Inspection on 11/10/05 for Nightingale House (Strafford Road)

This inspection was carried out on 11th October 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Nightingale House (Strafford... 11/06/07

Nightingale House (Strafford... 21/11/06

Nightingale House (Strafford... 26/04/06

Nightingale House (Strafford... 12/05/05

Nightingale House (Strafford... 23/11/04

Nightingale House (Strafford... 15/06/04

Nightingale House (Strafford... 17/11/03

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Birchwood

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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 10 Strafford Road Twickenham Middlesex TW1 3AE Lead Inspector Simon Smith Unannounced Inspection 11th October 2005 11.00a 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 DS0000017384.V260163.R01.S.doc Version 5.0 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 DS0000017384.V260163.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Nightingale House Address 10 Strafford Road Twickenham Middlesex TW1 3AE 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 8892 1854 02088915541 v.nayar@btinternet.com Mr Vipin Nayar Ms Sushma Nayar Mrs Sushma Nayar Care Home 21 Category(ies) of Dementia - over 65 years of age (9), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (21) Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Condition of registration of categories of care The Commission has a list of the service users who have dementia or mental health needs. A condition of registration of the categories of care, is that the number of places for dementia and mental health needs are for the existing service users only and the home is not to admit any new service users with these conditions unless another variation is submitted for consideration. 12th May 2005 Date of last inspection Brief Description of the Service: Nightingale House has been registered as a care home since 1976 and was purchased by the present owners in 1998. The home provides accommodation for a maximum of 21 older people in single and shared rooms. The registration category of the home currently includes provision for 9 residents who may have dementia. It should be noted that this provision relates to specific residents and is not a permanent amendment to the home’s registration category. The property is situated in a quiet residential area but is within walking distance of Twickenham town centre, which provides a range of shops, pubs, restaurants and community resources. The River Thames and open spaces are within easy reach and access to public transport is good. Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a single afternoon and involved discussion with residents, relatives, the owner, the manager and staff. The inspector was also able to join residents for a meal. A sample of records was examined, including staff and residents’ files, and a tour of the premises made. The home met 8 of 23 National Minimum Standards assessed at this visit. 10 Standards were almost met and 5 Standards were not met. A number of Requirements made at the last inspection had not been met by the home, including some that related to the health and safety of residents. The home must improve the response to the Requirements made in this report to avoid enforcement action. A new manager has started work at the home since the last inspection and it is hoped that her input will improve the home’s performance in the areas highlighted in this report. The manager said that three residents had been admitted since last inspection. Residents made positive comments about staff at the home and the care they provide. One resident said, “The staff are all so helpful.” Visiting family members said that they are made welcome when they visit and that they are consulted about their relatives’ care. One visitor said of the staff team, “They’re really caring people, and very patient”. What the service does well: What has improved since the last inspection? What they could do better: Improve the response to statutory Requirements. Provide each resident with a written agreement that accurately sets out the terms and conditions of their placement. Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 Page 6 Provide clear written guidance for staff in the delivery of individual personal care. Provide appropriate storage for medication requiring refrigeration. Improve the range of activities and outings available to residents. Check all new staff against the Protection of Vulnerable Adults list. Ensure that all staff attend training in the Protection of Vulnerable Adults. Store dangerous substances safely. Replace the flooring in one second floor bathroom. Install privacy screens in shared bedrooms Replace the carpet in one second floor bedroom. Fit all radiators with covers to prevent the risk of scalding. Ensure that all bathrooms and toilets contain hand washing and drying facilities to prevent the risk of infection. Keep the home free of unpleasant odours. Ensure that all staff are registered for NVQ training where necessary. Obtain appropriate Criminal Records Bureau disclosures for all staff employed at the home. Ensure that all new staff participate in a structured induction programme. Ensure that all staff have individual supervision at least six times each year. 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 DS0000017384.V260163.R01.S.doc Version 5.0 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 DS0000017384.V260163.R01.S.doc Version 5.0 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): 2 Residents must be issued with a written agreement that sets out the terms and conditions of their placement. EVIDENCE: The last inspection report made a Requirement that all residents must be issued with a contract that accurately outlines the terms and conditions of their placement. The owner was able to demonstrate that a new standard contract has been drawn up for residents. However examination of residents’ files indicated that not all residents have yet been issued with, and agreed to, the standard contract document. The Requirement is therefore reinstated in this report. See Requirement 1. Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 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, 9, 10 Guidance for staff in the delivery of personal care must improve. Residents’ healthcare needs are met. Residents’ privacy and dignity are respected and maintained. EVIDENCE: An individual plan of care is in place for each resident. The manager advised that residents’ keyworkers are responsible for monthly updates of care plans. All the care plans examined provided evidence of monthly review. Whilst care plans record residents’ needs, strengths and preferences across a range of areas, such as diet, mobility and general health, they do not currently provide clear guidance for staff about how to deliver personal care to residents. Staff completing care plans must ensure that these documents contain detailed guidance for care staff regarding the delivery of personal care. See Requirement 2. All residents are registered with a general practitioner locally. Records showed that other healthcare professionals, such as physiotherapists, chiropodists and Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 Page 10 opticians, visit the home where necessary. District nurses provide support to the care staff team in managing some healthcare conditions experienced by residents. District nurses are also able to make referrals to specialist community health services if necessary. The manager advised that the home has changed the pharmacist responsible for the supply of medication. The owner reported that the new pharmacist had provided medication training for staff and that another session was booked for November 2005. Medication stored in the fridge must be kept in a lockable storage box. See Requirement 3. Staff spoke to residents with respect and promoted individual choice during the inspection. Personal care needs were met promptly and with discretion. Comments made by residents confirmed that they are consulted on issues that affect them at the home. Residents and their relatives also confirmed that they are able to spend time in private whenever they wish. A number of residents chose to spend time alone in their rooms during the inspection. The home has a formal Confidentiality policy. Staff agree to work within this policy when they start work and sign to record this agreement. Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 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, 13 The range of activities available to residents is poor. Residents are supported to maintain contact with their friends and families. Residents’ visitors are made welcome when they visit. EVIDENCE: During discussion, some residents indicated that they would like the chance to go out occasionally whilst others said that they would like entertainers to visit the home. Previous inspection reports have identified that the home should improve the range of leisure opportunities available to residents. There was little evidence that improvements had been made in this area but the manager reported that she plans to introduce a new programme of activities. This remains an area in which the home needs to improve and this Requirement is reinstated in this report. See Requirement 4. Residents confirmed that they are able to have visitors whenever they like. All family members spoken to during the inspection reported that they are made welcome by staff when they visit and that they are able to talk to their relative in private. Relatives also advised that their opinions are sought at residents’ reviews. One resident celebrated a birthday at the home on the day of Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 Page 12 inspection. This event was well supported by staff, who arranged a cake and celebrations with other residents. Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 Page 13 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, 18 Appropriate procedures are in place for the management of complaints. Residents and their relatives feel any complaints raised would be properly addressed. The home’s recruitment procedures must improve to ensure the protection of residents. EVIDENCE: The home has a formal Complaints procedure, which gives details of arrangements for dealing with complaints and concerns. Residents and their relatives spoken to during the inspection were confident that any complaint they made would be dealt with properly. No complaints have been made about the home to the CSCI since the last inspection. The last inspection report made a Requirement that all new staff be checked against the Protection of Vulnerable Adults (POVA) list before beginning work at the home. Staff files did not provide evidence that these checks have been made for all new employees. This Requirement is reinstated in this report. See Requirement 5. (See also Standard 29). Training records did not provide evidence that all staff have attended training in the Protection of Vulnerable Adults (POVA). It is important that all staff attend training regarding the recognition and prevention of abuse. See Requirement 6. Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 Page 14 Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 Page 15 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, 20, 21, 23, 24, 25, 26 Residents’ bedrooms are personalised and reflect individual tastes and preferences. Residents are not adequately protected from the risk of scalding. Potentially dangerous substances were not stored safely in the home. Residents are not adequately protected from the risk of infection. EVIDENCE: Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 Page 16 The communal rooms of the home include a residents’ lounge and separate dining room. The home also has a well maintained garden. Residents’ private accommodation is arranged over three storeys, which can be reached by lift. Basic aids to mobility, such as grab rails in bathrooms and double handrails on the stairs, are in place throughout the home. Residents’ bedrooms are personalised and reflect individual tastes and preferences. Residents are able to bring personal items with them on admission and to install a private telephone line should they wish. The home currently accommodates four residents in two shared bedrooms. All residents’ bedrooms have a call bell, although not all units were reachable from the bed. The manager advised that a new call bell system will be installed in the near future. A good deal of refurbishment work during the last year has improved the appearance of the home. Many areas have been repainted and much of the carpet has been replaced. Whilst these developments are encouraging, a number of require attention to comply with the National Minimum Standards. These are as follows: An Immediate Requirement was made regarding the storage of potentially dangerous chemicals in a ground floor toilet accessible. This issue has been identified as a problem at previous inspections and represents a serious risk to residents’ health and safety. See Requirement 7. New baths had been installed in two communal bathrooms but the flooring requires replacement. See Requirement 8. The manager reported that the hoists used to assist residents to access the baths will also be replaced in the near future. A privacy screen for one of the home’s shared bedrooms has not yet been installed. See Requirement 9. The carpet in one resident’s room on the second floor requires replacement. See Requirement 10. A number of radiators around the home remain uncovered. Radiators must be covered to prevent the risk of scalding. See Requirement 11. A number of communal toilets on the ground floor had no hand washing facilities. This presents a serious risk of infection. An Immediate Requirement was made regarding this issue. See Requirement 12. Previous inspection reports have identified unpleasant odours as a problem in the home. Staff were able to demonstrate that a number of different methods have been implemented to address this problem. However odours continue to Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 Page 17 present a problem in some areas. This Requirement is therefore reinstated. See Requirement 13. Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The number and skill mix of staff was appropriate at the time of inspection. The home’s recruitment practices must improve. There is insufficient evidence that new staff attend induction training. EVIDENCE: The manager reported that a number of staff have been employed since the last inspection and that the home is fully staffed. Staff were available in sufficient numbers and interacted positively with residents and relatives throughout the visit. Residents spoke highly of staff and the care they provide. The manager reported that she has commenced an NVQ Assessor’s course. The owner advised that several members of staff need to register for the NVQ level 2 award. See Requirement 14. Four staff files were examined during the inspection. All contained evidence of job description, contract of employment and demonstrated that staff sign to record their understanding of the home’s confidentiality policy. (See also Standard 10). Staff files also contained proof of identity and two references. One staff file did not contain a Criminal Records Bureau disclosure. See Requirement 15. Staff files must also provide evidence that checks are made against the POVA list prior to employment. (See also Standard 18). Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 Page 19 The last inspection report required the Registered Person to demonstrate that new staff participate in a structured induction programme. Staff files did not provide evidence that this Requirement has been met. The Requirement is therefore reinstated here. See Requirement 16. Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 38 The appointment of a new manager should improve the home’s performance against the National Minimum Standards. Staff do not receive individual supervision regularly enough. EVIDENCE: A new manager has begun work at the home since the last inspection. It is envisaged that she will work alongside the owner in managing the home. The manager advised that she has been issued with a written contract and job description outlining her role. The manager confirmed that meetings designed to seek residents’ views on a range of issues within the home will be held monthly. The owner advised that residents’ families and representatives would be invited to these meetings on a quarterly basis. Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 Page 21 Employee files did not demonstrate that staff receive individual on a regular basis. This issue was identified as requiring improvement at the last inspection. See Requirement 17. Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 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 X 1 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 3 2 X 2 2 2 1 STAFFING Standard No Score 27 3 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 X X Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 Page 23 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 OP2 Regulation 5(b)(c) Timescale for action Residents must be issued with a 30/11/05 written agreement that accurately sets out the terms and conditions of their placement. Contracts must be signed by residents or their appointed representatives. This Requirement is reinstated from the last inspection. Provide clear written guidance for staff in the delivery of individual personal care. Provide appropriate, lockable storage for medication requiring refrigeration. Improve the range of activities and outings available to residents. This Requirement is reinstated from the last inspection. All staff appointments must include checks against the Protection of Vulnerable Adults list. This Requirement is reinstated from the last inspection. Nightingale House DS0000017384.V260163.R01.S.doc Version 5.0 Page 24 Requirement 2 3 4 OP7 OP9 OP12 12 13(5)(6) 13(2) 16(m)(n) 30/11/05 30/11/05 30/12/05 5 OP18 13(4)(c) 19(1) 15/11/05 6 7 OP18 OP19 13(6) 12(1) 13(4) All staff must attend training in the Protection of Vulnerable Adults. All potentially dangerous substances must be stored safely. This Requirement is reinstated from the last inspection. Replace the flooring in one second floor bathroom. Privacy screens must be installed in shared bedrooms. This Requirement is reinstated from the last inspection. Replace the carpet in one second floor bedroom. Fit covers to all radiators to prevent the risk of scalding. Provide hand washing and drying facilities in all bathrooms and toilets. This Requirement is reinstated from the last inspection. Keep the home free of unpleasant odours. This Requirement is reinstated from the last inspection. Ensure that staff are registered for NVQ training where necessary. Obtain appropriate Criminal Records Bureau disclosures for all staff employed at the home. Demonstrate that all new staff participate in a structured induction programme. This Requirement is reinstated from the last inspection. The manager must submit an application for registration. Ensure all staff have supervision at least six times each year. DS0000017384.V260163.R01.S.doc 30/01/06 11/10/05 8 9 OP21 OP23 23(2)(b) 12(4) 16(2)(c) 30/11/05 30/11/05 10 11 12 OP24 OP25 OP26 16(2)(c) 23(2)(b) 13(4) 13(3)(4) 16(2)(j) 30/12/05 30/11/05 15/10/05 13 OP26 16(2)(k) 30/11/05 14 15 16 OP28 OP29 OP30 18(1) (a)(c) 19(1) 18(1) 30/12/05 30/11/05 30/11/05 17 18 OP31 OP36 8 12(5) 18(2) 30/11/05 30/11/05 Nightingale House Version 5.0 Page 25 This Requirement is reinstated from the last inspection. 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 DS0000017384.V260163.R01.S.doc Version 5.0 Page 26 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 DS0000017384.V260163.R01.S.doc Version 5.0 Page 27 - 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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