Care Home: The Regency Nursing Home

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What the care home does well There are good systems to assess people`s needs before they move into the home. This helps to ensure that the home is able to meet people`s needs. Visitors are made welcome in the home and people enjoy the meals that are provided for them. People are provided with a clean and homely environment that they feel meets their needs. What has improved since the last inspection? The home now has good care planning, risk assessment and medicine management systems. This helps to ensure staff provide the right support to meet people`s health and personal care needs. People are now provided with support to take part in a range of activities they enjoy. The service now has good systems to respond to complaints and allegations of abuse. This helps to assure people that any complaints will be taken seriously and investigated. The home now has good staffing arrangements, with staff being thoroughly checked before starting work. This helps to keep people safe. What the care home could do better: The manager needs to take action to improve the availability of storage areas in the laundry room. This will ensure bags of soiled laundry can be securely stored whilst waiting to be washed. The manager needs to ensure staff receive regular formal supervision sessions. This will help to ensure staff feel supported and enable any issues with the way staff are working to be formally addressed. Key inspection report Care homes for older people Name: Address: The Regency Nursing Home St Helens Parade Southsea Portsmouth Hampshire PO4 0QJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Craig Willis     Date: 1 1 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 22 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 22 Information about the care home Name of care home: Address: The Regency Nursing Home St Helens Parade Southsea Portsmouth Hampshire PO4 0QJ (023)92820722 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): regencynursinghome@hotmail.com Mr Michael Raven,Mrs Julia Christina Raven Name of registered manager (if applicable) Mrs Hazel Adeoye Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 26. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home The Regency Nursing Home is currently registered to accommodate 26 service users under the registration categories of Older Persons requiring nursing and personal care. The service is situated along St Helens Parade, Southsea and is a short walk from the Care Homes for Older People Page 4 of 22 Over 65 26 0 0 1 1 2 2 0 0 8 Brief description of the care home attractions of Southsea front and pier. The property is a period town house, which has been adapted to accommodate the service users, 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. Information about the fees charged should be sought from the service. Care Homes for Older People Page 5 of 22 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The evidence used to write this report was gathered from a review of the information we have received since the last key inspection of the service and an unannounced inspection of the service on 11 May 2010. During the visit we looked at all of the shared areas of the home and a sample of bedrooms, spoke to people who live in the home and a visiting relative, spoke to staff on duty and the manager and inspected documents relating to the running of the home. Both of the registered providers were present during the visit. Care Homes for Older People Page 6 of 22 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 22 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 22 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good systems to assess peoples needs before they move into the home, which helps to ensure that the home is able to meet peoples needs Evidence: Following the last key inspection we found that there was good information in the needs assessments but it was not clear that assessments were always completed before people moved into the home as the assessments were not always dated. During this visit we looked at the needs assessment for one person who moved into the home since the last inspection. This person had a detailed assessment of their needs that was dated and had been completed in the week before they moved into the home. The information from this needs assessment was used to develop a set of care plans and risk management plans for the person. The service does not provide intermediate care, therefore outcomes for this standard have not been assessed. Care Homes for Older People Page 9 of 22 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home now has good care planning, risk assessment and medicine management systems. This helps to ensure staff provide the right support to meet peoples health and personal care needs. Evidence: Following the last key inspection we made requirements about the details in care plans and how often the plans are reviewed, ensuring that people have nutritional screening and access to specialist assessments where necessary, ensuring staff keep accurate records of what people eat and drink and ensuring that medication is safely managed. Following this visit we assessed that all of these requirements had been complied with. The manager reported that she had reviewed all of the care plans and supporting documentation since the last inspection. During the visit we looked at the records for five people who live in the home. Each person had a set of care plans that had been developed from their needs assessments. The plans had all been reviewed regularly, with most being reviewed each month. The plans we looked at gave clear information about how the persons assessed needs should be met. Staff spoken with said the Care Homes for Older People Page 10 of 22 Evidence: plans were useful and contained accurate information. Where people needed external professional assessments these were in place, for example speech and language therapy assessments. A nutritional screening tool had been used and where it was identified that people were at risk of malnutrition a plan of care was put in place. Records demonstrated that people were weighed regularly and action taken to refer people to the nutritionist and GP where a loss of weight was recorded. Where people were prescribed a thickening agent for fluids there were clear care plans setting out the consistency that liquids should be thickened to and the amount of the thickening agent to use. Staff were keeping records of peoples food and fluid intake, including fluid intake overnight that had been identified as a problem at the last inspection. People spoken with reported that the home met their needs and they received external health services as they need to. During the visit we looked at the way the home was managing medicines. Medicines were all stored in either a locked trolley, locked cabinet or a locked fridge. Medicines that had a limited shelf life once opened, for example insulin and eye drops, had been dated when opened and there was clear information about how long they could be kept before being destroyed. The home had obtained guidance from their pharmacist regarding refrigeration of medication and which medicines need to be kept in the fridge. This guidance was being followed. The home was keeping some controlled drugs. These are medicines that are sometimes misused and there are specific ways in which they must be stored and recorded. We found that these medicines were stored in an appropriate controlled drugs cupboard and recorded in a controlled drugs register. We checked the controlled drugs held for three people and found that the medicine recorded matched that held by the home. The manager reported that staff check the controlled drugs each day to ensure there have been no errors. We looked at the medication administration records for a sample of people who live in the home and found that they had been fully completed. This gave a record of the medicine that people had taken and the staff who had provided the support. The charts also gave a record of medicines received into the home and a balance of medicines remaining. We found that the balance was correct for the sample that we checked. The home also has a record of medicines that are removed from the home to be destroyed when they are no longer needed. Care Homes for Older People Page 11 of 22 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with support to take part in a range of activities they enjoy, although these are not always recorded effectively. Visitors are made welcome in the home and people enjoy the meals that are provided. Evidence: Following the last key inspection we made a requirement that the home must make arrangements for people to take part in social activities and leisure interests. Following this visit we found that the home had complied with this requirement. The manager reported that since the last inspection they had recruited a new activities co-ordinator, however, the person did not take up the post. The manager is now actively recruiting to the post again. During the visit we spoke to people who live in the home who reported that there were lots of activities taking place. Examples include group games, arts and crafts activities, music sessions and gardening. The care plans that we looked at contained details of peoples social and cultural needs and support that they need. Some of the people we spoke with reported that they dont like to take part in the large group activities but said they had opportunities for other activities such as knitting, reading, completing crosswords and socialising. Visitors are able to come to the home at any time and those we spoke with said they were made to feel welcome. The home has a planned menu, which is displayed in the lounge. The menu has one Care Homes for Older People Page 12 of 22 Evidence: main meal, but people spoken with confirmed they could have an alternative if they requested it. Details of peoples likes and dislikes, as well as medical and cultural diets were included in the care plans we saw and had been provided to kitchen staff. Care Homes for Older People Page 13 of 22 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service now has good systems to respond to allegations of abuse and complaints. This helps to assure people that any complaints will be taken seriously and investigated. Evidence: Following the last key inspection we made a requirement that all complaints and allegations of abuse must be followed up and recorded. We found that this requirement had been complied with. Since the last key inspection there have been two allegations of abuse in the home. These have been investigated by the local safeguarding team from adult services and the home has letters on file confirming that there was no evidence to substantiate the allegations. Records were available in the home of the actions taken by the provider and the findings of the investigations. Staff have completed training in keeping people safe from abuse and there was further refresher training booked for the week following our visit. Staff spoken with demonstrated a good understanding of different types of abuse and what action to take if abuse is reported, witnessed or suspected. The homes complaints procedure is displayed on a noticeboard in the hallway and provided to people when the move in. Care Homes for Older People Page 14 of 22 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a clean and homely environment that they feel meets their needs. Evidence: During the visit we looked at all of the shared areas of the home and a sample of the bedrooms. The home has a large lounge, a small dining room and conservatory. The dining room is not big enough to accommodate everyone who lives in the home and some people eat in the lounge and some in their rooms. All of the shared areas we saw were clean and people spoken with said this was always the case. People are encouraged to make their bedrooms homely and to bring in personal items. The home has a main laundry room on the ground floor, which is fitted with washing machines and driers. During the visit we noticed that a bag of soiled bedding was being stored in the the bathroom next to the laundry room. The bathroom was not being used at the time and staff reported that peoples whose bedrooms were near the bathroom were unlikely to remove the bag or its contents. The manager reported that this was due to not having sufficient space in the laundry room to store the bags whilst waiting for washing machines to become available, but that action would be taken to ensure space was made available. Chemicals used in the home were locked away when not in use. Care Homes for Older People Page 15 of 22 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home now has good staffing arrangements, with staff being thoroughly checked before starting work, sufficient staff at all times and good staff training. This helps to ensure that the staffing arrangements are suitable to meet peoples needs. Evidence: Following the last key inspection we made a requirement that staff must be thoroughly checked before working at the home and a record of the checks must be available. Following this visit we found that this requirement had been complied with. We inspected the records held for two members of staff employed since the last inspection. For both staff members the service had obtained a Criminal Records Bureau disclosure or confirmation that they were not barred from working in care homes, two written references and confirmation of their identity before they started work in the home. Records of all these checks were available in the home for inspection. During the visit we spoke with a sample of people who live in the home and a visiting relative. People said they thought there were sufficient staff on duty at all times. The relative spoken with reported that they could always find a nurse when they needed to. Staff spoken with during the visit also said they thought there were sufficient staff on each shift to meet peoples needs. In addition to the nursing and care staff there were kitchen, housekeeping and maintenance staff available. Care Homes for Older People Page 16 of 22 Evidence: The home has a training programme and the manager has a system of tracking the training that staff have completed to ensure the training programme is effective. Courses staff have completed include fire safety, moving and handling, health and safety, safeguarding people from abuse, dementia, infection control, first aid, medication administration, eating and drinking, care planning systems, Parkinsons disease, catheter care and tissue viability. Staff spoken with said they thought the training was useful and helped them to meet peoples needs. Care Homes for Older People Page 17 of 22 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered providers and manager have taken action to address all of the issues identified following the last inspection of the home. This progress now needs to be sustained and embedded in practice. Staff feel well supported, however, they do not receive regular formal supervision sessions. These are needed to ensure staff are supported and any issues with the way staff are working are addressed formally. Evidence: Following the last key inspection we made requirements that the registered person must ensure monthly visits are made to the service and a record made of the visit and that the home makes proper provision to promote the health and safety of people who live in the home. We found that both of these requirements had been complied with. We inspected the reports made by the registered person of visits to the home for the previous three months. The reports included assessments of the environment, catering, health and safety records, a review of any falls, maintenance issues, complaints and fire safety issues. Other health and safety issues highlighted in the last Care Homes for Older People Page 18 of 22 Evidence: inspection report have been addressed. The home has a registered manager who is a nurse and has completed the registered managers award. Both of the registered providers were present during the visit and reported that they are involved in the running of the service. Staff spoken with during the visit reported that they received formal supervision sessions from their manager approximately once a year. We looked at the supervision records for three staff members. One member of staff had a record of three supervision meetings since July 2008, one had a record of three supervision meetings since July 2007 and one had a record of three meetings, but only one was dated and happened in September 2009. The registered person reported that they had identified the need to provide additional staff supervision as part of their application for registration under the Health and Social Care Act 2008. The service had a set of workplace risk assessments that had been reviewed in April 2010. We looked at a sample of the servicing and maintenance records, which demonstrated that equipment was being maintained and checked as required. Care Homes for Older People Page 19 of 22 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 20 of 22 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 36 18 The registered person must ensure staff receive formal supervision sessions at least six times a year. This will help to support staff and ensure that any issues with their performance are raised formally. 30/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 21 of 22 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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