Inspection on 04/09/07 for Nightingale House Care Centre

This inspection was carried out on 4th September 2007.

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

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

Other inspections for this house

Nightingale House Care Centre 27/06/06

Nightingale House Care Centre 20/02/06

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 Doug Tunmore Key Unannounced Inspection 4th September 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000002546.V349978.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. DS0000002546.V349978.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingale House Care Centre Address Clovermead Farm Main Road Bucknall Lincs LN10 5DT 01526 388261 01526 388487 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) Knightingale Care Limited Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45), Physical disability (6) of places DS0000002546.V349978.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Knightingale Care Limited in Nightingale House are registered to provide the following categories: Older people (OP) 45. Physical disability (PD) 6 The maximum number of service users to be accommodated at Nightingale House is 45. 27th June 2006 2. Date of last inspection 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. The fees at the inspection visit on the 04/09/2007 ranged from £395 to £625 each week. Extras are for hairdressing which range from £5:00 to £6.50, chiropody £15:00, toiletries, personal newspapers and magazines. Information about the home can be obtained from the manager of the home. The service user’s guide and the homes terms of condition relating to the stay of residents at this home is given to residents prior to admission. DS0000002546.V349978.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and took into account any previous information held by the Commission for Social Care Inspection (commission) including the homes previous inspection reports and their service history. The homes Annual Assurance Assessment, form hereafter in this report referred to as AQAA, was also sent to the home by the commission prior to this inspection. The Commission also sent residents survey forms (Have Your say) to the home and seven were returned. The site inspection consisted of case tracking a sample of three residents records and assessing their care. The inspector spoke with two of the people who were being case tracked and joined five other people for lunch where a general discussion took place about the care on offer at this home. The inspector also spent time with the manager, the senior nurse on duty, a senior carer and five visitors. A full tour of the home and a review of a sample of the records were also included. What the service does well: What has improved since the last inspection? Improvements continue in the home. Training has been provided to improve the care and support to residents in the home. The décor was seen to be of a god standard throughout the home and two new shower units are to be installed giving residents a choice of bathing or having a shower. Future plans are for a safe walkway in the grounds leading to a summerhouse, which is to be built in the near future. The acting manager has introduced comment cards DS0000002546.V349978.R01.S.doc Version 5.2 Page 6 for residents and visitors which are placed in the entrance to the home and which provides useful feedback regarding the running of the home. What they could do better: 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. DS0000002546.V349978.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 DS0000002546.V349978.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): Standards 1, 2, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are admitted into the home only after a full needs assessment has been carried out, either by the home and/or health care or social care agencies, so as to ensure that their assessed needs can be met. EVIDENCE: A review of all information available prior to this inspection including previous visit record dated June 06 and evidence seen at this inspection in peoples files showed that the home does not admit residents without a care needs assessment being undertaken. Prospective residents are also written to by the home confirming whether they can meet the residents care needs or not. Surveys confirmed that five people have received a contract and two have not received a contract. All seven surveys evidenced that all residents received DS0000002546.V349978.R01.S.doc Version 5.2 Page 9 enough information prior to admission. We looked at the files of those residents who were being case tracked and found that they contained contracts relating to the terms and conditions of a residents stay. The providers AQAA confirms that thorough pre-admission care assessments are in place at the home and residents and their relatives are fully involved in this process. Comments received by visitors about the admission process were that people were visited prior to admission. This home does not provide intermediate care. DS0000002546.V349978.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): Standards 7, 8, 9 and 10 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The health and welfare needs of people living in the home are fully met. Medication is safely administered. Care plans do not address the intimate care needs of residents or their wishes regarding their privacy and dignity. EVIDENCE: Previous visits have found that residents have individual care plans, which evidenced that health care professionals in relation to their health care needs have seen residents. The providers AQAA shows that the home makes sure that residents health, personal and social needs are set out on individual plans of care. We looked at the care plans of those people who were being case tracked and found that admission assessments cover diet, weight, sight, hearing, communications, falls, nutrition, contingency, drugs, mental state and social interests. DS0000002546.V349978.R01.S.doc Version 5.2 Page 11 The reviews and care plans of residents had not in all cases been signed and dated by the carer and the resident. Care plans have not established the intimate care needs of residents and what help they require when bathing or toileting or how their privacy and dignity can be maintained. There must be a discussion with individual residents to establish their individual needs. The acting manager confirmed that this would be addressed and implemented as soon as possible. All those people seen confirmed that carers respected their privacy and dignity. One resident stated that ‘I didn’t think I would like it in a home, but I do. This home is excellent’. Surveys showed that four residents/relatives believe that they receive the care and support they need, two usually did and one sometimes received the care and support he needed. All but one survey stated that staff listen and act on what we say. Surveys also evidenced that four residents/relatives felt they received the medical support they need and three stated that they usually get the medical support they need. A comment in one survey was that ‘we are very satisfied in the way they are treating my mother at his home in every respect’. The pharmacist visited the home on the July 07 and recorded that storage, stock control, a medication review and a spot check of records is carried out appropriately. The pharmacist visits every three months and due to the recent visit a full inspection of medication was not undertaken. The acting manager confirmed that training in safe handling of medication is planned for the near future. The providers AQAA showed that any allergies have been recorded on their medication sheets. However, a note should be made in medication sheets indicating those people who do not have any allergies so as to show that this has been explored. People’s files evidenced that GPs, chiropodist and district nurses visit this home on a regular basis. DS0000002546.V349978.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager and staff make relatives and friends of residents welcome in this home. A range of stimulating activities is made available to residents both inside and outside of this home. Choices of meals are made available at this home, which are discussed with residents. EVIDENCE: A previous visit in June 06 evidenced that the notice board in reception showed a programme of activities. The residents complete a social activities form and then their participation is recorded. One record shows that opportunities have been made available for a resident to participate in activities that they enjoy. Surveys from this visit reflected that all but one resident/relative stated that activities are available always or usually. The providers AQAA evidenced that on admission, a social profile and dietary preference is discussed with residents and their representatives. The activities coordinator sees each service user to find out what their hobbies and likes or dislikes of games are, i.e.: dominoes, bingo etc. They are told DS0000002546.V349978.R01.S.doc Version 5.2 Page 13 about the various activities available i.e. raffia basket weaving. Residents are also informed about any outings organised by the home. Residents meting are held and the minutes of the last meeting held in July 07 showed that activities, outings and the menu are standing items. The inspector joined residents at lunch and they confirmed that their relatives visit the home and are made most welcome. They also stated that they get involved in those activities that interest them or they have the choice of reading or watching television in the privacy of their rooms. All those residents and one relative seen had high praise for the quality of the meals at this home. The inspector found the food provided on the day to be hot, nutritious and very tasty. One resident stated that she gets fresh fruit every day and that the vegetables are always fresh and well cooked. Surveys showed that five people felt that they usually liked the meals and two always liked the meals. DS0000002546.V349978.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures for addressing and monitoring complaints and concerns are in place and residents are aware of how to make a complaint. Residents feel safe and confident in approaching care staff regarding any concerns that they might have. EVIDENCE: The providers service users guide, which contains the homes complaint procedures is available to all residents and is placed in the reception area. The home has a detailed complaints procedure. The homes AQAA evidenced that one complaint has been received and addressed within twenty-eight days. No vulnerable adults issues have taken place since the last visit. Residents surveys recorded overwhelmingly that they were aware of how to make a complaint and knew who to speak to if they were unhappy. Other verbal comments were ‘ I have no complaints and they (the staff) are very kind’ and ‘we feel very safe here’. One survey received from a resident stated that ‘I made a complaint through my daughter. The manager then handled it with my daughter and me’. The acting manager commented that protecting vulnerable adults training was undertaken in December 06, certificates were seen which confirmed that a DS0000002546.V349978.R01.S.doc Version 5.2 Page 15 large number of staff attended this training. A senior carer stated that if she became aware of an abusive situation she would report it to the acting manager. She also confirmed that she had undertaken protecting vulnerable adults training. DS0000002546.V349978.R01.S.doc Version 5.2 Page 16 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): Standard 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in clean, well-decorated, homely and safe accommodation. Any maintenance is promptly addressed. EVIDENCE: All surveys received apart from one confirmed that the home is kept fresh and clean. The provider AQAA states that a maintenance programme is in place and a maintenance person is employed. Routine maintenance is recorded in the maintenance log. The corridor areas and lounge have been re-carpeted and twenty bedrooms have been decorated since the last inspection. We toured the home and found that rooms had been personalised and they we clean and tidy. Cleaning systems and schedules are in place for the housekeepers, to ensure the home is clean and free from unpleasant odours. DS0000002546.V349978.R01.S.doc Version 5.2 Page 17 All the residents spoke highly of the accommodation and how much they liked their bedrooms. Comments were, ‘I have a nice room with a lovely view’. ‘My room is cleaned every day and I have brought in my own things’. Visitors also made mention that they have not noticed any unpleasant odours and that the home is always fresh and clean. However, it was noted that in one rooms ensuite facility was used to store intimate items of personal care (continence pads), which could be embarrassing for residents and takes up their private space. These should be stored in a more suitable storage space. A second visit to this room found that they had been removed. DS0000002546.V349978.R01.S.doc Version 5.2 Page 18 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): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not have adequate numbers of carers to ensure that any absences can be filled. The home is staffed with carers who were experienced, competent and educated to care for older people. Residents are protected by robust recruitment practices. EVIDENCE: A review of all information available prior to this inspection including the homes AQAA and the last visit carried out in June 06 showed that thorough recruitment practices are undertaken to ensure the safety of residents. The providers AQAA evidences that duty rotas identify the skill mix and staffing levels and can be adjusted according to the needs of the service users. The home employs housekeepers, laundresses, catering staff, an administrator, activities co-ordinator and a maintenance person. Induction training and supervisions of staff is given. The home has four staff with a National Vocational Qualification in caring for the elderly (NVQ) and one working towards completing this qualification. All carers have a copy of the General Social Care Council Codes of Practice, which sets out their responsibilities as care workers looking after vulnerable adults. DS0000002546.V349978.R01.S.doc Version 5.2 Page 19 The acting manager confirmed that the Skills For Care induction pack is to be used in the future training of new carers giving a fuller insight into caring for the elderly. Surveys confirm that two residents/relatives felt that staff were always available when they needed them and four felt that they usually were and one felt that they were sometimes available. The acting manager confirmed that the home has been short staffed for some time and adverts have been placed for new carers. One survey completed by a visitor stated that ‘at times and more recently staff has been skeleton and as a family we believe this home is run on basic staff only’. The minutes of the care assistants meeting evidenced that there was a shortage of carers and adverts would be placed to address this issue. The acting manager confirmed that they have a full compliment of nurses. A senior carer confirmed that she has a NVQ level 3, and added this is a happy and very friendly home. She also confirmed that they have been short of two staff for a long time and it is a bit stressful. DS0000002546.V349978.R01.S.doc Version 5.2 Page 20 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): Standards 31,33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well lead by a competent and committed acting manager. This had resulted in a confident, supported and trained staff team. Records show that residents’ health and general welfare and safety are promoted. The home ensures that that the residents have the opportunity to voice their views and opinions. EVIDENCE: The manager has approximately 20 years experience in working with the elderly. She has been a deputy matron and a manager in the past. She has been in post 5 months and is awaiting a ‘fit person’ interview with the DS0000002546.V349978.R01.S.doc Version 5.2 Page 21 commission. A rating of 2 has been made against this standard but no requirement has been made due to a pending interview. Staff and residents had confidence in the manager. Comments were, ‘the matrons first class’ and ‘the manager is really supportive, she has an open door policy’. The providers AQAA evidenced that quality assurance questionnaires are avaialble in the recption area for residents, family and professionals, including GPs. Informal processes are used in conjunction with the more formal process. The home is curretly trialing Comment cards to family/representatives and friends. There are a range of policies and procedures available in the home relating to fire safety and fire risk assessments. The homes AQAA evidenced that fire alarm, fire drills and emergency lighting checks have been undertaken. The servicing of aids and adaptations are undertaken and fully documented. Care staff also receive fire training as part of the homes initial training and as a regular training event. There were comprehensive risk assessments and health and safety policies. The home only deals with personal allowances of residents, which are kept safe. The manager undertakes audits with the administrator, on a monthly basis. Past visits have found that the proprietor and manager are not responsible for any residents affairs they are handled by resident’s families. We made a check of resident’s monies and found that an accurate record is kept with receipts available for monies spent. DS0000002546.V349978.R01.S.doc Version 5.2 Page 22 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 3 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x 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 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 3 DS0000002546.V349978.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 18(1)(a) Requirement Staffing vacancies must be filled to ensure that the assessed needs of residents are met and that any staff absences can be absorb by having a full compliment of staff. Timescale for action 25/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000002546.V349978.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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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