Inspection on 07/05/08 for Aquarius Nursing and Residential Care Home

This inspection was carried out on 7th May 2008.

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

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

Other inspections for this house

Aquarius Nursing and Residential... 10/03/09

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

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

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Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Aquarius Nursing and Residential Care Home 4 Spencer Road Southsea Hampshire PO4 9RN Lead Inspector Anita Tengnah & Mark Sims Unannounced Inspection 7th May 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.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.V363530.R02.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 Position Vacant 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.V363530.R02.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. 23rd April 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 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-£870 per week. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience Poor quality outcomes An unannounced visit to the service was undertaken as part of the inspection on the 18th April 2008. Two inspectors carried out this visit. The process included a tour of the service where a number of the bedrooms, communal areas, kitchen, and bathrooms were viewed. As part of case tracking 6 staff and 7 service users and a visitor’s views were sought and care records were looked at. Information gained from the Annual Quality Assurance Assessment (AQAA) was also used and included in this report, as was information gathered by the commission since the last inspection to contribute in assessing judgements in this report. We also sent out service users surveys to people using the service and staff. We gave feedback to the person representing the organisation at the time of the visit. We have received 11 completed residents’ surveys and 10 from the staff we surveyed. The home does not currently have a registered manager in post, the acting manager has been in post since May 2007 and has as yet to register with the Commission. What the service does well: What has improved since the last inspection? A number of the bedrooms have been refurbished including the communal bathroom on the ground floor. A statement of purpose has been put in place following the last visit, however this does not contain all the information required and further development is needed. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 6 An occupational therapist assessment of the environment has been completed and has highlighted many areas for improvement. The ground floor bathroom has been refurbished to include assisted bath, shower facility and ceiling hoist. Some of the residents’ bedrooms had been refurbished. What they could do better: Following this visit there are a number of additional requirements that have been made and some that the service has failed to meet by the set timescales. The statement of purpose must give accurate details in order that prospective service users can make an informed choice when choosing to use the service. Although there has been an improvement in care planning, further attention to details is required to ensure the care plans identify all the care needs of the residents and the actions required by staff to meet those needs. Detailed records of care given must be maintained to demonstrate how the assessed needs of people are being met. Any identified risk such as falls and nutritional risks must be followed by a care plan to demonstrate how these risks will be managed and inform staff practices. Records and evidence of how choices are offered to people must be clear and detailed to promote autonomy and choices. Staff were not adhering to the safe procedures for dealing with medicines. Medication including creams and ointments must only be used for the named person. A record of all medication received into the service for a service user must be maintained. Variable dosages must be recorded when dealing with medication. A review of access to healthcare and record of visits to external services such as dental, ophthalmic, auditory care must be maintained. This must include any follow up that has been arranged. The registered person must be able to demonstrate how people with dementia are supported through an assessment and care planning to meet their identified needs. The records of all allegations of abuse and any actions taken following investigations from adult services must be in place. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 7 Inappropriate manual handling transfers were observed during the visit. Staff must be instructed in the safe handling of people. Training in moving and handling must be completed by all staff prior to working with people. Infection control procedures must be looked into and action taken to protect people from the risk of cross infection in communal toilets with no hand washing facilities. All the necessary checks must be completed for all staff prior to employment in order to ensure that people are safeguarded. Records of these must be maintained at the service. All new staff must complete an induction-training programme that meets with the skills for care guidance. The home must 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 manager must submit a valid application to register with the Commission. It is an offence to manage a registered service without registration from the commission. The registered person must inform the commission, with timescales, of the planned programme to fit appropriate locks to the service users’ bedrooms 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.V363530.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 1,3,6 Some information was available, however the statement of purpose did not, in part, contain accurate information for people to be able to make an informed choice. There is a pre assessment process in place. Evidence of service users/ others involved in the pre assessment process was lacking. The service does not provide intermediate care. EVIDENCE: The last visit report showed that the statement of purpose needed developing to give information to the prospective and current people using the service. Requirements have been made about this since 2006. A copy of the document was sent to us and this showed that there was some information available such Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 10 as evidence of a standard form of contract and summary of the complaints procedure. The statement of purpose contained inaccuracies such as the home has a registered manager; the manager has not as yet applied to register with the commission as required. With regards to National Vocational training for care staff, it stated “over 50 of our care staff will be trained to these levels at any one time.” Information that we have received from the AQAA showed that only 6 of the 19 permanent care staff had completed this training. This document must be updated to ensure that all information is accurate and current to enable people planning to use the service to make an informed choice. It also stated that routines and activities are planned around individual needs and preferences ensuring that choices are made which fit our residents’ abilities, values, habits and previous roles. There was little evidence of this in the care plans seen. The care plans of six service users were looked at as part of this visit. We found that there was a pre- admission assessment for one of the new residents who had been admitted. The pre assessment document contained information including continence, psychological, history of falls, personal care and mobility. The assessment was not dated and it was not possible to evidence when this was completed. Staff stated that information from the pre assessments are used to formulate the care plans. There was no evidence that the residents/ relatives or carers were involved in the pre assessment process to ensure that all the care needs are identified. This was discussed with the staff at the time of the visit. The registered person must supply the residents with written confirmation that following assessment the home is suitable to meet their health and personal care needs. Staff reported that prospective people are offered the choice if visiting the home. Comments received included “ We had a good look around and liked it”. The nurse in charge confirmed that the service did not provide intermediate care. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 7,8,9,10 There is a lack of clear guidance in care plans and inadequate assessments to promote and protect people’s welfare and safety. The access to external healthcare provision is satisfactory. However people’s healthcare needs are not satisfactorily met. The medication management is poor and puts people at risk. The privacy and dignity of people using the service is mainly protected. EVIDENCE: We looked at six records of people receiving care at the home. Care plans were formulated and there was basic information about the needs of people. The records contained some risk assessments and charts for moving and handling, however the information was not clear, as it did not tell the staff how the risks were to be managed in practice. Information available to staff for moving and Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 12 handling stated one carer, or one carer and chairlift. It did not state how the person was to be moved, or any specific equipment to be used. Records had information about the pressure risks assessments such as Waterlow score. One resident who was at high risk and nursed in bed, the care plan recorded three hourly turns for pressure relief care and to use slide sheet to turn. Equipment was available for the relief and prevention of pressure ulcers. However these were not consistent for all those assessed as high risk of pressure ulcers and there were no care plans in place to demonstrate how these risks would be managed. Care plans contained details of care given such as washed and dressed. The staff reported that the registered nurses wrote the care plans of care provided by the carers. There were inadequate details in the care plans to show what the residents could do and what type of assistance they required to meet their personal care needs. As discussed the care plans did not show the support that people needed in order to meet their needs. Some of the comments we received were that “care is more person centred and we discuss all aspects of care with the service users and their families”. There was very little evidence of this in the care records seen. Staff said that they have enough information to deliver care. Other comments were “ The clients here mostly do not get washed unless it is one of the good staff.” Similarly people’s care records seen identified them as high and moderate risks of falls. One of the residents record showed that they were at high risk of falls on the stairs, however no care plan was available to show how this risk will be managed. Risk assessments for the use of bed rails were in place, and one of them included fitting of covers to the bed rails. There was no evidence of consultation or consent from the residents/ advocates for the use of bed rails. The last inspection record of April 07 showed that the home had introduced a key worker system and this had improved the care delivery. Information we have received from the AQAA indicated that there had been difficulty in continuing this system and it will be re introduced. Staff spoken with were not aware of the key worker system but one staff stated that this was something that had been discussed. The care records did not include information about preferred daily routines for getting up and where people spend their time. Care was provided as task orientated rather than enabling and supporting people. The care plans for personal care were inadequate as it contained very little details as how people like to be supported. Risk assessments were generic such as bathing, using the bath hoist even when people were using the shower. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 13 The responsible individual discussed that the service had been working hard in introducing assessments, care planning, and personal profiles for all the service users and agreed that not all the necessary documentations were available at the time of the visit in order to inform staff practices. Staff reported that the assessments and related documentation had been destroyed. The care records contained assessments for nutrition and one contained a swallowing assessment following referral from the GP. The record showed that a dietetic assessment was requested and she recorded that the staff were not aware why the referral was made. Three of the care records seen showed that people were assessed as requiring fortified drinks and meals. People’s weights were being recorded. The weight record for one of the residents was recorded that the resident had lost 7 kg in weight from March 08- April 08. Following the inspection the responsible individual has submitted a document which states that this weightloss was 3kg. The care plan showed that the resident is dependent on others to feed. There was no action plan in place in the care plan looked at, to reflect how the nutritional needs of this person will be met. We observed the cooked meal served at lunchtime and the person did not eat any of it and no assistance was provided. Staff removed the cooked meal untouched and sandwiches were provided instead. Another person’s care plan showed that the person was on fortified milk. Staff stated that there were records of this, no record could be found including kitchen records that we looked at. Care records showed that people were on thick and easy. There was no guidance in all the three care plans seen regarding amount, frequency of the thickening agent to be added and this was not prescribed on the Medication Administration Record (MAR) sheet seen. Another resident record showed that they were allergic to Penicillin. However the updated care record that had been put in place stated that allergy as nil known. This was brought to a trained staff attention at the time and responded that they had forgotten to transfer this important information. The residents were registered with the local surgery and staff reported that they were supported. Records of GP visits were recorded in the records seen other records included optician and dentist visits. However this was not consistent for all the residents. One of the care records identified a resident as having loose broken teeth and referral to the dentist. Another recorded complaining of loose dentures. There were no action plan or records to show whether these problems as identified had been resolved and what action had been taken. A staff member reported that the son of one of these residents took them to the dentist two to three weeks ago but did not know the outcome of the visit and there was no record in their care plan seen. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 14 Of the six records seen three of them recorded that the residents had dementia and staff reported that the majority of the people accommodated had a varying degree of dementia. None of the records contained any information such as dementia care mapping/assessments. There was no evidence that the residents/ relatives/ advocates were involved in the care planning. This is particularly pertinent for those people with dementia who may not be able to participate in their plan of care. Although the care records identified that people were using pads to manage their incontinence this was not supported by assessments to ensure that this was managed appropriately. Information about frequency of pads changed, type of pads used was not available. Following the visit the responsible individual sent us a list of people who had pads delivered in May 08. As discussed care plans must be developed to demonstrate how this will be managed in practice. One of the care records seen showed that a person was sleeping in the lounge downstairs and staff had previously raised their concerns. The care record gave conflicting information about this person’s sleeping arrangements. Records showed that this person had two armchairs put together and slept in the lounge. This person was washed and dressed by 07:30 prior to other people using the lounge, while a member of staff reported to us that a recliner was available. We also observed that the resident had a mattress on the floor and no bed. The area of the home is accessed via a chairlift and it would not be possible to use a hoist if needed. Another resident’s risk assessment showed that if allowed to go out independently they would become a missing person due to “confusion and mental capacity”. There was no action plan to show what measures must be in place in order to support this person to go out and protect them. A sample of (MAR) sheets was looked at as part of this visit. These were satisfactory and contained records of medicines administered. The service was using a monitored dosage system at the time of the visit. A list for the use of homely remedies was available and signed by the GP as required. The home was maintaining a record of the medication received for the residents but this was not consistent, as some of these were not recorded. There were inadequate records for varying dosages when administered. This included the administration of a controlled medication when the prescription was changed to twice a day. Other concerns noted were that the inspector found that there was not a good audit trail audit of medication sampled and the amount recorded did not correlate with the number of tablets left for the residents. Controlled mediation was stored safely and recorded in the controlled drug register as required. A system was in place for the disposal of medication. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 15 We noted that a large quantity of prescribed creams and ointments were found in the residents’ rooms. They were not labelled appropriately with the residents’ names, others were prescribed for other people and found in other residents’ rooms. A sample of MAR sheets records showed that not all the creams ointments used were recorded and prescribed on the MAR sheets. As discussed these pose high infection control risks and must be rectified inn order to safeguard people. The registered person must ensure that prescribed medication are only used for the person for whom they are prescribed. We also found that creams/ointments that were stored in the basement room was unlocked and other staff had access to this area. The surveys received and people spoken with said that they were treated with respect. We observed two carers transferring a resident in the lounge. They ensured that a screen was available to promote her privacy. Staff were observed to interact in a friendly manner with the residents. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 16 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, 15, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are some activities available, however these did not meet the needs of all the people. Further development is needed to meeting social, emotional and recreational needs through more individualised assessment and planning. The visiting policy supports people to maintain contacts with their relatives. There are some choices available to people, however this was not consistent and must be further developed to meet people’s needs. The meals at the home were satisfactory and choices were offered. EVIDENCE: Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 17 The home has an activity coordinator who works three days a week. We observed that the residents were taken out to the sea front in their wheelchairs on the day of the visit. We looked at records of activities that were provided and recorded in their care records. These were basic and the only records available were activities such as hair washed, nail care, and reminiscence. These showed that activities occurred once to three times a month. Development in meeting the social care needs of people must be further developed to reflect how the people’s assessed needs are being met. The responsible individual stated that assessments such as past history and life profiles of the residents had been recently completed, however these could not be found at the time of the visit. As discussed profiles of their likes/dislikes and past interests/ hobbies should form part of meeting needs and care planning. This will help in accessing meaningful activities in meeting people’s social and cultural needs. Surveys showed that people said “usually” activities were provided and three commented that they liked the activities very much. A visiting entertainer was at the home on the afternoon of the visit and some of the residents appeared to enjoy the musical interlude. Staff reported that this organised activity such as this happened at a regular interval. A resident spoken with said that she preferred to stay in her room and spent all her time there and staff respected her choice. However observations of care practices and staff spoken with did not reflect how choices are offered with regards to activities of daily living. Care records seen did not indicate people’s preferences about the times they wish to get up or go to bed. Staff were unable to demonstrate how people’s choices were supported, particularly for those who were unable to articulate their wishes. One of the comments we received was that a person was unhappy as “was disturbed every night”. Staff reported that this person did not have capacity and the son had consented to the night checks. There was no assessment to show how the decision regarding the lack of capacity was made. The home operated an open visiting policy and evidence from the visitors’ record as maintained at the service supported this. People spoken with said that they could receive their visitors in private. The home has a support manager that was responsible for the meals at the service. We observed the lunchtime meal that offered choices and the meal provided was varied. Meals looked appetising and balanced, pureed / soft diets were served individually. Staff reported that the residents were asked about their choice of meals in the morning. Meals were taken in the communal dining room and a number of residents had their meals in the lounge. We observed staff were offering support to three people with their meals in the lounge. All the comments we received indicated that people liked the meals provided. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 18 The support manager offered the residents a choice of ice creams for the afternoon tea and a choice of cooked meal was offered at teatime. Staff reported that hot and cold drinks are available at all times. The support for people eating in the lounge should be reviewed and staff must ensure that the tables’ heights, positions are appropriate to enable them to eat comfortably. We observed two people struggling to access their meal. Comments from our surveys included “ I like the food”. “Everything seems to be all right to me.” “I never complain I like the food”. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 16,18 There is an adequate process in place for reporting and investigating complaints. Staff had knowledge of safeguarding and there was evidence of staff training in the prevention of abuse is lacking. EVIDENCE: The home has a complaint procedure and copies of the procedure were seen in a number of the residents’ rooms we visited. People spoken with said that they would tell the staff if they were unhappy. Comments from our surveys showed that people were aware of how to raise a concern. The home has a complaint log where the service had received four complaints since the last inspection. Records as maintained at the service showed that these had been responded to and resolved. The record also contained thank you letters and compliments from family of service users. The home has the Hampshire safeguarding procedure. We undertook a survey of staff awareness of the safeguarding procedure as part of this visit. This showed that staff were aware of what constituted abuse and were confident in raising any allegations/ poor practices to the person in charge. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 20 There have been three allegations of abuse at the service. These had been reported and dealt with by Social Services. We were able to track only one of these records at the service and this was discussed with the responsible individual at the time of the visit. We also received conflicting reports about the outcome of one of these safeguarding referrals from the acting manager, as we were advised that this had been completed. However the responsible individual confirmed that the home was still dealing with this particular allegation. The outcome of these investigations has not been determined at the time of writing this report. As part of safeguarding people a referral was made to Portsmouth Social services Department following our visit and information which we have received from our surveys, under our information sharing protocols. The responsible individual was pro active in dealing with any allegation of abuse including her responsibility to refer to the POVA list as appropriate. We were unable to assess how many staff had completed training in safeguarding due to the lack of training record. We noted that training was planned for this month as displayed in the office. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 21 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): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home continues with its programme of refurbishment and there had been some improvement to the service. Some of the infection control procedures in place do not fully protect people. EVIDENCE: The service has in place a renovation programme. Information we have received and observation from this visit showed that some of the bedrooms had been redecorated. The ground floor bathroom has been refurbished and fitted with assisted bath, shower facility and overhead track hoist. This was clean and in good state of repair. The service has well equipped communal lounges and dining areas for the use of people accommodated. The Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 22 patio/garden to the back of the home was well maintained, secure and seating was provided. We walked round the service and looked at a number of the bedrooms. Some of these were personalised and it was evident that the residents were encouraged to bring in items of personal belongings. Call bells’ points were available including double points in the shared bedrooms. Screens were available in the shared bedrooms as required to ensure privacy. We noted that some of the residents were left without access to the call bells when they sat out as these were either too far and could not be reached or left by the bed away from where they sat. Other bedrooms were crowded, untidy and disorganised with access to some en suite facilities blocked. Commodes and chairs were left so as they restricted access for the residents in particular in the shared rooms. The residents were supplied with small washing bowls, we noted none of these were labelled in the shared rooms we visited. We found toiletries in one of the communal bathrooms including prescribed creams that could be used for others. The creams/ointments and the toiletries in the shared rooms did not contain the person’s names. All of these pose a high infection control risks and must be managed to safeguard people’s health. The bedrooms to the residents’ bedrooms did not have appropriate locks fitted and the sliding doors in two of the communal toilets seen did not provide adequate privacy. The issue about appropriate locks was raised at the last inspection and the registered person must ensure that locks are appropriate for the residents needs and accessible to staff from the outside to prevent entrapment. The senior person in charge confirmed that locks for all the service users’ bedrooms had been purchased and a programme to fit these will commence soon. We also found that none of the rooms we visited were fitted with carpets as they all had linoleum flooring. There was no record that the residents were given a choice to the type of flooring in their bedrooms and this does not promote autonomy and choice. The issue of blinds fitted to the outside of bedrooms’ doors was brought to the attention of the senior person in charge. They were not fitted to the inside, so that they could be used for privacy. We were assured that this will be dealt with and immediate action will ensue. We noted that staff were using a portable ramp for access to the dining room and to the garden from the communal lounge. The last inspection report in April 07 and the occupational therapist report identified that people with mobility needs should not be accommodated in rooms that can only be Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 23 accessed via three steps. The home has put in place a portable lifting device to enable people with limited mobility to access this area. The last report in April 07 indicated that the occupational therapist recommended that lever taps be fitted in all bathrooms for ease of use by people living at the home. This has not been put in place. We also noted that the hoist on the ground floor required a thorough cleaning and the rusty parts made good as they pose infection control risk and cannot be adequately cleaned. We noted that the ground floor bathroom that also included a large area and access for disabled toilet facility was locked. Staff spoken to stated that this is kept locked as three to four residents go in and turn on the taps. This was discussed with the senior person in charge who was not aware of this and said she will be looking into it. We noted that two of the communal toilets seen did not contain any hand washing facilities. Action is required to stop the spread of infection and safeguard the residents. Comments we have received included: “Significant improvement has taken place in the past year in the environment”. “More bathrooms needed that are suitable for disabled clients”. The home has a laundry where all the residents clothing and laundry is undertaken internally. The laundry was equipped with two industrial size washers and two driers. There was a wash hand basin available in the laundry. Dirty clothing was kept in large bins outside the laundry. The laundry floor had carpet fitted and not impermeable and easily cleaned. Staff stated that the carpet was fitted to stop the laundry assistant having chill blains. Infection control measures for cleaning the flooring in the laundry must be put in place. The laundry staff reported that all the residents’ laundry was marked with their names to prevent them getting lost. However we noted that there were two containers of clothing that could not be returned to the residents, as these were not labelled. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 24 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): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staffing was adequate to meet the present needs of people accommodated. There is a lack of evidence to show that staff have the skills to deliver care safely. The recruitment process was inadequate and did not include all necessary staff checks to safeguard people using the service. There was a lack of training record to demonstrate that staff had the skills to deliver care safely. EVIDENCE: The home has a duty roster for the nurses and carers and a separate roster for the ancillary staff. There were 2 trained nurses and 7 carers on the day shifts at the time of the visit. The staffing was split between the two floors. The nurse in charge reported that there is a trained staff and a senior carer on each floor. The home had a list in the main office detailing staff allocation and tasks for the day. The staff spoken with said that staffing was adequate Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 25 although “ we have busy times as most of the residents need help”. Other comment was “ there is an activity lady three days a week and we have to manage other times”. Comments from the surveys were that usually there are enough staff. Comments include “Since the new management has been in place, there has been increased staffing and training given”. Two surveys said usually and one said not enough staff. Another comment was “ Sometimes because of sickness and annual leave we are short, but agencies are called to help”. Information from the AQAA indicated that of the 19 permanent carers 6 had achieved national Vocational Qualification (NVQ) 2 or above and 4 were working towards the qualification. We looked at three newly recruited staff records and there was no evidence of an induction when they started work. Comments from our surveys were mixed where some staff said induction was available and others said no. We also looked at the recruitment files of four newly recruited staff. Applications forms were completed and references were sought. Three of the staff records showed that they had all been employed prior to POVA first checks and CRB clearances. Another staff member had started the week of the unannounced visit. The file could not be located and the responsible person stated that she was not aware that this person had been employed. The file was later found and again there was no evidence of the necessary checks being completed prior to starting work. This recruitment process pose risks to people living at the home as it does not ensure the fitness of people employed. We received notification on the following day to say that the person had stopped working at the service until all checks have been completed. Staff records contained the visas/eligibility to work in this country except for one of them who was a dependent and whose visa had expired in April 08. This was brought to the attention of the responsible individual and must be addressed. Comments from staff included: “All the staff are checked before starting work” “Started work prior to CRB checks in place, but they have been done since”. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 26 We spoke to staff who stated that there is a training programme and there was a list displayed in the ground floor office for the planned training in May 08. These included abuse awareness, food hygiene and dysphagia and feeding planned for June 08. We have received a copy of the training record and as staff stated the record for training was poor. These are of concern as the record showed that people are working at the home prior to completing moving and handling training which is to the detriment of the residents. We were unable to assess what training staff had completed as the person in charge reported that the training record was not up to date. This issue was highlighted in the last report issued to the home. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 31,33,35,38 There is no registered manager. There is a lack of consistency in the delivery of care. The disquiet among staff must be addressed and clear lines of accountability put in place. There is a satisfactory internal audit in place that seek the views of people using the service. People are put at risk through inadequate training and poor staff practices. EVIDENCE: Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 28 The home does not have a registered manager although a manager has been at the service since May 2007. This was discussed with the person in charge and action is required to ensure that a valid application is submitted to the commission. The acting manager has not yet completed the Registered Manager’s Award and we have been told that she will be restarting this soon. Surveys from the staff indicated that they felt supported while others said that there was no consistency in her approach when dealing with staff. Comments included: “Manager is very supportive”. “I can say that the manager is in contact with the staff almost daily. She will make time to talk to the staff”. “The home is better run now than two years ago, the service users certainly have benefited”. “Stop employing people without NVQ and promoting them”. “The manager gossiping about staff”. “Get a new manager and better pay”. “Treat all staff the same not treating the manager’s friends like God and letting them get away with things”. “Poor management”. “Basic care due to poor management, workload” “Support only from experienced shift staff” The home has an internal audit that included staff and relatives meetings and minutes of these are maintained. The responsible individual was involved in the auditing of care and undertook Regulation 26 visits as required. There were 11service users’ surveys that dated back to April 07. There were positive remarks regarding cleanliness, food, staffing and staff politeness. Area of improvement identified was for the clients to wear their own clothing. The home’s administrator was in charge of invoicing and a sample of records seen showed that the residents were supplied with contracts that included the terms and condition of residency. This was a requirement from the last visit that has been met. We did not look into the service users’ finances during this visit. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 29 The last inspection reports highlighted concerns regarding the moving and handling practices at the service. Repeated requirements were made for staff to use proper equipments and practices when manually handling people at the service. We observed staff practices that were inappropriate when a service user was manhandled when being assisted at lunchtime. One staff member held on to the service user’s trousers in order to stand and transfer the person. Staff were observed to manoeuvre trolleys and hoists without the use of ramps. These practices pose risks to the staff and the residents and must be rectified to ensure that care is provided safely. The lack of training for staff in moving and handling put the residents at risks. The registered person must ensure that mandatory training in health and safety are in place for all staff. As previously reported the management of ointments and personal toiletries pose high infection control risks to people. Substances that are hazardous to health COSHH were not maintained safely at the time of the visit. An immediate requirement was issued at the time. Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 30 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X X X X 1 Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 31 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 4 (1) Requirement The review of the Statement of Purpose must be completed to ensure it contains up to date and accurate information. This must include management and staff details. The registered person must develop a plan of care and demonstrate how the personal care needs and the risks identified such as falls will be managed in order to safeguard the residents. The service users care plans must contain detailed assessments and care plans to show how the specific care needs and choices of people will be met. The registered person is required to put in place detailed care plans following nutritional screening, showing how the service users’ assessed dietary needs will be met. Records of these must be maintained The registered person must ensure that the residents are DS0000011470.V363530.R02.S.doc Timescale for action 30/06/08 2 OP7 13(4) (c) 30/06/08 3 OP7 15(1) 30/06/08 4 OP8 12(1)(a), 14(1) Schedule 3(o) 30/06/08 5 OP8 12(1) 13 (1) 30/06/08 Aquarius Nursing and Residential Care Home Version 5.2 Page 32 6 7 OP8 OP9 13(1) (b) 17(1) (a) supported in accessing healthcare facilities in the community as required. The registered person must follow assessment/ advice for the promotion of continence. The registered person must ensure that arrangements are in place for the safe- keeping, safe handling, administration and management of all medicines in the care home. Prescribed medication must only be administered to the named service user. Immediate Requirement issued. Individualised risk assessments must be undertaken for people living at the home including use of moving and handling equipment to negotiate steps within the home. Timescale of 01/06/07 has not been met. The registered person must ensure that records of all allegations of abuse are maintained at the service. The registered person must ensure that all necessary checks including CRB and POVA first checks are completed for all staff prior to employment. Records of these must be available at the service. Immediate requirement issued. An audit of all staff recruitment files must be undertaken and where the necessary information and evidence of pre-employment checks as specified in regulation 19 is not present this must be rectified. This is an outstanding DS0000011470.V363530.R02.S.doc 30/06/08 07/05/08 8 OP8 13(4) 30/06/08 9 OP18 13 (6) 30/06/08 10 OP29 19(1) 07/05/08 11 OP29 19 30/06/08 Aquarius Nursing and Residential Care Home Version 5.2 Page 33 requirement from 01/08/07 that has not been met. 12 OP30 18 (1)(a) The home must ensure that all 30/06/08 staff are equipped with the skills, qualifications and experience to meet people’s needs. The person in charge of the 30/06/08 home must submit a valid manager’s application for registration. You are required to ensure safe 30/06/08 working practices with regards to moving and handling of the service users. Staff must complete mandatory training in moving and handling and all staff must adhere to safe practices to protect people using the service. 13 OP31 8 and 9 14 OP38 13(4) (C) 13(5) 15 OP38 This Requirement was previously made with the previous timescales of 30/06/06, 15/10/06, 25/02/07,01/06/07 that has not been met. 13 (4) (c ) The registered person must ensure that all substances that re hazardous to health and maintained securely at all times. Immediate Requirement issued. 07/05/08 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.V363530.R02.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Aquarius Nursing and Residential Care Home DS0000011470.V363530.R02.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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