Inspection on 20/07/06 for 2 3 and 4 Nightingale Close

This inspection was carried out on 20th July 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

2 3 and 4 Nightingale Close 17/07/07

2 3 and 4 Nightingale Close 07/03/06

2 3 and 4 Nightingale Close 15/02/05

2 3 and 4 Nightingale Close 14/07/04

2 3 and 4 Nightingale Close 22/01/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 3 Nightingale Close Witham Essex CM8 1AP Lead Inspector Pauline Marshall Key Unannounced Inspection 20th July 2006 10:00 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 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 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 3 Nightingale Close Address Witham Essex CM8 1AP 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) 01376 511057 01376 501367 East Living Limited Ms Isobel Norton Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 6 persons) 7th March 2006 Date of last inspection Brief Description of the Service: 3, Nightingale Close is a purpose-built bungalow, which is registered to provide care to people with learning difficulties. The premises are well equipped with appropriate fittings and fixtures to meet the needs of service users. The home is situated in a cul-de-sac with two other homes offering similar facilities next door. The home has a well-maintained garden and patio area and is close to the local facilities of Witham town centre. On 8th August 2006 2, Nightingale Close was merged with 3, Nightingale Close and is now managed by Isobel Norton. All prospective residents are provided with a Statement of Purpose and Service User Guide that supplies them with up to date information on the home. Fees range from £1,391.00 to £1,539 and there are additional charges for hairdressing, toiletries, clothing, newspapers and magazines, and any personal activities undertaken including holidays, the home provides a small sum each year to assist residents with their annual holidays. 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that lasted for six hours and ten minutes. The process included a tour of the premises, a random selection of resident and staff files and discussions with residents, staff, and visiting relatives. As part of this inspection surveys were sent to all residents and their relatives at 2 and 3 Nightingale Close, two General Practitioners and one district nurse to obtain their views on the service the home provides. Eight residents surveys were returned and all were positive in their comments, saying that staff listened and acted on what they said. Nine relatives surveys were returned and were mainly positive in their comments, three of these said they did not have access to the CSCI reports. Both General Practitioner and District Nurses surveys were returned and were positive about their relationships with the home. Twenty-seven of the forty-three standards were inspected. What the service does well: What has improved since the last inspection? The home now has a clear business plan and has merged with 2 Nightingale Close under the one manager. Residents’ contracts include specific information on any extra charges. 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 6 All staff have received training in the Protection of Vulnerable Adults and have a copy of the local procedure. New flooring and soft furnishings have been purchased since the last inspection. 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. 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The home will carry out a thorough pre-admission assessment of needs and provides prospective residents with sufficient information to enable them to make an informed choice. EVIDENCE: The Statement of Purpose and Service User Guide have recently been reviewed and the Service User Guide is now written in a more assessable format. Most of the residents at 3 Nightingale Close moved in to the home in 1993, when assessments were carried out by the social work team. The last admission to the home was on 1/3/04 and the practice of using the social worker assessment was in use until that date. The home has now devised its own pre-admission assessment check form, which is comprehensive and user friendly, this will be used on all future admissions. Any new admissions will have the opportunity to visit the home on several occasions prior to their admission to assess whether the home is suitable; these visits will include an overnight stay. Each resident has a license agreement that was completed and signed by the residents; the agreement has a schedule 3 document attached that explains what is and is not included in the fees. Each year residents receive a letter 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 9 from East Living Housing stating their weekly contribution to the fees and the amount of any personal allowances. 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The homes care plans contain the information required to meet the residents’ needs, however one care plan was not reviewed due to staff sickness. The home has good clear risk assessments and management plans. EVIDENCE: Three care files were examined, two of the files showed good daily records and that the care plans were reviewed on a regular basis with the residents involvement. The one remaining care file examined had not been reviewed and the manager said that the key worker had been on long-term sick leave. Care plans must be reviewed regularly to reflect any changing needs and ensure that they are met. The care plans included all the relevant information. Residents meetings and residents spoken with confirmed that they have a major role in decision making that includes deciding on the menu for the following week and purchasing the food. Staff helped residents to voice their views and they showed a good understanding of the various communication skills of each resident. Residents spoken with said they made decisions and choices all the time. 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 11 A risk assessment and plans of how to manage any identified risks are in place for each resident. 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents participate in appropriate activities within the local community and are encouraged to develop and maintain relationships with others. Residents’ rights are respected and responsibilities recognised. Mealtimes are pleasant and relaxed and residents enjoy a healthy balanced diet of their choice. EVIDENCE: Residents work together with their key workers on the development of their person centred plans. These plans contain symbols and pictures to assist residents to better understand them. The “circles of support” and the person centred plans were used by residents to look at the activities they wanted to do with family and friends in the local community. One resident works in a local shop, others attend the adult education college and the local day centre. The home arranges many activities locally and on the day of the inspection a group of residents and staff went to Maldon for a 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 13 picnic. Residents often attend church and go to the local shops. One resident is supported to attend the gym twice a week and also goes dancing weekly. Residents spoken with said they phone their friends, girlfriend and family often and have regular visits from them. One resident said how they had enjoyed a recent holiday with their family in Germany. Care plans identified the residents’ rights and responsibilities and it was evident by talking with residents that they felt treated with respect. The care plans identified the tasks that each individual were responsible for and the level of assistance required enabling them to perform the task as independently as possible. The residents plan menus weekly and they accompany staff to the supermarket to purchase the shopping. The staff has worked together with the residents to encourage healthy eating and residents were quite clear that they could choose what they wanted to eat. Residents were finishing their breakfast and appeared to be relaxed and enjoying chatting to each other and the staff. 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents’ personal care and support is provided in the way they prefer and their emotional and health care needs are met. Residents’ are protected by the homes medication policies and procedures and are encouraged and supported to administer their own medication when possible. EVIDENCE: Residents spoken with confirmed that staff provides their personal care in the way that they prefer and that they choose when to go to bed and when to get up. Residents commented on how good staff were and how much they liked them. Staff and residents were observed to communicate well together and residents spoken with confirmed this. Staff were aware of each individual residents support needs and offered physical assistance in a kind and caring manner when required. Residents said they felt able to talk to staff and that staff would always listen, particularly their key worker. The home has good clear records of all health appointments. The home has clear policies and procedures on medication. Each resident has a locked cupboard in his or her room and staff administers medication from 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 15 these cupboards. One resident administers their own medication in the presence of staff and staff signs the medication record. 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents feel that their views are listened to and acted upon and are protected from abuse. EVIDENCE: The home has a clear complaints procedure and residents and relatives are aware of this. Residents and relatives spoken with confirmed that they knew how to complain and who to complain to if they had any concerns and that they were happy to do so. Each resident had an information pack in their bedroom that contained details of how to complain. The home has its own Protection of Vulnerable Adult procedure that works within the Essex County Council Procedure. Staff spoken with confirmed that they had received training and that they were aware of the need to contact other agencies with any concerns. Each staff member has been given a copy of the “Guidelines for all staff who work with Vulnerable Adults in Essex” booklet. 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents live in a safe comfortable clean environment that meets their needs and lifestyles. EVIDENCE: The home is well maintained and individual bedrooms contained many personal items. Bedrooms were comfortable and have a homely feel to them, residents spoken with said they were happy with their rooms and that they enjoyed playing their music in private when they wanted. The home was clean and tidy. 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents are supported by qualified and competent staff and are protected by the homes recruitment policies and practice. Staff are well trained and supervised. EVIDENCE: Residents spoken with said that staff are approachable and that they communicated well and listened to them. The staff team at 3 Nightingale Close are well established and most have worked at the home for many years. On the day of the inspection staff were observed communicating with residents in various forms and showed that they were interested, motivated and committed. Eight of the staff team have achieved NVQ level 2 in Care and one staff NVQ level 3 in Care. Staff are recruited by the home and checks are carried out by the Human Recourses department at East Living. Three staff files were examined and all contained evidence of training and supervision and all had copies of two written reference. Most of the staff have been employed at the home since it opened, a list of the CRB checks seen by the previous inspector and destroyed includes one of the names on the staff files examined. More recently employed staff had CRB checks. 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 19 The home has its own induction programme and is aware of the new Skills for Care “Common Induction Standards” that commence this September. All new staff members will be registered on this programme. Each staff member has supervision six times a year and staff spoken with had a good awareness of the benefits of regular supervision. Staff meetings are held bi-monthly and staff spoken with confirms that these are also useful and help them to feel supported. 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The home is well run and residents’ views are sought on a daily basis, however development of the homes quality assurance system needs to be continued to ensure that the views of all relevant people are included. There is a possible risk of the spread of infection due to using communal towels in the bathrooms and toilets. The electricity system in the home needs attention. EVIDENCE: The registered manager has worked at the home since it opened in 1993 and has achieved NVQ 4/Registered Managers Award and NVQ Assessors award and regularly updates her knowledge and skills. The quality assurance system is in the process of being developed and the manager is working together with the manager of number 4 Nightingale Close to progress this. Surveys will be undertaken and a report of the findings made 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 21 and shared with all relevant people including the CSCI, the manager said she expects to complete this by 1st November 2006. The communal toilets and bathrooms contained terry hand towels, which could present a possible risk of the spread of infection. Disposable towels and liquid soap must be provided in communal bathrooms and toilets to reduce the possible risks of the spread of infection. The periodic inspection report for the electrical installation could not be located on the day of inspection. A copy was received in the CSCI office on 22nd August 2006 and declared the installation as unsatisfactory on 11th May 2005. As a matter of urgency the electrical system must be checked and certified as satisfactory and the manager must supply a copy of the certificate to the CSCI. 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 23 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 YA39 Regulation 24 Requirement The registered person must establish and maintain a system for the review and improvement of the quality of care provided at the home. This refers to the development of the quality assurance system. 2. YA42 13 (3) This is a repeat requirement. The registered person must 01/11/06 make suitable arrangements to prevent the spread of infection in the care home. This refers to the need for liquid soap and paper towels in communal toilets and bathrooms. The registered person shall ensure that all parts of the home to which residents have access are as far as reasonably practicable free from hazards to their safety. This refers to the electrical system unsatisfactory test certificate. Timescale for action 01/11/06 3. YA42 13 (a) 01/11/06 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 24 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 3 Nightingale Close DS0000017733.V304558.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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. 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