Inspection on 20/02/07 for Nightingale

This inspection was carried out on 20th February 2007.

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

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

Other inspections for this house

Nightingale 26/03/08

Nightingale 20/02/06

Nightingale 20/09/05

Nightingale 09/03/05

Nightingale 21/09/04

Nightingale 26/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Nightingale Nether Lane Ecclesfield Sheffield South Yorkshire S35 9ZX Lead Inspector Ivan Barker Key Unannounced Inspection 20th February 2007 10:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nightingale DS0000002990.V318604.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingale Address Nether Lane Ecclesfield Sheffield South Yorkshire S35 9ZX 0114 257 1281 0114 257 1279 none None Paxfield Associates (Sheffield) Limited 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) Ms Janice Maw Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (40) Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Under 65`s can only be accommodated with the consent of the Registering Authority. 20th February 2006 Date of last inspection Brief Description of the Service: Nightingale care home is a purpose built, two storey building overlooking fields to one aspect and situated in Ecclesfield. Some rooms have en suite facilities. The service caters for a client group aged 65 years and over who require personal care because of their diagnosis of Dementia (DE) or Mental Disorder (MD). The home is sited on a bus route and is close to a supermarket, chemist, bank and other shops. Copies of Service User guides were available to service users and stored in their rooms. The manager advised the inspector that the fee range is between £348 and £371 including third party top up fees. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Only a limited number of the National Minimum Standards were examined at this inspection (with emphasis on the ‘key standards’), and the previous requirements. The person present at the inspection was: Mrs J Maw, manager. Within this site visit, which occurred over a five-hour period, the inspector toured the building, examined requirements relating to the previous inspection, case tracked 3 service users (Case tracked means looking at the care and service provided to specific service users living at the home; checking records relating to their health and welfare (care plans and other records); by talking to the residents themselves; talking with staff; viewing their personal accommodation as well as communal living areas) and spoke with other service user, and relatives and also 3 staff and examined assessments, care plans, risk assessments, accident documentation, activity records, included within the diary, staff files and quality audit information. The history of the service was examined prior to the site visit. This included telephone contacts, letters, notifications etc. What the service does well: Comprehensive assessments are obtained prior to the service user’s admission to the home. Extensive care plans are produced from these assessments and will contribute to the delivery of care. However to produce a more structured documentation the service is striving to further improve by introducing new documentation and training staff prior to the introduction of the documentation. Service users were satisfied with the care and service they received. The positive comments were’ ‘The care is good’ and ‘They look after us well’. ‘The care is good and I’m looking for a place here. ‘They look after us well and do my nails’. ‘They do things when they can, they are very busy’. ‘The staff entertain us’. ‘The entertainers are good’ ‘The food is good’. ‘Always have a choice’. ‘If we don’t like it, they will do us something else’. ‘Always too much food’. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 6 The service users and relatives commended the efforts of the staff. The good practices within storage and administration of medications should provide protection for the service users. An experienced registered manager is in post. This will contributed to the effective organisation and operation of the service. Extensive quality assurance systems were in place that should assist the manager and company to measure the service against expected outcomes. What has improved 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. The summary of this inspection report can be made available in other formats on request. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Accurate comprehensive assessments were in place either from the care management team, except for one service user, or from the staff of the service. This ensured that the service have sufficient information to be aware of the service user’s needs prior to admission. EVIDENCE: On examination of the service users’ care management assessments, of the three service users, two service users had care assessments from the care management team. However one service user’s file did not contain a care management assessment. On further analysis of the file it was established that the service user transferred from another care home. Transfer documentation identifying the service user’s needs had been provided by the previous care home. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 9 The lack of care management documentation was discussed with the manager who agreed that the care management team should have provided the necessary assessment documentation, prior to the admission of the service user. She has agreed to raise the matter with the care management team. Documentation regarding the assessment undertaken by the staff of the service, relating to the service users was examined and found them to be comprehensive, and detailed the service users needs which would assist in providing sufficient information for a care plan to be drawn up. The manager advised that no intermediate care was provided within the service. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Accurate care plans and care reviews with service users and relatives enabled them to offer their input, and will contribute to the delivery of care. Service users were satisfied with the care they received. The good practices within storage and administration of medications should provide protection for the service users. EVIDENCE: On examination of the care plans it was established that all three care plans were up to date, and had been evaluated on a monthly basis, and had evidence that the service user or family had been consulted on the content of the care plans. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 11 The manager advised that the present documentation was to be superseded by a more comprehensive documentation that had been purchased by the company and the intention was to have this new documentation within each of the services owned by the company, to prove consistency throughout the company. The staff were yet to receive training on the use of the documentation, which was planned to occur prior to the implementation of the documentation. Risk assessment were included within the present documentation and included moving and handling, pressure area, and nutritional, risk assessments. Risk assessments and falls had been raised as concerns prior to the inspection. Risk assessment and accident documentation was inspected as part of the case tracking process. The risk assessments were completed and reviewed. Accident documentation was completed and the care plans reviewed as part of the process. Service users and relatives expressed their views, during the inspection. Their opinions were; ‘The care is good’. ‘They look after us well’. ‘The care is good and I’m looking for a place here. On examination of the storage of medications, it was observed that the storage room was very small and limited for space. The medication trolley was secured to the wall, and the door to the room was secured with a substantial five-lever lock. It was agreed that, because of the total security of the room with the higher specification of the door security, then the trolley chain securing the trolley to the wall could be removed. This would allow more flexibility of movement and safer working practices within the room. Otherwise the storage was satisfactory. The medication administration records were up to date with all the records signed as appropriate. The ordering, administration and disposal procedures were discussed with the manager. The procedures explained were satisfactory. It was observed that visitors were allowed to visit the service user in the communal areas or in the privacy of their own room. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Various activities were organised within the service, and this is to be reviewed to introduce more, which would provide stimulation to service users and enhance their quality of life. Service users were given the opportunity to exercise their right of choice regarding the provision of meals. EVIDENCE: The manager advised that the staff were responsible for organising activities. She produced the daily diary of the service, which showed evidence that activities were planned. This included visits by ‘entertainers’. During the inspection it was observed that 2 staff were undertaking beauty sessions with individual service users, by painting their nails. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 13 The provision of more structured sessions for all the service users who wished to participate was discussed with the manager. She agreed that the structure could be improved, as at present staff were undertaking activities and other duties and the priorities was at the discretion of the care staff. The manager identified that a specific care staff would be identified on each shift to be responsible for organising activities for that day, which would ensure that a session, of some type would be available to service users, and would not compete with other duties. On discussing the activities with the service users, their opinions were that; ‘They look after us well and do my nails’. ‘They do things when they can, they are very busy’. ‘The staff entertain us’. ‘The entertainers are good’ Regarding the meals, the manager advised that the service users were offered a choice of meal. The manager provided evidence that there was a four weekly menu record and menus were displayed within the corridor, adjacent to the dining room. Positive comments were received from the service users and relatives regarding the food. The general comments were that; ‘The food is good’. ‘Always have a choice’. ‘If we don’t like it, they will do us something else’. ‘Always too much food’. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service had a complaints procedure in place, however there was minimal available evidence, of one entry, to judge, if it was operating according to the company policy and if complaints were resolved within the expected timescales. The service was able to evidence that the staff had received Safeguarding Adults training. Therefore staff would be aware of their responsibility regarding the protection of vulnerable adults. EVIDENCE: The complaints procedure was displayed and available to the service users and relatives. On discussing complaints with the service users, and relatives they stated that they were satisfied with their care, and had no complaints. There had been concerns addressed to the Commission, over the 12 months prior to this inspection, one had been referred to the service to address prior to the inspection. The other concerns were to be reviewed at the time of inspection. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 15 Regarding the one which had been referred to the service, the manager was able to evidence the action taken, including showing copies of correspondence sent and received from the contracting department and correspondence with the relatives who had raised the concern. The total concerns were relating to staffing, falls, risk assessments, cleanliness, odour and sticky floor covering. Each of these areas was examined on this inspection and the finding stated with the relevant section of the report. For example, Staffing under the Staffing section, Cleanliness under the Environment section. Other than the one concern addressed to the service from the CSCI, there were no other concerns. It was discussed with the manager how the complaints procedure and documentation could be improved to benefit service users, relatives and the service. She agreed to review the procedure. Regarding safeguarding adults, the service had policies and procedures which were available to staff. Staff had undertaken safeguarding adults training, and the manager was able to evidence this by showing training records and certificates. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment, monitored at the site visit, had not been maintained to the required standard to provide a safe, well-maintained environment for services users. EVIDENCE: On touring the building, the home was found to be clean and adequately decorated and in a reasonable state of repair except for the following areas: Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 17 Within the Toilet (Number 4) and the en suite within room 32, both floor coverings were tired and worn and in need of replacement. The manager identified that continuous cleaning had worn away the floor covering and agreed that they were in need of replacement. She advised that the coverings would be replaced and offered a timescale of 4 months. This timescale was accepted. The rooms had been personalised and many contained photographs, personal belongings and items of furniture, which the individual or the family had provided. Regarding the concerns that had been expressed prior to the inspection, detailed in the Complaints and Protection section, it was established that the service was clean throughout, and free of any unpleasant odours. Some patches of the vinyl areas of the corridor and dining room were found to be ‘sticky’ onto the shoe, but not to the hand. The areas looked clean and well maintained. Following discussions with the manager it was agreed that the stickiness maybe because of the type of floor cleaning agent being used, or the level of concentrate to water mixture of the cleaning solution being used, or the type of rubber on the individual’s shoe. She agreed to explore these possibilities and act up her findings, if action was deemed necessary. Regarding the corridor carpet from this previous inspection. This had now received attention and was now satisfactory. The toilets and bathrooms had received attention. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager was able to provide evidence that staff had received training, which should reflect on the quality of care being delivered to the service users and the staff recruitment process should provide protection for the service users. EVIDENCE: On examination of the staff rotas and examination of staff on duty, the following was established: Am – Pm – Night shift – 7 care staff 6 care staff 3 care staff Plus A deputy manager (who worked 7am to 4 pm, Mon –Fri). And the manager. Caring for a present occupancy of 40 service users. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 19 Ancillary staff included. An administrator, (3 days per week). A receptionist, (5 days per week). And domestic and catering staff. A full assessment of the dependency levels of the service users was not undertaken and compared with the indicated staffing levels. On examination of the three staff files, all contained the required documentation, including Criminal Records Bureau and POVA (Protection of Vulnerable adults) checks. The previous requirement of indicating that POVA checks had been undertaken had been acted upon. On examination of the staff training records there were records and certificates that indicated all staff had received moving and handling, fire, adult protection training and other specific training regarding the client group that they were caring for. Staff advised that they were satisfied with the care and service provision and did not express any concerns. Regarding the concern of staffing, no service user, relative or staff expressed any concerns regarding staffing levels. The number of staff of duty at the time of inspection appeared to be delivering the care required by the service users. The service users and relatives commended the efforts of the staff. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An experienced registered manager is in post. This will contributed to the effective organisation and operation of the service. Extensive quality assurance systems were in place that should assist the manager and company to measure the service against expected outcomes. EVIDENCE: A registered manager was in post. Regarding her qualifications and experience she identified that she had over 10 years experience and had obtained the Registered Managers Award. Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 21 Regarding the Quality Assurance there was regular monitoring with weekly, quarterly and annual monitoring by the managers. Also 6 monthly questionnaires were sent out to families and care professionals, (care managers, GPs, health professional etc), as part of the service user’s care review undertaken by the staff of the service. Copies of these were observed. Regulation 26 documentations, which are a record of the registered person’s monthly visits, had been completed on a monthly basis and were on site for inspection, and contained the information as stated in the requirement from the previous inspection. Regulation 37 notices, which are documents that are sent to the Commission regarding untoward occurrences, including falls, accidents etc; had been received by CSCI (Commission for Social Care Inspection). On examination of these notices it had been established that 34 had been received since the last inspection. On discussing the number and content with the manager it was established and agreed that the staff had been very proactive and informing the Commission of minor slips and falls which had resulted in no injuries to the service users. The pre inspection questionnaire confirmed that the necessary maintenance and servicing had occurred. Nightingale DS0000002990.V318604.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 23 Requirement The floor coverings within the toilet and en-suite must be replaced. Timescale for action 20/06/07 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 Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Nightingale DS0000002990.V318604.R01.S.doc Version 5.2 Page 25 - 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!