Inspection on 02/04/08 for Nightingale House

This inspection was carried out on 2nd April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Nightingale House 30/04/09

Nightingale House 24/04/07

Nightingale House 26/05/06

Nightingale House 02/12/05

Nightingale House 08/02/05

Nightingale House 12/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Nightingale House 69-71 Crowstone Road Westcliff On Sea Essex SS0 8BG Lead Inspector Carolyn Delaney Unannounced Inspection 2nd April 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingale House Address 69-71 Crowstone Road Westcliff On Sea Essex SS0 8BG 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) 01702 338552 01702 331788 xassist@aol.com Mr Abi Oduyelu Mrs Anita Mary Veronica Martin Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The number of service users for whom personal care is to be provided should not exceed 30 (total number not to exceed 30). Personal care may be provided for up to 30 people over the age of 65. Personal care may be provided for up to 30 service users with dementia over the age of 65. One named person known to the CSCI who is under 65 years of age. Date of last inspection 24th April 2007 Brief Description of the Service: Nightingale House is registered to care for both older people over the age of 65 and those over 65 who may have dementia. At the current time the home is primarily caring for people with dementia. The home is situated near Southend seafront. It is close to the shops and local bus routes. The home has a small car park to the front and a garden at the rear. The fees are £425.00 to £430.00. Additional charges would be made for hairdressing, chiropody etc. The home has information available for prospective residents. A copy of the latest inspection report is readily available in the reception area. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection. The inspection visit was carried out on 2nd April 2008 between the hours of 10.00 and 18.30. As part of the inspection process residents, staff and visitors were spoken with to obtain their views about the home. Recorded information about residents, including assessment documents, care plans and risk assessments were examined. Staff were observed when providing general support to residents and these observations were used to help make judgement about the care and support that individuals receive. Records in respect of staff employed in the home were examined to help determine whether staff were recruited robustly, trained and supported, and employed in sufficient numbers to meet the needs of people living in the home. Other records in respect of how complaints are received and managed, how the home is maintained and managed were also examined as part of the inspection process. In addition, the information provided to us by the manager and proprietor such as notifications of occurrences in the home including injury, admission to hospital or the death of a resident were reviewed as part of the inspection planning process to help us identify any areas of good or poor practices which may affect residents. The manager also provided us with their Annual Quality Assurance Assessment (AQAA). This is used by the proprietor to self assess how well they are meeting outcomes for people living in the home. This information was used in to plan the inspection and referred to throughout the inspection visit. A brief tour of the building including resident’s’ bedrooms, communal spaces such as the lounge, dining rooms and bathrooms was undertaken. Other areas including the laundry and kitchen were also viewed. What the service does well: Residents and their relatives are generally happy with the home and the support and care provided. The care team at the home has good relationships with local healthcare teams and staff act on the information and advice given by health and medical Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 6 practitioners. This helps to ensure that residents’ healthcare needs are met promptly. The manager has an open approach. People feel confident that the manager will deal with any issues that they may have. The staff team feel supported and they receive ongoing training to help them care for people living in the home. What has improved since the last inspection? What they could do better: The way in which staff plan and deliver care and support for residents needs to be developed so as to promote residents’ choice and independence so far as possible. When assessing the support each resident needs staff should take into consideration resident’s strengths and the things that they are capable of doing. This would help to keep residents as active and involved in their care as possible. The manager must ensure that staff are available to assist and support residents, particularly at mealtimes so that residents have the support that they need. The provision of activities needs to be reviewed, as residents do not benefit from activities and stimulation. The range of activities is very limited and staff should be more creative in providing ways to keep residents occupied and stimulated. Some areas of the home are poorly maintained and this detracts form the overall environment and may even pose potential risks to the safety of residents and staff. Staff are not recruited robustly and all of the checks that should be carried out to determine that a person is suitable to work in the home are not carried out before a person is employed. This practice could potentially put residents’ welfare at risk. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People wanting to move into Nightingales receive sufficient information and assessment to know that their needs can be met, however a more person centred approach would improve the experience for residents. EVIDENCE: The AQAA did not describe how the manager assures residents and their relatives that the home will be suitable, however there is a standard and consistent procedure for assessing prospective residents’ needs. The manager visits people in their home or hospital and carries out an assessment of their needs and the support they require in respect of daily activities of living including maintaining personal hygiene, eating and drinking and personal safety. The assessments for two people who had recently moved into the home were examined. The manager had carried out each assessment before they had Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 10 been offered a place in the home. As identified at the last inspection, information about residents’ needs could be more person centred and could include details of people’s strengths and capabilities rather than just their need for support. This would help to assure residents that they would receive individualised care and that they would be supported in remaining as independent as possible. Two people who had recently moved into the home were spoken with, however they could not tell us about their experience of moving into the home due to their poor memory and dementia. The relatives of three people who had moved into the home since the last inspection were spoken with. Each of the them confirmed that they had visited the home and the manager had made them feel welcome and provided them with information about the home to assist them in making a decision as to whether their loved ones would be happy and well cared for. One person said that their ‘initial impression of the home was good’. They said that their relative had only been living in Nightingale House for a short period but that they ‘appeared settled and happy there’. Another person said that they had read the previous inspection report to assist them in making their decision about the home. Staff who were spoken with during the inspection said that they receive training and support so as to enable them to care for residents. Staff said that they feel residents are well cared for. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home are supported according to written care plans that do not always give opportunity for choice and independence. EVIDENCE: Staff assess residents’ physical and mental health needs from which they develop a plan of care for each person. The information viewed about residents’ needs was noted to be somewhat basic and lacked detail as to the individual’s capabilities. Where needs had been assessed it was not clear as to how this impacted upon the person’s ability to carry out daily activities of living such as washing and dressing, eating and drinking etc. For example it was recorded for one person in their care plan for personal care that the person ‘requires full assistance with one carer for this area’. The plan did not include any information about this person’s abilities or preferences regarding maintaining personal care needs. It was recorded in another person’s care plan for personal care that ‘staff should encourage the person to do as much for themselves as possible’. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 12 However there was no information recorded as to what this individual was capable of doing. This information is important as it provides staff with details of how they can best support each person to remain as independent as possible while supporting them according to their needs. Staff review residents’ care plans usually once each month. Some care plans had been reviewed more regularly where there had been a change in the person’s condition. Some care plans, which had been reviewed by staff, had been amended due to changes in the person’s condition or the level of support they required. However when staff review care plans generally they do not record what changes there have been since the last review or how these changes affect the care and support the person may need. There was no evidence that residents’ families had been involved in the review of care, however the manager does inform relatives verbally when there been changes to the care or treatment of residents. People who were spoken with confirmed this. There is a system in place for assessing risks to each person’s health and safety. In general risks to residents’ health and safety are well managed. In particular the risks associated with reduced mobility are assessed and there is clear guidance and information for staff to follow to minimise the risk of the person developing pressure sores. A district nurse who was spoken with during the inspection said that staff always ‘follow advice given’ and that staff ‘always contact them if they have any worries about a resident’s skin integrity’. Records indicate that where risks are identified that staff inform the manager who obtains appropriate pressure relieving mattresses and cushions to minimise risks of skin breakdown and to promote the person’s comfort. A number of people living at the home had been assessed as being at particular risks of sustaining injury through falls due to them being unsteady on their feet and general problems with mobility. Staff complete records in respect of accidents and any injuries sustained by people living in the home. These records were examined and they were well maintained and no person was identified as having sustained any serious injury from falls. Relatives confirmed that they were informed if residents had a fall or sustained any other injuries. People living in the home rely upon staff to ensure that they receive the medicines, which have been prescribed for them. There is a policy in respect of the safe receipt, storage, administration and disposal of medicines in the home. Staff are aware of the policy and generally adhere to it. Staff who are responsible for administering and dealing with medicines receive training and this is updated regularly (usually once a year). Staff who were spoken with during the inspection said that they had received training within the past few months and staff training certificates confirmed this. The Medication Administration Records (MAR) were examined during the inspection visit. Records were generally well maintained and staff signed to indicate that they had administered medicines to residents. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 13 It was noted that where medicines are handwritten on MAR that entries are not checked with a second member of staff to minimise the risk of potential errors. Two people should check handwritten entries on MAR. A sample of medicines for three residents were counted and checked against the records. The numbers of tablets were correct for two residents. However for one resident it was recorded that they had brought 35 tablets when they moved into the home. Records indicated that 8 tablets had been administered since admission. This meant that there should have been 27 tablets left, however there were 28. This highlights the need for more robust checking procedures regarding medicines received and administered in the home. Three residents were spoken with during the inspection. While these people could not describe the care they receive they did indicate that staff were good and that they were happy living in the home. The majority of relatives who were spoken with said that they were overall happy with the care that residents received in the home. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home do not benefit from activities and opportunities for stimulation or exercise, which are suited to their needs or reflect their preferences. EVIDENCE: From the AQAA we were told that staff assist and encourage residents to develop and promote new interests that fall within their capabilities. On the day of the inspection there was a plan of activities available. The plan included ball games, card games, puzzles, nail care and hand massage. Staff record what activities are provided for residents. These records were viewed and the majority of records indicated that the activities provided consisted of ‘watching television’ or ‘listening to music’. There were care plans in place for residents in respect of activities. However these did not generally indicate what activities the person would enjoy and where there was information as to preferences there was no indication that these activities were offered. The manager said that she and staff do try to provide activities for residents however it was not always possible due to resident’s dementia. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 15 However during the course of the inspection it was noted that staff did not initiate activities as planned. During observations made in the lounge areas in the morning and afternoon residents spent long periods sitting in their chairs with little stimulation available to them. Televisions were switched on in both lounge areas however residents did not appear to be interested. Some residents spent this time sleeping. Some relatives visit residents and take them out of the home to visit family etc. There was no evidence that staff in the home provide activities outside of the home for residents. One relative commented that while there is a plan of activities that ‘these do not happen and that residents spend a lot of the time sleeping from what they see when they visit the home’. Another person commented that ‘they wished their relative could get out more’. The lack of provision of suitable activities has been identified at previous inspections. The manager and owner must review he provision of activities so as to improve the experience of living in the home for residents. Relatives who visited the home on the day of the inspection said that they can visit at any time and that the manager and staff always make them feel welcomed. Relatives may take residents out for lunch etc. During the inspection one resident’s family were planning a celebratory party for the resident in the home and the manager was arranging for party food and decorations to be provided for the event. There is a cook employed for four days per week. The manager or a member of staff cook for residents on the three remaining days. There was a planned menu for meals available for inspection. This indicated that there is a choice of meals available each day. The manager provided the inspector with a copy of a report by a nutritionist indicating that the menu was nutritionally well balanced. While the nutritionist was generally impressed with the range of foods available and staff support, they did recommend that starchy puddings be replaced with more healthy options such as fruit and that the use of tinned and packet foods should be reduced. The manager said that fresh meat and vegetables are bought each week and that the use of tinned and or processed foods has been reduced following the comments made in the previous inspection report. Residents were offered fresh fruit as a snack during the afternoon. The menus indicated that puddings generally consist of mousses and tinned fruits. Consideration should be given to providing a range of more healthy alternatives. On the day of the inspection residents were not offered a choice of meal. Resident’s were given beef with mashed potatoes and a selection of vegetables. The meal looked appetising. Those residents who are more capable of eating without assistance were seated in the conservatory which provides an ambient setting where they can enjoy their meals together. Most residents appeared to enjoy their meal and some people indicated that it was good. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 16 Other residents who required assistance with prompting or feeding were seated in both lounges. It was noted that in the downstairs lounge three residents required assistance. Two members of staff spent some time in this lounge to assist residents. However staff did not stay with residents to ensure that they ate their meal and two residents were observed to eat very little of the meal. These residents struggled to use the cutlery and dropped food on their clothing. One relative commented that there are not enough staff about at mealtimes and that residents ‘play with their food and it ends up all down them’. Staff maintain records for each resident regarding how much of each meal the person eats. This is done so as to identify anyone who may have reduced appetite so that appropriate action may be taken. However it was worrying to note that staff had recorded that residents ate their lunchtime meal when in fact they had not. This practice means that issues regarding a person’s appetite and nutrition may not be detected and acted upon. This was brought to the attention of the manager who said that she would review and monitor staff practices. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are dealt with appropriately and residents are safeguarded from harm. EVIDENCE: From the AQAA we were informed that there is a complaints policy and procedure, which is readily available to residents and their relatives or representatives. The majority of people living in the home have dementia and it is generally relatives who bring issues of concern to the manager’s attention. People who were spoken with during the inspection confirmed that they were aware of how to make a complaint and who to speak with if they were unhappy. Relatives said that the manager was very good at dealing with any issues raised. Any complaints received are recorded with details of the action taken and the outcomes. Records, which were viewed during the inspection visit, indicated that there had been three complaints made since the last inspection. There was evidence that the manager had investigated these complaints and responses had been sent to the complainant. None of the three complaints had been upheld. Records indicated that staff have received training in respect of safeguarding residents from harm, abuse and neglect. Staff who were spoken with could demonstrate that they understood the safeguarding process and that they Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 18 were aware of what action to take if they witnessed or suspected any ill treatment of residents. Relatives who were spoken with said that staff treated residents well. The practices for recruiting staff to work in the home are not consistent or robust and this may potentially put residents welfare at risk. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Nightingale House is generally clean, safe and comfortable and suited to the needs of people who live there. EVIDENCE: In the AQAA the manager and proprietor told us of the improvements made to the physical environment since the last inspection. This included improvements to the lighting within the home, renewal of flooring to communal spaces and some resident’s bedrooms and redecoration. There was evidence during the inspection of the improvements made. New carpets had been fitted and new furniture had been provided in a number of bedrooms. Rooms were well lit and generally clean. The lounges and dining rooms were noted to be clean, bright and nicely decorated. Residents had comfortable seating and small tables for drinks etc. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 20 Some bedroom carpets were dirty or badly stained and some bedroom furniture was chipped and broken. This detracts overall from the ambience of the home. The home employs a cleaner for 25 hours per week, however this person said that they were not always guaranteed these hours. It was not evident that there is a regular and consistent plan for the cleaning of the home. Bathrooms and communal toilets were seen to be cluttered and could do with a tidy up in order to make them a more pleasant place. Wheelchairs were stored in some bathrooms. Wherever possible these should be in residents’ rooms to allow residents access to this facility. This had been identified at the previous inspection and it is disappointing that the practice of storing wheelchairs in bathrooms continues. Some wheelchairs were dirty with old dried on food etc. Bed linen looked clean but unironed which may detract from resident’s comfort. In one bedroom the ensuite wash hand basin was not fixed securely to the wall and posed a risk should a resident lean on it. Hand washing soap and towels were not available for staff and residents in all of the bathrooms. This does not promote good infection control practices within the home. There has been some work completed in the laundry and new washing machines had been installed. However the room itself was cluttered and does not provide a suitable or safe environment for staff. The manager and proprietor said that regular audits are carried out in respect of the environment however it is disappointing that the issues identified, some of which have been ongoing had not been dealt with. Residents who were spoken with during the inspection were not capable of making comments about the environment. Relatives who were spoken with said that the home was generally clean. One relative said that ‘it seems to take a long time for things to get done in the home’. Another said that home is ‘shabby’ Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment practices are poor and may put residents at risk. Staff are well trained but the deployment of staff does not always meet residents’ needs. EVIDENCE: From the AQAA we were informed that there is a good skill mix with staff who are skilled and trained. Staff have regular days off and do not work excessive hours. Staffing numbers are maintained however there does not always appear to be sufficient staff available to support residents, particularly at mealtimes. This was observed during the day of the inspection and some relatives also commented that there was a lack of staff at mealtimes. Records indicate that in general staff turnover is low and that there is not a heavy reliance on the use of temporary agency staff. Where agency staff are used the manager should obtain information in respect of the person’s skills and experience and evidence that the person has a satisfactory Criminal Records Bureau (CRB) disclosure. This is to ensure that all measures are taken to safeguard people living in the home. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 22 We were told that there is an up to date recruitment policy. However when staff recruitment files were assessed it was noted that checks had not been carried out for individuals so as to determine that the person was suited to work in the home. It was of concern to note that each individual’s work history had not been explored. In general there was only information available in respect of the person’s most recent employer and there was no indication as to how long the person had worked in the establishment or their reason for leaving. References had been obtained from friends in some instances, and there were no references on file from the managers of the establishments where individuals had worked. This practice is not safe and is inconsistent with the home’s policy and current regulations. There was no evidence for two people that they were eligible to live and work in the United Kingdom. People are interviewed by the manager and complete a questionnaire as part of the recruitment process, which is good practice as it gives the manager an indication as to whether the person will be suited to work in the home. There is a period of induction, which new staff complete whereby they read the home’s policies and procedures and shadow staff to get an understanding of the residents, their needs and the work involved. One person who had just commenced their induction in the home was spoken with. This person said that they ‘had a good feeling about the home’ and felt that they would enjoy working there. There is an ongoing programme in place for training staff. This includes training in respect of the safe moving and handling of people, fire safety, Control of Substances Hazardous to Health (COSHH) and infection control. In addition staff receive training in respect of caring for people who have dementia / Alzheimer’s disease and safeguarding people from harm. Six of the seventeen (29 ) care staff employed at the home had undertaken National Vocational Qualification (NVQ) and a further five care staff were undertaking this training at the time of this inspection. This helps to ensure that staff who are trained and assessed to national vocational standards in care practices supports residents. Staff who were spoken with confirmed that they receive ongoing training and said that the manager is very supportive and helpful. One person said that the work is challenging but that there is always support and training available. Relatives who were spoken with during the inspection were generally very complimentary. One person said that ‘staff give 100 of their time and effort ‘ to care for residents. Two healthcare professionals commented that staff had good knowledge of preventing pressure sores. One healthcare professional said that staff were aware of residents needs and followed instructions effectively. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Nightingale house is generally well managed however there are areas which need to be improved upon so as to provide better outcomes for residents. EVIDENCE: The manager and proprietor informed us in the AQAA that the home is well managed and that this is evidenced by the positive comments made by residents and their relatives. Staff, residents and visitors who spoken with the inspector all spoke very highly of the manager. They said that she was approachable and dealt with any issues brought to her attention promptly. At the inspection the proprietor said that there were plans to delegate some of the daily tasks to senior staff so as to free the manager in order that she could Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 24 concentrate on the management of the home. It was not clear that this had been implemented effectively. There were a number of issues identified during the inspection, which need to be dealt with more consistently. These include development of care planning, the safe recruitment of staff and the overall maintenance of the environment. People who live in the home and their relatives are consulted informally on a regular basis to obtain their views about the home. People who were spoken with during the inspection confirmed this and two people said that ‘the manager was always available if they needed to speak with her’. Another person said that ‘the manager and staff give 100 of their time and that they could not ask for more’ Additionally surveys are sent out each year. Those surveys, which had been returned, were available at the time of the inspection. These indicated that overall relatives were satisfied with the home. This process could be further developed to include an analysis of the information received and from this improvement plans, which reflect what people say could be developed. It is the policy of the home to bill residents / relatives for extra services such as hairdressing and chiropody etc. Residents may keep small amounts of money in the home. Records in respect of monies held on behalf of residents were examined. Records were well maintained and monies were checked and accurate. There was evidence that electrical, gas and mechanical equipment in the home is maintained, repaired and renewed as necessary and there were certificates and records in respect of maintenance available for inspection. These were up to date and appropriate. Records in respect of accidents and other incidents in the home were well maintained and did not indicate any adverse trends or identify any particular individuals as being at particular risk. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must be kept up to date and accurate and where possible include the input of residents or their relatives so as to help ensure that care and support provided by staff is individualised according the resident’s needs and capabilities. This requirement is outstanding from the previous two inspections. 2. OP9 13(2) Procedures for checking all 30/06/08 medicines received, administered and disposed of must be reviewed so as to ensure that residents receive medicines which have been prescribed for them and to minimise the risk or errors and mishanding 16 (m and A meaningful programme of 31/07/08 n). activities for residents must be provided in the home both on an individual and group basis, to ensure that residents’ needs are met. This is requirement is outstanding from the last inspection. DS0000015550.V361570.R01.S.doc Version 5.2 Page 27 Timescale for action 31/07/08 3 OP12 Nightingale House 4 OP15 16(2) (i) 5 6. OP27 OP29 18(1) (a) 19 Staff must be available to 30/07/08 support residents at mealtimes according to their needs so as to help ensure that resident’s nutritional needs are met. Staff must be employed in 30/07/08 sufficient numbers so as to meet the assessed needs of residents. People must only be employed to 30/07/08 work in the home once all of the checks in respect of their fitness, including checks in respect of previous employment and references have been carried out. 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 OP3 Good Practice Recommendations A person centred approach to pre-admission assessments and the admission process should be developed in order to provide a more individualised service. A review of the use of processed and value food should be undertaken to ensure that residents are receiving a healthy and nutritional diet. A plan for the general maintenance and renewal of furnishings etc within the home should be developed and implemented so as to ensure that repairs etc are carried out in a more systematic and effective way. The arrangements for cleaning the home should be reviewed and a programme for cleaning should be implemented to ensure that all areas of the home are kept clean. DS0000015550.V361570.R01.S.doc Version 5.2 Page 28 2. OP15 3. OP19 4. OP26 Nightingale House 5. OP33 The quality assurance system in the home should be further developed so as to analyse the information received and from this plan changes to improve the service provided. Nightingale House DS0000015550.V361570.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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