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Inspection on 07/11/05 for The Regency Nursing Home

Also see our care home review for The Regency Nursing Home for more information

This inspection was carried out on 7th November 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 upkeep of the premises appears to be a priority for the proprietors, who have been noted, at both inspections this year, to be investing money in the refurbishment of the property. At this visit it was evident that work was ongoing both internally and externally, with a new shower facility being created internally and improved access to the building underway externally. The manager and her staff team appear to develop good relationships with service users and their visitors, as evidenced by the comments of several people during the inspection. People describing how they are always made to feel welcome upon arrival to the home, how they are offered a drink and how they are kept informed of issues affecting their relative`s (if immediate next of kin) wellbeing, etc. The visitors spoken to also confirmed that the decision to come into The Regency had been a positive choice made by the service user (in association with key family) and following visits to both The Regency and other homes within the same locality.

What has improved since the last inspection?

The proprietors have made arrangements for the access to the premises to be improved, the steps to the front of property having been / or being extended so that the steps are wider and more gradual. In an ideal world this area would have been ramped, although it is unlikely that sufficient space was available to achieve this, therefore by enlarging each step to accommodate either a wheelchair or person using a frame, the proprietors have created a far safer point of entry or exit from the home than previously existed. The installation of a new shower facility for service users was also nearing completion during the inspection, this amenity offering both an alternative to the bath for service users who prefer showers and a more accessible facility for those individuals with mobility concerns.

CARE HOMES FOR OLDER PEOPLE The Regency Nursing & Residential Care Home St Helens Parade Southsea Portsmouth Hampshire PO4 OQJ Lead Inspector Mark Sims Unannounced Inspection 7th November 2005 12:30 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 The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 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. The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Regency Nursing & Residential Care Home Address St Helens Parade Southsea Portsmouth Hampshire PO4 OQJ (023) 92 820722 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) Mr Michael Raven Mrs Julia Christina Raven Mrs Hazel Adeoye Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26), Terminally ill over 65 years of age (26) of places The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing levels apply No more than 2 beds may be used at anyone time for service users who are in need of personal care 4th May 2005 Date of last inspection Brief Description of the Service: The Regency Nursing Home is currently registered to accommodate 26 service users under the registration categories of Older Persons (OP) and Terminal Illness (TI), both categories registered in respect of 26 places. The Regency is situated along St Helens Parade, Southsea and is a short walk from the attractions of Southsea front and pier, although the amenities of the town are less readily accessible. Transportation links in and around the nursing home are good with several local providers operating buses nearby and taxis can be accessed along the front. The property is a period town house, which has been adapted to accommodate patients, offering a passenger lift to all floors and ramped access where required. The bedrooms are a mix of single and shared accommodation and communal facilities include a dining room, lounge and sun lounge. The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was undertaken unannounced and formed the second statutory inspection of the year for The Regency Nursing Home. The inspection focused on those core standards not addressed at the 4th May 2005 inspection and various sources of evidence were considered in the formulation of judgements, records, observations and discussions with service users and staff/management. What the service does well: What has improved since the last inspection? The proprietors have made arrangements for the access to the premises to be improved, the steps to the front of property having been / or being extended so that the steps are wider and more gradual. In an ideal world this area would have been ramped, although it is unlikely that sufficient space was available to achieve this, therefore by enlarging each step to accommodate either a wheelchair or person using a frame, the proprietors The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 6 have created a far safer point of entry or exit from the home than previously existed. The installation of a new shower facility for service users was also nearing completion during the inspection, this amenity offering both an alternative to the bath for service users who prefer showers and a more accessible facility for those individuals with mobility concerns. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 7 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 The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 The manager is appropriately carrying out pre-admission assessments for all prospective service users. EVIDENCE: The pre-admission process for the home is well structured and established, with all contacts made with the home documented on a contact sheet, appointments for all pre-admission visits agreed with the prospective service user and all assessments signed and dated by the assessing staff member. On the day of the inspection two pre-admission assessments were reviewed, where it is possible for the inspector to trace the process including the dates of contact, the dates of appointment for assessment and the confirmation that the assessment was completed on the signed and dated form. It was also evident that this process is used in the decision-making about the suitability of a placement and that the information is transferred onto the initial care-plans and early risk assessment documents. The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 9 What was also pleasing during the inspection was the verification from visitors that the choice of coming to The Regency had been an informed choice and that the service user or representative (if applicable) had visited the home, met with key staff and toured the premises before committing to admission. Several people spoken with confirming that The Regency had been one of a number of homes visited within the same locality and that its services and facilities far better suited their relative’s needs than many other similar establishments. The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 8 The health and social care needs of service users are appropriately met and documented. EVIDENCE: As part of the pre-admission assessment process or post admission period each service user will have their health screened and appropriate records generated. These records document information relating to the individual’s past medical history, involvement with allied health professionals and details of various current health care needs, i.e. wound care – (skin integrity and previous injuries) and moving and handling assessments, etc. The pre-admission or admission information sheets also record details of the person’s current medical practitioner and associated surgery, this information is also transferred to a board within the nursing office for rapid access. Running records are used to document any and all contacts with general practitioners or allied professionals, these records used to measure a person’s The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 11 condition, record treatment plans and assess and review the effects of current treatments. The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 14 Where possible service users are encouraged to exercise their rights to selfdetermination and choice, the risk assessment process key to this process. EVIDENCE: The home appears to have a philosophy or ethos that encourages people to exercise their right to choice and self-determination, areas such as rising and retiring, choice of meal, whether to participate in activities provided or over the control of financial affairs, etc., demonstrating the home’s approach. Where some of these issues require the home to consider any potential harm or risk to the service user, the home uses its risk assessment process to minimise the potential for harm, although the number of potentially harmful activities accessible to the client group are limited by the boundaries of their physical and mental health. However, on making this statement it is important to reflect upon those occasions when homes are required to take steps or actions that may appear to challenge the convention of freedom and the right to self –determination. At those times it is important that the home’s recording practices be as accurate and clear as can be, as the records maintained are the proof of the decision-making process contemplated by the home. The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 13 An example of this process in action was identified during the inspection, where the home has used its risk assessment process in reaching a decision over the secreting of a liquid medication in drink for an individual, as it believed this person’s health would be affected, to their detriment, without the medication. This process has involved several key players; general practitioner, family members, consultant geriatrician and the senior nursing staff of the home, the person being unable to give an opinion of their own. The only issue noted to be outstanding with regards to the process is the fact neither the general practitioner nor consultant have, as yet, recorded their belief that this medication is essential for the client’s wellbeing, although the manager was confident this confirmation would be available shortly. The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 18 Copies of all relevant documents are available to staff and training needs addressed. EVIDENCE: The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 15 The home has provided an adult protection procedure that is fully compliant with the recommendations of the ‘National Minimum Standards’ and reflects the guidance provided via the ‘Local Authority Adult Protection Procedure’, which was created in accordance with ‘No Secrets’, a Department of Health document. The advice supplied to the staff is largely literature based, with the policies purchased from the ‘Nursing Homes Association’ (NHA) and the training pack being photocopies of a slide presentation from the local authority. The latter slide show appears fairly comprehensive and includes information relating to definitions of abuse, people’s roles in reporting and monitoring for signs of abuse and several case studies, which can be used as learning tools. The manager has tried on several occasions to access more practically based training, as evidenced by a letter from the local authority informing the home that the last ‘adult protection’ training event was over subscribed and that further dates would be available in the New Year. The home has also brought into play the ‘Whistle Blowing Policy’, created by the NHA, in accordance with the ‘Public Disclosure Act’, which along with the adult protection guidance is made available to staff within the nursing office. The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 21 & 24 The creation of a new shower facility should prove a positive addition for service users. Individual service users have personalised their bedrooms creating familiar and comfortable environments. EVIDENCE: The tour of the premises evidenced that the home is well maintained and that a good decorative standard is continued throughout. The home employs maintenance staff or sub-contractors who undertake routine repairs and remedial works, as well as tackling larger jobs, as evidenced by the current work ongoing to the front of the property and also the refurbishment / creation of a new shower facility. The latter project should on completion see the installation of a new shower facility for service users that offers both an alternative to the bath for those The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 17 service users who prefer showers and a more accessible facility for those individuals with mobility concerns or issues. The tour of the premises also enabled the inspector to view a handful of residents’ bedrooms, evidencing that where possible individuals had set out and furnished their bedroom in accordance with their personal preferences, reflecting the type of space the occupant felt familiar and comfortable within. People using small items such as pictures, paintings and ornaments and larger pieces of furniture, chairs, televisions and wardrobes from their own homes to generate the sense of ownership and belonging you would expect in someone’s own property. In conversation with the service users and visitors it was evident that they were happy with the accommodation and felt it generally met their needs, most people opting to retire to their bedrooms in the evening to watch their own televisions, etc. in peace. In conversation with visitors it was ascertained that they felt the home was extremely well maintained and that this had largely contributed to the decision for their relative/ friend to come into the home, in preference for other less well appointed local establishments. The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 29. The arrangements for recruiting new staff are robust and well managed. EVIDENCE: The proprietors have produced a robust recruitment and selection process that meets the requirements and recommendations of the Care Homes Regulations 2001 and National Minimum Standards. The files of two recently recruited staff were inspected to ensure the home’s selection process was being adhered to accordingly and that full employment details were gathered and verified prior to applicants being confirmed in post, including references, Criminal Records Bureau (CRB) checks and Protection Of Vulnerable Adult (POVA) checks. All files were found to be in order. In addition to the information listed above each file also contained a recent health declaration, job description, application form, information/contact sheet and supporting documentation used in the CRB checking process. The manager in discussion about recruitment and selection advised the inspector that advertisements are mainly placed in local papers and that all applicants are interviewed before appointment. She also confirmed that the home has a generally low turnover of staff and that new posts are created only when someone decides to leave or is dismissed. The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 33 & 35. The company is committed to ensuring the best interests of service users are promoted at all times. The home’s approach to supporting service users manage their finances is allowing people to go into debt. EVIDENCE: The proprietors have purchased a quality auditing system produced by the ‘Nursing Homes Association (NHA), which is used annually to benchmark the home’s performance against the ‘National Minimum Standards’, the auditing process last completed on 21 January 2005 and involving both proprietors, the manager and key staff. In addition to this largely paperwork based system, the proprietors also regularly look to canvass the opinions of both service users and visitors on the performance of the home and the service delivered. The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 20 The evidence from the questionnaires returned is that people generally have little by way of negative comments to make and praised the home for being ‘clean, tidy and well maintained’, for having a good activities programme and for the attitude of the staff. Where negative comments had been made, i.e. about the quality of the lighting within certain areas of the home, action had been taken to review and address the situation, details of the proposed action recorded on the Q.A. response questionnaire. The home is also ensuring that regular visits are being made to the home in accordance with Regulation 26 and that details of the visits are being documented and copies forwarded to the Commission for information. It is the policy of the home not to become involved in the management of service users’ monies, although where a person wishes to retain control of their own financial arrangements every effort to support them is given. As an alternative arrangement to holding monies for service users the home offer a tick system, whereby the home will purchase items for a service user or pay for services and then recoup the money at the end of the month by invoice. People may choose not to settle this account immediately, however the proprietors have established an upper limit of £100 beyond which a person’s debt is not allowed to exceed. Receipts for all purchases are obtained and made available to the families upon request and the account balance sheets maintained by the proprietors list all incomings and out goings on the tick system. The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 21 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X 3 X X 3 X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA National Enquiry Line: 0845 015 0120 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 The Regency Nursing & Residential Care Home DS0000011523.V267908.R01.S.doc Version 5.0 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!