Inspection on 04/12/07 for Angelus Nursing Home

This inspection was carried out on 4th December 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 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 26/06/07

Angelus Nursing Home 11/12/06

Angelus Nursing Home 14/08/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 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 4th December 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Angelus Nursing Home DS0000066729.V353277.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.V353277.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 Ltd Vacant Post 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.V353277.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. 26th June 2007 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 fifteen single bedrooms and eight twin rooms. A total of twelve bedrooms (nine single and four twin) have en-suite facilities. Bedrooms are located over the three floors and are all accessible via a passenger lift. The home provides a range of communal rooms and there is level access to an enclosed rear courtyard style garden. Cherry Garden Properties Limited owns the home and at the time of the inspection visit did not have a registered manager. 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.V353277.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the fourth key inspection of the service since the current provider 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 June 2007. The visit to the home was undertaken by two inspectors and lasted approximately seven hours commencing at 10.00 a.m. and being completed at about 5.15 p.m. All core standards and a number of additional standards were assessed. Compliance with requirements and recommendations issued after the previous inspection in June 2007 were also assessed. The inspectors were able to spend time with the nursing and care staff on duty and were provided with free access to all areas of the home, documentation requested, 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 a number of visitors. Information received about the service by CSCI since the last inspection was reviewed and the improvement plan provided by the home following the previous inspection was assessed. Information from a safeguarding adults investigation undertaken by Portsmouth City Council Social Services Department was also considered as part of the evidence included in this report. Prior to the inspection visit the home completed an Annual Quality Assurance Assessment (AQQA) and information from this is also considered. Comment cards were received from nine people who live at the home although some stated they had been completed by their relatives on their behalf. Six comment cards were received from staff working at the home. The inspectors met four visiting health professionals whilst at the home. The provider visited the home towards the end of the inspectors visit and was present for initial feedback presented by the inspectors to the newly appointed manager and head of care. What the service does well: The service has done well to address all previous requirements and has appointed a new experienced manager with a nursing qualification. Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 6 People who live at the home and their relatives stated that they were happy with the care and support provided and state that staff are cheerful and meet their needs. Additional comments on peoples survey forms stated ‘we have always been happy with mothers care and have no complaints’. Other similar positive comments about the staff were made including ‘on behalf of my wife I would like to express my sincere thanks to all the staff at Angelus for their care and kindness’. Positive comments were made by visiting external professionals, staff, visitors and people who live at the home about the homes head of care. What has improved since the last inspection? The home has complied with all the requirements made following the previous inspection. The home has worked with external professionals to review the care planning and risk assessment processes used in the home. Completed new care plans seen by the inspectors were detailed and provide good working documents. The home has reviewed the staffing levels at busy times (mornings and lunch time) and as a result has provided an additional carer during this time. The home has also appointed an activities person so that care staff are able to concentrate on care duties. There are further plans underway to recruit additional domestic and kitchen staff. The kitchen assistant will also have responsibilities for morning hot drinks and assisting people who require help during the lunchtime meal. The home now has the necessary equipment for the destruction of controlled medication and has implemented a regular audit of controlled medication held in the home. People were seen to have access to their call bells. Nursing and care staff have undertaken a range of mandatory and service specific training. Nursing and care staff are now receiving formal supervision. Qualified nurses who supervise care staff have undertaken training to fulfil this role. Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Angelus Nursing Home DS0000066729.V353277.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.V353277.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 good. 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. Equipment and staff are 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: A copy of the statement of purpose/service users guide was on display in the entrance hall. These documents provide relevant information in a written format for people or their representatives however they will need to be updated in respect of the registered managers name as this still states the previous registered manager who resigned in July 2007. The previous report Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 10 identified that people who had completed comment cards or spoke with the inspector had received information about the home prior to admission. A sample of the standard terms and conditions of admission was included in the service users guide. During a previous inspection in December 2006 files audited indicated that people are provided with a statement of terms and conditions. Comment cards were received from nine people all indicated that they had received a contract/terms and conditions of residency. This non-core standard was therefore not re-assessed on this inspection. The home has not admitted any new people for approximately two months prior to the inspection as Portsmouth City Council Social Services had held placements whilst undertaking a safeguarding adults investigation at the home. The inspectors viewed the pre-admission assessments of two people admitted to the home prior to this and saw pre-admission assessments for other people in their care plans. In addition to the homes comprehensive preadmission assessment form information had also been sourced from the local authority and health professionals with knowledge of the person and their needs. The head of care undertakes pre admission assessments on all referrals. 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. Discussions with staff and the head of care and records seen indicated that the home is aware of the level of need it can accommodate and would only admit people whose needs it can meet. The home does not provide intermediate care. The home could provide respite/short stay placements if a bed were available and the above preadmission procedures would be undertaken. Angelus Nursing Home DS0000066729.V353277.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, 9,10 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Everyone has a care plan which sets out how their health, personal and social care needs will be met. Medication is appropriately stored and administered, however the home must ensure that medication that is stored in the fridge is maintained at the correct temperature. People are treated with respect and their right to privacy is upheld. The home supports people at the end of their lives with care, sensitivity and respect. EVIDENCE: The inspectors viewed care plans, case tracked two people and discussed these with the head of care, care staff, relatives, visiting professionals and people who live at the home. Everyone had a care plan contained within folders and stored within the nurse’s office. The inspector’s viewed four care plan folders selected randomly, one of a person who had been supported on an end of life pathway. Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 12 Since the previous inspection visit in June 2007 the home has worked with external professionals in respect of the care planning process and introduced a new system, which was organised and provided comprehensive information in a suitable format. This had been a requirement following the previous inspection. Care plans contained a photograph, evidence of pre admission assessment, a nursing summary on admission and health nursing assessment completed by the head of care, life history completed by a relative and risk assessments including individual manual handling assessments. There was evidence that action had been taken to address and minimise identified risks. Care plans were seen to have been reviewed with evidence that outcomes changed as a result of review such as when a person’s manual handling plan was changed as the hoist was causing anxiety and pain. Discussions with care staff demonstrated that they were aware of how risks and individual people should be supported. Care plans contained relevant details as to how peoples individual needs should be met including specific details as to things they could do for themselves such that independence could be maximised. The majority of care plans had been reviewed monthly however some parts of one care plan seen had not been reviewed since 4th October 2007 and applied to skin care, pain management, constipation and diet. This resulted in some information contradicting information recorded elsewhere. Care plans contained daily care notes that had been well maintained by both care and nursing staff. Each person has a named nurse and key worker who is member of the care staff team. People and relatives the inspector spoke with stated that they felt their care needs were met, with all people who completed surveys stating that their care needs are always or usually met. Observation of people throughout the inspection visit indicated that care needs were met. A comment from a relative in a comment card being ‘my mum doesn’t speak now, when I visit she is always clean and fed’. The nurse in charge 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. The head of care/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. Since the previous inspection the home has increased the numbers of care staff at busy times of the day. Comment cards from care staff stated that they usually have time to meet people’s needs. Care plans contained evidence of regular health checks and access to a range of healthcare professionals such as GP’s, Macmillan Nurses etc. Health outcome Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 13 sheets were maintained with information of the outcome of visits. The majority of people who completed surveys stated that they always receive the medical support they require. The previous report stated that qualified nurses had undertaken a range of training relevant to the needs of the people living at the home. Discussions with qualified nurses confirmed that they continue to receive training and on the day of the unannounced inspection visit qualified nurses (some off duty and who came into the home for training) had a training session with an external nursing professional in relation to care planning and strokes. Nursing staff have undertaken training in the Liverpool care pathway and one care plan reviewed was that of a person who had been supported at the home during his final days. External professionals had been involved in the care and care plan with a comment from an external professional stating ‘not for transfer to x as well managed at Angelus’. Discussions with visiting professionals during the inspection visit confirmed that they were very happy with the care provided to this person and that staff were open and welcoming to external professionals and followed their advice and guidance. 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. During the previous inspection it was noted that not all people had access to their call bells and the home was required to ensure that people would be able to summon assistance if required. The home has 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. Observations made during this inspection visit and by the investigation team from Portsmouth City Council indicated that people had access to their call bells. Discussions with care staff and people indicated that consideration is given to people’s wishes when planning times for getting people up in the morning. The inspector viewed medication records, observed part of a medication round and viewed storage arrangements and controlled medications. 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 during the previous inspection 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. Following the previous inspection a requirement was made in connection with the need to immediately destroy controlled medication when no longer in use and to ensure that records maintained are accurate. One inspector randomly audited the controlled medications held in the home and these all corresponded to records held. Destruction kits for controlled medications were seen in the medications room. The home has recently purchased a new medications fridge that is kept in the medications room. The home records the temperature of the fridge daily. The records for this stated that on a number of Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 14 occasions the temperature had been below zero degrees on occasions as low as –4. There was no indication that any action had been taken as a result of the very low fridge temperature. The thermometer in use only records the temperature in the fridge at the time and the home is recommended to use a maximum minimum thermometer and must ensure that when recordings indicate that medication has been either too hot or too cold advice should be sort from the pharmacist as to whether the medication should be replaced. As part of the investigation undertaken by Portsmouth City Council a specialist from the health authority visited the home and reviewed the medications prescribed/administered to people at the home. This concluded that there was no indication of over prescribing of medication that may sedate people, in fact this medication was rarely used in the home. Other evidence seen showed that the home had requested a review of a persons medication prescribed to help manage inappropriate behaviours as the nurses felt this was not required. Angelus Nursing Home DS0000066729.V353277.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 good. This judgement has been made using available evidence including a visit to this service. People are now provided with opportunities for choice and staff respect these. Activities are provided. People receive an appealing diet in pleasing surroundings at times convenient to them. EVIDENCE: Surveys from people living at the home indicated that the home provides activities. Additional comments being ‘there are activities which, if I wish, I can take part’, also ‘I would probably be able to take part in everything but most of the time I prefer to stay in my room with my paints/books/tv. I enjoy the visits from the recreational/arty lady who comes in once a week and has kindly given me canvasses and paints etc’. Since the previous inspection the home has appointed an activities organiser who works two hours every afternoon. The inspectors met the activities person and viewed her records and discussed her plans for providing activities in the home. Individual and group activities are provided including to people who have chosen or due to the level of disability/health need must remain in their beds. The activities person told the Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 16 inspector about a recent outing for some people at the home to a theatre production. The home also has external visiting professionals who provide organised activities three mornings per week. During the inspection the activities person was overheard organising for a local religious choir to visit the home near Christmas to sing carols. The home maintains records of activities in care plans. The home would support people to continue their chosen religious/cultural activities. Care plans seen contained life histories, completed by a relative that provides information about a person’s previous social and leisure activities. Discussions with people during the inspection indicated that they enjoyed activities with staff stating that they try to encourage people to attend but would respect their wishes. 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, 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. The inspectors were able to meet with a number of relatives during their visit to the home. 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. In addition to two lounges on the ground floors the home has a smaller lounge on the first floor that could be used for private visits if this were required. The home maintains a visitors book however it was noticed that not everyone signs this. The home must try to ensure that all visitors sign the visitors book both as a record of visitors and also in the event of a fire they would be aware of who was in the home. Following the previous inspection there was a requirement that the home review staffing levels at busy times, as it was apparent that some people had to wait a prolonged period for their meals. The home now has an additional carer on duty in the mornings covering the busy time and lunchtime. The inspectors observed the lunch time arrangements and although the home has a number of people who require assistance this was provided in a relaxed, unhurried manner with people not having to wait too long for their meals. The inspectors observed staff while they assisted people to eat their meals. This was done respectfully and thoughtfully. With staff members seen to speak to the person while they were assisting them and offered explanations about what they were doing. Comment cards received and discussions with people during the visit stated that they always/usually liked the meals provided at the home. Evidence was seen that people are offered choice in respect of meals. Breakfasts lists showed that people has a variety of different breakfasts including porridge, cereals, toast, eggs and bacon and scrambled eggs as per their choice. There Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 17 were two choices of main meals at lunchtime and a choice at teatime. Records within care plans included weight charts and nutritional assessments. One relative commented ‘mothers food is pureed as she has difficulty in swallowing and eats most of the food’. The home maintains full records of all diet and fluids taken by the more vulnerable people. These were viewed and showed that people are offered frequent fluids and diet. This was also the finding of the investigation undertaken by Portsmouth Social Services department. The inspectors viewed the homes food stores and food ordering records. The home uses a lot of frozen products. It was reported that the home receive two deliveries of fresh fruit and vegetables a week. However on the day of the visit the only fresh fruit was a small bunch of bananas and very little fresh vegetables. On the day of the visit dieticians were in the home to provide advice and carry out assessments. They stated that they did not have any significant concerns about the home however they would be requesting that instead of juice people identified as requiring a high calorie intake are provided with supplement drinks when offered fluids at night. Soup is provided in the evenings and care staff were observed preparing this. Due to the lack of fresh vegetables they were using packet soups. Care staff stated that this is what they usually use. The inspectors discussed this with the manager and it was suggested that the home consult the dietician to establish whether the packet soups provided sufficient nutritional value. Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People and their relatives are able to complain. Staff have had safeguarding adults training and were aware of the locally agreed procedures for reporting incidents of abuse. EVIDENCE: The homes complaints procedure was seen on display in the hallway. This will need to be reviewed to take into account that there has been a change of manager. It was last reviewed in September 2006. Evidence recorded within the homes complaints log demonstrated that peoples complaints are recorded and taken seriously. There was evidence that complaints are fully investigated and action taken to resolve issues such as requests to get up later in the day being actioned. Discussions with relatives and people living at the home and responses in comment cards stated that people were aware of how to complain and would do so. No one raised any complaints to the inspectors. The AQQA completed by the home prior to the inspectors visit stated that all staff have attended safeguarding adults training. Staff confirmed this to the inspector including the new activities person however the maintenance person and other ancillary staff have not undertaken safeguarding training. The home has fully cooperated in a comprehensive safeguarding adult’s investigation Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 19 undertaken by Portsmouth Social Services department that concluded that there are no safeguarding concerns at the home. Staff confirmed that in addition to safeguarding training they have undertaken challenging behaviour and dementia awareness training. Discussions with external professionals visiting the home confirmed that the home is reluctant to use medication as a means of managing inappropriate behaviour and care records seen demonstrated that they had requested a review/reduction in medication for a person they felt did not require this. An inventory of people’s personal belongings is completed when they move into the home. Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The provider continues to invest in the environment of the home that is now more suitable to meet people’s needs. The provider must ensure that the requirements made by the local Environmental health officer are complied with and the kitchen and equipment therein is kept clean. EVIDENCE: During the visit to the home the inspectors looked around all the communal areas of the home including bathrooms, toilets, the three lounges, dining area as well as a number of bedrooms and the homes kitchen and rear courtyard garden. Discussions with people and relatives indicated that they were happy Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 21 with their private accommodation and could bring in personal items should they wish to do so. Bedrooms and all communal areas were clean and odour free. The home employs laundry, domestic and maintenance staff. Discussions with the head of care indicated that the home is in the process of employing an additional domestic staff member to ensure that on all days at least one cleaner is available and on other days two staff are on duty who can then undertake more intensive cleaning of bedrooms. All comment cards and discussions with people living at the home and their relatives confirmed that the home is always clean and odour free. The exception to this was the kitchen and this is discussed in greater detail in the management section of this report covering health and safety. The provider continues to invest in the homes environment. Since the previous inspection further redecoration work has been undertaken and the work underway during the previous inspection visit has been completed. The home now has a CCTV system for security to the front of 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 inspector checked pressure settings on several beds and these would appear correct. The home has a range of moving and handling equipment. The laundry room was not assessed, as there had been no previous issues re this however the home must ensure that the door to the laundry room is kept shut and can only be opened via the keypad system. At one point during the inspection visit this was left open and presents on a risk to people, as there are steep steps down to the cellar immediately inside the door. Liquid soap and hand paper towels were present in bathrooms and WC with care staff confirming they had ample supplies of disposable gloves. The previous report stated that staff had received infection control training. Discussions with staff confirmed that they had received infection control training however the maintenance person had not. At the start of the inspection visit the maintenance person was deep cleaning a carpet in a room that had been heavily soiled. The maintenance person confirmed that his job did involve contact with potentially contaminated areas. Angelus Nursing Home DS0000066729.V353277.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 good. This judgement has been made using available evidence including a visit to this service. People’s needs are met by the numbers and skill mix of staff. People are protected by the homes recruitment procedures however the provider must ensure that references are authentic and the homes induction procedures are included all the induction areas in the Skills for Care Programme. EVIDENCE: Throughout the inspection and in comment cards received numerous positive comments were made about the nursing and care staff employed at the home. These included ‘on behalf of my wife I would like to express my sincere thanks to all the staff at Angelus for their care and kindness’. One inspector discussed the staffing arrangements with the head of care and viewed duty rotas. Since the previous inspection the home has reviewed its staffing levels and has increased the number of care staff on duty in the morning from five to six with two qualified nurses and weekdays the manager or head of care is also available. Care staff are organised in pairs and allocated people to look after. One qualified nurse is responsible for medications and the other undertakes dressings and supports care staff with people with high care needs. In the afternoon four care and two qualified nurses are provided and at Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 23 night one qualified nurse and two care staff. The head of care informed the inspector that the home has appointed an activities person five afternoons per week and are aiming to recruit additional domestic and kitchen staff to include an evening kitchen assistant to work from 4.30 to 7.00. The home also has an administrator, laundry and maintenance person. Nursing and care staff stated that since the home has increased the number of morning care staff they have generally been able to meet people’s needs. At the time of the inspection the home had five vacant beds. The inspector discussed this with the proprietor, manager and head of care who confirmed that staffing levels would be kept under review when the home was fully occupied to ensure that peoples needs would continue to be met. The AQQA contained information about the numbers of care staff with an NVQ qualification. The home employs seventeen care staff, nine of whom have an NVQ of at least level 2 and one undertaking this qualification. Discussions with care staff confirmed that a number had NVQ level three. Duty rotas stated which staff had an NVQ. The home therefore meets the fifty percent target for care staff having an NVQ of at least level two. The recruitment records of three members of staff who had been employed by the home since the last inspection were examined. These demonstrated that the home carries out all relevant checks on staff prior to recruitment. Whilst there were two written references for each person it was not always clear or easy to establish the designation and name of the referee. Evidence was seen that new staff had completed a range of core training such as fire, health and safety, moving and handling, food hygiene and protection of vulnerable adults. Other training included dealing with challenging people and dementia care. Some of these were in house video based learning sessions. There was no evidence that new staff had undertaken infection control training. All new staff had completed or were in the process of completing an induction workbook and whilst it was clear that these had been checked and discussed with the individual it was not clear whether the content and areas covered within the induction were sufficient and whether they included all the induction areas in the Skills for Care Programme. Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 24 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 adequate. This judgement has been made using available evidence including a visit to this service. The home does not have a registered manager that continues to affect the overall running of the home. Some quality assurance work has been undertaken however there is no evidence to suggest that changes have been made to the service provided as a result of quality assurance work. Appropriate staff supervision has now commenced and records are better maintained. There remains some health and safety issues which means that the home cannot guarantee the health, safety and welfare of people living there. EVIDENCE: Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 25 Since the previous inspection in June 2007 the then registered manager who was working part time at the home with other responsibilities with the providers company has resigned. A manager was appointed but also decided to resign and did not register with the Commission. The provider has now appointed a manager who commenced working at the home one day prior to this inspection visit. The new manager informed the inspectors that she is a qualified nurse with a management qualification and experience of managing a specialist health unit. Positive comments were made by visiting external professionals, staff, visitors and people who live at the home about the homes head of care. The positive impact on the home made by the head of care was also recognised by the investigation team from Portsmouth City Council following their safeguarding adults investigation. The home had sent questionnaires out in July 2007 to relatives of people who live at the home. Responses had been received and the findings collated, however there was no evidence that any action/changes had been made as a result of the questionnaires. Questionnaires were not sent to other stakeholders such as external professionals or staff. The home does undertake service user/relatives meetings with the administrator seen typing up the minutes from the most recent meeting during the inspection. The provider was present for part of the inspectors visit and for the initial feedback at the end of the inspection. The provider has not been undertaking (or delegating a suitable person) to undertake visits and assessments of the home as required under Regulation 26. A selection of peoples finances looked after by the home were examined. Each persons was stored in individual wallets. On the day of the inspection visit the cabinet used to store the money was not locked neither was the office in which it was stored. The head of care said that both the cabinet and office were normally locked and that the new manager was not yet up with the procedure and the presence of the inspectors may also have influenced this situation. The home does regularly carry out an audit of people’s money and the fact that one person’s money was short by seventeen pounds had been identified during this audit. This shortfall was thought by the home to be due to the money being debited for hairdressing (£5) and chiropody (£12). This demonstrated the need to ensure that all transactions are recorded and receipted. The inspectors were informed that the hairdresser or chiropodist does not provide receipts. The staff files of several members of nursing and care staff were examined during the visit to the home. Evidence was seen that recently recruited staff has attended appraisal meetings in November and that existing staff have all received supervision and appraisals. Care staff confirmed to the inspector and in comment cards that they have received appraisals and are now receiving supervision. Supervision is organised on a cascade system with the head of Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 26 care supervising the qualified nurses who in turn supervise a number of care staff. The provider has informed the commission that the qualified nurses have attended supervision training and this was confirmed by them to the inspector. The quality of record keeping within the home has improved since the previous inspection. Records were seen to be correctly stored. The inspectors noted that in the main bathroom a list of people who had had baths and the water temperatures was recorded on one sheet of paper. This could be viewed by anyone and might compromise confidentiality. As identified in the relevant section of this report some records could be improved such as those for people’s personal money, visitors book and the lack of clear evidence on recruitment references of who has completed the reference. The home has addressed previous concerns in respect of health and safety which primarily surrounded the lack of staff and lack of staff training to ensure that peoples needs could be met. As previously identified not all staff had completed infection control training and the door leading to steep steps down to the laundry had been left unlocked. However some additional concerns in respect of health and safety were noted during this inspection. The kitchen was dirty and required a thorough cleaning. The oven and hobs were very greasy and dirty as was the side of the cooker, walls and floors especially around the skirting area. Tins used for cooking were greasy and carbon stained. The home does have a kitchen cleaning schedule/cleaning checklist although this clearly was either not being followed or was insufficient. The head of care and manager explained that they had been without a kitchen assistant for some time. A kitchen assistant has started the week of the inspectors visit for a week’s trial. Requirements had been made by environmental health inspectors after that previous visit in the summer of 2007 however it was unclear if these had been completed or whether they had returned to check compliance. In other respects it was clear that food hygiene procedures were being followed. Fridge/freezer temperatures were recorded daily and core temperatures of cooked meats monitored and recorded. Records were maintained of what each person living at the home had eaten and all foods were stored correctly and labelled/covered and dated. The inspectors viewed the records of the checks of the fire detection equipment (fire alarms). Generally these had been completed weekly however some weeks these had not been done. Emergency lighting and automatic door closures were checked on a regular basis. Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 3 3 2 Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 28 NO Are there any outstanding requirements from the last inspection? 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 OP9 Regulation 13 (2) Requirement Timescale for action 05/01/08 2. OP29 19 (4)(c) 3. OP33 26 4. OP38 23 (2)(d) The provider must ensure that when temperature recordings in the medications fridge indicate that medication has been either too hot or too cold advice should be sort from the pharmacist. The provider must ensure that 01/02/08 he is satisfied on reasonable grounds of the authenticity of the references received on respect of people employed at the home and can clearly identify who has provided the references. The provider must ensure that 01/02/08 the care home is visited by a representative of the provider at least once per month in order to form an opinion of the standard of care provided and prepare a written report on the conduct of home. The provider must ensure that 05/01/08 the requirements made by the local Environmental health officer are complied with and the kitchen and equipment therein is kept clean. Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP9 OP29 OP35 Good Practice Recommendations The home is recommended to use a maximum minimum thermometer to record temperatures in the medications fridge. The provider should ensure that the induction workbook used at the home follows the Skills for Care induction standards. The provider should ensure that all transactions are recorded and receipted. Angelus Nursing Home DS0000066729.V353277.R01.S.doc Version 5.2 Page 30 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.V353277.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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