Inspection on 19/03/06 for Nightingale Lodge

This inspection was carried out on 19th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 04/10/05

Nightingale Lodge 29/06/05

Nightingale Lodge 28/02/05

Nightingale Lodge 14/12/04

Nightingale Lodge 25/11/03

Similar services:

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

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

CARE HOMES FOR OLDER PEOPLE Nightingale Lodge 6-8 Austin Street Hunstanton Norfolk PE36 6AL Lead Inspector Maggie Prettyman Unannounced Inspection 19th March 2007 09:30 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 Lodge DS0000027482.V333728.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 DS0000027482.V333728.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingale Lodge Address 6-8 Austin Street Hunstanton Norfolk PE36 6AL 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) 01485 533590 P/F01485 533590 Black Swan International Limited Mrs Sandra Rowe Care Home 22 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (20) of places Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Up to twenty (20) Older People may be accommodated. Two (2) named persons with dementia over 65 years of age may be accommodated. The total number of persons accommodated shall not exceed twentytwo (22). 4th October 2005 Date of last inspection Brief Description of the Service: Nightingale Lodge is a registered home for 22 older people situated in the seaside resort of Hunstanton. It offers personal care, but not nursing care. It sits in a quiet road with access to the main shops within walking distance. There is a Methodist church next door and the sea front is at the end of the road. The house was originally two homes, which have been converted into one. The majority of bedrooms are on the first floor with access by a shaft lift. There are three double rooms and 16 single rooms all with toilets and hand wash basin facilities. On the ground floor there are two lounge areas and a dining room. The current range of weekly fees is £338 - £450. Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the provider, some residents and their relatives as well as other who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and current judgements for each outcome group. What the service does well: Nightingale Lodge is a good home that demonstrates excellent standards in some areas. Good needs assessments are made and service users have accurate information about the home to help them choose to live there. People’s health and personal care needs are carefully attended to, and service users are treated with the utmost respect at all times. End of life care is supportive and compassionate. The daily life and social activities of the home meet peoples needs, with contact with family and the community well supported and the autonomy and choice of service users respected at all times. The food in the home is good, the kitchen spotless and menus drawn up from service user consultation. Service user comment and complaint is listened to and action taken by the home as a result. Good training adult protection is given to staff, who are further advised and supported by the manager in the course of their duties. The environment is safe, clean, tidy and well maintained. Service users have their own furniture and possessions around them in their rooms. The home is clean, pleasant and hygienic throughout. A long serving, hard working and well-trained staff team offer a kind and caring service. Service users commented positively about the care given. One said” I could not ask for more, they are all so kind and caring. Another said, “ They are always so courteous and pleasant, they make my life here very comfortable”. The home has excellent management standards, with great emphasis on open “hands on” management and many detailed quality audits. Staff are well supervised and safe working practices are employed Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2, 3 and 6 Each service user has a written contract and statement of terms and conditions of the home. No service user moves into the home without having their needs assessed. Service users on short stays are properly assessed and enabled to return home at the end of their stay. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 9 EVIDENCE: Examination of service user files and observations in service user rooms demonstrated that contracts are in place for all service users and service user guides are placed in all service user rooms. Evidence in service user files demonstrated that a detailed assessment of service user needs, competencies and circumstances is undertaken prior to anyone coming to stay in the home. A file relating to a short stay service user was inspected. Assessments and care plans were in place with competences and abilities noted and supported. Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 and 11 Service user care needs are set out in an individual plan of care. Service user health care needs are fully met. Service users are protected by the home’s medication procedures. Service users are treated with respect and dignity. Service users receiving end of life care and their families are offered excellent care and support. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 11 EVIDENCE: Inspection of service user individual files demonstrated that good care plans are in place. Detailed risk and lifestyle assessments were seen. All records are reviewed monthly. Evidence in service user files demonstrated that service user health care needs are promoted. Two exercise classes are held regularly in the home. Service users are encouraged to walk and to maintain or regain mobility. Weight records are kept. Good relationships are maintained with district nursing services. Nutritional screening is not currently undertaken. It is recommended that the MUST system of nutritional assessment be implemented by the home. The home uses a Boots MDS system of medication. All records were found to be accurate. The manager stated that she regularly audits these records. Evidence of staff training was seen. Storage of medicines was appropriate and well organised. Medication reviews are undertaken with the local pharmacist. Dividers do not separate individual drug records. It is recommended that the home use photographs and names of choice on dividers between individual drug records. The medication fridge is in an open passageway and is not locked. It is recommended that the medication fridge door is kept locked. Feedback from pre inspection questionnaires, discussion with service users and observation on the day of inspection demonstrate that service users are treated with respect and dignity at all times. Staff are appropriately trained at induction, and ongoing training and supervision supports this. Service users were seen to have their own telephones at hand in their rooms. Letters were seen handed out unopened. Clear instruction about name of choice is in care plans. Clothes are clearly labelled and carefully handled. Discussion with the manager as well as evidence from letters of thanks from service user families demonstrated that high standards of care are used to support service users at the end of their lives. Spiritual needs are supported and families are enabled to remain at the home at this time. Good support from district nurses supports the good practice of the home. Other service users at the home are also supported and involved in funerals and events to mark and celebrate people’s lives. Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Service users enjoy the lifestyle and activities of the home. Service users are supported to maintain relationships with their families and use community services. Service users exercise choice and control in their lives. Service users have a wholesome and appealing diet. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with service users demonstrated that the home is flexible and is run to fit with their needs and expectations. Service user files have information about lifestyle preferences. The key worker system is seen to work well by service users and visiting professionals. A notice board in the home details forthcoming activities as well as other information including minutes of residents meetings. Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 13 Observation of the home during the inspection, feedback from pre inspection questionnaires and discussions with service users demonstrated that the home supports service users and their families to maintain good relationships. Community facilities including shops, church, GPs and pharmacies are all accessed by service users direct where possible. Discussion with service users as well as records of service user meetings and individual service user files demonstrated that the home is run to maximise the autonomy and choice of the people who live there. Service user rooms are filled with personal possessions. A new access to records policy has been introduced by the home this year. Information about advocacy and contact information about the Commission is clearly displayed in the hallway. Concerned and competent staff were seen providing wholesome food from a clean and well-organised kitchen. The dining room is relaxed and pleasant and service users reported that the food is good. No choice is offered at lunchtime, but there is choice at breakfast and teatime. Individual alternatives are offered if a service user does not like the set lunch. Service users enjoy the opportunity of bacon and eggs on Sundays, but are also clear that they can have this choice or an alternative at any time of the week. Lists of likes and dislikes are kept in the kitchen. Meals and menus were discussed at a recent residents meeting as a result of the in house quality survey. Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Service user complaints and comments are listened to. Service users are protected from abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No formal complaints have been received by the home since the last inspection. Minor complaints and comments are noted in individual service user records. Group issues are addressed at service user meetings, which are held with one of the proprietors. The complaints procedure is clearly displayed. The contact details of the Commission are also clearly displayed. Minor complaints and comments are not currently audited. It is recommended that an audit of minor complaints, comments and compliments be audited to identify any underlying patterns and trends. Adult protection is covered during induction, and evidence of regular update training was seen in worker files. Evidence of supportive guidance for dealing with verbal challenge was seen in the communication book. Service user monies are safely looked after. Lockable doors and drawers were seen in individual service user rooms. Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Service users live in a safe well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users own rooms suit their needs. The home is clean, pleasant and hygienic. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The location and layout of the home make it suitable for its purpose. It is accessible and well maintained. Individual and collective needs are met in a comfortable and homely way. Records demonstrated a regular programme of maintenance. The home is tidy, and its grounds are attractive and accessible. Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 16 Excellent records of audit of compliance with environmental and fire regulation requirements are maintained. Communal spaces in the home are homely and conducive to social interaction. A pleasant and welcoming dining room facilitates relaxed and pleasant mealtimes. The garden is adapted to physical needs of service users, with more adaptation planned for this year. Lighting and furnishing is domestic and promotes social and individual activities. A tour of the building showed that service user rooms are individual and furnished tastefully; often with service users own furniture. Each room has its own lock, and secure storage is also available. Shared rooms have separate washing areas for individual service users. The home is clean, pleasant and hygienic. There are good laundry facilities. Protective clothing ad hand washing facilities are freely available Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Service user needs are met by the numbers and skill mix of staff. The home continues to encourage staff to complete NVQ training. The home has recently significantly improved its recruitment practice. The home has good ongoing training systems. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In section of staff rotas, feedback from questionnaires and observation of the home demonstrate that staffing levels are good and that service users are well supported as a result. Additional staff are employed for activities or to support end of life care. The cleanliness of the home reflects a sufficient and hardworking domestic staff team. Currently just less than 50 of staff are NVQ qualified. The manager confirmed that staff continue to be encouraged to gain NVQ qualification, and that the homes proprietors are supportive of this. Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 18 Inspection of staff files demonstrated that not all elements of this standard have been achieved in the past. However the home and its proprietors have worked hard to improve the recruitment process. A copy of “Safe and Sound”, good practice in recruitment guide, was left for the managers information. It is recommended that the good recruitment practice outlined in ”Safe and Sound” be implemented by the home. Training records demonstrated that ongoing mandatory and supplemental training is maintained by the home. The home has introduced a detailed and much improved induction training system for new staff. Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36, 37 and 38 The home is run by an experienced and caring manager. The leadership and management of the home is open and supportive. The home is run in the best interests of service users. Service users financial interests are safeguarded. Staff are appropriately supervised. Health, safety and welfare are promoted and protected. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager of the home demonstrated that she is a skilled, competent and compassionate manager. She demonstrated good knowledge of both care and home management. Training records show that she has attended many suitable and progressive courses to develop her management skills. Circumstances have currently prevented her gaining her NVQ Qualification. However, her lack of formal management qualification is not in any way detrimental to the running of the home. It is recommended, if possible, that the manager seek to identify a course that suits her needs and requirements. Feedback from pre inspection questionnaires, service users and staff demonstrate that the home is managed in an open and inclusive way. Particular reference was made to the positive and calm atmosphere of the home. The manager was observed to give clear leadership and direction. Service users have access to the homes proprietors directly through residents meetings. The home has conducted a residents survey and taken action to remedy some identified issues. The results of the survey are clearly displayed and all items were discussed at a residents meeting. Policies and procedures are reviewed and updated. An annual development plan is in place. Many areas of practice and service within the home are regularly audited, with written reports provided to the proprietor monthly. Money held on behalf of service users was checked and found to be accurate. It is stored in the safe and records are kept and checked by they manager. The inspector observed appropriate support given to a service user managing his own finances. Staff files demonstrate that supervision is given regularly, records are kept, and positive feedback about performance is always recorded. Records demonstrated that mandatory training is updated regularly by the home. Excellent records of safety, equipment and fire checks and drills are maintained. Risk assessments are recorded and accidents and incidents reported appropriately. A record of falls is kept, but is not yet audited. Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 21 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 3 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 X X X 4 X 3 STAFFING Standard No Score 27 4 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 X 3 3 X 4 Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP8 OP9 OP9 OP16 OP29 OP31 Good Practice Recommendations The home should consider implementing the MUST system of nutritional assessment. Dividers with photographs and name of choice of service users would improve the medication record system. The medication fridge should be locked. An audit of minor complaints, comments and compliments should be kept. Good recruitment practice as outlined in “Safe and Sound” should be adopted by the home. If possible, the manager should identify a suitable training course to meet her needs. Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Nightingale Lodge DS0000027482.V333728.R01.S.doc Version 5.2 Page 24 - 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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