Inspection on 14/08/06 for Nightingales Residential Home

This inspection was carried out on 14th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Nightingales Residential Home 13/02/08

Nightingales Residential Home 15/06/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Nightingales Residential Home Wolverley Court Wolverley Road Wolverley Kidderminster Worcestershire DY10 3RP Lead Inspector Andrew Spearing-Brown Unannounced Inspection 7:30 14 August and 16 September 2006 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nightingales Residential Home DS0000065919.V304666.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.V304666.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 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.V304666.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. New service Date of last inspection Brief Description of the Service: Nightingale Residental 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. The pre inspection information received by the Commission on the 14th August 2006 stated that fees at Nightingales Residential Home currently range from £410.00 to £495.00 per week. Charges / fees do not include newspapers / magazines, hairdressing, chiropody (private), transport (taxis) and holidays. Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An inspector from the Worcester office of the Commission for Social Care Inspection (CSCI) carried out this inspection. The focus of any inspection carried out by the CSCI is to assess the outcomes for people who use the service. As part of the overall inspection of the service offered at Nightingale Residential Care Home two visits to the home were undertaken. The visits to the home were unannounced and lasted a total of 9 hours. The first visit commencing at 7.30 a.m on a weekday while the second visit commenced at lunchtime on a Saturday. This inspection was the first statutory inspection carried out at Nightingale Residential Care Home since the home was registration in March 2006. Prior to the visits a pre inspection questionnaire was posted to the registered persons requesting certain information. This document arrived at the Commission for Social Care Inspection on the same day as the first visit and therefore was not viewed until after that visit. In addition to the pre-inspection questionnaire a number of questionnaires were also sent to the home. A total of 7 residents questionnaires were returned to the commission prior to the inspection while another was received in between the two visits to the home. Some of the questionnaires included additional comments made by residents. Comment cards were also returned from other persons including relatives / visitors as well as health and social care professionals. Comments from these questionnaires are included within this report. At the time of this inspection 11 residents were living at the home including 1 resident who was receiving respite care. As this was the first inspection at Nightingales Residential home certain key standards were concentrated upon to ensure compliance with the regulations. A number of the standards were either only partly assessed or not assessed; these will be fully assessed as part of future key and random visits to the home. What the service does well: Throughout this inspection a number of persons gave positive comments regarding the service provided at Nightingale Residential care home. Some of these comments are included within this report. ‘I am very happy here.’ Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 6 ‘The love and care given . . exceptional’ The main mid day meal seen during this inspection was well presented and tasty. The environment is well kept, clean and tidy without any unpleasant odours. The layout of chairs in the lounge was as such to encourage interaction between residents. The dining room was laid out in an attractive manner. The registered manager has since the registration of the home gained her level 4 National Vocational Qualification – Registered Managers Award. What has improved since the last inspection? What they could do better: The registered persons accept that they have some way to go in order that the service they are registered to manage fully meets the regulations. The registered persons must at all times be mindful of their categories of registration and ensure that people admitted into the home fall into these categories. Care planning and risk assessments were identified as an area of concern in that they were either lacking detail or not in place. Care plans and risk assessments must be regularly reviewed and must be an accurate account of current care needs in order to give guidance to care staff. A number of concerns were noted regarding the management and recording of medication. Evidence of suitable and meaningful activates within the home needs to be developed. Records seen were not sufficient to demonstrate that all staff have received the required mandatory and good practice training. Recruitment procedures shortfalls were identified and need improvement to fully meet the required standard. Some health and safety shortfalls were identified. The practice of propping open fire doors must cease. Other health and safety concerns needed urgent action and as a result an immediate requirement notice was issued. One of Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 7 the registered persons has confirmed to the commission that suitable action took place within the timescale given. 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 Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3 and 4. Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some information is available within bedrooms to assist potential residents and or their representatives make a positive choice; as a new service this needs to be reviewed. Shortfalls in the pre admission assessment and an admission out of category results in the care home failing to have suitable systems in place to ensure that identified care needs of potential residents can be met. EVIDENCE: A copy of the homes Statement of Purpose and Service Users Guide was submitted to the Commission for Social Care Inspection prior to the homes registration. These documents need to be kept under review especially as the service is new. The registered persons must ensure that both documents fully comply with the associated regulations. A copy of any revised versions must Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 10 be sent to the local office of the commission. Each bedroom contained a plastic holder in which a copy of the service users guide was held. A copy of the homes statement of terms and conditions is included within the service users guide and therefore available to residents. In response to the question ‘Have you received a contract?’ on the residents questionnaire five out of seven persons answered ‘Yes’. A copy of the statement of terms and conditions signed by either individual residents or their representative was not in place. The pre admission assessment undertaken by a Director of the home as well as the documentation provided by the placing social worker regarding a recently admitted resident was viewed. Viewing these documents gave cause for concern, as it was clear that the individual resident was admitted out of the homes categories of registration. Staff need to receive appropriate training regarding the meeting of care needs in line with the registration categories agreed and specialist assistance needs to be available as necessary. Some sections of the assessment form completed by a representative of the home were blank; this was of particular concern due to the fact that it was evident that a care need either existed or potentially existed in some of these areas. If the assessment of need is not sufficiently recorded it is not possible to ensure that staff know they can meet the needs of the residents prior to admission. In the event of any future requests for a placement out of registration an application for a variation must be made to the commission and approval gained prior to the admission. Although pre admission assessments take place the registered providers stated that a letter confirming the assessment and their ability to meet care needs is not written to potential residents or their representative. This needs to be introduced for future admissions. Intermediate care is not offered at Nightingale Residential Care Home and the registered persons have no plans to provide such a service in the future. Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care planning and associated risk assessments fail to support care needs due to insufficient detail, which can potentially place individuals at risk. The management and recording of medication was seen to have a number of shortfalls, which could also place residents at risk of harm. Positive feedback was received regarding the care offered to a resident who was terminally ill evidencing a caring attitude at the home. EVIDENCE: As recorded within the section above the initial assessment of one resident was of concern due to the lack of information upon it. The concern was increased due to the fact that no care plan was in place to provide information to carers. As a result cares were provided within very basic or scant detail or information such as: Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 12 ‘little assistance with p/c’ It’s assumed ‘p/c’ refers to personal care. ‘no teeth’ From some information gleaned it was evident that care needs in areas such as sight and mental state existed however no care plan was in place. In addition to no care plans it was also evident that no risk assessments had taken place. The care plan of another resident was also found to be very scant in detail. The daily notes gave cause for concern due to the continual entries regarding sore areas yet they gave no indication for over a week of any intervention by the community nurse. The daily notes failed to give any information regarding the actions to be taken by carers following the community nurse intervention. Risk assessments were either non-existent or insufficient regarding all areas of daily living. Following some areas of concern noted by carers on daily sheets no subsequent observations or action taken was recorded. Another care plan viewed showed no evidence of a review since February 2006. Care plans must be reviewed and up date on at least a monthly basis or more frequently to reflect the changing care needs of residents. As a result of the feedback given regarding care planning one of the registered persons complied some new documentation prior to the second visit of this inspection. The new documentation contained significantly more information. Care plans and risk assessments will be reassessed as part of a forthcoming visit to the home. In response to a question on the questionnaire asking ‘Do you receive the medical support you need?’ 5 people answered ‘Always’ while 2 answered ‘Usually’. ‘I am very happy here.’ ‘The house has a warm friendly atmosphere. .’ ‘ . . the care and kindness afforded to xx at Nightingales are beyond xx expectations, in other words FIRST CLASS.’ Neither care plans nor medication records contained a photograph of individual residents in order that residents could be identified if needed. As part of the inspection the management of medication was assessed. In order to carry out this assessment the storage and recording of medication was examined. As well as the current Medication Administration Record (MAR) sheets a number of previous months sheets held on file were also viewed. Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 13 Concerns were noted regarding some elements of recording upon a number of the MAR sheets viewed which require urgent improvement to safeguard the health, safety and welfare of residents. A number of gaps were evident whereby staff had failed to either sign for medication as given or enter a code to explain why it was omitted. One MAR sheet covering the last week of June showed a course of antibiotic medication consisting of 21 tablets whereby only 19 signatures were in place. Any medication including creams and ointments must be signed for to confirm administration. A list of specimen signatures of those authorised to administer medication was not in place. The majority of medication was booked into the home however on occasions this was not the case. The vast majority of MAR sheets failed to show any known allergies, if none are know the MAR sheets must state this fact. Previous months MAR sheets showed occasions when medication prescribed on a variable dosage was not always recorded correctly to show the actual dose given. It was evident that a review of these drugs has taken place and the variable dosages removed and therefore currently elevating this concern however this needs to be taken into account for any variable dosages in the future. It was noted that a number of MAR sheets were handwritten, any handwritten entries must be double signed to ensure accuracy, the MAR sheets seen were not double signed. A discussion took place regarding amending medication dosages following a telephone call; any such amendments must be confirmed by means of a fax from the surgery, hospital or clinic. MAR sheets showed a small number of medicines, which are self-administered by residents; no risk assessments are in place regarding this as required. Medication was held in a suitable medication trolley. A small stock of medication is held elsewhere, no over stocking was evident. Staff are not recording the date when medication, not included within the monitored dosage system, is opened; this makes a full drug audit difficult. At the time of this inspection no residents were prescribed any controlled medication. The registered persons have attended suitable training regarding medication as stipulated within the National Minimum Standards – Older People. Other staff who have a responsibility for administering medication have received in house training however this is not in line with the required standard whereby training needs to be accredited. Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 14 Standard 11 of the National Minimum Standards looks at the outcomes regarding the care provided to residents who are terminally ill. This standard was not fully assessed however one relative informed the commission of their experience at Nightingales including the following sentiment: ‘ our family were made extremely welcome at Nightingales . . the staff cared for us too, providing food, constant pots of tea and support. The night xx died there was always someone there.’ Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The provision and recording of activities within the home needs to be reviewed taking into account recognised care needs. Meals provided are nourishing and well presented. EVIDENCE: Visitors are able to visit at any reasonable time. Visitors are able to use communal areas such as the lounge or dining room as well as resident’s own rooms as they wish. Involvement with the local community is limited. A scheduled programme of planned activities was displayed outside the office. This notice showed an activity for each day of the week between Monday and Friday. This inspection commenced on a Monday and therefore according to the planned schedule music and movement should of taken place; however this was reported to of moved to a Thursday. In response to a question on the questionnaire asking ‘Are there activities arranged by the home that you can take part in?’ 2 people answered ‘Always’ while 4 answered ‘Usually’ and 1 person answered ‘Sometimes’. Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 16 The scheduled events corresponded to those recorded as requested by residents during a meeting held on 16th June 2006. Two of the registered persons reported that residents tend to go to their bedrooms after lunch and therefore not wishing to partake in any activity taking place. It was reported that no residents attend any outside clubs or society although one resident is an adamant football supporter and attends matches with a member of her family. The religious needs of two residents are meet by means of a visiting priest and vicar. It was evident that residents are able to bring their own personal possessions into the care home. As part of the visits to Nightingales the opportunity was taken to have lunch at the same time as residents. Residents are requested to choose their meal the day beforehand. The main meal on the first day of this inspection was either pork chop and stuffing or cottage pie. The meal was well presented, plentiful and tasty. One comment received by the commission prior to the inspections stated: ‘I like the old fashioned methods of cooking’ Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 17 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): Standards 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some documentation needs to be improved regarding adult protection procedures in order to fully safeguard residents. EVIDENCE: The Commission for Social Care inspection have not received any complaints regarding the service provided at Nightingales. A small number of concerns recorded upon some of the questionnaires sent to residents, their representatives and visiting professionals are recorded elsewhere within this report. Information recorded upon the pre-inspection questionnaire and confirmed during the inspection stated that no complaints have been received at the home regarding the service provided. The homes procedures regarding the protection of vulnerable adults need to be reviewed in line with Worcestershire guidelines. Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 18 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): Standards 19, 20, 21, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The continual desire to improve the environment provides residents with a comfortable place to reside where care needs can be met. Some shortfalls were identified during the inspection, which need to be addressed to ensure safety. EVIDENCE: The dining room is a pleasant area with a number of small tables in place; the walls are adorned with displays of plates and saucers. On arriving for the first visit the tables were set out in an attractive manner for breakfast. Tables were equally well laid out for lunch later in the day. The main lounge on the ground floor has furniture laid out in a manner that could encourage small groups of residents to sit together in order to take part in board games or chat. Lighting within the lounge and the dining room is Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 19 domestic in character. Handrails are not provided; this needs to be regularly risk assessed in relation to the identified care needs of residents. A number of fire doors were held open by means of wooden wedges. The registered persons undertook to take suitable action to provide devises to hold doors open therefore not reducing residents ease of access but also not placing residents at risk in the event of a fire. No officers from either the local Environmental Health Department or Hereford and Worcester Combined Fire Service have visited the home since its registration in March of this year. All areas of the home that were viewed were well decorated and clean, no offensive odours were detected. 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. All bedrooms contain en-suite facilities. It was evident that sufficient hand washing facilities with liquid soap are available as well as personal protective equipment such as gloves and aprons. All carers had anti - bacterial hand gel on their person. A sluicing machine is in place. Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 20 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): Standards 27, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some recruitment shortfalls and shortfalls regarding training provided are of concern and need improvement. EVIDENCE: A staff rota was viewed which evidenced that 2 carers are on duty at all times including the night shift. In response to a question on the questionnaire asking ‘Do staff listen and act on what you say?’ everybody replied ‘Yes’ – however in response to a question ‘Are staff available when you need them?’ 3 people answered ‘Always’ while 5 answered ‘Usually’. One response stated ‘Aware that they have other duties.’ While another reply stated that staff listen ‘When they have time’. Some comments were received from relatives and General Practitioners whereby the comments on whether sufficient numbers of staff are on duty were mixed including a comment about a lack of experienced staff. Taking into account that the home was not fully occupied at the time of the inspection these comments need to be taken into account as further residents are admitted and therefore increasing the number of persons requiring care. Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 21 The files of three members of staff were viewed. It was evidenced that either a PoVA first (Protection of Vulnerable People) clearance or a CRB (Criminal Records Bureau disclosure) was obtained prior to the commencement of duties as necessary. Shortfalls were nevertheless evident regarding the up take of 2 written references prior to the commencement of duties in two out of the three files viewed. Full training records and evidence of training needs analyses taking place were not fully available or in place. These records will be assessed as part of a forthcoming inspection. In the meantime the commission draws the registered persons attention to the associated standards and regulations. Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 22 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): Standards 31, 33, 34, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The successful completion of the manager upon the Registered Managers Award should assist in promoting good practice and safeguard residents. Quality Assurance systems need commencing to assist in the development of the home. A number of health and safety shortfalls were noted which could potentially place residents at risk. EVIDENCE: As part of the registration process the registered manager was required to obtain the Registered Managers Award, level 4 National Vocational Qualification (NVQ). This award was obtained in July 2006. Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 23 The home does not routinely hold money in safe keeping for residents. A small amount of cash is retained for one resident; after an initial error in recording was sorted the money held was found to balance with the record held. As the home is newly registered and currently caring for a small number of residents no quality assurance systems were assessed as part of this inspection. Methods for measuring the quality of care provided will be assessed as part of a future inspection. Staff supervision is not taking place as stipulated within the National Minimum Standards. The formal process of staff supervision therefore needs to be introduced. As reported elsewhere within this report it was evident that some records are not sufficiently up to date in order to ensure effective and efficient running of the home. The registered person supplied a copy of the homes policies and procedures, which were viewed outside of the actual visits to the home. The registered persons are aware of the requirement to notify the commission of certain events or circumstances within the home. Records of water temperatures are maintained, showing that all outlets recorded a hot water temperature of 43°C /- 1°C on two occasions since registration. In order to provide sufficient hot water the registered providers have installed a combi boiler on each floor. Documentation was faxed to the commission to demonstrate that water chlorination had taken place. Lifting equipment within the care home is either new or was serviced prior to registration. Documentation was faxed over to the commission following the inspection. The registered persons need to be mindful that under the Lifting Operations and Lifting Equipment Regulations 1998 all equipment used to lift persons must be serviced every 6 months. A number of health and safety concerns were noted as part of the second visit to the care home. As a result of these concerns an immediate requirement notice was issued which was followed up by means of a letter to the registered persons. The company secretary responded immediately to the letter confirming that the required action had taken place. In order to ensure continual compliance the home must ensure the following: 1. That all cleaning materials and any other substances listed under the Control of Substances Hazardous to Health Regulations (COSHH) are held securely at all times. 2. That the fire alarm is tested on a weekly basis and in sequential order. 3. That all fire doors close fully into their rebates. Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 24 As indicated elsewhere within this report the training records of staff were not fully available and will therefore need to be assessed as part of a forthcoming inspection. Some health and safety records were not available and therefore will be assessed as part of the next inspection. The registered persons need to ensure that all records are in order and available for future inspection. Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 25 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 2 2 1 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 X 11 3 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 2 2 3 3 X X 3 3 3 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 1 2 2 Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/A 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 Timescale for action 31/10/06 2. OP3 14 3. OP3 14 4. OP4 14(1)(d) The registered persons must ensure that residents are provided with an individual and signed copy of their terms and conditions. The registered persons must 14/08/06 ensure that a full assessment of prospective residents is undertaken prior to them moving into the home and must include all aspects of their care needs. The registered persons must 14/08/06 ensure that residents admitted into the care home fall within registration categories or otherwise an application for a variation of registration must be submitted prior to admission. The registered persons must be able to evidence that staff within the home have the necessary skills and experience to manage the care needs of any person for whom a variation may be sought. The registered persons must 31/10/06 ensure that a letter confirming the homes assessment and the ability to meet care needs is sent DS0000065919.V304666.R01.S.doc Version 5.2 Nightingales Residential Home Page 27 5. OP7 15 6. OP7 15 7. OP8 12 13 8. OP9 13 (2) 9. OP9 13 (2) 10. 11. OP9 OP9 13 (2) 13 (2) 12. 13. 14. OP18 OP19 OP38 OP19 12 13 23 23 (4) to potential residents or their representative. Each resident must have a comprehensive care plan in place which is regularly reviewed and updated and reflects all aspects of their care needs. Care plans must be signed, dated and, where possible, the signature of the resident or representative included. Risk assessments must be carried out and reviewed on a regular basis in relation to all aspects of actual or potential care need. The information from the risk assessment must form part of a comprehensive care plan. The Medication Administration Record (MAR) sheets must not contain any blanks. Each space must be either signed to show that medication was administered as prescribed or a code must be in place to demonstrate the reason for the omission. The MAR sheets must indicate any known allergies. If non are known the MAR sheets must reflect this information. Handwritten amendments to MAR sheets must be double signed. The date when all prescribed medication including creams not included within the blister pack system must be recorded upon the box / bottle / container. The procedure for dealing with suspicions or allegations of abuse must be reviewed. Fire doors must close fully into their rebates The registered persons must make suitable arrangements to DS0000065919.V304666.R01.S.doc 14/08/06 14/08/06 14/08/06 14/08/06 14/08/06 14/08/06 14/08/06 31/10/06 18/09/06 31/10/06 Page 28 Nightingales Residential Home Version 5.2 OP38 15. OP27 18 16. OP29 19 17. OP30 OP38 18 18. OP33 24 19. OP36 18 (2) 20. 21. OP37 OP38 17 13 22. OP38 23 ensure that fire doors do not have to be propped open to afford residents ease of passage. The registered persons must ensure that a suitable number of staff are on duty throughout the day to meet the care needs of residents. Staff employment files must contain all the required information as specified in Regulation 7, 9, 19 and Schedule 2. All staff must receive the training to meet the care needs of residents and the requirements of the standards. A quality assurance system must be put in place in order to audit the service provided by the home. Care staff must receive formal supervision at least six times a year that includes all aspects of practice, philosophy of care in the home and career development needs. All records must be kept in accordance with the regulations. The registered persons must continue to ensure that all hazardous substances are held securely at all times. The registered person must ensure that full and accurate fire safety records are maintained and available for inspection. 31/10/06 31/10/06 31/12/06 30/11/06 31/01/07 31/10/06 18/09/06 18/09/06 Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 29 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. Refer to Standard OP1 Good Practice Recommendations The statement of purpose should be reviewed following a period of six months registration to ensure it accurately accounts for the service offered and meets the necessary regulation. The service users guide should be reviewed following a period of six months registration to ensure it accurately accounts for the service offered and meets the necessary regulation. 2. OP1 Nightingales Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Residential Home DS0000065919.V304666.R01.S.doc Version 5.2 Page 31 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!