Inspection on 02/07/07 for Nightingale House

This inspection was carried out on 2nd July 2007.

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

The inspector 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 04/09/06

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

CARE HOMES FOR OLDER PEOPLE Nightingale House 57 Main Road Gidea Park Romford Essex RM2 5EH Lead Inspector Julie Legg Key Unannounced Inspection 10:00 2nd- 5th July 2007 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 DS0000066621.V343733.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. DS0000066621.V343733.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingale House Address 57 Main Road Gidea Park Romford Essex RM2 5EH 01708 763 124 01708 745 087 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) Nightingale Residential Care Home Ltd vacant post Care Home 37 Category(ies) of Dementia - over 65 years of age (37) registration, with number of places DS0000066621.V343733.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th September 2006 Brief Description of the Service: Nightingale House is a registered care home for 37 people aged 65 and over. The home is situated in a residential area of Romford. It is on several bus routes and approximately ten minutes walk from a main line station. The home is a large two storey detached house with extensions, the house is set back from the main road and surrounded by well - maintained gardens. There are a total of 22 bedrooms, providing shared and single accommodation and two of the single rooms have an en-suite. All of the other bedrooms have a vanity unit and there are ample communal toilets on both floors. There are five bathrooms, three of which have medic baths, which are a special walk- in and sit down type of bath. There is also a shower room and a further domestic bath. Personal care is provided on a 24- hour basis, with health care needs being provided by health professionals such as GPs and community nurses. The Statement of Purpose and the Service User Guide are issued to every prospective resident and both of these documents are displayed in the entrance hall of the home. A copy of the most recent inspection report is also available. A resident or relative/representative could ask for his or her own copy, which the manager would make available. The fees for the home are £475-£600 a week. The acting manager made this information available on 11th July 2007. DS0000066621.V343733.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which took place over two days. The acting manager and the area manager were present during the inspection and both were available for the feedback at the end of the inspection. Some discussion also took place with the registered provider. The visit also included talking to care staff about the care residents receives and were also observed carrying out their duties. The inspector spoke to a number of residents who were asked to give their views on the service and their experience of living in the home. Relatives and a GP who were visiting the home at the time of the inspection were asked their views and the local funding authority (London Borough of Havering) was also contacted. A tour of the home was undertaken and all rooms were clean with no offensive odours present throughout. A random sample of residents’ files was case tracked, together with the examination of staff and other records. These included medication administration, staff rotas, training schedules, maintenance records and staff recruitment procedures and files. Additional information relevant to this inspection has been gained fro the Annual Quality Assurance assessment, monthly regulation 26 reports and Regulation 37 notifications. The inspector had a discussion with the manager on the broad spectrum of equality and diversity issues and she was able to demonstrate a good understanding of the varied needs around religion, sexuality, culture, disability and gender. The inspector had a discussion with the manager and people living in the home about how they wished to be referred to during the inspection and in the report. They expressed a wish to be referred to as residents this is reflected accordingly in this report. The inspector would like to thank the residents and staff for their input during the inspection. What the service does well: The home has a welcoming atmosphere and is clean and tidy. Residents, relatives and staff all spoke about Nightingale House being a nice place to live DS0000066621.V343733.R01.S.doc Version 5.2 Page 6 and work. All of the residents bedrooms were personalise and are a testament of residents way of life prior to them living at Nightingale House. Residents were complimentary and stated, “I like living here, I don’t want to move”, another resident stated, “It’s not the same as living in my home but they do a good job”. Relatives were also complimentary, one stated “I am happy with the care my Mum receives, I don’t have any concerns”, another relative stated “She is happy, then I’m happy”. Staff retention is good and staffing levels are appropriate. All of the care staff that were spoken to were aware of the residents’ needs. One member of staff stated, “I really enjoy working here”. What has improved since the last inspection? What they could do better: The Statement of Purpose needs to be revised and amended to include that the home now offers ‘respite care’. All care plans and risk assessments must be DS0000066621.V343733.R01.S.doc Version 5.2 Page 7 evaluated and reviewed regularly to ensure that residents’ current needs are being met and that residents and staff are not being put at risk. The home is registered for people living with dementia and the environment and activities must be appropriate to ensure that these residents’ needs are adequately met. Some of the bedrooms still require redecoration and refurbishment and the lounge and dining room also need to be redecorated. There must be more investment in staff training, to ensure that 50 of all care staff have attained their NVQ 2. The acting manager must submit an application to the Commission to become the registered manager. The home must develop a Quality Assurance system and from the outcomes draw up an annual development plan. 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. DS0000066621.V343733.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 DS0000066621.V343733.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): 1,3,4 and 5 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Prospective residents and their relatives have detailed information on the home, which assists them to make an informed choice about moving into the home. However the Statement of Purpose needs to be amended as the home now offers respite care. A pre-admission assessment is undertaken of all prospective residents, this will ensure that their identified needs can be appropriately met by the home. Prospective residents and their relatives are able to visit the home prior to their admission. EVIDENCE: DS0000066621.V343733.R01.S.doc Version 5.2 Page 10 The Statement of Purpose sets out the objectives and philosophy of the service and states what the home can provide. This document needs to be amended to state that Nightingale House now offers respite care. This is Requirement 1. The Service user guide is informative and written in plain English, a copy of this document has been given to all of the residents. It would be good practice if the Service User Guide was also produced in pictorial format. This is Recommendation 1. The files of three residents were looked at. The manager has undertaken an assessment, which includes sections on; personal care, mobility, transfers, communication, medical history covering physical and mental health, personal safety. An assessment from the local authority had been undertaken and information had been gathered from families and GP. During the first week of admission a further detailed assessment takes place that leads to a comprehensive care plan. See standard 7. Residents and relatives are able to visit the home prior to a resident moving in. the inspector spoke to five relatives, all of whom stated their parents or partners were unable to visit the home prior to their admission due to their frailty. However all of the relatives had visited the prior to their relative’s admission. One relative stated “ I visited four homes and this was by far the best, they made me feel welcome and nothing was too much trouble for them”. Another relative stated, “ I liked the atmosphere, it was quite lively and people were chatting”. The home does not provide Intermediate Care. DS0000066621.V343733.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 and 11 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The health, social and personal care needs of each resident are set out in individual care plans. These plans provide staff with detailed information but they must be evaluated and reviewed to ensure that residents’ current needs are identified and met. There are clear medication policies and procedures for staff to follow and medication records are being completed correctly. However some of the medication records were not displaying a photograph of the resident. This could put residents at risk of a misadministration of their medication. Residents are treated with respect and the arrangements for their personal care ensures that their right to privacy is upheld. Residents and relatives can be assured at the time of the resident’s death that they are treated with sensitivity and respect. DS0000066621.V343733.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each resident has their own care plan; the inspector examined four of these plans. Each resident’s care plan identifies his or her personal care, social, health, and cultural and religious needs. Each resident also has an individual night care plan. The care plans are detailed and person centred, such as ‘X likes to have a different breakfast cereal each day’, ‘Y likes to come down at about 8pm and have a cup of tea or horlicks’, ‘and Z likes a cup of coffee with her breakfast’. Daily records indicated that care plans are being followed. There was evidence that some care plans had been reviewed but the acting manager needs to devise a system to ensure that all care plans are evaluated on a monthly basis and that residents and relatives are involved in six monthly reviews. This is Requirement 2 Residents’ health needs are identified as part of their care plan and how these needs should be met. The recordings of fluid and food intake and pressure wound charts would be used if required. All residents are weighed regularly and if any weight loss is noted over two consecutive months, then the resident is referred to their GP. Residents’ files also have written evidence that they are seen by other health professionals including opticians, dentists, chiropodists, community nurses, GP and hospital out patient appointments. Some of the residents are taken for health appointment and other residents receive their health care within the home. The inspector was able to speak to a GP who was visiting the home at the time of the inspection, she stated, “the residents are looked after and they call if there are any problems”. One resident stated, “I have been in here eight months and in that time I have seen the optician, the chiropodist and the dentist” Risk assessments were examined; those seen were detailed and covered areas, such as, skin pressure area care, self-medication, nutritional needs, continence, use of hoists and wheelchairs. Residents where possible and relatives have been consulted in formulating these assessments. Most of the residents are now accessing the community and risk assessments should be undertaken to ensure that residents or staff are not at risk. This is Requirement 3 Medication policies and procedures were examined and found to be up to date. Only senior staff can administer medication and all have received training. Four residents’ Medication Administration Records (MAR) were examined and all had been completed appropriately and medication given correlated with the MSR charts. Medication audits are undertaken every three months. Some of the DS0000066621.V343733.R01.S.doc Version 5.2 Page 13 residents’ medication records were not displaying a photograph, it is essential that all records have an up to date photograph to ensure that a resident is not given the wrong medication. This is Requirement 4 The home is currently involved with the ‘End of Life’ care initiative and is completing with the assistance of the residents and relatives ‘end of life’ care plans. The McMillan nurse and the local funeral directors have already spoken to the staff and they are to receive further training in this area. The home recently had a resident who expressed her wishes to remain in the home. The care staff, community and McMillan nurses, GP and relatives all worked together to ensure the resident’s wishes were met. The resident’s daughter stated after her mother passed away, “Wonderful care my Mum received particularly at the end, the girls were so attentive and couldn’t have wanted better attention”. The acting manager and staff are to be commended on the work they are doing towards residents’ ‘End of Life’ care and a score of 4 (commendable) has been given in recognition of this. The inspector spoke to a number of residents and relatives who all said that the staff were very respectful when attending to personal care. One resident stated “they really look after me”, another stated “the girls are very kind”. A relative stated “I am very pleased with the care my mum receives”, another stated, “They treat my mum with respect and are very kind”. Staff were talked to and observed to treat residents in a respectful and sensitive manner. They understood the need to promote dignity through practices such as, the way they addressed residents and knocking on bedroom and bathroom doors before entering. Residents’ privacy and dignity are covered during the staff’s induction programme. DS0000066621.V343733.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The residents are able to participate in a varied programme of activities, which suit individual needs, preferences and capacities. Visiting times are flexible and people are made to feel welcome, this ensures that residents are able to maintain contact with relatives and friends. Residents are able to exercise choice and control aver their lives. The meals in the home are well presented and nutritionally balanced and they offer both choice and variety to the residents. EVIDENCE: Residents were asked their views and care plans and other records were examined. The signing-in book showed that there is a steady stream of visitors to the home every day. The care plans contain information about preferred activities including spiritual and cultural activities. Most of this information has DS0000066621.V343733.R01.S.doc Version 5.2 Page 15 been gathered through staff, residents and relatives completing ‘Life Stories’ on each resident. One of the proprietors organises all of the social activities and she visits the home four days a week. Daily activities that are taking place include card games, ball games, and board games. Weekly activities include all of the residents (who wishes) going out at least once a week, either to the shops or the local park. On a Thursday morning a keep fit instructor visits the home and carries out exercises to music and the proprietor is arranging for an arts & crafts session to take place. Cookery sessions are held on a Friday morning and residents have made sausage rolls, cakes, and Cornish pasties. The hairdresser also visits weekly and staff manicure residents’ nails. Residents make full use of the garden, when the weather permits and some of the residents have been knitting squares for the local school. Monthly entertainment is arranged as well as a Saturday coffee morning, relatives are invited to both of these activities. At Easter the residents made cards and were all given an Easter egg and a BBQ has been arranged for August. Two trips to Southend-on-Sea have taken place within the last two weeks and a trip to the local theatre has been arranged for 14th July. Pub lunches with 40’s entertainment have also been enjoyed and the local children’s dance school have put on shows. A qualified masseur, who massaged hands, feet, head, neck and shoulders, has also visited the residents. Feedback from residents was that they found this very relaxing. One resident stated, “It was wonderful, I nearly went to sleep”. It is recognised that the male residents might want some different activities and they are being consulted as to their choices. Staff are also encouraged to spend time sitting and talking to residents on a one to one basis. Some of the residents are living with dementia and the proprietors must be mindful that activities that are available are appropriate for them. This is Recommendation 2 Visiting times are flexible and visitors confirmed that they could visit at any time. All of the relatives that were spoken to said that they were made to feel welcome and they were always offered a cup of tea or coffee. One relative stated, “I turn up at all different times, I always feel welcome”. Relatives confirmed that they could the resident either in the lounge, in their own bedroom or in the garden. Resident’s care plans indicate their preferred name, their choice as to where they take their meals and their wishes regarding illness or death. Residents are encouraged to bring into the home their own personal possessions and this was evident when the inspector visited residents’ bedrooms. Residents meetings are also taking place and a befriending service has been arranged for one of the residents and another resident has been referred to the local advocacy service. Meals are mostly served in the dining room, though residents can take their meals in their bedroom if they so wish. The cook has worked at the home for the past eight months and she has previous experience of working in a care DS0000066621.V343733.R01.S.doc Version 5.2 Page 16 home. She is very aware of residents’ likes and dislikes and has recently devised new menus, in consultation with the residents. There are three residents that are diabetic and the cook advised the inspector that she tries to provide them with the same or similar dessert, so that they do not feel different from the other residents. Two of the residents are on pureed diets and there meals are presented on a plate with all of the foods pureed separately. On the day of the inspection there were two choices at lunchtime and at teatime. The sandwiches for teatime were not single sandwiches for each resident but a large tray with different fillings; this enabled the residents to have a selection rather than just one sandwich. The cook confirmed that if a resident did not want either of the choices, she would prepare them something different. The refrigerators and the freezers were adequately stocked and the cook confirmed that all of the fruit and vegetables were bought from a farm shop. Fresh fruit platters are regularly available, as is fresh fruit juices and on some days residents are offered cornets or ice-lollies. Both residents and relatives were complimentary of the food. A few of the residents require assistance with eating their meals and staff were seen to carry out this task appropriately, talking to residents and not rushing them. DS0000066621.V343733.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): 16 and 18 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents and relatives can be confident that their complaints will be listened to and acted upon. There are policies and procedures on safeguarding adults and staff have undertaken training, which ensures there is an appropriate response to any allegations or concerns regarding abuse. EVIDENCE: The complaints book was examined during the inspection and no complaints have been recorded since the last inspection. The complaints procedure is on the notice board and three residents were asked, “If you were unhappy about anything in the home, who would you talk to”? One resident said, “I would tell my daughter”, two residents said “ I would tell X (a member of staff)” and the other resident said, “I would talk to Jane (acting manager)”. All of the residents baring one have family who are in regular contact. The manager has referred this resident to Age Concern for an advocate to visit. The home is also in discussion with Age Concern regarding a befriending service as some of the residents could find it easier to talk to someone other than a relative or a member of staff. Relatives that were spoken to said that they would talk to the acting manager or Ashley/Nav (two of the proprietors) and felt confident that DS0000066621.V343733.R01.S.doc Version 5.2 Page 18 their concern would be listened to and acted upon. One relative stated, “I did speak to someone about something minor and it was dealt with straight away”. The inspector spoke to a health professional who was visiting the home at the time of the inspection and she confirmed that she would talk to the manager if she had any concerns regarding the welfare of the residents. The inspector is satisfied that the acting manager would act promptly on any concerns or complaints but it is recommended that any complaint or concern, however trivial be recorded. This is Recommendation 3 Families or representatives administer all of the residents’ finances. The home hold small amounts of money for hairdressing, newspapers and chiropody and toiletries. Four residents money were checked and all were accurate with receipts tallying with the amount of money spent. There is a written procedure and policy for dealing with safeguarding adults and whistle blowing. The home also has a copy of the Department of health’s document ‘No Secrets’ and the local authority (Havering) documentation on adult abuse. There was an allegation that was dealt with under the Safeguarding Adults procedure, the manager dealt with this appropriately and referred directly t the local authority. The allegation was fully investigated and the conclusion was that a member of staff required further training and support. The acting manager was able to evidence that all recommendations had taken place. The Commission had been notified of the incident and was kept up to date with the investigation and the findings. Staff that were spoken to were aware of the actions to be taken if there were any concerns regarding the welfare and safety of the residents. Safeguarding Adults is dealt with as part of all staff’s induction programme and further training has also been undertaken. DS0000066621.V343733.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): 19,20,21,23,24,25 and 26 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents live in a safe, clean and hygienic environment, with access to indoor and outdoor facilities. However some of the bedrooms still require redecorating and some furnishings need to be replaced. There are sufficient toilets and bathrooms situated on both floors. EVIDENCE: A tour of the home was undertaken and all areas of the home were inspected including the kitchen and laundry room. Both of these rooms were maintained to a good standard. There was a good supply of food within the refrigerators DS0000066621.V343733.R01.S.doc Version 5.2 Page 20 and freezers and this was stored appropriately. There was evidence that refrigerator and freezer tempretures are regularly recorded. The living area of the home consists of a large lounge and separate dining room, both of these rooms are clean and the dining room has been rearranged so that residents sit at tables for two or four people rather than all sitting at two large tables. All of the tables had clean tablecloths and small vases of fresh flowers; this coupled with the seating arrangements gave the dining room a more homely feel to it. One of the residents stated, “It looks more friendly”. One of the relatives stated, “They are really working hard to improve the home”. One of the owners advised the inspector that both of the rooms are going to be redecorated and they are in the process of buying new dining room furniture and carpet and armchairs for the lounge. As the ability of people living with dementia to communicate with words decreases, the use of non-verbal cues and the environment are important in enabling them to cope with daily life and orientation. For example, through the use of visual clues such as colour and signage, changes in colour in different areas to assist with orientation, toilet seats that are in a different colour to the rest of the room and using pictorial signs as well as written signs to assist with identifying different rooms. Containers with suitable materials could be located around the home so that residents can touch and feel things as they are walking along. The use of calming resources such as lighting or a small aquarium could also be used. Appropriate pictures such as photographs of the local area and of London, that would have been familiar to residents in their younger days, can be used as points of discussion with people with dementia. This is Requirement 5 All of the corridors and some of the bedrooms have been redecorated and one of the proprietors advised the inspector that new carpets and bed linen are to be chosen by the residents. All of the bedrooms are personalised with resident’s own furniture such as, dressing tables, chests of drawers, a writing bureau, as well as televisions, radios, photographs, pictures, ornaments and one resident has a budgerigar in his bedroom. Two of the bedrooms are shared rooms and a married couple share one of these rooms. The remaining bedrooms still need to be redecorated and the bedrooms that have vinyl flooring still needs to be replaced, as well as some of the bedroom furniture needs repairing or replacing. The redecoration programme is ongoing, however the previous timescale has not been met. Therefore this requirement is set with a new timescale. This is Requirement 6 There are sufficient toilets and bathrooms on both floors, three of the bathrooms have medic baths, which are a special walk-in and sit down type of bath. The remaining bath is an ordinary bath that residents have difficulty in using, it was suggested to the proprietor that it would offer residents a greater choice if this room had the bath removed and a shower installed. This is Recommendation 4 DS0000066621.V343733.R01.S.doc Version 5.2 Page 21 The gardens are well maintained and the residents enjoy sitting out under the pergola, as seen on the day of the inspection. The home is cleaned on a daily basis and throughout the inspection all areas of the home were found to be very clean and tidy. Additional cleaning time is made available once a week to ensure that the standard of cleanliness is maintained. There are adequate control systems in place to ensure that the home is free from any offensive odours. DS0000066621.V343733.R01.S.doc Version 5.2 Page 22 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 and 30 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home’s staffing levels are satisfactory and there are sufficient staff on duty, however not all of the staff have the appropriate skills and training to meet the individual needs of the residents. The home has a clear recruitment policy and procedure and appropriate checks are undertaken, which ensures the protection of the residents. EVIDENCE: Staff rotas were examined and the rota correlated with the number of staff on duty, during the day there are four care staff, at least one of the staff is a senior and two waking night staff, as well as an activities co-ordinator who works approximately five hours a day, four days a week. The home has good staff retention; only two staff have left the service in the past twelve months. The home is currently fully staffed and on the day of the inspection there was sufficient number of staff on duty to meet the needs of the residents. Four staff files were examined and all showed that all the relevant recruitment procedures had been adhered to. All files had a completed application form; two written references, satisfactory Criminal Records Bureau checks and copies DS0000066621.V343733.R01.S.doc Version 5.2 Page 23 of birth certificate and passport were also on file. Normally two people are involved with interviewing prospective staff and in keeping with equality & diversity; all candidates are asked the same questions. All newly appointed staff undertake an induction programme, which is in line with the Skills for Care Council. Topics covered during the induction period are, moving & handling, first aid, understanding the principles of care, recognising and responding to abuse, equality & diversity, communicating effectively and maintaining safety at work. Other training that has been undertaken in the past twelve months includes: record keeping & report writing, managing challenging behaviour, safeguarding adults, risk assessment & fire awareness, what to do when a death occurs, moving & handling and community care and the law. Most of the staff have attended a one-day course on dementia awareness, however the home is registered for people with dementia and the care staff should be attending the three-day course to ensure that they can effectively meet the needs of people living with dementia. Seven care staff have attained their NVQ2 and two staff are currently undertaking this qualification. The acting manager needs to ensure that at least 50 of the care staff have achieved their NVQ2 and that the staff are appropriately trained to meet the needs of the residents. This is Requirement 7 Staff that were spoken to stated “I really enjoy working here “, another staff member stated, “I have worked in other care homes and this is by far the best” and “The new manager is working hard and we want to work with her”. DS0000066621.V343733.R01.S.doc Version 5.2 Page 24 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): 31,33,35,36 and 38 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. During the absence of a registered manager, an acting manager is currently managing the home. She has experience of working in a care home and has taken on board the areas in which the home need to improve. Residents, relatives, staff and stakeholders need to be further consulted to ensure that the home is run in the best interests of the residents. Residents’ financial interests are safeguarded by the policies and procedures of the home. Residents and staffs’ health, safety and welfare are promoted and protected. There is a system in place to ensure that staff receive regular supervision and yearly appraisals. DS0000066621.V343733.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home has been without a registered manager for the past year. The acting manager has been in post for two months and has experience of working in this care home in a senior care worker’s post. This is her first managerial post and the organisation’s area manager is closely mentoring her. She was observed carrying out her job, in which she had discussions with staff and was seen talking to the residents. She is looking to commence her NVQ4 in care within the next couple of months. The acting manager has a good understanding of the needs of the residents and is learning about the areas in which the home needs to improve. Comments from residents, relatives and staff were complimentary, saying that she is helpful, supportive and always has time to listen. It is a requirement that the acting manager applies to the Commission to become the registered manager. This is Requirement 8 Under the requirements of Regulation 26 of the Care Home Regulations the registered provider should be carrying out monthly visits and reports of these visits should be available to the Commission. There was evidence that these visits are taking place and information within these reports is comprehensive. As stated in the last inspection report the registered provider is looking to further develop and increase the number of residents at the home, he must be mindful to engage with residents and relatives on a regular basis, to ensure that they are fully informed of developments within the home. Regular residents and relatives’ meetings are now taking place and residents are being consulted with on various aspects of the home, such as, menu planning, social activities and the redecoration of the home. However the registered provider needs to carry out a quality assurance survey involving residents, relatives, and stakeholders and from the results develop an annual development plan, which reflects the aims and outcomes for the residents. This is Requirement 9 It would also be good practice if there were a Quality Assurance group within the home, which would consist of residents, relatives and staff. This group cold look at various aspects of the home. This is Recommendation 5 The home has an appropriate policy and procedures regarding the safeguarding of residents’ finances. Residents’ accounts that were checked, showed sound financial procedures are being followed. From discussion with the acting manager, the area manager and staff it was evident that staff supervision is taking place, as well as regular staff meetings and yearly appraisals. Staff that are performing well have been rewarded with DS0000066621.V343733.R01.S.doc Version 5.2 Page 26 cash bonuses and two members of staff have attended a ‘spa day’ for outstanding work and commitment. The home has carried out all health and safety checks. Fire drill and alarm testing are regularly undertaken as are water, freezer and refrigerator temperatures. Fire alarms and extinguishers, portable appliances, the lift and the electrical installation have all been tested this year and the gas service is due next month. The acting manager is notifying The Commission of all serious incidents, hospital admission and death of a resident via Regulation 37 notifications. DS0000066621.V343733.R01.S.doc Version 5.2 Page 27 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 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 X 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 3 DS0000066621.V343733.R01.S.doc Version 5.2 Page 28 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 2 Standard OP1 OP7 Regulation 6 15(2)(b) Requirement The Statement of Purpose needs to be amended to state that respite care is provided. All residents’ care plans must be regularly evaluated and reviewed, this will ensure that residents’ current needs are being met. All residents’ risk assessments must be regularly evaluated and reviewed, this will ensure that residents and staff are not put at undue risk. All medication folders must display a recent photograph of the resident. The registered provider must ensure that the home has appropriate pictorial signage, photographs and colour schemes, which will assist the residents who are living with dementia in finding their way around the home. All of the residents’ bedroom furniture, floor covering and decor are fit for the purpose. Previous timescale of 31/05/07 not met. DS0000066621.V343733.R01.S.doc Timescale for action 31/08/07 31/10/07 3 OP7 15(2)(b) 31/10/07 4 5 OP9 OP20 17(1)(a) 23(2)(a) 31/08/07 30/11/07 6 OP24 23(2) (b) 30/11/07 Version 5.2 Page 29 7 8 OP30 OP31 18(1)(c) 8(1) 9 OP33 24(1)(2) The registered provider must ensure that 50 of all care staff has attained their NVQ 2. The registered provide must ensure that the acting manager submits an application to the Commission to become the registered manager There must be an effective Quality Assurance system in place and the findings of the QA feed into a development plan for the home. 30/11/07 31/08/07 30/11/07 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 OP1 OP12 OP16 OP21 OP33 Good Practice Recommendations The Service User Guide to be produced in pictorial format That the activities meet the needs of people living with dementia All concerns however trivial are logged under the home’s complaints procedure The bathroom that is not being used could be refurbished as a walk in shower, which would give residents more choice regarding their bathing facilities It would be good practice if a Quality Assurance group were developed. This group could consist of residents, relatives and staff. DS0000066621.V343733.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 DS0000066621.V343733.R01.S.doc Version 5.2 Page 31 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!