Inspection on 13/03/09 for Nightingale Lodge

This is the latest available inspection report for this service, carried out on 13th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nightingale Lodge 04/10/05

Nightingale Lodge 29/06/05

Nightingale Lodge 28/02/05

Nightingale Lodge 14/12/04

Nightingale Lodge 25/11/03

Similar services:

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Nightingale Lodge 6-8 Austin Street Hunstanton Norfolk PE36 6AL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Brenda Pears     Date: 1 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Nightingale Lodge 6-8 Austin Street Hunstanton Norfolk PE36 6AL 01485533590 P/F01485533590 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Black Swan International Limited Name of registered manager (if applicable) Mrs Sandra Rowe Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The total number of persons accommodated shall not exceed twenty-four (24). Two (2) named persons with dementia over 65 years of age may be accommodated. Up to twenty-two (22) Older People may be accommodated. Date of last inspection Brief description of the care home Nightingale Lodge is a registered home for 22 older people situated in the seaside resort of Hunstanton. It offers personal care, but not nursing care. It sits in a quiet road with access to the main shops within walking distance. There is a Methodist church next door and the sea front is at the end of the road. The house was originally two homes, which have been converted into one. The majority of bedrooms are on the first floor with access by a shaft lift. There are three double rooms and 16 single rooms all with toilets and hand wash basin facilities. On the ground floor there are two lounge Care Homes for Older People Page 4 of 26 care home 24 Over 65 2 22 0 0 Brief description of the care home areas and a dining room. Care Homes for Older People Page 5 of 26 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 quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced inspection undertaken on the 13th March 2009 and started at 10.00am. The focus of this inspection was on the previous requirements, on the core national minimum standards and on the quality of life for people who receive support in the home. The methods used to complete this inspection consisted of looking at the care a resident receives and the records that support this. Information has been provided to us by the home on an assessment form known as an Annual Quality Assurance Assessment (AQAA). During the visit to the home we spoke to the manager, with members of staff, with five residents and also with the provider. These methods Care Homes for Older People Page 6 of 26 and previous findings all inform the outcomes of this report. What the care home does well: What has improved since the last inspection? What they could do better: While a regular check is undertaken on any maintainance issues, checks should also indentify any areas that require upgrading in the home. For instance, we found more than one area of the home that required new carpet and one bathroom that needs upgrading. This bathroom is currently looking very old and tired and does not provide a good experience for those bathing in this room. The provider subsequently informed us that these areas have been identified on monthly audit checks, however, these areas currently remain in need of attention. Care Homes for Older People Page 8 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 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. A full assessment of the needs of any new client is completed to make sure individuals can be fully supported before an agreement is undertaken. Evidence: An assessment is undertaken before support is agreed and appropriate staffing levels are provided. One person who has recently moved into the home confirmed that information was provided and full discussions were carried out prior to agreements being completed. The pre admission assessments were also seen on care plans at this time. Care Homes for Older People Page 11 of 26 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 care plans contain clear information that enables staff to meet individual needs. Medication is handled and stored correctly for the safety and well being of those living in the home. Evidence: We looked at three care plans and these confirmed the information in the AQAA that stated that the care plans and risk assessments are regularly reviewed. The care plan format has detailed sections of information that shows both doctors and district nurses provide support and other healthcare services are accessed when necessary. People wishing to deal with their own medication are supported to do this safely following a full risk assessment. Full information was seen when we looked at daily records. These contained detailed information about how the person had spent their day. When the accident book was checked, we found these details on the daily record and on the medical sheet when a Care Homes for Older People Page 12 of 26 Evidence: health check had been necessary, showing that staff had clearly recorded all areas of this information. Care plans are orderly and well organised showing sections that include nutrition, likes and dislikes regarding food and life history contained clear information that informs staff of the person and their life prior to moving into the home. The storage of medication complies with guidelines for the safe handling of medication. Records of the administration of medication were clearly completed, up to date and medication was in date and stored in an orderly way. The manager said that regular audits are carried out to make sure medication is stored and handled correctly. We saw that the temperatures of the medication fridge are taken and recorded regularly. Care plans show that people are regularly weighed and this is recorded on care plans along with information about nutrition. Records also show that other health services such as chiropodist, local hospitals and GPs are used when necessary and reasons and outcomes are fully recorded on care plans. Records also show where staff have observed something that may require attention and the subsequent actions taken to address this matter. Care Homes for Older People Page 13 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are actively encouraged and supported to be in control of their own lives and access a variety of social situations. Evidence: Residents confirmed that they are able to go out when they choose and one person told us that they prefer to stay in their room and this is accepted by staff, although this person is kept fully informed of any outings. Trips undertaken last summer included a train ride along the front at Wells, a visit at Christmas to a local pantomime and one to one trips are regularly taken. Some people enjoy a trip out for tea and cakes, to the church or just a walk around the garden assisted by staff or using the guide rails. Other trips include outings for a short walk or to the town for some fresh air or to the beautician. Discussions with residents at this time confirmed the above outings had taken place and that staff do offer various trips outside the home. It was also confimed that visitors are made welcome in the home and that family members are kept informed of events at all times. Fish and chips are enjoyed on a Friday and at this inspection there were people in the Care Homes for Older People Page 14 of 26 Evidence: dining room and trays were set for people who wished to eat in their room. A variety of drinks are offered and people can choose a soft drink or alcoholic drink if they prefer. Due to regular meetings for both staff and residents, any matters needing attention are quickly dealt with and this enables the wishes of the individual to be met. Activities are recorded and details of who attended are monitored to allow any person in their room or anyone with a visual impairment to have time spent with them and appropriate activities offered. These activities and routines were confirmed by viewing records and through discussions with residents and staff at this time. We were told that details regarding activities are being further developed in care plans. This will support a closer monitoring of those people who do not take part in activities. Staff can then discuss this and try to identify some form of past time for that person. Care Homes for Older People Page 15 of 26 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. Residents know who to complain to and feel they will be taken seriously. Staff undertake appropriate training to provide them with skills and awareness of protection. Evidence: There is a complaints policy and procedure that is displayed in the front hallway of the home. Staff sign to confirm they have read and understood the policy on the protection of vulnerable adults and training is also provided for this area. Recruitment processes also support the safety of residents. Regular resident meetings and questionnaires continually provide an opportunity for residents to highlight any areas of concern. Residents spoken to at this inspection confirmed that they feel safe in the home and that any worries or concerns would be addressed appropriately. We were also told by residents that people living in the home feel they can talk to staff or the manger at any time and they feel they are fully supported to live their lives as they wish. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does provide a safe, clean environment, however, there are some areas of carpeting that need replacing. Evidence: The atmosphere in the home is welcoming and calm with a fresh and clean environment throughout. The home is to be extended by the addition of two extra bedrooms and this work is due to start next week. Both rooms will have en suite facilities and the addition of a conservatory will provide additional communal space. There are some areas noted that have worn carpet and one such area will be addressed when the planned extention work has been completed. This worn carpet will then be replaced with matching carpet into the extention area. One room seen at this time had very thin carpet that was uneven and ruffled, presenting a risk. This was discussed with the manager who stated that this would be identified for immediate replacement. An area of the stair carpet was also found to be very worn and did not provide a particularly comfortable environment. A bathroom seen at this inspection had very dull lighting and this room, along with the cupboard and chair seen here, looked very old and worn and not providing a homely Care Homes for Older People Page 17 of 26 Evidence: experience for those who use this bathroom. This bathroom also had toiletries on a shelf that were not named and had no supporting risk assessment. While there was a dispenser with soap and paper towels available, another bathroom did not have these facilities available for staff and residents. However, it is noted that sanitiser sprays were in place around the home. Rooms also have external medication cream left out and these will require full risk assessments placed on individual care plans for the safety of all residents in the home. The dining room is comfortable and we saw that tables were set and people enjoyed a chat over their lunch time meal. All bedrooms have an ongoing programme of redecoration and the resident chooses colours for paint and soft furnishings with assistance from staff or family members if this is needed. Care Homes for Older People Page 18 of 26 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. People living in the home have their needs met by a consistent staff team who are well trained and regularly supervised, providing stability and continuity of care. Evidence: Staff confirmed they have all undertaken an induction and that they would ask if they felt any additional training would be beneficial. Staff expressed a thorough knowledge regarding the needs of individual residents and how they would support each person. A review of staff files showed that these have been changed and the original copies of all checks are now retained at the head office of the company. However, the home does have paperwork that confirms when references and criminal record checks have been received and are satisfactory. Any of these papers can be reviewed by giving notice to the home prior to an inspection. All appropriate checks have to be received prior to a new member of staff starting work in the home. Supervision and induction programmes are completed for all staff and records and discussions confirmed this is the case. Staff have ongoing training that includes moving and handling, abuse and training has also been booked for twelve staff to undertake palliative care. This information will Care Homes for Older People Page 19 of 26 Evidence: then be filtered down to all members of the staff team. Care Homes for Older People Page 20 of 26 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. Residents live in a home that is managed by a suitable person and is run in their best interests. Evidence: The manager operates an open door policy that means residents or staff are able to discuss any matters when they wish. This was confirmed through discussions with staff and residents carried out at this time. There is a record of up to date servicing certificates for electrical items (PAT), hoists and all fire extinguishers. The fire alarm records were up to date and regular checks are undertaken and recorded for hot water temperatures, emergency lighting and on the emergency call system. There are written policies and procedures in place that cover areas including concerns and complaints, bullying, dealing with aggression and missing persons. Care Homes for Older People Page 21 of 26 Evidence: The home regularly undertakes surveys for the monitoring of quality assurance. There is an induction programme in place to provide staff with information that will assist them in their roles. Staff confirmed that they feel suppored by the management and also by other staff members. We were told that the home operates in a relaxed way and that staff work together to meet the needs of residents. Staff who spoke to us at this time said they enjoy working in the home and that they can always ask for training or support when needed. Two staff said that they would not want to work anywhere else. Care Homes for Older People Page 22 of 26 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 23 of 26 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 19 23 (1a) The premises are suitable for the purpose of achieving the aims and objectives set out in the statement of purpose. (2b) The premises are kept in a good state of repair externally and internally. That all rooms and communal areas of the home are well maintained particularly with regard to the condition of carpets. 31/07/2009 2 21 23 1a) The premises are suitable for the purpose of achieving the aims and objectives set out in the statement of purpose. (2b) The premises are kept in a good state of repair externally and internally. That all bathrooms are maintained to a comfortable and homely standard. 31/10/2009 3 25 13 (4a/b) All parts of the home to which service users have 05/06/2009 Care Homes for Older People Page 24 of 26 access are so far as reasonably practicable free from hazards to their safety. Unnecessary risks to the health or safety of service users are identified and so far as possible, eliminated. That all medication is risk assessed for the safety and well being of residents and securely stored as appropriate. (Particularly regarding external creams) 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 1 25 All toiletries should be named to ensure that each resident has their own allocated toiletries used at all times and that these are not shared. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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!