Inspection on 24/04/07 for Nightingale House

This inspection was carried out on 24th April 2007.

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 02/04/08

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 Diane Roberts Key Unannounced Inspection 24th April 2007 09:30 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.V338318.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.V338318.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.V338318.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 26th May 2006 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. As of the 24/4/07 the fees were £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.V338318.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out as part of the annual inspection programme for this home. The registered manager was available on the fieldwork day of the inspection. The inspection focused upon all of the key standards. A partial tour of the premises was undertaken. Evidence was also taken from the Annual Quality Assurance Assessment completed by the management of the home and submitted to the CSCI. 3 residents and 3 staff were spoken to during the inspection and Residents completed feedback sheets; some with the help of relatives and visiting healthcare professionals also gave feedback. All these comments were taken into account when writing the report. Some aspects of this service have failed to improve over the last two CSCI inspections. These are highlighted in the agenda for action. Failure to comply with these regulatory requirements may result in the Commission taking legal action. What the service does well: What has improved since the last inspection? What they could do better: The manager needs to develop systems in the home in relation to care planning, health monitoring and quality assurance. The activities/social programme for residents needs to be developed. Ongoing maintenance of the premises and standards of décor could be better in some areas. Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 6 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.V338318.R01.S.doc Version 5.2 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.V338318.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Whilst the assessment and admission process at the home is generally sound, further work could be done to improve the experience for residents. EVIDENCE: The home has a good pre-admission assessment system in place, which helps to ensure that the home will be able to meet the needs of the residents they admit. When reviewing this documentation, thought should be given to incorporating a more person centred approach, for example, identifying strengths as well as any weaknesses. From discussion with the manager and the staff standard admission procedures apply and new residents are shown around the home, introduced to other residents and given refreshments, depending upon their choice. Consideration should be given to developing the admission process further so that an individual service is offered and evidenced, with a key member of staff, including providing information from Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 9 the service users guide over a period of time. Residents who commented on the homes quality assurance survey stated that the ‘welcome procedure’ to the home was important to them. Both the statement of purpose and service user guide have been reviewed this year. Whilst the content is generally sound, consideration should be given to the format in relation to the resident group and a pictorial system may be of value. Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care standards at this home are generally sound but could be enhanced by better assessment, planning and use of the care planning system. EVIDENCE: The home has a care planning system in place. It is disappointing to note that there has been little development or improvement since the last inspection. Overall care plans were seen to be a bit more up to date than they were at the last inspection, but they still are basic with significant shortfalls. Odd care plans were noted that contained a good level of detail, recognised resident choice and were written respectfully and acknowledged psychological needs. The manager, with limited time, still writes the majority of the care plans and assessments. Care staff undertake a monthly review but records show that these rarely result in an adjustment of the care plan, even when significant changes are noted. Significant changes in residents’ health are often noted, especially on return from hospital, but no plan of care is put into place Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 11 regarding ongoing management. From discussion and observation the care plans do not always reflect the care in place or provided. The team at the home must get this system working properly if they are to evidence a good individualised and up to date approach to the care of their residents. Person centred care planning was discussed with the manager, especially in relation to the care of people with dementia. There is limited information regarding the residents’ personal history and preferences and care plan focuses on need rather than strengths. There is no evidence that residents or their relatives have been involved or offered involvement in the care planning system at the home and this has been raised previously. It was also noted that records relating to care are a bit disorganised and old sets are being used when new ones are in place. The management state in their annual self assessment that ‘they plan to undertake an improvement in care planning records’ and ‘achieve a greater involvement of seniors care staff in record keeping’. Residents, relatives and visiting healthcare professionals speak highly of the care staff team and the care provided. Overall the team at the home is better at evidencing that they meet the healthcare needs of residents. Gp visits notes were good and showed a proactive and timely approach but changes did not always link into the care planning system. On discussion with the visiting district nurse and the manager, dependency levels regarding the healthcare needs of residents are quite high and the home generally manages this well. Some residents do attend the surgery and records show that residents in the home attend a lot of outpatient appointments. Records show links with the practice nurses for vaccinations etc. and that residents have access to the chiropodist and optician. Referrals are made to dieticians where needs are identified, but the team are not always fully assessing nutritional need using a risk assessment. Weight monitoring for residents was also note to be inconsistent at times. Risk assessments are in place for a range of issues, including, manual handling, falls, fractures etc. These were not always regularly reviewed and some were significantly out of date. It was also noted that the results, where significant did not link into the care planning system. Medication management at the home is good. The home operates a bottle to mouth system and records are well maintained. There is good evidence of review and the manager, a qualified nurse, takes a proactive approach to this. Stock control is good and the staff have received training on this subject. Whilst the team at the home have an understanding of equal opportunities, they need to develop their knowledge of wider diversity issues and this should be reflected in their care planning and other policies and procedures in the home. Residents state that staff are good with maintaining their privacy and dignity although it was noted that staff were shaving gentlemen in the communal lounge rather than in their own rooms. This was discussed with the manager. Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 12 Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 13 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst there has been some good progression in relation to catering within the home, work still needs to be done to ensure that residents are offered activities that relate to them as individual and that can also meet their group needs. This would further enhance their quality of life within the home. EVIDENCE: On review, care plans showed limited information regarding residents’ personal/social histories and their personal choices and daily routines. Some care plans were better than others, but it was a shame to note that there were social histories missing in care plans where the resident would be able to have input. Because of the limited information in the care plans and limitations on discussion with the majority of residents, it is difficult to assess how well the daily routine caters for individual’s needs/choices. Those residents who are able to express choice or are self-caring feel that they have choice within their day. Some care plans show an appreciation of social need and some good work was noted, however the majority have no real assessment of social need and Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 14 therefore the social activity programme is not based upon residents needs. The programme was seen to be basic and was not followed on the day of the inspection, although the regulation officer appreciates that with the resident group some activities need to be spontaneous. Records were very limited and whilst residents and relatives could say that singsongs and ‘a game once’ had been provided, they were unable to state what else goes on. Records, for all of the residents’ records reviewed, stated ‘watched tv’, ‘music’, and ‘singsong’. Discussion with staff identifies some household tasks that residents may get involved with but there is limited evidence of this. The manager stated that they have purchased some appropriate quizzes for residents and have videos that ask questions and stimulate discussion as well. Again there is no evidence that these resources are being used. There are good reminiscence photos on the walls in the hallway. The manager reports that where possible she takes residents out on a one to one basis to run errands and do shopping. One resident is able to access a local club where they are able to spend time and attend outings. The management state in the annual self-assessment that ‘we could organise more activities for clients within and outside the home’. The home has an open visiting policy and relatives who commented said that they felt welcome in the home and were invited to social events at Christmas and on birthdays. Some residents have link with local churches and have attended services in the past. At the current time there are no residents in the home who are using advocacy services. In the past the manager has actively used these services to good effect and has appropriate information available. The manager has a good appreciation of residents’ rights and always acts in the residents’ best interests. From discussion, the chef knows the residents well and is concerned for their welfare. For residents who are unable to choose, he ensures that they have a good rotation of healthy options and more calorific foods. Menus show that there is always a good option available. The Chef shows a lot of insight into what is appropriate for the elderly person. Feedback from residents regarding the quality of food and choice available was very positive. Residents also confirmed that snacks would be available should they so wish. Food stores were reviewed with the manager and it was noted that there was a significant use of convenience/processed and value foods. These are mainly used at tea time when the chef is not around to cook, as he only works until 2.30.p.m. The use of processed and value foods were discussed with the manager, who agreed to review their use as they can have high salt and sugar content. The chef always makes fresh pastry, cakes and uses a lot of fresh vegetables. Menu changes are based on feedback from residents and monitoring of waste food. Care staff and residents confirm that the chef regularly talks to them about the food. Lunch was observed to be a relaxed affair and the quality and quantity of the food looked good and choice was available. It was noted that some meals and snacks are limited, as the kitchen does not have a grill. Consideration should be given to this. Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 15 Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 16 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be reassured that their concerns would be listened to and dealt with objectively. Staff are trained and systems are in place to help ensure the protection of vulnerable adults. EVIDENCE: The home has a satisfactory complaints procedure in place that is displayed in the main entrance hall and can be found in the service users guide. Since the last inspection the home has not received any complaints. Residents and relatives who commented stated that they were aware of the procedure and would in the first instance, contact the manager who is very approachable. The manager very close with many of the residents and they call for her specifically when they have a query. Consideration should be given to the format of the complaints procedure to ensure that it is appropriate for the range of residents living at the home. The home has received several compliment cards since the last inspection and these were available to review. Comments included ‘my worries disappeared because I knew my relative so well looked after’, ‘my relative is settled and happy’ and ‘thank you for your loving and tender care’. The home has a satisfactory and up to date adult protection policy in place, which includes local procedures. On discussion, the manager is very aware of Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 17 residents’ rights and puts their best interests first. This was echoed by the positive comments received by several health care professionals who visit the home regularly. Training records show that majority of staff have received training in adult protection. Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 18 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the premises standards are generally sound, there is room for improvement/investment, which would make the home better for residents and staff. EVIDENCE: A tour of the home was undertaken. Since the last inspection some work has been done to improve a few of the ensuite toilet/showers by replacing flooring. This has helped with the odour control in some rooms but the overall condition of the ensuites needs to improve. It is a concern that the management team do not identify these as an area for improvement in its annual assessment. Corridors and lounges have been painted which helps to give the home a brighter feel and better lighting in some areas has also helped. Previous issues Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 19 with damp in the downstairs corridor have been addressed. Some bedrooms have new furniture and some have new carpets. The home is without a maintenance man at the current time. Wardrobes were seen to be broken and tiles were broken around sinks in bedrooms. One room has not had a light shade in over a year; this was noted at the last inspection and reflects the limited quality assurance systems that are in place in the home. The management team states in their annual self-assessment that ‘the manager and the proprietor plan to undertake three monthly audit of the home to establish areas of the home that need further action’. This would be beneficial. The home was seen to be generally clean but attention to detail is needed. This is exacerbated by the fact that the home does not have any cleaning staff at the current time and the care staff are taking on this role. Cleanliness in the kitchen is good and has improved with the new chef in post. It was noted that the dishwasher is not working properly and this is detracting from food preparation time and this should be addressed. Following feedback from their residents and relatives, the management at the home state that they plan to ‘replace and upgrade the existing carpets with new carpets and flooring throughout the corridors, lounges and communal areas on both the ground and first floor’. There are odours in some bedrooms but these are contained within the rooms and the manager is working to try and control these problems. Residents and relatives who commented felt that the home was kept clean. 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. One toilet was seen to be filled with wheelchairs, which should be in residents’ rooms to allow access to this facility. The broken bathroom floor, noted at the last inspection, had been mended but has broken again and again has a tripping hazard. Different flooring, other than small tiles, should be considered. As stated in the previous CSCI report, the standards of maintenance and repairs reflect poorly on the home. A fire safety risk assessment has been carried out dated 2005. It is recommended that this be reviewed on a regular basis to ensure changes have been taken into account. Maintenance certificates were available for the fire alarm and emergency lighting but not for the annual check of the fire extinguishers. This should be addressed. Records showed that fire alarms are not being checked consistently and this should be addressed in order to ensure that safety systems are working correctly. Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 20 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management at the home are steadily developing the staff team by providing a good level of training and support, which will help to improve outcomes for residents. Staff knowledge and skills, however, should be reflected in care planning systems in the home. EVIDENCE: Staffing levels at the home have improved since the last inspection. The manager now has another senior member of staff in post and this will enable her to spend more time on the management of the home, development of the services and improving outcomes for residents. On the day of the inspection there were 4 care staff and the manager on duty where previously there would be three carers and the manager. Turnover of staff at the home is quite low and agency use is minimal. The home is fully staffed but the manager hopes to employ more staff to cover sickness and holidays. Records show that 6 out of 17 staff have achieved NVQ level 2 or above and a further 3 are working towards this. This would help the home achieve its 50 target as outlined in the national minimum standards. Since the last inspection the home have introduced an induction that is linked to Skills for Care and evidence was available to show that staff have been completing these. The Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 21 manager also provides an induction to the home and there was evidence that staff had completed this, on their individual files. Staff files were inspected at random and were found to be maintained in good order with all the required checks and documentation in place. The filing system has improved since the last inspection. The manager plans to update the application form for staff in relation to age and gender questions. Training records submitted to the CSCI show that staff training at the home has improved since the last inspection with a higher compliance level for statutory training and additional training has also been undertaken and study days attended. The majority of staff have undertaken training in understanding and caring for people with dementia and published resources are available for staff from the Alzheimer’s Society. It would be good to see this training reflected in the care planning for residents. From discussion with the manager, she is starting to get better organised with regard to training and having an overall plan/programme. She has recently taken external advice on this subject. The management’s annual self-assessment states that they plan to ‘improve staff training, develop existing staff skills and acquire new ones to help improve care practice’. Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 22 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 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Day to day management at the home is stable. The manager needs to work on developing systems to ensure effective management and ongoing development of services in the home. EVIDENCE: The manager has worked at the home for several years and provides a stable management approach. Residents, relatives, care staff and visiting professionals all speak highly of her. Staff meetings are held regularly and records show that staff have the opportunity to raise any issues of concern. It is hoped that now staffing has improved the manager will have the opportunity to review systems in the home and develop services further, as this has been Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 23 an issue in the past. The manager states in the annual self-assessment that she ‘plans to undergo the registered managers award during the next 12 months’. Since the last inspection the quality assurance system has developed in relation to satisfaction questionnaires. Those completed by relatives were available for inspection and were seen to be very positive along with one from a resident. Comments included: I feel my relative is being well looked after’, ‘I feel the proprietor and staff are working to improve the home and make a homely environment for the residents and are very welcoming and kind to relatives’, ‘the care of residents is a priority and I am reassured to know that my relative’s comfort and wellbeing is so well looked after, their physical and mental health has improved since they came to the home’, ‘very friendly and nice home’, ‘the standard of care is excellent’, ‘pleased with the attitude and attentiveness of staff who show a great understanding of needs and problems’, ‘the manager is first class and makes everyone feel at home’. Healthcare professionals comments included: ‘the manager is truly unique in her approach and dedication to resident care’. Whilst this system is good, the management need to look at different ways of obtaining feedback from residents with complex care needs. Consideration should also be given to developing an internal audit system to ensure that other aspects of the service are also maintained and developed, for example, environmental audits, recording system audits etc. The home holds small amounts of monies of behalf of residents in the home and records were available for inspection. The recording system needs a review so that records are clearer and an audit trail is evident with an ongoing balance. When checked residents monies were in order. The home has a satisfactory health and safety policy in place. Health and safety audits would be of value to ensure that issues in the home are attended to, for example, tripping hazards. Accident records were found to be well recorded and there is recorded evidence that care team have liaised with the local fall prevention team. It was also noted that following accidents there was good follow through where required including reviews of medication. However, it was noted that falls risk assessments are not reviewed regularly, one left 9 months, and this could have contributed to a fall from bed for one resident. Maintenance and safety certificates were inspected at random for the fixtures, fittings and equipment in the home and found to be in good order. The manager has undertaken safe working practice risk assessments. These should be kept under review. It was noted that there are residents in the home using bed rails without the correct padded protection - using an improvised system. This should be addressed and was discussed with the manager on the day of the inspection. The correct equipment must be used. Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 24 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 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 3 28 2 29 3 30 2 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.V338318.R01.S.doc Version 5.2 Page 25 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 Timescale for action 31/07/07 2. OP8 3. OP12 4. OP19 A plan of care must be provided that is kept up to date and where possible involves the resident or their relative/representative to ensure that residents care needs are fully met and with their wishes taken into account. This is a second repeat requirement. 13 All health related risk assessments must be in place and kept under review to ensue that all residents’ health needs are monitored and met. With particular reference to manual handling, falls and nutrition. This is a repeat requirement. 16 (m and A meaningful programme of n). activities for residents must be provided in the home both on an individual and group basis, to ensure that residents’ needs are met. Records, including care plans, should reflect assessments of social needs and activities offered. This is a repeat requirement. 23 (2) The home must be maintained to DS0000015550.V338318.R01.S.doc 31/07/07 31/07/07 30/06/07 Page 26 Nightingale House Version 5.2 5. OP33 24 a satisfactory standard with regard to flooring in bathrooms so it does not create a health and safety hazard for residents and staff. This is a second repeat requirement. The system for monitoring the quality of care provided by the home must be developed further so that more residents’ feedback can be taken into account and services developed. 01/08/07 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. 6. 7. 8. 9. Refer to Standard OP1 OP3 OP10 OP15 OP16 OP19 OP28 OP30 OP33 Good Practice Recommendations The format of the service users guide should be reviewed to ensure it meets the needs of the residents admitted to the home. A person centred approach to pre-admission assessments and the admission process should be developed in order to provide a more individualised service. The care team should develop a better understanding of the issues surrounding equality and diversity. A review of the use of processed and value food should be undertaken to ensure that residents are receiving a healthy and nutritional diet. The format of the complaints procedure should be reviewed to ensure that it meets residents’ needs. Fire risk assessment should be review to ensure that any changes have been taken into account. Staff should continue to be supported to undertake NVQ qualifications so that care outcomes for residents improve. The management team should evaluate staff training to ensure that skills obtained are put to good use, so that care standards and outcomes for residents improve. The development of internal management audits should be considered to hep with maintaining and developing standards. DS0000015550.V338318.R01.S.doc Version 5.2 Page 27 Nightingale House Nightingale House DS0000015550.V338318.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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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