Inspection on 01/10/05 for Nightingale House

This inspection was carried out on 1st October 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

Nightingale House 13/10/09

Nightingale House 14/09/07

Nightingale House 13/04/06

Nightingale House 24/05/05

Nightingale House 03/09/04

Nightingale House 19/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Nightingale House 22 Elgin Road London N22 4UE Lead Inspector Peter Illes Unannounced Inspection 1st October 2005 09:30 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 House DS0000010741.V252080.R01.S.doc Version 5.0 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 House DS0000010741.V252080.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Nightingale House Address 22 Elgin Road London N22 4UE 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) 020 8889 7885 020 8883 7198 Miss Renouka Devi Sisteedhur Mrs Vijaylaksmi Devi Sisteedhur Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (9), Old age, not falling within any other category (9), Physical disability (3), Physical disability over 65 years of age (9) Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Limited to 9 people of either gender who fall into the category of old age (OP) who may also have a physical disability (PD(E)) and who may also have a mental disorder (MD(E) 3 of the 9 places may accommodate a person of either gender who is between the age of 59 years and 65 years who may have a physical disability (PD) and may also have a mental disorder (MD). Date of last inspection 24th May 2005 Brief Description of the Service: Nightingale House is a registered care home for nine older service users who may also have mental health needs. Three service users may also be younger and have a physical disability and may also have a mental disorder. The home is not registered to accommodate service users with a diagnosis of dementia. The home is privately owned with the registered provider being the daughter of the registered manager. The home is a large converted three storey domestic premises. There are three single service user bedrooms and three shared. There is a single room, a double room and a toilet on the ground floor. The home has a lift to the first floor where there are two single rooms, two double rooms and a bathroom and toilet. The home’s communal areas are on the ground floor and consist of a large sitting room and separate dining area. The kitchen, utility room and a toilet are also situated on the ground floor The second floor consists of the staff sleeping in room/ office. There is a large pleasant garden at the back of the house. The home is situated in a quiet residential street and close to local shops, a library and a public house. It is also situated reasonably close to the larger range of shops and amenities in Muswell Hill Broadway. The stated objective of the home is to enable service users to live independent and fulfilled lives as far as they are able, with dignity and privacy in a tranquil and elegant environment. Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Saturday and lasted approximately three and three quarter hours. The registered manager was out of the country on annual leave at the time. A designated shift leader at the home was present or available throughout the inspection. The shift leader was open and helpful, demonstrating an effective day-to-day working knowledge of the running of the home and the needs of the service users. The home was accommodating nine service users and had no vacancies. The inspection consisted of: meeting all of the nine service users and speaking to eight of them including four independently; speaking independently to the two other care staff on duty and speaking to the registered provider by telephone as part of the inspection. Further information was obtained from a tour of the premises, as well as a range of documentation kept in the home. As the registered manager was on leave certain documentation was not available at the time for inspection. What the service does well: Service users spoken to, who had a range of individual needs, indicated that the personal care they received at the home was of good quality. The home was able to function well on a day-to-day basis while the registered manager was away. Arrangements had been made for additional support to be available to the home from the registered provider while the registered manager was away. All the staff on duty demonstrated a quiet confidence as well as respect for the service users and an awareness of their needs. Staff also had good access to a range of key documentation to assist them in meeting the service users needs. Service users are well supported to address their health care needs with the home accessing external healthcare professionals assistance when appropriate. Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards in this section were inspected. EVIDENCE: N/A Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 7, 8, 9 & 10 Service users needs are clearly set out in their care plans and staff were familiar with these needs. Service users health needs are well monitored and service users are supported in addressing these with relevant health professionals. Service users receive sensitive support with their personal care from staff and are treated with respect by them. EVIDENCE: The full service user files were not available during the inspection as the registered manager was away. Detailed care plans for all service users were available to staff and were seen by the inspector, three care plans were inspected at random. These plans were detailed and showed a relevant variety of needs for each individual and gave clear guidance to staff on how to assist service users meet these needs. The needs recorded included health, medication, personal care, appetite and diet, assistance when travelling in the community and personal care needs as well as a range of individual needs relating to each service user. There was evidence that the care plans were being regularly reviewed. The inspector was pleased to see that one identified Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 10 service user’s care plan had been amended as required at the last inspection. The inspector was also informed that all service users needs had been assessed as part of the review process in order to ensure that care plans were up to date. This indicated that a requirement made at the last inspection regarding ongoing assessment of any changing needs had been complied with. However, full documentation relating to the actual assessment process was not inspected as it was not available in the registered managers absence. Staff spoken to were knowledgeable about the service users needs. There was also up to date and relevant day to day information regarding service users needs recorded in the home’s communication book and in the individual daily logs kept in the home. Staff were also able to talk knowledgably about individual service users health needs one of which of which were relatively complex. One service user needed a substantial amount of physical assistance by staff with daily living tasks and were observed providing this with a great deal of care and sensitivity. Relevant guidance for staff regarding this was seen in that service user’s care plan. Staff informed the inspector that external health care professionals were currently reviewing this service user’s condition. Staff informed the inspector that a community dentist had visited the home and seen all the service users. There was evidence to support this from both the visitor’s book and from independent discussion with service users. A requirement had been made at the last inspection regarding supporting service users to see a dentist on a regular basis and the inspector was pleased that this had been complied with. There was also similar evidence that an optician had visited the home over a two day period since the last inspection to see all service users. There was an additional record in the visitors book that the optician had visited the home again recently to deliver new glasses to service users. There was also a note in the communication book reminding staff to encourage service users to wear their new glasses. Contact details of relevant health professionals for each service user was recorded on individual information sheets that were seen kept with the care plans and which staff were familiar with. Other evidence was seen that a community nurse visits the home to see one service user and that another service user had also been supported to attend a local hospital for an identified medical condition. Medication and medication administration record (MAR) charts were inspected for three service users and were satisfactory. There was also evidence that the dispensing pharmacist had attended the home on 31/8/05 to undertake an annual inspection of the home’s medication procedures. The report of this was not available although the shift leader was of the opinion that this had not been received yet and that there no problems had been identified by the pharmacist. The interaction between staff and the service users was seen to be appropriate and indicated a respectful approach by staff to service users. Service users Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 11 were appropriately dressed and presented. Those spoken to independently indicated that they were satisfied with the support they received with their personal care at the home. Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 15 The home provides a range of social activities to address service users needs and wishes. The overall options available to them however would still benefit from further review. This is to maximise the service users opportunities to participate in more worthwhile activities that they may enjoy. The home provides a range of nutritious meals that service users enjoy. EVIDENCE: One service user attends external day services three days a week and that service user stated that they really enjoyed this. A good practice recommendation was made at the last inspection that the home should review the range of activities available to service users and investigate whether any other structured activities could be arranged that service users may enjoy. There was some evidence that this had been acted on and the inspector was informed that three service users had recently been assisted to register with the local library since then. There was evidence that the home had organised an outing to Southend in the summer and service users and staff both stated that this had been a successful day out. The home has an activities board in the lounge with activities listed for different days including: walk to the shops; various games - indoors and outdoors; discussion on current affairs; reading – library, books, magazines and newspapers and a pub/ café lunch on a Friday Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 13 for more able service users. One of the service users stated that he liked playing cards and did so with another service user. Others said that they liked going out to lunch on Friday when that was arranged by the home. However, on the morning of the inspection one service user, who was able to travel independently had gone out for a walk on his own and returned for lunch. Two other service users went out with a staff member for a walk for a short while, returning before lunch. The remainder of the service users were sitting in the lounge, many looking bored, with the television on. A number of service users indicated to the inspector that they were indeed bored and that there was not a lot to do at the home on any day. Staff stated that they did try to encourage service users to be more active but that it was difficult to motivate many of them to try new activities. The inspector accepts that the service users have a range of differing needs, some of them complex that require significant staff time to deal with. The inspector also accepts that many of the service users are reluctant to try new opportunities that are offered despite stating that they are bored. However given the inspector’s observations and the feedback from service users the recommendation is made again at this inspection. The home has a satisfactory two week menu that was seen. The lunch on the day of the inspection was sausages, mash and vegetables and was seen to be pleasantly presented to service users. The member of staff cooking the lunch stated that she had a current food hygiene certificate. The main meal for the next day, Sunday, was roast chicken and the ingredients for that meal were seen. The home keeps some food stored in the kitchen and further supplies of food kept in the cellar. The inspector checked the food kept in both the kitchen and in the cellar. There was sufficient food stored in the home, including fresh vegetables and fresh fruit. The food was satisfactorily stored and was within its use by date. Service users spoken to stated that they enjoyed the food served and several stated that they also liked going out for lunch when this was arranged by the home. Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 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 the following standard(s): 16 Service users can be confident that any concerns they raise with the home will be appropriately dealt with. EVIDENCE: The home had a satisfactory residents charter and complaints policy that were seen, the complaints policy included the contact details for the Commission. One complaint had been made directly to the Commission in April 2005 and had been satisfactorily investigated by the registered persons. The inspector was informed that no new complaints had been received at the home since the last inspection. Service users spoken to indicated that they could raise issues with the manager or staff if they felt the need. Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 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 the following standard(s): 19, 21, 23 & 26 Service users live in a home that is generally safe, well decorated and well maintained although one identified service user’s bedroom needs redecorating. Service users also have access to an adequate number of toilets and bathrooms that generally meet their needs although the hand washing facilities in one of these needed improving and some routine maintenance is needed in the bathroom. The home was clean and tidy throughout creating a pleasant environment for service users, staff and visitors. EVIDENCE: The home is a converted three storey premises with three double and three single service user bedrooms on the ground and first floors with a lift connecting these two floors. Although somewhat limited by its design the home is generally well decorated, maintained, safe and meets the current service users needs. The home has a wheelchair accessible ramp built to its front door. Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 16 During a tour of the building the inspector noted that there was no hand drying facilities in the first floor bathroom/ toilet. The hand washing facilities in that bathroom also need to be used by anyone using the adjacent separate toilet on the first floor. A requirement is made regarding this. Two tiles were seen to have come away from the wall above the bath and these need re-fixing in place. A requirement is made regarding this. The inspector also noted that the service user’s bedrooms were generally satisfactory with privacy screens available in the shared rooms. One of the single bedrooms, bedroom six, had wallpaper that was significantly starting to lift from the wall in two places. A requirement is made regarding this. The home had satisfactory laundry facilities that were seen and the home was clean, tidy and free from offensive odours. Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29 The home has an effective staff team, in sufficient numbers, to support service users and to assist in meeting their assessed needs. The home must improve the implementation of its recruitment procedures to ensure that service users are fully protected at all times. EVIDENCE: Three care staff were on duty during the inspection, one of these designated as the shift leader. A satisfactory staff rota was displayed in the home that indicated who was in charge of each shift while the registered manager was on leave. The rota showed three staff on duty for the early and late shifts with one waking and one sleeping-in staff at night. The staff on duty matched the rota. The inspector did not inspect the home’s recruitment procedure on this occasion, as the staff files were not available due to the registered manager being on leave. He did however talk to all three staff on duty independently including one staff member that had been recruited since the last inspection. This staff member told the inspector that she had a current enhanced criminal records bureau (CRB) check but that this was from her previous employer. She went on to say that she had applied through the home for a new enhanced CRB as part of the recruitment procedure for her current post but that this had not yet been received. The inspector spoke by telephone to the registered provider during the inspection who confirmed that this was the case. The registered provider stated that the member of staff did not work unsupervised Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 18 and stated that the home was experiencing a real problem caused by the delay in receiving back enhanced CRB’s from that agency. A requirement is made that the identified member of staff must be supervised at all times by a member of staff who has that clearance until a satisfactory enhanced CRB is received. Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 The home has health and safety procedures in place that generally protect service users and others that work or visit the home although staff must remain vigilant in implementing all their fire procedures at all times. EVIDENCE: The majority of the documentation relating to health and safety was not inspected at this inspection. This was primarily due to the registered manager being on leave and that the documentation was inspected and found to be satisfactory at the last inspection. There was evidence on the fire fighting equipment seen throughout the home that it had been serviced since the last inspection. Staff spoken to stated that the home had regular fire drills and were able to tell the inspector what procedures they would follow in the event of a fire. However, when the inspector arrived at the home for the inspection a number of fire doors were wedged open including one at the top of the stairs Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 20 leading to the first floor landing. The shift leader rectified this straight away. A requirement is made regarding keeping the fire doors closed at all times when not in use. No other health and safety issues were identified during the inspection. The shift leader was asked what support he would have access to in the event of a serious incident occurring. He stated that the registered provider had visited the home while the registered manager was away and that he could contact her for advice whenever necessary. The inspector asked the shift leader to demonstrate this by contacting the registered provider at the time of the inspection. The shift leader did this and the inspector was able to speak to the registered provider by telephone. She confirmed that she was visiting and monitoring the care at the home more regularly for the period that the registered manager was on leave. Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X 2 X 2 X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 22 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 OP21 Regulation 13(4) Requirement The registered persons must ensure that there are handdrying facilities in the bathroom on the first floor to minimise the spread of infection. The registered persons must ensure that two tiles in the first floor bathroom are re-fixed in place. The registered persons must ensure that service user bedroom number six is redecorated. The registered persons must ensure that a satisfactory enhanced CRB clearance is received for an identified member of staff. That member of staff must be supervised at all times by a member of staff that has such clearance until the identified member of staff’s clearance is received. The registered persons must ensure that all fire doors are kept closed at all times when not in use unless held open by a device approved by the fire officer. DS0000010741.V252080.R01.S.doc Timescale for action 31/10/05 2 OP21 23(2) 31/10/05 3 OP23 23(2) 30/11/05 4 OP29 19(5), Sch.2(7) 30/10/05 5 OP38 23(4) 30/10/05 Nightingale House Version 5.0 Page 23 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 OP12 Good Practice Recommendations The registered persons should review the range of activities available to service users and investigate whether any other structured activities could be introduced that service users may enjoy and participate in. Nightingale House DS0000010741.V252080.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 House DS0000010741.V252080.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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