CARE HOMES FOR OLDER PEOPLE
Nightingale Nursing Home 85 New Road Ware Hertfordshire SG12 7BY Lead Inspector
Sheila Knopp Unannounced 10 May 2005 09:50 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 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 Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Nightingale Nursing Home Address 85 New Road Ware Hertfordshire SG12 7BY 01920 463123 01920 463013 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Greenswan Consultants Limited Lianne Humphries Care Home 34 Category(ies) of OP Old Age 34 registration, with number TI Terminally Ill 3 of places Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: This home may accommodate 34 older people who require respite nursing care. This home may accommodate 3 older people with terminal illness who require nursing care. This home may accommodate 34 older people who require nursing care. Date of last inspection 16 September 2004 Brief Description of the Service: Nightingale Nursing Home is a five-storey building converted from a former doctors residence and surgery. It provides nursing care for 34 Older People, some of whom may have terminal illnesses. It is owned by Greenswan Consultants limited. The home is situated close to Ware town centre in a residential area, opposite a church. It has 24 single bedrooms and 5 shared bedrooms, 3 lounges and one dining room. There are 2 bathrooms with over bath hoists and an assisted shower room. All floors are serviced by a lift. There are parking facilities and a garden to the rear of the building. Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of this inspection was to review a large number of requirements and recommendations made following the last inspection particularly in relation to the physical environment of the home. Some of these requirements have been brought forward into this inspection report for further action. The personal care of residents and staffing levels were also assessed. This inspection was carried out by 2 inspectors who had discussions with 11 residents, 7 visitors and 4 staff. The interaction between staff and residents was observed and care and service records were sampled. A total of 14 hours 20 minutes of inspector time has contributed towards this inspection. What the service does well:
The manager, nursing and care staff provide a good standard of nursing and personal care, which was responsive to the changing needs of the residents. The residents spoken to were very positive about the support they receive from staff. The inspector spoke to a resident, who said they had been at the home for a number of years and would not change anything. Two new residents commented on the quality of care and staff. A residents said the food is good and ‘you can’t grumble we are well looked after here’. Another person who said they were very fussy about food said it was very good. One resident said ‘ the staff treat me well, they have to do everything for me. The girls (staff) are lovely’. One lady was very excited about celebrating her 90th birthday and a birthday cake was being prepared in the kitchen. A visitor asked to comment on the home said they felt reassured by the manager and the cleanliness of the home. Another person who has been visiting daily for a number of years confirmed the staff were very good and approachable. Since the last inspection an advocacy service supported by Age Concern has started in the home. The manager was able to provide examples of the benefits this extra contact had meant for individual residents. The manager has successfully completed the Registered Managers Award required by care home managers. Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
This home does not meet a number of the environmental factors detailed in the National Minimum Standards, which would be required of homes registered after April 2002. These are particularly in relation to the furniture and fittings in bedrooms. This is pointed out to relatives who are asked to sign a disclaimer form. This period building is dark and dingy. The quality of the carpets and poor standard of fitting is of concern and several of the new carpets are having to be replaced. The lighting in the individual bedrooms and corridors is poor. While the majority of rooms are stated to have en-suite showers in practice these are not used having been disconnected or being too small to support good moving and handling practices. Dining and lounge space is cramped. The window of the basement lounge looks out on to brick wall and does not provide an attractive environment for residents. Some residents say there could be more to do and that there should be more staff so they had time to sit and talk. Staff acknowledged that other than when providing personal care there was little time to spend with residents. There is no activities budget and additional staff hours are not identified for social care either by employing an activities organiser or identifying additional care staff during the day to carry out this function. The working environment in laundry poor. There are no hand washing facilities and no access to the back of the equipment to prevent a build up of dust without climbing over it.
Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 7 There is a long-standing vacancy for a weekend cook. This post is being covered by staff within the home including the manager who on occasions comes in and cooks at weekends. 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 Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The pre-admission assessment process in place ensures that staff are able to meet the needs of the residents admitted to the home. This includes ensuring that equipment such as pressure relieving mattresses are available at the time of admission. EVIDENCE: The four care plans examine provided details of the pre- admission assessment carried out. For residents funded by the local authority a review involving the social worker and family members is held after six weeks. In discussion with the manager it was suggested that it is good practice to also provide an opportunity for a formal review for residents who are self funded. The manager reported that in order to maintain the terminal care registration category staff have received training in the past and she has links with the local hospice. On-going training and updating in this area needs to be included in the development plan for the home. Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 The care of residents is supported by a detailed plan of care setting how their individual needs are to be met. EVIDENCE: All the residents observed appeared to be comfortable and had been assisted to achieve good standards of personal care and hygiene. Residents were assisted to change position throughout the day and offered regular drinks. Pressure relieving mattresses and cushions were available for service users identified at risk of developing pressure sores. The records demonstrated a low incidence of accidents and pressure sores occurring in the home. The care plans examined demonstrated the involvement of the resident / representative in planning their care. No concerns related to the nursing and personal care provided were raised by residents or their relatives. The care plan identified specific areas of care and the action required by staff. The details of clinical care well recorded. The care plans were up to date and those examined had been regularly reviewed. The medication systems were checked and found to be well organised. Oxygen is stored in this are and the manager needs to replace the current sign with an official sign.
Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 11 The carpet in clinical room needs replacing as it is worn, torn and badly stained. It should be replaced with a surface more suited to a clinical area. Three staff were observed approaching residents in a lounge wearing latex gloves. This does not reflect current infection control practice and is undignified identifying the resident as some one who cannot be touched. Eight residents in the basement lounge were not able to attract the attention of staff because the call bell hand set had not been placed in reach. There are a number of electrically operated recliner chairs and a ‘bucket’ style chair in the home. These have a potential for restricting movement and require individual risk assessments to be in place. CSCI guidance on the safe use of furniture has been sent to the manager for information. Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The residents were very positive in relation to the variety and standard of meals served to them. EVIDENCE: Details of the meals served and individual choices made are recorded in a diary. The residents describe the meals as good homely cooking. A variety of soft and puree diets were served according to individual need. The cook plans the meals according to the deliveries made and does not follow a set menu. The manager reported that when a weekly menu was tried the residents felt they were being served the same food all the time. Given the extremely positive comments received by inspectors this area seems to be functioning well and meeting the needs of the residents. Fresh meat, seasonal vegetables and fruit are delivered. It was recommended that the manager may wish to have the records of meals served nutritionally assessed by a dietician. Staff are monitoring the weight of residents and food supplements are available. Food safety records are kept. There has been a recent Environmental Health Inspection (EHO). It was recommended that the manager ask the EHO department whether covers are required on the kitchen light fittings to prevent food being spoiled in the event of a fluorescent tube shattering. Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 It was felt from the discussions the inspectors had with residents, relatives and staff that the open and supportive atmosphere in the home enables people to raise issues as they arise and have confidence that their concerns will be addressed. EVIDENCE: No complaints have been received by the Commission since the last inspection. The manager reported that no formal complaint had been received. Informal issues brought to the attention of staff are recorded in a communication book. No concerns have been raised with the Commission by other health or social care agencies working with the home. Two relatives confirmed they had received lots of information about the home including details of how to make a complaint. Relatives and residents stated they would raise any problems with the manager. As part of the quality assurance programme the manager has introduced a comment box but it is clearly indicated that this is not a replacement for one to one contact. A positive development since the last inspection is the introduction of any advocacy service available in the home to residents. Advocates from Age Concern hold a monthly surgery and the manager reported that their involvement with residents is increasing. Staff confirmed they received training in the protection of Vulnerable adults. A copy of the Hertfordshire multi-agency policy was available. Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 14 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 standard(s) 19 & 26 Overall the home was found to be clean and odour free but there are a number of stained carpets in the public areas and stairwells that are due to be replaced, and other environmental issues that have a bearing on the safety of service users. EVIDENCE: This home would benefit from a major review of services by a specialist so that a comprehensive development plan can be put in place to reduce the effects of the haphazard developments that have taken place over a number of years. A maintnence person is employed and overall the home is keeping on top of day-to-day wear and tear and redecoration of individual rooms. However the overall impression due to the haphazard build up of old furniture and fittings is not one of quality. The home is dark and dingy with a lot of dark wood. Lounge and dining space is crowded. The residents and their visitors did not raise any concerns about the environmental standards. Personal possessions had been added to the bedrooms. Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 15 Twenty single and 5 double bedrooms have an en-suite toilet and shower. The showers are not in use. Some have had the plumbing or shower tray removed. Others have equipment stored in them. These rooms are cramped and the toilets although raised are tight up against the wall and do not enable staff to assist residents from both sides. A high proportion of residents use commodes. It is recommended that the proprietor gets an occupational therapist to assess the provision with view to removing the showers where space is restricted and putting in proper assisted toilets with hand rails and left / right transfer. There is also concern where the showerhead is still in use whether regular flushing is being carried out in relation to the prevention of legionella. No test certificates were available and a requirement has been made. The home has two bathrooms with over bath hoists and a shower room for 34 residents. The standards say there should be one bathroom to every 8 service users. Following requirements made at the last inspection a planned programme of carpet replacement has been put in place but the timetable has slipped and some of the work already carried out is below standard and some of the seams have spilt and edges have become frayed. A further requirement has been made. The programme to cover the radiators to prevent accidents from scalding is nearing completion and it was anticipated that the remaining radiators would be covered with a week. A further requirement has been made. Risk assessments are recorded for radiators in the en- suite toilets where it is not practical to cover them. The inspector asked for one en-suite radiator with a surface temperature of 60.50C to adjusted during the inspection. The risk assessment in place confirmed this person was not independently mobile. Lighting is poor in bedrooms and the corridors. Many of the central lights in rooms are small with energy saving bulbs, which do not give off a suitable light for older people. Some residents in double rooms are not able to turn off their lights independently and there are few bedside lights. The accidents records do not indicate any problems as a result of the poor lighting, ill-fitting carpets and inaccessible en-suite showers. Residents confirmed their beds were comfortable. A high proportion of beds are fitted with bed rails. Brief risk assessments are recorded as part of the care plan. The manager feels that the majority of residents are requesting bed rails because of their long stays in hospital prior to admission when rails were used. It is recommended that the manager reviews the bed rail risk assessments to provide a more detailed assessment in line with MHRA medical device alert guidance. Some of the bed linen looked worn and tired. The manager reported that there is a system for regularly replacing bed linen and she would review it.
Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 16 The small basement laundry does not provide a good working environment for staff. There is no wash hand basin and the laundry assistant uses antiseptic wipes. A small sluice adjacent to the laundry is no longer used and it may be possible to plumb in a wash hand basin from this area. To clean behind the washers and dryer staff have to climb over the machines. Dust had built up in this area and needs to be removed. It was recommended that advice is sought on whether it is advisable to wear a facemask when cleaning the tumble dryer filter. Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, & 30 It was assessed that the physical needs of the residents is being met by the current staffing levels, which are set at minimum levels. The recruitment and staff training programme is protecting service users by ensuring appropriate checks are carried out before people start work and that they are trained in safe working practices. EVIDENCE: Staff have started to develop a more detailed activities programme to provide more stimulation and support the social needs of residents. This needs to be developed further and additional staff hours provided. The pattern of staffing in the home is that which was agreed prior to 2002 with the previous registration authority for low to medium dependency residents. This needs to be kept under review and additional staff hours identified to support the social needs of service users particularly those requiring one to one care. In the morning 2 registered nurses and 5 care assistants are provided with 2 registered nurses and 5 care assistants in the afternoon. One registered nurses and 2 care assents are provided at night. The manager works as part of the shift team but is allocated supernumerary time. There is no administrative support. A spot check of 3 personnel files confirmed the required checks are carried out before staff start work in the home. Criminal Record Bureau (CRB) checks were seen for 8 staff. One staff file required the addition of a photograph. Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 18 The records confirm that the personal identity numbers (PIN) for the registered nurses are checked with the nursing and midwifery council (NMC). It was recommended that the volunteer policy is updated to include the requirement to have references and a CRB in place before joining the home. Each member of staff has a training file. Four out of 18 care staff have NVQ 2 and a further 6 are completing the award. The aim is for 50 of care staff to achieve an NVQ 2. Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 35 The inspectors found the areas of the home which the manager Lianne Humphries had direct control of were well managed and supporting the care of the residents. There is concern about the on-going development and refurbishment of the building and provision of support staff, which come within the remit of the owner. These areas need to be addressed to support the needs of frail residents requiring nursing care. EVIDENCE: The manager, who is a registered nurse, is to be congratulated on achieving the required NVQ 4 Registered Managers award. Staff confirm that the manager and senior staff are open and supportive. Formal supervision of care has been started following a requirement made at the last inspection. Staff confirmed this was taking place and details of the supervision arrangements were seen.
Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 20 The manager also provides nursing and personal care to residents giving her the opportunity to observe at first hand how residents respond to the care they are receiving from staff. A quality auditing programme is in place and feedback to residents and relatives from questionnaires is included in the updated Statement of Purpose. While the audit is wide ranging across systems and services within the home it does not cover the quality of nursing care as required under this regulation and it is recommended that this area is developed further. It was reported that Mr Raja, Director of Greenswan Consultants Ltd visits the home about 3 days afternoons a week. A record of management discussions between Mr Raja and the manager is maintained. As the home is a limited company and Mr Raja is not in day to day control of the home a written report cover the areas specified under regulation 26 (2)(3)(4)(5) is required with a copy the manager and available to CSCI. The information seen did not cover contact with service users or an inspection of the premises and record of complaints. CSCI have a copy of a suitable format on their web site and it is suggested that this is used. The system for looking after small amounts of personal money for residents was checked. It was recommended that the manager issues a receipt or asked the residents / relative to sign the ledger sheet when money is paid in and out. Insurance certificate / contract includes details of level of insurance cover for resident’s personal possessions. Standard 38 was not fully assessed but the fire safety, hot water and moving and handling equipment checks were verified and the accident records examined. Details of the gas safety check, risk assessment under the Workplace Place (Fire Precautions) Regulations and Legionella checks were not available and requirements have been made. A fire drill took place on 22.4.05 and the fire safety systems were checked by contractors on 15.2.05. Lists of residents and their room numbers are displayed around the home. The manager reported that this is at the insistence of the fire authority. She has been requested to clarify whether this information could be kept in a fire register at the front door or the room number omitted to protect residents from unwanted visitors. Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 1 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x 3 x x x 2 Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 22 Are there any outstanding requirements from the last inspection? 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 7 Regulation 13(7) Requirement Record risk asessments for the safe use of furniture and equipment which has the potential to restrain. Review recording of risk asessment details so that it is in line with current in line with MHRA guidance for the use of bed rails. Requirment brought forward and updated from 16.9.04 and updated. Ensure all worn, stained damaged, ill fitting carepts are replaced. Replace the worn carpet in the clinical room with a more suitable surface. Provide monthly updates as part of the regulation 26 report on the progress of the carpet and furniture replacement programme. Provide written confirmation that remaining radiators and pipe work in the public areas and resident bedrooms have been covered. Ensure the surface temperature of radiators in the en-suite bathrooms does not exceed 43 degrees centigrade. Timescale for action 10.7.05 2. 7 13(4)(c) 31.7.05 3. 19 23(2)(b) (c)&(d) 10.7.05 4. 19 13(4)(a) & (c) 10.7.05 5. 19 13(4)(c) 10.5.05 Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 23 6. 7. 24 26 12(4)(a) 16(1) 23(2)(j) 8. 26 13(3) 9. 10. 33 33 24(1)(a) & (b) 26(4) 26(5)(a) 11. 38 23(2)(b) 12. 38 23(2)(b) 13. 38 23(4)(a), (b)&(c) Replace dividing curtain in room 34 is replaced so it is in working order and screens the bed. Carry out a review of the ensuite shower provision. Return all showers to full working order. Where the current provision does not support good moving and handling pracitces it is reccomended that specilaist advice is sought on providing fuly assisted toilets and a report submitted to CSCI. Ensure the laundry is dust free and the area behind the equipment is regulalry cleaned. Take advice from the community infection control nurse on provision of suitable handwashing and consider plumbing in a wash hand basin. Take advice on whether the laundry staff should wear face masks when cleaning tumble dryer filters. Introduce an audit of nursing care as part of the homes qulaity auditing system This requirement has been brought forward 16.9.04. The registered provider must ensure that monthly Regulation 26 reports covering the areas described under this regualtion are provided to the manager and CSCI. Provide a copy of the Leigonella test certificate and confirm that the arrangements in place meet current guidelines in relation to the regular flushing of shower heads. This requirement has been brought forward from 16.9.04. Provide a copy of the annual gas safety certificate Provide a copy of the risk asesment required under the The 31.7.05 10.11.05 31,7,05 10.11.05 31.7.05 31.7.05 31.7.05 31.7.05
Page 24 Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Fire precautions (Workplace) regulations 1997 (as amended). A copy should also be made available to the manager. 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. Refer to Standard 35 10 10 15 Good Practice Recommendations Provide an official oxygen fire safety sign for the clinical room door. Ensure staff do not wear disposable gloves inappropriately Ensure staff provide residents in the lounges with access to a call bell hand set. Consider having details of the meals served nutritionally asessed by a dietician as part of the homes quality audit and to demonstrate that the current ad hoc systems for choosing the menu are nutritionally sound. That lighting is reviewed throughout the home and residents are given acess to bed side lights and independent control of the central light where this does not already exist. It is reccomended that a part time activities co-ordinator is employed or additional designated care staff hours increased to cover development of this area. Update the volunteers recruitment policy to include taking up of two references and a criminal records check. Issue a receipt or ask the resident / relative to counter sign the ledger entry for personal money deposited/withdrawn from the account held by the home 5. 20 6. 7. 8. 27 29 35 Nightingale Nursing Home I52 s19483 Nightingale v225646 100505 stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Al7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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