make the courtyard area look pretty’ and re hanging baskets. Rubbish and old furniture has been removed from the courtyard areas. The provider continues to invest in the homes environment. On the day of the inspectors visit work was being undertaken on the front exterior of the home, and a new reception/nurses office was being created. The carpets in hallways and the majority of bedrooms have been replaced and some rooms redecorated. Other areas of the home have also been redecorated. The home has removed the ground floor hoist bath and this area has been redesigned to provide additional space for the nurse’s office and a large ground floor WC suitable for use for people who require stand aids or hoists. The WC adjacent to the lower ground floor lounge/dining room has been redesigned such that it is now accessible for people with mobility needs. A new hoist bathroom has been provided on the first floor with care staff confirming that it was a vast improvement and could be used for many of the people at the home. A walk in shower has also been provided in another first floor bathroom. The previous food storage area to the front of the home has new patio style doors and the manager is considering its future use as a possible bedroom. The registered manager is aware of the environmental requirements and action she should take with the registration team if she decides that this is to happen. At the time of the inspection this room was being used by the builders to store equipment and supplies. The inspector was shown a new sluice (not quite operational) that will ensure items are disinfected to the required standard. The provider has organised for CCTV to be fitted at the home. The home is responsible for ensuring his does not effect the rights and the rights and privacy of people living at the home. The home supports a high number of people with high physical care needs and many of the beds within the home were seen to have pressure-relieving mattresses in place. The manager was heard confirming an order for two additional mattresses one being required by a person to be admitted. The inspector checked pressure settings on several beds and these would appear correct. The home has a range of moving and handling equipment. The home has had a visit from the environmental health office shortly before the inspectors visit. This focused on the kitchen and identified a number of areas where improvements were required including replacement of some utensils, deep cleaning, replacement of mastic to the back of the sink, fly screen and attention to flaky paintwork. The chef confirmed that some of these have been addressed and when the maintenance person returns to work they will move some of the heavier kitchen cabinets to enable a thorough cleaning behind these areas. Surveys from people who live at the home stated that the home was usually or always clean and fresh. During the inspectors visit the home was clean and Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 21 free from offensive odours. The home employs specific domestic staff who were observed during the visit to the home. The laundry room was not assessed, as there had been no previous issues re this. Liquid soap and hand paper towels were present in bathrooms and WC with care staff confirming they had ample supplies of disposable gloves. Training records stated that ten staff have received infection control training. The remaining staff must complete infection control training. Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 22 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 must review its staffing levels and ensure that all staff have undertaken all mandatory and specific training necessary to ensure that peoples needs are met. People are protected by the homes recruitment procedures however new staff are not undertaking an induction or mandatory training. EVIDENCE: Additional comments on relatives and peoples survey forms stated that nursing and care staff ‘treat residents with the utmost care and respect’, ‘care for all the residents with a friendly and professional manner’. Other similar positive comments about the staff were made. The inspector viewed staff duty rotas and discussed staffing levels and organisation with the registered manager, new manager, head of care and staff. Following the previous inspection the home was required to change the way care staff are organised to ensure that peoples needs are met in a timely way and that they do not have to wait for their carer to assist other staff or wait for a second person to assist them. The home has reorganised the staff on duty and the nurse in charge now allocates named care staff to assist named Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 23 people living at the home with a record kept of who has been allocated to whom. Carers were seen to be allocated in twos and the head of care stated that consideration is given to the level of support individual people require and their location within the home. Care staff confirmed that they work in pairs and stated that the new system is working well. The home provided two qualified nurses and five care staff in the morning, two qualified and four care in the afternoon/evening and one qualified and two care at night. In addition laundry, domestic and catering staff are provided. Many of the people living at the home have high dependency levels. The inspector noted in the qualified nurses minutes that nurses felt they were not meeting everybody’s needs especially around personal hygiene, nutrition and activities due to the numbers of very high dependency people. The minutes from the carers meeting identified similar issues and that they did not have time to undertake activities with people. The home needs to review staffing levels, especially around peak times such as mornings and meal times should more people with higher dependency levels be admitted. With the recent appointment of the new manager the head of care is now working four days per week as one of the qualified nurses. The new manager does not have a nursing background or qualification, therefore it is essential that the head of care has sufficient time to complete her head of care role in addition to working most of the time as a member of the shift. The manager provided the inspector with information about the numbers of care staff with an NVQ qualification. Three care staff have a level two qualification and six have a level three qualification making a total of nine out of the seventeen care staff with a NVQ. The inspector was informed that two staff are to be enrolled on NVQ level 2 in September 2006 and that two care staff have an overseas nursing qualification. The home therefore meets the fifty percent target for care staff having an NVQ of at least level two. The registered manager provided the inspector with a full list of training undertaken since the previous inspection in December 2006. This indicates that staff have received some training but not all staff have undertaken all mandatory training or specific training relevant to the people they are caring for. The inspector requested a training programme for training planned for the remainder of the year, however the home does not have a training plan. The inspector was informed in December 2006 during the previous inspection that a six month programme was to commence in January 2007 for all staff based on the Skills for Care recommendations and the Portsmouth City Council personal development Portfolio. The training would be portfolio format supported by in house training sessions and supervision. This has not occurred and whilst some staff have attended training others have not. Nursing and care staff have not had appraisals or supervision such that individual or collective training needs may be identified and met. New staff do not have a formal induction. Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 24 The home has recruited four new staff since the previous inspection in December 2006. The recruitment files for all were viewed. These indicated that full and correct pre-employment procedures and checks were undertaken however no new staff had undertaken a formal induction and the one new carer had only undertaken manual handling training. Kitchen staff recruited had not undertaken an induction or any relevant training such as fire awareness, safeguarding adults or infection control. There was no indication that any new staff had received any supervision. Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 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 at the home very much and has delegated some responsibilities to others but this has adversely impacted on the service, putting people who live at the home at risk. Staff are not being supervised, records are not well maintained and the home cannot guarantee the health, safety and welfare of people living there. EVIDENCE: The homes registered manager continues to have other roles within the company and spends approximately two days per week at the home. The home has recently appointed a new manager, who is a non-nurse but is experienced Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 26 in managing nursing and care homes. The new manager has yet to commence the registration process. The home has a head of care who is a registered nurse, however since the appointment of the new manager she is now working four days per week as one of the two qualified nurses on duty and one day as head of care. The head of care was unsure if this would provide her with adequate time for the head of care role. The registered manager has yet to provide the head of care and new manager with definitive job descriptions. The new manager has only been in post for four weeks and has identified issues that need addressing. The current registered manager and proprietor will need to ensure that the new manager is fully involved in decisions about the home as she was unaware that it had been arranged for CCTV to be fitted until the firm arrived to install the system on the day of the inspectors visit. The new manager did not have a copy of the December 2006 inspection report. The Registered Manager is still not managing the home and continues to delegate most of her responsibilities to the head of care and newly appointed manager. Until the new manager is registered the registered manager is still legally accountable for the deficits identified in this report and repeated requirements. During the inspectors visit the new manager showed the inspector some quality assurance questionnaires that have been provided to relatives and visitors. As yet there is no formal analysis of these or any other quality assurance work undertaken at the home. The home undertakes a range of meetings, qualified nurses, care staff and service users. Discussions with the new manager indicated that she had a good understanding of quality assurance. During discussions with the registered manager towards the end of the inspectors visit the registered manager was reminded that the home will need to commence Regulation 26 visits and reports. As identified earlier in the report the home does not become the appointee for anyone, however it does hold small amounts of personal money for some people. The records and storage of these were viewed. With the exception of one persons personal money all correlated to the records. One person had ten pounds too much in their money wallet. Issues with incorrect money in personal wallets was identified at the previous inspection and the registered manager must ensure that peoples money is correctly handled in the home with accurate records maintained. As previously identified in the staffing section nursing and care staff are not receiving formal supervisions or appraisals. The inspector identified a folder labelled supervision amongst other files in the temporary nurses office. This contained records of two supervision sessions undertaken by one of the qualified nurses on carers. These private and confidential records must be stored securely and appeared to have been the only supervisions undertaken since the home was required to undertake supervisions for all staff following the previous inspection. Discussions with care staff confirmed that they do not Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 27 receive supervisions. If the home has decided that the qualified nurses are to undertake supervisions on a group of care staff then the qualified nurses must be competent and trained at providing supervision. Throughout the inspection records were viewed and have been discussed in the relevant sections of this report. Requirements have been made in respect of care plans, risk assessments, controlled medication records, induction, training and supervision records. Following the previous report significant concerns were raised in respect of the health and safety of people living at the home. Whilst many of these have been addressed and the environment improvements have been made there are still concerns about the health, safety and welfare of people. These have been identified in the relevant sections of this report, however they relate to the lack of mandatory and specific training for staff, no induction or supervision and some peoples needs not being met as identified by nursing and care staff. Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 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 1 2 2 X 2 1 2 2 Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 Requirement The registered manager must ensure that care plans are reviewed to ensure that they provide an accurate record of peoples current care needs. Care plans must be reorganised to ensure that information is readily available to nursing and care staff. The registered manager must review staffing levels especially at peak times such as mornings and mealtimes to ensure that peoples needs are met. The registered manager must ensure that controlled medication no longer in use is destroyed following the appropriate procedures. The registered manager must ensure the discrepancies in the volumes of liquid controlled medication are investigated and record any action needed as a result of the findings to prevent any reoccurrence. Timescale for action 01/09/07 2. OP7 12 (1)(a) 01/09/07 3. OP9 13(2) 01/08/07 Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 30 4. OP10 14 (4)(a) Service users must have access 01/08/07 to, and know how to use, their call bells at all times according to needs and wishes. This requirement was previously made following the inspection in December 2006. 5. OP30 18(1)(c) All staff must undertake all mandatory training (fire awareness, infection control, manual handling, safe guarding adults), and additional training specific to the peoples needs who live at the home. All new staff must have a formal structured induction. The home must ensure it has a training plan in place. Previous requirements have been made in respect of staff training following inspections in August and December 2006. The provider must ensure that there are sufficient management hours and skills to meet the needs of service users on a day to day basis. This amended requirement was made following the previous inspection in December 2006. All staff must have formal supervision at least six times per year and a yearly appraisal. Staff undertaking supervision of other staff must have received training to do so. 01/09/07 6. OP31 10 08/08/07 7. OP36 18 (2)(a) 01/09/07 Angelus Nursing Home DS0000066729.V331923.R01.S.doc Version 5.2 Page 31 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.V331923.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hampshire Office 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.V331923.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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