Inspection on 31/07/06 for Nightingales

This inspection was carried out on 31st July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 27/09/07

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 Zeta Joseph Unannounced Inspection 31st July 2006 12.30 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.V306199.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.V306199.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 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.V306199.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th February 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. Nightingales DS0000017015.V306199.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork inspection was unannounced and there were thirteen residents, and two day care service users in the home. Relatives who were visiting were spoken to about their opinion of the home, they were positive about this and confirmed how well their relative was cared for by all the staff, especially the manager. The Inspector spoke with residents sitting in the lounge, when asked about life in the home they said they were happy and comfortable. A resident was being cared for in one of the bedrooms and a medical professional was undertaking a reassessment. The Inspection focussed on outstanding requirements from the last inspection. Key inspection standards that relate to the welfare, health, safety and protection of residents were also assessed plus additional standards as appropriate. A staff record and four residents’ records were examined and the home was toured. The Senior Carer in charge of the shift was available throughout the inspection. What the service does well: Care staff were co-operative throughout the fieldwork inspection process and provided the necessary information requested. Four residents were spoken to about life at the home; they spoke highly about the care staff being kind and thoughtful towards them. Examination of residents’ records indicated that care is taken to accurately record events relating to care and support for residents. Health and safety of resident are managed well, the multidisciplinary records examined include up to date risk and manual handling assessments that were reviewed in some cases monthly. Service users care plan assessments is a multidisciplinary record of gender, age, disability and religion/beliefs, health and safety, daily records and medication reports. The kitchen continues to be robustly managed by an experienced cook. A working infection control procedure is implemented within the kitchen and laundry to ensure high standards are met. There is a cleaning rota in place to ensure high standards are met, this is evident by robust kitchen management. Nightingales DS0000017015.V306199.R01.S.doc Version 5.2 Page 6 A professional company has been signed up to provide professional advice in employment, health and safety, risk assessment, policies and procedural matters so that the home operates efficiently and residents will benefit from this. The manager is continuing with the Registered Managers Award qualification as part of her personal development. The manager is already qualified to the equivalent of National Vocational Qualification (NVQ) level 4. What has improved since the last inspection? What they could do better: Recordings on accident/incident forms received by the Commission indicates that residents were ‘lifted’. The manager must instruct staff to record the manual handing technique used to assist residents. The manager must conduct a risk assessment for the areas of the home where repairs to the walls and ceilings are being undertaken and where residents have access to so that whilst repairs or redecoration is being undertaken, residents are not put at risk. The manager must implement a quality assurance system based on outcomes for residents. Nightingales DS0000017015.V306199.R01.S.doc Version 5.2 Page 7 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.V306199.R01.S.doc Version 5.2 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 Nightingales DS0000017015.V306199.R01.S.doc Version 5.2 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): 1,2,3,4,5 Quality in this outcome area is judgement is good. This judgement has been made using available evidence including a visit to this service. The Service User Guide is available so that current and prospective residents have the information needed. From the information contained in the Service User Guide, prospective residents, relatives and friends can visit the home to assess the facilities available. A multidisciplinary care assessment is completed for each resident. A summary care plan is obtained through the care management arrangements for residents assessed by Social Care and Health. This means that residents’ individual needs are known, recorded and can be met. A placement authorisation from Social Care and Health provides confirmation of the individual residents’ stay at the home, this means that the resident is authorised to stay at the home. Nightingales DS0000017015.V306199.R01.S.doc Version 5.2 Page 10 EVIDENCE: Service User Guide information about the home is available to current and prospective residents in larger print sizes and this document can be translated into other languages available on the computer software. A multidisciplinary care assessment is completed for residents so that their needs are identified and met by the home; this is in addition to the care plan assessment undertaken by the Social Care and health Department, this means that prospective resident is individually assessed before they can stay at the home. Each resident has an allocated key worker who is responsible for providing personal care and updating the care assessment. Prospective residents, relatives and friends can visit to assess whether the home will meet their needs because they have a copy of the Service User Guide and a brochure for the home. People can ring the home to arrange a time to visit the home, meet the manager, assess whether the home can meet needs and arrange a trial stay. There were no resident assessed and referred solely for intermediate care. Nightingales DS0000017015.V306199.R01.S.doc Version 5.2 Page 11 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, 9, 10, 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs were well planned and met and the multi-disciplinary team are involved when required. This means residents’ health care needs are consistently met in the way they prefer. Medication management was good ensuring service users get the correct prescribed medication when they need it. The multidisciplinary records include the wishes of individual residents about dying and the arrangements they want after death, this means that residents’ wishes are discussed and recorded. EVIDENCE: Nightingales DS0000017015.V306199.R01.S.doc Version 5.2 Page 12 Assessment records for five residents were examined. These showed that reviews had been undertaken by the senior care staff so that the presenting circumstances of residents’ whose health is deteriorating, changes in manual handling and risk are accurately recorded so that needs can continue to be met. Meetings with social workers and visits from the district nurse and GP are recorded and actions are put into place so that care needs are safely met. Referrals to specialists are recorded so that reasons for example residents falling are identified and actioned. Residents’ relatives are consulted and their involvement encouraged in regard to the continuous care of very frail residents. A relative was spoken to and she spoke highly and positively about the care provided by competent staff, and of the management team. Reviews of care plans have taken place and residents and their relatives are involved. Residents spoken to said they were happy with their care. Five manual handling risk assessments were examined and these were representative of dependency levels discussed with the manager at the last inspection and these have been reviewed on a monthly basis. Medication records were examined and the pharmacist confirmed to the Inspector the help and support provided. The policies and procedures reflect actual practice. All medicines received and administered are accurately recorded; this includes all controlled drugs. Medication is stored in medipaks and each pack is labelled with a photograph and name of the resident so that the risk of error in drugs administration is minimised. Records also show both the resident and family discuss arrangements they want after death; some of the records indicate the person’s funeral preference. Nightingales DS0000017015.V306199.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff were seen interacting with residents and assisting with residents who preferred to eat their lunch in the lounge. Residents are provided with a variety of choices of meals, religious observance and routines of daily living so that residents assessed needs continue to be met. There is a menu offering various meals over a four-week period, which means that residents are offered choices. There is a planned schedule of activities for residents’ to try to participate in. These have been planned following consultation with residents and were described by residents as being varied, stimulating and often enough. EVIDENCE: There is an activities rota drawn up with the residents at one of their residents meetings. Routines and activities are flexible so that residents can choose whether or not to participate. They can sit and chat with one another if they choose or watch the activity and not participate. The types of activities include an entertainer, manicure, and visits to the theatre or meals outside the home. Nightingales DS0000017015.V306199.R01.S.doc Version 5.2 Page 14 Residents meetings are open to relatives to attend so that the needs of residents who are unable to state their preferences are discussed. Notes of residents’ meetings are available and twelve residents attended the last meeting in July 2006. The menu was examined and choices are available at breakfast and evening teatime. The menu is varied for four weeks and includes a variety of dishes for the resident to choose. There is one meal option available at lunchtime and no other choices indicated on the menu or for residents on a special diet, this might be an oversight by the person drawing up the menu and must be reviewed because the Inspector saw that residents were offered a variety of meals. Mealtime is a social occasion and residents were seen sitting in the dinning room and in the lounge to eat their meal. Staff were seen to be discreet when assisting residents to eat. The cook is experienced and welcomes the inspection of the kitchen and has maintained good practice whereby samples of meals are retained for seven days than discarded as advised by the Environmental Health Officer. The kitchen cleaning rota is being implemented to ensure high standards of hygiene. Nightingales DS0000017015.V306199.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There has not been any complaints against the home since the last inspection and residents and their relatives can access the complaints procedure. Residents and their relatives can be assured that complaints and concerns will be investigated and resolved, and the manager is active in seeking feedback from residents about the home to ensure it is managed to their satisfaction and meets their needs. The abuse procedure provides satisfactory protection and staff have been provided with adult protection training including the Local Authority Multi Agency Guidelines. Residents are safeguarded by the procedures. EVIDENCE: The Registered Manager ensures that the complaints procedure is accessible, and a numerical log complaints 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.V306199.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,24,26 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. The premises at Nightingales meet the varied needs of residents in a homely and comfortable way. Specialist equipment is available to promote independence and for safe handling of people without full mobility. EVIDENCE: The Inspector toured the home that was clean, pleasant and comfortable and suited for residents accommodated. There are sufficient toilet, washing and bathing facilities provided to meet the needs of residents. Nightingales DS0000017015.V306199.R01.S.doc Version 5.2 Page 17 The inspector saw that plastering work had been undertaken in some areas of the home. A risk assessment must be carried out for areas of the home where residents have access to including areas where work has been carried out and for when painting/redecorating is to be completed. Residents’ bedrooms were individualised with their personal possessions. The bed linen for the rooms sampled were clean and provided comfort for the resident. Residents have been assessed and encouraged to use specialist equipment such as a hoist so that their manual handling needs can be carried out safely. Records relating to this were examined and reflect current practice. The Manager has implemented a working Infection Control Policy that reflects practice. It includes spillage of bodily waste, clinical waste and hand washing techniques. A copy of this was seen in the laundry and a copy is available in the kitchen. The Inspector was provided with a copy. Nightingales DS0000017015.V306199.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. The rota indicates efficient use of staff at peak times which means there are adequate numbers of staff on duty at peak times to meet the needs of residents. There is a stable team of carers employed and there has not been new staff employed since the last inspection in February 2006, which promotes continuity of care. One senior carer file was sampled and this showed robust recruitment procedures, which would ensure residents’ are protected from harm. Care staff are undertaking Skills for Care induction courses and mandatory training which means they would have the skills required to provide care. EVIDENCE: A copy of the rota indicates that sufficient staff are on duty throughout the busy times of the day and they can meet the changing needs of residents. The senior care staff recruitment record examined meets the minimum standards. The manager confirmed valid reasons for the gap in the employment record for a staff member recruited last year and whose file was Nightingales DS0000017015.V306199.R01.S.doc Version 5.2 Page 19 sampled at the last inspection. This ensures residents are protected by robust recruitment practices managed. The Inspector was shown a sample workbook by care staff undertaking induction training that meets the Skills for Care foundation standards. Mandatory training is provided that includes Adult Protection, Manual Handling and Risk Assessment. External providers deliver training so that person centred services are promoted. A stable team of carer’s means that residents are provided with continuity of care from care staff known to them. Staff spoke highly of the low turnover of employees; there is no evidence of use of agency or temporary staff. Nightingales DS0000017015.V306199.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,37,38 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to this service. This service is well managed and this promotes and protects residents’ interests with a manager who is committed to making improvements. Equality and diversity are managed well throughout the assessment, daily records and review process; residents’ benefit from this because of their care is monitored on a daily basis. Staff supervision records sampled demonstrates that care practice issues are discussed so that residents are provided with quality care. Records required to safeguard residents are maintained, up to date and accurate. Nightingales DS0000017015.V306199.R01.S.doc Version 5.2 Page 21 A quality assurance system has been developed to manage quality assurance issues and outcomes for residents based on consultation with them about their views and opinions. EVIDENCE: The senior carers on duty were informative about their roles and were keen to explain how the service had improved, indicating their approach to understanding policies and putting these into practice. Management of staff is demonstrated thorough clear leadership and directives from the registered manager this shows that staff are supported through the actions taken and written recordings maintained within staff supervision notes. Record keeping has improved it is clear that management and senior care staff have worked hard to maintain this standard of their work practice so that outcomes in the areas of age, gender, disability and belief is recorded and incorporated into the care practice to meet the diverse needs of residents. The premises were toured and there were no concerns identified apart from the risk assessment relating to the repairs to the walls and ceilings. Regulation 37 incidents and accidents was discussed with the person in charge of the shift and service users care plan records were examined; the Inspector is satisfied that safe methods of care practice was being implemented, however the manual handling techniques used by staff to reposition the resident after a fall must be more clearly recorded. The home has an appropriate five-year wiring certificate. There was evidence of maintenance of fire equipment and alarms. The emergency lighting and fire panel had recently been replaced and updated. The home has evidence of clinical waste disposal and pest control contracts. The Manager confirmed that the current quality system would be audited so that any improvements that are necessary are made. Nightingales DS0000017015.V306199.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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 2 X 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 3 3 Nightingales DS0000017015.V306199.R01.S.doc Version 5.2 Page 23 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 OP19 Regulation 13(4) Requirement The Manager must undertake a risk assessment for areas of the home undergoing remedial works so that areas where residents have access to are made safe and that residents are not put at risk. The Manager shall ensure the quality assurance process measures outcomes for residents so that their views are recorded and acted on appropriately. THIS IS OUTSTANDING FROM THE LAST INSPECTION 30/10/05 The Manager to confirm the manual handling technique used to assist residents after they have fallen from Regulation 37 incident forms received at the Commission 05/05/06 to 03/07/06 inclusive. Timescale for action 30/09/06 2. OP33 13(4) 30/12/06 3. OP38 13 30/09/06 Nightingales DS0000017015.V306199.R01.S.doc Version 5.2 Page 24 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.V306199.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: 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.V306199.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. 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