Inspection on 10/07/06 for Nightingale House (Nightingale Lane)

This inspection was carried out on 10th July 2006.

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 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 (Nightingale... 26/01/06

Nightingale House (Nightingale... 25/08/05

Nightingale House (Nightingale... 10/01/05

Nightingale House (Nightingale... 28/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Nightingale House (Nightingale Lane) 105 Nightingale Lane London SW12 8NB Lead Inspector Janet Pitt Unannounced Inspection 10th July 2006 10:15 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 (Nightingale Lane) DS0000019109.V302727.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 (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingale House (Nightingale Lane) Address 105 Nightingale Lane London SW12 8NB 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) 020 8673 3495 020 8675 2258 www.nightingalehouse.org.uk Nightingale House Soobhug Awatar Care Home 253 Category(ies) of Dementia (39), Old age, not falling within any registration, with number other category (253) of places Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The total number of beds that are residential is 144 The total number of beds that are nursing is 109 Date of last inspection Brief Description of the Service: Nightingale is a large home providing care for older people who are Jewish or of the Jewish faith. The home has three residential units and three nursing units. There is a fourth unit, known as the Sampson Floor. The home benefits from having a large activities department in addition to its own Therapies Department. Other facilities include a Synagogue, concert hall and landscaped gardens. The home is situated close to local amenities and public transport. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken unannounced by two inspectors and lasted a total of eight and three quarter hours. Surveys were sent to residents, relatives and staff prior to the inspection and comments from them have been included in this report. Records relating to staff, training and care were inspected. Lunchtime was observed on two units, one residential and one nursing. Discussion was held with visitors, residents, the management team and members of staff. What the service does well: What has improved since the last inspection? Improvements are being made to the way training is recorded to make sure that staff received mandatory training and training specific to their role. Nightingale House has a food forum, which allows residents the opportunity to discuss menu choices. The home is planning customer care training, which should address issues of staff interaction with residents and focus care on the people who are receiving it. The requirements from the previous inspection were in relation to medications. The inspecting pharmacist had been due to visit, but unfortunately at the time of the site visit Nightingale House had an infection outbreak, which was being dealt with appropriately. The inspecting pharmacist will visit the home once the infection has cleared and a report will be made available in due course. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 6 What they could do better: Residents’ needs must be fully identified on admission, to make sure that all needs are identified. In particular manual handling and continence assessments require improvement to detail specific care needed. Information on social history needs to be detailed to enable staff to work appropriately with residents. Residents’ needs are known by staff, but this must be consistently documented in care plans and daily records, to evidence care given. (see under Health and Personal Care for further details.) Specific interventions, such as wound care and pain relief, must be documented accurately to evidence that residents are receiving appropriate care. Care plans need to detail how specific needs in relation to sexuality are to be met i.e. privacy given if required. The home accommodates a married couple and consideration should be given to how they are enabled to maintain a relationship. Privacy and dignity of residents must be respected at all times. This was reflected in the following comments received from surveys: ‘Some staff will endeavour to make sure food is soft, but others are not bothered whether the resident has appropriate food or not. Some make sure food is served hot, other couldn’t care less.’ ‘To make sure that all staff are aware that it is the residents home we work intheir needs come first and they are individuals that should make as many of their own decisions as is possible. Small considerations can make a big difference to our residents.’ An incident was witnessed where a member of staff tried to remove a jug of apple juice prior to the resident finishing their meal. The reason given was that ‘things had to be cleared away’ as the worker finished at 2pm. This is not acceptable and residents must be given as much time as they need to finish their meal and fluids must be readily available at all times. Residents and their representatives need to be confident that concerns will be handled at a local level. Please see under all the sections for further information relating to the above issues. Please contact the provider for advice of actions taken in response to this Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. Prospective residents and their family have the opportunity to visit the home prior to admission. An assessment of needs is undertaken prior to and on admission. The home must make sure that assessments on admission are completed fully to identify all needs, in particular social and relationship needs. EVIDENCE: Of the nineteen surveys received from residents, sixteen of them considered that they had sufficient information on Nightingale house, prior to moving in. One resident stated that they did not have sufficient information and the remaining two commented that ‘[I] was advised [it was the] best place for me [and I am] satisfied and contented’. The other resident commented that ‘We did not have advanced warning of the circumstances which caused me to wish to live here.’ One relative had replied on behalf of a resident and stated that they had received enough information ‘including visits, meetings with staff and recommendations.’ Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 10 Residents are able to access a Service Users Guide and assessment of their needs is undertaken prior to admission. A further assessment is undertaken on admission, but these need to be fully completed in order that all needs are identified. Assessments examined on the site visit were not fully completed. It was noted that physiotherapy assessments had been done, but manual handling assessments were not consistently completed. Some assessments such as continence assessments required specific details on number of continence pads to be used and the amount of fluid intake needed. It was observed that carer preference was documented; one resident did not wish to be cared for by male members of staff. Sleep and waking times were detailed and preferences for baths or showers. Social and personal history must be expanded upon, to make sure that relevant information is held on residents. One assessment had personal interests and family details noted, but there was a lack of information on how long the resident had been alone since their spouse died. There was an entry, which related to worries the resident had, but these were not expanded upon. One assessment did not have any personal history on the resident completed. The home is in the process of changing care documentation but care needs to be taken to make sure that the new format contains specific details; to enable care needs to be identified. On one assessment there were minimal details, even though prompts are present to aid completion, i.e. ‘sleep routines: no problems’ and ‘elimination: no problem.’ This does not indicate patterns of behaviour and where interventions might be required. The format of the assessment is Standard compliant, but information must be completed properly to make sure that the Standard is met and all needs are identified. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Residents’ needs are known by staff, but the care documentation does not consistently evidence this. Care must be resident focused and maintain residents’ privacy and dignity and reflect their preferences. EVIDENCE: Staff demonstrated an awareness of the importance of making sure needs are met, however, this must be achieved consistently. Comments from residents’ surveys included: ‘I have been totally ignored in one unit and assisted in another.’ ‘[the resident’s] dental problems have been much ignored’ and ‘quite happy in a caring environment.’ Handovers are held three times daily, between shifts. A handover from the early to the late shift was observed. The member of staff giving the handover provided an update for incoming staff on the welfare of each resident. The handover detailed care provided for each resident, any healthcare issues, food/fluid intake and how each resident had spent their morning. The staff must make sure that this information is contained in the daily records of the Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 12 residents, as this level of detail was not found consistently. One daily record stated that ‘[the resident] was assisted to get up and dressed, consumed breakfast of fish, bread and fruit, also lunch of soup, meat potatoes, veg, also pudding.’ This demonstrated that care had been given as planned and the record also contained details of personal hygiene regimes. However, one resident had a care plan for general baths, but the record showed that the last general bath the resident had had, was on 21/06/06. This was also noted to be inconsistent in other residents care plans. The frequency of continence care planned was not detailed in the daily records and care plans e.g. ‘provide pads and pants’ and ‘needs regular toileting’, but there was no information on how many or frequencies. Care plans examined on two units recorded residents’ skills and needs in areas including sleeping, dressing, eating and drinking, mobility, hearing, oral and foot care, continence, skin integrity and risk of falls. In addition care plans record brief details of family history, hobbies and social needs. Healthcare conditions such as diabetes were recorded. Dietary issues (for example high fibre/soft diet) and allergies were noted. Daily notes for each resident were also on file. Each resident has a named nurse, who is identified on the resident’s care plan. One residents planned care indicated that they required ‘help of staff to express [their] sexuality.’ but there was no indication of how this was to be achieved. Where care plans identified needs, such as a risk of falls, these had been addressed, for example through a referral to physiotherapist for assessment and the use of equipment (such as indoor shoes and a quad stick). However, this was not consistent and not all residents had risk assessments for falls, even though they had a history of falls. Care must also be taken to make sure that food and fluid intake is recorded accurately when required. Use of cot sides and lap belts must be risk assessed, documented and reviewed in consultation with the resident or their representative, to make sure that there is no unnecessary restraint of residents. There was evidence of interventions by other health professionals, with a recording sheet for their input, which was noted to be appropriate. Surveys received from residents indicated that medical support was generally available. Staff must make sure that their interventions are accurately documented, for example one wound care plan had the following evaluation: ‘Wound done not too good still black slough.’ Full details of wound condition must be documented in line with the Regulations and National Institute of Clinical Excellence guidance. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 13 Similarly with administration of analgesia, one entry in a resident’s plan read: ‘c/o slight pain in wound, medications given as prescribed’, there was no indication whether analgesia had been given and whether it was effective. This must be documented to evidence that care needs have been met. The Director of Nursing advised that home is changing the system of care planning used. The new system has been designed in house and is more person-centred. Staff have been given a three-month time scale to update residents’ care plans. The Director of Nursing stated all staff have had training on the new care planning documentation. The long-term aim is to have computerised care plans that staff can access easily. Training will be delivered to staff before implementing this, to make sure they have relevant computer skills. Care plans were not always updated or review within specified timescales identified by staff. Care plans did not consistently indicated that there was involvement of the resident or their representative in the process, as not all care plans were signed by the resident or their representative. The Director of Nursing said that there is a commitment to improving the quality of service for people with dementia. This extends to being accurate in assessing residents’ needs and ensuring appropriate staff support such as training. Privacy and dignity of residents must be respected at all times. One comment on a survey stated that staff ‘sometimes ignore me’, in relation to whether staff listen and act on their requests. Further issues relating to privacy and dignity are summarised under the Daily Life and Social Activities section. The Deputy Chief Executive outlined the home’s commitment to providing quality services in the area of palliative care. The home plans to introduce specialist teams who have high skill levels in providing end of life care as it is felt that the home’s general practitioners do not have specialist skills in this field. Currently the home uses Trinity Hospice, a local organisation who are specialists in the provision of palliative and end of life care. The home is for Jewish residents and all staff are instructed on induction about the importance of rituals required at the end of life. However, staff must make sure that specific individual wishes of residents are noted and acted upon. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 14 A light system, which operates when a carer is in a resident’s room, makes sure that they are not unduly interrupted. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 15 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, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. Family and friends feel welcome and know they can visit the home at any time. Some staff listen to residents and make efforts to provide a flexible service, but this still requires further improvement with regard to choice and activities offered. Staff must make sure that they respect residents and enable them to maintain independent living skills for as long as possible. EVIDENCE: Residents are able to have appropriate food served either in their room or in the dining rooms. The Director of Nursing said that there is a committee of twelve people who plan the home’s menu. Volunteers from the Home Committee visit the units weekly to monitor food and feed back on quality. There is also a ‘Food Forum’, held monthly, which is designed to ensure that residents’ feedback about the food provided is heard. A new menu was introduced approximately three months ago. Comments received about food in Nightingale House included: ‘I believe the food is of a high standard but it is not always ordered correctly or served Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 16 correctly’, ‘[meals] could be more varied’ and ‘some of the residents complain about food and the home has instituted several measures to address them.’ The Director of Nursing advised that changes were made to the home’s shift pattern to ensure that sufficient numbers of staff are available at lunchtime to provide support to residents. One inspector joined residents for lunch in the residential dining room to observe staff practice and residents’ experience. The other inspector observed lunch in the nursing unit. In the residential unit staff numbers were sufficient and staff were seen to interact positively with residents. Some residents had visitors who joined them for lunch. The food provided was appetising and was well received by residents. There were a number of choices on the advertised menu. Residents who did not want anything from the menu were able to have alternatives if they wished. Staff provided support with eating and drinking where necessary. One member of staff assisted a resident with eating when it was not clear that this assistance was necessary or that the resident wanted support. The resident was managing successfully, albeit very slowly, and appeared to be quite content. The member of staff did not ask the resident whether they wanted support but mashed the food up on the plate and began to feed the resident with a spoon. As the resident had been managing successfully prior to the member of staff’s intervention, it was not necessary to mash the food up on the plate before serving. Whilst the member of staff may have acted with good intentions, this demonstrated that staff should identify whether residents’ want assistance with eating before they initiate support. On the nursing unit it was observed that residents were not offered linen napkins, even though care had been taken to dress tables attractively. Blue plastic aprons were noted to be used to protect clothing. This does not enable residents to maintain their dignity. Some residents were in wheelchairs and it was not apparent whether it was their choice to remain in a wheelchair for lunch. There was a choice of juice, but residents were not consistently asked which one they would prefer. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 17 At one point during the serving of lunch there were five staff queuing with trays to collect meals and staff were talking amongst themselves and ignoring the residents. One carer was over heard to say to a resident: ‘Want soup? You try, you like it.’ This was demeaning to the resident and the member of staff was not treating the resident as an adult. Good interaction between one member of staff assisting and a resident was observed. The carer took time to explain what food was being offered and checking that the meal was not too hot. At one point during the meal the resident was asked what their favourite food was. Some members of staff were seen standing up to assist residents with their meals, which is considered poor practice and one carer did not interact at all with the resident they were assisting. The inspector intervened during the meal as a carer was knocking a spoon against a plate to get excess food off the spoon. This made a considerable irritating noise. The nurse in charge of the unit was asked to stop this action. The carer was then removed from assisting the resident and another carer took over. There was no indication that an effort was made to explain to the carer the appropriate way to assist. Comments overheard during the meal included: [the resident] is eating jelly’, ‘Do you want it, do you want meal’ and ‘can you have some drink for me please’. Staff must make sure that they interact appropriately with residents. There must be evidence that residents’ meal choices are confirmed at the time of serving meals. The activities co-ordinator discussed the weekly programme of activities and demonstrated a commitment to involving all residents rather than just those able to access the programme. The co-ordinator aims to hold both large and small group classes. This was reflected in survey responses received: ‘[the resident has dementia and is wheelchair bound], if I didn’t take her to the musical activities or into the garden no-one would.’ and ‘All the residents need constant stimulation; interaction and reassurance. Many care staff are unable to deliver these emotional props. The activities co-ordinators, however, are superb, but the patients need to be taken or involved in regular interaction.’ Regular activities include: bingo, exercise class, flower arranging, music group, massage, discussion, and reminiscence work. Events that celebrate Jewish festivals and culture are arranged, along with regular prayers and a special meal on Friday nights. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 18 Outings are arranged into the community and further afield, the activities coordinator has access to a vehicle on a rota basis. Residents can also access trips organised centrally by the home. Three residents from the unit attended a trip to Portsmouth on the day of the site visit. On the residential unit, the manager advised that staff aim to create a number of spaces on the unit in which residents may wish to spend time. This works well; residents were engaged in small groups around the unit. Some were talking 1:1 with staff, one was knitting, others chatting and listening to music and another played Scrabble with a member of staff. This evidence of good practice must be built on to make sure that all residents can benefit from meaningful activities and lead a fulfilling life. One resident in the home visits their spouse on a daily basis, as they live in separate units. Consideration should be given to enabling this couple to live in closer proximity, to make sure they can continue their relationship. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 19 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): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. There needs to be improvement in handling of concerns at a local level to make sure that residents and their relatives are confident in the process. Formal complaints handling and Protection of Vulnerable Adults investigations are handled well. EVIDENCE: The majority of surveys returned from residents indicated that they knew how to make a complaint. Some responders were unsure and comments were: ‘need explaining again’ and ‘not sure how to go about it’. Each unit keeps a record of complaints received with actions and outcomes. There were varying responses regarding how complaints are handled within the home: ‘The staff are always ready to listen and act on any comments I have to make about [the resident’s] needs’ and ‘complaints are received politely and are acted on: - Always, Usually, Sometimes, Never.’ The home must make sure that residents and their representatives are aware of how to access the complaints procedure. Issues must dealt with at a local level when possible, as one comment received stated: ‘ I have found the only way to achieve a response is to write simultaneously to all management and trustees.’ The home has not had any Protection of Vulnerable Adults investigations since the previous inspection. This is not due to a lack of awareness of staff, but a lack of incidents. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 20 Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. The home has a well-maintained environment, which provides aids and equipment to meet the care needs of the residents. The home is generally clean and tidy. EVIDENCE: All surveys received from residents indicated that they thought Nightingale House was clean and tidy. However, one comment said that: ‘Surfaces in some bedrooms are not always wiped clean and at weekends the floors of some bedrooms are strewn with crumbs and tissue litter. Beds and bathrooms are usually clean.’ At the site visit there were no issues with the cleanliness of the environment. The home is well maintained and is a suitable environment in which to meet residents’ needs. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 22 The Director of Nursing plans to improve the environment for people with dementia, including the introduction of pictorial signage and bright colour schemes on dementia units. Also, persons who ‘pace’ (i.e. walk around a lot) will be able to do this with as few restrictions as possible. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 23 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 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. Management encourage staff members to undertake external qualifications beyond the basic requirements. Residents generally have confidence in the staff that care for them, but attention needs to be given deployment of staff on the units to make sure that care is given in a timely manner and there are positive interactions between staff and residents. EVIDENCE: There are adequate numbers of staff available to support residents. Surveys received indicated that staff were available and one commented that staff were ‘very responsive’. However, some residents feel they are ignored. One comment was: ‘Qualifications of staff vary considerably, as does commitment. I have noticed some staff sit where they cannot actually see the residents they are supposed to be caring for and doing nothing to ease any discomfort i.e. runny nose, dribbling.’ This was reflected in others comments as follows, ‘[staff are available] only in the dementia unit.in all other units all staff are stretched and sometimes thin on the ground. I have noticed a lack of stimulation or interaction between care staff and residents in nursing units who are bordering dementia. These residents are left in emotionally isolated groups staring at nothing; the “carer” does not attempt to talk to them. Another comment was: ‘You may call a member of staff and make two requests. The first has a good chance of being acted upon; the second very little and a repeated request will be necessary.’ Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 24 The home must make sure that there is positive interaction with residents. The home has already reviewed staffing at mealtimes and need to look at all areas of care giving within the home, as there may be issues with deployment of staff, which could be altered to make sure that residents needs are meet. The manager and Deputy Chief Executive explained that the Nursing department is currently undergoing restructure. The Practice Development Nurse and clinical lead posts will not longer exist and will be replaced with two Deputy Directors of Nursing. Any staff that have to made redundant are being supported with curriculum vitae and interview skills training. The Director of Nursing, the Personnel Manager and the Marketing Manager are developing Customer Care package, which will provide experiential learning experiences for staff. All staff employed will undertake this training. At the time of the site visit all Registered Nurse posts were filled and the home is able to access bank staff if required. This helps to ensure continuity of staff. Residents can be confident that staff have access to appropriate training provided in-house and by external trainers if needed. The home has a number of NVQ assessors in house and the Director of Nursing said that the NVQ training programme is going well. There is a commitment to providing training for staff in dementia. A one-day dementia awareness course is followed by a four-day dementia course, which is overseen by a visiting consultant. There is a training and education strategy group, which meets quarterly to discuss mandatory training and also focuses on areas where training is required, to make sure that residents needs are identified and met. A falls prevention group has been developed; this group gathers data on falls within the home and whether specific up date training is needed. The Director of Human Resources explained that she is developing a ‘Training Passport’ system for staff, which is computer based and will record training undertaken and when training is required. At present training undertaken by staff is poorly recorded and checked. It was noted that manual-handling training is not given consistently each year to staff, and it was observed on the site visit that some residents were moved inappropriately. Staff must be made aware that it is their responsibility as well to make sure that all mandatory training is up dated within the prescribed timescales. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 25 Residents can be confident that through recruitment procedures are followed and necessary checks are made on potential employees. Staff records examined contained the information required in the Regulations and Standard. The Director of Human Resources said that sets of job descriptions are kept on each unit and are used in supervision sessions with staff. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 26 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, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. The management team is developing to provide a good structure with clear lines of accountability. EVIDENCE: The Director of Nursing has been in post for almost two years. He thinks that he has implemented many changes, including staff interaction with residents. The Director of Nursing has spent time observing staff practice and will advise on how to improve. He acknowledged that this area needs to be kept under close monitoring. Each unit has manager and deputy manager and there is one deputy manager vacancy at present. A unit manager advised that team meetings are held monthly and staff receive individual supervision every 6-8 weeks. The unit Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 27 manager also said that they are in the process of re-introducing a staff appraisal system. Staff spoken with during the inspection confirmed that they receive regular supervision and that their managers are approachable and supportive. Residents and relatives meetings take occur every two or three months. The Director of Nursing meets the unit managers weekly and on a one to one basis. As mentioned previously, the home has forums for residents to discuss specific things, such as menus. The home also benefits from a group of volunteers who visit and they are able to feedback any concerns residents may have. The Director of Nursing reported that the home held a falls prevention day in the week prior to inspection and that training in this area has been delivered to staff. The home has instituted the use of hip protectors and the Director of Nursing reported that these have been successful in preventing fractured femurs. Residents’ families generally deal with their finances. If the home manages the personal allowance, records are maintained. Care must be taken when staff record personal items brought in by residents. One care plan it had been written that a gold plated watch had been brought in; this should have been described as a ‘yellow metal watch’. There were no issues with regard to health and safety within the home. Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 28 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A 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 OP3 Regulation 12 (1) (a) Requirement The registered person must ensure that all assessments are completed fully to make sure that all needs are identified. The registered person must ensure that care plans and daily records evidence care required and care given. The registered person must ensure that the resident or their representative are involved in the care planning process. The registered person must ensure that wound condition is documented accurately. The registered person must ensure that interventions carried out by staff have a record of whether the intervention was appropriate for the resident. The registered person must ensure that the privacy and dignity of residents is maintained and they are able to continue with meaningful relationships. The registered person must ensure that residents are treated with respect by staff. Blue aprons must not be used at DS0000019109.V302727.R01.S.doc Timescale for action 30/12/06 2. OP7 15 30/12/06 3. OP7 15 (2) (c) 30/12/06 4. 5. OP8 OP8 Sch 3 (3) (k) Sch 3 (3) (k) 30/12/06 30/12/06 6. OP10 12 (4) 30/12/06 7. OP10 12 (4) (a) & 12 (5) (b) 30/12/06 Nightingale House (Nightingale Lane) Version 5.2 Page 30 8. OP10 12 (2) & (3) 16 (2) (m) & (n) 9. OP12 10. 11. OP14 OP14 12 (2) 12 (2) 12. OP15 12 & 16 (i) 13. OP16 12 (5) (a) mealtimes for residents and staff must address resident in an appropriate manner. The registered person must ensure that any specific wishes of residents are acted upon during end of life care. The registered person must ensure that the activities programme continues to develop to provide meaningful activities for all residents. The registered person must evidence that the residents have choice in their daily activities. The registered person must ensure that residents are able to maintain independent living skills. The registered person must ensure that residents have sufficient time to enjoy their meals and fluids are readily available. The registered person must ensure that residents and their representatives are confident in the complaints process at a local level. 30/12/06 30/12/06 30/12/06 30/12/06 30/12/06 30/12/06 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 Nightingale House (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 (Nightingale Lane) DS0000019109.V302727.R01.S.doc Version 5.2 Page 32 - 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. 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