Inspection on 14/09/07 for Nightingale House

This inspection was carried out on 14th September 2007.

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

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

Other inspections for this house

Nightingale House 13/10/09

Nightingale House 13/04/06

Nightingale House 01/10/05

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 7UE Lead Inspector Duncan Paterson Key Unannounced Inspection 14th September 2007 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.V350613.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 House DS0000010741.V350613.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingale House Address 22 Elgin Road London N22 7UE 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 Roshanlall Sisteedhur Care Home 9 Category(ies) of Dementia - over 65 years of age (9), Mental registration, with number disorder, excluding learning disability or of places dementia (3), Mental Disorder, excluding 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.V350613.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 13th April 2006 Brief Description of the Service: Nightingale House is a registered care home for nine older people who may also have a range of additional needs - see the category and conditions of registration. The home is privately owned and managed by the Sisteedhur family. The home is a large converted three storey domestic premises. There are three single bedrooms and three shared bedrooms situated on the ground and first floors with a lift providing access to the first floor. 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. The home is also reasonably near the larger range of shops and amenities in Muswell Hill Broadway. The current minimum charge at the home starts at £500 per week and may rise according to the persons assessed needs. Additional charges may be made for personal items such as newspapers and toiletries and for hairdressing and chiropody. A range of information, including CSCI inspection reports, is shared with people using the service at regular meetings. The information is on display on a notice board in the home. Inspection reports are also made available to prospective residents and their representatives as part of the referral process. The stated objective of the home is to enable people 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.V350613.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place on 14 September 2007. The inspection involved speaking with each of the six people resident that day, the staff on duty and the manager. Care managers and relatives were spoken with on the telephone after the inspection and a small number of questionnaires were received. A standard form, the Annual Quality Assurance Assessment (AQAA), was returned to CSCI by the manager and this was taken into consideration. The inspection also involved the case tracking of three people’s care, the assessment of a range of the home’s records, procedures and forms as well as observation and a tour of the premises. What the service does well: The home is small with registration for a maximum of nine people. The manager and staff have been successful in creating a friendly, caring and warm atmosphere for people using the service. Staff know the residents well and carry out their work in a relaxed and friendly manner. Some of the people using the service have lived there for many years. People using the service said that they liked the staff and got on well with them. Relatives spoken with said that staff were, “very caring and co-operative”, and always, “welcoming”. A health care professional, responding via a questionnaire, said that the service was, “well organised, highly professional, responsive and caring.” People using the service have a diverse range of backgrounds. Staff are able to address this sensitively and professionally and provide good individualised care for each person. This is helped as there is, in the home, an overall good knowledge about residents’ needs as well as clear, concise care plans. Contact with relatives is good. Relatives spoke about good communication with the staff and the manager and they were confident that the staff would telephone them to inform them of changes. The manager has established some clear, simple and effective administrative systems which assist with the smooth running of the service. There is good attention to detail in terms of maintaining the home and addressing health and safety matters. There is a friendly staff team who have received relevant training. Recruitment is robust as are the arrangements for staff supervision. Overall, the service is good at providing care to the small number of people it is registered for. A friendly, caring home has been created where staff know residents well and are able to provide a good level of individual support for each person. Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Assessment and review information set out clearly the needs of people using the service. Staff know residents well and they use this knowledge as well as the assessment information to work with people to best need their needs. Refining and updating the risk assessment information will improve the service further. EVIDENCE: I used the CSCI case tracking method throughout this inspection to assess the quality of the service. This involved selecting three people using the service and looking in detail at their care plans and other records held in the home. It also involved talking with people using the service about the care provided as well as talking with staff, the manager and relatives and care managers where possible. This allowed me to reach an overall judgement about the quality of the service provided. Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 9 All of the people using the service are funded by local authorities. I was shown copies of local authority contracts as well as copies of individual agreements between the service and residents. Two of the people being case tracked had been resident for a number of years. I did not see original assessments of their needs but I did see recent reviews that had been carried out by the funding local authorities. The information available from these reviews was detailed and provided evidence that the main issues relating to each person had been identified and were being responded to. I noted that the home’s care plans reflected these issues and staff were able to discuss with me the arrangements made to provide care. The manager and staff were able to demonstrate a good knowledge of each person using the service. The third person I case tracked had moved to the home within the last year. I saw a detailed initial assessment from a NHS trust as well as follow up reviews and input from health professionals. This tied up with letters from the next of kin (a relative). The relative was spoken with on the telephone who commented that there was good communication about the needs of the person using the service and that there was dialogue about care provided. The relative may occasionally be involved in assisting staff with communication with the resident. Whilst the overall assessment information was useful and assisted staff with providing appropriate care I noted that there was a need for more detailed coverage of risk assessments. For example, a number of the people using the service go out of the home unescorted. There had been one recent accident involving a resident outside the home. However, the care plans did not fully reflect the ways in which staff worked in that staff practice was sometimes different to that stated on the care plan. There is a need to be consistent and reflect the specific decisions and actual ways staff worked. More detail about this is provided in the next section, “health and personal care” and a requirement is given. Equality and diversity initiatives were discussed with the manager. People using the service have a variety of different racial and gender backgrounds as do staff. The manager said that the approach taken was to have a positive attitude to people’s diversity based on knowing people using the service well. They can provide for people’s religious or cultural needs, such as providing a particular range of food or supporting people to go to a place of religion. For the current people living at the home there was little desire for particular or specific services. This was endorsed through my observations and discussions with people using the service, staff and relatives. The statement of purpose was updated after the home’s application last year to include dementia as one of the categories of registration. CSCI is currently undertaking a review of all care home’s registration I started this review during the inspection visit. There may need to be further discussion with the Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 10 manager before a new certificate of registration is provided. An amendment to the statement of purpose may be needed. Intermediate care is not provided and therefore standard six was not assessed. Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using this service receive care from staff who know them well. The clear care plans, supporting documentation and medication arrangements allow staff to have relevant and up-to-date information about the people they care for. There are good links with heath care professionals although there is a need to ensure that preventative health care appointments are made and recorded. People using the service will benefit from risk assessments that cover all the options available to support them when they go out of the home. EVIDENCE: I inspected the care plans for three people using the service as part of my case tracking. Discussions were held with two of the people as well as staff on duty and the manager. Relatives and care managers were spoken with on the telephone and observations were made during the inspection visit. I noted that there were concise care plans in place for each person. These set out the issues to address, the desired outcome and the work that staff must action in order to address the issue. Staff were knowledgeable the needs of people using the service and there was evidence from the care plans that staff Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 12 had links with relevant health care professionals and that reviews were carried out both internally and by the funding local authorities. The people using the service confirmed that staff helped them with a variety of tasks such as shopping, money management and going out of the home. Relatives confirmed the care arrangements and said that they were aware with the individual work staff did for their relatives. As described above, I identified that development work was needed to address the possible risks associated with people who go out of the home alone. This is part of a wider need to address and document possible risks and how they are being managed. A requirement is given about this and a second requirement is given under management and administration later in the report. The issue being that not all care plans had risk assessments and there were times when the risk assessments that did exist were not comprehensive about how possible risks of going out of the home unescorted were to be addressed. For example, staff told me that they may sometimes escort a person who was going out of the home but not always. This depended on a number of factors which were entirely appropriate, such as the weather and how the resident was feeling. However, the care plan for that person stated that the resident would go out of the home unescorted. Care plan need to be supported by a detailed risk assessments which reflects the nature of the care provided and include coverage of the options available for the resident and staff. It is also useful for the home’s overall risk assessment to link with individual risk assessments and have generic coverage of arrangements for people going out of the home. The concise care planning documentation is complemented by a range of documents. These record significant events relating to each person using the service and appointments with GPs, dentists and other health care professionals. There are good recording systems in use which allow provide a comprehensive picture of each person using the service. The manager showed me all these documents. I made the observation that there had not been a dental visit for one year. And that the privately arranged chiropodist had also not visited for over one year although a small number of people using the service had NHS foot care provided. Also, although there had been a recent opticians visit to the service, there was no record of the visit or treatment provided. The manager said that arrangements had been made for dental appointments. A requirement is given that such preventative health care appointments are made for people using the service and that they are documented. I looked at the medication records and the medication storage arrangements. The Nomad system is used. I was shown a medication policy and procedure which outlined the actions staff must follow. I checked a sample of the Nomad boxes against the records and the medicines stored in the medication Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 13 cupboards. Recording was good with no gaps identified. Each care plan has an individual medication profile which provides staff with details as to medicines and what they have been prescribed for. Relatives provided some feedback on medication which was positive about the staff and how they had been very good at making sure that medication was administered properly. They have noted benefits to their relatives as a result. One relative wished the timings of medication to be reviewed and this has been feedback to the manager of the home. On a similar note as above, relatives provided generally positive feedback about privacy and dignity for the people using the service. Staff were viewed to work well with individuals to ensure that privacy and dignity were maintained. Staff assisting with shopping for clothes was one example. I observed a kind and patient approach being adopted by staff in their work with residents. Some suggestions for possible improvements were put forward by relatives and these have been passed on the manager. Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are some positive and effective links with relatives which allows valuable input into the care for people using the service. People using the service have been supported and enabled to maintain community contact. The range of activities provided, although suitable for many of the people living at the home, needs a review to ensure that provision is suitable and flexible for all who live at the service. EVIDENCE: I spoke with all six of people currently resident in the home. One person was in hospital and there were two vacancies. I identified that each person has a routine based on his or her interests. For example, one person attends a day centre three days each week and another goes out of the home often to use the local facilities such as the library. The others tend to spend their time in the home. The manager said that outside entertainers attend periodically but otherwise activities are provided in-house. A list of activities for each day is on display in the lounge. The manager said that staff usually provide an exercise activity in the morning. I observed staff working providing some activities in the Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 15 afternoon. One staff member was doing a jigsaw with a resident and others were spending time talking with residents. One person living at the service told me that he would prefer more going on in the home. He said that he found it quiet. A member of staff said something similar and that she liked more going on. During the inspection it was quiet for a while with only four residents in during the morning. Relatives acknowledged that it can be difficult for staff to motivate the people using the service and would, ideally, like to see more going on. A recommendation is given for the manager to review activity provision taking into consideration the views of people using the service and relatives. I observed the meal arrangements. There is no cook so staff take it in turns to prepare meals. I noted that staff had encouraged people using the service to assist with various aspects of meal preparation such as setting the tables and clearing away. With one exception, mainly because of a health issue, the people using the service I spoke with said they liked the food. The meal I saw was fish and chips with jelly for dessert. An alternative meal was provided by request to one resident. I was shown the two week cycle of menus used. The meals provided were largely traditional British style food including breakfast, a main meal at lunchtime and a light supper. There was some evidence of food provided to suit the tastes of the diverse range of residents, such as plantains, but this was not every day. The manager said that alternative meals can be provided and in such a small setting provision of different meals should not be difficult. Staff work closely with residents and there are monthly residents meetings so there are opportunities for residents to express their views about the food. Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints and safeguarding adults arrangements provide adequate means for the people using the service to complain and for abuse to be properly responded to. The small size of the service and positive approach taken by the manager and staff results in concerns, or matters that could result in complaints, being addressed quickly. There is a need to obtain the most recent local authority safeguarding adults procedure and for staff to receive further safeguarding training. EVIDENCE: Complaints and safeguarding adults arrangements were discussed with the manager. In general, the arrangements are sound and only minor improvements are needed. I was shown the complaints procedure which was displayed on the wall in ground floor hallway. There is a need to update the procedure to ensure that the CSCI address is correct. The manager undertook to do this. There is no complaints book as there have been no recent complaints made to the service. There had been a complaint made in the last year but that was raised with CSCI first and then the local authority who undertook an investigation. The manager said that there are complaints record forms which would be filled in should there be a complaint. I was shown the home’s safeguarding adults procedure as well as copies of the local authority safeguarding adults procedure. The local authority safeguarding adults procedure was dated 2002. An updated one must be obtained by the Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 17 manager as changes have been introduced since 2002 such as the introduction of the Protection of Vulnerable Adults (POVA) scheme. It is also recommended that safeguarding adults training for staff is obtained from the local authority so that staff are provided with specific details about the local authority arrangements and safeguarding adults matters in general. Staff had received safeguarding adults training as part of their induction and foundation training and the local authority training will complement this. Since the last inspection of April 2006 there had been one safeguarding adults matter at the home. The local authority had lead an investigation which arose out of the complaint mentioned above. The manager had made some changes to the service as a result including the installation of a keypad door entry system and a review of staffing arrangements. Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24, 25 & 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service benefit from a pleasant, homely environment that is currently being upgraded. Further improvements will add to the quality of life experienced. The relative small scale of the service has the benefit of bringing staff and residents together to aid communication and provide added value to day-to-day life. EVIDENCE: During my inspection I sat with the people using the service in the lounge and in the dining room. I toured the premises with the manager and I spoke with residents and staff about the home, the bedrooms and the improvements that were taking place. New carpets were being fitted throughout the home on the day I visited and the manager said there were plans to renovate the kitchen. And that there had been redecoration of parts of the home. Overall, I found the home welcoming and homely although there is a further need to upgrade the facilities. The installations of new carpets and a new Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 19 kitchen will help and further work is needed to areas of the home such as the dining room and bathroom. The dining room is looking a little worn and the bathroom needs redecoration and some refurbishment. There was an old and worn looking handrail, for example, and some old fashioned tiling and units. Space is a little restricted in parts. There are three double bedrooms, for example, so that some of the people living at the home have to share. No one expressed dissatisfaction with sharing and the double rooms were fairly large and attractive but it can have an effect on privacy. There is also only one bathroom which is relatively small. It does have a chairlift to assist people to get into the bath if needed but space is still tight and could be difficult for people with disabilities. In some ways, the small scale of the home suits the atmosphere. The dining room is right next to the kitchen so that meal preparation and interaction with staff is enhanced by people being close together. The lounge area is of a comfortable size for the numbers of people allowing sitting space as well as areas that can be used for conversations or activities. There is also a downstairs toilet located just off the lounge which is helpful. There is a pleasant garden to the rear with plenty of space for people to sit outside on fine days. There is a passenger lift as well as a smooth raised path up to the front door making the home accessible for wheelchair users. However, apart form the chairlift in the bathroom and the lift there are no other mechanical adaptations at the home such as electric hoists. There would need to be further adaptations made to the home to enable the service to meet the needs of people with physical disabilities. None of the current residents have physical disabilities although some need supervision from staff at times when they are moving around the home. I was able to see a selection of bedrooms. It was a little difficult to assess as a number of the bedrooms were in the process of having new carpets installed and possessions and furniture had been moved around. However, one resident showed me her bedroom and that had been nicely arranged with her possessions. Other bedrooms seen, although relatively basic, were comfortable with many having a great deal of natural light. Safety precautions had been taken, such as radiators having been covered. Some of the furnishings, such as beds will require upgrading in the near future. I visited the laundry and discussed the laundry arrangements with a member of staff and the manager. The laundry is sited at the rear of the home with one washing machine, a dryer and a sluice facility. There is plenty of space for laundry to dry in the garden. Staff and the manager said that foul laundry was minimal and could be managed via the sluice and a high temperature wash in the machine. Staff complete laundry duties alongside their other caring and catering duties. The laundry arrangements are suitable for the current needs Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 20 of residents. However, there is a need for infection control procedures, and how they may affect the laundry arrangements, to be written down in the home’s overall risk assessment. A requirement about this is given in the Management and Administration section. Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 & 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are knowledgeable and collectively have the skills, experience and qualities to care for the people using the service. Training and recruitment arrangements are sound but require some attention to make sure that second references are obtained and that staff training is matched by certificates. EVIDENCE: In order to assess the staffing standards I spoke with the people using the service. I also spoke with staff on duty, including the manager, observed staff working, looked at the staff rota and inspected the records of training and recruitment. All of the people using the service I spoke with said they liked the staff and found them helpful. I observed positive relations. Staff clearly knew the people using the service well and demonstrated patience and kindness in their work with them. There was a familiarity to these interactions which produced a warm, caring atmosphere. All staff were very welcoming and were happy to talk about their work and how they assisted residents. One was able to explain her keyworking role which involved working closely with two residents, helping them to shop for clothes, for example. Staff I spoke with confirmed that they had received relevant training and were able to demonstrate a good understanding of residents, their needs and how staff were expected to work with them. Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 22 I was shown the staff rota. It was not dated but drawn up for a period of one month. There are three staff scheduled to be on duty throughout the day. At night there are two staff on duty: one awake and the other providing back up cover. The staffing complement on the day corresponded to the staff rota. This is an adequate level of staff cover for the number and needs of the people living at the home. I inspected the personal files of five staff members. Overall, I found evidence of a thorough recruitment process, of regular staff supervision and of staff having received a range of suitable training. However, there were some gaps such as only one, rather than two, references, having been obtained for two members of staff. And there is a need for the manager to obtain certificates of training for staff. For example, Induction and foundation training had been provided by a training organisation but they had not provided training certificates. The manager undertook to follow this up. A requirement is given about it. The manager also undertook to obtain certificates so that the staff individual training matrix matches the relevant training certificates. They matched in some cases but not in all. A requirement is given about this. Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 & 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager is enthusiastic and provides sound leadership and support for staff. The all round competent management and administrative organisation provides benefits for people using the service. They can be sure that the overall focus is for staff aiming to provide the service with their needs and wishes uppermost in their minds. This could be further improved by the manager drawing up a quality assurance development plan. EVIDENCE: The manager helped with the inspection. He has been registered now for over one year. The service is family run with family members taking lead roles in either providing or managing the service. The manager was very friendly and approachable and clearly knew the people using the service well. He was able to talk about the home’s ethos which is to treat people using the service as individuals and to allow them to have their say as to the running of the home. Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 24 He described the service as being the “residents’ home”, first and foremost. The manager was able to talk about residents needs in detail and demonstrated a good knowledge of significant others in resident’s lives such as relatives. This was endorsed from conversations with relatives. The manager described the quality assurance approach taken. Overall, this is a fairly informal process involving lots of communication with people using the service as well as relatives. The manager described how people using the service would tell him or staff if they wished changes. On top of these informal methods there are monthly meetings with people using the service and regular use of questionnaires. I was shown minutes of the meetings and copies of returned questionnaires. In summary, the quality assurance arrangements are varied and considered. However, there is no quality assurance annual development plan or policy and a recommendation is given for the manager to draw one up. Such a plan would be able to detail the quality assurance initiatives followed and could be used to adopt new ones such as involving relatives and care managers in questionnaires. Financial procedures were not inspected but I was shown a copy of the insurance certificate for the service which was on display in the hallway. The arrangements for looking after the money for the people using the service were discussed with the manager. He said that for the majority of the people using the service the relevant local authority was the appointee and therefore managed each person’s money. Money was made available to the manager to buy small everyday items. For the remainder of the people using the service either the person themselves looked after their money or a relative. One person using the service I spoke with confirmed these arrangements as did two relatives whom I spoke with on the telephone following the inspection visit. I was shown a sample of staff supervision records. One new member of staff had not had a recorded staff supervision session but the other staff members had records of supervision sessions that were being held every two months. Staff I spoke to confirmed that they received regular supervision from the manager. I was also shown the minutes of monthly staff meetings. I was shown certificates of maintenance and checks for the home’s installations and equipment such as the passenger lift, the electrical systems and of gas safety. There was evidence of good attention to detail and a responsible approach to maintaining health and safety. For example, annual tests for legionella were being carried out as were regular fire drills and weekly tests of the fire alarm. I was told that a new fire alarm system had been installed. The warranty paperwork was not available for me to see but the Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 25 manager undertook to provide evidence of the warranty. A requirement is given about this. The fire safety risk assessment and overall risk assessment for the service was shown to me. As described in earlier sections of the report, I identified that there was a need to make this overall risk assessment more detailed so that all potential risks had been recorded and the safety measures taken also recorded. For example, the overall risk assessment did not provide sufficient details about infection control and manual handling and the safety measures taken in respect of both. Also, the overall risk assessment needs to link to safety measures taken in respect of individual residents. For example, to the recording of the precise arrangements about when residents go out of the home and whether they have a staff escort or not. Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 2 Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13(4)(b) Requirement The registered persons must ensure risk assessments are drawn up for each person using the service and that risk assessments detail the specific actions taken to minimise risks. The registered persons must ensure that preventative heath care appointments are made for people using the service and that they are documented. The registered persons must ensure that the most recent local authority Safeguarding Adults policy and procedure is obtained and brought to the attention of staff. The registered persons must ensure that a timetabled programme of redecoration and refurbishment to the home is drawn up and made available for inspection. The registered persons must ensure that two written references are obtained for staff before they start work at the home. The registered persons must DS0000010741.V350613.R01.S.doc Timescale for action 01/11/07 2 OP8 12(1)(a) 01/11/07 3 OP18 13(6) 01/12/07 4 OP19 23(2)(b) 01/12/07 5 OP29 19(1)(b) 01/12/07 6 OP30 18(1)(c)i 01/12/07 Page 28 Nightingale House Version 5.2 7 OP38 23(4)(a) 8 OP38 13(4)(a) ensure that staff training certificates are obtained for induction and foundation training and that training certificates match the staff training matrix. The registered persons must 01/11/07 ensure that evidence is supplied to CSCI that the new fire alarm system is covered by a warranty. The registered persons must 01/12/07 ensure that the overall risk assessment for the service is more detailed so that all potential risks and safety measures are recorded. The risk assessment to include coverage of infection control arrangements. 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 OP12 OP18 OP33 Good Practice Recommendations The registered persons should review the activity provision for people using the service taking into consideration the views of people using the service and relatives. The registered persons should ensure that staff are provided with Safeguarding Adults training from the local authority. The registered persons should ensure that there is a quality assurance annual development plan. Nightingale House DS0000010741.V350613.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 House DS0000010741.V350613.R01.S.doc Version 5.2 Page 30 - 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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