Inspection on 10/03/09 for Aquarius Nursing and Residential Care Home

This inspection was carried out on 10th March 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Aquarius Nursing and Residential... 25/09/08

Aquarius Nursing and Residential... 07/05/08

Aquarius Nursing and Residential... 23/04/07

Aquarius Nursing and Residential... 14/09/06

Aquarius Nursing and Residential... 09/05/06

Aquarius Nursing and Residential... 28/09/05

Aquarius Nursing and Residential... 27/04/05

Aquarius Nursing and Residential... 02/11/04

Aquarius Nursing and Residential... 29/06/04

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St Vincents

The Cotswold Home

Winton House

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Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 20/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Aquarius Nursing and Residential Care Home 4 Spencer Road Southsea Hampshire PO4 9RN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janet Ktomi     Date: 1 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Aquarius Nursing and Residential Care Home 4 Spencer Road Southsea Hampshire PO4 9RN (023)92811824 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Qualitycare Management Ltd care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 38. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection 2 5 0 9 2 0 0 8 38 38 0 Over 65 0 0 38 Care Homes for Older People Page 4 of 37 Brief description of the care home The Aquarius Nursing and Residential Care Home is a care home providing nursing care for up to 38 people over the age of 65 years who suffer from mental frailty, mental disorder, excluding learning disabilities. The Aquarius is the only care home owned by Quality Care Management Ltd. At the time of the key inspection the home did not have a registered manager. The home is located in a residential area of Southsea, close to the sea front and the local amenities of the city of Portsmouth. The home consists of three large houses that have been joined together as a large town house. There is a pleasant courtyard at the front of the house and an enclosed patio area at the rear of the home. Nine of the eighteen single bedrooms have en-suite facilities. There are ten double rooms seven of which have en-suite facilities. There is a passenger lift fitted from the ground floor to the first floor only. Chair lifts are in place on some of the other flights of stairs that access other floors. Rooms that have been identified as having only access via a flight of stairs can only accommodate service users who are fully mobile. There are extra charges for items such as chiropody, hairdressing, toiletries, which are not included in the fee. The current fee charged is £560 - £900 per week. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that people who use the service experience adequate quality outcomes. This report contains information gained prior to and during an unannounced visit which formed part of a key inspection of the home undertaken on the 10th March 2008. All core standards and a number of additional standards were assessed. Compliance with the three requirements made following the previous inspection in September 2008 was also assessed. The visit to the home was undertaken by two inspectors and lasted approximately nine hours commencing at 09.30 am and being completed at 6.45 p.m. The inspectors were able to spend time with the provider, person in charge and staff Care Homes for Older People Page 6 of 37 on duty and was provided with free access to all areas of the home, documentation requested, visitors and people who live at the home. Prior to the visit the Responsible Individual completed an Annual Quality Assurance Questionnaire (AQAA), information from which is included in this report. Comment cards were sent to the home for distribution to people who live at the home. Nine comment cards were received from people who live at the home and three responses were received from staff members. Information was also gained from the link inspector and the homes file containing notifications of incidents in the home. Following the inspection telephone contact was made with external health and social care professionals who have had contact with the home. During the visit to the home the inspectors were able to meet with and talk to people who live at the home and visitors. What the care home does well: What has improved since the last inspection? What they could do better: Five requirements were made following this key inspection. The home must ensure that allergies are recorded on Medication Administration Records to reduce the risk that people may be prescribed or administered medication that they are allergic too. The home should also ensure that nursing staff have clear guidelines as to when as required and variable dose medication should be given. There have been incidents in the home where service users have been verbally and physically assaulted by other people who live at the home. These incidents have not been reported to the local safeguarding team or the commission. Staff have received Care Homes for Older People Page 8 of 37 training in safeguarding but they were unclear as to the action they should take in terms of reporting. The homes procedure on reporting and safeguarding does not clearly identify all forms of abuse as requiring reporting. The home must ensure that people are safe from all forms of abuse. The home must ensure that the training staff receive adequately equips them with the knowledge and skills to meet peoples needs and keep them safe. The home must review staffing levels to ensure that adequate staff are provided at all times to meet peoples needs and keep them safe. The home must ensure that the commission is notified of all events in the home which adversely affect the well being and safety of service users. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All people are assessed prior to moving into the home to establish what their needs are and if the home can meet these needs, however it is not clear how people already living at the home are considered when deciding if the home should admit a new person. People, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard 6 is not applicable, as the home does not provide intermediate care. Evidence: Two pre-admission assessments were viewed for people admitted shortly before the inspection visit. The inspectors discussed new admissions with staff. Comments from surveys completed by people who live at the home and staff are also considered. The previous report identified that a revised copy of the homes statement of purpose had been received at the Commission in August 2008 and that this provided an Care Homes for Older People Page 11 of 37 Evidence: appropriate level of information for service users or their representatives. This was therefore not viewed during this inspection visit. Information about the home was seen at the entrance hall with further copies located in each bedroom. Comment cards were received from nine service users and all stated they had received enough information (or relatives had) one added a full list of the homes aims and procedures, together with the previous report of the last inspection of the home. People also confirmed in comment cards that they had had the opportunity to visit the home stating the family were very impressed with the home, cleanliness etc and the staff were very friendly and helpful. We were shown round the whole place and shown the room where our relative would be staying. The home identified in the AQAA that they have revised their pre-assessment processes to ensure that we can meet individual residents needs and that assessments are not made before the family of the resident has visited and seen the service and had an opportunity to ask questions. The AQAA also identified that as part of Portsmouth Social Services monitoring of the home, all pre-admission assessments are viewed by the Portsmouth Social Services, prior to agreeing to fund the admissions. The completed assessments viewed during this inspection visit covered all the relevant areas necessary for the home to identify if it would be able to meet a persons needs. Information had also been obtained from care managers and other relevant external professionals and family members. Family members are requested to complete a social history form that provides a range of personal information as well as known preferences for the person to be admitted. One person stated on their comment card the home went out of their way to make sure I had my own room near a toilet suited to my needs. Pre-service assessments identified the needs of the person to be admitted including any risks to the person however the assessments did not demonstrate how consideration of whether the person to be admitted may impact on people already living at the home. Some of the people whose assessments were viewed indicated that they could have an impact on other people living at home. This was discussed with the person in charge who stated that there is an intention to increase the staffing numbers when the next person is admitted to the home. During the inspection visit the person in charge confirmed that they had assessed a person the previous evening and were heard contacting external professionals to clarify some of the information. There was information that this person may impact on other people living at the home. The inspectors were also concerned that the home were considering further admissions at Care Homes for Older People Page 12 of 37 Evidence: a time when part of the home was without central heating and awaiting the fitting of a new boiler. Discussions with staff indicated that they felt they generally had enough information about new people admitted to the home. However in one file viewed there was a letter from a relative who was concerned that their relative had been living at the home for ten days and staff were not clear about some aspects of their relatives care needs. The home does not provide dedicated accommodation for short-term, intermediate care or specialised facilities for rehabilitation. Care Homes for Older People Page 13 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, personal and social care needs are set out in an individual plan of care which contains risk assessments. Medication is appropriately stored and records maintained however known allergies were not recorded on medication administration record sheets putting people at risk that someone may miss an identified allergy and give unsuitable medication. Nurses do not have clear guidelines as to when as required or variable dose medication should be given. People are treated with respect and their dignity maintained. Evidence: Five care plans were viewed one for a new person and the others for people who had been at the home for a longer time. The inspectors discussed with staff, visitors and people who live at the home how care needs were met. Information from notifications of incidents in the home and accident records are also considered. The inspectors observed how peoples needs are met at the home. Main care plans are held in the nurses office with shorter daily care needs plans located in bedrooms. The care plans in bedrooms provided a good level of information Care Homes for Older People Page 14 of 37 Evidence: as to how peoples care needs should be met. These care plans do contain some confidential information and could be read by visitors as are located in view. This could present a confidentially issue especially as the home has a number of twin bedrooms. This was discussed with the person in charge who agreed to consider keeping room care plans out of view but where care staff would be able to access them when required. The main care plans held in the nurses office viewed contained the necessary information for staff to ensure that all aspects of health, personal and social care needs could be individually met. Care plans are divided in daily activities such as personal care, continence. Information in care plans related to the persons assessment. Plans are reviewed on a monthly basis and there was evidence that people or their relatives have been involved in care plans and had signed care plans. A key worker system is in place. It was not possible to discuss care plans with people living at the home due to their level of cognitive impairment. Following the previous inspection in September 2008 the home was required to ensure that individual risk assessments were undertaken and a plan in place to manage any identified risks. The report identified that the service was using a generic approach to risk assessment. This requirement had previously been made following inspections undertaken in May 2008 and July 2008. Care plans viewed contained both generic risk assessments for activities such as using the stair climber and individual risk assessments and management plans including nutrition, falls, and any individual risks such as resulting from age related memory loss. There was evidence that risk assessments were being reviewed and action taken as a result of incidents and reviews. The inspectors noted inconsistencies on one care plan of those viewed as to whether a hoist should be used or if the person could stand and walk short distances with a walking frame. This was discussed with the person in charge and the explanation given should be included on the persons moving and handling assessment and plan and clear guidance available to staff as to how they should decide the most appropriate method of moving the person. The inspectors noted in daily records, incident reports and accident books some instances where the behaviour of people at the home had impacted adversely on other people living at the home. These had not all been reported as notifications to the Commission. Within some bedrooms were records relating to care, food and drink people had received. Those viewed appeared to be well maintained and up to date. These Care Homes for Older People Page 15 of 37 Evidence: recording sheets were also used to record checks undertaken on people at night. Comment cards from the people who live at the home stated that they always received the care and support (including medical care) they need. The inspectors spoke with some visitors during the unannounced inspection and no concerns were raised in respect of health or personal care their relative received. Following the inspection one inspector telephone local social services and health professionals known to visit the home. Neither raised any specific concerns about the home or care provided. Within care plans there was evidence that people had been supported to access external health professionals with records of involvement of opticians, continence nurses, general practitioners, dentists, community nurses, dietitian and chiropody services. It was noted that following a visit from a community Dentist a specific form of toothpaste had been suggested and this was noted in the persons bedroom with their tooth brush. Discussions with visitors and residents during the inspectors visit indicated that they felt their health and care needs were met and that staff always treated them with dignity and respect. Observations of staff interactions and all comment cards received confirmed that people are treated with respect and their right to dignity maintained. The inspectors noted that one WC on the ground floor had the lock fitted the wrong way so that when in the WC the door could not be locked however it could be locked from the outside. Comment cards and discussions with residents confirmed that staff listen and act on what they say. Twin bedrooms were seen to have screens and staff used screens to maintain peoples dignity during moving and handling in communal areas. One bedroom had a strong unpleasant odour. This was discussed with the person in charge and the persons care plan viewed. These indicated that the person was not always willing to enguage with staff for personal care and that external mental health professionals were involved. The training matrix provided by the home showed that managing challenging behviour has been undertaken by many of the homes nursing and care staff. Care staff gave mixed responses when asked if they had sufficient time time to meet peoples needs with discussions indicating that they had a good understanding of individual peoples needs and how these should be met. Staff stated that they have a handover before and during each shift and are therefore updated about anything that has changed or needs particular attention. At the time of the inspection visit nobody was self medicating and medication is only Care Homes for Older People Page 16 of 37 Evidence: administered by a qualified nurse who was observed doing part of the morning medication round. Medication was all seen to be stored securely and at correct temperatures. The inspectors identified that the disposal bin for unused and no longer required medication could be accessed and medication potentially removed from this. The home moved this during the inspection to a secure location and therefore a requirement is not made. The inspectors noted that a number of people are prescribed medication to be administered as required. Discussions with nursing staff indicated that they were clear as to when they would give such medications however there is a need to have specific guidelines in place providing nursing staff with clear advice as to when as required or variable dose medication should be given. The medication administration records were viewed and it was noted that allergies were not included on all record sheets. The inspectors identified that a person had several medication allergies and although this information was available elsewhere it was not on the persons medication administration record. The home must ensure that allergies are recorded on Medication administration Records. Records relating to medication received into the home, administered were viewed and had been maintained to a good standard. Care Homes for Older People Page 17 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with choice about aspects of their lives and social and recreational activities are being provided. Visitors are able to visit at any times. There is choice about meals and appropriate diets are provided. Evidence: Information from care plans, surveys, discussions with staff, visitors and people who live at the home and observations during the inspection visit are considered. Care plans contained information about peoples social histories and preferences in respect of leisure and social activities. This information is obtained from family members as part of the pre-service assessment. Within care plans is a section on activities and a record of activities undertaken. The home employs an activities organiser who was present on the day of the unannounced inspection visit and seen to spend time with people in their own rooms and in the homes communal areas. The activities organiser stated that although she does not have a specific budget she is able to request items required and is building up activities equipment. Care Homes for Older People Page 18 of 37 Evidence: Comment cards were received from nine people who live at the home the majority stated that the home always or usually provided activities they could join in with whilst two stated that activities were never organised that they could join in with. During the inspection visit the activities staff were observed organising several activities in the communal areas and had visited at least one person in their room to discuss the days news. The routines for daily living and activities made available are flexible and varied to suit peoples individual needs. People confirmed to the inspector that they are able to choose where in the home they spend their day, some were seen to spend time in the homes lounge areas with others choosing to remain in their bedrooms. The inspectors met several visitors, all of whom confirmed that they could visit when they wished. The home does not have a private room for visiting and people were observed sitting in the lounges with their visitors. Visitors did not raise this as a concern. One visitor commented that the home had organised for a carer to accompany their relative for a visit to the family home for a Christmas event at which the whole family would be present. People confirmed to the inspectors that they are given choice over their meals with options being chosen on a daily basis. There was information in care plans about special meals people may require and clear guidelines for staff as to the addition of fluid thickener for people who required this on medical grounds. The home has a dining room and also dining tables adjacent to the main lounge area. People were seen being assisted to move to dining tables to eat meals with some remaining in their lounge chairs and others having their lunchtime meal in their rooms as was their choice. People were provided with a choice of main meals (beef curry or lamb and vegetables). The inspectors also noted that people had been provided with other alternatives. People who required their meals in an altered format received this and this was well presented with the various parts of the meal pureed separately. Support was provided to people who required assistance to eat. In comment cards all people stated that they usually or always liked the meals available at the home. People were observed to be eating their meal and those asked confirmed that the meal had tasted good. Nutritional assessments are completed on admission and care plans contained evidence that people are weighed on a regular basis. Care Homes for Older People Page 19 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of 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 may be at risk of physical or verbal abuse from other people who live at the home. Evidence: The home has a clear complaints policy and procedure and is included in the patient information book kept in each bedroom and also in the statement of purpose available in the hallway and separate complaints leaflets located in the entrance hallway by the visitors signing in book. Comment cards returned from people who live at the home and their relatives indicated that they were aware of how to complain. Discussions with staff and staff surveys received confirmed they were aware of what to do if a person complained or raised an issue. The homes AQAA identified that seven complaints had been received, all had been investigated within twenty-eight days and that six complaints had been upheld. The homes complaints log was viewed and this evidenced that each complaint is investigated at a senior level and the complainant is provided with a written response of the investigation, where appropriate an apology and information as to what the home intends to do to prevent a recurrence. The homes training matrix evidenced that staff have undertaken safeguarding training and the inspectors saw certificates for recent safeguarding training ready to be handed Care Homes for Older People Page 20 of 37 Evidence: out to staff. One inspector spoke with nursing staff who were unable to clearly identify the procedures they should take should abuse have occurred and did not know about safeguarding reporting. They eventually found the homes policy and procedure. The homes procedure contained a sheet detailing instances when to notify the team leader, manager or nurse in charge. The only instances relating to safeguarding was violent attack by a resident on another resident resulting in serious injury and any other unexpected situation which may put residents or staff at risk. This would result in an incident form being completed. The procedure for dealing with allegations of abuse was reviewed in February 2009 and required staff to report abuse to the nurse in charge who should take full details and ensure the safety of the person and then contact the manager who would consult with Social Services, CSCI, the police, Responsible person and relatives. There was no clear guidance as to when staff should report, or the action they should take in instances of verbal abuse. The inspectors viewed the homes accident logs, incident records, notifications and daily records. There were records detailing how service users had been shouted at, verbally abused and physically assaulted by other people who live at the home. One instance resulted in a person being pushed and a bruise being noted on their chest, others in people being made to move from where they wanted to sit and staff being physically assaulted in front of service users. Records detailed that people were frightened and this fear had resulted on one occasion in a person attempting to leave the home and falling at night outside, suffering significant injuries which required attention at hospital. There were considerable differences in the recording of the same incidents between daily records, accident records, incident logs, behaviour charts and notifications. Although one was reported to the Commission the full details such as the reason why a person was trying to leave the home at night were not included and the report was therefore that of a fall not a safeguarding notification. Records indicated that the home had contacted external health professionals and identified higher risk times for incidents however the home does not have sufficient staff to provide the one to one monitoring that would be required to ensure the safety of the person and other service users. Daily logs and behaviour charts also identified instances when staff used restraint including one instance when four staff were required to provide personal care to a service user who had been incontinent. Although many staff have attended challenging behaviour training the training matrix shows that this is provided on one day (exact number of hours not clear) and it is unlikely that this has included sufficient training for staff to undertake safe restraint procedures as such courses normally last several days. Instances when restraint have been required should be Care Homes for Older People Page 21 of 37 Evidence: reported under safeguarding to social services and the commission and this had not occurred. There were also records of incidents/accidents where people had been placed at risk which had not been reported to social services or the commission. Following the inspection visit the inspectors contacted Portsmouth Social Services who are monitoring the home and informed them of their concerns that the home was not fully reporting safeguarding concerns. The home procedures in respect of recruitment and peoples personal finances are satisfactory. Care Homes for Older People Page 22 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home contributes to restrictions in mobility and freedom of movement, however it is generally clean, comfortable and well maintianed. Evidence: The inspectors viewed the home towards the start of the inspection visit and viewed records relating to the environment. The home was generally well maintained throughout with the decor in the bedrooms, corridors and communal areas of a reasonable standard. The home offers a mix of single and shared (twin) accommodation. Rooms that are shared have access to additional screening to ensure privacy is promoted during the delivery of personal care. All bedroom doors have been fitted with locks, that appear suitable for the use of the occupant should they wish and which still allows the staff to gain access in case of emergencies. There are WC facilities located close to bedrooms and communal facilities. The inspectors noted that one WC on the ground floor had the lock fitted the wrong way round such that when inside it is not possible to lock the door to ensure privacy but the door can be locked from the outside risking people being locked inside. This must be removed and a correct lock fitted. Care Homes for Older People Page 23 of 37 Evidence: Bedrooms are provided on three different levels, ground, first and second floors with different levels accessed by short flights of stairs on these floors. The home has been created by joining three previously individual house to create one home. This has lead to a large number of stairways being located around the home, which can restrict the freedom and independence of people with restricted mobility. because of the stairways and people being at risk of falls bedrooms have been fitted with alarms. If a person anders or comes out of their room an alarm may go off. One person whose room was located between two stes of stairds had an alram fitted. They were at risk of falls. However it took three minutes for a member of staff to respond when the alarm was sounded during the visit. This impacts on staff particularly at key times, such as late afternoon and evening when people may wander. The home has a passenger lift which covers the ground to first floor and bedrooms are then accessed via a series of stair lifts to additional floors and levels. There are however, a series of smaller flights of stairs around the home which are neither covered by the lift or stair lifts and which can only be negotiated by some service users via a stair climber. The home failed to notify the Commission when the passenger lift was out of action and a staff member became trapped in the lift for a period of time. The home heating in the middle part of the home was not working as the boiler had broken and the heating engineer had stated that it should be condemned and a new one fitted. The home would be without heating in the middle part of the home for approximately two weeks. The home had increased the heating in the other parts of the home resulting in some bedrooms towards the top of the home being very hot. Additional stand alone heating had been placed in bedrooms in the middle home however these were very hot to touch so this may put people at risk of scalding. The communal lounges provide social space for service users although dining space is inadequate and all service users could not be sat to a table at one sitting. Consequently some people had their main lunchtime meal in the lounge chairs. The home is generally clean and tidy throughout. One bedroom had a strong unpleasant odour. The home employs a team of domestic staff who also undertake laundry tasks. The training matrix evidenced that staff have undertaken infection control training and staff confirmed this as well as stating that they have adequate supplies of infection control equipment such as disposable gloves and aprons. Care Homes for Older People Page 24 of 37 Evidence: Care Homes for Older People Page 25 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes recruitment procedures are generally satisfactory and staff have received training to support the people who live there. The home must satisfy itself as to the quality of the training provided by external trainers and that agency staff have the necessary recruitment and training to work at the home. The home must review the staffing levels to ensure that adequate staff are provided at all times to ensure the safety of people living at the home and meet their needs. Evidence: Duty rotas, recruitment records, staff files, training records and information in comment cards from staff and service users is considered as is observation of staff during the inspection visit. Comment cards were received from nine of the people who live at the home who were generally positive about the homes staff. Service users stated that they always/usually received the care and support they need, most that staff listen and act on what they say and that staff are always/usually available when they need them. Additional comments included the management and staff are very attentive at all times, only been here a few days, everyone seems very caring and welcoming, we are very pleased with the treatment and care by the staff who are very friendly. Following the inspection the inspector telephone health and social care professionals Care Homes for Older People Page 26 of 37 Evidence: none of whom raised any concerns about the staff at the home. Comment cards were received from one qualified nurse and one carer. Both stated that they felt the quality of care provided at the home had improved over recent months. Duty rotas were seen during the visit to the home. Duty rotas stated that two qualified and seven care staff are provided in the morning; two qualified and six care in the afternoon early evening and one qualified and three care at night. Cleaners, activities, administration, maintenance and kitchen staff are also employed. During the inspectors visit staff on duty corresponded to those on the duty rota. One staff member had called in as unable to work on the morning of the inspection visit so staff were one short. The home has used agency nurses to cover staff sickness but had not been able to get a replacement at such short notice. The list of agency staff that have been used was seen and an agency staff member was on duty in the afternoon. Some care staff stated that they felt they had enough time to meet peoples needs and others that they did not. During the afternoon and early part of the evening the home aims to have one staff member monitoring several people who may place themselves or others at risk. The home has identified that there have been a greater number of incidents at this time. However the number of incidents that would appear to still be occurring would indicate that staffing levels at this time are inadequate to ensure the safety of all people and especially after 8pm when the day staff have left and the home only has four staff (one qualified nurse and three care staff). The qualified nurse having to administer all the night time medications and many people requiring two staff for moving and handling and negotiating the stair lifts to get people to their bedrooms. The AQAA stated that nineteen of the people living at the home required two or more staff to help with their care by day and night. The home must review staffing levels to ensure that adequate staff are provided to ensure people are safe and their needs met. The person in charge provided training and qualification information during the inspection and on the AQAA. A copy of the homes training matrix was provided to the inspectors. The AQAA stated that the home has twenty care staff of whom eight have an NVQ and four are currently studying for their NVQ. Following the inspection the home provided more up to date information about NVQs for care staff. This showed that on the day of the inspection the home had eleven care staff with and NVQ and a further six undertaking this qualification. Following the inspections in May 2008 and July 2008 the home was required to ensure that all staff had the necessary skills and expereince and were provided in sufficient Care Homes for Older People Page 27 of 37 Evidence: numbers to meet peoples needs. The inspection undertaken in September 2008 recorded that this had been met. The training matrix provided during this inspection also showed that most staff have undertaken all mandatory training and staff have also undertaken additional training relevant to the needs of the people who live at the home such as dementia awareness and challenging behaviour. As identified all staff have undertaken safeguarding training however they were still not able to identify immediately the action they should take with reference to reporting concerns and had failed to identify that verbal abuse and people being frightened of other service users should be treated as abuse and safeguarding procedures instigated. The home uses external training providers and must satisfy themselves as to the quality of the training that staff are receiving. Nursing and care staff stated that they felt they had the necessary skills to meet peoples needs and were not expected to undertake activities for which they had not been trained. The recruitment records for four people recruited since the previous inspection were viewed including a qualified nurse, care staff and ancillary staff. The recruitment procedures and record files were much improved from previous inspections in May and July 2008 when requirements had been made in respect of pre-employment checks. These contained evidence that the home undertakes checks on staff including references, CRB and POVA checks prior to commencing employment at the home. The inspectors noted that on one file a reference had not been sought from the person in charge of the previous place of employment but from another staff member who worked there at at a similar level as the applicant. It is possible that another staff member may not be aware of any disciplinary or other concerns that people in charge may have. This was discussed during the inspection and whilst it is understood that people may not want current employers to know that they are looking for alternative work, the home should ensure that if they are going to offer a person a job that they inform the applicant that they have a job pending a satisfactory reference from their current employer. Where staff have previously been employed at the home and then left and returned the home should not act as one of the persons references. The home uses agency staff generally provided by one of two agencies. There was an agency staff member on duty on the day of the inspection however the home did not have any information about the agency workers training, experience or that the agency had completed all the recruitment checks to determine the persons suitability to work at the home. During the inspection the home contacted the agency and arranged to meet with them to agree a procedure to ensure that they had the necessary information about staff supplied. A requirement is therefore not made in Care Homes for Older People Page 28 of 37 Evidence: this respect. The person in charge explained the homes induction procedure and confirmed on the AQAA that this meets the induction training recommended by Skills for Care induction. Induction checklists were seen in recruitment files and the inspectors were shown the induction workbooks completed by care staff. Care staff keep the induction workbooks therefore the home must determine how they will evidence that inductions have been completed. Care Homes for Older People Page 29 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not have a registered manager, which has been the case over a long period of time. The home has failed to ensure the safety of people living at the home and has not met regulatory requirements in respect of notifications of incidents at the home. Further requirements have been made following this inspection. Evidence: The inspectors viewed records relating to the homes management, met the provider and the newly appointed manager. Three requirements were made following the previous inspection in September 2008. These have either been fully or partly met and none are repeated following this inspection. New requirements are made in respect of medication, safeguarding, staffing and notification of incidents which adversely affect the well being of service users. The home has been without a registered manager for a considerable time this being Care Homes for Older People Page 30 of 37 Evidence: noted in the report following the inspection in May 2008 when it was stated that there had been a manager in post since May 2007 but that person had failed during the year employed at the home to apply for registration. The home therefore has not had a registered manager for at least two years or more. Throughout this time the home has been subject to safeguarding investigations and continues to be monitored by Portsmouth Social Services to ensure the safety of people living there. The home has now appointed a new manager who informed the inspectors that they had an appointment to visit the commissions Southampton office the week of the inspection to complete a CRB with the commission as the first part of the registration process. The new manager informed the inspectors that she is a registered nurse who has completed the registered managers award and previously managed other nursing homes. The requirement that the home must recruit a manager and submit an application for registration has therefore been partly met. The progress of the managers application will be monitored and the requirement will not be repeated. The home has failed to notify the commission of events in the home that have adversely affected the health and welfare of the people who live there. These events include the failure of the boiler in part of the home, the breakdown of the lift, accidents in which a person could have fallen down stairs in a wheelchair and several instances when people have been verbally and physically assaulted by other service users. The home has also failed to inform the local safeguarding team of these occurrences. Following the inspection in September 2008 a requirement was made that the home must ensure that information gathered during quality audits is used effectively to review and where necessary improve practice. The home undertakes a variety of meetings with service users, relatives and different staff groups with minutes available. Dates for future meetings were seen. The home has also undertaken a quality audit survey with questionnaires sent out with invoices in December 2008 and January 2009. The responses had been collated and the home had identified areas for improvement which included updating tired decor and furniture, chairs for relatives when visiting and refreshments to be routinely provided to visitors. The home had not yet fully actioned these areas however the person in charge stated that they were in the process of achieving this and given the short time scales since the surveys were sent the requirement is not repeated and will be further assessed at the next inspection. The home also undertakes a range of audits such as medication. Care Homes for Older People Page 31 of 37 Evidence: Previous reports identified, and the situation was confirmed to be the same at this inspection visit, that the home does not become involved with peoples personal finances. Any additional charges for services not covered by the fees such as hairdressing and chiropody are added to invoices on a monthly basis. An example of an invoice was viewed and this clearly stated what additional charges were being made and why. During the inspection visit a range of records were viewed including those relating to service users and staff. Generally these were stored securely and access only available to people who should have access. The home agreed to move the room care plans to an alternative place in peoples rooms to ensure confidentiality whilst maintaining access to care staff. There were inconsistencies noted between records of the same incidents as recorded in daily records, behaviour charts, accident records, incident reports and notifications. Medication Administration records did not have allergies recorded. Previous reports have identified concerns in relation to substances hazardous to health (COSHH). All COSHH substances were seen to be stored securely during this inspection visit. The home moved the discarded medication container to a more secure location when inspectors identified that, although locked, it was possible to remove discarded medication from the container. The home has not ensured the safety of people living at the home who have been verbally and physically assaulted by other service users. Care Homes for Older People Page 32 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The responsible person must 01/04/2009 ensure that allergies are recorded on Medication Administration Records. So that prescribing doctors, dispencing pharmacists and administrating nurses are fully aware of known allergies. 2 18 13 The responsible person must 01/04/2009 ensure that people are safe from all forms of abuse. The responsible person must ensure that staff are aware of the correct procedures for safeguarding including the full reporting of all safeguarding concerns. To ensure that people are safe. 3 25 18 The responsible person must 01/04/2009 review the staffing levels to ensure that adequate staff are provided at all times. Page 34 of 37 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure the safety of people and that their needs are met. 4 26 18 The responsible person must 01/05/2009 ensure that the training staff receive adequately equips them to meet peoples needs. To ensure that people are safe and their needs met. 5 27 18 The responsible person must 01/04/2009 review the staffing levels to ensure that adequate staff are provided at all times. To ensure the safety of people and that their needs are met. 6 30 18 The responsible person must 01/05/2009 ensure that the training staff receive adequately equips them to meet peoples needs. To ensure that people are safe and their needs met. 7 38 37 The repsonsible person must 01/04/2009 ensure that the commission is notified of all events in the home which adversly affect the well-being or safety of service users. To ensure that people are safe. Care Homes for Older People Page 35 of 37 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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