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Inspection on 23/04/07 for Aquarius Nursing and Residential Care Home

Also see our care home review for Aquarius Nursing and Residential Care Home for more information

This inspection was carried out on 23rd April 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The provider has done well to address the management arrangements within the home that has enabled the progress in respect of the previous requirements made.

What has improved since the last inspection?

Following the inspection in September 2006 thirty-one requirements were made. When the commission undertook a random inspection in January 2007 most of these had not been addressed and additional requirements were made. The provider then appointed an external consultant to assess the Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 6service and work by the turnaround team commenced in mid February 2007. The inspectors noted that in the relatively short period of time the consultants have met many of the requirements with work to meet the remaining requirements prioritised and planned. The inspectors felt the atmosphere within the home to be generally more relaxed and cheerful which was confirmed in staff comments and reflected in professional responses and management statements. Further information as to these improvements is contained within this report however the following are an indication of the requirements that are now considered to have been met. The pre-admission assessment form has been revised, however as the home has not admitted any new people since September 2006 its effectiveness cannot be assessed at this time. Discussions with the new manager indicated that people with mobility needs would not be admitted into rooms that are not accessible for them. The home has reviewed the care planning systems and these are now more individualised and person centred. There is still work to be completed on care plans however the progress so far indicates that this area is now being addressed. The home is now using a key-worker system which, combined with the new practise of allocating care staff to provide total care for people either on the ground or first floor, has resulted in the previous task orientated and institutional practises being no longer evident. The home is providing more staff that enables staff to provide more individual care. Evidence now indicates that people living at the home have their health care needs met. Medication is appropriately stored, administered and full records maintained. People living at the home are now treated with respect and their rights to privacy and dignity upheld. Interactions between staff and the people who live at the home were warm and friendly with interactions observed to be initiated by both staff and the people who live at the home. People living at the home are offered a range of activities, are able to maintain contact with their relatives/friends and provided with choice and control over their lives. People are provided with a choice of meals with support available if required. New call bells have been fitted which can be removed from the wall and a remote unit placed within reach of the person.Seating in the lounge and dining rooms is being reviewed following the occupational therapist report. Two new recliner chairs have recently been purchased. The home has removed the macerator from the laundry area as required. The home has made arrangements to review bathroom, toilet and bedroom door locks in line with the occupational therapist report and previous requirements. Wheelchairs were seen to be fitted with footplates. Many bedrooms have been redecorated and provided with new curtains and bed linen since the visit in January 2007. On the day of the inspectors visit blinds were being fitted to the ground floor front bedrooms that look straight out onto the street. The management arrangements are now open and transparent with the commission being kept fully informed about incidents and issues within the home. Staff, relative and service user meetings are now being held.

What the care home could do better:

A number of requirements were not met and these are repeated with additional timescales for compliance. The home must review the statement of purpose, service users guide and contracts/terms and conditions of residency and provide a copy of each document to everyone living at the home or their relative/representative. Care plans do not contain individual risk assessments. Individual risk assessments must be undertaken on all people for whom bed rails are used. Inappropriate manual handling transfers were observed by the inspectors during their visit and also detailed in the report undertaken by an independent occupational therapist in March 2007. The home does have some plans to address manual handling issues however a requirement is made that only appropriate manual handling techniques must be used. The heated meal trolley must be cleaned after every meal. Within the main ground floor bathroom the Mobray toilet seat and surround must be replaced, as must the linoleum floor as both are worn out. The occupational therapist recommended that lever taps be fitted in all bathrooms. The ground floor bath hoist seat requires a thorough cleaning.Training information provided by the home stated that staff have now have had abuse awareness training however staff are still not clear re the actions they should take should they suspect abuse may or has occurred. The home has yet to complete a training needs analysis and plan training for the coming year to ensure that staff have all the necessary mandatory and additional training to meet peoples needs. The home must identify how it will provide a minimum of fifty per cent of NVQ trained care staff. The home has yet to audit staff files to ensure that all pre-employment checks have been undertaken and take the necessary action to protect people living at the home.

CARE HOMES FOR OLDER PEOPLE Aquarius Nursing and Residential Care Home 4 Spencer Road Southsea Hampshire PO4 9RN Lead Inspector Janet Ktomi Unannounced Inspection 23rd April 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Aquarius Nursing and Residential Care Home DS0000011470.V337581.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. Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aquarius Nursing and Residential Care Home Address 4 Spencer Road Southsea Hampshire PO4 9RN 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) (023) 92 811824 Qualitycare Management Limited Care Home 38 Category(ies) of Dementia - over 65 years of age (38), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (38), Old age, not falling within any other category (38), Terminally ill over 65 years of age (26) Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three service users between the ages of 55 and 64 years of age may be accommodated at any one time in the categories DE and MD. 8th January 2007 Date of last inspection Brief Description of the Service: 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 home is also registered to accommodate 26 older people with life limiting diseases. The Aquarius is the only care home owned by Quality Care Management Ltd. 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 to the effect of 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. Fees range £450 - £800 dependant on assessed needs Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows a key inspection of the service that included an unannounced site visit to the home undertaken by two inspectors over a period of one day lasting eight hours. The report also contains information received prior to the site visit and includes reference to an unannounced random inspection visit undertaken by two inspectors in January 2007. The inspector also spoke by telephone with the consultant who is part of the Turnaround team who have been working with the home since February 2007, to address issues raised in the previous inspection undertaken in September 2006 and the random inspection in January 2007. Because of the level of concern following the inspection of 12th September 2006, the Commission proposed to impose conditions of registration. At the time of this inspection, an appeal has been made by the organisation to the Care Standards Tribunal in respect of this. Care managers and district nurses were contacted following the inspection visit to determine their views on the service. Staff questionnaires were sent to the home prior to the inspectors visit and four were returned. At the random inspection undertaken in January 2007 it was evident that little progress had been made to meet the thirty-one requirements made following the inspection in September 2006. However this inspection visit in April 2007 indicated that significant improvements have been made following the appointment of an external management team in February 2007. Not all requirements have been met, however important areas of care and management have been addressed. What the service does well: What has improved since the last inspection? Following the inspection in September 2006 thirty-one requirements were made. When the commission undertook a random inspection in January 2007 most of these had not been addressed and additional requirements were made. The provider then appointed an external consultant to assess the Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 6 service and work by the turnaround team commenced in mid February 2007. The inspectors noted that in the relatively short period of time the consultants have met many of the requirements with work to meet the remaining requirements prioritised and planned. The inspectors felt the atmosphere within the home to be generally more relaxed and cheerful which was confirmed in staff comments and reflected in professional responses and management statements. Further information as to these improvements is contained within this report however the following are an indication of the requirements that are now considered to have been met. The pre-admission assessment form has been revised, however as the home has not admitted any new people since September 2006 its effectiveness cannot be assessed at this time. Discussions with the new manager indicated that people with mobility needs would not be admitted into rooms that are not accessible for them. The home has reviewed the care planning systems and these are now more individualised and person centred. There is still work to be completed on care plans however the progress so far indicates that this area is now being addressed. The home is now using a key-worker system which, combined with the new practise of allocating care staff to provide total care for people either on the ground or first floor, has resulted in the previous task orientated and institutional practises being no longer evident. The home is providing more staff that enables staff to provide more individual care. Evidence now indicates that people living at the home have their health care needs met. Medication is appropriately stored, administered and full records maintained. People living at the home are now treated with respect and their rights to privacy and dignity upheld. Interactions between staff and the people who live at the home were warm and friendly with interactions observed to be initiated by both staff and the people who live at the home. People living at the home are offered a range of activities, are able to maintain contact with their relatives/friends and provided with choice and control over their lives. People are provided with a choice of meals with support available if required. New call bells have been fitted which can be removed from the wall and a remote unit placed within reach of the person. Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 7 Seating in the lounge and dining rooms is being reviewed following the occupational therapist report. Two new recliner chairs have recently been purchased. The home has removed the macerator from the laundry area as required. The home has made arrangements to review bathroom, toilet and bedroom door locks in line with the occupational therapist report and previous requirements. Wheelchairs were seen to be fitted with footplates. Many bedrooms have been redecorated and provided with new curtains and bed linen since the visit in January 2007. On the day of the inspectors visit blinds were being fitted to the ground floor front bedrooms that look straight out onto the street. The management arrangements are now open and transparent with the commission being kept fully informed about incidents and issues within the home. Staff, relative and service user meetings are now being held. What they could do better: A number of requirements were not met and these are repeated with additional timescales for compliance. The home must review the statement of purpose, service users guide and contracts/terms and conditions of residency and provide a copy of each document to everyone living at the home or their relative/representative. Care plans do not contain individual risk assessments. Individual risk assessments must be undertaken on all people for whom bed rails are used. Inappropriate manual handling transfers were observed by the inspectors during their visit and also detailed in the report undertaken by an independent occupational therapist in March 2007. The home does have some plans to address manual handling issues however a requirement is made that only appropriate manual handling techniques must be used. The heated meal trolley must be cleaned after every meal. Within the main ground floor bathroom the Mobray toilet seat and surround must be replaced, as must the linoleum floor as both are worn out. The occupational therapist recommended that lever taps be fitted in all bathrooms. The ground floor bath hoist seat requires a thorough cleaning. Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 8 Training information provided by the home stated that staff have now have had abuse awareness training however staff are still not clear re the actions they should take should they suspect abuse may or has occurred. The home has yet to complete a training needs analysis and plan training for the coming year to ensure that staff have all the necessary mandatory and additional training to meet peoples needs. The home must identify how it will provide a minimum of fifty per cent of NVQ trained care staff. The home has yet to audit staff files to ensure that all pre-employment checks have been undertaken and take the necessary action to protect people living at the home. 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. Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4. The home does not provide intermediate care therefore standard six is not applicable. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has not yet addressed the previous requirements and must review the statement of purpose, service users guide and terms and conditions of residency/contracts. The pre-admission assessment form has been revised, however as the home has not admitted any new people since September 2006 its effectiveness cannot be assessed at this time. EVIDENCE: Following the previous four inspections the home has been required to ensure that the statement of purpose and service users guide is updated and made available to current and potential service users and their relatives. Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 11 These documents were viewed during the random inspection in January 2007. When it was acknowledged that work on updating the ‘Service Users Guide’ had occurred, it still failed to address all of the required elements, as set out under Regulation 5 of the Care Homes Regulations 2001, amendments to the Care Homes Regulations 2004 & 2006 and guidance contained within the National Minimum Standards for Older People (Standard 1). In January a copy of the proposed, brochure style, ‘Service users Guide’ was provided to the visiting inspectors for reference purposes and found to have omitted or wrongly represented the following: • • • • • • • • • No details of the arrangements for paying fees. No details of the arrangements for paying additional charges. No information regarding any periods of notice or payment of fees in the event of death. There is no evidence of a standard form of contract. No information relating to the latest inspection report. No summary of the complaints process No details relating to the address of the Commission. The document states that 50 of the staff currently possesses a National Vocational Qualification at level 2 or above, the actual percentage is 12.8 . The document makes statements regarding ‘ stimulating activities, full risk assessments, nutritional plans, weekly patient weights being undertaken and recorded. The statement of purpose was also reviewed during the random inspection and it was felt that the ‘statement of purpose’ failed to comply with the requirements set out under Regulation 4 of the Care Homes Regulations, associated Schedules (as specified within the regulation) and amendments to the Regulations in 2004 & 2006. The ‘statement of purpose’ was found to be very user unfriendly, with a poor layout and repetitive information. It was also felt that insufficient consideration had been given to the following areas: • • • • • • • The aims, objectives and philosophy of the care home. Details of the terms and conditions of residency. The age range of the clients catered for. The arrangements for consulting service users (meaningfully) about the operation of the home. Clear & transparent details of the fees and what is covered/provided. The arrangements for reviewing and updating care plans, following consultation with the service users. The arrangements made for respecting the privacy and dignity of the service users. Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 12 In April 2007 the turnaround manager stated to the inspector that she had not yet addressed the statement of purpose and service users guide having focused her time since appointment, only six weeks previously, on care and organisational issues. A further timescale for these documents to be reviewed and re-written is agreed and the service must send a copy of the new statement of purpose and service users guide to the Commission once completed. During the inspection in September 2006 it was identified that contracts/terms and conditions of residency did not reflect the current terms and fees of the accommodation and services provided or how payments to cover the costs including any top-ups are arranged. A requirement was made in respect of this. The inspectors viewed these again in January 2007 and April 2007 and found, on reviewing files on both occasions, that the contracts provided to residents varied depending on the amount of time the person had been accommodated at the home. However, neither new service users contracts nor those relating to existing service users, (as defined by The Care Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2006) are provided with contracts, terms & conditions that comply with Regulation 5 requirements: • • • • No details of the arrangements for paying fees. No details of the arrangements for paying additional charges. No details of the arrangements for paying fees if the service user’s care was being funded in whole or in part by a person other then the service user. Information relating to service users having been notified as to whether a nursing contribution is paid in respect of nursing care. The turnaround manager stated to the inspector that she had not yet addressed the terms and conditions/contracts and that these would be addressed with the service users guide and statement of purpose. Letters to relatives/representatives were seen in service user files from the turnaround manager to inform relatives that any additional services (chiropody, hairdressing etc) would now be invoiced separately. A further time scale for reviewing the terms and conditions of residency/contracts is made. A requirement was made in September 2006 that the home must review the pre-admission assessment process and records. Some work on this has been commenced and the inspectors were shown a revised pre-admission assessment form. During the discussions with the new manager it was evident that she would consider carefully before admitting new people to the home to ensure that their physical and mental health needs could be fully met at the home. The home has not admitted any new people since the 12th September Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 13 2006 therefore this requirement cannot be fully assessed/reviewed at this time. Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are now more person centred and individualised, health care needs are met, however the home must undertake individual risk assessments. Medication is appropriately managed and people are now treated with respect and their right to privacy is upheld. EVIDENCE: During previous inspection visits, including the random visit in January 2007, the commission identified that the service provided to people living at the home was organised on task orientated and institutional lines with little consideration of individual likes and dislikes or choice. The home has since reorganised how care staff work. Care staff are now key-workers for individual people and the shifts are organised with identified carers allocated to the ground and first floor providing all care required for people they are allocated Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 15 to. Work allocations were seen in the nurse’s office diary and care staff confirmed this arrangement. Three service user care plans were viewed during the visit in April 2007. Since the inspectors visit in January 2007 the home has reviewed the care planning system and care plans are now more person centred and individualised. Care plans were noted to contain a daily schedule that was individual to the person whose plan of care it was. The daily schedules included information about preferred daily routines for getting up and where people spend their time. The inspectors identified some inconsistencies within care plans, one stating that a person was overweight on a manual handling assessment and average weight on a waterlow assessment. Another that a person received nutritional supplements whilst other information in the file stated that she ate a good normal diet. Care plans also contained information about specialist equipment required and daily records of care received. During the inspection visit care staff were observed completing records of people they had cared for. Care plans had manual handling assessments, however they did not contain specific risk assessments. Noted in some care plans were the generic risk assessments, which had been signed by relatives giving permission for the home to undertake a range of activities (use of cot sides, wheelchairs etc), these must be removed and individual risk assessments completed where necessary. Following the inspection in September 2006 the home was required to ensure that service users health needs and their entitlements to NHS treatment were maintained. In April 2007 care plans contained information about service users health needs and recorded visits from opticians and chiropodists. The desk diary detailed an out patient appointment for one person and also identified the member of care staff to accompany the service user to the hospital. The home has a link district nurse. The inspector telephoned the link district nurse following the visit. She stated that she is available to support the home, has not visited the home for a period of time and has not had any areas of concern identified to her by other visiting medical personnel. During the inspection visit in January 2007 inspectors identified that pressure relieving equipment was at the incorrect setting and would have placed people at higher risk of pressure injuries. On this visit equipment settings appeared to be correct however two of the three mattresses viewed had fitted sheets, which hinder the action of the mattress and must not be used. This was discussed with members of the management team who will address this issue with staff. A requirement is not made on this occasion however this will be reviewed at the next inspection. Many of the beds at the home have bed rails fitted to them. Care plans did not have specific individual risk assessments in respect of bed rails or indicate why these were in use for individual people. One record viewed stated that a Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 16 service user had fallen from a bed having passed between the bed rail and the top of the bed. This would indicate that the bed rail had been incorrectly fitted and that a bed rail may not be appropriate for this person. Further recordings for this person indicated that it took several days before the bed rail was extended and correctly fitted to prevent a re-occurrence. Individual risk assessments must be undertaken on all people for whom bed rails are used. Care plans contained manual handling assessments and care staff have received manual handling training. The home has a range of hoists and standaids. However inappropriate manual handling transfers were observed by the inspectors during their visit and also detailed in the report undertaken by an independent occupational therapist in March 2007. A notice on the board outside the office stated that the home was planning to appoint a manual handling assessor within the home who would be responsible for staff training and ensuring that correct procedures will be used on all occasions. The home must ensure that only appropriate manual handling techniques are used at all times. The inspectors observed the mid morning medication administration and viewed medication administration records. In January 2006 the home had an unannounced inspection by the commissions pharmacist. The requirements from this visit have been met. The home now uses a blister pack system with all medication administered by a qualified nurse. The arrangements for the storage of controlled medications were assessed and records viewed. Topical creams and applications are now stored appropriately. The turnaround team manager informed the inspector that she is arranging a disposal contract for non used medication as this can no longer be returned to the local pharmacy due to changes in the disposal of hazardous waste laws. The home is now using the medication administration records supplied by the pharmacist that records all the information in a format suitable for retrieval at a later date if required. Medication administration records were viewed and were fully completed. The new manager stated that once fully in post she would be requesting Gp’s to review all service users medication prescriptions and undertake a ‘medical’ for everyone living at the home. Medication policies and procedures were seen at the front of the Medication Administration Records file and had all been re-written in January 2007. Previous key and random inspection identified that care is task orientated and institutional with a lack of dignity and privacy for service users. It was also noted that service users were being treated in a dismissive and derogatory manor in both previous inspections, eg a meal having been salted by one service user who then changed her mind passed onto another service user. During this inspection the atmosphere in the home appeared more relaxed with staff happy and observed to be interacting positively with the people who live in the home. Interactions were initiated by staff and also by the people who live at the home. No instances of derogatory or dismissive treatment was Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 17 noted. People living at the home able to voice an opinion stated that the staff were very nice. People unable to voice an opinion appeared relaxed and at ease when staff approached them. Screening was seen to be provided in twin bedrooms and peoples preferred terms of address were recorded in care plans. Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are offered a range of activities, are able to maintain contact with their relatives/friends and provided with choice and control over their lives. People are provided with a choice of meals with support available if required. EVIDENCE: Previous reports identified concerns that people living at the home were not provided with activities, choice or suitable meals. Evidence received and the inspector’s observations would indicate that this is no longer the situation and the lifestyles of people living at the home have greatly improved. The home has appointed an activities organiser who works each morning providing a variety of group and individual activities. A four week activities plan was seen on the office wall and listed crafts, card making, board games and card games. The home also has a visiting musician. Examples of craft work were seen on display in the home. The activities organiser was overheard asking people if they wanted to play a board game. People living at the home Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 19 stated that they enjoyed the activities and that they were able to choose to participate or not. Activities people had participated in were seen recorded in daily records. The home is located close to Southsea sea front with a level walk to the parade. Daily records and the nurses office diary detailed people who had been taken out for walks by care staff. Service users confirmed that they are able to have visitors and names of visitors were seen written in the homes visitors book. One person was overheard requesting to phone her son and was supported to do so by staff. The home has a main lounge, a smaller back lounge, further lounge area adjacent to the main lounge and a dining room. The home does not have a private room for meetings, however if private space is required this could be organised, outside of meal times, in the dining room. As previously stated care plans contained individual daily schedules stating peoples preferred daily routines and positive interactions were observed between staff and the people who live at the home. Staff were observed asking people if they wanted to join activities, different options were seen provided at meal times and people living at the home were heard requesting another cup of tea (which was provided). These indicate that people are able to make choices and their decisions are now being respected and met. During previous inspection visits it was noted that some people did not have their own toiletries and hairbrushes. This would appear to no longer be the case and individual toiletries and personal items of grooming were seen in vanity cabinets in bedrooms. In twin rooms’ items were clearly labelled to identify to whom they belonged. Requirements were made in respect of meals and nutrition at previous inspections. The home has fully addressed these issues. The inspectors observed the main lunchtime meal and discussed food with people living at the home able to make a comment. They stated that the food was good and they were able to make a choice. There is a notice board in the dining room on which the main daily menu and the alternatives available are written. Meals seen were well presented with sufficient staff to support people requiring assistance. Adapted equipment was provided to maximise people’s independence. Fluids were provided with meals. People were offered the main meal with some choosing a range of alternatives (sandwiches, chips). Other alternatives available included omelettes and jacket potatoes, salads. Staff checked that people were all right and seconds were offered and accepted. Most people were seen eating their meal in the main dining room with a second smaller dining area provided adjacent to the main lounge. One person was eating in the lounge and stated to inspectors that this was her choice. The home must ensure that the heated meal trolley is cleaned following every meal. Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People and their relatives are able to complain and their complaints will be acted upon. People are protected from abuse, however staff are not clear as to the actions they should take if they suspect abuse may have occurred. EVIDENCE: The report following the inspection in September 2006 identified that complaints were not logged and not appropriately investigated. The situation was the same in January 2007 and it is therefore not possible to identify how many complaints have been made directly to the service since the previous inspection in September 2007. Staff comment cards received in March 2007 stated that paper and pen would be given to service users for them to write down their complaint that would be passed to manager. Although it is likely that not all people who live at the home would be able to write down a complaint this does indicate that staff would ensure that complaints would be taken seriously, a record of the complaint would be made and this would be passed onto the manager to investigate. Interactions between staff and people who live at the home were warm and positive and it is likely that they would feel able to make a negative comment without fear of retribution. Two people directly asked stated they would say if they had any complaints but did not have any at the time of the inspectors visit. The turnaround manager has held Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 21 meetings for service users and their relatives and stated that she has encouraged people to discuss any concerns or complaints with her. There have been previous concerns that care practises at the home were abusive with needs neglected, lack of dignity and choice. As detailed in previous sections of this report there have been improvements in these areas and there is now no indication that people’s needs are being neglected and dignity and choice are respected. A requirement was made in September 2006 and repeated in January 2007 that staff must have adult protection training. Two of the four staff comment cards returned did not complete the question relating to adult protection and those who did complete this question had not answered it fully and made no reference to locally agreed procedures or the commission. Staff had received challenging behaviour training prior to the inspection in January 2007 but had not had adult protection training. One staff member listed abuse awareness in training undertaken. The local policy and procedures for adult protection were seen in the nurse’s office. Training information provided by the home stated that staff have now have had abuse awareness training however staff are still not clear re the actions they should take should they suspect abuse may or has occurred. Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 22 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, 20, 21, 22, 23, 24, and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is working to improve the environment and address the issues that result from the physical layout of the home and many short flights of stairs that present a risk to people with mobility needs. With the exception of the ground floor bathroom bath hoist seat the home was generally clean and free from offensive odours. EVIDENCE: A number of requirements concerning the environment have been made in previous reports. The turnaround manager requested an independent occupational therapist to undertake an assessment of the home and the provider sent a copy of the report following this assessment to the Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 23 commission. The inspectors undertook a tour of the home with a senior staff member and the new manager. The home is situated in a pleasant residential area of Southsea with level walking access to the sea front and parade. The home is three conjoined buildings set on three floors, with many short rises of stairs. The occupational therapist report identified that people with mobility needs should not be accommodated in rooms that can only be accessed via stairs. The home has now moved all non-mobile people from one area in the ‘link’ between houses. The occupational therapist and inspectors noted that some rooms on the ground floor are accessed by three steps and that staff are using emergency egress seats to navigate these stairs. The occupational therapist identified that this practise is inappropriate. The turnaround manager stated that she has contacted an engineering company who have stated that they are able to provide a portable ramp/lifting devise for use in this situation. A requirement is therefore not made as efforts are being made to resolve this situation. Discussions with the new manager indicated that she would fully consider mobility issues when considering admissions to the home. The occupational therapist also identified access issues into the home for people with mobility needs. The home is considering the suggestions made by the occupational therapist and these issues will be re-assessed during the next inspection. The home has an enclosed rear patio garden. The home has a large lounge, smaller lounge to the rear of the home and a sitting area adjacent to the main lounge and secondary dining area. The home has a good sized dining room which has one step leading down to it from the main lounge level. The home are considering what action can be taken in respect of this step as part of the other steps and stairs with in the home and this will be assessed again at the next inspection. The occupational therapist and inspectors noted that chairs within the dining area are not suitable for all people who live in the home. The occupational therapist also noted that lounge chairs were not appropriate for all people with some sitting precariously. During the January 2007 random inspection visit inspectors observed a person sliding from her lounge chair. The home has recently purchased two recliner chairs and stated that seating is being considered in light of the occupational therapist report. People were seen sitting in all lounge areas and stated that they could choose where they sat. All communal areas were appropriately warm, clean and well lit although the occasional/individual tables would benefit from a thorough cleaning of the legs and bases. The home was previously required to review the call bells within the lounges, as these were not accessible to all people. New call bells have been fitted which can be removed from the wall and a remote unit placed within reach of the person. This requirement is therefore met. The home has a main bathroom on the ground floor and further bathrooms located on other floors. Within the main ground floor bathroom the Mobray Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 24 toilet seat and surround must be replaced, as must the linoleum floor as both are worn out. The occupational therapist recommended that lever taps be fitted in all bathrooms for ease of use by people living at the home. The inspectors also noted that the ground floor bath hoist seat requires a thorough cleaning. The inspectors viewed many of the bedrooms. Many of which have been redecorated and provided with new curtains and bed linen since the visit in January 2007. On the day of the inspectors visit blinds were being fitted to the ground floor front bedrooms that look straight out onto the street. This is to improve privacy for people in the room. Occupied bedrooms were seen to contain personal items. Since previous inspections the home has removed many of the dated pictures not belonging to people occupying rooms. As stated the home has now been assessed by an occupational therapist, the report indicating a range of actions the home should consider to make the environment more appropriate for people with limited mobility, sensory loss and dementia. The occupational therapist visit was undertaken on the 26th March and therefore time to undertake all the recommendations was not possible prior to this inspection visit. This will be further assessed during the next inspection however discussions with the turnaround manager indicated that consideration was being made as to how the recommendations and suggestions contained in the report could be implemented with some already actioned. The inspection in September 2006 required that locks be fitted to bathrooms and bedroom doors such that people’s dignity and privacy could be maintained. Locks were noted to have been fitted to most doors in January 2007 however a number of these had been incorrectly fitted such that toilet doors could only be locked from the outside. The home was required to review all locks and make sure that these were correctly fitted and appropriate for the people who live at the home. The home has consulted with a locksmith and was awaiting the occupational therapist report before amending the locks. The inspectors were shown the quote from the locksmith, which the home stated would now be actioned including the additional issues identified by the occupational therapist. The home has removed the macerator from the laundry area as required following previous inspections. Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service provides adequate numbers of qualified nurses and care staff. The service has yet to complete a full training needs analysis and subsequently produce a training plan to meet identified individual and collective training needs. Staff recently employed have been appropriately recruited however the home has yet to review all recruitment files to identify and rectify any gaps in pre-employment checks. EVIDENCE: The inspectors viewed the duty rota, discussed staffing with care staff, people who live at the home and the turnaround manager as well as observing staff throughout the inspection visit. Staff surveys were sent to the home and four were completed and returned. Staff surveys and the duty rotas demonstrated that there has been an increase in the numbers of staff provided at the home. As previously stated care staff are now the nominated key-worker for individual people at the home. The home has also changed the way that staff are organised and they are now allocated to care for people whose bedrooms are either on the ground or first floor. This was seen in the nurse’s office diary and confirmed by care staff. The Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 26 turnaround manager confirmed staffing numbers with three qualified staff and seven care staff on a morning shift, three qualified and five care on an afternoon and one qualified and three care on at night. On the day of the inspectors visit there were three qualified and five care on duty. Duty rotas indicated that two care staff were off sick. Comment cards from care staff stated that there were more staff and more time to meet people’s needs. During discussions the turnaround manager confirmed that staffing numbers could be increased when the numbers of people living at the home increased. At the time of the inspection the home had twenty-eight people living there with the potential to accommodate up to thirty-eight people. The home also employs ancillary staff including a cook, maintenance person and housekeeping/cleaners. Service users stated that care staff were kind and helpful and that they felt there were enough staff to meet their needs. Care staff stated that there were improved staffing levels, improved training, more communication and were positive about the future. Care staff confirmed that as key-workers they had input into care plans and that staff meetings were now held. The turnaround manager informed the inspector that she has yet to complete training needs analysis for individual staff and the staff team as a whole. The turnaround manager stated that some staff files contained certificates from training undertaken and that discussions with staff indicated that some had certificates at their homes. The turnaround manager stated that she will be completing a review of what training staff have undertaken in the past two years and then plan what training is required for the future. The inspectors were provided with information concerning NVQ’s for care staff. This indicated that once staff currently undertaking NVQ training have completed their courses the home will have approximately thirty per cent of staff with an NVQ qualification. As part of the training needs planning the home will need to consider how it will ensure that at least fifty per cent of care staff have an NVQ qualification. The inspectors were shown certificates for ten staff who completed an infection control course in March 2007 with further infection control training planned for late April 07. Care staff questionnaires indicated that other training has been provided. The inspectors were not able to view staff records during their visit to the service. When viewed previously in September 2006 and January 2007 these had shown that full pre-employment checks were not being undertaken before people commenced employment at the home. The turnaround manager informed the inspector that she had yet to address recruitment records. She stated that all staff recruited since her involvement had undergone a though recruitment process including all pre employment checks however she was aware that some staff employed prior to this had not had two references taken up or all other checks prior to employment. The inspector therefore did not Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 27 return to the service when the manager would be present to view the recruitment records as it had been stated that these were not complete and would be addressed in the near future. This requirement will therefore be re assessed during the next inspection. Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 28 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, 32, 33, 34, 37, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management arrangements at the home are now open and transparent and the management team are working hard to ensure that the home meets people’s needs. EVIDENCE: Since the inspection in January 2007 the home has had a change in its management team including the directors of the company. The provider contracted with a care home management consultant team who have undertaken a review of the service and are now providing management consultancy as part of the turnaround team. Since their appointment, Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 29 approximately six weeks prior to the inspectors visit, the turnaround team have met many of the previous requirements as identified in previous sections of this report. The home has also appointed a new manager who was visiting the home for an induction/orientation day on the day of the unannounced inspection visit. The new manager informed inspectors that she has previously been managing a larger nursing home elsewhere in the county and has the necessary skills and experience to manager the service. Discussions with the new manager indicated that she had a good level of understanding of the issues facing the service and how these could be resolved. The new manager stated that she will be applying to the commission for registration and had commenced this process with the CRB and medical forms. Nursing and care staff were positive about the changes that have recently occurred at the home. Staff stated that there are now kept informed of changes and what is happening. They are able to discuss any issues with the turnaround manager and that there are regular staff meetings. The inspectors and visiting professionals stated that they felt that the atmosphere in the home was positive, warm, friendly and welcoming. In September 2006 and again in January 2007 it was identified that the home was not open and transparent in its management. The home was required to ensure that the commission was kept informed of incidents affecting service users. Since the above-mentioned management changes the home are now informing the commission of incidents that require notification. The inspectors viewed the accident book. In January 2007 a number if accidents and incidents were noted in the accident book and care records which should have been notified to the commission and social services but no notifications had been received. On this occasion the inspectors found no evidence that notifiable incidents were not being reported. The new management are keeping the commission informed of changes within the home as evidenced by their supplying the commission with a copy of the occupational therapist report. The home was previously required to ensure that all staff, including the manager had written job descriptions. Discussions with the newly appointed manager and turnaround manager indicated that new job descriptions would be written in the near future. The new manager stated that she had raised issues about her job description with the turnaround manager and been informed that this was an old document and that it was to be revised. The home is now undertaking relative and service user meetings and arranging for people placed by social services to be reviewed. Minutes of staff meetings were seen and dates for the next relatives and service users meetings were seen for the 17th and 24th May respectively. Dates for service user review meetings were seen in the nurse’s office diary and the inspector spoke with one care manager who had recently completed a review for two people. The social worker was positive about the home. Care staff confirmed that they have staff meetings and are kept informed and involved in the changes and Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 30 decisions occurring at the home. As stated the home has commissioned an occupational therapy assessment of the service and is now addressing the issues in the report. Regulation 26 visits (monthly unannounced inspections undertaken by a suitable person on behalf of the homes owner) are now being undertaken and the reports of two such visits were seen during the inspector’s visits. The home is therefore considered to be addressing quality assurance issues and the outcomes of these will be assessed in future inspections. The turnaround team manager informed the inspectors that the home is no longer holding money on behalf of the people who live at the home. Letters were seen within people’s files informing relatives that the home will now include additional services (hairdressing, chiropody etc) as itemised additions to invoices. Some letters also requested permission from relatives for the home to purchase suitable footwear for people whose current foot wear was posing a risk of trips or falls to the person. As this process is not yet in operation no invoices could be seen and these will be seen during the next visit. Care staff and the turnaround manager stated that staff meetings are occurring but at the present time formal supervision (one to one recorded supervisions) are not yet occurring. The plan is that formal supervision will be organised as a cascade system with the manger supervising the qualified nurses and then the qualified nurses supervising an identified team of care staff. The turnaround team manager has commenced work with the qualified nurses as part of this process. A requirement is not made in respect of supervision as this process has already been identified and work initiated to meet this standard. This will be assessed at the next inspection. The home was previously required to ensure that all records were fully maintained and stored appropriately to protect confidentiality. A number of records were viewed during this visit including Medication administration records, care plans, risk assessments, accident book, files for people living at the home, meeting minutes and diaries. As identified previously the home is in the process of renewing care plans and these were seen not to have individual risk assessments. People’s files did not have up to date contracts and the service users guide and statement of purpose has yet to be rewritten. Other records were seen to be generally well maintained and stored appropriately. Previous reports have identified many concerns in respect of the health, safety and welfare of staff and people living at the home. Many of these issues have or are being addressed by the new management of the home. The inspectors main concern on this visit was the inappropriate manual handling procedures seen in use despite staff having the necessary equipment and having received training. The home must ensure that staff practises are continuously monitored to ensure appropriate procedures are used at all times. Issues re staff training Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 31 have already been identified and a training audit and plan is to be undertaken by the management. This should then ensure that all staff have the necessary training to meet peoples needs. Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 1 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 2 2 2 2 2 2 2 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 2 2 2 Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 Requirement A Service User Guide must be made available for all potential service users and/or their relatives. A copy of this document must be submitted to the CSCI within the stated timescales. Outstanding: An initial timescale of 30/6/05 was not met, a further timescale of 15/12/05 was not met, a revised timescale of 15/07/06 was not met, the timescale following the September visit was for compliance to be achieved by 10/12/06. The Statement of Purpose must be reviewed to ensure it contains up to date and accurate information. Outstanding: An initial timescale of Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 34 Timescale for action 01/09/07 2. OP1 4 01/09/07 3. OP2 5 31/07/06 was not met the timescale following the September visit was for compliance to be achieved by 10/12/06. The home must provide each service user or their relative/representative with a statement specifying the terms and conditions of residency including information about fees payable. Outstanding: This requirement was also made in September 2006 and a compliance date of 10/12/07 has not been met Individualised risk assessments must be undertaken for people living at the home including use of bed rails and moving and handling equipment to negotiate steps within the home. The home must ensure that only appropriate moving and handling techniques are used. The heated food trolley must be cleaned following each meal. All staff must be clear as to the actions they should take should they suspect that abuse is or has occurred. The main ground floor bathroom Mobray toilet seat and surround must be replaced. The home must inform the commission of plans to replace the linoleum floor. The ground floor bath hoist seat must be kept clean at all times. An audit of all staff recruitment files must be undertaken and where the necessary information and evidence of pre-employment DS0000011470.V337581.R01.S.doc 01/09/07 4. OP8 4 01/06/07 5. 6. 7. OP8 OP15 OP18 13 (5) 13 (3) 13 (6) 01/06/07 01/06/07 01/06/07 8. OP21 23 (2)(b) 01/06/07 9. OP29 19 01/08/07 Aquarius Nursing and Residential Care Home Version 5.2 Page 35 10 OP30 18 (1)(a) checks as specified in regulation 19 is not present this must rectified. The home must undertake an audit of staff training and identify training required by individual and the staff group to ensure that peoples needs are fully met. 01/08/07 11. OP38 13 The home must consider how it will ensure that a minimum of fifty per cent of care staff have at least an NVQ level 2 in care. You are required to ensure safe 01/06/07 working practices with regards to moving and handling of the service users. Trained nurses must undertake the appropriate use of equipment following a risk assessment. Outstanding: This requirement was not met by the timescale of 30/06/06 and was raised again at the 12th September 2006 inspection with a new timescale of 15/10/06 established. This was not met and new timescale of 25/02/07 was made. A further new timescale of 01/06/07 has been made. The home must review all job 01/08/07 descriptions and provide all staff with a copy. A similar requirement was made in September 2006 and repeated in January 2007. 12. OP31 9 and 12. Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 36 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Aquarius Nursing and Residential Care Home DS0000011470.V337581.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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