Inspection on 20/02/06 for Nightingales

This inspection was carried out on 20th February 2006.

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

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

Other inspections for this house

Nightingales 17/09/08

Nightingales 27/09/07

Nightingales 31/07/06

Nightingales 04/08/05

Nightingales 06/01/05

Nightingales 20/05/04

Nightingales 28/01/04

Nightingales 30/09/03

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Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Nightingales 34 Florence Road Wylde Green Sutton Coldfield West Midlands B73 5NG Lead Inspector Zeta Joseph Unannounced Inspection 20th February 2006 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 Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Nightingales Address 34 Florence Road Wylde Green Sutton Coldfield West Midlands B73 5NG 0121 350 0243 0121 686 1312 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) Tuskholme Limited Mrs Gayle Goodhead, Ms Gill Crosse, Mr Philip Zaudi-Crosse Mrs Gayle Goodhead Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th August 2005 Brief Description of the Service: Nightingales is a family run home that operates as part of a limited company Tuskholme Ltd. It cares for thirteen older people both male and female. It is situated in a road off the main Birmingham to Sutton Coldfield road near to Wylde Green shops. Therefore there is access to local amenities and to buses into the main areas of Birmingham and Sutton Coldfield. There is a cross - city rail line in the vicinity. The home itself is housed in an extended large double fronted Victorian House that is not out of place in the surrounding area. It has three floors two of which are used by the service users and one that is used as an office and staff on call accommodation. There is a stair lift that allows service users to reach the first floor although some bedrooms have further steps to negotiate. On the ground floor there is a lounge/dining room, a bathroom, and a conservatory. There is a mixture of both single and shared rooms and some of the rooms are ensuite rooms. The home offers a day care service and a meals delivery service to people in the locality Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took five and a half hours to complete. There were twelve residents sitting in the lounge, two people had arrived for their day care and two relatives were visiting a resident. The Inspector spoke with three residents, they were ‘happy with everything at the home’ and one resident was doing a numerical puzzle, which she said she enjoyed because it helped her to think and calculate. Three other residents were being cared for in their bedrooms; Health and Social Care professionals were reassessing one of these residents. The inspection focused on outstanding requirements from the last inspection, examination of staff and residents’ records and a tour around the building. The co-director was available for the inspection and the registered manager for part of the inspection. What the service does well: What has improved since the last inspection? There was evidence in resident’s care plans that the Community Health Care team were actively involved in patient care. Examination of the multidisciplinary charts indicated that more care was taken of accurately recording events relating to providing care and support for residents. Staff have been provided with manual handling and risk assessment training. There is a cleaning rota in place to ensure high standards are met, this is evident by robust kitchen management. The Manager confirmed that service users have access to a copy of the Service User Guide in larger print font format. Equipment belonging to the home is no longer stored in a resident’s bedroom. The complaints log includes a numerical log. Staff files examined contained satisfactory information. Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 6 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. Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 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 Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 The Service User Guide has been developed so that it is available in a larger print size. Residents are provided with a copy of their contractual terms of residency. A care plan is completed for each resident. EVIDENCE: The Service User Guide is available in a larger print size and can be translated by use of computer software available on the Internet. All residents are provided with a copy of their contract of residency. From files examined these contained the newly implemented multidisciplinary assessment formats so that the each resident is provided with individualised care and support. Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 9 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, 10 The Community Health Care and Social Care Team are involved with residents’ health care. Residents’ are fully involved in their plan of care. Records relating to residents’ changing circumstances have not been reviewed. Residents spoken to say they were happy with all the care provided. EVIDENCE: The health care service were actively involved in residents’ health promotion. Residents’ who deteriorate, or those with behaviours that challenge must have their care plan and manual handling risk assessments reviewed and records updated to reflect changes in residents’ presenting circumstances. Residents’ relatives were consulted in regard to the plan of care of very frail residents; however agreements must be recorded so that an action plan is drawn up to confirm methods of care delivery. Risk assessments examined for two residents were found not to be representative of dependency levels discussed with the manager. Residents bedrooms did not contain equipment belonging to the home, therefore residents enjoyed privacy within their bedrooms. Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14, 15 Residents are offered prayers and ministerial services. Staff were seen to interact with residents in the lounge. Residents are provided with a variety of choices of meals, religious observance and routines of daily living. EVIDENCE: Visitors are made welcome at the home at any reasonable time; some relatives represent residents at residents meetings. Residents spoken to were satisfied with the care provided and were assisted to exercise choice and control over their lives. Residents’ interests are recorded within the multidisciplinary record. A resident sitting in the lounge was active with her mathematical puzzle book and explained to the Inspector how these are done. The Registered Manager ensures that residents receive a varied, appealing diet, which is suited to individual assessed and recorded requirements. Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 There has not been any complaint against the home and residents and their relatives can access the complaints procedure. The abuse procedure provides satisfactory protection. EVIDENCE: The Registered Manager ensures that the complaints procedure is accessible, and a numerical log is maintained so that complaints received can be tracked. Residents are protected from abuse because care staff (including the manager) have been provided with training and understanding of adult abuse including the Multidisciplinary Guidelines for Birmingham. Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 12 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): 21, 26 There are adequate bathrooms and toilet facilities. The handbook for carers includes infection control information. An infection control policy that reflects practice within the home is outstanding from previous inspections. Resident’s personal items were found in the communal bathroom. EVIDENCE: There are sufficient toilet, washing and bathing facilities provided to meet the needs of residents. A working infection control policy must be developed so that it reflects the practice in the home especially within the laundry and kitchen. This is outstanding from previous inspections. A bin lid was missing from the ground floor bathroom and crème and bath formula belonging to a resident was seen in this bathroom. Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 13 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30 The rota has been modified to meet standards. The interviewer must record gaps in employment history. The Manager had provided staff with some mandatory training. EVIDENCE: Examination of the rota revealed that the Manager of the domiciliary agency had covered some night shifts when the registered manager of the home considered that an emergency situation to protect residents and staff warranted this. Where the Manager has knowledge of reasons for gaps in employment records; this must be recorded on the staff file. The Manager is progressing with mandatory training, and has provided risk assessment and manual handling for staff so that they can provide a safe environment and care services for residents. It was not possible to evidence whether this training meets the requirements set by Skills for Care (TOPPS). Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 14 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): 32, 33, 36, 37, 38 The manager has not demonstrated the support provided for staff when concerns arise during provision for care of residents. A quality assurance system must be developed. Staff supervision notes do not demonstrate that care practice issues are discussed. Records required to safeguard residents are not maintained, up to date and accurate. The manager has not assured that high standards of manual handling techniques are implemented. Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 15 EVIDENCE: The Manager confirmed that the Domiciliary Care Manager covered two night shifts in an emergency situation to protect staff and residents. Rotas for this period evidenced this. However discussions with the manager and examination of supervision records relating to managing concerns regarding care of a resident during the night were not robust enough to ensure that staff were counselled, their work practice monitored to a satisfactory resolution. Management of service users must be demonstrated thorough clear leadership and directives so that staff are supported, actions taken and written recordings maintained within staff supervision notes. The manager shall ensure that a quality assurance system is implemented so that a formal process is developed regarding residents views and opinions. The manager confirmed after the inspection that a system has been developed but she is discussing changing it. The Inspector saw a technique used by a staff member to be dangerous putting themselves and the service user at serious risk. Handling assessments must be representative of the residents’ current circumstances; this is outstanding from the last inspection. However the Manager confirmed after the inspection that she was waiting for the physiotherapist and nursing assessments as detailed in a letter received at the Commission after the inspection. Records such as care plans; risk assessments and supervision records were examined and these were found not to safeguard all residents and staff. The standard of kitchen managements has improved; a cleaning rota for the kitchen and storeroom has been implemented. An infection control policy for the kitchen must be developed and is outstanding from the last inspection. Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 16 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X 3 X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 2 X X 2 X 2 Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 17 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13(4) Requirement Timescale for action 04/08/05 2. OP26 13(3) 3. OP26 13(3) 4. OP29 18 Sch 2 The Manager must update residents’ risk and manual handling assessments so that changes in their health care needs are reflected. This requirement is outstanding. The Manager must devise a 31/01/05 working Infection Control Policy that reflects practice. A copy of the relevant sections must be available in the kitchen and laundry and the Commission must be provided with a copy. This requirement remains outstanding. The Manager shall ensure that 21/01/05 communal toiletries are removed from bathrooms and toilets. This requirement remains outstanding. The Manager must ensure that 31/01/05 staff recruitment is managed more robustly and that written reasons for gaps in employment histories are recorded so that the required information meets the standards. This requirement remains outstanding. DS0000017015.V282132.R01.S.doc Version 5.1 Nightingales Page 18 5. OP30 18(1) 6. OP32 18(2) 7. OP33 13(4) 8. OP36 18(2) 9. OP36 18(2) 10. OP37 17(1) 11. OP38 13(4) The Manager shall ensure all staff are provided with Skills for Care training within the recommended guidelines. The Manager shall demonstrate the support provided for staff when difficulties arise during care provision. The Manager shall ensure the quality assurance process measures outcomes for residents so that their views are recorded and acted on appropriately. The Manager shall ensure persons working at the home are appropriately supervised, their care practice discussed in line with records maintained in line with the minimum standards. This requirement remains outstanding. The Manager shall ensure that persons working at the care home are appropriately supervised in line with the minimum standards with records maintained. This requirement remains outstanding. The Manager shall ensure all residents are safeguarded by the minimum standards required. This requirement remains outstanding. The Manager shall ensure residents risk and manual handling assessments are representative of their current circumstances. This requirement remains outstanding. 31/03/06 31/03/06 30/10/05 30/11/05 30/11/05 30/11/05 30/10/05 Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Nightingales DS0000017015.V282132.R01.S.doc Version 5.1 Page 21 - 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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