Inspection on 12/07/06 for Nightingale Lodge

This inspection was carried out on 12th 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 Lodge 17/09/07

Nightingale Lodge 11/10/05

Nightingale Lodge 11/05/05

Nightingale Lodge 23/11/04

Nightingale Lodge 23/06/04

Nightingale Lodge 30/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Nightingale Lodge Great Well Drive Romsey Hampshire SO51 7QN Lead Inspector Nick Morrison Unannounced Inspection 12th July 2006 12:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nightingale Lodge DS0000037414.V298987.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 Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingale Lodge Address Great Well Drive Romsey Hampshire SO51 7QN 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) 01794 512138 Hampshire County Council Care Home 44 Category(ies) of Dementia - over 65 years of age (44), Old age, registration, with number not falling within any other category (44) of places Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th October 2005 Brief Description of the Service: Nightingale Lodge is a large purpose built, two storey building situated in a quiet area of Romsey. There are a small number of local shops within walking distance. The home is registered to provide accommodation for 44 older persons but only accommodates 43 at any one time. Nightingale Lodge is divided into 5 living units all with their own kitchen, lounge/diner and bathing/toilet facilities. The home provides 41 single bedrooms and one double bedroom. None of the rooms have en-suite facilities· The home also offers facilities for service users requiring respite care. Other facilities comprise of a range of offices/staff room, main kitchen, large entrance hall, laundry and separate activity rooms. To the front of the home is a small garden and car parking area and to the rear is a large enclosed designed garden and patio area. Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place on 12 July 2006 and lasted for five and a half hours. The Inspector spoke with four service users and one relative as well as the Manager and other staff. Records and other documents referred to in the report were all seen on the day of the visit and the care plans of four service users were followed through to look at the care they were receiving. Current fees within the home range from £392 to £434 per week. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 6 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 Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Service users benefit from having their needs assessed prior to admission. The home does not provide intermediate care. EVIDENCE: Four service user files were seen and each one contained a pre-admission assessment that had been completed prior to the person moving into the home. Assessments were comprehensive and covered a full range of need areas. The assessments were clearly written and had been used in devising the care plan for each person. Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 8 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 and 10 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. Service users were protected by the home’s medication policies and practices and were treated with respect. Service users would further benefit from their Care Plans being kept under regular review and from full records being kept in relation to the Care Plans and from having their healthcare needs monitored. EVIDENCE: Each service user had a care plan in place that had been written in response to the initial assessment. Care plans consisted of a night plan and a daytime plan. All of the night care plans sampled had been reviewed on a regular basis but all of the daytime plans had not been reviewed for a number of months. The home has a system of using contact sheets to record against the care plans on a daily basis. Care plans contained instructions such as “maintain E’s verbal communication”, but there was no way of identifying how this was to be done and no way of reviewing whether or not the action taken had met the identified need. Another care plan identified that a service user was interested in “reading and group Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 9 discussions” but again there was no way of identifying whether anything had happened in response to this or what effect it had had for the service user. Service users were supported to access healthcare services as necessary and advice was sought from relevant professionals as necessary. One service user’s care plan identified that there was a need to “monitor and record changes to her health”. The medication system in the home was well managed. Clear records were kept of all medication coming into and going out of the home as well as all medication received by service users. Staff involved in administering medication had received training and all medication was stored appropriately. The home has regular input and support from the chemist and the Manager demonstrated a good understanding of medication issues. There was a Medication Policy in place and staff signed to say they had read and understood the medication procedures. Staff observed demonstrated they were clear about how to maintain the privacy and dignity of service users and demonstrated an ability to interact with service users in a supportive and sympathetic manner. Service users spoken with said staff treated them with respect and felt that they had sufficient privacy when they needed it. Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 10 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 adequate. This judgement has been made using the available evidence including a visit to the service. Service users benefited from being able to see friends and relatives as they wished. They benefited from a healthy, balanced diet and were able to exercise control over their own lives. Service users would benefit further from a coordinated programme of activities based on their interests. EVIDENCE: The home employs an Activities Co-ordinator, but only for six hours a week at present. The interests of service users are assessed on admission, but there appeared to be no system for planning a programme of activities based on those identified interests. The Manager reported that the Activities Coordinator comes into the home and asks service users whether or no they might be interested in the activity she had planned for the day. She also did one-to-one activities with particular service users. There were also performers regularly coming into the home to entertain service users. The manager acknowledged that a more structured process for planning activities based on the known interests of service users is necessary and that records need to be kept in relation to each service user’s involvement in and response to each activity. Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 11 The home has a clear Visitors’ Policy that encourages family and friends to visit at any reasonable time in consultation with the service user. Service users spoken with said they were able to see their friends and family regularly and that they were made to feel welcome by staff in the home. Service users were encouraged to bring their own personal items into the home, subject to safety requirements and information was available on local advocacy services. Staff observed on the day of inspection were able to demonstrate an understanding of the need for service users to make choices and remain in control of their lives as far as possible. Food in the home was of good quality. Menus showed that there was a variety of food on offer and that meals were balanced and were based on the known preferences of service users. The special dietary requirements of individual service users were recorded and addressed. Most service users spoken with on the day of inspection were aware of what they were having that day and confirmed that different options were always available if they did not want what was on the menu. Food seen on the day of inspection was well presented and sufficient staff were available to provide support for people who needed it at mealtimes. Service users and relatives spoken with said the food at the home was very good. Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Service users were protected by the home’s complaints and abuse policies and practices. EVIDENCE: The home had an adequate Complaints Procedure in place that was made available to all service users and their families on admission. Copies of the policy were also placed around the building, in the foyer and on notice boards. A clear procedure was in place for recording, analysing and responding to complaints. Three substantiated complaints had been received in the last year and had been recorded and responded to correctly. The Manager was aware of issues of abuse and how to respond to them, although there had been none in the home. The home has a copy of the local procedure for dealing with suspected abuse and this is complimented by in-house policies to protect service users. Staff had signed to say they had read and understood them and had also had relevant training. Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Service users benefited from living in a safe, comfortable and clean home. EVIDENCE: There had been a requirement from the previous inspection that the home must produce a redecoration programme. This had been put in place and some work had begun on redecoration. There were also records of regular maintenance within the home. The home is suitable for its purpose and is well situated. The home and the grounds outside were kept clean and safe. The garden area was well planned and provided a number of different areas in which service users could sit. There were plenty of shaded areas so that people could avoid the sun. The garden was designed so that service users were able to be involved in maintaining it. Some service users spoken with had been doing some weeding on the morning of the visit. Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 14 The home was clean throughout and specific staff were employed for cleaning. The laundry was well managed and clean and clear infection control procedures were in place. Staff had signed to said they had understood these and relevant training had been provided. Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using the available evidence including a visit to the service. Service users benefited from being supported by sufficient numbers of well-trained and well-supported staff but would benefit further from more staff being trained to NVQ level 2. EVIDENCE: A rota was kept that clearly identified which staff were on duty at any time and this corresponded with the staff on duty at the time of the visit. The staff hours provided within the home were calculated according to the needs of service users and service users spoken with felt that there were adequate numbers of staff on duty throughout. A requirement had been made at the previous inspection that the home ensures that at least fifty per cent of staff are trained to NVQ level 2 or equivalent. There was evidence of some improvement in this and staff were booked on courses during this year with the aim of at least fifty per cent of staff being trained by the end of the year. A sample of four staff files were seen and these demonstrated that all necessary pre-employment checks were in place for staff. The home has a formal recruitment policy and procedures that ensure an emphasis on equal opportunities and ensuring the safety of service users. The Deputy Manager collated training information. The system was in the process of being updated so that information was more readily available and easier to find. Detailed records were kept of all staff training that had occurred Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 16 along with the training needs of each member of staff. Training was kept upto-date. Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using the available evidence including a visit to the service. Service users benefit from a well-managed service, having their financial interests protected and are protected by the home’s management of health and safety issues. They would benefit further from having their views represented in the home’s development plans. EVIDENCE: Since the previous inspection a new manager had been appointed to the home. She was previously registered as the manager of another home and has appropriate qualifications, skills and experience. The Commission has not yet received an application from the new manager to be registered in respect of this home and this must be completed without further delay. Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 18 There were a number of different quality assurance processes in place in the home and the provider is in the process of updating quality assurance procedures. At present the different processes that are in place are not clearly co-ordinated and are not focussed on the needs and views of people using the service. The home has a clear procedure in place for protecting the financial interests of service users. The home has no involvement in the bank accounts or pensions of service users, who each have family members or others to manage their affairs for them if necessary. The home keeps a small amount of money for each service user, if required. There is a limit of fifty pounds set on this and clear procedures are in place to ensure that the money is handled correctly. Each service user’s money is kept individually within a safe and clear records are kept of all money going in and out of the safe. The system is regularly checked and monitored by managers and, on the day of the visit, all records corresponded with the amounts each service user had. Health and safety is well managed in the home. All staff had received relevant health and safety training and were clear about their own responsibilities. Risk assessments were in place where potential risks had been identified and safe working practices were encouraged. Records were kept of all incidents and accidents and these analysed by the manager to ensure that any necessary action was taken to prevent the occurrence of similar things in the future. Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement All Care Plans must clearly describe the support that each person requires and must be kept under regular review. The healthcare needs of all service users must be assessed and monitored A programme of activities based upon the known interests of service users must be implemented A minimum of fifty per cent of care staff must be trained to NVQ level 2 The Manager must apply to become registered The Quality Assurance process must be based on the views of service users Timescale for action 12/10/06 2 3 OP8 OP12 15 16 12/10/06 12/10/06 4 5 6 OP28 OP31 OP33 18 8 21 31/12/06 12/08/06 12/10/06 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 Good Practice Recommendations DS0000037414.V298987.R01.S.doc Version 5.2 Page 21 Nightingale Lodge Standard Nightingale Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Lodge DS0000037414.V298987.R01.S.doc Version 5.2 Page 23 - 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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