Inspection on 17/03/09 for Nightingale House

This inspection was carried out on 17th March 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nightingale House 16/09/08

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 18/02/2010.

CARE HOME ADULTS 18-65 Nightingale House Landscore Close Teignmouth Devon TQ14 9LD Lead Inspector Judy Hill Unannounced Inspection 17th March 2009 10:00 Nightingale House DS0000072611.V374580.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.V374580.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.V374580.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.V374580.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. 16th September 2008 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 registered service providers is KorCare Limited and in their Statement of Purpose KorCare Limited state their aim is to provide a supportive secure environment for those needing residential care due to Korsakoff’s Disorder. The registered manager is Mrs Wendy Apps. 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 their website www.korcare.co.uk. Copies of previous reports can be requested from the home and are also available on Care Quality Commissions Website www.cqc.org.uk. The weekly fees are initially £775 a week, but may vary according to individual need. The Service Users Guide states that the fees include all personal care, food and dietary requirements, basic utilities, in-house therapies and laundry. Extra charges are made for professional hairdressing, chiropody, dental fees not covered by the NHS, external entertainment, holidays, clothing, toiletries Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 5 and other personal expenditure. Nightingale House DS0000072611.V374580.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 1 star. This means that the people who use this service experience adequate quality outcomes. This key inspection included a site visit that was carried out on 17th and 20th March 2009. The main focus of the site visit was to follow up the requirements and recommendations that were made in the report of the previous inspection, which was completed in September 2008. We looked at the service providers response to the previous report, which included an action plan, and spoke with some of the people who use the service, one of the Company directors, the registered manager, the care manager and some of the staff on duty to see if the requirements and recommendations made in the report had been dealt with. We also looked some of the records that are kept at the home, including a sample of care plans and staff recruitment records and carried out a physical inspection of the premises. What the service does well: What has improved since the last inspection? The Statement of Purpose and the Service Users Guide have been revised since the last inspection. The people who use the service are now being given a copy of the Service Users Guide. People are now offered a choice of at least two set dishes at mealtimes. Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 7 Care is now being taken to ensure that the medication administration records are kept up to date. All toilets and bathrooms are now provided with liquid soap, hot air hand driers and adequate supplies of toilet paper. What they could do better: Although the Statement of Purpose and Service User’s Guide have been revised since the last key inspection further revision is necessary to ensure that people have access to the information they need about the service provided. No evidence was seen to demonstrate that the people who use the service are directly involved in developing and reviewing their individual plan of care. This means that their individual wishes and needs are being identified and the care provided is institutional rather than person centred. Institutional practices could be reduced to enable the people who use the service to regain some of their independence and to exercise more choice in their daily lives. The rights of the residents to receive visitors and make and receive telephone calls as and when they choose to do so without seeking permission from the staff should be respected. People could be provided with facilities to make themselves hot and cold drinks and snacks. People should have free access to and from their home whenever they choose and if individual risk assessments suggest that they would not be safe to go out alone, sufficient staff should be available to escort them. More emphasis could be placed on meeting the residents psychological and emotional needs by enabling them maintain control over their daily lives. Complaints and concerns made by the people who use the service are not always taken seriously and dealt with appropriately. This does not enable the people who use the service to influence how the home is run. Some of the institutional practices carried on within the home do not enable the people living there to exercise their right to choice. The homes environment is generally basic and presents an impersonal impression. Please contact the provider for advice of actions taken in response to this Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 8 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.V374580.R01.S.doc Version 5.2 Page 9 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.V374580.R01.S.doc Version 5.2 Page 10 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 adequate. The initial needs assessment process is good. However, some of the written information provided to prospective service users and their representatives does not accurately reflect the service provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last key inspection both the Statement of Purpose and the Service Users Guides have been updated and copies of both documents were sent to us and made available to us on request during the site visit. We were told that Service Users Guides had been given to the people who use the service and these were seen on notice boards in some of their bedrooms. We read the Statement of Purpose and noted that further revisions need to be made. For example, although the reader is told that the Company and the registered manager are very experienced in the provision of care for people who have Korsakoff’s syndrome and alcohol related brain disease, no reference is made to any qualifications and training in these specialist areas that has been undertaken by them or by the staff. Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 11 Arrangements for consultation with the professional representatives of the people who use the service and the service management are referred to several times in the Statement of Purpose but more information is needed to demonstrate how the people who use the service will be directly involved with planning and reviewing their plan of care. The referral and admissions procedures are included in the Statement of Purpose and previous inspections tell us that initial referrals, which must come through Social Services or Care Trusts, are carefully considered to ensuring that the person referred has gone through any necessary detoxification programmes as Nightingale House does not offer the nursing care needed to provide such treatments. The pre-admission assessment process is thorough and well documented and should, together with the Social Service or Care Trust case management care plan, provide all of the information that the home needs to prepare detailed care plans, risk assessments and risk management plans in consultation with the people who use the service. The Service Users Guide contains a summary of the Statement of Purpose and the general terms and conditions of residence. The amount and method of payment of fees is still not included in the Service Users Guide on an individual basis and although a weekly fee of 775.00 pounds a week is mentioned, we were told that the actual fees charged vary. Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 12 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: Since the last inspection the home has purchased a new system for recording care plans. At the time of this inspection we saw that a senior member of staff had started to complete the new care planning forms but saw no evidence to suggest that the people who use the service are being involved or consulted in this process. Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 13 The development of the new care plans is slow and the staff continue to use the old care plans which we know from the last inspection do not provide sufficient information about the individual residents wishes or needs. The previous inspection report highlighted a number of restrictions that are imposed on the people who use the service. We spoke again with some of the people who use the service and were told that institutional practices continue to prevent them from making their some decisions for themselves. For example: Three of the people who use the service have en-suite bedrooms, a sitting room and kitchen at Porch House, which is in a separate building but comes under the registration of Nightingale House. They are brought from Porch House to Nightingale House in the morning and do not return to Porch House until the evening. Their medication is kept at Nightingale House and they have their meals at Nightingale House. Two of the residents told us that they would like to spend more time at Porch House but cannot do so because Porch House is not staffed during the day. This was discussed with the registered manager who said that if any of the people who have bedrooms at Porch House want to spend time at Porch House during the day arrangements would be made for a member of staff to accompany them. The people who live sleep at Porch House were not aware that this was an option. We were told that the television set in the lounge is turned off from 10am to 15.55pm. This was discussed with the registered manager who confirmed that the staff turn the television off in the lounge during the day. The rationale for this was that people could not watch television when the lounge was being used for other activities, however, activities are not provided for most of this time. She said that people could watch TV in their bedrooms if they wanted to, but several people said that they would prefer to sit in the lounge and got bored if they were not allowed to watch television and no activities were taking place. One of the residents told us that he liked to spend time in the garden but access to the garden, which is through the smoking room, was not allowed for two hours at lunchtime. We discussed this with the registered manager who said that the floor in the smoking room was washed at lunchtime and for health and safety reasons the residents could not use it until it was dry. We were told that there is an exit to the garden from the communal lounge, but we observed that this entrance is blocked by furniture. This means that people are restricted in their movements around their home, which is not acceptable. The Service Users Guide states that the residents are not allowed to bring mobile phone into the home with them, but offers no rationale for this. There is no communal telephone for the residents to use to make or receive calls but they can ask the staff if they can use the phone in the office. The rationale for this is to restrict direct family/friend contact within the initial three month Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 14 assessment period to enable people to settle in. The Service Users Guide also tells us that visits by families or friends should be arranged in advance. The rational for this is that other activities may have been arranged. Unless it can be demonstrated through individual care planning, which is not currently the case, that such restrictions on telephone calls and visits from families and friends will benefit individual residents, such restrictions are not acceptable. The policy of the home, as stated in the Service Users Guide, is not to allow the residents to have direct access to their money. Again this is not justified through individual risk assessments. The front door is locked with a key pad which denies the residents free access to and from their home. Yet again this not justified through individual risk assessments. In conclusion, the care planning practices do not take into account the individual wishes and needs of the people who use the service. Restrictions are applied which are not based on individual risk assessments to determine if a risk exists, and if a risk does exist, how to manage it on an individual basis. 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. Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 15 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 adequate. The potential that the service providers have to enable the people who live at Nightingale House lead fulfilling lives is undermined by institutional practices and poor staffing levels. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some improvements had been made in the provision of group activities outside the home and this was demonstrated by illustrated posters pinned to a notice board in the hallway asking the residents to add their names to a list of participants if they are interested in joining in. We were told that a bowling trip was oversubscribed and that a second visit was being arranged. Other popular venues include the theatre, especially to see tribute bands, and visits to a local fish and chip restaurant. Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 16 A range of in house activities are provided, including quizzes, musical entertainment and animal visits, however some of the residents spoken with told us they were bored, which indicates that more could be done to help people to fill their time. Suggestions included in the last inspection report, which were gained in conversation with the residents by an Expert by Experience, about how recreational facilities could be improved by the provision of a pool table and darts board had not been taken on board by management. Further suggestions were made to the management following conversations with the residents during this site visit which included suggestions that an existing workshop and greenhouse could be put to use to encourage people take an interest in gardening and DIY. There was no evidence of an increase in peoples ability to participate in the community on an individual basis as, although this is not supported by individual risk assessments, the management expressed concerns that the residents would not be safe to go out alone because of their physical disabilities, short term memory loss or previous addiction to alcohol. Although the manager and staff escort people on an individual basis to enable them to keep hospital, doctor and other medical appointments, we did not consider the staffing levels to be high enough to enable a staff escort to be provided whenever people wished to go out on an individual basis. The front door to the home is kept locked with a keypad and one of the residents told us that he would like to go out for a walk occasionally but that people were “locked in” and that the home was not his home but a prison. The people who use the service are not able to keep in contact with their families and friends without going through the staff as they do not have direct access to a telephone. Families and friends are asked to give the registered manager notice of any visits they intend to make. The justification provided by the home for these restrictions are, in the case of a recently admitted resident, to give the person a chance to settle in, and in the case of visits, to avoid calling when people may be engaged in other activities. There are no individual risk assessments to show that any of the people using the service would be at risk if these restrictions were not in place and unless records are kept to show that an individual resident has asked the home to restrict visitors and phone calls, we find such restrictions unacceptable. Since the last inspection the menu plans have been reviewed and the residents are now offered a choice of a set meal and a range of alternatives. Meals are served in the dining room at Nightingale House in two sittings. One resident has her meals in her room as she cannot access the dining room because she cannot negotiate the stairs. She told us that she is happy with this arrangement. Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 17 Very positive feedback was received from the people who use the service about the quality of the meals provided but the residents still do not have facilities to make themselves hot or cold drinks and snacks. Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 18 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 adequate. The people who use the service are helped to maintain their physical health and personal hygiene, but their specialist care needs are not being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nightingale House provides care for people with alcohol related conditions such as Wernicke-Korsakoff’s disease and other an alcohol related brain diseases. The home does not provide detoxification treatments, any other rehabilitative therapies or counselling. Although short-term care can be provided, most of the people who live at Nightingale House are unlikely to be able to return to independent living and require long term care. The people who were seen during the site visit were clean and well dressed which tells us that the staff are helping them to maintain their personal hygiene. Records of visits to hospital, GP’s, dentists and opticians told us that the home is monitoring the residents health care needs, making appointments Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 19 with health care professionals as and when necessary and escorting residents to enable them to keep health care appointments. The Statement of Purpose and Service Users Guide and the Companies website acknowledge that the people who have Korsakoff’s syndrome and Alcohol Related Brain Disease need a specialist service to ensure that their ‘holistic’ needs, which include their ‘physical, emotional, psychological, intellectual and spiritual needs’ can be met. Although there is evidence to show that the home is meeting peoples physical needs, there is no evidence to show that the management or staff have the training, knowledge and expertise needed to understand and meet the emotional, psychological, intellectual and spiritual needs of people with Korsakoff’s syndrome and Alcohol Related Brain Disorders or that these needs are being fully considered when drawing up plans of care and reviewing care plans. All of the residents medication is administered by the staff. The arrangements for the safe storage of medicines are satisfactory. We carried out a spot check of the medicines and medication administration records and found that the records were clear and up to date. Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 20 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. Complaints and concerns made by the people who use the service are not always taken seriously and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Concerns, Complaints and Protection Information about how to make a complaint is included in both the homes Statement of Purpose and Service Users Guide. Two of the people we spoke with during the site visit made positive comments about the home and the service they received. However, some people told us that they were not happy and did not feel that their complaints and concerns were taken seriously and acted upon. Policies and procedure are in place to safeguard the residents from the threat of abuse and the staff have received training in the Protection of Vulnerable Adults. However, conversations with the management and staff suggest that further training is needed to enable them to understand that restricting peoples rights and liberties could be regarded as a form of abuse. Nightingale House DS0000072611.V374580.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. With the exception of Porch House, The homes environment is generally basic and presents a bleak and impersonal impression, meaning that it is not a homely place for people to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registration for Nightingale House includes Porch House, which is a separate self-contained house providing bedrooms, a lounge, kitchen and bathrooms for three people. Porch House is only staffed at night so the people who sleep there are brought to Nightingale House in the morning and return in the evening. A gateway is being made to link the two houses through their gardens but this had not been completed at the time of the site visit. Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 22 The residents accommodation at Nightingale House is on the ground and first floor. The second and third floors of the home provide office space for the care manager and directors and accommodation for one of the directors. The registered manager and the staff have offices on the ground floor and the staff also have a large staff room/lounge. The laundry facilities are accessed through the staff room and are not easily accessible to the residents. The communal rooms at Nightingale House consist of a large lounge, a dining room that is not large enough to accommodate all of the residents in a single sitting and a smoking room. Although there are several exits from the house to the garden, which is at the back of the house, the main exit is through the smoking room and the other exits are blocked with furniture or are only used as fire exits. The communal rooms, and in particular the dining room would benefit from redecoration. The furniture in all three communal rooms is adequate for the needs of the home. However consideration could be given to rearranging the furniture in the lounge to give the room a more homely appearance. The garden to the back of the house is well landscaped and provides a very pleasant outdoor area for the residents. There is a large workshop in the garden which not accessible to the residents and a greenhouse, which is also not available for use by the residents as it is being used to provide an additional storage facility. The possibility of utilising both of these to provide occupational facilities for the residents was discussed with the service providers. Since the last inspection the service providers have fitted hot air driers and liquid soap dispensers in all of the communal toilets and in the bathrooms and shower rooms that have toilets in them. The presentation of the bedrooms vary considerably. The bedrooms at Porch House are well decorated and comfortably furnished and each of them has ensuite facilities. Some of the bedrooms at Nightingale House have been personalised by their occupants and have a very homely appearance, others contain very few personal belongings and are very impersonal and poorly furnished. The Service User’s Guide tells us that the people who use the service are not permitted to bring items of their own furniture into the home with them and to keep personal belongings to a minimum because storage space is limited. The bedroom doors have been fitted with locks but the residents do not have keys to their rooms so they cannot lock them from the outside for security. Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 23 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.V374580.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, 33, 34 & 35 Quality in this outcome area is poor. The staffing levels are not high enough to provide the individual support that the people who use the service need to enable them to lead active lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff recruitment practices were found to be poor at the last inspection, with incomplete application forms being accepted and references not being taken up. We saw that these records had not been reviewed and updated by this inspection, but it was agreed that this would be done. No new staff had been appointed since the last inspection so we could not check if safe staff recruitment practices are now being used. However, we were told that two people were shortly to be interviewed for a vacant post. Only one person had completed an application form and we were told that application forms are not always sent to people, because of the low rate of return. The completed application form we did see did not provide sufficient space for the Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 25 applicant to provide a full employment history and did not ask for the address of two referees, to enable written references to be obtained. Although the registered manager said that she felt that staffing levels were generous, we looked at the staff rota and did not agree. The staff rotas tell us that there are usually between two and three Care Support Workers on duty between 8am and 2pm and two Care Support Workers on duty from 2pm to 8pm. In addition to this the registered manager, a Senior Support Worker and the Care Manager, whose duties are largely administrative, work at the home from Monday to Friday, but not at weekends. Some of the Care Support Workers divide their shifts between care, cleaning and cooking duties. The home currently has twenty-six residents and is on two separate sites. Porch House is not staffed during the day or evening so the three people who sleep there are brought to Nightingale House in the morning and remain there until late in the evening. The staff on duty were seen to be very busy but we saw very little interaction between them and the residents. Some of the residents told us that they did not have enough to do and that they were bored. Overnight staffing levels are satisfactory. Two members of staff are on waking night duty at Nightingale House and one member of staff sleeps in and is oncall at Porch House. Staff training in health and safety related topics, including First Aid, Manual Handling, Fire Safety, Food Hygiene, Health and Safety and Infection Control is provided. Specialist training, which would help the staff to gain an understanding of the needs of the residents, is not provided. Difficulties in accessing specialist training courses were discussed with the registered manager and it was suggested that she contact Social Services and Charitable Organisations for guidance. The staff are encouraged to complete National Vocational Qualifications in Care. Nightingale House DS0000072611.V374580.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 adequate. The home is service led and that the rights of the residents to make individual choices are highly 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. The training records seen showed us that Mrs Apps has undertaken periodic training while managing the home, however we did discuss the need for her to look for Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 27 further training opportunities, particularly in the specialist areas of dementia care, mental illness and person centred planning. Overall the service provided is institutional and the people who use the service must adapt to the routines of the home. This approach is outdated and current thinking is to encourage people who need to live in residential care home to be involved in planning the care that they would like to receive and for the care provided to be based on their individual wishes and needs. This approach should enable the people who use care services to exercise control over their lives and develop or retain their independence as much as possible and lead fulfilled lives. Daily routines stifle personal development and peoples plans of care lack any detail. It is the policy of the home not to allow the people living there to look after their own personal spending money. This is a blanket restriction and is not based on individual need or individual risk assessments. The Company Secretary acts as the Client Finance Manager. The quality assurance/quality monitoring system has improved since that last inspection and this has led to the production of an annual development plan for 2009 which should lead to improvements in the service provided. Further work needs to be done in this area to ensure that the people who use the service, people who are involved with them on a professional or personal basis and the staff all have an input in the way the service develops. 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. Nightingale House DS0000072611.V374580.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 2 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 1 23 2 ENVIRONMENT Standard No Score 24 2 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 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 1 X 2 X X 2 X Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 29 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 Requirement Further amendments must be made to the Statement of Purpose to ensure that all of the required information is included. To meet this standard it will also be necessary to include the recommended information. This is to ensure that current and prospective residents have access to full and accurate information about the service provided. 2. YA1 5 Further amendments must be made to the Service Users Guide to ensure that all of the required information is included. To meet this standard it will also be necessary to include the recommended information. This is to ensure that current and prospective residents have access to full and accurate information about the service provided. 04/09/09 Timescale for action 04/09/09 Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 30 3. YA6 12 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. Previous timescale for compliance 04/02/09 not met. 04/09/09 4. YA7 12 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, mealtime choices and all regimes that are restrictive. Previous timescale for compliance 08/01/09 not met. 04/09/09 5. YA9 12 & 13 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. Previous timescale for compliance 08/01/09 not met. 04/09/09 6. YA13 18 Adequate staffing levels must be 04/09/09 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 DS0000072611.V374580.R01.S.doc Version 5.2 Page 31 Nightingale House staff rota. Previous timescale for compliance 04/02/09 not met. 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. Previous timescale for compliance 08/01/09 not met. 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. Previous timescale for compliance 08/01/09 not met. 9. YA17 16 Safe facilities must be provided to enable the residents to make themselves snacks and hot drinks, if and when they choose to do so. Previous timescale for compliance 04/02/09 not met. 10. YA33 18 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. Previous timescale for Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 32 7. YA15 16 & 4 04/07/09 8. YA16 13 04/07/09 04/07/09 04/07/09 compliance 04/02/09 not met. 11. YA39 24 The registered providers must 04/08/09 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 with the people who use the service and their representatives. Previous timescale for compliance 08/01/09 not met. 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 YA22 Good Practice Recommendations 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. YA37 Nightingale House DS0000072611.V374580.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.V374580.R01.S.doc Version 5.2 Page 34 Nightingale House DS0000072611.V374580.R01.S.doc Version 5.2 Page 35 - 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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