Inspection on 27/09/07 for Nightingales

This inspection was carried out on 27th September 2007.

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

Nightingales 17/09/08

Nightingales 31/07/06

Nightingales 20/02/06

Nightingales 04/08/05

Nightingales 06/01/05

Nightingales 20/05/04

Nightingales 28/01/04

Nightingales 30/09/03

Similar services:

Maple Lodge

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 Mrs Mandy Beck Key Unannounced Inspection 09:00 27 and 28 September 2007 th th 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.V351918.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. Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingales Address 34 Florence Road Wylde Green Sutton Coldfield West Midlands B73 5NG 0121 350 0243 0121 3501135 tuskhome@btconnect.com 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.V351918.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2006 Brief Description of the Service: Nightingales is a family run home that operates as part of a limited company Tuskholme Ltd and 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; the service users use two floors and the third floor is used as an office and for staff on call accommodation. There is a stair lift that allows residents to access the first floor, there are some steps to access some of the bedrooms on this floor and there is a communal bathroom on this floor. There are stairs to access the second floor. This means that people with limited mobility could not be accommodated on the second floor. On the ground floor there are residents bedrooms, a large lounge, a laundry room, kitchen and a conservatory/dinning area. 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 meal delivery service to people in the locality. The fees this home charges for residency are displayed in the entrance hall on the notice board. Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which took place over two days. We have used a variety of different methods to collect information about this service. The home has supplied information about the home in their Annual Quality Assurance Assessment (AQAA). We have used some of the information they gave us in this report. We spent time talking to some of the people who live there and the staff during this inspection to find out what life is like at Nightingales. We looked at care plans for people who use this service as part of our case tracking process. This means that each persons records are looked at in depth and this allows us to make decisions about whether the home is meeting the needs of the people who live there. The inspector would like to thank everyone at the home for their hospitality during the inspection. What the service does well: What has improved since the last inspection? The manager has now introduced a quality assurance system for the home. This means that there will now be a regular audit system in the home that will identify areas for improvement and enable the home to make an action plan to address them. Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 6 The repair works identified during the home’s last inspection have now been completed and the home is undergoing more refurbishment work in order to improve the environment for the people who live there. 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. Nightingales DS0000017015.V351918.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 Nightingales DS0000017015.V351918.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): 3,6 Quality in this outcome area is good. The home provides good sources of information for people who may wish to use this service. People can be assured that their needs will be assessed in full before they move in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the assessments of three people who live at this home. We found that they were mostly detailed and gave a good indication of the needs each person had. There were also assessments available from the multidisciplinary care assessment team. The manager will visit people in their own homes or hospital to complete her own assessment with each person before agreeing that the home can meet their needs. All prospective new residents are encouraged to spend time at the home before agreeing to move in. In some cases this transition is made easier Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 9 because residents tend to know the home after having used the day care facility it offers. The home does not offer intermediate care services. Nightingales DS0000017015.V351918.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): 7,8,9,10.11 Quality in this outcome area is good. People who use this service can feel confident their health needs will be met. And they will be treated with respect and dignity at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has good systems in place for recording care. Resident’s files were seen as part of the case tracking process, it was pleasing to see that all of them contained care plans and some risk assessments. The home is supported by the district nursing service that provide pressure relieving equipment, bed rails and commodes if residents need them. The manager said that they contact the nurses when they detect any changes in service users health. We noticed that the home does not routinely screen its residents for their risk of malnutrition. This was discussed with the manager who said they do observe service users and when they notice any changes they refer them to the GP or the dietician for further advice. It was recommended the home introduce a screening tool so that service users who are potentially at risk are Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 11 spotted sooner rather than wait for the problem to become more pronounced. Other risk assessments the home may wish to consider introducing are those for falls, and pressure sore risk, again these risk assessments can help identify those residents at increased risk and enable them to receive help and assistance earlier. We noticed that the home does not have footplates on any of the wheelchairs. The manager explained that the footplates have been removed because residents were experiencing injury’s to their chins and calves. A risk assessment has been completed the manager has also found information about shin pad and calf protectors that will protect residents further when using the wheelchairs. It is hoped to trial them soon. Reviews of residents care are undertaken regularly and involve the residents wherever possible. Relatives are also consulted and encouraged to be involved in care reviews. Residents are seen by a variety of community services such as district nursing, Macmillan nurses and chiropody when the need arises. Medication systems in the home are good and protect residents well being. There were a couple of areas identified that would improve the process further. These were pointed out to the manager during the inspection for instance, there must be no gaps on the Medication Administration Record (MAR) every box must have an entry. The medication round was observed and although two staff complete this between them it was noticed that one carer signs the MAR and the other administers the medication to residents. It is recommended that the person who dispenses the medication should be the person who administers it and therefore signs the MAR sheet. Throughout the inspection residents were seen to be helped in a sensitive manner by care staff. They spent time with residents encouraging them to talk about their needs, they did not rush them and gave them plenty of time to answer questions. Staff were seen to be knocking doors to resident’s bedrooms before they entered and when residents were using the toilets. One resident said “they never rush me but they know what I want”. The manager also discussed her plans to introduce the Gold Framework for End of Life Care. This is a positive step and should enable residents to have the end of life care and support they want in the comfort of the home. Nightingales DS0000017015.V351918.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): 12,13,14,15 Quality in this outcome area is good. People who use this service are encouraged to take part in activites and to maintain contact with their family and friends. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home as a activity timetable on the display board in the entrance hall. The plan is flexible and residents only take part if they choose to do so. Activites included quizzes, sing alongs and massages. The manager said that at times it can be difficult to get some of the residents motivated to take part in planned activities. Relatives are encouraged to visit whenever they want to. The home has no restrictions on visiting for them. Residents can choose who they want to see and where they want to see them. They are offered the privacy of their own rooms although staff said most visitors tend to stay in the lounge because they like to talk to the other residents as well. On the day of this inspection new cook had just started employment. One resident said “he has big shoes to fill the other one was very good, but there’s Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 13 not complaints yet so that’s good isn’t it”. Residents are offered choices of meals throughout the day and they can choose to eat either in the dining room located in the conservatory or stay in the lounge and eat their meals there. Nightingales DS0000017015.V351918.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): 16,18 Quality in this outcome area is adequate. People who live here can feel confident that their views will be listened to and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has not received any complaints since the last inspection. The complaints policy has not changed and the manager continues to make sure that the complaints procedure is available and a numerical log of complaints is kept should they arise. The home was in the process of revising its Vulnerable Adults Policy during this inspection. The revised policy should give staff clearer guidance and understanding of what to do if abuse is suspected. We spoke to staff about their understanding of Abuse and their role in reporting and supporting residents. Although they were able to give some detailed answered it is apparent that further “refresher” training would benefit the staff group. The training should also include the guidance from the local authority. We looked at the staff files of two new workers and found that none of the required safety checks, i.e. PoVAfirst and Criminal Records Bureau (CRB) had been obtained before they had commenced employment. This was discussed Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 15 with the manager who explained that the PoVAfirst and CRB had been applied for but due to an administrative error and her annual leave the process had stalled. We were able to evidence this at the time of the inspection. The manager was also informed of other safeguards that should be in place to further protect residents when new workers commence employment with only a PoVAfirst check in place. We also looked at the way in which the home manages resident’s monies. We found that there were incorrect balances for a lot of the residents, the amounts missing varied from £20 to £100. As a result of these findings the manager called the police immediately. Furthermore the manager has now put new systems in place for the receipt and storage of resident’s monies to ensure that this doesn’t happen again. All of the residents who had missing money have now been fully reimbursed by the home. Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 16 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): 19,26 Quality in this outcome area is good. People who live in this home, live in a comfortable and homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked around the home and found that there are various refurbishment works being undertaken. Since the last inspection the plaster work has been completed and work has begun on decorating residents bedrooms. The manager told us that new radiators had been supplied and a chimneybreast had been taken out in order to make one bedroom more spacious. Bathroom doorframes have been widened to allow easy access for residents to get in and out of them. The shower room had been made into a wet room so that residents can enjoy a shower if they want one. Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 17 It was also pleasing to see that residents who need equipment such as air mattresses and bed rails have them supplied to them by the district nursing service. The home must make sure that it records temperature of the hot water on a regular basis and records this. If temperatures do not fall within the recommended scales then they must also record what action they have taken to rectify this. The manager said that the plumber was due on site to check all of the water outlets and radiators as part of their ongoing improvements. The lounge and dining area are comfortably furnished and residents seemed to be happy in their surroundings. The home also has extensive gardens that are pleasantly maintained provide a lovely view from the lounge and the conservatory. The laundry is tiny but well managed. The kitchen is clean, tidy and well equipped. The home supplies liquid soap and paper towels throughout in order to help reduce the risks of cross infection to residents. The home has also been asked to obtain a copy of the Department of Health guidance Essential Steps for infection control in care homes. It is also recommended that staff receive training in infection control and current best practice. Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 18 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): 27,28,29,30 Quality in this outcome area is good. People who use this service are looked after by staff that are supplied in sufficient numbers to meet their needs. Further staff training would enhance the knowledge and skills of the existing staff group. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is sufficient staff on duty at all times to make sure that residents needs are met. We looked at staff files and despite the shortfalls found with security checks other recruitment processes were generally satisfactory. It is recommended that the manager conduct an audit of staff files against the requirements in the Care Home Regulations 2001 to make sure that all information has been obtained. We looked at the induction booklet that the home has reviewed and amended. The booklet appears to meet all of the expected contents from the Skills for Care Induction standards. The induction package now includes subjects like dementia and biography recording for residents. In order for this to be successful for residents it is recommended that all staff receive training in person centred care. Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 19 The people who live in the home were very complimentary about the staff. They said they were “golden and they would do anything for us”. Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 20 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): 31,33,35,38 Quality in this outcome area is good. This home is well managed and run in the best interests of the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home continues to be managed with clear leadership and direction. The manager has demonstrated throughout the inspection a commitment to improve the service the home provides for the residents. For example, when we found discrepancies with resident’s monies she took immediate action to ensure that this would not happen again. Mrs Goodhead had also taken steps to rectify the issues surrounding PoVAfirst and CRB checks for new workers. It is acknowledged that these problems had Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 21 been encountered whilst she was on holiday and were sorted out immediately upon her return. Since the last inspection the home has purchased a quality assurance system. This means that monthly audits are now being conducted and will address specific areas each time. For instance, the environment, care planning and medication. Once an audit has been completed any areas for improvement are easily identified and allows the home to prepare an action plan to address them. The home will also be audited annually by the company who supplied them with the Quality Assurance system. The manager also said that they ask residents and relatives to participate in surveys on a yearly basis and the questionnaires were in the process of being sent out now. The home also keeps relatives and residents informed of changes and developments by way of a newsletter and regular meetings. In order to check if the home is meeting is health and safety responsibilities we spot checked safety certificates, all of which were in order. We did find that staff would benefit from further training in subject area such as infection control, health and safety, food hygiene and fire safety. Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 1 X X 2 Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 23 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 OP18 Regulation 19 Requirement New workers must have a PoVA and CRB check before they begin working in the home in order to safeguard residents The home must have effective systems in place to make sure that residents money is safe if the home has agreed to look after it for them. Timescale for action 01/10/07 2 OP35 13(6) 01/10/07 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 Refer to Standard OP4 OP8 OP9 Good Practice Recommendations It is recommended that staff have further training in dementia care and person centred care. It is recommended that the home introduces risk assessments that would identify those service users at risk of malnutrition, pressure sore development and falls. It is recommended that the person who dispenses medication for residents also administers it and signs the DS0000017015.V351918.R01.S.doc Version 5.2 Page 24 Nightingales MAR sheet. Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Nightingales DS0000017015.V351918.R01.S.doc Version 5.2 Page 26 - 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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