Inspection on 02/12/05 for Nightingale House

This inspection was carried out on 2nd December 2005.

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

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

Other inspections for this house

Nightingale House 30/04/09

Nightingale House 02/04/08

Nightingale House 24/04/07

Nightingale House 26/05/06

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 Diane Roberts Unannounced Inspection 2nd December 2005 12 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.V269598.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 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.V269598.R01.S.doc Version 5.0 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 20th June 2005 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. Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over four hours and was carried out as part of the annual inspection programme for this home. The registered manager was present at the inspection The Inspection focused upon the homes response to the last agenda for action and work that had progressed with regard to both care and the premises. A partial tour of the premises was undertaken. One relative, three residents and a visiting district nurse were spoken to during the inspection. One comment card was also received from a relative. Due to the care needs of the residents at the home if was not possible to fully obtain their views but residents’ appeared happy, relaxed and comfortable. What the service does well: What has improved since the last inspection? What they could do better: Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 6 The home is steadily improving but shortfalls remain in staff training, resident’s activities, health and safety, premises and some record keeping. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Standard 6 is not applicable to this home. The home provides reasonable information for residents prior to admission, but this could be clearer in some areas. The home needs to improve upon the system for resident’s contracts. EVIDENCE: The Service Users Guide and Statement of Purpose were inspected. The Statement of Purpose is generally in order with only minor adjustments needed, such as making it clear that the home does not provide nursing care and updating the complaint procedure to include the correct address for the CSCI office. The Service Users Guide was also seen to be generally in order, but also requires some minor adjustments such as stating that ‘everyone will have their own individual room and may have to share common facilities’, which does not account for the 7 double rooms in the home. Guidance also needs to be available on accessing the current inspection report for the home and the complaints procedure. Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 9 The home has a standard contract of residence in place. These were not available for inspection on the day of inspection. This needs to be addressed, as it is not possible to say whether each resident has a contract in place. The content of the contract was seen to be satisfactory and outlines clear terms and conditions. Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 and 11. The home has satisfactory systems in place for the safe handling of medicines. The home provides a caring and sensitive service at the end of life. EVIDENCE: The home has up to date policies and procedures in place for the safe handling of medicines. They also have copies of local and national guidance. Records show that all staff that handle medications are either trained or about to undertake a refresher course. The record sheets and medication stock was inspected and seen to be in good order, with clear records and good stock control. The home was not managing any controlled medications at his inspection and records show that a satisfactory returns system is in place. Both General Practitioners and Nurse Practitioners undertake medication reviews at the home. The manager has undertaken a significant training course on the care of the dying. The manager has a hands on approach in the home but records show Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 11 that she has not cascaded any training down to staff on this subject. This should be considered. Policies and procedures are in place on the care of the dying and these include practical advice for staff. Compliment cards seen; reflect relatives satisfaction with the care provided at the end of life. Where possible the home aims to care for residents as long as possible as per the wishes of the individual and their family. Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 15. The home has a basic activities programme in place that needs to be developed and records fully maintained. As far as possible, residents are helped to exercise choice and control over their lives. The home provides a satisfactory meal service, but needs to ensure a current menu is in place. EVIDENCE: Records show that the homes’ activities programme is basic and needs development. Records are limited at times and perhaps do not accurately reflect all the work that is undertaken, such as life skills. From discussion with staff, this is evident. One resident said that the home has bought her a sewing machine and that she took part in life skills such as dusting and hovering her room but records do not reflect this. The home needs to ensure that they are meeting the needs of all the residents and that the programme is kept under review. This was again discussed with the manager after being raised at the previous inspection. The manager reports that three residents do attend the local stroke club and that residents Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 13 do go out shopping etc. It is also reported that the home has good links with the local dementia support group. The home encourages either family or representatives to deal with financial matters on behalf of residents. The home has information on advocacy and has actively used advocate in the past, which the inspecting officer has met in the home. The home needs to consider providing this information to resident’s relatives either on display in the home or in the Service Users Guide. Inspection of resident’s rooms show that where able, residents have brought in their own personal items including small pieces of furniture. The home has a new chef in post, who is currently reviewing the menus in liaison with the manager. The current menus do not reflect the meals being provided. A daily choice with the main meal is available and when required alternatives are provided. Records show individual preferences and choices that residents have made. The record also shows how well they ate. Specialist diets are dealt with appropriately and the home has fresh fruit and vegetables delivered. Residents spoken to commented positively regarding the meal at lunchtime on the day of inspection and confirmed that they were given an alternative because of personal preferences. Relatives spoken to felt that the food always looks appealing and feel that their relatives are well fed. Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards in this section were assessed. EVIDENCE: Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The home is generally safe and well maintained, but further attention to detail could improve this. The home is clean but needs work to ensure that it is pleasant and free from odours. EVIDENCE: A partial tour of the home was undertaken. The home has recently had a problem with rising damp at the rear of the home. This has affected the corridors and some resident’s bedrooms, near the doorways. The manager reports that the cause has now been rectified. At the time of the inspection a damp odour was noted and there is a need for redecoration in the affected areas. The manager reported that this work was due to be undertaken soon after Christmas 2005 and the carpets were due to be cleaned a few days after the inspection. Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 16 It was noted that attention to detail with the cleaning in the kitchen is needed and work is required to address the tripping hazard with the floor in and upstairs bathroom. This was discussed with the manager on the day of the inspection. The home has a garden to the rear, which is accessible to residents. The garden primarily consists of lawn, which is maintained. This area could be made more attractive. The home was seen to be clean and generally pleasant apart from the issues noted above. The home has plenty of resources and information on infection control, but upon review these were seen to be quite old and therefore the advice may be out of date. It was recommend to the manager that she obtains the most local recent advice form the Community Infection Control Team. Records show that no training has been given to staff on this subject. Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30. Resident’s needs are met by the number and type of staff on duty but shortfalls in training may affect this. Whilst training has improved there remain areas where there are shortfalls. EVIDENCE: Recent staff rotas were inspected at random. The home maintains 4 staff on each day shift and 3 at night. On occasions the manager works on the floor but this is less than before and she reports that she is managing to get more supernumerary time. Staff rotas were clear and identified the roles of staff. Dependency levels were discussed and it was felt that the current staffing levels were appropriate although the manager has not assessed these against the DOH guidance. More staff are on duty when escorts are required for hospital visits etc. Sufficient domestic and kitchen staff are employed at the current time. Whilst training has steadily improved, the home has yet to put a formal training programme in place, along with a recognised induction programme i.e. linked to Skills for Care. The home only provided one partially completed record of a carer induction, despite being asked for three. The record shows that the induction is unstructured and incomplete. The dates on the records also show that the induction was undertaken sometime after the carer started employment at the home. This needs to be addressed. The provision of staff training was highlighted at the last inspection. Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 18 Records show that significant numbers of current staff have attended training in Dementia, Food Hygiene, First Aid, Protection of Vulnerable Adults and Moving and Handling. No records were provided which evidence that care staff at the home are undertaken or have achieved NVQ 2 or above. Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 and 38. The home has satisfactory systems in place, which would safeguard resident’s monies. Systems are in place for the health and safety of residents at the home but some of these need developing further. EVIDENCE: The home encourages families and/or representatives to act on the resident’s behalf and deal with their personal monies as far as possible. This is due to the care needs of residents. Where required, the home with deal with small amounts of personal monies and the records for these were inspected at random. These were found to be in order with appropriate records and receipts. The manager does not act as an appointee for any residents. Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 20 The home has a satisfactory health and safety policy in place. A risk assessment has been completed in relation to fire but no other safe working practice risk assessments are in place. This was discussed with the manager. Training records supplied to the CSCI show that no staff have attended or completed health and safety training. This needs to be addressed. Training has been provided to care staff on safe manual handling and compliance is good but not 100 . Nine staff have attended first aid training and thirteen staff have undertaken basic food hygiene training. Nineteen care staff are employed. The manager has recently attended a fire marshals course. Safety certification for fittings and equipment were inspected and found to be in order, with contracts in place for maintenance etc. The home has a maintenance man who undertakes hot water temperature checks. On a tour of the building a tripping hazard was noted in an upstairs bathroom as tiles have lifted near the doorway. The floor in this bathroom is in need of refurbishment. This was pointed out to the manager on the day of inspection. Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 22 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 OP1 Regulation 4 Requirement The registered person must review and update the Statement of Purpose to ensure it contains the correct information. The registered person must review and update the Service Users Guide to ensure it contains the correct information. The registered person must provide a plan of care that is kept up to date and where possible involves the resident or their relative/representative. The registered person must ensure that all health related checks and assessments are in place and are under review. The registered person must provide a record of food provided for service users in sufficient detail – with regard to menus. The registered person must ensure that the home is maintained to a satisfactory standard with regard to the decoration and flooring in bathrooms. The registered person must DS0000015550.V269598.R01.S.doc Timescale for action 31/03/06 2 OP1 5 31/03/06 3. OP7 15 01/09/05 4. OP8 13 01/09/05 5. OP15 17(2) Schedule 3 23 (2) 31/03/06 6. OP19 14/09/05 7 OP26 16(j) 02/12/05 Page 23 Nightingale House Version 5.0 8. OP30 18 9. OP33 24 10 OP38 12/13 ensure that the kitchen is cleaned to a satisfactory standard with particular attention to detail. The registered person must 31/03/06 ensure that staff are trained appropriately for the work they are to do and given assistance to obtain further qualifications. This refers to staff induction, health and safety training and NVQ qualifications. Full records must be maintained. The registered person must 01/09/05 ensure that there is a system for monitoring the quality of care provided by the home. The registered person must 31/03/06 ensure safe working practice risk assessments are in place and are kept under review. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP2 OP14 OP30 OP26 OP19 Good Practice Recommendations The registered person should keep a copy of every resident’s contract of admission in the home. The registered person should ensure that information on advocacy services are made available to residents and their families/representatives. The registered person should provide training to staff on the care of the dying and infection control. The registered person should obtain copies of the most up to date infection control advice. The registered person should give consideration to making the garden a more attractive area. Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Nightingale House DS0000015550.V269598.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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