Inspection on 13/02/08 for Nightingales Residential Home

This inspection was carried out on 13th February 2008.

CSCI found this care home to be providing an Adequate service.

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 Residential Home 15/06/07

Nightingales Residential Home 14/08/06

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Maple Lodge

Heathlands

Aston Court Nursing Home

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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 Residential Home Wolverley Court Wolverley Road Wolverley Kidderminster Worcestershire DY10 3RP Lead Inspector Andrew Spearing-Brown Unannounced Inspection 13th February 2008 09:15 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 Residential Home DS0000065919.V360066.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 Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingales Residential Home Address Wolverley Court Wolverley Road Wolverley Kidderminster Worcestershire DY10 3RP 01562 850201 01562 852530 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) Miss Samantha Tracey Wilkins Mrs Frances Jane Butterell, Mrs Dawn Lillian Wilkes Mrs Dawn Lillian Wilkes Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26), Physical disability (3) of places Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents residing within the self contained flat must be in the category OP only. 15th June 2007 Date of last inspection Brief Description of the Service: Nightingales Residential Care Home Wolverley Court is a large Grade two-listed country house. It is situated in a rural area and is served via a private driveway. The village of Wolverley is on the outskirts of Kidderminster. The house was converted a number of years ago into a care home providing residential care for older people. Following the closure of the former care home the building was unused for a period of time until the current owners purchased it and sought a new registration. The house has three floors with 24 beds in total, in addition is a two bedded self-contained ‘flat’ bringing the total number of registered places to 26. Within the main house bedrooms are situated on the ground floor, first floor and second floor these can be reached by means of a passenger lift. The house retains its historical status as a grade two listed building - most of the original windows are in place. Planning permission is required for any changes to the building both internally and externally. The gardens are extensive and well maintained. Ample car parking is available to the front of the house. For up to date information regarding fee levels at Nightingales the reader should contact the provider directly. Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We, the commission carried out this inspection without any prior notice. Two of the owners were available during this inspection. The registered manager, who is also an owner of the home, was not on duty during this visit. This inspection takes into account information we have received since the last inspection as well as the visits to the home. During the inspection discussions were held with the above owners, the deputy manager, a number of staff members and people using the service. We had a look around the home and observed what was happening. In addition we viewed the care documents regarding some people using the service such as care plans, risk assessments and daily records. In addition we viewed medication records, staff training records and recruitment records. What the service does well: Information is available regarding the home for potential users of the service. The registered providers ensure they have sufficient details of the care needs of an individual prior to their admission in to the home. Daily notes are extensive and highlight significant events that have taken place. We saw evidence that activities are provided for people using the service. The environment is well kept, clean and tidy. No unpleasant odours were detected during our time in the home. The furniture in the lounge was set out in a way to encourage people to talk to each other. The dining room was attractive and created a pleasing place to eat. The grounds around the home are well maintained and extensive. People using the service were complementary about the food provided. People were also complementary about staff and the care they receive. Nightingales Residential Home DS0000065919.V360066.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. The summary of this inspection report can be made available in other formats on request. Nightingales Residential Home DS0000065919.V360066.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 Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 5. Standard 6 is not applicable. Quality in this outcome area is adequate People’s care needs are assessed prior to them potentially moving into the care home to ensure that care needs can be met. The information available to people prior to admission and information to ensure that people’s rights are observed following admission needs to be amended and up dated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We did not view either the Statement of Purpose or Service Users Guide as part of this inspection. We were informed that no amendments have taken place to either of these documents. It was agreed during this inspection that a review needs to happen to ensure that both documents fully reflect the current situation within the home. It was noted that copies of the users guide were available within each bedroom. Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 9 We were informed that the necessary amendments to the homes terms and conditions have not yet happened and that the registered providers are currently revising this document. The file of one person using the service contained a copy of the document formally used. These amendments need to happen with a degree of urgency in order that people receive up to date information and have their rights preserved. The file regarding one person recently admitted into the home was viewed. The file contained a copy of the Community Care Assessment completed by a social worker in the funding authority. From this document an initial care plan was set up. We saw evidence that the provider carried out their own assessment of care needs and that the persons representatives visited the home before the admission. From the information available to the provider an initial care plan was devised which continued sufficient information Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is adequate Improvements have taken place regarding care planning processes within the home although they are not always totally up today. Care staff are aware of individual care needs but having up to date care plans would ensure that care is given in a constant manner. Some further improvements are necessary regarding the management of medication to ensure that people are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We viewed a number of care plans as part of this inspection. We have in the past had concern about care planning within Nightingales care home. At the time of the last random inspection we stated that that the registered persons had obtained new care documentation. We reported that the new documents were extremely lengthy containing many pages that may be unnecessary. Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 11 Since the above inspection it is evident that staff have spent a considerable amount of time completing the documentation. The documents are extensive and in places repetitive. The paperwork identified a range of care needs. Care plans were in place in relation to the majority of these needs. The care plans in place are reviewed on a regular basis and we saw evidence that people using the service were involved in or have signed that they agreed with the plan of care. Daily notes continue to be very detailed. We noted that significant events were highlighted in order to ensure that they were brought to the attention of the reader. The daily notes in relation to one person showed a number of issues where no care plan was drawn up such as during a chest infection and while the individual was on antibiotic medication. The same person had trouble with his hearing. Although advice was sought no plan of action was implemented. The daily notes were unclear as to the agreed plan of care in relation to applying some cream. The notes stated that following a visit from the community nurse staff were not to ‘use the blue cream anymore’ – it was not possible to establish what the ‘blue cream’ was. Information on the care plan was inconsistent with the daily notes regarding where the cream was to be applied. Although gaps or omissions were found in the care planning care staff had a good knowledge of care needs. The registered person accepted that further improvements are necessary with the care planning to ensure that it meets the necessary standard. One person was heard saying that she was late waking up therefore ‘must be feeling better.’ Another person described staff as ‘very good – all good’ and told us that she has a wash every morning and then has a cup of tea when she first comes down. People using the service told us that staff knock on bedroom doors before entering their bedroom. Nobody raised concern regarding the care they receive. As part of this inspection we assessed the management of medication. In order to carry out this assessment we viewed the current months Medication Administration Record (MAR) sheets. We also checked some of the medication held within the trolley. The trolley was suitably secured to the wall and was found to be clean and tidy. Overall we have seen a significant improvement in the management of medication within the home. It was evident that the senior staff who were present at the time of our visit are keen to get the management of medication right. They acknowledged the importance of ensuing that people receive the right medication at the right time with acturate and up to date records in place. Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 12 The majority of the records were in order although a number of shortfalls were noted. We found that one person had run out of medication however we were assured that the relevant GP’s surgery was contacted as it was evident that the monthly prescription was not sufficient to cover the whole month. We found a similar situation on another MAR sheet. The fact that we found some evidence of medication running out during both this and the previous inspection was a concern. Although evident that the home had made effort to bring the matter to the attention of the relevant GP it is essential that this matter is sorted. Some further improvement is necessary to ensure that medication carried over from one month to another is recorded in order that a full medication audit is possible. A number of audits were carried out. In order for this to be done it is essential that the date when boxed medication is opened is recorded, we found that this was not always the case. One audit balanced fully while another one showed a difference of ½ a table. We counted the signatures recorded on the MAR sheet following a course of antibiotic medication and found an excess of signatures. This indicated that staff are not always checking the MAR sheet and signing at the point of administration. At the time of this inspection no controlled medication was held. On arriving for the second part of this inspection the medication trolley was in the dining room as the member of staff needed to attend a situation elsewhere in the home. Although the trolley was not secured to a wall it was locked and therefore unauthorised persons could not open it. Nightingales Residential Home DS0000065919.V360066.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good Stimulation is provided within the home by means of different social and recreational events. The food provided meets people’s expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection we were informed that no activities coordinator was employed but that a post had been advertised. As a result care staff currently undertake this role as part of their duties. One carer stated that more time is needed to fully meet peoples care needs regarding activities but confirmed that events such as exercise sessions and sing songs happen. A number of people told us about the things they do during the day. We were told that people can have their hair done on a Tuesday and people spoke about attending an exercise session on a Thursday. We were told that staff spend time doing people’s nails. One person stated ‘something to do most days.’ Another person told us that she spends most of her time in her bedroom but does attend the bingo. Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 14 On the afternoon of our second visit to the home an entertainer visited. A number of people using the service attended the music session in the lounge joining in with many of the popular songs. We were told that nobody currently attends church services outside of the home. A religious minister was reported to visit the home once a week to visit one person. It was reported that nobody else has expressed any interest in meeting any religious care need and therefore no in house services take place. Library books are available for people to borrow, it is planned to explore the availability of talking books for anybody who might be interested in using that resource. Some photographs in the entrance hall showed a small number of people who use the service attending a recent Proms concert in Kidderminster. The record keeping demonstrating what activities have taken place and who attended need to be improved in order to evidence what has taken place. These records could also be a means of evaluating the effectiveness and meaningfulness of activities provided. We were informed that people are able to go to bed and get up when they wish. One person using the service was complementary regarding the food available within the home ‘ Have a good breakfast. Some people have bacon and egg’. When speaking about the main mid day meal the same person stated ‘Have a choice of two each day. Yesterday we had chicken and rice or belly draft and a variety of vegetables.’ Nightingales Residential Home DS0000065919.V360066.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 17. Quality in this outcome area is adequate The availability of the complaints procedure and the recording of any concerns made needs to be improved to ensure that people’s rights are protected. The training method regarding safeguarding needs to be reviewed to ensure that it fully meets the needs of staff in order that people are aware of their responsibilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last key inspection we have received a number of concerns in relation to the service provided at Nightingales. One matter was brought to our attention via a local community nursing team regarding the service provided to a named individual. This matter was referred to the local Adult Social Services who take the lead in coordinating safeguarding matters and the concerns were discussed with the registered providers. The registered providers cooperated with the investigation and provided an improvement plan, as required following our previous inspection, as part of their action plan. At the same time as the above safeguarding investigation was taking place an additional concern was received regarding the availability of staff to attend to visiting professionals. These concerns were forwarded to the registered providers for them to investigate and take appropriate action. Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 16 The homes complaints procedure is included within the service users guide. The registered person is aware that this needs to be amended. The complaints procedure was not displayed within the home. The home did not have a complaints log available although issues were recorded and held on individual peoples files. The registered person was aware of the local safeguarding procedures and of the safeguarding coordinator having met that person during the above investigation. It was evident that staff have received in house training in safeguarding however one member of staff stated that she did not learn a lot from the DVD used for the training. The actual content and substance of this training was not fully assessed however staff consulted had a suitable knowledge on the action they would take in the event of actual or potential abusive situations. Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 24 and 26 Quality in this outcome area is good People living in the home are provided with a homely, comfortable and clean environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nightingales Residential Care Home is a large Grade two-listed country house situated in Wolverley on the outskirts of Kidderminster. The home is reached by means of a private driveway. The home is registered to accommodate 26 people as detailed earlier in this report. We undertook a tour of some parts of the home. All the areas we viewed were reasonably decorated, clean and tidy. Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 18 The home has a large open reception entrance hall leading to both the main lounge and the dining room. The dining room itself is a pleasant area with a number of small tables seating a maximum of four people each. Dining room tables were well set out for forthcoming meals. The dining room walls are adorned with displays of plates and saucers. The main lounge on the ground floor has furniture laid out in a manner that could encourage small groups of people using the service to sit together in order to take part in board games or chat. Lighting within the lounge and the dining room is domestic in character. Handrails are not provided; this needs to be regularly risk assessed in relation to the identified care needs of individuals receiving a service. All the radiators that we saw during our visit were suitably covered to prevent accidental scalding. Some pipe work feeding a radiator was very hot to touch and needed to be risk assessed to establish the risk of people either falling on to it or somehow coming into contact with it and the potential risk of injury. We have previously noted that a fire door leading into the lounge did not close fully into its rebate. It was previously stated that due to the fact that the property is a listed building the registered providers were experiencing difficulty in fitting a replacement door. Although the door continued to not close we were informed that the matter is now resolved and the problem could now be addressed in order to safeguard people against the risk of fire spreading. One door on the top floor was wedged open. We were informed that a devise that would automatically close the door in the event of the alarm sounding was going to be fitted. Communal areas such as bathrooms and toilets were clean. The home has 3 bathrooms, one on each floor although the bath on the top floor has no hoisting equipment over it. In addition a shower is provided on the ground floor. Liquid soap was available in the areas we viewed All bedrooms contain en-suite facilities. It was evident that people residing within the home are able to bring in personal belongings such as furniture and ordainments. People using the service stated that hot water was plentiful. The grounds around the home are extensive and well maintained. One person mentioned the outlook as one reason for selecting the home. Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate The level of staffing was sufficient to meet the care needs of people using the service. Improvements have taken place regarding the provision of training, future training needs to be purposeful and carried out by all members of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prior to this inspection we received a concern from a visiting professional regarding the amount of time it took to have the door answered. Once entry was gained the same person was concerned that no member of staff was available and needed to seek assistance from a member of staff not involved in the delivery of personal care. As a result of the concern the registered persons stated that they intended to have a member of staff available to answer the door and the telephone in order to prevent any future occurrence. When we arrived for the second visit of this inspection the door was opened to us by somebody who had arrived for work at the same time and had entered the home herself via another door. Once inside the home no carers could be found. It was evident that the person who had been administering medication was called away to assist elsewhere in the home. Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 20 At the time of this inspection 15 people were residing within the home. Staffing levels were sufficient to care for this number of people. Staffing levels will need to be reviewed once additional people are admitted into the home especially during the afternoon and in the evening. In addition to care staff were two domestics and the cook. We were assured that staffing levels at weekends are usually the same as throughout the week. People consulted were generally complementary about the staff employed. Staff recruitment was inspected as part of our random inspection during November 2007 at which time we were satisfied that suitable recruitment procedures were in place. We were informed that no new employees have joined the staff team since the random visit. At the time of our last inspection we acknowledged that a training manager had recently started and that the necessary actions would be taken to address the shortfalls in training. We saw improvement as part of this inspection although further improvement is needed in order to ensure that staff have the necessary knowledge and skills to carry out their jobs fully and effectively. It was reported that a new company to carry out moving and handling training was sought and that this training was due to take place the in the two weeks after this inspection. We were also informed that most staff had attended basic food hygiene training and that staff were awaiting their certificates. The training manager carries out some of the training herself such as fire training and safeguarding, it is essential that the person carrying out the training has suitable and sufficient knowledge themselves in order to deliver this training. One member of staff commented that she had not learnt a great deal by watching a DVD on safeguarding. It was evidenced that one of the registered persons and the deputy manager cover the carers duties while staff are on training events. The number of people who have obtained a National Vocational Qualification has improved. At the time of this inspection a total of 8 members of staff out of 19 carers have completed this training therefore just short of the 50 stipulated as needed within the National Minimum Standards. We were informed that a further 3 members of staff are currently undertaking this training and that another 3 are due to commence the training. Assuming no other changes take place once the above staff have finished this training the percentage of trained staff will be in excess of the 50 level. Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Quality in this outcome area is adequate Management systems need to be reviewed and improved to ensure that staff feel they receive suitable support and direction. Quality monitoring systems need to be in place to ensure that standards can be assessed and continually improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager was not on duty during this inspection. Following the registration process the manager completed the Registered Managers Award (RMA), which is a level 4 qualification in care. We were informed at the time of registration that one of the other owners would be taking on the role of Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 22 responsible individual. It was evident from documentation such as care plans, staff minutes and comments made by people using the service that the above arrangements are not actually what is happening. People using the service named the responsible individual as the person in charge or the person they would speak to if they had any concerns. We must be informed of proposed or already completed changes to the management responsibilities if they, as believed from above, affect the registration status of the home. Staff meetings are now taking place. Significant improvements have taken place in formal staff supervision although some staff have not received any supervision session at the time of this inspection. The training manager who now carries out the supervision of staff was aware of the people that she had not as yet seen. A new format for recording these sessions is in place. It was evident that staff had received a copy of the General Social Care Councils guidelines during their first session. We were concerned about some of the comments coming out from staff especially in relation to the management of the home. The majority of concerns were in relation to a lack of direction and leadership. These concerns were discussed with the registered person present who gave us assurance that action was taking place to resolve these concerns. People using the service were complementary of the registered person and gave no indication of any concern. The registered persons have, since our last inspection, purchased a commercially produced quality assurance document. To date no action has taken place in implementing this. The registered person stated that she had concentrated on improving care plans and therefore some areas including quality assurance still needed to be actioned. We briefly viewed the fire records and found them to be satisfactorily with evidence of weekly testing in sequential order of the fire alarm. A piece of hoisting equipment had a label on it evidencing that recent servicing had taken place. Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 24 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 OP2 Regulation 5 (1) (b) Requirement The registered persons must ensure that the review of terms and conditions takes place and that individuals receive a copy of this document. Care plans must be up to date and fully reflect current care needs in order that carers are given sufficient guidance and instruction regarding these needs. Medication records must be an accurate account of items given and must be completed at the time of administration. All members of Staff must receive appropriate training in order to carry out the full range of their duties. Timescale for action 30/04/08 2. OP7 15 30/04/08 3. OP9 13 (2) 13/02/08 4. OP30 18 31/05/08 Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 25 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. 5. Refer to Standard OP1 OP1 OP18 OP33 OP36 Good Practice Recommendations The proposed reviewed of the statement of purpose should take place to ensure that it accurately accounts for the service offered. The service users guide should be reviewed to ensure it accurately accounts for the service offered. A review of the effectiveness and suitability of the current training in safeguarding should take place to ensure it is fit for purpose and protects people using the service. A quality assurance system should be implemented to monitor service delivery and assist in continual improvement. The improvements noted regarding the frequency of staff supervision should continue to include all carers employed within the home. Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Nightingales Residential Home DS0000065919.V360066.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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