Inspection on 15/06/07 for Nightingales Residential Home

This inspection was carried out on 15th June 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Nightingales Residential Home 13/02/08

Nightingales Residential Home 14/08/06

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 15th June 2007 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nightingales Residential Home DS0000065919.V335781.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.V335781.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.V335781.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. 14th August 2006 Date of last inspection Brief Description of the Service: Nightingale 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. The pre inspection information received by the Commission on the 23rd May 2007 stated that fees at Nightingales Residential Home currently range from £430.00 to £500.00 per week. Charges / fees do not include newspapers / magazines, hairdressing, chiropody (private), transport (taxis) and holidays. Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One regulation inspector based at the Worcester office of the Commission for Social Care Inspection (CSCI) undertook this unannounced key inspection over two separate days. This inspection takes into account any information received by the CSCI in relation to the home since the previous inspection which took place during August 2006. Prior to this inspection a pre-inspection questionnaire (PIQ) was posted to the home for completion. A completed document was returned to the commission prior to the first visit to the home. In addition to the PIQ a number of questionnaires were also sent to the home to be distributed amongst people using the service and their relatives. A small number of completed questionnaires were returned to the commission. The contents of these questionnaires are taken into account as part of this inspection. The registered manager was present within the home during a sizeable part of this inspection. Discussions took place with the registered manager, another of the registered providers, two visitors, some members of staff and a number of people using the service. A partial look around the home took place, which included a number of bedrooms and communal areas. The care documents of a number of people were viewed including care plans, daily notes and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. At the time of this inspection the home was accommodating 16 people therefore a number of vacancies existed. The ‘flat’ accommodation has not been used since the home was registered with the current providers. What the service does well: Both prior to this inspection and during the visits to the home the commission received a number of positive comments regarding the care provided at Nightingale Care Home. These comments were either by means of questionnaires sent out to people or verbally to the inspector while in the home. A letter containing a complement regarding the service provided was seen during this inspection. A number of these comments are included within this report. Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 6 Staff were seen to be suitably respectful to people using the service. The main mid day meal seen during this inspection was well presented and tasty. A number of people using the service mentioned that activities take place within the home and spoke to a recent outing. Following a recent incident within the home the registered providers have increased their awareness of procedures surrounding the protection of people using the service. 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 people using the service. 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: Following the last inspection the registered persons accepted that they had some way to go in order that the service they are registered to manage fully meets the regulations. These persons still have a sizeable way to go in order to meet the regulations especially in relation to care planning and medication management. Care plans and risk assessments must be in place and must be regularly reviewed. Care plans must be an accurate account of current care needs in order to give guidance to care staff. Pre admission assessments must be in sufficient detail in order that a care plan can be generated. A number of concerns were noted regarding the management and recording of medication. The number of staff on duty at certain times of the day needs to be reviewed to ensure that the care needs of people using the service can be met. The Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 7 recent appointment of a training manager should assist the home in providing the required training. Quality assurance systems need to be introduced into the home. A number of health and safety matters need to be addressed including ensuring that suitable window restrictors are in place and the safe storage of cleaning materials. Unmet requirements from the previous inspection have been revised and group into a more limited number in line with CSCI policy. Therefore the number of requirements is reduced however this does not necessarily indicate improvement in the associated standards. 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.V335781.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.V335781.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3. Standard 6 is not applicable to this service. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The care needs of people who may potentially reside within the home are assessed prior to their admission. However the detail and extent of the assessment is not always sufficient to ensure that care needs are going to be able to be met. EVIDENCE: Neither the Statement of Purpose or the Service Users Guide were viewed as part of this inspection. The previous inspection visit had noted that the users guide was available within each bedroom. It was noted during the previous inspection that as the service was relatively newly registered these documents needed to be reviewed regularly to ensure that they were an accurate reflection of the service offered. Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 10 The pre admission assessment of a person using the service was viewed. The individual concern had entered the home on a respite basis (short stay) however the placement was extended. It was evident that an assessment had taken place by one of the providers however the document was not dated and not signed. Another pre –admission assessment was also viewed and although acknowledge that it formed a reasonable baseline for a care plan no care plan was devised. As a result the only information available to carers was the initial assessment, which was therefore too scant in detail. It is of concern because a lack of detail was also highlighted as part of the previous inspection report. There was no evidence to suggest on this occasion that the home had admitted anybody outside of its registration categories. Although Nightingale Residential Home provides respite care it does not provide intermediate care and has no plans to do so in the future. Nightingales Residential Home DS0000065919.V335781.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 and 11 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Care plans were not always in place or up to date therefore care staff were not provided with the necessary information to ensure consistency in care delivery. Medication records were insufficient and did not at times evidence that people using the service are receiving their prescribed medication. EVIDENCE: As part of this inspection a random sample of care plans and associated documents were requested and viewed. Three separate cardboard folders were in place in relation to each person using the service. One folder contained medication records, one contained daily notes and the third one contained other information. Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 12 The care plans seen during the first visit were of a poor quality, lacked detail and were out of date. As highlighted within the previous section one person using the service was initially admitted into the care home for a short respite period. The placement was extended and a number of months later no care plan existed. The lack of a care plan was mentioned within the previous inspection report and was therefore a concern that this shortfall was found as part of this visit. One persons care plan was dated January 2007. Since that date no amendments or reviews could be found. A file showed records regarding weights however these were last recorded towards the end of April 2007. On another file weights were last recorded in February 2007. The care plan was not dated and the moving and handling document was done prior to December 2006 with no reviews having taken place. Another care plan viewed did not contain information, which was evident from reading the daily notes. This could lead to inconstancy in care delivery or care needs not met. As a result of the concerns noted an urgent action letter was issued giving the registered providers 28 days to ensure that a comprehensive care plan was in place in relation to each person using the service. The second part of this inspection took place after the above period of time had elapsed. It was noted that the registered providers had failed to respond in writing to the urgent action letter as required. The failure to respond to this letter is a concern. A sample number of care plans were viewed as part of the second visit to the home. Initially the plans seen were similar to those seen during the first visit giving further cause for concern, as they appeared to be equally insufficient. It became apparent that revised care plans were available however they were held within a locked draw and therefore not accessible to care staff. The standard of the revised care plans was significantly better. The remaining care plans needed to be brought up to a higher standard and the improvement needs to be sustained. As a result of the findings during this inspection care plans will be reassessed as part of a forthcoming visit to the service. Although cares plans were in many cases insufficient the daily notes held were detailed and generally provided a good account of how individuals had spent their day. Shortfalls were however found with the daily records as concerns mentioned were not always followed up or if they were the action taken was not always recorded. Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 13 People using the service have access to health care services such as GP’s and community nursing services. No medical professionals have raised any concerns to the commission regarding the care provided. It was reported that the home operates a key worker (named worker system). Key workers provide information to one of the registered providers so that care plans can be undated. The current system for the up dating and monitoring of care plans needs to be reviewed following the findings of this inspection. A relatively small number of questionnaires were returned to the commission completed by relatives of people using the service. Two out of three respondents believed that the home always meets the care needs of their relative while one stated usually. All three respondents believed that the home keeps in touch with them as needed. One member of staff stated that s/he believed the best thing about the home to be ‘ the care residents receive’ ‘the care is fantastic’. One person was using a ‘hospital style’ bed. Bedrails were in use however bumpers to prevent entrapment were not available. A risk assessment was seen however it lacked proper instructions and potentially left the individual at risk of serious injury. On the first day of this inspection it became evident that the registered providers were not aware that a Controlled Drugs Register (CDR) was necessary to record the stock of medication held and the administering of controlled medication. It was of concern that the providers were not aware of the need to have a CDR despite training undertaken and the availability of guidance. Following a further discussion with the inspector a CDR was obtained and available for inspection during the second visit to the home. Some concern remained however as an item which needed to be recorded within the CRD was not. Medication dispensed on the 14th July did not have two signatures as required. The MAR (Medication Administration Record) sheets were viewed during both visits to the service. Some areas of good practice were seen for example the medication trolley was secure and found to be clean and tidy. However a number of areas were in need of improvement. It was likely that staff were signing the MAR sheets before administration or before the people using the service had taken the medication as a number of signatures were over signed by a code indicating that the medication was not taken after all. An audit of some antibiotic medication was incorrect. The sheet showed that a total of 21 tablets were booked into the home however the sheet only contained 20 signatures and stated ‘course finished’. A similar shortfall was noted as part of the previous inspection. Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 14 When medication was prescribed on a variable dosage the actual amount given was not recorded therefore making a drug audit difficult. This was evidenced on one MAR sheet when it was not possible to establish now many painkillers had been given over a period of days. It was of some concern to note that medication prescribed to one person had run out on a couple of occasions. As a result it was apparent that the individual person using the service had not received prescribed medication for a period of time. Some archived MAR sheets only showed the date and not the month therefore causing possible confusion. Staff were suitably respectful towards people using the service. People were appropriately dressed taking into account gender and weather conditions. One relative stated that washing is returned from the laundry the day after it is sent. Standard 11 concentrates on the care of people who are terminally ill. The previous report included some favourable comments from the family of a person who had recently died. During this inspection it was noted that staff were invited to a funeral which was due to take place. A relative wrote ‘ my relatives tell me ** had a comfortable room, and attentive care. One could not ask for more.’ Nightingales Residential Home DS0000065919.V335781.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Stimulation is provide within the home by means of social and recreational activities. People using the service are able to maintain contact with family and friends. The food provided appeared appetizing and in line with peoples expectations. EVIDENCE: Relatives and friends are able to visit at any reasonable time. Visitors are able to use communal areas such as the lounge or dining room or the bedroom belonging to the particular individual residing within the home. Involvement with the local community is limited. A scheduled programme of planned activities was displayed outside the office. These covered the days Monday – Friday. The inspector was informed that activities such as hairdressing, bingo and board games taken place most afternoons. Records regarding activities were limited and need to be improved to evidence events which have taken place, who took part and any evaluation Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 16 of the event. One person using the service stated that she did ‘keep fit’ and ‘watched t.v or went into the garden ’. Another person said ‘ I love it here – going to have a fete and go to the safari park – have a few games.’ Photographs were displayed in the entrance hall of a day out at a local steam railway. Activities were described as playing games such as bingo as well as keep fit. A number of people made reference to parties / celebrations within the home such as Halloween and Valentines. It was evident that people using the service are able to bring their own personal possessions into the care home. Lunch on the first visit to the home consisted of fish and chips with peas. The meals were served to people using the service ready plated from the kitchen. Staff were seen offering a choice of orange or cranberry juice. The main meal on the second visit, which was a Sunday, was a traditional roast dinner. Tea on the first day of this inspection was due to be beef sandwiches or cheese and potato pie. The dining room was set out in a way that was conducive to providing a pleasant experience. The meals appeared appetising. One visitor stated that her relative ‘enjoyed his food’. One person using the service stated that the food is ‘nicely cooked.’ Another said that the food is ‘ very good some have bacon for breakfast.’ The kitchen was seen to be clean and tidy, fresh vegetables were available including cauliflower, parsnips and carrots. Nightingales Residential Home DS0000065919.V335781.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People using the service and their representatives are aware of the home’s complaints procedures. The registered providers have increased their awareness of safeguarding adult procedures to ensure that people living within the home are protected. EVIDENCE: Since the last inspection at Nightingales the commission has received a letter containing a number of concerns regarding the service offered. The letter had earlier been sent to the registered providers however the complainant believed that a number of areas had not been resolved. This letter was passed back to the registered providers to resolve. All three relatives who responded to the questionnaire sent out by the commission stated that they were aware of the homes complaints procedure. One person using the service said that if she were unhappy she would speak to either ‘Dawn or Sam’ (two of the registered providers). From information recorded upon the pre inspection questionnaire returned to the commission prior to the visit it was noted that the home had received 2 complaints over the previous 12 months. Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 18 Since the last inspection the home has had one incident which should have been reported to the safeguard adults coordinator employed by Worcestershire County Council. Although the home carried out a full investigation and employed an outside agency to assist with this matters the details should of gone to the above coordinator and the commission sooner than they did. It is believed that the registered person have learnt from this and would inform people as necessary should another situation happen. One member of staff gave a reasonable account of the actions s/he would take in the event of actual or potential abuse. It was reported that staff have received in house training on the recognition of abuse in the past. As the service has recently appointed a training manager the suitability of previous training needs to be reviewed. Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 19 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 This judgement has been made using available evidence including a visit to this service. People living within the home are provided with a homely, comfortable and clean environment. 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 ready for the mid day meal. 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.V335781.R01.S.doc Version 5.2 Page 20 domestic in character. Handrails are not provided; this needs to be regularly risk assessed in relation to the identified care needs of residents. Radiators are covered to prevent accidental scalding Fire doors on the ground floor were held open by devises which enable the doors to close on the sounding of the fire alarm. It was noted that a fire door leading into the lounge did not close fully into its rebate. The registered manager was aware of this. It was stated that due to the fact that the property is a listed building the registered providers were experiencing difficulty in fitting a replacement door. In the meantime having a door not closing in the event of an emergency could be placing people using the service at risk in the event of a fire. All areas of the home that were viewed were reasonably decorated. 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. One bathroom contained a toothbrush and a bar of soap, these could be a concern regarding infection control if they were shared. The shower room had bars of soap All bedrooms contain en-suite facilities. Some wardrobes were secured to the wall to prevent them toppling over while others were not. Some bedrooms have low-level glazing; the windows cannot be altered due to the fact that the building is grade two listed. The glazing was reported to be to the necessary standard and motifs are in place. It was evident that sufficient hand washing facilities with liquid soap are available as well as personal protective equipment such as gloves and aprons. A sluicing machine is in place. Since the previous inspection the registered providers have fitted a new emergency call system into the home. During this inspection it was noted that staff were responding appropriately and within a reasonable timeframe. People consulted throughout this inspection believed the home to be kept clean and tidy. No offensive odours were detected. Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 21 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 This judgement has been made using available evidence including a visit to this service. The number of staff on duty at certain times needs to be reviewed to ensure that the personal and healthcare needs of people using the service can be met. Shortfalls in training undertaken were noted. Having a training and qualified workforces can complement the care provided as well as ensuring that health safety and welfare are maintained. EVIDENCE: On the first day of this inspection staff on duty consisted of the deputy manager (who was working as a carer) a senior care assistant and a care assistant. Other staff within the home included catering staff, domestic staff and a maintenance person. Two of the registered providers were working within the domiciliary care agency office which is within the grounds of the home. The inspector was informed that usually two to three carers plus one of the registered providers are on duty on weekday mornings and afternoons. This figure was however reduced to two during the late afternoon and at weekends. Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 22 As between two / three people using the service require more than one carer the level of staff on duty needs to be kept under review to ensure that sufficient staff are on duty to be able to meet everybody’s care needs. One relative when asked on a questionnaire what the service does well stated ‘ shows care and kindness.’ During this inspection one relative described the staff as ‘excellent’. The registered manager acknowledged that improvements were needed in relation to some areas of staff training. It was stated that a training manager had been recently appointed with the responsibility of ensuring that staff received the necessary training. The pre-inspection questionnaire gave details of the training which is planned for the future. The level of training undertaken will be assessed as part of a future inspection. Two out of the three responses to the questionnaire returned to the commission believed that staff usually had the right skills and experience to look after people properly while one person stated always. It was reported during the inspection that three carers currently hold a level 2 NVQ (National Vocational Qualification). As the home had a staffing complement of thirteen carers this level accounted for 23 . As additional carers are currently undertaking this training this will, assuming nothing else changes, take the level to 50 which is the level needed in order to meet the standard. Having a qualified workforce should complement the level of care provided. The files of some recently appointed staff members were viewed. These were generally satisfactory although some improvement is necessary. Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 23 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, 36 and 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 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.V335781.R01.S.doc Version 5.2 Page 24 The formal supervision of staff currently addresses staff strengths and weaknesses but systems need to be developed to ensure the sessions are purposeful. Staff meetings are not happening. A small amount of money is held in safekeeping on behalf of some people using the service. The balance of two peoples money was checked and found to balance. It was reported that questionnaires have recently been sent out to seek the opinions of individuals involved in the home. Once these are returned the findings need to be collated and made available to all interested parties. Meetings for people using the service were reported to happen on a monthly basis, minutes were not available during this inspection. No other quality assurance systems are in place. The previous inspection report following the inspection during August and September 2006 highlighted that an immediate requirement notice was issued regarding the safe storage of cleaning materials. The report stated that the commission had received confirmation from a registered person that required action had taken place. On arriving at the home for the first part of this inspection it was noted that the laundry door was open therefore giving free access to a range of cleaning materials within that area. It was reported that hoisting equipment was last serviced during May 2007 therefore the next service will be due during November 2007. The window restrictor in an empty bedroom was broken. Window restrictors are vital to prevent accidental or deliberate falling to the ground. The suitability of restrictors needs to be kept under constant review. The registered manager is aware of the need to inform the commission of certain events which may occur within the home. Records held within the kitchen were generally satisfactory regarding temperatures and cleaning however no records were available regarding the temperature of hot food on serving. One member of staff had knowledge of the location of the gas cut off switch but did not know the location of the water stop tap. In the event of a major incident the location of these taps / switches could be vital. The fire records were viewed and need to be improved. The frequency of testing the fire alarm was not in line with the guidance provided by the fire service and against information noted within the previous report. The registered providers recently received a report following a fire risk assessment Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 25 conducted during February 2007. The report highlighted a number of areas which need attention. The registered providers must provide an action plan to the commission regarding the improvements needed. It was noted that a carer had some jewellery on her fingers. Jewellery can be dangerous to both people using the service and the member of staff concerned. Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 26 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5 (1) (b) Requirement The registered persons must ensure that residents are provided with an individual and signed copy of their terms and conditions. Not assessed as part of this inspection visit. The previous timescale of 31/10/06 remains. The date given is the date of the inspection. 2 OP3 14 A full assessment of prospective residents must be undertaken prior to people moving into the home and must include all aspects of their care needs. The above requirement is similar to a previous requirement which is unmet. The former timescale was 14/08/06. A new timescale is given which must be met. 31/08/07 Timescale for action 15/07/07 Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 28 3 OP7 15 A full and comprehensive care plan must be in place in relation to each person using the service. The care plan must be regularly reviewed and updated to reflect all aspects of their care needs. The above requirement is similar to a previous requirement which is unmet. The former timescale was 14/08/06. This was not met. An urgent action letter gave 28 days following the inspection on the 16/06/07 to comply. This was not fully met. The revised timescale given must be met. 31/08/07 4 OP8 12 13 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. A timescale of 14/08/06 was not met. A new revised timescale is given. 31/08/07 5 OP9 13 (2) Medication must be given as prescribed and recorded accurately including handwritten amendments to safeguard the welfare of people using the service. Sufficient stocks of medication must be maintained to ensure that people are able to receive medication prescribed. The above requirement is similar to a previous requirement which is unmet. 15/07/07 Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 29 This requirement must be met in full. 6 OP18 1213 The procedure for dealing with suspicions or allegations of abuse must be reviewed. This requirement was not assessed. A new timescale is given. 7 OP19 23 Fire doors must close fully into their rebates. This requirement is repeated due to another concern noted as part of this inspection. 8 OP27 18 Suitable sufficient staff must be on duty throughout the day to meet the care needs of people using the service. The above requirement is similar to a previous requirement which is unmet. The previous timescale was 31/10/06. A new timescale is given. 9 OP29 19 Staff employment files must 31/08/07 contain all the required information as specified in Regulation 7, 9, 19 and Schedule 2. The previous timescale was 31/10/06. This was part met. A new timescale is given. 10 OP30 18 All staff must receive the training 30/11/07 to meet the care needs of residents and the requirements of the standards. A revised timescale is given. Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 30 31/08/07 31/08/07 31/08/07 The previous timescale of 31/12/06 was not met. 11 OP33 24 A quality assurance system must be put in place in order to audit the service provided by the home. The previous timescale of 31/11/06 was not met. A new timescale is given. 12 OP38 13 All hazardous substances must be held securely at all times. The above requirement is similar to a previous requirement which was unmet. The previous timescale was 18/09/06. This was not met. A new timescale is given which must be met. 13 OP38 23 Full detailed fire records must be held. The above requirement is similar to a previous requirement which was unmet. Safe systems must be in place to protect the health, safety and welfare of people using the service. 15/07/07 15/07/07 30/09/07 14 OP38 13 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000065919.V335781.R01.S.doc Version 5.2 Page 31 Nightingales Residential Home 1 Standard OP1 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. Staff should receive appropriate formal supervision. 2 OP1 3 OP36 Nightingales Residential Home DS0000065919.V335781.R01.S.doc Version 5.2 Page 32 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: 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. 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