Key inspection report CARE HOMES FOR OLDER PEOPLE
Nightingales Nursing Home 355A Norbreck Road Thornton Cleveleys Blackpool Lancashire FY5 1PB Lead Inspector
Mrs Marie Louise Cordingley Key Unannounced Inspection 09:30 23rd July 2009
DS0000067380.V375478.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 2 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Nightingales Nursing Home Address 355A Norbreck Road Thornton Cleveleys Blackpool Lancashire FY5 1PB 01253 822558 01253 829020 contact@nightingalescarehome.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) Nightingales Care Ltd Mrs Suzanne Chick Care Home 55 Category(ies) of Dementia (21), Old age, not falling within any registration, with number other category (34), Physical disability (1) of places Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 55 service users to include up to 21 service users in the category of DE (dementia) up to 33 service users in the category of OP (older people over the age of 65 years) one named person in the category of PD (physical disability under the age of 65 years) 23rd January 2007 Date of last inspection Brief Description of the Service: Nightingales is a Care Home situated in the residential area of Thornton Cleveleys, offering residential and nursing care for 55 residents, including people with dementia. The home was registered under a new provider in April 2006. The manager and staff have remained with the new provider. The main building is a converted and purpose built extension to a farmhouse and has a ground and first floor facility. There are single and double bedrooms which all have en-suite facilities. There is a passenger lift in place. There is another residential building within the grounds and this is known as The Barn, again with ground and first floor facilities. This also has a passenger lift in place. In both buildings of the home there are bedrooms, dining areas and communal lounges. All garden areas around the home are accessible by wheelchair and this includes paved and sitting areas. There is a domiciliary care agency, operated from a small office within the main building. A day care facility is provided to the side of the building. The home is owned by Nightingales Care Ltd and managed by Mrs Suzanne Chick. At the time of this inspection visit (23/7/09) the fees for the home ranged from £375 - £665 with added expenses for hairdressing and chiropody. A daily
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DS0000067380.V375478.R01.S.doc Version 5.2 Page 5 newspaper is provided for the home, but any extra newspapers or magazines are not included in the fees. Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating of this home is one star. This means that people using the service experience adequate quality outcomes. The inspection of this home included a site visit which was carried out over one day. The visit was unannounced which meant that the manager, staff and residents didn’t know it would be taking place until we arrived. During the visit we examined a variety of paperwork including a selection of residents’ care plans and staff personnel files. We also carried out a tour of the home viewing communal areas and a selection of residents’ bedrooms. As part of the inspection we carried out a case tracking exercise. This involved us looking very closely at the care provided to a small number of residents from the point that they were admitted to the home. Prior to our visit, we wrote to the manager and asked her to complete a comprehensive self assessment. This document examines all aspects of the service and also contains some numerical information such as staff numbers and qualifications. We wrote to a selection of people who live or work at the home before we visited and asked them to take part in a written survey about all aspects of the service. We received a number of completed surveys. What the service does well:
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DS0000067380.V375478.R01.S.doc Version 5.2 Page 7 Most of the people who responded to our survey expressed satisfaction with all aspects of the service. Comments included; ‘The home cares for all the residents’ needs. Very friendly and have a good understanding of people’s behaviour.’ ‘Always helpful, friendly and kind. Mum beams with delight whenever she sees a member of staff and this speaks volumes.’ ‘I’d recommend anybody to come here.’ ‘The home seems well organised and there is always a member of staff when you need one.’ During our visit we spoke with several residents and staff members. Again, people were very positive about the home and expressed their satisfaction. One resident told us ‘’I am very well looked after here, I am very happy.’’ Some residents were not able to talk to us but looked relaxed and comfortable in their surroundings. We observed carers going about their daily duties in a pleasant and cheerful manner. Carers seemed to get along well with residents and addressed them in a polite, respectful manner. The home provides a good level of information to people considering a move there, by way of an informative Service User Guide. In addition, people are provided with copies of inspection reports and results from residents’ surveys which are carried out on a regular basis. The home ensures that a care needs assessment is carried out for all prospective residents prior to offering them a place. This is important because it means that new residents can be confident that their needs are understood and will be met. We found that all the residents’ care plans we viewed were very well organised. This means that carers can access information quickly and easily. The home follows thorough procedures when recruiting new staff ensuring that all necessary background checks are carried out prior to a candidate being offered a post. This is important because it helps ensure that only suitable people are offered employment therefore safeguarding residents. The home has a good approach to the induction and ongoing training of new staff. Over half of the care staff employed at the home hold National Vocational Qualifications in care at level 2 or above which means the home are exceeding the national standard in this area.
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DS0000067380.V375478.R01.S.doc Version 5.2 Page 8 In discussion staff told us that they felt well supported and that the management team were approachable. We were able to confirm that all staff have access to regular opportunities to meet with their manager and discuss areas such as training and general work practice. We also noted that the home enjoys a very low turnover of staff which means that residents receive their care from a consistent staff team. We found that the management keep up to date with health and safety legislation and ensure that staff are provided with regular training in areas such as moving and handling and fire safety to help ensure they work with people in a safe manner. There are a number of systems in place to help managers monitor quality and identify areas for improvement. Residents, their relatives and other stakeholders are involved in this process, for instance by taking part in regular surveys held by the home. What has improved since the last inspection?
Some improvements have been made to the environment and several communal areas have been redecorated and refurnished. A number of residents’ bedrooms have also been updated and new carpets have been laid in some areas of the home. Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 9 What they could do better:
We found that assessments covered the necessary areas and explored people’s needs in areas such as mobility, personal care and nutrition. However, in most cases information was brief and lacked detail about the individual, their preferred daily routines and thoughts about how they wanted their care to be provided. This sort of information is important because it helps carers to provide support that is tailored to meet the residents’ individual needs and preferences. Care planning is an extremely important tool when providing care for people who have dementia. Some people with dementia will find it difficult to communicate their needs and wishes, or their preferences in relation to daily life. However, detailed care plans that are well researched, sensitively written and recognise the person’s individuality can assist staff in providing person centred care. Some care plans we viewed lacked detail about people’s social histories and failed to address people’s personal views and preferences. In some examples, there was little information about people’s communication needs or their personal experience of dementia. The home has procedures for the safe receipt, storage, administration and disposal of people’s medicines but we found evidence that these are not followed in the residential unit at all times. When viewing residents’ medication administration records on the residential unit we found some errors. We also found examples of quantities of residents’ medicines not adding up with records. This indicates that some medication had been given but not signed for and some examples indicated that people’s medication had been signed for but not given. Not receiving medication as prescribed can seriously affect people’s health and wellbeing. Some residents’ medication records were not clear and very difficult to follow. We found some examples of hand written entries on the records which were confusing. If records are unclear and hard to understand this increases the chance of people making mistakes. Some residents at the home are prescribed medication on an ‘as and when required’ basis. We found that in some examples, there was little or no written information for staff about what the medicines were for and when they should be taken. It is important that this information be clearly stated so that staff can ensure residents receive their medication when they need it. Activities are provided for people who live at the home but information is not always gathered about individual residents and their needs and preferences in relation to this area. This sort of information is important because it means carers can provide activities the suit the individual.
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DS0000067380.V375478.R01.S.doc Version 5.2 Page 10 The manager is currently in the process of researching good practice in relation to activities for people with dementia. We advised that the area of activities be reviewed to ensure that all residents’ needs are met. We have made a recommendation that consideration be given to appointing an activities coordinator who could oversee this area. The home is generally well maintained and nicely furnished but we did note some issues that need to be addressed. We were concerned to find that not all residents had access to working call bells in their bedrooms. The temperature in one area of the home was found to be extremely warm and we noted that some residents felt uncomfortable due to this. We were also advised by a staff member that the sixteen residents on the residential side of the home only had access to one bathing facility as the remaining facility was out of use. The above matters were discussed with the registered manager following our inspection. We have made some requirements and recommendations in relation to the matters which are detailed later in this report. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 11 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 Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensure they understand and can meet someone’s needs before agreeing to admit them EVIDENCE: A Service User Guide is available for anyone requiring information about the home. The guide covers all aspects of the service including facilities available and fees payable for care and accommodation. The guide also provides a picture of daily life at the home describing arrangements for areas such as mealtimes and activities. In discussion, the manager confirmed that the Service User Guide is available in large print as well as its standard written format. We advised the manager
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DS0000067380.V375478.R01.S.doc Version 5.2 Page 13 to consider other formats the guide could be made available in, for example audio, to help ensure that more people have access to the information within it. We tracked the care of a number of residents and in all cases found that the home had carried out a pre-admission assessment prior to the person moving there. This is important because it means that the manager can be sure that they can meet a person’s needs before they agree to provide them with care and accommodation. It also means that carers have some insight into a person’s needs and can plan their care properly at the point they arrive. We found that assessments covered the necessary areas and explored people’s needs in areas such as mobility, personal care and nutrition. However, in most cases information was brief and lacked detail about the individual, their preferred daily routines and thoughts about how they wanted their care to be provided. This sort of information is important because it helps carers to provide support that is tailored to meet the residents’ individual needs and preferences. We spoke to the manager about our findings and made a recommendation that the assessment process be more person centred to help ensure that people have a say about how their care is provided from the point of their admission. We were pleased to note that around six weeks after a resident’s admission, the home carry out a survey with the residents and where appropriate their families, to ensure that they are satisfied with the service. This is good practice because it gives people the opportunity to be involved in their care planning or discuss any concerns they may have. Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home’s medication procedures need to be followed consistently to help ensure residents’ good health and wellbeing. EVIDENCE: We tracked the care of several residents and found that there were care plans in place for all of them. All the care plans we viewed were well organised and in good order which meant that information could be accessed quickly and easily. People’s care plans contained information about their daily care needs in areas such as health care, nutrition and mobility. Risks to people in areas such as falling or developing pressure sores were carefully assessed and where
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DS0000067380.V375478.R01.S.doc Version 5.2 Page 15 significant risk was identified, there was additional guidance in place to help carers keep people safe. We also found evidence that the home were quick to act when issues were identified in relation to a person’s state of health. Records confirmed that people were supported to access their GPs and other community health care professionals when they needed to. Whilst we found that care plans contained a good level of information about people’s health care needs we did find some examples where they lacked detail about the individual such as their life history, important relationships and hobbies, for example. People’s preferred daily routines, likes, dislikes and views on how they would like their care to be provided were not included in the majority of plans we viewed. In several cases, we found a particular lack of information about the residents’ individual experience of dementia and how this may affect their ability to communicate or make their needs and preferences known. It is particularly important when caring for people with dementia that care plans are well researched and detailed so that staff can provide person centred care which is in line with people’s individual needs and wishes. We tracked the care of one resident who had some complex behavioural needs. Whilst this area of need had been addressed in the resident’s care plan to a certain extent, information was brief and there was little in the way of guidance to staff in dealing with challenging situations. We made a recommendation that more detailed and individualised guidance about how to approach complex behaviours be put in place, so that carers can deal with such situations confidently and consistently. The home has a policy and procedures in place for the safe receipt, storage administration and disposal of people’s medicines. However, we found evidence during our visit that these procedures were not always followed consistently in the residential unit. When checking stocks of medication against records held in the home we found several examples of incorrect numbers of tablets. This indicated that carers had on some occasions, signed to say they had given a tablet when they hadn’t. We also found one example where a tablet had been given but not signed for. A number of residents were prescribed certain medicines on an ‘as and when required’ basis. However, in some cases there was little or no information about what the medicines were actually for and in what circumstances they should be given. This information is essential to ensure that people are given the medicines when they actually need them. Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 16 We found that some medication records were unclear and difficult to follow. In one example the dates on the record could not be determined. There were several hand written entries on medication records that were hard to understand increasing the risk of carers making errors when administering people’s medication. We spoke with the manager about our findings and have made some requirements and recommendation as a result of the issues identified. Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More attention to people’s individual needs and preferences in relation to activities would help carers enhance residents’ daily lives. EVIDENCE: We were advised that activities were made available in the home which included pastimes such as dominoes, crafts and musical entertainers. In addition, we noted that the home has a minibus available for the use of residents and some people had enjoyed trips to places such as the lake district and Blackpool illuminations. People we spoke with during our visit told us that the home didn’t have a set activities programme as such, and that carers tended to organise things on a more informal basis. Whilst it is recognised that a degree of flexibility is necessary due to the fact that people’s preferences may change on a daily basis, we advised that a
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DS0000067380.V375478.R01.S.doc Version 5.2 Page 18 programme should be in place so that residents and their relatives can plan for activities they want to take part in. During our case tracking exercise we found that the majority of people’s care plans lacked information about their preferences in relation to daily routines and activities. Most care plans failed to state people’s hobbies and pastimes or any evidence that they were provided with regular opportunity to take part in things they enjoyed doing. This information is important because it helps carers provide activities that suit people’s individual needs and preferences. The manager advised us that she was in the process of researching the area of activities that meet the needs of people who have dementia but that no specific changes had been made in the area at that time. We advised the manager to continue with her research and develop the activities programme to meet the needs of everyone living at the home. People who responded to our written survey expressed satisfaction with the quality and variety of meals provided. We observed a meal time and noted that all residents were provided with a choice of main course. People spoke with confirmed that this was regular practice. Menus confirmed that the home provides a varied and nutritious diet. The meal served looked appetising and well presented. The mealtime was an unhurried affair and people who required support to eat were given assistance in a discrete manner. Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to raise concerns. Any concerns raised are dealt with appropriately. EVIDENCE: The home has a complaints procedure in place that provides advice about how to raise concerns and the processes that will be followed by the home in this event. We noted that the procedure was included in the home’s Service User Guide and also posted in various places around the home. In discussion, we were advised that if necessary, the procedure could be made available in large print in addition to the standard written format. We advised the manager to consider additional formats such as audio, to ensure that more people have access to the information. The home keeps a record of all complaints received and action taken. We viewed the record which confirmed that the home had dealt with all concerns raised appropriately. There was one ongoing complaint at the time of our visit which had been referred onto additional agencies in line with the home’s procedures.
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DS0000067380.V375478.R01.S.doc Version 5.2 Page 20 During our visit we discussed important changes in the law relating to caring for people who do not have capacity, which have recently taken place. The manager showed a good understanding of the new legislation and confirmed that the home’s polices and procedures had been updated to reflect it. The manager advised us that training was planned for all staff members to help ensure that they understood the new legislation and worked in accordance with it. All homes are required to have procedures that are to be followed in the event that it is suspected a resident has been the victim of abuse – these are called safeguarding procedures. We were able to confirm that the home had safeguarding procedures in place and all those spoken with showed a good understanding of them. Training records confirmed that the majority of staff had been provided with training in safeguarding. The manager advised us that a new training package was now in place and being rolled out as a refresher for all staff members including those who are not involved in people’s care such as domestic or catering staff. Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained and furnished to a good standard. EVIDENCE: During our visit we carried out a tour of the home viewing all communal areas and a selection of residents’ bedrooms. In general, we found the home to be clean, and most areas were well maintained and nicely furnished. People’s bedrooms were comfortable and personalised with possessions such as ornaments and pictures to help them feel at home in their surroundings.
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DS0000067380.V375478.R01.S.doc Version 5.2 Page 22 The manager advised us that the home has a routine programme of maintenance in place. This helps ensures that all areas are maintained in good condition. During our visit we noted that the dining area in the residential side of the home was extremely warm. We witnessed two residents’ raising concerns with staff about the temperature and one resident had to move tables during her lunch because she was uncomfortable with the heat. We spoke with staff who told us that it had been difficult to maintain a comfortable temperature in this area for some time. When viewing the bedrooms of people living on the residential side of the home we were concerned to note that a number of call bells appeared to be out of use. We discussed this with a staff member who advised us that the call bell system was not used in this side of the home. This was of concern as people need to be able to summon help if they need it. However, we were advised at a later date that people were not provided with leads to use their call bells following risk assessments regarding their use. We advised the manager to ensure that such risk assessments were available for inspection in people’s care plans and regularly updated. We were able to confirm that the home has infection control procedures in place and that training is provided for staff in this area. It was pleasing to note that one staff member takes part in a local infection control forum, which enables her to keep up to date with all new developments and good practice and ensures the same is implemented within the home. Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home’s careful recruitment procedures help protect the safety and wellbeing of people who live there. EVIDENCE: We spoke to people who live and work at the home prior to and during our visit. In general people told us that staffing levels were appropriate to meet residents’ needs. One relative wrote ‘There always seems to be a staff member available if you need one.’ We viewed a selection of staff personnel records which confirmed that the home follow careful processes when recruiting new employees. In all the staff members’ files we viewed, there was evidence that appropriate background checks had been carried out such as Criminal Records Bureau checks and a full employment history, prior to the person being offered employment. Carrying out background checks on all candidates helps ensure residents’ safety and wellbeing. Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 24 Records confirmed that all new staff members were provided with induction at the start of their employment. We noted that the induction provided was in line with ‘Skills for Care’ standards and covered areas such as maintaining people’s privacy and dignity and safeguarding. The majority of records we viewed in relation to induction had been signed by all parties however, we did come across come examples where this was not the case. We made a recommendation that all aspects of induction be recorded and signed by all parties as confirmation it has been provided. The home has a good approach to staff training and staff we spoke with told us that they received a good amount of training to help them carry out their roles well. People told us that they had been provided with training in the important health and safety areas such as moving and handling and fire safety. Additional courses in areas such as safeguarding had been attended by some staff we spoke with. However we did note that only a small number of staff had been provided with training in working with people with dementia. This training is important because it helps carers understand how dementia can affect people on a daily basis and the support they need. We made a recommendation in relation to this. Training records confirmed that well over half of the staff at the home have achieved National Vocational Qualifications in care at level 2 or above, meaning that the home have exceeded the national standard in this area. Staff we consulted told us that they were happy working at the home, felt that they provided a good service and also felt that managers were approachable and supportive. Records also showed that people are offered regular supervision where they can meet with their manager and discuss issues such as training or daily working practices. The fact that people felt supported and valued was also reflected in the very low staff turnover enjoyed by the home. A low staff turnover benefits residents because it means they receive their care from people they know and who know them. Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a competent manager who is able to address the areas for development identified in this report. EVIDENCE: The home’s manager has recently registered with the Care Quality Commission and during the process demonstrated that she had the appropriate experience and knowledge to manage the home effectively. Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 26 Throughout the inspection the manager was helpful and cooperative and appeared keen to address the areas we identified for development. The home has its own quality assurance procedures in place which include regular audits and also includes the gathering of residents’ and relatives’ views on a regular basis by way of satisfaction surveys. In addition, the home holds the Investors in People award which requires it to maintain standards in relation to staff training that are monitored by an external agency. An annual development plan is in place and can be made available for anyone wishing to see it. This demonstrates that the home attempt to develop all aspects of the service and keep up to date with good practice. The home has a health and safety policy in place which is supported by a number of individual procedures in areas such as fire safety and infection control. Staff training records showed that the home has a good approach to health and safety training and ensures that staff receive regular updates and refresher training in important areas such as moving and handling. Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 27 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 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x 3 2 x x 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 3 x x 3 Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 13 Requirement Residents’ medicines must be administered as prescribed. This is because not receiving medication as prescribed can seriously affect a person’s health and wellbeing. Records relating to residents’ medicines but be completed in an accurate and clear manner. This is because unclear records could increase the risk of carers making errors when administering a resident’s medication. It must be ensured that any staff member administering residents’ medicines is competent to do so. This is to help ensure the safety and wellbeing of residents. All residents must be provided with access to a working call bell in their bedroom unless a risk assessment determines otherwise. This is to help ensure residents’ safety and wellbeing. The temperature of the home must be maintained at an appropriate level at all times. This is to help ensure residents
DS0000067380.V375478.R01.S.doc Timescale for action 23/08/09 2. OP9 13 23/08/09 3. OP9 18 23/08/09 4. OP22 16 23/10/09 5. OP25 23 23/08/09 Nightingales Nursing Home Version 5.2 Page 29 safety and wellbeing. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP1 OP3 OP3 OP7 Good Practice Recommendations The Service User Guide should be made available in additional formats so that more people have access to the information. The assessment process should be more individualised so that carers have more knowledge and understanding about individual residents. Assessments for people returning for respite care should be carried out prior to their arrival so that the home are aware of any changing needs. People’s care plans should contain more information about areas such as social history, relationships and personal preferences. This will help carers provide a more person centred service. People’s care plans should include evidence that they and where appropriate, their representatives have been involved in the development of their plan. People’s moving and handling plans should be more detailed to help ensure that carers have a good standard of guidance about how to support people in a safe manner. Where people have complex, behavioural needs, individual guidance should be clearly stated in their care plans so that staff have the guidance they need to deal with challenging situations consistently and confidently. Formal, recorded competency assessments should be carried out for all staff who deal with residents’ medication and regularly reviewed. This is to help ensure residents’ safety and wellbeing. Detailed plans should be in place for all residents’ ‘as and when required’ medication. This is to help ensure that people are given their medicines when they need them. All handwritten entries on residents’ medication administration records should be witnessed and countersigned to help reduce the risk of errors. The activities programme should be reviewed to ensure that it meets the needs of all the people living in the
DS0000067380.V375478.R01.S.doc Version 5.2 Page 30 5. 6. 7. OP7 OP8 OP8 8. OP9 9. 10. 11. OP9 OP9 OP12 Nightingales Nursing Home 12. OP12 13. 14. 15. 16. 17. 18. OP16 OP30 OP30 OP30 OP33 OP33 home. Consideration should be given to the appointment of a dedicated activities organiser to help ensure people are given regular opportunities to spend their time in an enjoyable and fulfilling way. The complaints procedure should be made available in additional formats to help ensure that more people have access to the information. All carers should be provided with training in the area of working with people with dementia. All staff should be provided with training in the Mental Capacity Act. All aspects of induction training should be recorded and signed by both parties. Staff meetings should be held on a regular basis. Meetings for residents and their relatives should be held on a regular basis. Nightingales Nursing Home DS0000067380.V375478.R01.S.doc Version 5.2 Page 31 Care Quality Commission North West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk
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