Inspection on 26/03/08 for Nightingale

This inspection was carried out on 26th March 2008.

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

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 20/02/07

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 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Nightingale Nether Lane Ecclesfield Sheffield South Yorkshire S35 9ZX Lead Inspector Ramchand Samachetty. Unannounced Inspection 09:15 26 . March 2008 th 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.V358284.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.V358284.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) Vacant 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.V358284.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 2007 Date of last inspection Brief Description of the Service: Nightingale care home is a purpose built, two-storey building situated in Ecclesfield. It can accommodate up to 40 older people aged 65 years and over, who require personal care because they suffer from dementia or mental disorder. It is located near a shopping area and is close to a supermarket, a chemist shop and a bank. It is accessible by public transport. The home is owned by Carevale Company Limited and run on a day-to-day basis by a manager; Mr Shaun Brennan. The manager informed us that the range of fees charged at 27 March 2008, was between £369.00 and £395.00 per week, including third party top up fees. Items not covered by the fee, included hairdressing, personal toiletries, newspapers and private chiropody. Further information about Nightingale and its services can be obtained from the home. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. (Since the inspection CSCI has met with the provider and manager, both have assured CSCI that improvements have been made). This key unannounced inspection was carried out on 26 and 27 March 2008, starting at 09.15 hours on the first day and ending at 18.00 hours. On the second day, the inspection started at 14.30 hours and ended at 16.00 hours. There were 33 people in residence at the time of this inspection, all of whom suffered from dementia. The manager was present on both days of this inspection. The responsible individual, who was also a director of the new company, which owns the home, was also present for some time during our inspection. The inspection included a tour of the premises, examination of care documents and records relating to policies and procedures, medicines, complaints, management of people’s personal monies and to staff employment and training. We spoke to three people who live at the home, five relatives who were visiting and six members of staff. The care of three people was examined and some aspects of care provision were observed. We looked at the feedback we received from a survey that we conducted with people who use the service and their representatives. We also referred to the home’s ‘Annual Quality Assurance Assessment’ that was provided by the previous registered manager before this inspection. Feedback on our initial findings was given to the manager and the responsible individual. We would like to thank all the people living at the home, relatives and staff who helped with this inspection. What the service does well: There is a good staff team, which is working hard to provide as good a standard of care as they can. Staff also showed that they were managing change well, after a new company took over ownership of the home in December 2007. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 6 People who use the service and their relatives were satisfied with the care that was being provided. The new owner has introduced good administration and management arrangements at the home, backed by appropriate service improvement objectives. What has improved since the last inspection? What they could do better: Although the statement of purpose and service user guide had been reviewed, these documents should be further improved. They need to give more information about the service that is provided for people with dementia and other information as contained in the relevant guidance and regulations. The care planning system must be reviewed to make sure that individual care plans are based on identified needs and risks. Care plans must be appropriately implemented and care provided to individuals must be properly recorded. Care plans must be evaluated and regularly reviewed. There were some minor shortfalls in the management and audit of medicines. These need to be remedied in order to avoid potential errors in the administration of medicines. Management and staff need to review and improve the provision of social and recreational activities in relation to the needs and capabilities of people who experience dementia. Staff must also demonstrate that they are able to assist people in their care to express preferences and to observe such preferences. These actions will help to avoid the isolation and withdrawal of people who have dementia and improve their quality of life. The adult safeguarding procedures must be reviewed to make sure it is in line with those of the local multi-disciplinary safeguarding team. Training on adult safeguarding issues must be prioritised for all staff working at the home to enable them to promote the safety and welfare of people in their care. Although there was a refurbishment plan in place, we have highlighted some areas where remedial action is needed. These include the provision of sufficient Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 7 ‘coffee and side tables’ for the benefit of people who live at the home. Arrangements for the appropriate storage of various items are also needed. At this inspection, the issue of staff recruitment and selection was of concern to us. There is an urgent need to improve the recruitment and selection procedures, in order to make sure that all pre-employment checks are appropriately carried out before staff start to work at the home. It is also necessary to ensure that the job roles of staff, including their terms and conditions of employment, are made clear, particularly where staff are employed to carry out two separate jobs in the home. We acknowledge that the manager has started reviewing the training needs of all care staff. It is necessary to address the shortfalls identified, some of which are highlighted in this report. The manager must also make sure that a plan for the provision of staff supervision is developed and implemented. The registered person must ensure that appropriate quality monitoring methods and quality assurance system are developed and effectively implemented in order to further improve the service. 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.V358284.R01.S.doc Version 5.2 Page 8 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.V358284.R01.S.doc Version 5.2 Page 9 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): 1 and 3. Standard 6 is not applicable to this service. People who use the service experience good quality outcomes in this area. We have made this judgement using available evidence, including a visit to the service. People who used the service and those interested in using it, were supplied with information to help them make informed choices about their care. However, the statement of purpose and service user guide lacked relevant information and clarity about the way the service for people with dementia, was provided. The needs of people were assessed before their admission to make sure that such needs could be met. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 10 EVIDENCE: A statement of purpose and service user guide was available to people living at the home and for those who were interested in using the service. The documents gave them information about the home and its facilities in order to allow them to make informed choices about the service. We spoke to a few people who were living at the home and their relatives. They said that they had been given copies of the statement of purpose and service user guide and felt they had sufficient information to help them choose the home. The documents had been revised following a change in ownership and management. However, these documents did not contain sufficient information about the specific service available for people who experience dementia. They also lacked details in a few areas, such as the accommodation facilities provided and about the criteria for admission. We looked at the care documents relating to the more recent admission of people to the home. These showed that full assessments had been carried out either by the placing social worker or by staff. This helped to ensure that the service was able to meet the identified needs of people who were being admitted. The home was not registered to provide an intermediate care service. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9 and 10. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People living at the home and their relatives were satisfied with the care being provided, which they felt was generally ensuring security and wellbeing. However, the planning, provision and review of care was not always satisfactory. This has meant that some people using the service had not always received as good a quality of care as was possible. EVIDENCE: We spoke to a few people who were living at the home and their relatives. They stated that they were satisfied with the care that was being provided at the home. They said that staff were “good and friendly”. People living at the home said that personal care was provided to them in the privacy of their own bedrooms and in bathrooms. During our inspection, we noted that the Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 12 interactions between staff and people, who were living at the home, were courteous and friendly. The care plans of three people, who experience dementia, were checked. They were generally based on the assessment of needs. However, in two instances, we noted that not all the identified needs had been addressed in the care plans. These were about continence, social care and the specific needs relating to dementia. In the care plans that we looked at, risks that people faced in their activities of daily living were not always identified and appropriately assessed. There was, therefore, no clear plan of action of how to manage those risks. The care provided was often recorded in a generalised manner and therefore lacked relevant information. In a number of instances, care records included entries such as ‘ care given as planned’. There was little information, which could be used to evaluate and review the care being provided to each person. In fact we noted that care plans had not been regularly reviewed and therefore changes in care needs were not always identified and addressed. The care plans that we checked indicated that people using the service were appropriately supported in accessing community health care services. People living at the home had been able to obtain timely assistance from health professionals like the GPs, Community psychiatric and district nurses and opticians. We looked at the management of medicines at the home. There were some minor shortfalls. Medicines received at the home were not always appropriately recorded. There were some handwritten entries on the medicines administration record (MAR) sheets, which had not been signed and dated by the person writing them. These could lead to errors in medicines administration. One member of the care staff was observed administering medicines. She explained that although she was not a nurse, she had received an in-house training session on the safe handling of medicines. None of the people using the service were administering their own medicines. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. We have made this judgement using available evidence, including a visit to the service. Although some recreational activities were organised from time to time, there was a lack of relevant social stimulation for people who suffer from dementia. This could lead them to experience further isolation and withdrawal. EVIDENCE: People living at the home were observed spending most of their time sitting in the lounge and in their bedrooms, in between meals and care interventions. The television set was playing in the main lounge. We noted that people were most often left on their own unless they needed assistance with their care. We spoke to three visiting relatives who were spending some time in the lounge, with their loved ones. They said that they were always welcomed at the home. They commented that staff often ‘put on various activities’ for people living at the home and felt that not all of them could benefit because of their condition. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 14 They stated that for most of the time, their loved ones could not express their preferences concerning their care or about things that they liked to do. However, they were confident that staff did their best to help people in their care. We spoke to the activities co-ordinator who stated that he had just joined the staff team. He explained that he usually ‘goes round to find out what people want to do’. The activities co-ordinator was observed playing a game of dominoes with three people. Social and recreational activities were not always assessed and planned and those that were organised were not related to needs, preferences or capabilities of people using the service. We looked at three care plans of people who experience dementia. They did not contain sufficient and relevant information about their social care needs, which therefore were mostly unmet. In one instance, the care records of a person using the service listed her social activities as comprising of ‘sitting in the lounge’ and ‘talking’. In fact, staff confirmed that she was spending most of her time on her own. The arrangements for meeting the social care needs of people living at the home did not reflect the importance of the social environment and social stimulation for their wellbeing. People using the service and their relatives said that the meals served at the home were usually ‘good and tasty’. We observed lunch being served. The menu for the day comprised of steak pie and turkey burgers with vegetables. Staff explained that they usually ‘go round and tell people what was on the menu’ and helped them to express their preferences. However, we noted that staff gave every person an orange drink at lunchtime, without ascertaining their choice first. Three members of staff were observed helping people with their meals. Some people who needed help to eat their meals had to wait for staff assistance. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 15 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): 16 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using available evidence, including a visit to the service. Relatives of people living at the home were satisfied that they could express their concerns to staff and that these would be addressed and they could also use the complaints procedure. The policy and procedures on adult safeguarding could be improved. Staff training could also be further developed. EVIDENCE: There was a complaint procedure in place and it gave brief information on how to make a complaint and how it would be managed. The procedure was included in the statement of purpose. Copies were displayed in the home and also made available to people who used the service and their representatives. A few relatives commented that they were aware of the complaints procedure and would use it if necessary. They said they would talk to staff if they had any concerns and were confident that these would be dealt with appropriately. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 16 The manager explained that one complaint had been referred to the home by Social Services’ s staff for investigation. The complaint was about the attitude and behaviour of a specific member of the care staff and her care practices. The manager had investigated the complaint and upheld it. The care worker concerned has been dismissed. Records of the investigation were appropriately kept. We looked at the adult safeguarding policy and procedures, which provided guidance to staff. This document was a copy of the joint policy statement on the management of vulnerable adults issued by the local adult safeguarding team. There was no other policy or procedures at the home for the benefit of people who use the service, their relatives and of the staff team. There was a policy, which gave some guidance to staff on ‘Public Interest Disclosure’ referred to as ‘whistle -blowing’. However, staff we spoke to, were not aware of this policy. In discussion, a number of care staff stated that they had not received training on adult safeguarding and on whistle-blowing issues. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 17 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): 19 and 26. People who use the service experience adequate quality outcomes in this area. We have made this judgement using available evidence, including a visit to the service. The environment was adequately maintained and provided people who use the service with a homely place to live in. However, some health and safety issues were not well managed and could make the environment a less safe place than it could be. EVIDENCE: We carried out an inspection of the premises in the company of a senior member of staff. We noted that the main entrance to the building was Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 18 wheelchair accessible through a ramp. However, there was limited space for wheelchair users to move about in comfort at the entrance. The communal areas were on the ground floor and consisted of the lounge and dining room. The kitchen and laundry were also located on the ground floor. There was inadequate signage of the communal areas, including toilets and bathrooms, for people who experience dementia. The private accommodation for people living at the home was provided on both the ground and first floor. Access between the floors was through a passenger lift and a set of staircase. The main doors were provided with keypads to ensure the security of people living at the home. The building was in a good state of repair and adequately decorated. Some areas of the home had been provided with new carpets. In other areas, particularly on the top floor, some areas of the carpet were stained. The manager explained that the registered provider had put in place a refurbishment programme to ensure continuing improvement of the physical environment. In the lounge areas, we noted a lack of ‘coffee’ and side tables for people to use. At coffee time, we noted that some people had to hold hot drinks on their laps or to keep them on the floor, although there were dining tables in the vicinity. Such a practice was unsafe and undignified. We found that a number of items of indoor games were stored on the floor of the lounge, and therefore created a potential hazard. We found that boxes of continence wear had been stored in a number of bathrooms and in some parts of the corridor. Some of the bathroom taps had not been fitted with mixer valves and the hot water was ‘too hot’ to the touch and could cause scalding. We viewed a small number of bedrooms with the permission of people who lived in them and their relatives. The bedrooms were adequately decorated, furnished and were clean. However, in one instance, we found that one person was using his bedside table to eat his lunch from, the provider has stated this is this persons choice. We noted that two bedrooms were used for shared accommodation. The manager stated that the people living in them and their relatives had consented to sharing their accommodation. People we spoke to, told us that they were satisfied with the accommodation provided. They stated that the home was always kept clean and tidy. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 19 Laundry facilities were adequately provided so that bedding could be washed at the correct temperature to reduce the risk of infection. However, dirty linen was found in plastic buckets, which overflowed and dropped on the floor. This could cause a spread of infection. The surrounding grounds, which were mostly asphalted and used as a car park, were well maintained. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 20 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): 27, 28, 29 and 30. People who use the service experience poor quality outcomes in this area. We have made this judgement using available evidence, including a visit to the service. Staff recruitment and selection procedures and staff training and development were inadequate in ensuring the protection, safety and wellbeing of people living at the home. EVIDENCE: At the time of this inspection, there were 33 people in occupancy at the home, all of whom, suffered from dementia. The care staff on duty, besides the manager, comprised of the deputy manager and five care assistants. However, for two of the care assistants, it was their first day at the home and they were new to care work. In discussion, they stated that they had not yet received any induction or training. The support staff included the cook and a kitchen assistant, a domestic and an activities co-ordinator, who also worked as a ‘handy person’. The domestic staff told us that she also worked as a care assistant. We noted that both the domestic and the handy person did not have Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 21 dedicated hours and guidance for their dual roles and these were not specified in their contracts. We checked the duty rota and it showed that the home operated a long day shift (12 hours) and a 12- hour night shift. Four or five care workers were regularly scheduled to work during the day and three at night. We noted that the level of care staffing was not based on the dependency needs of people living at the home and on the lay out of the building. Staff we spoke to, said that they were pleased that the new manager was recruiting more care staff, as there had not been sufficient staff to provide care. During our visit, we noted that staff interaction with people who experience dementia was limited and rather inconsistent. Staff were observed undertaking a series of care tasks and on occasions, one member of staff or the activities co-ordinator would spend some time in the lounge, with the people who were spending time there. Care staff told us that as part of their work, they also had to undertake laundry duties. Four new employees had joined the home staff since December 2007. We looked at the procedures that were used in their recruitment and selection. One of the new employees had been interviewed by only one person. Gaps in employment history were not always checked and explained. In a number of instances, the required pre-employment checks, including the appropriate disclosures and work references, had not been sought and obtained before staff started working at the home. The welfare and safety of people who use the service were therefore put at risk. We spoke to care workers about the training they had received in order to equip them with the required skills and knowledge to provide care, especially to people who experience dementia. We noted that two new care assistants who had started working on the day of this inspection had not received any induction. One of them was observed moving and handling people on her own, without checking their moving and handling needs. She was therefore unable to provide assistance with moving and handling of people in a safe manner. In discussion with other care workers, we noted that two of them had received training on ‘dementia care’. About four care workers told us that they had undertaken training on topics like food hygiene, first aid and health and safety over two years ago and had not yet received any refresher training. None of the staff we spoke to, could confirm that they had received training on ‘adult safeguarding’ issues. We also noted that care workers were unaware of the policy and procedures regarding Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 22 the protection of vulnerable adults and the ‘Public Interest Disclosure Act’. Also care workers have not yet received training on the ‘Mental Capacity Act’. They, therefore, lacked guidance on how to work with people whose capacity to make decisions may be uncertain or questionable. We noted also that no training had been provided to staff on issues of equality and diversity. This may affect the way care is provided to people who use the service. In discussion, the manager explained that he was organising training for all the care staff on dementia care and would be addressing other staff training needs in due course. We noted from the ‘Annual Quality Assurance Assessment’ that was provided to us before this inspection that over 50 of the care staff had completed their ‘National Vocational Qualification (NVQ) level 2 in care. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35, 36 and 38. People who use the service experience adequate quality outcomes in this area. We have made this judgement using available evidence, including a visit to the service. Adequate management arrangements were in place to ensure the proper dayto-day running of the home. However, internal monitoring systems were not being effectively used to ensure the continued improvement of the service. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 24 EVIDENCE: A new manager was in post. He joined the home in December 2007. He is a first level registered nurse and has experience of managing health services. He stated that he was applying for registration with our Commission (CSCI). Relatives and staff told us that they were satisfied with the way the manager was running the home. Staff felt that they were working well as a team and so were able to provide as good a service as possible. The ‘Annual Quality Assurance Assessment’ (AQAA) indicated that there were a few quality- monitoring tools that were being used in order to improve the service. These included audits of care plans, staff issues and staff records, the environment and the management of the personal monies of people living at the home. However, the shortfalls we identified in care planning and in the area of recruitment and selection of staff and the physical environment showed that the quality monitoring system was not robust enough to secure the required service improvement. We noted that there had been a change in ownership of the home in December 2007 and that new management arrangements had been put in place. We looked at two most recent reports of the new responsible individual and were satisfied with the way action was being planned and performance monitored. Arrangements were in place to support people living at the home with the management of their personal monies. The home- owner was an appointee for two people. Their monies were kept in a separate bank account to which the owner and the administrator were signatories. Interest on this account was regularly shared with the two people concerned. The administrator was overseeing the management of the monies that were left by relatives for their loved ones. All financial transactions undertaken on behalf of people concerned were appropriately recorded and receipts were kept. However, we noted that staff did not have to sign when they request and are given money to spend on behalf of people. We also found that some people had paid out of their personal monies, the costs of taxis to attend hospitals and that people who suffer from diabetes had paid for private chiropody. Accounts checked were in balance. We noted that a small sum of money was made available for people who may need their money outside office hours. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 25 Two care workers stated that they were receiving supervision from senior staff and that they did not know when they would receive further supervision. Other care workers we spoke to, could not confirm whether they had received the required number and frequency of supervision sessions. This was partly explained by the management changes that had occurred at the home. The manager is aware re the supervision needs and is in the process of addressing this. Information about the maintenance of equipment in use at the home was provided in the ‘Annual Quality Assurance Assessment’ document that was provided to us before this inspection. Health and safety issues were discussed with the manager and a sample of records was checked and found satisfactory. However, we highlighted our concerns about the way accidents at the home were being recorded. This was not in line with the recommended data protection practice. The provider and manager have stated that they have assessed the homes fall profile and took advice from the primary care trust falls specialist. This positive action resulted in a reduction in the number of falls. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 26 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 Requirement Timescale for action 2. OP9 13 3. OP12 16 Individual care plans must be improved to ensure they are 03/06/08 appropriately developed, implemented and the care provided must be properly recorded, evaluated and reviewed. Risks that people face must be appropriately assessed and managed. This will ensure that all identified care needs are addressed. All medicines received at the home must be appropriately 03/06/08 recorded so that they can be accounted for. Handwritten entries and amendments on the medicines administration records must be signed and dated. These actions will help protect the health of people living at the home. The social care needs of people with dementia must be 03/06/08 appropriately assessed and action taken to meet such needs must be part of the individual’s care plan. Social and recreational activities that are organised must reflect the preferences and capabilities of people who use DS0000002990.V358284.R01.S.doc Version 5.2 Page 28 Nightingale 4. OP18 12 5. OP19 23 6. OP19 23 7. OP19 23 8. OP19 23 9. OP27 18 10. OP29 18 the service. This is to ensure that they are provided with appropriate social stimulation and to enhance their quality of life. An appropriate policy and procedures must be developed on the issue of adult safeguarding. All staff must be provided with training on the subject, in order to promote the safety and welfare of people using the service. The areas of floor covering that are stained must be cleansed or replaced, in order to make the place more pleasant. Appropriate and sufficient furniture must be provided in both the communal and private areas used by people who live at the home, to ensure their comfort and safety. The storage of continence wear and of some items of ‘indoor games’ in communal and private areas must be discontinued, in order to avoid potential hazards and to respect private space of people living at the home. Soiled linen must be kept in appropriate bags, in order to avoid any possible spread of infection. Appropriate arrangements and guidance must be put in place for staff who, undertake to do two different jobs at the home. These must be supported with the appropriate terms and conditions of such employment. The recruitment and selection procedures must be improved to make sure that the required preemployment checks, including written references and disclosures, are appropriately sought and received before staff DS0000002990.V358284.R01.S.doc 03/06/08 01/07/08 01/07/08 03/06/08 03/06/08 03/06/08 03/06/08 Nightingale Version 5.2 Page 29 11. OP30 18 12. OP33 24 13. OP36 18 start working at the home. This is to make sure that people who live at the home are protected from potential harm. All staff must be provided with a 03/06/08 programme of induction when they first start working at the home. All care staff who, work with people with dementia, must be appropriately trained to do so. The manager must review the training needs of all care staff and plan any required training within an agreed timescale. This is necessary in order to safeguard and promote the health and wellbeing of people who use the service. Effective internal audits and a quality assurance system, which 17/06/08 include the views of people using the service and of their representatives, must be developed and implemented and their outcomes made available. This will help to further improve the overall service. A plan for regular supervision of staff must be developed and 03/06/08 implemented to enable staff to receive appropriate guidance and support in their work. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The statement of purpose and service user guide should be improved to include all the necessary information, particularly with regards to dementia care, to assist people in making an informed choice about the service. DS0000002990.V358284.R01.S.doc Version 5.2 Page 30 Nightingale 2 3. 4. 5. 6. OP15 OP15 OP19 OP31 OP35 7. OP38 Staff should try to establish the ‘drinks’ preferences of people at mealtimes. Specialised cutlery should be made available to people who may benefit from their use. Appropriate signage should be displayed in communal parts of the home for the benefit of people who have communication difficulties. The manager should apply for his registration with CSCI as soon as possible. Staff should sign when they take the personal money of people, in order to carry out purchases on their behalf. The monies of people should also be managed in a way that promotes their best interest and their entitlements to cost-free services should be pursued. Accidents should be recorded in line with the recommended data protection practice. Nightingale DS0000002990.V358284.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB 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.V358284.R01.S.doc Version 5.2 Page 32 - 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. 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