Inspection on 05/09/05 for Nightingales

This inspection was carried out on 5th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 08/11/05

Nightingales 21/05/05

Nightingales 06/03/05

Nightingales 17/08/04

Nightingales 17/06/02

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Nightingales 38 Western Road Newick East Sussex BN8 4LF Lead Inspector Elaine Green Key Unannounced Inspection 5th September 2006 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 Nightingales DS0000021172.V314715.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 DS0000021172.V314715.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingales Address 38 Western Road Newick East Sussex BN8 4LF 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) 01825 721120 Mrs Anne Lewis Mrs Anne Lewis Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated is Seventeen (17). 8th November 2005 Date of last inspection Brief Description of the Service: Nightingales is an older extended property situated in the village of Newick. The village centre with its facilities and shops is a short level walk away and local bus services run past the home. Accommodation is over two floors, a stair lift is fitted to assist access to the first floor. Bedroom accommodation consists of fifteen single and one double room. The home has large gardens to the side and rear and ample off road parking at the front of the building. The home is registered to accommodate seventeen older people and the registered provider is Mrs Anne Lewis. The fees charged start from £453 per week and are assessed on an individual basis dependant on care needs and size of room. Charges include all hotel costs, the provision of personal care, basic toiletries, all activities including outings to a local luncheon club and day care provision. The visiting hairdresser charges from £3.50 to £8.00 and £28 for a perm, Chiropody from the visiting chiropodist is charged at £12 per person. The most recent Inspection report is contained in the homes’ statement of purpose and is also available upon request. Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of the Unannounced Inspection of Nightingales a site visit took place of the home. This took place between 10am and 4.30pm on the 5th September 2006. The Inspector had a tour of the building, joined service users in the dining room for their midday meal. The Inspector had discussions with 8 service users, the manager deputy manager and members of staff team and their comments will be reflected within the report. A range of records and documentation were also examined and included some of the homes’ policies, procedures, guidelines and daily records, service users care plans, medication records and records pertaining to health and safety. Service user questionnaires were sent by the Commission for Social Care Inspection (CSCI) prior to the visit and feedback from the 8 completed questionnaires received will be included within the report. What the service does well: The manager of the home appropriately assesses prospective service users prior to their admission to the home. Care plans contain detailed and informative information for staff to follow in relation to supporting service users appropriately. The health care needs of service users resident in the home are met and the medication policies and procedures adopted by the home are safe. All staff receive training in the administration of medication. Nightingales is homely and relaxed. The quality of the food provided to the residents of Nightingales is good and all the comments received by the Inspector in relation to the food were positive. The food served for the midday meal on the day of the site visit was hot, homemade and of good quality, an alternative was available. One service user wrote that the meals at the home were ‘excellent’. Service users have a choice of what time they get up or go to bed and what time they have their breakfast. Many service users stated that they have their breakfast in their rooms and enjoy this. There is a varied programme of activities on offer at the home that the service users are happy with. Staff are employed in sufficient numbers to meet the needs of the people who reside there and receive a comprehensive induction and training programme. The staff team are enthusiastic and open to new ways of working, appear relaxed and interact well with service users. The management of the home is open and transparent. Service users, visitors and staff feel the management are approachable. The health, safety and welfare of service users and staff are largely protected and promoted. Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 DS0000021172.V314715.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 DS0000021172.V314715.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are assessed prior to admission and prospective service users are provided with the documented information they require to make an informed decision about whether or not to reside there. EVIDENCE: All prospective service users are provided with copies of the homes’ Statement of Purpose and Service User Guide and preadmission assessments are undertaken by the manager prior to them being admitted. If the home is able to meet their needs this is confimed in writing. Preadmission assessment documentation was examined and found to be in order. However, not all documentation was signed and dated and it is recomened that the methods used to assess service users is specified e.g. observation, formal assessment tool etc. The home has obtained copies of social services assessments where possible, and this information had been transfered onto the care plan. Service users are able to visit the home to look round, and the first months stay is on a trial basis. Two service users confirmed that they were able to visit and test drive the home before making a decision about whether or not to reside there. Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 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, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users care plans provide the guidance required for staff to support service users in their daily lives. Service users health and social care needs are met. EVIDENCE: Four Care plans were examined and found to be in order. The information provided is detailed and some plans have been signed by service users. Care plans are reviewed on a regular basis and amended as and when needed. Care plans generally provide the guidance required for staff when supporting service users in their daily lives. However, in some care plans specific guidance was missing e.g. one care plan states that assistance is needed for a service user to bathe but it does not specify what this assistance is. As the amount of assistance required varies greatly from individual to individual it is required that care plans detail the guidance that staff need to follow to ensure that the care provided is individualised and promotes independance. Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 10 Medication records were examined and were in order, however, where service users have been prescribed medication that they administer themselves a risk assessment must be completed. Furthermore, it would be useful for staff if care plans specified the condition the medication had been prescibed to treat along with the dose and frequency that it needs to be administered. Discussions with the manager, 2 service users and the examination of care plans and other supporting documentation confirmed that appropriate health care referals are made when required. Service users stated that they see health care professionals in the privacy of their own rooms. Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 11 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 excellent. This judgement has been made using available evidence including a visit to this service. Service users are provided with the opportunity to participate in appropriate leisure and social activities. The food provided is wholesome and nutritious. EVIDENCE: The home provides service users the opportunity to participate in appropriate, enjoyable and stimulating activities. Service users stated they were happy with the activities on offer and the frequency of them. Activities currently on offer in the home include poetry reading, going out for coffee, attending a local lunch club, sing-a-long, a visiting musician, bingo, cards and kareoke. The home employs an activity organiser who works two or three mornings or afternoons a week. Much of her time is spent working on a one to one basis or with small groups providing individualised activities or outings. The home continualy reassesses the activities on offer and is in the process of consulting with residents about whether or not to reinstate residents meetings. They are also asking service users what their preferences are through a questionnaire called ‘Do the residents want it?’. Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 12 Service users stated that they have choice and control over their lives and are able to chose for themselves when to get up, go to bed, what they eat, when they eat, what to wear and whether or not they participate in the activities on offer in the home. The Inspector joined service users for their midday meal. The food served was hot, wholesome, nutritious, of a high quality and well presented. A choice was available and service users stated that they are asked on a daily basis what their preference is for the day. The homes’ menu was examined and confirmed that a varied diet is provided. One service user wrote that the meals at the home were ‘excellent’ another that ‘They always have a good menu – very nice home-made soup.’ Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected by the homes’ adult protection and policies and procedures, and service users feel they are listened to. EVIDENCE: Appropriate safeguarding referrals are made by the home when required and an examination of records confirmed this. None of the service users currently resident in the home present a level of behaviour that is challenging however if this did occur the manager assured the Inspector she would reassess the individuals’ needs make referrals for a more appropriate placement to be found. The homes complaints policies and procedures are satisfactory and service users stated that they are confident in approaching the management if they had any complaints. Service users surveys also indicate this. The home has a copy of the local adult protection policies, procedures and guidelines and the homes’ policies and procedures in relation to raising an adult protection alert have been updated as required at the last Inspection. The home provides staff with the appropriate training in recognising abuse. Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24,25 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, homely, safe, well maintained and clean environment for service users to reside in. EVIDENCE: The Inspector had a tour of the building and grounds on the day of the site visit. The home was clean and hygienic. A lot of effort is made at Nightingales to provide a homely environment for the service users resident in the home. There is a small communal room that contains a computer, library and pleasant seating area. Service users were observed using this room to read newspapers and to spend time with visitors. The lounge area is large and has a range of comfortable armchairs, a piano, television, radio, books, magazines, games, jigsaws and there is a box of biscuits and cooled water on the table. This room leads onto the newly constructed, but as yet incomplete, conservatory that looks out over gardens at the side of the property. Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 15 There is a patio and seating area to the side of the property and many service users enjoy sitting outside the front of the home or in the porch area that is sheltered. There is an extension currently under construction which will provide further bedrooms and the manager explained that improvements are planned for the gardens and patio areas of the home to ensure that all areas are accessible to service users. Service users bedrooms are personalised and meet their needs. Some service users have brought their own furniture and others have chosen to use those provided by the home. Two bedrooms have been redecorated and some of the exterior paintwork has been repainted since the last Inspection. Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 16 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 including a visit to this service. Service users needs are met by the numbers and skills of the well trained staff employed by the home. The recuitment procedures adopted by the home are safe. Not all staff hold the relevant qualifications. EVIDENCE: The home provides a comprehensive, induction and training programme for all the staff employed. The staffing rotas were examined and there are sufficient numbers of staff on duty at all times to meet the needs of the service users resident in the home. Service users stated that under normal circumstances that the staff are able to give them the support they require in a timely way and that they are never rushed. Staff stated that they felt the manager and deputy managers of the home supported them and that they are approachable. The manager stated that being a small home she found it effective to work alongside staff on duty and that she speaks to all the staff on duty each day. The home now employs 2 deputy managers and the manager is in the process of delegating some of her responsibilities to the newly appointed deputy whilst inducting her into the role. The new deputy has obtained a National Vocational Qualification (NVQ) in Care at Level 4 and will soon begin the Registered Managers Award NVQ Level 4. Unfortunately the target of 50 of the care staff employed by the home achieving an NVQ in Care at Level 2 or above has not been met but assurances were given to the Inspector that the home is working hard towards achieving the required number of qualified staff. Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 17 Observations of the staff practice on the day of the site visit confirm that staff are competent and confident. Several staff were able to detail the support required by individual service users and how this support should be delivered. The staff team as a whole appear positive, enthusiastic and open to new ways of working. The recruitment policies and procedures adopted by the home are safe and all the required checks are completed prior to individuals being deployed to work in the home. However, on one of the files examined one of the 2 references obtained had come from a friend of the employee and this is not considered to be good practice. This was discussed with the manager on the day of the Inspection and she assured the Inspector that in future more appropriate references would be obtained. Staff confirmed that they shadowed other staff when they first started working at the home and were required to complete an induction before they could work on their own. Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 18 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): 31,32,33,35,36,37 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is appropriately experienced and qualified and runs the home in the best interest of the service users who reside there. The administration and management systems adpoted by the home are good. The health, safety and welfare of service users and staff is largely protected and promoted. EVIDENCE: The manager of Nightingales is qualified and experienced and has owned and managed the home for a number of years. The service users, and staff that the Inspector had discussions with on the day of the site visit all spoke highly of her management style and stated that they found her approachable. Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 19 The home has service users questionnaires that are given out on a yearly basis and are used to help the home make improvements to the services they offer to service users. An examination of these surveys confirmed that the home consults with service users in relation to food, activities and whether or not they would like a newsletter. Service users stated that they had completed these questionnaires and as a result some were in the process of contributing to the forthcoming newsletter. The home also has a residents comments book that service users use to record comments in relation to food they have enjoyed or would like and the sort of activities they would like to participate in e.g. sewing or do some gardening. The manager explained that these activities have been provided and service users confirmed this to be the case. The home does not manage service users’ finances. On the day of the site visit the manger was meeting with one of the deputies to arrange supervision dates for the staff team. The manager and staff stated that supervision take place on a regular basis and an examination of records confirmed this. Staff meetings take place 2 or 3 times a year, senior care meetings take place on a monthly basis and information is cascaded down to care workers through supervision. All the records examined in the day of the site visit were accurate legible, complete and stored appropriately. Health and safety records were examined and found to be in order. Water temperatures are monitored on a monthly basis and a comprehensive fire risk assessment has been undertaken. In addition to this fire risk assessment of the home it is also required that a fire evacuation plan is implemented for all service users in the home that is based on individual risk assessments. Of concern was the number of fire doors that were wedged or otherwise propped open throughout the home. An immediate requirement was made on the day of the site visit for these to be removed and confirmation that this has been actioned has been received from the manager of the home. Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 20 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 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 2 Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 21 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 15(1) Timescale for action Care plans must provide the 30/10/06 specific guidance required for staff to follow when supporting individual service users. Risk assessments must be 30/10/06 completed for service users who self medicate. Requirement 2. OP9 12(4c) 13(4c) 15(1) 18(1)(a) 3. OP28 4. OP38 5. OP38 That the home continues to work 30/03/07 towards the target of 50 of staff trained to NVQ level 2. This requirement was made following the last inspection of the home timescale 30/12/05 not met. 23(4bc(iii) That the home implements an 30/10/06 e) individual evacuation plan for every service user and that these is used as a basis to formulate an evacuation plan for the home. 23(abc(i)) That no fire doors are wedged or 05/09/06 otherwise propped open, with immediate affect. Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 22 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. Refer to Standard OP3 OP9 Good Practice Recommendations That the home documents the methods used to assess prospective service users and ensures all documentation is signed and dated. That care plans specify the condition for which medication has been prescribed, the dose and frequency of administration. Nightingales DS0000021172.V314715.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 DS0000021172.V314715.R01.S.doc Version 5.2 Page 24 - 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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