Inspection on 20/02/06 for Nightingale House Care Centre

This inspection was carried out on 20th February 2006.

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 Care Centre 04/09/07

Nightingale House Care Centre 27/06/06

Nightingale House Care Centre 29/03/05

Nightingale House Care Centre 15/12/04

Nightingale House Care Centre 11/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Nightingale House Care Centre Clovermead Farm Main Road Bucknall Lincs LN10 5DT Lead Inspector Jill Clifton Unannounced Inspection 20th February 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nightingale House Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 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 Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Nightingale House Care Centre Address Clovermead Farm Main Road Bucknall Lincs LN10 5DT 01526 388261 01526 388261 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) Halcyon Care Limited Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Nightingale House Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd December 2005 Brief Description of the Service: Nightingale House is a single story building, which has been extended and adapted to provide accommodation for up to 45 Older People who require personal or nursing care. The home is a detached property, which is accessed from a main road through the village of Bucknall. There is car parking available and the home is set within grounds, which can be easily accessed by service users. The home has had a new extension built in 2000. The home is located in a village, which is approximately 12 miles from Lincoln and 7 from Horncastle. Nightingale House Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5 hours. The main method of inspection used is called ‘case tracking’ which involved selecting four service users and tracking the care that they receive through the checking of their records, discussions with them and the care staff and observation of care practices. There were forty one service users living in the home at the time of this inspection A tour of the premises was conducted and care and staff records were examined. Six service users, three visitors and four staff including the acting manager were spoken to. What the service does well: What has improved since the last inspection? What they could do better: It is important to note that the current manager has only been in post for 4 months and has inherited a number of systems and records which do need improving. Care plans must be improved in detail and kept under review. Risk assessments must show a plan of action and kept under review to keep service users safe. The health needs of service users must be identified and supported by a plan of care. The storage of unwanted medicines needs to be reviewed to prevent large amount being kept on the premises. Fire safety in terms of using door wedges must be reviewed following the fire safety officer’s visit in February 2006. Nightingale House Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 Page 6 The Commission has not yet received an application from the manager applying for registration; this must be instigated as a matter of priority. 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 Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 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 Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 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): 3 and 4 Service users needs are identified prior to admission. Service users recieve written confirmation that their needs can be met. EVIDENCE: Pre assessment documentation for three service users was checked and found to be basic. The manager is aware of this and recognises the need to improve the current system. It was noted that where a letter had been sent to a service user confirming a placement and that their individual needs could be met this was 2 weeks after admission. The manager is now ensuring that these letters are issued prior to admission. Nightingale House Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 Page 9 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): 7, 8 and 9 Shortfalls in the identification and provision of a detailed plan of care could put service users at risk from not receiving the required care. The storage arrangements for unwanted medication could put people at risk. Service users are able to confirm that staff respect privacy and dignity when attending to their needs. EVIDENCE: Admission details had not in some instances been completed and signed by the service user (as indicated on the forms such as access to health records, care record agreement and consent for photograph). One service user had a care plan, which was initiated one month after admission, the details in the pre assessment did not indicate the care required, therefore it is uncertain how staff knew what care to provide. Plans of care relating to personal hygiene and dressing did not reflect the needs of the individual service user; reviews stated ‘care as planned’ but it is unsure what care was planned. Nightingale House Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 Page 10 All three service users who were case tracked had a nutritional assessment with a scoring outcome of high or very high, which then describes referral to a dietician, which had not taken place. All three assessments showed review dates for monitoring of nutritional assessments and weighing but these had not been undertaken There was no reference in the plans of care as to monitoring food or fluid intake. Assessment and care plan information conflict and therefore the manager was unsure as to what care the service user required or being received. To assess peoples skin integrity an assessment and scoring tool is used called the Douglas score, one service user who had a consistently high score was not provided with appropriate pressure relieving equipment in the form of specialist mattress for several months, the manager said that this service user was not offered this because the home probably did not have one at the time. Other care plans that indicate that there is a high scoring risk do not have an action plan. Two of the service users case tracked had bed rails insitu but there was no reviewed risk assessment to support this decision and no confirmation that the service user or their family had agreed to this practice. The home had a large stock of unwanted medication, which was stored in a contract bin and awaiting removal, for security the manager was advised to keep this bin in a locked cupboard because of the large amount. There was a large amount of controlled medications stored in the controlled medicine cabinet but these were no longer required; the manager said that the bin for disposal was too small to accommodate these medications; the manager must therefore review this with the contracted clinical waste company. One service user had a recorded allergy to a prescribed medication on her assessment details but this was not transferred to her medicine sheet which would help prevent this medication being prescribed and given in error. There are a number of service users prescribed the same controlled medication but not all boxes of controlled medications had been individually labelled and this could lead to confusion in checking the amounts of the medication against the amount prescribed for each individual. Staff had not received updated medication training to confirm current standards and practices with regard to safe administration of medications. Staff spoken to were able to demonstrate how service users privacy and dignity is maintained and the service users spoken to verified this. Nightingale House Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 Page 11 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 and 13 Choices for social stimulation need to reflect individual needs and abilities. Visitors and made to feel welcome. EVIDENCE: Activities including trips out are recorded but there is little evidence of service users individual needs regarding social stimulation being assessed. The manager has initiated a monthly magazine for service users and visitors, the first edition was on the notice board. The manager stated that visitors are welcome after 10.30 am. Visitors spoken to confirmed that they were made to feel welcome by staff: ‘We are always made to feel welcome, staff are friendly and approachable’ There are two service users who do not have family or friends to support them, the manager had not yet offered the opportunity for advocacy. The home supports a regular visitor, the manager needs to undertake a risk assessment to establish whether a Criminal Record Bureau check needs to be completed by the visitor. Nightingale House Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 Page 12 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): 18 Service Users are protected from abuse. EVIDENCE: A new policy and procedure has been supplied by the company regarding the protection of vulnerable adults. The manager has a copy of the Lincolnshire policy but could not verify as to whether this was an up to date version as the front cover had been removed. The manager is aware of the need to check this out. Some staff had received training but those spoken to indicated that they were able to identify and report abuse without hesitation. Nightingale House Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 Page 13 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): 26 The environment is clean and comfortable with procedures that protect against cross infection. EVIDENCE: The home is clean and non odorous. All areas seen on inspection were well maintained. There are systems in place, which help protect cross infection occurring within the home. Nightingale House Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 Page 14 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, 28, 29 and 30 Service users benefit from a staff group which are trained and recruited in an appropriate manner. EVIDENCE: The manager is aware of the need to keep staffing levels under review to ensure that the number of nursing and care staff on duty can meet the needs of service users. Today was an exceptionally busy day and staff were working hard. The manager stated that 50 of staff have the National Vocational Award in care level 2 (NVQ) the remaining staff apart from one are currently undertaking level 2 and 3 awards. The manager stated that that the induction was not comprehensive for staff and therefore this would be reviewed in the next 2 months. The manager is waiting to commence her training on the Registered Manager Award. She is currently completing her preliminary study days. Staff confirmed that there are training opportunities and these have included moving and handling, first aid and abuse. Three staff recruitment files were checked and found to contain all the required checks, which help protect service users from possible abuse or harm. Nightingale House Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 Page 15 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): 31,35,36 and 38 The health and safety of service users are compromised environmental risk assessments have not been reviewed. Fire safety is compromised in the home and has the potential to put both service users and staff at risk EVIDENCE: The Commission has yet to receive an application from the manager to apply to become the Registered Manager. Staff had positive comments about the managers presence in the home, ‘she is approachable and fair’. The homes administrator was very busy at the time of inspection but confirmed that personal allowances for service users were checked at the previous inspection and no issues were identified. Nightingale House Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 Page 16 The manager confirmed that regular, formal supervision for nursing staff had not taken place but would be completed by April 2006. Clinical Supervision is being introduced shortly. The manager stated that care staff receive supervision every 3 months from the nursing staff, a staff member confirmed that this had taken place 6 monthly. Environmental risk assessments did not show that they had been reviewed since March 2004.There are a number of risk assessments in place whereby service users are consenting to having a wedge in their door. These assessments are not appropriate because the consent does not consider the risk to other service users and staff who may be placed at unnecessary risk from doors being wedged open. The majority of bedroom doors were wedged open at the time of inspection thus putting service users and staff at potential risk. Since the previous inspection 9 dorgards (devices which are noise sensitive) have been purchased in order that service user bedroom doors can be kept open safely. A full risk assessment is not in place for the two oxygen cylinders stored, chained in a cupboard. The manager confirmed that that storage of these two has been verbally agreed with the Fire Officer. Accident recording did not in some instances state what action was taken. The manager should review all accidents and incidents to ensure that appropriate recording of the action taken, monitoring and risk assessments are in place. During the inspection a maintenance person was undertaking portable appliance testing of equipment, which helps ensure that equipment is electrically safe to use. Nightingale House Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 Page 17 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 3 x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 x x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x 3 x 2 Nightingale House Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 Page 18 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 OP8 Regulation 17 (1) (3) (a) Requirement Timescale for action 28/02/06 2 3 OP9 OP38 13 (2) 23 (4) (a)(b)(c) Health needs of individual service users must be identified and have a plan of action and risk assessments that are kept under review. The storage and disposal 28/02/06 arrangements for unwanted medications must be reviewed. The manager must adhere to the 28/02/06 fire safety requirements made by the fire officer regarding the use of door wedges. The practice of door wedging must cease. This is outstanding from 09/12/05. A risk assessment on the oxygen cylinders is also required. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP38 Good Practice Recommendations Accident recording must contain an audit trail of the action taken and outcome. DS0000002546.V283781.R01.S.doc Version 5.1 Page 19 Nightingale House Care Centre Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Care Centre DS0000002546.V283781.R01.S.doc Version 5.1 Page 20 - 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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