Inspection on 16/09/08 for Nightingale House

This inspection was carried out on 16th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nightingale House 17/03/09

Similar services:

Clouds House

Trevaylor Manor

Closereach

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

CARE HOME ADULTS 18-65 Nightingale House Landscore Close Teignmouth Devon TQ14 9LD Lead Inspector Judy Hill Unannounced Inspection 16th September 2008 09:45 Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 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 DS0000072611.V372331.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 Adults 18-65. 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 DS0000072611.V372331.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingale House Address Landscore Close Teignmouth Devon TQ14 9LD 01626 773904 01626 770331 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) www.korcare.co.uk Korcare Limited Mrs Wendy Apps Care Home 27 Category(ies) of Past or present alcohol dependence (27), Mental registration, with number disorder, excluding learning disability or of places dementia (27) Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Mental disorder (Code MD) 2. Past or present alcohol dependency (Code A) The maximum number of service users who can be accommodated is 27. Not Applicable Date of last inspection Brief Description of the Service: Nightingale House is registered to provide residential accommodation and care for a maximum of twenty-seven people in the registration categories of Mental Disorder and Past or Present Alcohol Dependency. The service is newly registered because the partnership that was previously registered formed a Limited Company, KorCare Limited. The registration of Nightingale House now includes Porch House, which was previously registered separately. In their Statement of Purpose KorCare Limited state that their aim is to provide a supportive secure environment for those needing residential care due to Korsakoff’s Disorder. Nightingale House is situated in the seaside town of Teignmouth in Devon. The home is within walking distance of the town centre, which has a good range of shops and facilities, the beach, the train station and local bus services. Information about the service is available from the service providers in a Statement of Purpose and Service Users Guide and on a website www.korcare.co.uk. As this is a new service previous inspection reports are not available on the CSCI website but can be requested from the home. The weekly fees are initially £775 a week, but may be reduced to £725 after the initial three months trial period. The Service Users Guide states that the Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 5 fees include all personal care, food and dietary requirements, basic utilities, inhouse therapies and laundry. Extra charges are made for professional hairdressing, chiropody, dental fees not covered by the NHS, external entertainment, holidays, clothing, toiletries and other personal expenditure. Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is zero star. This means the people who use this service experience poor quality outcomes. This key inspection included a site visit that was carried out over two consecutive days. On the first day of the site visit we used an expert by experience. CSCI are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are now using a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘expert by experience’ used in this report describes a person whose knowledge about social care services comes directly from using them. The expert helped to speak to people about their experiences of living at the home as well as making general observations. His comments are included throughout this report. KorCare Limited ensured that an Annual Quality Assurance Assessment was completed and returned to the Commission. Other documents used to gather information include the homes Statement of Purpose, Service Users Guide and staff and residents records. An inspection of the premises was carried out and direct and indirect observations were made about the service provided. Both the registered manager and the management team were spoken with during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 7 The registered providers need to update their policies, procedures and practices to ensure that the individual and collective needs of the residents are fully considered in all aspects of the service provided for them. A lot of restrictions are in place and these need to be justified on an individual basis to ensure that the residents retain the right to choice and autonomy. The care staffing levels are not high enough to meet the social, occupational and recreational needs of the residents. This means that the residents are under stimulated and bored. 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 DS0000072611.V372331.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is poor. Although the initial needs assessment procedures are thorough, people considering using the service and their representatives may find some of the information they receive about the service misleading. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose and a copy was given to us on request. The Statement of Purpose provides information about the home and the service provided but some of the information is misleading and needs to be amended. Examples of this include references to Porch House, which the Statement of Purpose claims provides twenty-four hour care for three residents with one staff member. The people who have bedrooms at Porch House told us that Porch House is only staffed at night and that they are brought to Nightingale House before breakfast and remain there until about 8.30pm. This was confirmed by the registered manager who said that the three residents have all of their meals at Nightingale House and that their medication, with the exception of their night time medication, is stored at Nightingale House. Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 10 A further example is that the Statement of Purpose states “Family and friends are encouraged to visit and make contact by letter and/or telephone”. This is contradicted by the information included in the Service Users Guide and in a framed notice in the entrance hall of the home, which states that restrictions are placed on visiting and the use of the telephone. The home has produced Service Users Guides and a copy was given to us on request. The registered management said that none of the people who use the service currently had a Service Users Guide. The Service User Guide does not contain all of the information required or recommended in the Care Homes Regulations and the National Minimum Standards. Further information about KorCare Limited and Nightingale House is available on their website. The Statement of Purpose and Service Users Guide provide details of the initial referral and assessment procedures. People considering moving into Nightingale House and their representatives are requested to complete an application form and risk assessment and provide relevant information, which could include an occupational therapy assessment, psychiatric report and nursing needs assessment. An external needs assessment and initial care plan are requested from a Social Worker or Community Psychiatric Nurse. It is the care manager, who is not directly managed by the registered manager, who deals with initial enquiries and takes the leading role in the internal assessment process. The internal needs assessment starts with a visit to the prospective residents and evidence was seen in the resident’s records that these visits are taking place. Following admission there is a three month trial period. The placement will be reviewed after six weeks and again after three months. Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is poor. The care provided does not focus enough on the individual needs of the people who use the service and institutional practices and routines mean that most of them have very limited opportunities to exercise choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at three of the residents care plans and could find no evidence that the individual residents had been directly involved in their care planning or reviews. Two of the care plans that were inspected in the registered managers office provided a very basic summaries of needs and the third care plan was written in the form of a review. A number of restrictions are imposed on the residents, which severely limit their ability to make decisions about their lives. For example, some of the residents told us that they are told when they must go to bed and get up. However the manager advised that this was not the case and residents could Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 12 go to bed when they pleased. Porch House, which is not directly accessible from Nightingale House, is not staffed during the day. The people who live there told us that they cannot return to their home during the day. The manager told us that arrangements for staff cover could be made so that residents could return if they wished. The cook and the registered manager told us that the residents do not have a choice of meals or meal times, but peoples favourite meals were included in the menu planning stage. No facilities are provided for residents to make their own hot drinks and snacks and hot drinks are served at set times. Restrictions are placed on visitors, visiting times and personal telephone calls. The residents money is managed for them, as is their medication and smoking. The front door of the home is kept locked and we were told that the residents are not allowed out alone. Individual risk assessments were not seen to justify any of the above restrictions and/or denials of peoples right to exercise autonomy and retain control over their lives. Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is poor. The people who use the service are only able to make limited choices and decisions about their life style. This means that their rights and responsibilities are not respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the two days that we spend at the home we engaged several residents in conversation and directly and indirectly observed life at the home. The expert by experience spent time with the residents and his overall impression of Nightingale House was as follows:“Nightingale House seemed unnaturally quiet; residents were not stimulated, staff were not interacting enough with the residents and there were few Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 14 activities on offer.” He goes on to say that during the inspection he saw the residents sitting in the lounge with no stimulation. Throughout the two day site visit most people who live at Nightingale House remained seated in the lounge with no stimulation. At set times they went to the dining room for hot drinks, which are available at set times and not on request, and meals and to the smoking room for a cigarette. One of the residents told the expert by experience that cigarettes are held by the staff are allocated when times allows, rather than on request and that he was “…lucky to get one (cigarette) every two hours”. We asked the registered manager about the provision of activities, treatments and therapies are were told that a musical activity was provided on Wednesday (which was heard), an entertainer came to the home on Thursdays to sing 1960’s songs with the residents, either quizzes were held or animals were brought into the home on Fridays and that Bingo sessions are held once a fortnight. The registered manager told us that some of the residents go out with friends and relatives and that some of them are occasionally taken out by the staff to Torquay, a local garden centre, to the theatre, shopping or a meal if there are enough staff available to accompany them. The expert by experience was told that outings are usually arranged on resident’s birthdays, or a takeaway meal will be provided if they do not want to go out. The home has three mini busses, funded by the registered providers, to take people out in but the staff rota was seen and showed that there are usually only two care workers on duty, which would make it very difficult for the staff to provide an escort to take people out as and when they want to go out. Some of the residents told the expert by experience that they would like to go out more often but that staff shortages made this difficult. The homes management however, said that there were no staff shortages and they could arrange for extra staff when they were needed. The Service Users Guide and a notice on the wall of the home provide information about visits and phone calls. During the assessment period the home ask that direct family/friend contact is kept to emergencies only and recommend a four week period before receiving direct telephone calls and twelve weeks before receiving any visitors. The notice states that after four weeks telephone calls should be made between 7pm and 9.30pm so that the line can be kept free during the day for business calls as the payphone number is the same as the business line. Also the residents are told not to make arrangements to see visitors directly but to go through the home. As part of the Admissions policy, which is included in the Statement of Purpose, residents are requested not to bring in mobile phones or keep any money on them when they are living at the home. No satisfactory explanation was provided for these restrictions. Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 15 The registered manager said that arrangements had been made, in the last year, for nine of the people who use the service to take an annual holiday with staff escorting them. The residents told us that they enjoyed their meals and that the food was always good. Meals are provided at set times in the dining room. The Cook said that residents are not offered a choice of meals and that they all have the same meal. The registered manager said that choices are not offered because all of the people who use the service have short-term memory problems and in the past the provision of choice had caused confusion at meal times. It was suggested that by offering choices at meal times rather than in advance much of this confusion could be avoided. We are concerned that individual residents may have cultural and/or medical dietary needs and preferences that are not being catered for. Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is poor. The people who use the service are helped to maintain their health and personal hygiene, but they are not given enough opportunities to do things for themselves. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nightingale House does not provide any treatments, such as detoxification, and any treatments that prospective residents may need to help them to stop drinking must be provided before admission. The expert by experience was told that no counselling is offered, although reference to counselling is made in the Statement of Purpose. A limited number of organised activities are provided, which may have therapeutic value. Although the care provided can be short term, the service is aimed at providing long term care for people who have alcohol related brain damage and are unlikely to be able to return to independent living. By providing regular meals, help to make and keep medical appointments, help with personal hygiene, warmth and shelter the physical health of the residents Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 17 has improved considerably since admission and this is reflected in the letters containing positive feedback that were seen at the home. All of the people who were seen during the inspection looked clean and well groomed and this indicates that the staff are providing the residents with the help they need to maintain their personal hygiene. We were, however, concerned that most of the communal wash basins in the toilets and bathrooms had not been provided with soap or any means of drying hands after using the toilet. This is not hygienic and could lead to the spread of infections. We were concerned that the residents are given very little opportunity to take regular exercise. It is accepted that some rules and routines may be necessary. These may need to be quite rigid in services that provide short term treatments to help people to stop drinking. Nightingale House provides a long-term home for people who have already gone through a detoxification programme. Feedback from the people who use the service as well as our own observations suggest that the service provided may be too institutional. A television, Playstation, DVDs, music system and newspapers are provided in the lounge but more could be provided to encourage the residents to occupy themselves with stimulating activities within their home environment. For example, some of the residents told the expert by experience that they would like a pool or snooker tables and a darts board but these leisure facilities are not provided. Two of the residents were seen playing cards together but this interaction between residents was exceptional as most of the residents who were seen during the inspection were not actively engaged in any activities or interacting with each other. The Service Users Guide states that all of the medicines used by the people living at the home is administered by the staff. No evidence was seen that this had been individual risk assessment to assess if people could handle all or some of their medication themselves. With the exception of the night-time medication the for the people who live at Porch House, which is kept at Porch House, all of the resident’s medication is kept in a locked cupboard in the staff office at Nightingale House. The home uses a pharmacy controlled system to order, administer and dispose of medicines. The registered manager said that the staff who administer the medicines have received training to do so and records were seen to support this. However, the medication administration records were inspected and none of the medication administered on two separate occasions had been Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 18 initialled, although the medicine had been taken from the cassettes. The registered manager said that she was confident that the medicine had been administered but thought that the staff may have been distracted and forgotten to sign the record sheets. The staff should be signing the record sheets as they are administering medicines to each of the residents. The fact that none of the records had been signed indicates that they have been completing the record retrospectively. This is bad practice and indicates that the staff need additional training to ensure that the residents medication is handled safely. Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate The people who live at Nightingale House can not be confident that their view will be listened to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is included in the Statement of Purpose and the Service Users Guide and displayed in the entrance hall. The Annual Quality Assurance Assessment that had been completed by the care manager identified that three complaints had been made and that two of these had been resolved within twenty-eight days. During the site visit a number of complaints were made to us about the service by some of the people who live at the home. These included the lack of facilities such as a pool table and darts board and the inability of some of the residents to access their bedrooms during the day. The registered manager was made aware of these complaints and is now considering developing this suggestion. Policies are procedures are in place to safeguard the residents from the threat of abuse and records were seen to show that staff had received training in the Protection of Vulnerable Adults. This service imposes regimes that restrict the freedom of choice and movement, as people who live at Nightingale House cannot choose when to eat Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 20 or have a hot drink. Those who smoke cannot choose when to have a cigarette. Access to a telephone has restrictions and no-one is enabled to retain their own medication. We are concerned that the way that the care practices at Nightingale House are delivered do not respect the rights of the people who live there. Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is poor. The homes environment is generally basic and presents an impersonal impression. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nightingale House is a large property with an attractive enclosed garden at the back and off road parking at the front. Porch House, which comes under the same registration, provides bedrooms for three people and is situated behind Nightingale House. There is no direct access between the two houses although the service providers have told us that they intend to create an entrance through the adjoining gardens. At Nightingale House the resident’s accommodation is on the ground and first floor. The second and third floors contain the offices for the company Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 22 directors, the company secretary and the care manager and accommodation for one of the directors. The registered managers office is on the ground floor. A tour of the premises was carried during the site visit. The accommodation at Nightingale House consists of a lounge, a dining room and a smoking room, which has direct access out onto the garden to the back of the house. Each of the residents has a single bedroom and one of the bedrooms at Nightingale House and all three bedrooms at Porch House have en-suite facilities. The Statement of Purpose and the Service Users Guide ask residents to keep their personal possessions to a minimum as the rooms have limited storage space and not to bring any furniture into the home with them. Most of the bedrooms that were seen contained very few personal belongings and were very impersonal and poorly furnished. Locks have been fitted to bedroom doors, which enable the residents to lock the door from the inside, if they choose to do so. The Service Users Guide states that it is a policy of the home not to give the residents keys to their bedrooms, so they cannot lock their bedrooms from the outside. Individual risk assessments were not seen to explain why the residents could not have keys. Porch House is a separate house which has three bedrooms, a sitting room, a kitchen, bathroom, toilet and utility room. All three bedrooms have en-suite facilities and are furnished to a higher standard than Nightingale House. The bedrooms at Porch House have been personalised by the people who use them. The Statement of Purpose states that Porch House provides individual accommodation with twenty-four hour care but we found that this was not the case. The people who use the service told us that they were taken to Nightingale House before breakfast and not allowed to return to Porch House until the evening. The manager confirmed that the people who live at Porch House come to Nightingale House during the day and that their meals and medication (except night medication) are given to them at Nightingale House. There are several communal toilets at Nightingale House, some of which are in bathrooms or shower rooms. We were concerned that most of the toilets seen did not contain soap or any means of drying your hands after using the facilities. One did not contain any toilet paper. The laundry facilities are adequate for the needs of the residents. The residents can access the back garden from the smoking room and use the enclosed garden at the back of the house at any time. They cannot, however, Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 23 leave or enter the home independently through the front door as this has been fitted with a key pad and the code is not on display. There are no individual risk assessments that outline why people cannot choose to come and go from their home. Best use is not made of the space provided to provide the residents with a comfortable and homely environment to live in. Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is poor. The care staffing levels are too low to meet the stated aims of the service or the individual needs of the residents. Unsafe staff recruitment practice could place the residents at risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five staff files were inspected. The records showed that safe recruitment practices had not been used to ensure that the staff employed are suitable to work with vulnerable people. Four of the files contained incomplete application forms and one did not contain an application form at all. Only one of the application forms gave the name and address of a suitable referee and no written references were seen on the staff files. Evidence was seen that Criminal Record Bureau are being carried out. Records of staff training were seen on the staff files, the senior staff had attended training in First Time Management or Supervision and two of the staff files contained a record of induction training. The staff training records that Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 25 were seen showed considerable variation in training provision and updates were overdue for some of the training provided. Three of the care staff have gained a National Vocational Qualification in Care of Level 3 and four Level 2. The registered manager said that a further two care workers were about to start their NVQ at Level 2 in Care. We were told that the registered manager and a senior care worker have gained the Assessor A1 and A2 awards. A copy of the staff rota was inspected and this showed us that there are usually only two care staff on duty to care for the residents. There is also a cook who prepares the midday meals from Mondays to Fridays and cleaners who work six mornings a week. Separate maintenance staff are employed. Overnight cover is provided by two members of staff in the main house and one person sleeping in at Porch House. The hours worked by the registered manager and the care manager are not included on the rota. We were told that additional staff, whose hours are not included on the rota, are employed to provide peripatetic Therapy and Activity and to take the residents out. There is a low staff turnover with some staff working at the home in excess of five years. We do not consider the care staffing levels, as shown on the rota, to be high enough to provide a satisfactory service for up to twenty-seven people over two separate houses. Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is poor. The home is service lead and the right of the residents to make individual choices are restricted by the homes policies, procedures and practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is Mrs Wendy Apps. She has gained her Registered Managers Award and National Vocational Qualification in Care at Level 4. The registered manager is responsible for the day-to-day running of the home and she manages the senior care staff, care staff and ancillary staff. Records were seen to demonstrate that the Registered Manager has undertaken periodic training to maintain her skills and knowledge while managing the home. Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 27 The needs assessments and care plans that were seen during the inspection and, through conversations with the registered manager, indicate that she does not play a lead role in assessing and reviewing the needs of the residents or drawing up and reviewing care plans although she is responsible for managing the care staff and the day to day running of the home. This means that the registered manager, who has the legal responsibility for the day to day management of the home, may not be in a position to have significant imput into the care planning system. Staff recruitment practices are poor and although the staff have undertaken many statutory training courses none have received training specific to the client group cared for. Daily routines stifle personal development and peoples plans of care lack any detail. Systems, such as money management and medications are designed with safety in mind but do not allow people to exercise personal choice and retain or reawaken life skills. We asked to see the homes quality assurance/quality monitoring system and were shown complement letters and completed questionnaires. These had not been used to draw up an annual development plan for the home based on a systematic cycle of planning-action-review, reflecting aims and outcomes for the people who use the service. The Annual Quality Assurance Assessment also identified that the home does not have a policy or procedure on this. The Annual Quality Assurance Assessment (AQAA) identified that the servicing of the gas and electrical appliances was up to date. The AQAA also identifies that most of the required and recommended policies and procedures are in place and were reviewed in 2007, but that the home does not have written policies and procedures on Recruitment and employment including redundancies or Sexuality and relationships. Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 1 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 X 15 1 16 1 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 1 X 1 X 1 X X 2 X Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 29 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 YA1 Regulation 5(1) & 5(2) Requirement The amount and method of payment of individual fees must be included in the statement of terms and conditions in the Service Users Guide. Every resident must be given a Service Users Guide so that they know what to expect from the service. 2 YA6 12(1)a & b, 12(3), 12(4)a & b Care plans and reviews must demonstrate that the individual needs, wishes and aspirations of the people using the service are taken into account and provide clear guidance to the staff on how to meet each of the residents individual needs. The people who use the service must be offered choice and be able to make decisions about their lives. Their privacy and dignity must at all times be respected. Individual personal risk assessments must deal with access to and from the building, Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 30 Timescale for action 04/02/09 04/02/09 3 YA7 12(2) & 12(4)a & b & 14a & b 08/01/09 mealtime choices and all regimes that are restrictive. 4 YA9 12(4) & 13(7) The registered persons must demonstrate through individual personal risk assessments that any restraints or restrictions placed upon the residents are justified on the grounds of safety and well being of the individual. 08/01/09 5 YA13 18(1)a Adequate staffing levels must be 04/02/09 maintained to enable the residents to become a part of the community and engage in community activities. Evidence of this should be provided on the staff rota. The registered persons must ensure that the residents have access to a telephone that they can use to make and receive calls at any time. Unreasonable restrictions should not be placed on the ability of residents to receive visitors and the residents must be able to see their visitors in the privacy of their bedrooms if they so wish. 08/01/09 6 YA15 16(2) & 4(a) 7 YA16 13(6) The registered persons must ensure that the home operates in a way that enables the people who use the service to exercise their rights and retain control over their lives. Safe facilities must be provided to enable the residents to make themselves snacks and hot drinks, if and when they choose to do so. All communal hand basins must be provided with liquid soap and DS0000072611.V372331.R01.S.doc 08/01/09 8 YA17 16(2)h 04/02/09 9 YA18 13(2)c 08/01/09 Nightingale House Version 5.2 Page 31 disposable towels or hot air driers. This is to enable the residents and visitors to the home to wash their hands after using the toilets. An adequate supply of toilet paper must also be provided at all times. 10 YA19 16(2)n Opportunities must be provided 08/01/09 to enable and encourage the residents to take regular physical exercise, if and when they choose to do so. The registered persons must ensure that the staff that administering medicine to the residents sign the medication administration records when the medication is taken. This is to reduce the risk of errors being made. The registered persons must ensure that enough care staff are employed to meet social, occupational and recreational needs of the people who use the service as well as their personal care needs. The registered persons must ensure that safe practices are used to recruit staff. This should include the completion of an application form and must include gaining two written references. 08/01/09 11 YA20 13(2) & 3i 12 YA33 18 04/02/09 13 YA34 19 08/01/09 14 YA39 24(1) & (3) The registered providers must 08/01/09 establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the home. This quality monitoring system must include consultation DS0000072611.V372331.R01.S.doc Version 5.2 Page 32 Nightingale House with the people who use the service and their representatives. 15 YA42 13(3) The registered providers must make suitable arrangements to prevent infection and the spread of infection by ensuring that the communal toilets and bathrooms provide facilities to enable the residents and visitors to wash and dry their hands. 08/01/09 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 YA1 Good Practice Recommendations The Statement of Purpose and the Service Users Guides should be revised and amended to ensure that they provide a full and accurate description of the home and the service provided. The residents should be offered a choice of meals and meals should be made available outside set mealtimes if the set mealtimes are not convenient to any individual receiving the service. Any complaints or concerns raised by the people who use the service should be listened to, recorded and acted upon. The overall responsibilities of the registered manager need to be more clearly defined. 2 YA17 3 YA22 4 YA37 Nightingale House DS0000072611.V372331.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 DS0000072611.V372331.R01.S.doc Version 5.2 Page 34 - 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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