CARE HOME ADULTS 18-65
3 Nightingale Close Witham Essex CM8 1AP Lead Inspector
Kay Mehrtens Final Unannounced Inspection 7th March 2006 11:30 3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 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.V284655.R01.S.doc Version 5.1 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.V284655.R01.S.doc Version 5.1 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.V284655.R01.S.doc Version 5.1 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) 8th September 2005 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. 3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 7th March 2006. This was the second statutory inspection of the year and focussed on the remaining key standards not inspected at the last inspection, as well as a review of the requirements and recommendations from the last inspection. The inspection process included: discussions with the care staff and residents. The manager was on annual leave and the staff on duty ably assisted the inspector with the inspection. Residents joined in all aspects of the inspection visit. Information was also provided by the manager, at the request of the Commission, as part of the inspection process and will be referred to within this report. The inspector had the opportunity to meet four service users during the inspection. They were very friendly and the inspector would like to thank them for their hospitality. Samples of records were inspected. The inspection covered six standards. Additional requirements were made to those not addressed from the last inspection. What the service does well:
Nightingale Close is very much the residents’ home. Interaction between the residents and staff was observed to be very respectful and supportive throughout the inspection. The resident’s clearly enjoyed the company of the staff and spoke very positively about them to the inspector. There was a lot of laughter and gentle conversation between the staff and residents throughout the inspection. The staff responded calmly and respectfully to the requests of residents. The home felt happy, relaxed and provided a pleasant and safe place for residents. 3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
The manager and staff need to develop residents’ input into the development of policies and procedures. The care staff need to be aware of local protocols and procedures with regard to Protection of Vulnerable Adults. The ongoing situation with regard to the “block contract” for the care component of the residents’ agreements needs to be finalised and each resident provided with an individual contract and agreement that covers all aspects of their care and accommodation in the home. This has been raised at several inspections and the providers on-going response that it is being sorted is acknowledged but still impacts on the residents’ right to a written and costed contract or statement of terms and conditions. The standard with regard to quality assurance (39) was not inspected but the manager informed the inspector that she recognised this as an area that required work and development and hoped to improve the outcome for the next inspection. The commission has previously requested information from the provider with regard to the business and financial planning of the home and the neighbouring homes in the Close, all of which are registered with East Living. This information has not been provided. The issues with regard to the residents’ block contracts and the providers’ “take over” of the care component from the previous care provider has meant changes in the organisation and arrangements of the homes in the Close over the past year. These events have prompted the inspector to ask for information regarding the financial and business planning for the home. 3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 Page 7 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.V284655.R01.S.doc Version 5.1 Page 8 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.V284655.R01.S.doc Version 5.1 Page 9 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): EVIDENCE: These standards were not assessed at this inspection. There have been no new admissions since the last inspection. The home has clear admissions procedures. 3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 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): 7 Residents’ choice is respected in many aspects of their life in the home. EVIDENCE: The staff talked about residents’ rights and the need for them to be respected and included in all aspects of their life in the home. They acknowledged the need to develop residents’ input into the development of polices and procedures and suggested that it could be done in the regular residents meetings held in the home. The staff were very good at helping residents to voice their comments and needs. They showed a very good understanding of the different communication skills of each resident. The activity happening on the day of the inspection showed the staffs’ respect of residents’ choice, in that those residents that chose not to go out for lunch had stayed in. They had spent the morning with the care staff doing their own thing. Two residents have independent advocates though from comments from residents and staff they sound more like befrienders. The staff were aware of the need to access advocates, if needed.
3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 Page 11 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): 13, 14 and 17 Opportunities are provided for residents to participate in activities in the home and the local community. Catering arrangements are good. Residents enjoy a social and pleasant time during mealtimes. EVIDENCE: All the residents had worked with their key workers on developing their person centred plans and “circles of support”. There were lots of symbols and pictures in the plans that helped residents better understand them. They had used their plans and circles to look at what activities they wanted to do with their family, friends and in the community. The residents are supported to attend lots of different activities. Some go to college and told the inspector that they enjoyed it and that staff didn’t make them go if they didn’t want to. Daily records and comments from staff and residents showed that residents went to several local activities including the gym, swimming, dancing and
3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 Page 12 shops and pubs. Residents looked forward to different outings, some planned holidays and they showed real pleasure in telling the inspector about their holidays and activities. The residents work out their weekly menu on a Sunday evening. They go shopping with the staff, if they wish too. They are also encouraged and supported by staff to help prepare meals and snacks. The staff have worked with the residents to encourage a healthy eating menu that everyone joins in with but without special dieting. Residents were pleased that they ate healthy food and were clear that they could make choices about their food. The residents invited the inspector to stay for lunch. The lunchtime meal during the inspection was, for those that stayed in, just a snack. Even so, a choice of sandwiches or a cooked snack was offered. It was a relaxed and pleasant social time with lots of chatter and happy banter between residents and staff. 3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 Page 13 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 The staff are caring and positive in their contact with residents. EVIDENCE: Residents told the inspector that they could get up and go to bed whenever they want to. They liked the staff and felt well cared for. One resident told the inspector that they staff listened to them when they were anxious and tried to help. They also liked their key worker who helped them get to work. Another resident was pleased that the staff had looked after them, as they had been ill. The staff were observed to help residents that had communication difficulties in a gentle and caring manner. They showed a good understanding of residents individual communication needs and helped them share their comments with the inspector in a way that showed respect for residents’ dignity. The staff were aware of the individual support needed by residents such as wheelchairs, frames or physical assistance. They respected the residents’ personal choice to stay in their room or eat alone. The residents were very relaxed in their home and well supported by the staff on duty. 3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 Page 14 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): 23 Staff training was not sufficient to ensure the protection of residents. EVIDENCE: The staff told the inspector that they had done Protection of Vulnerable Adults training and had a good understanding about different areas of abuse and how to report it to their manager. However, they were not sure about the local POVA procedures or the need to refer concerns to different agencies. The inspector showed them a copy of the local information but they had not seen it. There was no evidence of the local documentation and information available for staff in the home. 3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 Page 15 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): EVIDENCE: These standards were not inspected at this inspection. 3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 Page 16 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): EVIDENCE: These standards were not inspected at this inspection. 3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 Page 17 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): EVIDENCE: These standards were not inspected at this inspection. The standard with regard to quality assurance (39) was not inspected but the manager informed the inspector that she recognised this as an area that required work and development and hoped to improve the outcome for the next inspection. 3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 Page 18 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 X 2 X 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X X X X X 2 X X X 2 3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 Page 19 Yes Are there any outstanding requirements from the last inspection? 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 YA5 Regulation 5 Requirement The registered person must ensure that service users have a clear written contract / statement of terms and conditions that is accessible to them. This is a repeat requirement for the 4th time. The registered person must ensure that staff receive training with regard to the Protection of Vulnerable Adults that reflects local procedures and practices. The registered person must ensure an effective quality assurance and monitoring systems are in place that are based on seeking the views of service users and to establish an annual development plan for the home. This is a repeat requirement. This standard was not inspected. The registered person must provide a financial and business plan for each registered home. This is a repeat requirement. This standard was not inspected. Timescale for action 24/05/06 2. YA23 13 24/05/06 3. YA39 24 24/05/06 4. YA43 25 24/05/06 3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 Page 20 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.V284655.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 3 Nightingale Close DS0000017733.V284655.R01.S.doc Version 5.1 Page 22 - 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!
