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Inspection on 26/04/06 for Nightingale House (Strafford Road)

Also see our care home review for Nightingale House (Strafford Road) for more information

This inspection was carried out on 26th April 2006.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents feel that staff know their individual needs and provide good care. The staff and management team is stable and knows residents well. Friends and families feel welcome when they visit and that staff provide good care for their relatives. Professionals say the home communicates well with them when needed.

What has improved since the last inspection?

Residents` care plans are more detailed and individualised. Staff have attended some relevant training. Staff now have regular individual supervision. The home notifies CSCI of incidents and accidents. Standards of health and safety are higher, although the risk posed by unguarded radiators must be addressed.

What the care home could do better:

Ensure that all residents (or their representatives where appropriate) have a signed contract that accurately sets out the terms and conditions of their placement. Develop a policy and demonstrate a proactive approach to the prevention of falls. Ensure there is an up to date moving and handling assessment for each resident. Ensure that all residents` photographs are attached to their medication records. Provide appropriate, lockable storage for medication requiring refrigeration. Ensure that consultations with healthcare professionals are conducted with consideration for residents` dignity, privacy and respect. Improve the range of activities and outings available to residents. Develop a risk assessment format that identifies risk factors and demonstrates how these factors can be managed. Prepare lunch must be immediately prior to the meal rather than cooking it in the morning and reheating at lunchtime.Serve vegetables at the table to enable residents to choose which they would like to accompany their meal. Provide training for all staff in the Protection of Vulnerable Adults. Replace the carpet in one second floor bedroom. Fit covers to all radiators to prevent the risk of scalding. Keep the home free of unpleasant odours. Obtain appropriate Criminal Records Bureau disclosures for all staff employed at the home. Demonstrate that staff have attended training relevant to their roles. The owner must complete the Registered Managers Award. Produce a written development plan for the home, which is subject to regular review and is based on positive outcomes for residents. Develop an effective Quality Assurance system, which takes into account the views of residents and other stakeholders. Ensure that all fire fighting equipment is checked by a qualified person each year.

CARE HOMES FOR OLDER PEOPLE Nightingale House (Strafford Road) 10 Strafford Road Twickenham Middlesex TW1 3AE Lead Inspector Simon Smith Unannounced Inspection 26th April 2006 12:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Nightingale House (Strafford Road) 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 (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 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. 11th October 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. Current weekly fees range from £450 to £510. The registration category of the home currently includes provision for nine residents who 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 and 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 (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector used evidence from a wide range of sources when making judgements about the home. These included two visits to the home and discussion with residents, relatives, the owner, the manager and staff. The inspector also joined residents for a meal. A sample of records was examined, including staff and residents’ files. The inspector was made welcome during the visits and wishes to thank residents, staff and all those who gave their views about the home. Surveys were given to residents, relatives and professionals who visit the home, including general practitioners and district nurses. Local authorities that fund and monitor residents’ care were also consulted. Eight residents and ten relatives returned surveys. Six general practitioners, three placement monitoring officers and another visiting health professional also responded. Many residents were unaware that they had a contract. The home should make sure this is made clear when people move in. 75 of residents returning surveys said that staff are “always available” when they need them. 25 said that staff are “usually available”. Residents spoke highly of staff and the care they provide, reporting that staff know their individual needs. 75 of residents said that they “always” enjoy the food provided by the home, whilst 25 said that they “usually” or “sometimes” enjoy it. No residents said that they had complained about the home although residents said they would feel confident in raising a concern. Almost half the residents returning surveys said that the home “sometimes” or “never” provides activities that they can take part in. Comments made by residents included: “I’m very happy here” “I’ve never had cause to complain but would speak to someone if there was a problem” “This is a happy home!” “I am very pleased to be here” “There are no activities I can take part in…There are no outings” “The food is very basic and bland” All family members said that the home communicates clearly with them about their relative and all were satisfied with the overall care provided by the home. Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 6 90 of relatives felt that residents are happy and fulfilled and 80 said that staff clearly understand residents’ needs. 40 of relatives felt that the home does not provide enough suitable activities for residents. This issue was also raised by visiting healthcare professionals and is addressed in the ‘Daily Life and Social Activities’ section of this report. Two relatives reported that they had complained about the home in the past. One said that the complaint had been dealt with satisfactorily, whilst the other said that the home’s response had been unsatisfactory. Relatives were also asked what the home could improve. Two relatives repeated that there should be more activities for residents. One relative identified the food as an area for improvement whilst another said that there are sometimes unpleasant odours in the home. (See the Environment section of this report). Comments made by relatives included: “I have always found the staff warm and friendly” “All the staff are very helpful and know and understand the residents’ needs” “I have yet to meet a member of staff who has not been kind and loving” “She (resident) has always been well looked after” “The home provides quality care” “The overall care is wonderful” ”I am very pleased with the care and attention that the staff give to the residents”. “They need to encourage clients to do more things and participate more” All the professionals who visit the home said that staff communicate clearly with them and understand residents’ needs. All said that they were satisfied with the overall standard of care provided and that they feel residents at the home are happy. Concerns were identified during the visit about residents’ rights to privacy and dignity. A visiting dentist examined residents in the lounge, which was occupied by other residents, staff and visitors. The home must ensure that residents’ dignity is maintained during consultations with healthcare professionals. The home met 12 of 27 National Minimum Standards assessed at this visit. Eleven Standards were almost met and four Standards were not met. Five Requirements made at the last inspection had not been met by the home and these are reinstated in this report. What the service does well: Residents feel that staff know their individual needs and provide good care. Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 7 The staff and management team is stable and knows residents well. Friends and families feel welcome when they visit and that staff provide good care for their relatives. Professionals say the home communicates well with them when needed. What has improved since the last inspection? What they could do better: Ensure that all residents (or their representatives where appropriate) have a signed contract that accurately sets out the terms and conditions of their placement. Develop a policy and demonstrate a proactive approach to the prevention of falls. Ensure there is an up to date moving and handling assessment for each resident. Ensure that all residents’ photographs are attached to their medication records. Provide appropriate, lockable storage for medication requiring refrigeration. Ensure that consultations with healthcare professionals are conducted with consideration for residents’ dignity, privacy and respect. Improve the range of activities and outings available to residents. Develop a risk assessment format that identifies risk factors and demonstrates how these factors can be managed. Prepare lunch must be immediately prior to the meal rather than cooking it in the morning and reheating at lunchtime. Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 8 Serve vegetables at the table to enable residents to choose which they would like to accompany their meal. Provide training for all staff in the Protection of Vulnerable Adults. Replace the carpet in one second floor bedroom. Fit covers to all radiators to prevent the risk of scalding. Keep the home free of unpleasant odours. Obtain appropriate Criminal Records Bureau disclosures for all staff employed at the home. Demonstrate that staff have attended training relevant to their roles. The owner must complete the Registered Managers Award. Produce a written development plan for the home, which is subject to regular review and is based on positive outcomes for residents. Develop an effective Quality Assurance system, which takes into account the views of residents and other stakeholders. Ensure that all fire fighting equipment is checked by a qualified person 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 (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 9 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 (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 10 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, 3, 6 Quality in this outcome areas is poor. This judgement has been made using available evidence including a visit to the home. The Service User Guide should be made more available to residents. Residents must be issued with a written agreement that is accurate and up to date. Residents should be clearly informed about their written agreement with the home when they move in. The written agreement must be signed by the resident or their representative. EVIDENCE: There was no evidence that a Service User Guide is readily available to residents. The manager agreed to place a copy in each resident’s room. Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 11 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. Examination of residents’ files during the visit indicated that this Requirement has not yet been met. In addition, some contracts were out of date or inaccurate. For example one resident’s contract related to a twelve week placement in 1993. The Requirement is therefore reinstated in this report. See Requirement 1. Residents’ surveys revealed that many residents do not know they have a contract. The home should aim to ensure that all residents are informed clearly about their written agreement with the home when they move in. Needs assessments were in place on the sample of residents’ files examined. Assessments record residents’ physical, emotional, social and spiritual needs and identify any specialist adaptations or equipment needed. The home does not admit residents for intermediate care. Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 12 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 Quality in this outcome area is adequate, although improvements in important areas of practice are necessary. This judgement has been made using available evidence including a visit to the home. The quality of written information about residents has improved. Further improvements and consistency in recording should be sought. Relatives and healthcare professionals report that the home meets residents’ healthcare needs well. The home must develop a proactive approach to the prevention of falls. The home must ensure that each resident has an up to date moving and handling assessment. Future consultations with healthcare professionals must be conducted with consideration for residents’ privacy, dignity and respect. EVIDENCE: Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 13 The last inspection report made a Requirement that the home improve written guidance for staff about how to deliver personalised care to residents. This visit found evidence that the standard of recording and the quality of care planning has improved. Whilst this is encouraging, the home should seek to improve the quality of recording further and ensure that written information about residents is of a consistently high standard. For example, staff should avoid phrases seen in daily notes such as “ate well” and “all care given”. As indicated in the summary of this report, the inspector received good feedback about the home from healthcare professionals and relatives. All relatives and the professionals who visit the home said that staff communicate clearly with them and understand residents’ needs. All said that they were satisfied with the overall standard of care provided. The home records accidents and incidents and reports these to appropriate parties, including the CSCI. 24 incidences of falls have been reported by the home in the last six months, which equates to one per resident during that period. However there was no evidence of a co-ordinated policy approach to the prevention of falls or an up to date moving and handling assessment for each resident. This area must be addressed by the home. See Requirements 2 and 3. The home has appropriate arrangements for the storage and recording of medication. Medication Administration Record sheets for five residents contained no gaps or errors. Residents’ photographs are on their medication records to ensure correct identification by staff but some residents photographs were missing. These should be added to their medication records. See Requirement 4. Records provided evidence that staff have attended medication training since the last inspection. The owner reported that the training had been provided by the pharmacist that supplies the home. The last inspection report made a Requirement that the home provide lockable storage for medication requiring refrigeration. The manager reported that the home has purchased a separate fridge for this purpose. As highlighted in the summary of this report, a dentist visited the home during the visit and examined residents one by one in the communal lounge. Residents were not given the choice to see the dentist in private. Individual examinations were therefore conducted with no consideration for the dignity, privacy or respect of residents. The home must ensure that, in future, residents’ dignity is maintained during consultations with healthcare professionals. See Requirement 5. Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 14 Staff were observed to assist residents appropriately where they needed help with eating or drinking. This support was provided in a sensitive and unobtrusive manner. Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 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, 15 Quality in this outcome area is poor, particularly in relation to activities and risk assessments. However, there is evidence to indicate that the home communicates well with relatives. This judgement has been made using available evidence including a visit to the home. The home does not provide enough activities and outings for residents. The home should appoint an activities co-ordinator to find out what activities residents want and to plan a programme that reflects these wishes. Family members feel the home keeps them well informed about their relatives and that staff welcome them at any time. The home must develop a risk assessment format that identifies factors posing a risk to residents and demonstrates how these factors can be managed. Lunch must be cooked immediately prior to the meal rather than being cooked in the morning and reheated at lunchtime. Vegetables should be served at the table to enable residents to choose which they would like to accompany their meal. EVIDENCE: Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 16 It is clear from observation during inspection visits and surveys returned by residents and relatives that the range of activities and outings needs to improve. See Requirement 6. Almost half the residents returning surveys said that the home “sometimes” or “never” provides activities that they can take part in, whilst 40 of relatives felt that the home does not provide enough suitable activities for residents. One relative said, “They need to encourage clients to do more things and participate more”. Residents reported during the inspection visits that they would like the opportunity to go out with staff more often. One resident stated, “There are no activities I can take part in…there are no outings”. The manager acknowledged that the current programme of activities is not stimulating to residents. Previous inspection reports have identified the programme of activities and outings as needing improvement but there has been little evidence of progress in this area. This report reiterates the need for a greater commitment to in house activities and occasional outings. A number of suggestions have been made to the manager, the adoption of which would improve the programme available to residents. These include the allocation of specific (part-time) hours to an activities co-ordinator, enabling the activities co-ordinator to attend training so that they learn skills in this area and/or enabling the activities co-ordinator to spend time with established activities co-ordinators in care homes locally. Currently the organisation of activities is allocated to whichever member of staff is on duty. As a result there is no member of staff allocated to seeking residents’ views on what they would like and planning a programme that reflects those wishes. In addition, there is no time allocated to the planning and preparation of activities. Further suggestions made to the manager include accessing resources available through organisations specialising in the provision of activities for older people, arranging entertainers to visit the home and recruiting volunteers to supplement the activities provided by staff. Surveys indicated that family members feel the home keeps them well informed about their relatives and that staff welcome them at any time. The inspector observed staff welcoming visitors and spending time with family members during fieldwork visits. A number of residents choose to spend time away from the home during the day without the support of staff. Whilst it is right that residents are able to Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 17 exercise choice in this way, the home must demonstrate that risk assessments have been completed to identify and manage any risks that arise through these activities. The risk assessments on file were not detailed enough or carried out using an appropriate format. The assessments did not identify risks or outline strategies for managing them. An appropriate risk assessment strategy must be developed, along with an effective risk assessment format. See Requirement 7. Comments from residents about the food provided by the home were generally positive, although they also identified areas for improvement. 75 of residents said that they “always” enjoy the food provided by the home, whilst 25 said that they “usually” or “sometimes” enjoy it. On the day of inspection the lunch was cooked and plated up by 11.00am although lunch was not served until noon. The food was then reheated on the plates at lunchtime. There is no reason that food should be prepared an hour before it is served. In addition, residents should be able to choose the vegetables to accompany their meal at the table rather than receiving a plate with the vegetables already served. See Requirement 8. Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 18 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Appropriate procedures are in place for the management of complaints. Residents feel any complaints raised would be properly addressed. The volume of complaints about the home is not a cause for concern. All staff must attend training in the recognition and prevention of abuse. The home obtains appropriate documentation from new staff before they start work. EVIDENCE: The home has a formal Complaints procedure, which gives details of arrangements for dealing with complaints and concerns. Residents returning surveys were confident that any complaint they made would be dealt with properly. Two of ten relatives returning surveys reported that they had complained about the home in the past. One said that the complaint had been dealt with satisfactorily, whilst the other said that the home’s response had been unsatisfactory. No complaints have been made about the home to the CSCI since the last inspection. Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 19 The last inspection report made a Requirement that the home ensure all staff attend training in the Protection of Vulnerable Adults. This has yet to be achieved and this Requirement is reinstated. See Requirement 9. Staff files demonstrated that the home obtains appropriate documentation from new staff before they start work, although needs to obtain a Criminal Records Bureau disclosure for one member of staff. (See the Staffing section of this report). Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 20 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, 24, 25, 26 Quality in this outcome area is adequate, although action must be taken to ensure residents’ safety and eliminate odours. This judgement has been made using available evidence including a visit to the home. Communal rooms are welcoming and homely. Residents’ bedrooms are personalised and reflect individual tastes and preferences. Residents are not adequately protected from the risk of scalding. Unpleasant odours are a problem in some areas of the home. EVIDENCE: Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 21 The communal rooms of the home include a residents’ lounge and separate dining room. The home has a well maintained garden. Residents’ 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 were personalised and reflected the tastes and preferences of their occupants. A number of bedrooms contained evidence of hobbies and interests. Residents are able to bring personal items, including furniture, with them on admission. The owner has demonstrated a commitment to improving the appearance of the home in recent years. Many areas have been repainted and much of the carpet has been replaced. Whilst these developments are encouraging, a number of require attention to meet the National Minimum Standards. The last inspection report made seven Requirements relating to the environment provided by the home. Three of these Requirements had not been met at this visit and are reinstated in this report. (See Requirements 10, 11 and 12). These Requirements relate to: • • The replacement of the carpet in one resident’s room on the second floor. Radiator covers. A number of radiators around the home remain uncovered, posing a potential risk to residents. The manager demonstrated that a risk assessment had been performed to address this issue. However (as highlighted in the Daily Life and Social Activities section of this report) risk assessments in the home are not detailed enough and are not performed using an appropriate format. In order that the risk of scalding is eliminated, all radiators must be fitted with covers. Unpleasant odours in the home. Previous inspection reports have identified this as a problem and some relatives highlighted the issue in their surveys. The manager was able to demonstrate that several different methods have been implemented to address this problem, although with limited success. The home must identify an effective solution to this problem. • Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 22 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The staff team is stable and staff know residents well. New staff must obtain a new Criminal Records Bureau disclosure when they take up a post at the home. The recording of training must improve. EVIDENCE: The staff team is stable, which is much appreciated by residents. The manager said that no new staff have been employed since the last inspection visit in October 2005. The manager said that one member of night staff has left during that period but advised that the vacant shifts were picked up by existing staff. There were enough staff on duty to meet the needs of residents during the inspection visit. 75 of residents said that staff are “always available” when they need them. 25 said that staff are “usually available”. The manager said that five staff are currently working towards NVQ level 2 and two staff are studying for NVQ level 3. Two staff are taking the award at college, whilst the others are being assessed in house by an external assessor. The manager advised that she hopes to gain the NVQ assessors’ award. Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 23 A sample of staff files was examined. Files provided evidence that staff are issued with a job description and contract when they start work. All but one files contained evidence of an appropriate Criminal Records Bureau disclosure. One staff file contained evidence a disclosure obtained in a previous post. All staff must obtain a new disclosure when they take up a new post. See Requirement 13. Staff training records did not provide evidence of training completed. Four of the six training records examined contained no entries. The remaining two training records each contained one entry. The home must be able to demonstrate that staff have attended training relevant to their roles. See Requirement 14. Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 24 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, 36, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. The owner needs to complete a relevant professional qualification. There is no evidence of future planning or development of the service provided to residents. There is no evidence of a Quality Assurance system, which takes into account the views of residents and other stakeholders. Standards of health and safety in the home have improved. EVIDENCE: Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 25 The manager has been in post since May 2005, although the owner continues as the manager registered with the CSCI. The owner must therefore complete the Registered Managers Award. See Requirement 15. There was no evidence of a development plan for the home or of an effective Quality Assurance system. These must be developed to ensure that residents and other stakeholders have the opportunity to give their views and influence the development of the service. The manager should consider National Minimum Standard 33 for guidance in this area. See Requirements 16 and 17. Residents manage their own money where they wish and are able to do so. The home provides facilities for residents to deposit valuable items for safekeeping. The home does not act as appointee for residents. Staff files provided evidence that staff now have regular individual supervision. The storage of chemicals and other household products has improved since the last inspection. There were no obvious health and safety hazards identified during the inspection visit. There was evidence that fire fighting appliances had been checked within the last twelve months. Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 26 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 1 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X X 2 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 3 X 3 Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 27 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) Requirement Residents must be issued with a 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. Develop a policy and demonstrate a proactive approach to the prevention of falls. Provide evidence of an up to date moving and handling assessment for each resident. Ensure each resident’s photograph is included on their medication record. Ensure that consultations with healthcare professionals are conducted with consideration for residents’ dignity, privacy and respect. Improve the range of activities and outings available to residents. Timescale for action 30/06/06 2 OP8 13(4) 30/06/06 3 4 5 OP8 OP9 OP10 12(1) 13(4)(5) 13(2) 12(1)(2) (3)(4) 30/06/06 30/06/06 30/05/06 6 OP12 16(m)(n) 30/06/06 Nightingale House (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 28 7 OP14 12(1)(a) 13(4) 16(2)(i) 8 OP15 This Requirement is reinstated from the last inspection. Develop a risk assessment format that identifies risk factors and demonstrates how these factors can be managed. • Lunch must be prepared immediately prior to the meal rather than being prepared in the morning and reheated at lunchtime. Vegetables should be served at the table to enable residents to choose which they would like to accompany their meal. All staff must attend training in the Protection of Vulnerable Adults. Replace the carpet in one second floor bedroom. This Requirement is reinstated from the last inspection. Fit covers to all radiators to prevent the risk of scalding. This Requirement is reinstated from the last inspection. Keep the home free of unpleasant odours. This Requirement is reinstated from the last inspection. Obtain appropriate Criminal Records Bureau disclosures for all staff employed at the home. Demonstrate that staff have attended training relevant to their roles. The owner must complete the Registered Managers Award. Produce a written development plan for the home, which is DS0000017384.V292964.R02.S.doc 30/06/06 30/05/06 • 9 10 OP18 OP24 13(6) 16(2)(c)2 3(2)(b) 30/07/06 30/06/06 11 OP25 13(4) 30/06/06 12 OP26 16(2)(k) 30/06/06 13 14 OP29 OP30 19(1) 18(1) (a)(c) 9(2)(b)(i) 30/06/06 30/06/06 15 OP31 30/12/06 16 OP33 24, 25(1) 30/08/06 Nightingale House (Strafford Road) Version 5.1 Page 29 17 OP33 12, 24 subject to regular review and is based on positive outcomes for residents. Develop an effective Quality Assurance system, which takes into account the views of residents and other stakeholders. 30/08/06 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 (Strafford Road) DS0000017384.V292964.R02.S.doc Version 5.1 Page 30 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. 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