Inspection on 11/12/07 for Nightingale Court Residential Home

This inspection was carried out on 11th December 2007.

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

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

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

CARE HOMES FOR OLDER PEOPLE Nightingale Court Residential Home 11 - 14 Comberton Road Kidderminster Worcestershire DY10 1AU Lead Inspector Andrew Spearing-Brown Key Unannounced Inspection 08:30 11 , 12 and 13th December 2007 th 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 Court Residential Home DS0000070151.V352573.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 Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingale Court Residential Home Address 11 - 14 Comberton Road Kidderminster Worcestershire DY10 1AU 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) 01562 824980 01562 740025 Majestic 3 Limited Position Vacant Care Home 43 Category(ies) of Dementia - over 65 years of age (43), Learning registration, with number disability over 65 years of age (4), Old age, not of places falling within any other category (43), Physical disability over 65 years of age (43) Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission are within the following category: Old age, not falling within any other category - Code OP. Physical disability - 65 years and over - Code PD(E). Dementia - 65 years and over - Code DE(E). Learning disability - 65 years and over - Code LD(E) (maximum number of places 4). 2. The maximum number of service users who can be accommodated is 43. New registration Date of last inspection Brief Description of the Service: Nightingale Court is registered to provide care for 43 older people who are frail, who may have physical disabilities or who may have experienced mental health problems. Registration has also been granted for four older people who have a learning disability. Accommodation for people using the service is situated on the ground, first and second floor and consists of single as well as some double bedrooms. All three floors can be accessed by means of a passenger lift although a small number of steps have to be negotiated to reach some rooms on the first floor. Majestic 3 Limited now owns Nightingale Court. Nightingale Court is situated near to the centre of Kidderminster, close to the railway station and also on a bus route, with a frequent service to the town centre. Car parking is available to the rear of the home. As both the Service Users Guide and Statement of Purpose are currently at the printers, following the change in ownership in June 2007, it was not possible to seek information regarding fee levels and what is included within the fee. The Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 5 reader may therefore wish to obtain up to date information from the care service. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Two regulation inspectors from the Commission for Social Care Inspection (CSCI) undertook this unannounced key inspection over a period of three days. At the time of this inspection the home was accommodating 35 people. This inspection is the first to take place since a change of ownership, which took place during June 2007. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was sent to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas where they believe they are doing well. As part of the inspection process a number of questionnaires were sent to a sample number of people using the service, their relatives and health care professionals. A number of completed questionnaires were returned to us prior to our visit. The manager designate was present throughout this inspection also the operations manager was present during the first day of the inspection. Discussions took place with members of staff, some people using the service and some relatives. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen during our visit included medication records and staffing records. What the service does well: The home was clean and tidy with no offensive odours in any communal areas. Throughout the inspection we saw staff upholding people’s privacy and dignity and people using the service engaged in a range of activities. A full time activities coordinator is employed within the home. People using the service are able to maintain contacts outside of the home enabling a good quality of life. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 7 The meals available are well balanced and nutritious. People using the service made a number of positive comments regarding the food during this inspection. Staff were seen assisting people to access food when necessary, this was carried out in a sensitive and unhurried manner. The provider has invested significant resources to improve the environmental standards within the home including improvements in the décor and facilities. This investment demonstrates a commitment to improve standards within the home. People using the service are able to personalise their own bedrooms. The vast majority of training necessary to equip staff with the knowledge and skills to care for people using the service is in place. The number of staff who have an NVQ qualification is above the minimum standards. What has improved since the last inspection? What they could do better: It was reported during this inspection that both the Statement of Purpose and the Service Users Guide were with the printers. As a result no information regarding the service provided was available to either potential users of the service or us. The assessment of a recently admitted person was insufficient in the detail recorded and the care plan drawn up upon admission was also insufficient with no further information added as it became available. Although care plans and risk assessments were in place they were either out of date and in need of reviewing or insufficient in detail and therefore in need of improvement. We had a number of concerns regarding the management and recording of medication. These areas were brought to the attention of the manager designate and the operational manager as they needed to be addressed without delay. Some health and safety concerns were brought to the attention of the manager designate, including the need for some risk assessments to be developed. Further improvements are necessary regarding the environment including some aspects highlighted by an Environmental Health Officer. The complaints procedure is in need of review and needs to be made more readily available within the home. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 8 Although improvements were noted regarding the environmental standards within the home further improvements are necessary. Some bedrooms were noted to be cool and need attention. Other shortfalls were discussed at the time of the inspection including a window restrictor, which needed to be improved, and a malodour in some bedrooms. The manager designate has not as yet made an application to become registered with us and this needs to happen with out delay. Management systems such as supervision and quality assurance are in need of some improvement. Ensuring that the above shortfalls are addressed will assist in service provision and improve outcomes for people using 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 Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 9 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 Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 10 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 1, 3 and 4. Standard 6 is not applicable to this service. Quality in this outcome area is poor The lack of a service users guide to inform people about the service provided denies individuals of written details and clarification regarding the service provided within the home. Pre-admission assessments and initial care plans are insufficient to ensure that the home can meet the individual care needs of people who are going to live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager designate confirmed that a Statement of Purpose and a Service Users Guide have been produced, but that the draft copies were with the printers, and therefore still not available to people who may wish to use the service or for us to view as part of the inspection process. In addition, we were told that a brochure is to be produced, that will provide more information, to assist people to decide if the home can meet their needs. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 11 Concerns were expressed to the manager designate about the extended period of time taken to produce the documentation, particularly in view of the fact that Majesticare has owned the home for the last six months. The importance of being able to measure how well the stated aims and objectives of the home are being met was stressed to the manager designate, therefore it was agreed that a copy would be sent to the Commission as soon as possible. At the time of writing this report we had not received a copy of either of the above documents. We were informed that no statement regarding the home’s terms and conditions had been drawn up in relation to an individual who was admitted into the home just under two weeks prior to this inspection. The initial assessment of the most recently admitted person residing at the home was sought. The details on the assessment were scant and did not give sufficient detail as to how the home would be able to meet care needs. A care plan was written on the day after admission however this was equally scant in detail. No further detail had been added to the care plan from that date to the day of the inspection. Nightingale Court is registered to care for people with a dementia type illness. According to a board on display within the office the majority of staff have attended specialist training while others are due to partake in training in the foreseeable future. Intermediate care is not provided at Nightingale Court and no plans exist to provide this service in the future. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 12 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 adequate. The care needs of people using the service are not consistently set out within care plans and risk assessments. These documents are not up to date in order to ensure that care needs are fully met. The management of medication needs to improve to ensure practices are safe. Staff demonstrated a good understanding of the needs of the people who use the service, and offer care in a way that encourages and promotes their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A random selection of care plans were viewed on the first day of this inspection. On viewing care plans a number of concerns were noted which were brought to the attention of the manager designate. It was noted that handover sheets used to relay information from one shift to the next contained reference to somebody having red hips on numerous Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 13 occasions. Due to these comments the care plan was viewed. The care plan made reference to pressure damage but it made no reference to the person’s hips, therefore it was not possible to assess how this care need was managed. The risk assessments regarding pressure care as well as other areas of care need were last reviewed during August 2007 and contained no up to date information. A sheet entitled Majesticare Assessment highlighted areas where care needs required a care plan to be in place. Under communication, the assessment stated ‘ Has communication deficits e.g. deafness, confusion, sight.’ The next column was headed ‘State deficits here’ but this section was blank and no care plan regarding communication existed, therefore it was not possible to establish via documentation what the care need was or whether it was being met appropriately. When a care plan did exist, the identified actions were global and not sufficiently detailed, using terms such as ‘requires the assistance of 1 carer.’ We found information suggesting that a person’s dietary assessment came to the conclusion that nutritional supplements may be required, however we could find no evidence that this course of action was being followed. A tick list to demonstrate that personal care tasks such as mouth care and the application of creams was not completed as necessary to evidence that these tasks were carried out. We found some similar shortfalls on another care plan whereby no monthly reviews had taken place on the care plan to reflect changing care needs. No care plan was drawn up following the fact that the person was unwell and taking antibiotic medication. As part of this visit we inspected the management and administration of medication. A trolley is provided to transport medication around the home. The senior person on duty holds the keys to the medication. We were assured that nobody else would be able to access the key ring on which the medication keys are held. The treatment room contains suitable wash hand facilities. A sample of the current months MAR (Medication Administration Record) sheets were view and in some cases cross-referenced to the care plan concerned. Although some areas of good practice were seen we also had a number of concerns. These concerns were brought to the attention of the manager designate and the operations manager. • • As a list of specimen signatures was not held it was not possible to verify the initials on the MAR sheets. The date of opening was not recorded on boxed medication therefore it was not possible to undertake a full audit. DS0000070151.V352573.R01.S.doc Version 5.2 Page 14 Nightingale Court Residential Home • An audit of a prescribed course of liquid antibiotic medication was incorrect in that it showed too many signatures for the amount of medication available. The majority of MAR sheets were completed satisfactorily, however a number of gaps were evident on some sheets whereby staff had failed to sign that medication was given or record a code as to why medication was not given. Incorrect coding was at times used or no explanation was given for the use of a code. A small number of MAR sheets were over signed by carers suggesting that medication records are not signed following administration. Hand written entries on MAR sheets were not double signed to verify that a second person had checked the original entry. One MAR sheet suggested that one tablet had run out for a period of time. Referring to the care plan and previous MAR sheets it was difficult to establish whether the individual concerned should have been taking the medication or not. An urgent medication review was therefore needed to establish the correct regime. The controlled drugs register was checked against the actual number of drugs held and balanced. However some concerns were evident. The apparent reduction in a drug regime was insufficiently recorded on the care plan and on daily notes resulting in conflicting information, which could of potentially resulted in a drug error. • • • • • Observations made during the inspection and discussions with people using the service confirmed that individuals are involved in making decisions about their daily lives. With support from staff to do as they wish, people are treated with respect and consideration at all times. Individual’s privacy and dignity is observed, and people are encouraged to be as independent as possible. People were seen to be doing various things throughout the home. The activities co-ordinator was working with several individuals seated around a table. Elsewhere some people were having their hair done while others were in the sitting rooms and either chatting, reading, knitting, watching television or just snoozing. People using the service confirmed to us that they can go to bed and get up when they choose. One individual was visited in his room at 10.30am and was found to be fast asleep in bed. He later stated that he doesn’t stay there all the time, but gets up when ready. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 15 Another gentleman being visited by his wife was unable to communicate verbally, but her comments were very positive; ‘ I am very satisfied with the care here, everything is very good, there have been noticeable improvements recently, and the new manager has made a big difference’. Discussions with staff confirmed that there is a choice of food at mealtimes, that people always wear their own clothing, that people have access to the telephone, and people are given their mail unopened, or are supervised if necessary. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 16 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. The social, emotional and spiritual needs of people using the service are identified, and various recreational opportunities provided to ensure their interests are fulfilled. People who live at the home have freedom in regard to their contacts, both within and outside the home, which enables a good quality of life to be maintained. People are offered a choice of nutritious, wholesome and well-balanced meals that helps in maintaining their health and wellbeing, although to ensure that standards are maintained adequate staffing is necessary and also all catering activities should be supported by risk assessments. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People using the service have freedom of choice in regard to their contacts, both within and outside the home, and they are enabled to make choices with regard to the activities of daily living, how to spend their day, and whether or not to join in the various pastimes. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 17 The home employs an Activities Co-ordinator, who works for 37 hours each week directly with residents, to ensure that people who live at the home are provided with opportunities for stimulation, and are enabled to do the things they enjoy. There is a daily timetable of proposed activities, although this is not always followed precisely, the co-ordinator explained, as sometimes it is necessary to respond to the atmosphere in the home at the time. The activities can be individual, one to one sessions or in groups, which are usually in-house, although sometimes involve outside interests. Activities provided include the following: shopping trips, pub visits for a meal or just for a drink, playing board or card games, craft work, watching a video or television and discussing current affairs, reminiscence, doing a quiz, enjoying a pampering session, being entertained, singing and dancing, or movement to music, and pet therapy – a donkey visits the home each month. In addition there is a monthly church service, with a choir to lead the hymn singing, and individuals are also enabled to attend church if they wish. Visits have also been made during recent months to Weston-Super-Mare, West Midlands Safari Park, and the Walsall Illuminations. The co-ordinator showed us the documentation relating to the activities organised at the home, and explained that a life history is developed for each person, with the help of family and friends and includes photographs, to create a profile of their likes and dislikes, and their previous interests. A report is maintained of the activities undertaken by each individual, and also the outcome, and these are reviewed each month. The various activities are supported by risk assessment, to promote the safety of those individuals taking part and to enable them to retain as much independence as possible. This is good practice and is commended. The involvement of friends and relatives at the home is actively encouraged, and everyone was positive about the standard of care at the home and the services and facilities provided. One relative who visits regularly was very positive about the way her husband has improved recently. The manager designate said that meetings are held with family and friends occasionally, and it is proposed that the frequency of these will be increased in the future, which should encourage more involvement. There is one person living in the home who is without any immediate family. The manager designate undertook to seek the involvement of advocacy services to ensure that appropriate decisions are made in the best interests of anybody without any immediate family. The catering arrangements at the home are satisfactory, and comments about the meals were all very good. One resident said, ‘I am given an alternative if there is something I don’t like’, and another person was very complimentary Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 18 about the food stating, ‘it’s always very good’, while a third person called at the office to say ‘how much he had enjoyed his breakfast’. The menus showed that a choice of meals is offered, except on Sunday when a roast lunch is served, and then an alternative can be provided if requested. We were told that discussions take place with people using the service about the menus and that their preferences are taken into consideration when menus are planned. The manager designate explained that the way in which food is provided at the home has been reviewed, as many people with a dementia type illness are unable to remember the meal they had ordered, and would often want something different when reminded. People are therefore shown the options available and make their choice at the time the food is served; this practice was seen taking place during the inspection and appeared to be beneficial. We observed carers assisting people in eating and drinking in a sensitive manner. On the first day of this inspection the main midday meal was a choice of either corned beef hash or fish fingers with parsley sauce. The menu for the day is recorded on a free standing chalk board in the dining room, and the manager designate agreed that this could cause a tripping hazard, therefore the practice is to be stopped, and replaced with a more appropriate one. We viewed the kitchen, which was clean, tidy, and organised with a wellstocked pantry, and time was spent talking with the chef, who has worked at the home for over eight years. She said that, ‘residents are consulted about the meals, and a list of likes and dislikes is maintained. Special diets can be provided although this only includes diabetic at present’. Fresh fruit and vegetables are used whenever possible, and snack stations are placed in each lounge, which are like a fruit bowl, but include sultanas, apricots, crisps, cheddars, biscuits and cakes. The home received a recent visit from an Environmental Health Officer, when several recommendations were made, the majority of which have been implemented, although the floor in the kitchen is still to be replaced as the seal has become detached in places. The ‘Safer Food, Better Business’ system, produced by the Food Standards Agency, which was developed to help compliance with the regulations relating to food management, has been introduced at the home, although this needs to be fully implemented to ensure that the appropriate documentation is maintained. Food Hygiene training is provided for all staff who handle food, and the chef has a City & Guilds qualification. Concerns were identified about the apparent shortage of catering staff and kitchen assistants, mainly due to long term sickness absence, and that shifts Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 19 were being covered by care staff, although we was assured that catering and caring duties were not allowed to overlap. The possibility of using agency staff to relieve the situation was discussed with the manager designate who agreed that consideration would be given to this solution. The need for detailed and thorough risk assessments to be completed for various aspects of the work in the kitchen, were discussed with the chef and the manager designate, to include items of machinery and equipment such as the deep fat fryer, the cooker and the food mixer. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 20 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 17. Quality in this outcome area is adequate The current complaints procedure is insufficient and is in need of revising to ensure that people are aware of their right to complain and to who they are entitled to raise concerns. The policy and procedures in place at the home relating to abuse should enhance the protection of the people who live there, but will be more effective when the management can confirm that all staff are fully familiar with them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection decorators were working in the main reception area of the home. As a result the complaints procedure, which was reported to be normally on display, was temporally removed. As mentioned earlier within this report people using the service currently do not have access to a service users guide and therefore no other information regarding complaints is readily available to them. The complaints procedure usually on display was shown to us, however the font (size of type) used was very small which could potentially make it difficult for some people to read. The procedure did not meet the standard as set out within the National Minimum Standards for Older People in that it failed to give a contact address for the Commission for Social Care Inspection. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 21 A satisfactory policy and procedure on adult protection at the home has been produced, and includes whistle blowing, managing violence and aggression, and the physical restraint of an individual. The manager designate said that these documents have been reviewed recently to ensure the protection of everyone at the home, but there was no evidence to show that staff had read the policies, therefore it was agreed that a signature sheet would be introduced. Discussion with several members of staff confirmed their understanding of whistle blowing, and that they are familiar with the Department of Health publication ‘No Secrets’. The manager designate demonstrated an understanding of the procedure to be followed in relation to staff who may be unsuitable to work with vulnerable people. However the need to bring to our attention any allegations of potentially abusive situations was reinforced during this inspection. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 22 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 adequate The programme of improvement and upgrading of the home is helping to enhance the quality of life for people who live there. Although not all the work has yet been completed this demonstrates a commitment to improve. People live in a pleasant environment that is clean and tidy, some health and safety issues and bedroom temperatures need to be addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nightingale Court was converted originally from four Victorian houses, and has been extended and upgraded to provide the present 3-storey accommodation, although this requires continual attention and regular maintenance. Specifically there are some wooden doors and windows that are in need of repair or replacement. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 23 The grounds, although not extensive, are accessible to people using the service. The fencing has been made more secure around the back of the home and the front garden has been replanted. The acting manager explained that they are to be further developed, to provide additional facilities for people during the better weather. A tour of the building was undertaken and we viewed several bedrooms. The rooms seen appeared to be comfortable and well personalised, and had been furnished and decorated to a reasonable standard. It was however noted that some bedrooms felt rather cool or chilly in comparison to the corridors and other bedrooms. The manager designate explained that this concern had been referred to the heating contractors for investigation; clearly with the winter months here this needs to be attended to as a matter of urgency. The use of some of the rooms on the second floor of the house is being reviewed. The manager designate explained that one room is now used as a training room for staff. Some of the rooms in the eaves of the house have a sloping ceiling that restricts movement and could create a hazard for both the person living in the room and staff. The need for risk assessment was identified, and also for furniture to be placed strategically to prevent a head injury. Several areas of the house have been upgraded as part of the ongoing refurbishment programme, which has further improved facilities for people who live and work at the home. These include redecoration of the communal areas, replacement of the handrails throughout the house, new carpeting and furnishings, specifically the new, good quality drapes in the lounge. In addition there are several projects underway to further improve the environment these include providing a dedicated hairdressing salon, upgrading bathrooms and providing assisted baths, a new shower room, a computer room, introducing en suite facilities, and the purchase of a new hoist. Wheelchairs are currently stored in a bathroom, due to a lack of suitable storage. It was noted that some wheelchairs had their footrests missing which can be a potentially hazardous practice due to the risk of entrapment. Window restrictors are in place to prevent accidental or deliberate falling to the ground. The restrictor seen in one empty bedroom was believed to be unsuitable and in need of review to ensure that the health and safety of people using the service was maintained. The home is clean and fresh throughout all the communal areas, however there are some rooms that persistently have a malodour, although the manager designate confirmed they had been given intensive attention and the carpets replaced. These are to be further investigated to ensure that any adverse odours are eliminated. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 24 Staff confirmed that they are familiar with the procedures regarding the control of infection, and that they have also been given training in continence management and health and safety matters. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 25 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. Staffing levels are sufficient to meet the needs of the people who live at the home. A commitment to NVQ training for staff, together with a relevant training programme, helps to ensure that the majority of staff have a clear understanding of their role and are able to deliver the appropriate care for people using the service. People using the service are protected by the recruitment and selection procedures that are followed by the management of the home. EVIDENCE: We were provided with staff rotas covering a three week period prior to this inspection. The rotas confirmed the number of staff on duty. The manager designate considers that care staffing levels are adequate for the needs of the people who live at the home. People using the service also confirmed this in the course of conversation, and comments from visitors to the home were complimentary about the staff and the care provided. We were informed that the reliance on agency staff is no longer necessary therefore providing continuity of care. Staff were seen to be very kind with the people they support, and evidence was seen of their commitment to maintaining a good standard of care. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 26 There has been a high incidence of staff change during the last few months, although there is a small, stable group who have worked at the home for several years. In addition the home has experienced several recent management changes, and some staff voiced their concerns about the need for a more settled period. The manager designate confirmed that the company is aware of the need for stability in order to ensure that a good standard of care can be maintained, and are dedicated to developing, ‘a superlative quality of life’ for the people who live at the home. They are also working towards achieving the Investors in People Award. Meetings with care staff are held bi-monthly, and meetings are also arranged with the ancillary staff, the acting manager said. In addition separate meetings are held with the night staff occasionally. Following discussion the manager designate proposed to increase the staff meetings to monthly, to ensure the highest level of communication is maintained. There is a commitment by the management of the home to providing a relevant training programme for staff, to ensure that people are care for by a competent team. It was however of some concern to discover that some staff working within the kitchen do not hold a basic food hygiene certificate. On arrival at the home the manager designate was in the process of arranging some courses for staff to attend in the coming year. An individual training and development assessment and profile is maintained for each member of staff, and a record kept of the training undertaken at the home, which covers both statutory and care related courses. The training matrix in the office clearly shows the training that has been provided for staff, during the past six months and includes the following: moving and handling, health and safety, basic first aid, fire safety, basic food hygiene, infection control and COSHH (Control of Substances Hazardous to Health). In addition, staff have attended care related training sessions on the administration of medication, dementia care, and abuse awareness. Five staff members hold the full First Aid at Work certificate. The commitment of both management and staff at the home to the National Vocational Qualification (NVQ) training scheme is commendable. Twelve members of staff have achieved the NVQ Level 2 in Care, and five staff are currently working towards the qualification. Four staff have the NVQ Level 3 in Care, and three more staff are doing the course. One person has the NVQ Level 4 and a further three senior staff are studying for the award. The number of care staff who hold an NVQ is equivalent to 65 of the total number employed which is in excess of the National Minimum Standard. There is noone working at the home who is a NVQ Assessor, therefore an external agency is used, but the acting manager expressed her intention to undertake this training as soon as possible. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 27 Staff who spoke to us confirmed that they enjoy their work, and all were very positive about being employed at the home. They said that induction training was provided, when they began their employment, and also confirmed that other training opportunities have since been available to them. A satisfactory policy is in place at the home in regard to recruitment and selection, which should ensure the safety and protection of the people who live at the home. The files of three members of staff were inspected, and the correct procedures had been followed. Relevant information is recorded and appropriate documentation is in place, and includes evidence of Criminal Records Bureau (CRB) checks undertaken prior to employment, an application form, two written references, health check, proof of identity, birth certificate, and training certificates providing evidence of qualifications. An interview report form is also completed. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 28 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, 34, 35, 36 and 38 Quality in this outcome area is adequate Both a quality assurance system and formal staff supervision need to be fully implemented to ensure that the home is run in the best interests of people using the service and provides appropriate care. The health, safety and welfare of people are generally promoted in respect of safe working practices, although some areas need to be developed or improved to ensure that people are fully protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although the manager designate has been working at Nightingale Court since the end of August 2007 no application for registration has been made to us. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 29 This now needs to happen without further delay in order for us to consider the application. The manager designate stated that she has worked in the care industry for 22 years. She informed us that she holds the Registered Managers Award (RMA) and a NVQ (National Vocational Qualification) level 4 in care as well as currently working towards a Diploma in Dementia Care. A quality assurance system has yet to be fully implemented within the home. A user satisfaction questionnaire entitled, ‘Living in the Home’, has been developed for people using the service, and their relatives. The need for further consideration to be given to seeking the views of professionals and other people associated with the home, and their experience of the service, was discussed with the manager designate. Once these systems are fully in place the results as to how the home is succeeding against their stated aims and objectives need to be collated, audited and published. The manager designate confirmed that staff do not have any involvement with the financial affairs of people using the service. Arrangements are in place for the family or a representative to take responsibility, where an individual lacks capacity or does not wish to be involved. Verbal confirmation was given in regard to the financial viability of the home. Appropriate insurance cover is provided, in respect of all aspects of the business, and the certificate was viewed during the course of the inspection. A business and financial plan for the home should be produced, and submitted to the Commission. People using the service are able to deposit small amounts of money in safekeeping at the home. We viewed the records held and checked the available balance in relation to a small sample of people and found them to be in good order. A procedure for the formal supervision and appraisal of staff has been developed, and the manager designate said that the process is being introduced, although not yet fully implemented. The importance of providing regular, ongoing supervision for all care staff was discussed, and the manager designate was advised that the format should reflect the process recommended in the National Minimum Standards, and cover care practice, philosophy of care in the home and career development needs. The training needs of staff, when identified through this process, should then inform the training programme. A health and safety policy and procedure is in place, and training in safe working practices is provided. We were able to speak with the newly appointed person with responsibility for the upkeep of the building, and he confirmed that a maintenance programme is being developed, that regular servicing arrangements are in place, and that Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 30 the equipment is in good working order. The records seen during the inspection relating to health and safety were well maintained and the certificates that were not available at the time of the inspection were subsequently provided to the Commission. The Fire Log shows that weekly checks of the fire alarm system are being done. In addition, the automatic closures are checked to ensure that the doors close fully on to their rebates. Further discussions identified that the emergency lighting is also checked, although had not been recorded. Fire drills and practices have been organised with an external trainer, and fire awareness training for staff is provided, although this should be undertaken every three months. The Fire Risk Assessment for the home has been completed. Some other health and safety matters are highlighted elsewhere within this report including the need for suitable risk assessments and window restrictors. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 31 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 1 X 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 2 17 X 18 3 2 X 2 X X X 2 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 2 3 2 X 2 Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Not applicable as this is a newly registered service. 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 OP3 Regulation 14 (1) (a) Requirement Each person must have an assessment of care needs compiled prior to their admission so that they can be confident that their needs can be met. Timescale for action 31/01/08 2 OP7 15 (2) Care plans must be in place and 31/01/08 up to date, clearly identifying the care needs of individuals and the actions necessary to ensure a consistent and appropriate approach to delivering care. When medication is administered to people using the service it must be carried out accurately and clearly documented to ensure that people receive their medication as prescribed. Attention must be given to the central heating system in order to maintain a suitable environment for the comfort of people using the service. The care manager designate must, without further delay, DS0000070151.V352573.R01.S.doc 3 OP9 13 (2) 11/12/07 4 OP25 23 (2) (p) 31/01/08 5 OP31 8 (2) 31/01/08 Nightingale Court Residential Home Version 5.2 Page 33 6 OP38 13 4 (a) submit an application for registration to the Commission. Windows within the home must be assessed for the risk they present to people using the service and action taken to minimise any identified risk. 31/01/08 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 availability of the Statement of Purpose and the Service Users Guide should be expedited to provide prospective residents with the information they need to make an informed choice about their future care needs. Advocacy services should be arranged for people without immediate family or friends to ensure that any decisions that need to made are in the best interests of the individual. The freestanding chalkboard in the dining room should be removed, as it could be a tripping hazard. The Safer Food – Better Business system should be fully implemented by catering staff to ensure that appropriate documentation is maintained. Risk assessments should be undertaken and the findings recorded in relation to catering activities and equipment in the kitchen to ensure the safety and protection of staff. Consideration should be given to providing additional staffing in the kitchen to cover long-term sickness absence, and to ensure that appropriate standards are maintained. A system should be introduced to confirm that all staff have read and understand the policies and procedures that DS0000070151.V352573.R01.S.doc Version 5.2 Page 34 2 OP14 3 4 OP15 OP15 5 OP15 6 OP18 7 OP18 Nightingale Court Residential Home are in place to ensure that the home is able to fulfil its stated purpose. 8 OP19 The wooden doors and windows and the kitchen flooring should be repaired or replaced to ensure that people using the service and staff continue to live and work in a safe and well maintained environment. The grounds and gardens of the home should be further developed to enhance the facilities available for people using the service during the summer months. The proposals for upgrading several areas of the home, which will further improve facilities and ensure that the physical environment meets the needs of people using the service, should continue. A review should be undertaken, followed by appropriate action, to reduce the risk of injury in the bedrooms with a sloping ceiling on the second floor of the home. Further action should be taken to eliminate the persistent malodour in some bedrooms to ensure that residents have a pleasant environment in which to live Every effort should be made by the management to ensure the stability of the staff team is maintained for the benefit of both the staff and residents. In order to maintain clear lines of communication with staff, more frequent and regular staff meetings should be organised. Further consideration should be given to the care manager undertaking the training to become an Assessor for the National Vocational Qualification. A quality assurance system should be implemented fully to ensure that the home is run in the best interests of the people who live there. The programme of supervision for care staff should be implemented fully, and cover care practice, the philosophy of care in the home and career development needs. A full test of the emergency lighting system should be undertaken to ensure that it is functional and the regular safety checks should be recorded. 9 OP20 10 OP20 11 OP23 12 13 OP26 OP27 14 OP27 15 OP28 16 17 18 OP33 OP36 OP38 Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 35 19 OP38 Fire awareness training for staff should be provided every three months to ensure the safety and protection of the people who live and work at the home. Nightingale Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Worcester Local Office 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 Court Residential Home DS0000070151.V352573.R01.S.doc Version 5.2 Page 37 - 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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