Inspection on 08/08/08 for Angelus Nursing Home

This inspection was carried out on 8th August 2008.

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 04/12/07

Angelus Nursing Home 26/06/07

Angelus Nursing Home 11/12/06

Angelus Nursing Home 14/08/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Angelus Nursing Home 24 - 26 Merton Road Southsea Portsmouth Hampshire PO5 2AQ Lead Inspector Janet Ktomi Unannounced Inspection 8th August 2008 08:45 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.V368998.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.V368998.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 02392 715 297 angelusnursing@btconnect.com 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 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.V368998.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. 4th December 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.V368998.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the fifth 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 December 2007. The visit to the home was undertaken by two inspectors and lasted approximately eight hours commencing at 08:45 a.m. and being completed at about 5.00 p.m. All core standards and a number of additional standards were assessed. Compliance with requirements and recommendations issued after the previous inspection in December 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. Information received about the service by the commission since the last inspection was reviewed and the improvement plan provided by the home following the previous inspection was assessed. The home completed an Annual Quality Assurance Assessment (AQAA) prior to the previous inspection in December 2007 and a new AQAA was not requested prior to this inspection. A representative of the provider visited the home towards the end of the inspectors visit and was present for initial feedback presented by the inspectors. What the service does well: The service has done well to address all previous requirements. The service has comprehensive admission procedures that should ensure that only people whose needs can be met at the home are admitted. People have a detailed plan of care that related to the persons assessment. The care plans are person centred and written in plain language providing detailed information as to how needs should be met. Risk assessments in care plans viewed appeared appropriate to the persons needs. Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 6 Observations of staff interactions indicated that people are treated with respect and their right to dignity maintained. People confirmed that staff listen and act on what they say. The routines for daily living and activities made available are flexible and varied to suit people’s individual needs. Family and friends are able to visit. People receive a balanced, nutritious diet with choice available at all meals and special diets catered for. People and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. People are protected from abuse. The home employs appropriate numbers of care staff that ensure that the needs of people living at the home are met. Good recruitment and induction procedures are in place. What has improved since the last inspection? The home has complied with all the requirements made following the previous inspection. The home has procedures and monitoring equipment in place to ensure that medication that must be stored at cooler temperatures (in a fridge) is stored at the correct temperatures. The home has a comprehensive induction workbook, which requires new staff to demonstrate their knowledge. The home has comprehensive recruitment procedures with evidence of all the necessary pre-employment checks in place. The provider has nominated a representative of the company (a manager from one of his other care homes) to undertake monthly visits to the home under Regulation 26. Reports following these visits are available for the provider and the people working at the home. At the time of the previous inspection the kitchen was dirty and required a thorough cleaning. The provider organised for an external contractor to deep clean the kitchen, although this did not occur for over one month after the inspectors identified the need for this. On this visit to the home the kitchen was clean. The provider continues to invest in the home’s environment with further decoration work undertaken and a twin room divided to provide two single rooms one with ensuite shower/wet room provided from a previously unused bathroom nest to the bedroom. Angelus Nursing Home DS0000066729.V368998.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.V368998.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.V368998.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, 4 and 5. People who use the service experience good outcomes in this area. 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 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. A sample of the standard terms and conditions of admission was included in the service users guide. Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 10 The inspectors viewed the pre-admission assessments of two people admitted to the home shortly before the unannounced inspection visit. In addition to the homes comprehensive pre-admission assessment form information had also been sourced from the local authority and health professionals with knowledge of the person and their needs. A senior member of the nursing team 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 nursing and care staff 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. During the inspection visit the inspectors overheard a telephone call from a person enquiring about vacancies at the home for a relative. The inspectors heard the person being informed that they should visit the home to view available rooms and find out more about the home. Also that people could only be admitted once an assessment of their needs had been completed and also some questions which clarified the person’s age and general needs. 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.V368998.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. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs are set out in an individual plan of care that clearly states how peoples needs should be met. Medication is correctly stored and administered with full records maintained. People are treated with respect and their dignity maintained. EVIDENCE: Four care plans were viewed one for a person recently admitted to the home and the others for people who had been living at the home for a longer time. The inspector’s discussed with staff, a visitor and people who live at the home how care needs were met. Care plans contained all the necessary information for staff to ensure that all aspects of health, personal and social care needs could be individually met. People have a detailed plan of care that related to the persons assessment. The care plans are person centred and written in plain language providing Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 12 detailed information as to how individual needs should be met. Plans are reviewed on a monthly basis. Photographs were seen in all care plans. Care plans contained records completed by care staff in relation to care provided on a daily basis. Within many bedrooms were records of food, fluid and care provided on a regular basis such as changes of position. Care plans contained relevant risk assessments and management plans including nutrition, falls and any individual risks such as resulting from age related memory loss. Care plans also contained guidance for staff in how inappropriate behaviours should be managed by care staff. Risk assessments viewed appeared appropriate to the persons needs. The inspector’s were able to talk with some of the people who live at the home who stated that they always received the care and support (including medical care) they need. Care plans contained records of medical appointments including doctors, specialist nurses, opticians and dentists. Care plans contained individual manual handling assessments. Manual handling equipment was viewed in the home and care staff stated that they had received manual handling training and this was recorded on the homes training matrix. The inspectors were able to observe care staff using manual handling equipment – equipment used correlated to care plans guidance for the person. The inspectors noted some discrepancies between the care plans and the care people were receiving. One persons care plan stated that she had swallowing problems and should receive a pureed diet. Daily recordings stated that she had been receiving a pureed diet however the inspectors noted that she was being fed fish and chips (non pureed) at lunchtime. this was discussed immediately with the nurse in charge who stated that usually the person has a pureed diet as she can choke but loves fish and chips and does not choke when eating this. The care plan and risk assessments must be updated to reflect this. The manual handling assessment and guidelines for another person stated that the person required hoist transfers however the person informed the inspectors that she was able to stand to transfer with one carer. The inspectors observed her doing this. Since admission the person’s mobility has improved however the care plan/manual handling profile had not been updated. People who live at the home who were able to express an opinion, stated that they felt that staff always treated them with dignity and respect. Observations of staff interactions indicated that people are treated with respect and their right to dignity maintained. All people confirmed that staff listen and act on what they say. The home provides both single bedrooms and twin rooms, which were seen to contain screens to ensure privacy during personal care tasks. Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 13 Care staff confirmed that they had sufficient time to meet people’s needs and discussions indicated that they had a good understanding of individual peoples needs and how these should be met. One inspector viewed medication records, observed part of a medication round and viewed storage arrangements and controlled medications. The inspectors observed one qualified nurse administering medications during the morning and at lunchtime. The nurse stated that each morning one nurse is allocated to medications and this ensures that she is not interrupted or distracted from medications by other tasks. The nurse stated that this also enables medications to be given at the correct time such as before meals etc. The Medications Administration records were viewed and found to be fully completed. The home needs to ensure that it is possible to audit some medications that may not be ordered each month such as ‘as required’ and variable dose medications. One of the quality audits undertaken in the home is in relation to medications and occurs every two weeks. Records of these audits were viewed. Only qualified nurses administer medications and they stated they had been provided with copies of the Nursing and Midwifery council guidelines and have completed medications questionnaires as part of update training in relation to medication. The home has recently purchased a second medications trolley and intends to divide the medications trolleys between the different floors of the home. Following the previous inspection a requirement was made that the home must record the action taken when temperature recordings in the medication fridge indicated that the fridge had been either too warm or too cold. Evidence on this occasion indicated that medications are stored at the correct temperatures, although the home was storing one medication in the fridge that did not require to be kept at cooler temperatures. Appropriate procedures and records are in place for the destruction of unwanted medications. The home does not currently have a kit to destroy controlled drugs, which can be kept in the controlled drugs cupboard. Controlled drugs for disposal were kept in a container on top of a cupboard in the clinic room. The home needs to monitor the temperature of the treatment room and may need to consider fitting a cooling system, as this room was hot on the day of the inspection. The inspectors identified several out of date supplement drinks in the ground floor beverage area. This was identified to the senior nurse on duty who immediately checked all the supplement drinks for use by date and removed all those that were out of date. The senior nurse stated that she would introduce a regular check on use by dates of the supplement drinks. The inspectors also found a small plastic container or tablets and pills in the beverage point. This was unlabelled. This was shown to the senior nurse on Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 14 duty who identified it as herbal supplements belonging to one of the staff on duty. The senior nurse returned this to the staff member and reminder her that this should be locked away if brought into the home. Angelus Nursing Home DS0000066729.V368998.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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The routines for daily living and activities made available are flexible and varied to suit people’s individual needs. Family and friends are able to visit. People receive a balanced diet. EVIDENCE: The home employs an activities person who works weekday afternoons, 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 home also has external visiting professionals who provide organised activities three mornings per week. The home maintains records of activities in care plans. These were detailed and demonstrate how people’s individual interests are encouraged and integrated into activities provided. The home would support people to continue their chosen religious/cultural activities. Most 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 Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 16 staff stating that they try to encourage people to attend group activities 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. People spoken with confirmed that they are given choices and these are respected. The inspectors saw the bathing plan and this stated where people disliked showers and preferred baths. One person who lives at the home stated she liked two baths per week and her name was seen to appear twice on the bathing list indicating that her wish was being met. The home maintains a visitors book and this showed that people feel able to visit at any reasonable time. The home has a small quiet lounge on the first floor that could be available for private visits if required. 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. The inspectors observed staff while they assisted people to eat their meals. This was done respectfully and thoughtfully. Staff members seen to speak to the person while they were assisting them and offered explanations about what they were doing. 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, or a cooked breakfast as per their choice. There were two choices of main meals at lunchtime and a choice at teatime. Records within care plans included weight charts and nutritional assessments. 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. Throughout the inspectors visit people were observed being given hot and cold drinks with biscuits available between meals. Some people receive a pureed diet and this was seen to be pleasantly presented. The inspectors viewed the homes food stores and food ordering records. Supplies of fresh fruit and vegetables were seen. Angelus Nursing Home DS0000066729.V368998.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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. People are protected from abuse. EVIDENCE: The homes complaints procedure was seen on display in the hallway. 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. Discussions with people living at the home indicated that that people were aware of how to complain and would do so. No one raised any complaints to the inspectors. The previous report identified that some staff, predominately the ancillary staff had not attended safeguarding training. Information supplied during the inspection in relation to training showed that ancillary staff have still not undertaken safeguarding training. This was discussed with the representative of the provider who visited the home towards the end of the inspectors visit. The inspectors were informed that ancillary staff would be included in safeguarding training. Staff confirmed that in addition to safeguarding training some have undertaken challenging behaviour and dementia awareness Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 18 training. This was also evidenced on the training matrix provided to the inspectors. An inventory of people’s personal belongings is completed when they move into the home. Angelus Nursing Home DS0000066729.V368998.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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a clean, safe, generally well-maintained home that meets their individual and collective needs. The home must ensure that all staff have received infection control training and regular updates. 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 the people who live at the home indicated that they were happy with their private accommodation and could bring in personal items should they wish to do so. Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 20 Bedrooms and all communal areas were clean and odour free. The home employs laundry, domestic and maintenance staff. 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 has divided a twin bedroom to make two single bedrooms, one incorporating a walk in shower room modernised from a previously unused standard bathroom. 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. One inspector visited the homes laundry room that is situated in the basement. The door leading to this is fitted with a keypad entry system, as there are steep steps immediately inside the door. This was secure throughout the inspection visit. The laundry room was noted to be very hot and consideration should be given to the need to install a cooling system in this area, in addition to the fans in place. Training records showed that the laundry assistant had not received any mandatory training notably infection control and manual handling. Liquid soap and hand paper towels were present in bathrooms and WC with care staff confirming they had assess to supplies of disposable gloves, however the inspectors did not see disposable gloves readily available around the home with the only box seen on the reception desk. The previous report identified that some key staff, notably ancillary staff including the maintenance person had not received infection control training. Training information provided to the inspectors stated that infection control training had been provided in February 2008 however there are still a number of nursing, care and ancillary staff who have not undertaken infection control training. Other staff have received infection control training over one year prior to the inspection (four in November 2006) but have not received updates/refresher training. A requirement is made in respect of staff training within the relevant section of the report. Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 21 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. People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home employs appropriate numbers of care staff that ensure that the needs of people living at the home are met. Staff have not all received the necessary mandatory and update training. EVIDENCE: Throughout the inspection positive comments were made about the nursing and care staff employed at the home. The inspectors discussed the staffing arrangements with the senior nurse on duty and viewed duty rotas. Staffing numbers would appear appropriate considering the high care needs of the people who live at the home. The home also has an administrator, laundry, kitchen and maintenance staff. Nursing and care staff stated that they are generally able to meet people’s needs. At the time of the inspection the home had six vacant beds. The inspectors observed care staff working in a non-hurried way with time to talk to the people who live at the home. Interactions observed between staff and the people who live at the home were warm and friendly. Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 22 The representative of the provider gave information about the numbers of care staff with an NVQ of at least level 2 in Care. The home employs sixteen care staff, six of whom have an NVQ of at least level 2 and one undertaking this qualification. Another carer is an overseas qualified nurse and therefore considered to be equal to an NVQ level 2. Discussions with care staff confirmed that a number had NVQ level three. The home therefore just 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. Following the previous inspection a requirement was made that references must be clear as to who has provided the reference. On this inspection it was clear who had provided the references for new staff. Within some staff files were copies of certificates for training undertaken. The inspectors were given copies of the homes training matrix, which showed when training had been undertaken for all staff employed at the home. This showed that a range of mandatory and service specific training has been undertaken however not all staff have completed all mandatory or role specific training. The provider must ensure that all staff have all mandatory training and have regular updates. This includes fire awareness, health and safety, manual handling, infection control and safeguarding adults. All new staff had completed or were in the process of completing a comprehensive induction workbook. This is completed by the staff member and reviewed by the nurse in charge of their induction. Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 23 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, and 38 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home does not have a registered manager and this 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 and it has been in excess of a year since service users views have been formally sought. Staff are receiving some supervision but this is not occurring on a regular basis. All staff have not received all mandatory training and there have not been regular checks on the homes fire detection equipment. Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 24 EVIDENCE: The home has not had a registered manager since June 2007. During the past year the provider has appointed several managers to the home however none have remained for longer than three months and none have commenced the process of applying to the commission to become the registered manager. The situation was discussed with the representative of the provider who visited the home on the day of the inspection who is aware of the need to appoint a manager and ensure that the person registers with the commission. The home undertakes a variety of internal audits including medications, mattress, nutritional risk assessments and pressure area assessments. A senior member of the homes nursing staff carries these out and the inspectors viewed records of the findings. The home also holds regular staff meetings with another planned for soon after the inspection visit. A notice advertising this being seen in the staff room. Surveys to people who live at the home or their relatives were last distributed in July 2007. As recorded in the report following this in December 2007 ‘ 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.’ Following the previous inspection the provider was required to commence undertaking Regulation 26 visits to the home. This regulation requires the responsible individual or a person nominated by him to visit the home on a monthly basis and prepare a report of the home. The inspector was shown reports made by the person who the provider has nominated to undertake this task. This requirement has therefore been met. The home does not become directly involved in managing peoples personal finances but will hold small amounts of personal money for some people who live at the home. A selection of people’s money looked after by the home were examined and found to be correct. Each person’s was stored in individual wallets. The home regularly carries out an audit of people’s money and several weeks prior to the inspection visit had identified that the amounts of money did not correlate to the records. This was referred to the police and local social services department as well as the commission. However there was a delay in the reporting of this by several days. Whilst viewing the homes diary there were two notations made that service users money had been placed in the homes controlled medications cupboard. The staff files of several members of nursing and care staff were examined during the visit to the home. Supervision is organised on a cascade system with the qualified nurses supervising nominated care staff. A staff supervision list was seen on the wall in the nurse’s station/reception area. It was not clear from the list if supervisions were up to date. Qualified nurses on duty Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 25 confirmed to the inspectors that they were having difficulty keeping up with supervision due to time constraints. The provider has informed the commission that the qualified nurses have attended supervision training and they confirmed this to the inspector at the previous inspection visit. Following the previous inspection on 4th December 2007 a requirement was made that the home must ensure the kitchen was clean and complied with the requirements made by the environmental health department. The responsible individual informed the commission on the homes improvement plan that the kitchen had been deep cleaned on 9th January 2008. This being about five weeks after the need was identified by the inspectors and longer since the local environmental health department required it. The kitchen was viewed by one inspector and found to be clean on this occasion. Therefore this requirement has been met however the time delay in meeting this requirement is a concern. As identified in the relevant sections of this report not all staff have received basic and updates for mandatory training. Training information provided on the training matrix stated that of the thirty-one staff employed only one has received health and safety training in the past year; eighteen have received manual handling training; eleven infection control training; seventeen safeguarding adults training and nine control of substances hazardous to health. Not all staff involved in the preparing of meals have received food handling training. A requirement is made that all staff must receive basic and update training in mandatory subjects at least yearly. 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. This was also the finding recorded following the previous inspection undertaken in December 2007. A requirement was not made on that occasion but one is now made following this inspection that the home must have procedures in place to ensure that weekly checks of the homes fire detection equipment are undertaken every week. Information provided on the homes training matrix showed that of the thirty-one nursing, care and ancillary staff employed at the home eleven have undertaken fire awareness training within the past year. Other staff have undertaken training in October 2006 but have not received training updates. Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 26 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 2 2 X 1 Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 27 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. 2. Standard OP9 OP31 Regulation 13 (2) 8 Requirement All medication must be stored securely. The provider must appoint a manager for the home who must apply to the commission to become the homes registered manager. The provider must ensure that weekly checks of the homes fire detection equipment are carried out and recorded. All staff must receive basic and update fire awareness training. The provider must ensure that all staff receive basic and yearly update training in all mandatory subjects including health and safety, infection control, fire awareness, manual handling, safeguarding adults and COSHH. All staff involved in food preparation must have food handling training. Timescale for action 01/09/08 01/12/08 3. OP38 23 (4) 01/09/08 4. OP38 18 01/12/08 Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 28 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 OP19 Good Practice Recommendations The laundry and treatment rooms were noted to be very hot and consideration should be given to the need to install a cooling system in these areas. Angelus Nursing Home DS0000066729.V368998.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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