Inspection on 16/11/05 for Nightingale Nursing Home

This inspection was carried out on 16th November 2005.

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

The inspector 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 Nursing Home 12/06/09

Nightingale Nursing Home 03/05/07

Nightingale Nursing Home 19/05/06

Nightingale Nursing Home 10/05/05

Nightingale Nursing Home 16/09/04

Nightingale Nursing Home 26/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Nightingale Nursing Home 85 New Road Ware Hertfordshire SG12 7BY Lead Inspector Mrs Sheila Knopp Unannounced Inspection 16th November 2005 10:00 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 Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Nightingale Nursing Home Address 85 New Road Ware Hertfordshire SG12 7BY 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) 01920 463123 Greenswan Consultants Limited Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34), Terminally ill (3) of places Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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. 10th May 2005 & 14th September 2005 (additional visit) Date of last inspection Brief Description of the Service: Nightingale Nursing Home is a five-storey period 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 DS0000019483.V264951.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report reflects what was observed on the day of the inspection and feedback from 21 relatives and 13 residents who returned completed comment cards to the Commission during September. This is the second of two unannounced inspections planned for the year April 2005 – March 2006. An additional visit was made on 14.9.05 to monitor the progress of the requirements made following the inspection on 10.5.05. While some progress has been made to address the environemental issues identified progress to replace stained and damaged carpets has been slow. Mr Raja, Director, was present at the inspection and provided details of arrangements being made with the contractor to start the work on replacing carpets before Christmas. The focus of this inspection was to follow through social opportunities being provided to residents and check the requirements from the last inspection. Two inspectors spent their time talking to residents, visitors and staff and observing the interaction between residents and staff during the day. Care records were reviewed. Fire maintenance and service records were examined. Nightingale Nursing Home has a new manager. Ms J Hewett took up the post on 1.8.05. No complaints have been brought to the attention of the Commission between inspections. What the service does well: A high level of satisfaction was expressed by residents and their relatives All 13 residents who returned completed comment cards said they were well cared for, treated well by staff and their privacy was respected. All 21 relatives who completed comment cards said they were satisfied with the overall care provided. The following additional comments were added to the questionnaire – ‘Always looks well cared for and comfortable’, ‘Staff are friendly’, ‘Staff are always cheerful and very caring’, ‘The staff are always pleasant and caring and the atmosphere is happy, at all stages we have been very happy with care and the co-operation of all staff’ ‘Everything is being done here to make our relative as comfortable as possible’. ‘My relatives condition on leaving hospital was such that all the family feared the worst. Their improvement since coming to Nightingale is beyond belief. She looks so well and is well settled’. Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 Page 6 The home is fully staffed with it’s own workers who are known to the residents which is reflected in the comments made by relatives. Residents are able to take advice and receive support from Age Concern Advocacy workers who visit the home regularly. Residents are looked after by a well trained staff team. Fifty percent of the care staff have achieved qualifications at NVQ level 2, which are the standards, required of care home workers by the end of 2005. What has improved since the last inspection? What they could do better: To ensure residents are cared for safely the manager needs to review the processes for recording and reviewing individual risk assessments. Particularly those in relation to recliner chairs, bed rails and wheelchair lap belts to ensure they are in line with current professional guidance. Poor moving and handling practices were observed, with staff using outdated under arm lifts, which can cause injuries to older people. Staff need to ensure windows opened by the domestic staff are shut before residents are returned to their rooms so that an appropriate level of heat is provided. Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 Page 7 The delay in replacing badly laid and stained carpets has not provided residents with the standard of environment they are entitled to. A number of housekeeping and infection control issues were identified. Liquid soap and disposable hand towels need to be available to staff. For residents spending time in their rooms it was recommended that their jug of water is changed twice daily. 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 DS0000019483.V264951.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 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 the following standard(s): Not inspected EVIDENCE: Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 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 the following standard(s): 7&8 This area was not fully inspected on this occasion. However good practice issues were identified under standards 7 & 8 which require attention to ensure residents are cared for safely. Overall residents appeared to be comfortable and had been supported to achieve a good standard of personal care. EVIDENCE: The review of risk assessments required following the inspection carried out on 10.5.05 has been delayed by the change in manager and further requirements have been made. The manager needs to ensure the risk assessments meet Health & Safety, Medical Health Regulation Agency guidance and CSCI (guidance provided). Standard 7 was not met because the risk assessments in place for the safe use of bed rails, rationale and directions for use of recliner chairs and wheelchair lap belts did not meet current professional guidelines or in the case of wheelchair lap belts were absent. Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 Page 11 Standard 8 was not met because 2 residents had been left in cold bedrooms with the window open. Staff were observed using inappropriate moving and handling techniques. Wheelchairs were being used without footplates in place. A resident whose care plan stated that bed rails must be in place at all times had been left in bed with one of the sides down. A member of staff reported that residents were being got up from 6am by the night staff. This needs to be reviewed by the manager to ensure residents are able to make choices about when they get up and their preferences recorded. Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 & 15 It is positive to report that this is a developing area. The opportunities for service users to take part in a wider range of social activities within the home has increased since the inspection in May. Of the 11 residents who completed the question about activities 5 felt suitable activities were provided, 3 said no and 3 said sometimes. Resident’s visitors and friends are welcome in the home. Staff are supporting relatives who wish to continue with their caring role. Links with Age Concern provide advocacy services for residents should they require support and information to organise aspects of their lives. Residents are provided with a planned menu of family style meals. The manager was asked to review the provision of drinks in resident’s rooms to ensure jugs were changed twice daily for those spending time in their rooms. Currently the jugs are replaced in the afternoon. EVIDENCE: Time has been identified each afternoon for staff to organise activities with groups of residents and on specific days to spend time with residents who are in their rooms or are in bed. Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 Page 13 It was suggested that the staff who are to be responsible for the sessions on a set day are identified on the rota so that they can find out from the residents what they would like to do and plan the session. Further training for key staff in the provision of activities for older people would enable this area to be developed more fully. The activity programme put in place has been achieved without an increase in staffing or the appointment of an activities organiser, which is commonplace in other homes of this size and will need to be kept under review. Visiting entertainers are arranged and residents are going out for Christmas lunch. Representatives of a local church visit each week to spend time with residents and a communion service is held each month. A positive aspect of the home is that residents have access to advocates from Age Concern who are regular visitors to the home. The manager reported she is hoping to set up a residents committee and has plans to hold a relatives meeting. A manicurist and hairdresser visit the home. The manager has arranged a clothes party so residents can choose their own purchases. All relatives who completed comment cards said they were welcome in the home at any time and able to visit in private. Details of activities are displayed but not currently circulated to residents. The introduction of a newsletter or weekly information sheet of activities and events to keep residents and relatives informed was discussed with the manager. The kitchen has recently been refurbished. In response to a requirement from the inspection in May a planned four weekly menu has replaced the ad hoc procedures previously used. The manager is in contact with local dieticians to get the menu nutritionally assessed. Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected. EVIDENCE: Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Requirements from the inspections carried out on 10.5.05 & 14.9.05 under standard 19 & 26 were reviewed. A planned programme to upgrade facilities and brighten up the home is in progress. However the replacement of stained and badly fitting carpets has not taken place within the agreed timescales. The radiators in at risk areas have been covered to protect residents from accidental scalding. A number of infection control and cleaning issues were identified which need to be addressed to promote the dignity and welfare of the residents. EVIDENCE: There is an odour from the carpets in the area adjacent to the lounge and due to poor fitting some of the carpets in the public areas and bedrooms are rucked up with seams coming apart. These are due to be replaced but the time scales provided by the provider have slipped. Tape has been applied to areas which pose a tripping hazard. Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 Page 16 The provider is looking into the use of the en-suite shower rooms with a view to making them more accessible to residents with disabilities. The ground floor communal toilet by room 4 needs upgrading. Mr Raja confirmed that this would be carried out as part of the upgrade. The hot water supplying the baths was found to be 38 degrees centigrade, which raised concerns about whether enough hot water is being provided to ensure residents can bathe comfortably. The laundry is being refurbished to improve the management of laundry and infection control issues. The manager needs to ensure liquid soap and paper hand towels are provided for staff in all areas where personal care clinical procedures are carried out to reduce the risk of infection. Staff need to ensure that wheelchairs and clinical equipment such as nebulisers are kept clean. Staff only had access to communal bars of soap in some areas to wash their hands, which is not good infection control practice. A member of staff raised concerns about daily access to fresh flannels for residents, which needs to be reviewed by the manager. A relative raised concerns about dirty wheelchairs and dead flowers being left in a bedroom, which was also reflected observations made on the day of inspection. Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 Residents receive support from registered nurses and care staff who have achieve qualifications in care practices. EVIDENCE: The information provided by the manager indicated that the qualifications of the care staff had achieved the 50 ratio with staff achieving NVQ level 2 in care. Providing details of qualifications on the rota, was discussed with the manager, so that the skill mix could be reflected in planned shifts and any changes in the ratio of staff with the required qualifications could be identified. Nineteen out of the 21 relatives who completed comment cards said there were always sufficient numbers of staff on duty. Two people did not respond to this question. As the dependency of residents increases the manager and provider need to ensure that the night staffing levels are sufficient for the number of residents who require 2 staff to attend to them. Historically 1 registered nurse and 3 carers have been provided to look after residents who have bedrooms on 4 floors. The home is staffed with it’s own staff. Bank staff pick up additional shifts therefore agency staff are not used. The rota demonstrates that 2 registered nurses and 5 care assistants work in the morning and 2 registered nurses and 4 carers work in the afternoon/evening. Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 Page 18 It is the responsibility of the manager to ensure adequate staffing is provided to meet the changing need of the residents. Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 38 An application to register the new manager, who is a registered nurse, under the Care Standards Act has been received by the Commission and is being reviewed. Relatives and staff confirmed that there is an open approach within the home. There is a quality assurance system in place to enable the manager and provider to review standards. The manager and provider now need to move to a position of issuing a report to residents, relatives, stakeholders and the Commission on the outcome of their review and development plan for the future. The manager has identified the need to update the outstanding statutory training for staff which has not been completed this year. Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 Page 20 EVIDENCE: To meet a requirement under standard 33 the manager has identified a quality audit which will enable her to review the quality of nursing care. The new manager has identified gaps in the statutory training for this year that now require attention and is booking first aid and fire training. Staff need updating on moving and handling practices. It was recommended that the manager develops a training matrix to plan the training needs of the staff group as a whole. In response to a previous requirement the fire safety risk assessment has been updated. Records for the regular servicing of equipment and utilities were available. Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 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 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 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 x 17 x 18 x 1 x x x x x x 2 STAFFING Standard No Score 27 x 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x x x x 2 Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 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. 1 Standard OP7 Regulation 13(4)&(7) Requirement Risk assessments, for bed rails, recliner chairs and wheelchair lap belts or restraining straps must be recorded and reviewed in line with current professional guidance. Brought forward from 10.5.05 & 14.9.05. Manager to provide details of action taken and copies of risk assessment forms. Staff must ensure that rooms are adequately heated and windows shut where required before returning residents to them. Footplates must be used when moving residents in wheelchairs unless otherwise stated in the risk assessment. Ensure staff use appropriate moving and handling techniques with senior staff and moving and handling assessors challenging poor practice. Replace all worn, stained, illfitting carpets. Brought forward from 16.9.04. Mr Raja to provide monthly update on progress being made. Ensure adequate supplies of hot DS0000019483.V264951.R01.S.doc Timescale for action 31/01/06 2 OP8 12(1)(a) 16/11/05 3 OP8 12(1)(a) 13(4)(c) 12(1)(a) 13(5) 31/01/06 4 OP8 16/11/06 5 OP19 23(2) 31/12/05 6 OP19 23(2) 16/11/05 Page 23 Nightingale Nursing Home Version 5.0 7 8 OP26 OP26 16(2) 12(4) 16(2) 24(2) 9 OP33 10 OP38 13(4) 18(1) water are provided at all times. Ensure wheelchairs are kept clean and well maintained. Ensure fresh flannels identified for individual use are provided for residents at each wash if required. Provide a date for issuing residents, stakeholders & the Commission with a report on the outcome of the quality review. Provide dates for statutory training where gaps have been identified –refer NMS 38.2 31/12/05 31/12/05 31/12/05 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP8 OP12 OP12 OP15 OP38 Good Practice Recommendations Review routines of night staff to ensure residents are given a choice of when they wish to get up and their preferences are recorded. Identify training for staff involved in providing activities. Circulate up to date information about activities to the residents. Replace drinks for residents spending time in their rooms twice daily. Develop a training matrix to identify gaps in training and ensure staff are up to date and the 50 ratio of care staff with NVQ qualifications is maintained. Nightingale Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Nursing Home DS0000019483.V264951.R01.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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