Inspection on 07/07/05 for Whitehaven (Gold Care Limited)

This inspection was carried out on 7th July 2005.

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.

Other inspections for this house

Whitehaven (Gold Care Limited) 26/05/09

Whitehaven (Gold Care Limited) 07/01/09

Whitehaven (Gold Care Limited) 24/01/07

Whitehaven (Gold Care Limited) 25/11/05

Whitehaven (Gold Care Limited) 05/11/04

Whitehaven (Gold Care Limited) 03/08/04

Whitehaven (Gold Care Limited) 31/03/04

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

CARE HOMES FOR OLDER PEOPLE Nightingale (Gold Care Ltd) 218-220 Kettering Road Northampton Northants NN1 4BN Lead Inspector Sarah Smart Unannounced 7th July 2005 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 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 (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Nightingale (Gold Care Ltd) Address 218-220 Kettering Road Northampton Northants NN1 4BN 01604 626272 01604 626272 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Gold Care Limited Mrs Sharon Sooriah Care Home with Nursing 19 Category(ies) of DE(E) Dementia - Over 65 (19) registration, with number DE Dementia (19) of places Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. No person under 50 years of age who falls within the category DE may be accommodated in the home. 2. The home may continue to accommodate two named service users whose needs fall within the category Mental Disorder over the age of 60 who were accommodated in the home prior to re-registration with CSCI. Date of last inspection 5th November 2004 Brief Description of the Service: Nightingale is a care home providing twenty-four hour care for up to 19 older people. The home is situated close to the centre of Northampton overlooking a large area of parkland. The home comprises a three-storey building, with off road parking to the rear of the house, and an enclosed garden area. The garden has been landscaped and provides a very pleasant, safe area for service users’ use. An awning has been fitted over a paved area just outside the back of the house to create a covered area for smokers. The original frontage of the house has been retained so that the home blends in with others in the road. There are two lounges a dining room and a sun lounge. Bedroom accommodation is in single and shared rooms, some of which have en-suite washbasins and toilets. Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was undertaken between the hours of 10.35am and 15.30pm. Preparation for the inspection included review of the pre inspection questionnaire, planning of the areas to be covered, and discovering the previous requirements made. The planning took approximately 1.5 hours. The pre-inspection questionnaire had been completed and returned to the inspector prior to the inspection. The primary method of inspection used was ‘case tracking’. This involves selecting a number of service users and tracking their care and experiences through review of their records, discussion with them, the care staff and observation of care practices. The following areas were covered during the inspection: case tracking, medication, sample of policy review, staff rota, staff files, accident records, complaints records, previous requirements made, and staff interviews. None of the service users in the home were able to give the inspectors feedback about living in the home. Therefore, direct observation of care was carried out. Three service users were case tracked. Three staff members, plus the manager, were interviewed at length, and several others briefly. What the service does well: Staff were meeting the needs of the service users at the time of the inspection, and demonstrated a good knowledge of the service users in their care when interviewed by the inspector. There were adequate staff on duty for the number of service users accommodated. Care plans were generally written to an acceptable standard, and showed evidence of the service users or relatives involvement in their writing. A dementia care plan was written to a high standard. Service users wishes in the event of their death were recorded, and the death policy gave adequate and correct information. Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 6 Staff demonstrated a good knowledge of the complaints procedure and the action to be taken in the event of an allegation of abuse. The home have not received any complaints since the last inspection. The home appeared clean and tidy at the time of the inspection. What has improved since the last inspection? What they could do better: Healthcare assessments are not carried out in any area for any service users, and these should be introduced at the earliest opportunity. The statement of purpose does not include one of the eighteen pieces of information outlined in schedule 1, meaning that the service users may not be adequately informed about the home. One service users care plan did not identify or advise the reader of the possible triggers for his aggression. The medication policy omitted to give some information, and the recording of medication did not extend to variable doses. The complaints policy did not advise that a complainant may approach the Commission for Social Care Inspection at any time. Staff files were not adequate, meaning that service users are not protected by robust recruitment practices. The confidentiality policy should contain further information. Accidents reviews should be recorded to ensure that injuries are not missed, and guidelines in relation to one service users accidents should be written. Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 Information and documentation was not thorough, although service users needs were met. EVIDENCE: The statement of purpose did not contain one of the eighteen pieces of information outlined in schedule 1. this was the room sizes. The manager stated that these would be added in the form of an appendix. Therefore a requirement has not been made. Contracts were seen on each file of the service users case tracked. These contracts did not state the room to be occupied by the service user, however the manager stated that such information is now included on the contracts for new service users. This was reflected in the admissions policy. Two of the service users files contained assessments, the third did not. The assessments viewed did not cover all areas outlined in standard three. The manager stated that these assessments were carried out many years ago, before the current requirements in relation to assessments were followed. Therefore, the manager is recommended to review these assessments, in line with the service users current needs, covering all of the areas in this standard. Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 10 Documentation indicated that service users needs are met. From observation of care practices, and discussions with care staff, this was reinforced. Staff demonstrated a good knowledge of the service users needs. Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,11 Service users healthcare needs are not identified and therefore there is a significant indication that they may not be met. EVIDENCE: The care plans belonging to three service users were viewed, and found to contain a satisfactory standard of information. In one instance the care plans were agreed by the service users daughter, and in another it was documented that the service user was unable to sign the document. The dementia care plan for one service user was written to a high standard, and all care plans had been reviewed timely. In one instances two care plans for the same service user gave conflicting advice in relation to his nightime toileting needs. His care plan for aggression did not indicate triggers for aggression. Healthcare assessments were very limited, and had not been completed in any of the cases viewed. One service user had been identified as at risk nutritionally, yet had not had an assessment carried out. The manager stated that the assessments will be introduced soon, however a requirement has been made to ensure that service users needs are identified at the earliest opportunity. Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 12 A sample of medication was viewed. Variable doses were not recorded in all instances. There was an error in the records pertaining to night sedation, however further investigation indicated that the error was only in the recording and not in the number or administration of the medication. All other records pertaining to medication were satisfactory. The medication policy gave adequate instruction should a service user wish to self medicate. I.e. a risk assessment. In relation to drug errors the policy did not state that the GP or the Commission for Social Care Inspection must be notified. The policy covers covert administration of medication, however it does not state that the pharmacists advice should be sought if tablets are to be crushed etc. Service users wishes in the event of their death were recorded in the care plans. The death policy was satisfactory. Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed at this inspection. EVIDENCE: These standards were not assessed at this inspection. Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Service users are not informed of the correct complaints procedure. Staff are aware of the action to be taken to protect service users. EVIDENCE: The complaints policy stated that a complaints file is maintained, however the manager stated that this is not the case. The policy does not state that the Commission for Social Care Inspection can be contacted at any time by a complainant. The manager added that there have not been any complaints made since the last inspection. Staff spoken to demonstrated a good knowledge of the action to be taken if they receive a complaint. The home have the Northamptonshire Inter-agency policy on abuse. Staff spoken to demonstrated a good knowledge of the action to be taken should they witness an incident. Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 26 Hygiene and cleanliness of the home is maintained. EVIDENCE: Communal areas of the home were clean and tidy, and maintained to a high standard. Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 Staffing levels were adequate, but recruitment practices did not protect the service users. EVIDENCE: The staff rota demonstrated that there is one trained nurse on duty 24 hours per day. In addition to this there are 4 carers on a morning shift, 3 carers on an afternoon shift, and currently one carer at night. The manager stated that from next week there will be two carers on each night shift. It was noted that some members of care staff are working excessive hours i.e. 8 or 9 shifts per week. These staff members had signed a working time directive opt out agreement, and the manager stated that their performance is monitored to ensure that there is no impact upon service users from tired staff. A sample of staff files demonstrated that safe recruitment practices are not followed. One file contained one reference, and one open reference, plus a Criminal Records Bureau check. A second file contained only one reference and no Criminal Records Bureau check. The manager appeared unclear as to whether a Protection of Vulnerable Adults first check had been obtained, however there was no evidence of it available. Another file had a Criminal Records Bureau check but no references. The manager stated that this person had been employed via a recruitment agency, and references were awaited. The final file contained a Criminal Records Bureau check, and one reference, however this was not from the staff members previous employer. The current requirements in relation to references and Criminal Records Bureau checks Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 17 was reiterated to the manager. Other documentation in the staff files was maintained to a high standard, for example, a signed job description, appraisal record, health checks, and equal opportunity monitoring. Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38 partially Additional records are needed in relation to accidents, and some policies should contain further information. EVIDENCE: A sample of policies was viewed. The home have purchased a set of policies from an independent company. The confidentiality policy was limited, and did not include such information as the divulging of information over the telephone or by fax, contact with the media, or conversations between staff outside the work environment. The policy in relation to quality assurance did not state how often views would be sought. Accident records indicated that there are no trends in the incidence of accidents. Reviews 12 and 36 hours after accidents were not recorded. One service user was noted to often have falls, sometime where he has been observed to place himself upon the floor. It was left to the staff member on duty to decide whether this should be recorded as an accident or not. It is Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 19 recommended that in such a case, clear guidelines are written for staff to follow when deciding whether the service users being on the floor should be recorded and treated as an accident. Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 1 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x x x x x 3 3 Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 21 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 8 Regulation 12(1) Requirement Healthcare assessments must be recorded and reviewed timely for all service users in relation to pressure sore risk, nutritional risk, and continence. Variable doses must be recorded when administering medication. Staff must have two references, one of which is from their most recent employer, and a Criminal Records Bureau check before commencing employment. Timescale for action By 30.8.05 2. 3. 4. 9 13(2) By 5.8.05 29 19 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. 2. 3. Refer to Standard 3 9 38 Good Practice Recommendations Assessments should cover all areas of standard 3, and be reviewed timely. The medication policy should include a risk assessemnt for who request to self medicate, and further information in relation to durg errors and the crushing of tablets. Guidelines should be written to instruct staff when to record a service users issues of laying on the floor as accidents. C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 22 Nightingale (Gold Care Ltd) 4. 5. 37 38 The confidentiality policy should contain further information. Reviews following accidents should be recorded 12 and 36 hours following an accident. Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Nightingale (Gold Care Ltd) C51 C08 S60368 Nightingale (Gold Care) V232221 070705 Stage 4.doc Version 1.30 Page 24 - 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. 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