CARE HOMES FOR OLDER PEOPLE
Nightingales Residential Home 24 Foxholes Road Southbourne Bournemouth Dorset BH6 3AT Lead Inspector
Marjorie Richards Key Unannounced Inspection 16th August 2006 10:30 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 DS0000061189.V307668.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. DS0000061189.V307668.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Nightingales Residential Home Address 24 Foxholes Road Southbourne Bournemouth Dorset BH6 3AT 01202 429515 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) rhodescarehomeltd@aol.com Rhodes Care Home Ltd Mr Geoffrey Rhodes Care Home 11 Category(ies) of Dementia - over 65 years of age (11), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (11) DS0000061189.V307668.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st October 2005 Brief Description of the Service: Nightingales is a care home for 11 older people with dementia or a mental disorder. It is situated in a quiet residential road, within walking distance of local shops and approximately half a mile from the cliff top and coastal walks. The main centre of Southbourne with all its amenities, such as post office, shops, churches, GP surgeries, library etc, is about one mile away. There is limited off-road car parking available at the front of the home, with further parking on the road outside. Buses are available nearby to and from Southbourne, Bournemouth, Christchurch and beyond. Nightingales is a large detached house that has been converted to a care home, offering accommodation on the ground and first floors. A stair lift is available to assist access between floors. There are nine bedrooms for residents in the home, two of which are shared by two people. Three of the bedrooms have ensuite facilities and there is sufficient bathroom and toilet provision on both floors. The home also has a lounge, separate dining room and porch area where some residents like to sit. There is an attractive rear garden that is accessible to residents and garden furniture is available. The accommodation is comfortable and homely. 24-hour personal care is provided. Laundering of personal clothing, bed linen etc is carried out on the premises. All meals are prepared and cooked within the home. Although a choice of menu is not offered for the lunchtime meal, a variety of alternatives are available to suit individual taste and preference. The current fees are as follows: -£461 per week for all residents. Rhodes Care Home Ltd also owns two other care homes in Dorset. DS0000061189.V307668.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 7 hours on the 16th August 2006. The purpose of this year’s first key unannounced inspection was to review all of the key National Minimum Standards, review progress in meeting the requirement and recommendations that had been made at the previous inspection and to ensure that the residents living at Nightingales Residential Home were safe and properly cared for. A tour of the premises took place and records and related documentation were examined, including the care records for three residents. Time was spent observing the interaction between residents and staff, as well as talking with seven residents. The daily routine was observed during the inspection, including the provision of meals. Discussion also took place with Mr Geoff Rhodes, the registered provider, and the members of staff on duty. The Inspector was made to feel welcome in the home throughout the visit. What the service does well:
Mr Rhodes always assesses any prospective residents coming to stay in the home, even where a Local Authority care plan is provided. Confirmation of the outcome of such assessments is given in writing, so prospective residents are fully assured that their care needs will be met. Nightingales Residential Home has a care planning system in place to ensure that staff have access to the information they need to meet the care needs of residents. Discussions with staff demonstrated that they had knowledge of residents’ individual care needs. Care plans are regularly reviewed, at least monthly and updated as necessary to reflect any changing needs. Detailed daily records are written by both day and night staff to evidence the care being provided. Records demonstrate that residents have access to health care services, with evidence of visiting health professionals e.g., GPs, district nurses, community psychiatric nurses, chiropodists, etc as necessary. This was also confirmed in discussion with residents and staff. DS0000061189.V307668.R01.S.doc Version 5.2 Page 6 The home has systems in place for managing medicines. Observation of the staff administering medication and examination of the records indicate that medicines are given as prescribed, to ensure the protection of residents. Staff were observed to be offering personal care discreetly and in a kindly manner. It was clear from the time spent with residents that they felt comfortable and at ease with staff. A range of activities and entertainment provides variation and interest for residents. Where possible, “life histories” are being completed, to enable staff to have knowledge about each resident’s background, hobbies and interests. Residents commented: I like going out in the garden. I like the singing best and the music. I enjoy looking at the newspapers. Open visiting arrangements are in place, so residents are able to maintain contact with visitors as they wish. Residents are encouraged to choose their own lifestyle within the home and their individual preferences and routines are respected. Residents commented, I do what I like. I come and go as I please. Sometimes I like to join in with things, but sometimes I decide not to. Meals are served wherever is most appropriate to suit the needs and wishes of residents, either in the lounge, dining room or their bedroom. During the warmer weather, some residents said they enjoyed meals outside in the garden. The record of food provided demonstrates that residents enjoy a healthy, well-balanced diet. Fresh fruit and vegetables are used wherever possible. The cook has an excellent awareness of each resident’s likes and dislikes with regard to food. Residents commented: I enjoyed that (lunch). It tasted even better because I did not have to cook it. I like the meals. I like the puddings best, they are all nice. A system is in place for dealing with any complaints. Residents appear confident that complaints or concerns would be listened to and dealt with appropriately. No complaints have been received since the last inspection. The home has an Adult Protection policy and procedure in place and staff have received Adult Protection training to ensure a proper response to any suspicion or allegation of abuse. The programme of refurbishment and redecoration is now almost complete, ensuring that residents live in safe, comfortable and well-maintained surroundings, where standards are constantly improving. Suitable equipment, such as a stair lift, assisted bath, grab rails, raised toilet seats and toilet frames is provided, to assist residents in maintaining their independence. DS0000061189.V307668.R01.S.doc Version 5.2 Page 7 The home provides homely and comfortable communal rooms. There is also an accessible, enclosed garden to the rear of the property. Nightingales Residential Home is clean and there are no unpleasant smells, making life within the home more pleasurable. The home employs sufficient staff to meet the current needs of residents and to ensure their safety and comfort. Residents spoke positively about staff. Residents commented, They help me get dressed. I am slow, but they dont seem to mind. The people here are alright I would say. Im happy here anyway. Nightingales Residential Home provides a supportive, caring and relaxed environment where residents feel comfortable and secure. Mr Rhodes is a very “hands-on” manager and feels it is important to remain open and accessible to residents, visitors and staff. This was demonstrated throughout the inspection. Discussions with staff show that they are well aware of their duties and responsibilities and feel the work they do is valued. Staff commented: “Everyone working here feels part of a team. We are well supported by Mr Rhodes.” “Mr Rhodes is very approachable and easy to talk to.” Residents are assured of sound management of their financial interests. What has improved since the last inspection?
One member of staff is now employed each weekday, from 1.30pm – 4.30pm to provide a range of activities for residents. Since the last inspection, Mr Rhodes has improved the paved areas in the garden, which had become rather uneven. New garden furniture has also been purchased so residents are able to sit outside and enjoy the garden much more. All residents’ bedrooms now have good quality new furniture in place. Commodes have been replaced throughout the home. The ground floor bathroom has also been completely refurbished. At the last inspection, a total of six requirements and five good practice recommendations were made. Five of these requirements and three recommendations have now been met. DS0000061189.V307668.R01.S.doc Version 5.2 Page 8 What they could do better:
Residents were seen to be treated respectfully by staff, with one exception. A member of staff demonstrated a lack of courtesy and respect whilst assisting a resident with feeding. One shared room does not have sufficient storage for toiletries, soaps and flannels, toothpaste etc. Many bedrooms have continence products on view, which does not demonstrate adequate respect for the preservation of residents’ privacy and dignity. Mr Rhodes is aware of these concerns and says these matters will be addressed when the planned new vanity units are fitted shortly, providing additional and more discreet storage. Some bedrooms do not have bedside or overbed lighting in place. Mr Rhodes explained that not all residents could cope with such lighting, but there were not always risk assessments available to evidence how these decisions had been reached. The home has a recruitment procedure in place, based on equal opportunities. Two staff files were examined. One of these revealed serious gaps in the recruitment process and the documentation obtained. For example, there was no reference from the last employer and only one reference on file, instead of the two written references required. Mrs Rhodes said she was now implementing the Skills for Care induction programme for all new staff. However, this could only be evidenced in one of the staff files examined. Although there has been considerable progress in providing training for staff, individual staff files demonstrate there are still shortfalls in the completion of mandatory training in the home, for example first aid, moving and handling, etc. At the last inspection it was also identified that staff needed to receive training appropriate to the work they are to perform, for example dealing with dementia, mental disorders and challenging behaviour. This is now being planned. Copies of all training certificates should be retained to provide evidence that staff receive a minimum of three paid days training per year. The home should now consider a more pro-active approach with regard to quality assurance to ensure Nightingales Residential Home is run in the best interests of residents. Care staff should receive formal supervision at least six times a year, as a means of ensuring good practice, emphasising the philosophy of care within the home and looking at individual career development needs etc. Not all staff are currently being supervised at the recommended intervals. It is difficult to evidence from records that all staff have received appropriate fire training at the required intervals. Mr Rhodes is developing a system that will more clearly record fire training and drills for all staff. The importance of
DS0000061189.V307668.R01.S.doc Version 5.2 Page 9 effective training and fire drills cannot be overstressed in ensuring that all staff know what to do in the event of fire, particularly where residents are vulnerable because of their dementia or mental disorder. 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. DS0000061189.V307668.R01.S.doc Version 5.2 Page 10 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 DS0000061189.V307668.R01.S.doc Version 5.2 Page 11 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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Nightingales Residential Home. Pre-admission assessments are carried out so residents are assured their care needs can be met. EVIDENCE: Individual care records are kept for each resident and three of these were examined. All showed that, prior to moving into the home, care needs had been assessed; all by Mr Rhodes and additionally, some by care managers from the Local Authority who then provided care plans to the home. Mr Rhodes says he always assesses any residents coming to stay in the home, even where he has received a Local Authority care plan, so that he can be sure the home can meet the needs of the prospective resident. Mr Rhodes then confirms the outcome of such assessments in writing, so residents are fully assured that their care needs will be met. DS0000061189.V307668.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Nightingales Residential Home. Nightingales Residential Home has a care planning system in place to ensure that staff have access to the information they need to meet the care needs of residents. Health needs are well met, with evidence of good support from community health professionals. The arrangements for storing and handling medicines in the home ensure residents’ safety. Residents are generally treated respectfully and care is offered in a way that protects their right to privacy and dignity. DS0000061189.V307668.R01.S.doc Version 5.2 Page 13 EVIDENCE: All three of the care plans examined were based upon information provided prior to admission by care managers from the Local Authority and from preadmission assessments undertaken by Mr Rhodes. The home then draws up its own care plan identifying the needs of each resident and how staff are to meet these needs. Discussions with staff demonstrated that they had knowledge of residents’ individual care needs. Care plans are regularly reviewed, at least monthly and updated as necessary to reflect any changing needs. Detailed daily records are written by both day and night staff to evidence the care being provided. Mr Rhodes is working to ensure that care plans are agreed and signed by the resident or their representative wherever possible. This should also apply to any significant reviews or changes in the care plan. At the last inspection, it was noted that little information was recorded about social care needs. Life histories are now being completed for each resident, providing information about background, hobbies and interests, which will lead to the development of more “person centred” care. Records demonstrate that residents have access to health care services. There was evidence of visiting health professionals e.g., GPs, district nurses, chiropodists, opticians and care managers, as necessary. This was also confirmed in discussion with residents and staff. The home has systems in place for managing medicines. Observation of the staff administering medication and examination of the records indicate that medicines are given as prescribed, to ensure the protection of residents. Seven bedrooms at Nightingales Residential Home are for single occupancy, giving residents opportunities for privacy if they wish. A further two rooms are shared and screens are available to assist privacy where needed. (See also Standard 24.) Staff were observed to be offering personal care discreetly and in a kindly manner. It was clear from the time spent with residents that they felt comfortable and at ease with staff. Residents were seen to be treated respectfully by staff, with one exception. Two members of staff were observed, each feeding a resident. The first demonstrated excellent skills whilst the other displayed a lack of courtesy and respect. The first care assistant sat with the resident, so there was good eye contact. The carer engaged in conversation, giving constant encouragement and proceeding slowly and patiently, at the pace of the resident. The other
DS0000061189.V307668.R01.S.doc Version 5.2 Page 14 care assistant stood above a resident, with little in the way of contact, just putting the food mechanically into the resident’s mouth. The care assistant appeared more interested in watching a programme on the television. DS0000061189.V307668.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): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Nightingales Residential Home. A range of activities and entertainment provides variation and interest for residents. Open visiting arrangements are in place, so residents are able to maintain contact with visitors as they wish. Residents are encouraged to choose their own lifestyle within the home and their individual preferences and routines are respected. Nightingales Residential Home serves a balanced and varied selection of food that meets residents’ tastes and dietary needs within pleasant surroundings. EVIDENCE: Staff undertake activities with residents both individually and as a group. One member of staff is employed each weekday, from 1.30pm – 4.30pm to provide a range of activities. Some activities are planned in advance but others may DS0000061189.V307668.R01.S.doc Version 5.2 Page 16 happen spontaneously. The daily living arrangements are flexible and can be varied to suit residents’ time and preference. Gentle armchair exercise to music and games such as armchair skittles, armchair football and softball are enjoyed. The home has a collection of CDs, videos and DVDs, which are used for pleasure and reminiscence purposes, and these have proved popular with residents. Residents enjoy “singalongs” and some reminiscence materials are also available. Monthly live entertainment is arranged and the home has access to karaoke equipment. The home gathers information about residents social, cultural, religious and recreational needs, to ensure their needs and expectations can be fully met. Where possible, “life histories” are being completed, to enable staff to have knowledge about each resident’s background, hobbies, interests etc. During the afternoon, residents were seen enjoying accompanied walks into the garden, sitting outside to enjoy refreshments, playing skittles and then later, softball in the lounge, as well as having one-to-one chats with staff. Residents commented: I like going out in the garden. I like the singing best and the music. I enjoy looking at the newspapers. Mr Rhodes says relatives and friends are always encouraged to visit as often as possible. This was confirmed in discussion with residents and staff and by viewing the Visitors Book. A written policy for maintaining the involvement of friends and relatives is also in place. Residents are encouraged to choose their own lifestyle within the home and make choices wherever possible. These include choosing how they wish to be addressed, when to get up or go to bed, what to wear, what to eat or drink and where to go within the home. Individual preferences and routines are respected. Details about individual preferences are recorded in the care plans, e.g., “Likes tea to be hot and strong with no sugar.” Residents are able to bring their own possessions into the home to personalise their bedrooms. Residents commented, I do what I like. I come and go as I please. Sometimes I like to join in with things, but sometimes I decide not to. Meals are served wherever is most appropriate to suit the needs and wishes of residents, either in the lounge, dining room or their bedroom. Most residents seem to enjoy coming together in the dining room at lunchtime. Those needing full assistance from staff with feeding are assisted in quieter surroundings, away from the dining room. (See also Standard 10.) Three course lunches are provided and on the day of inspection this was tomato soup, followed by roast pork with apple sauce, roast potatoes, cabbage, parsnips, mixed vegetables and gravy, then raspberry cheesecake and cream. Fruit squash is served with the meal, followed by tea or coffee DS0000061189.V307668.R01.S.doc Version 5.2 Page 17 afterwards. The meal was obviously much enjoyed by residents in a relaxed, unhurried manner. Menus are based around the known likes and dislikes of residents and the record of food provided demonstrates that residents enjoy a healthy, wellbalanced diet. Fresh fruit and vegetables are used wherever possible. Although no choice of menu is available, alternatives were seen to be provided to suit individual preference and taste. The cook demonstrated an excellent awareness of each resident’s likes and dislikes with regard to food. Residents commented very favourably about the food provided: I enjoyed that (lunch). It tasted even better because I did not have to cook it. I enjoy the food here. It is always very tasty. I especially like the soups. I like the meals. I like the puddings best, they are all nice. DS0000061189.V307668.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Nightingales Residential Home. A system is in place for dealing with any complaints. Residents appear confident that complaints or concerns would be listened to and dealt with appropriately. The home has an Adult Protection policy and procedure in place and staff have received Adult Protection training to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a complaints procedure and this is displayed in the entrance area and is also available in the Service Users Guide. All residents and/or their relative are given a copy of the Service Users Guide on admission to the home. A complaints record is maintained, but since the last inspection, no complaints have been received. Some residents were not able to comment about the complaints procedure, but others commented, If I am unhappy, I always tell someone but I am happy most of the time. I talk to the man in charge if anything goes wrong, (pointing out Mr Rhodes.) He soon put things right. He gets things done. I have no complaints about anything. DS0000061189.V307668.R01.S.doc Version 5.2 Page 19 Nightingales Residential Home has an Adult Protection policy in place. Mr Rhodes says that, with the exception of two new staff, all staff have received Adult Protection training to ensure a proper response to any suspicion or allegation of abuse. The new staff have so far received basic Adult Protection training as part of their induction. The staff on duty confirmed that they had received training in the Protection Of Vulnerable Adults. Bournemouth Borough Council Social Services Directorate has investigated one Adult Protection referral since the last inspection. Appropriate action was taken by the home to ensure the safety of residents. DS0000061189.V307668.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Nightingales Residential Home. The programme of refurbishment and redecoration is now almost complete, ensuring that residents live in safe, comfortable and well-maintained surroundings, where standards are constantly improving. Residents have access to comfortable communal areas, including a garden. Bedrooms are comfortably furnished and individually personalised to suit their occupants. Further improvements are planned to aid the preservation of privacy and dignity. The home is clean and pleasant, with no unpleasant odours. DS0000061189.V307668.R01.S.doc Version 5.2 Page 21 EVIDENCE: Since purchasing Nightingales Residential Home, Mr Rhodes has redecorated and re-carpeted the entrance hall, stairway, landing and corridors, lounge and dining room. Bedrooms have also been recarpeted and, since the last inspection, bedroom furniture has been replaced. Mr Rhodes is now planning to replace all existing wash hand basins in bedrooms and provide new basins and vanity units. Commodes have been replaced throughout the home. The ground floor bathroom has been completely refurbished. Suitable equipment, such as a stair lift, assisted bath, grab rails, raised toilet seats and toilet frames is provided, to assist residents in maintaining their independence. The home is well maintained to ensure resident safety. All radiators have their hot surfaces guarded and windows have only limited openings, to prevent any risk to residents. Maintenance records show that continual work is carried out to keep the home and garden in good condition. Care staff confirm that prompt attention is always paid to any defects. Both the lounge and dining room are homely and comfortable rooms. Additional communal space is available in the entrance hall and porch, where residents sometimes like to sit and watch the comings and goings. There is also an accessible, enclosed garden to the rear of the property with a variety of trees, shrubs and flowering plants as well as a small unfenced fishpond. Since the last inspection, Mr Rhodes has improved the paved areas in the garden, which had become rather uneven. New garden furniture has also been purchased. Because of the potential hazard from the fishpond, most residents are accompanied and never left alone in the garden. One resident said it was their job to feed the fish in the pond. A tour of the building confirms that residents’ bedrooms now have good quality new furniture in place and are personalised to varying degrees. One shared room does not have sufficient storage for toiletries, soaps and flannels, toothpaste etc. Many bedrooms have continence products on view, which does not demonstrate adequate respect for the preservation of residents’ privacy and dignity. Mr Rhodes is aware of these concerns and says these matters will be addressed when the planned new vanity units are fitted shortly, providing additional, more discreet storage. Clothing in wardrobes and drawers is clean and neatly stored. One bedroom door has a small opaque glass panel in place. Mr Rhodes has arranged to cover this, to ensure complete privacy. Some bedrooms do not have bedside or overbed lighting in place. Mr Rhodes explained that not all residents could cope with such lighting, but there were
DS0000061189.V307668.R01.S.doc Version 5.2 Page 22 not always risk assessments available to evidence how these decisions had been reached. Residents commented, “I like my room because it is all mine. No-one can come in unless I say so.” “My room is very nice and I am very comfortable there. The laundry is sited just outside the home and provides a commercial washing machine and tumble dryer. The walls of the laundry have now been painted to ensure they are readily cleanable. An infection control policy is in place. Mr Rhodes said all staff had completed training in infection control and the staff on duty confirmed this. Cleaning logs are maintained for the kitchen and kitchen equipment. The home is clean and there are no unpleasant smells, making life within the home more pleasurable. Suitable procedures are in place for the disposal of clinical waste. DS0000061189.V307668.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to Nightingales Residential Home. The home employs sufficient staff to meet the current needs of residents and to ensure their safety and comfort. The home is working towards the recommended ratio of 50 NVQ level 2 trained staff, to help ensure residents are in safe hands. Employment and recruiting procedures still need improvement to ensure the protection of residents. Work is still needed to ensure that staff are equipped with the training and skills necessary to meet the assessed needs of residents. EVIDENCE: Staffing rosters are in place, showing which members of staff are on duty and when. Care staff are responsible for carrying out all personal care tasks for residents, as well as some domestic duties such as laundry. On the day 8 a.m. -- 2 9 a.m. -- 1 9 a.m. -- 1 of inspection, p.m. 2 p.m. 1 p.m. 1 staffing was as follows: Care Assistants Cook Domestic Assistant
DS0000061189.V307668.R01.S.doc Version 5.2 Page 24 2 p.m. -- 8 p.m. 2 Care Assistants 1:30 p.m. -- 4:30 p.m. 1 Activities Organiser 8 p.m. -- 8 a.m. 1 wakeful Care Assistant and 1 sleeping in, on call. Mr Rhodes is available most days and although mainly involved in management tasks he also participates in cooking meals and the provision of entertainment and activities. From 8 p.m. until 8 a.m., one night Care Assistant is on wakeful duty and one works evenings and then sleeps on the premises and is on call if needed. Two part-time members of staff are also employed to carry out maintenance tasks and assist with administration. Residents spoke positively about staff. Residents commented, They help me get dressed. I am slow, but they dont seem to mind. Everyone here is my friend. They all like me and I like them. The people here are alright I would say. Im happy here anyway. At the last inspection it was recommended that a minimum ratio of 50 per cent trained members of care staff at NVQ level 2, or equivalent, is achieved by 2005. Mr Rhodes is still working towards achieving this standard. One member of staff has now achieved NVQ level 2 and two staff are currently studying for a NVQ level 2. Two members of staff have also commenced NVQ level 3 training. In addition, Mr Rhodes is employing three staff from overseas whom he believes have the equivalent of NVQ level 3 training, but this has yet to be evidenced. The home has a recruitment procedure in place, based on equal opportunities. Two staff files were examined and these revealed gaps in the recruitment process. For example, there was no reference from the last employer, and only one reference had been obtained, instead of the two written references required. The importance of implementing a more robust recruitment procedure for the protection of residents was discussed with Mr Rhodes. Mr Rhodes demonstrated that he is now implementing the Skills for Care induction programme for new staff. However, this could not be evidenced in one of the staff files examined. There was insufficient documentary evidence to demonstrate that all care staff had received training in first aid, moving and handling, health and safety etc. It is necessary to ensure that copies of all training certificates are retained in staff files to provide evidence that they have received a minimum of three paid days training per year. Mr Rhodes identified that some training had already been arranged, e.g., first aid, to take place in November. It is also important that staff receive training appropriate to the work they are to perform, for example dealing with dementia, mental disorders and challenging behaviour. Some staff have received dementia awareness training and Mr Rhodes has DS0000061189.V307668.R01.S.doc Version 5.2 Page 25 booked further training for three staff in Dementia Awareness, to take place shortly. One member of staff who has already undertaken this training commented, The dementia training was very useful. It made me see things in a different way when dealing with residents. A requirement about training has been made on three previous inspection reports. Although considerable progress has been made, continued failure to fully meet this requirement will result in enforcement action. Further information about staff training can be obtained from the following websites: www.picbdp.co.uk This is the Partners in Care web site and provides lots of information about funding streams for training including NVQ, Life skills and Leadership & Management. www.skillsforcare.org.uk This is the Skills for Care web site and there are downloadable knowledge sets and learning logs for: Dementia, Infection Control, Medication and also Workers not involved in direct care. These knowledge sets are the first 4 of approximately 30 that are currently planned. They are designed to improve consistency in underpinning knowledge for the adult social care work force in England. They identify learning outcomes and are designed to be used alongside the Common Induction Standards, which are also available from this web site. They also count as underpinning knowledge towards NVQs and link to the Health & Social Care National Occupational Standards. www.traintogain.gov.uk This is a programme and funding stream supported by the Learning and Skills Council and Business Link, who provide a skills brokerage role. (This project takes off from 1st August in Dorset.) www.lsc.gov.uk/bdp/employer/eggt_intro.htm This is the Employer Guide to Training website, which is aimed at assisting employers to choose the most suitable training provider to meet their workforce needs by the use of a search facility. DS0000061189.V307668.R01.S.doc Version 5.2 Page 26 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Nightingales Residential Home. Mr Rhodes demonstrated a good knowledge of the operation of the service and the needs of its residents. The home has commenced reviews of its performance to ensure Nightingales Residential Home is run in the best interests of residents, but a more proactive approach may be needed to ensure a better response. Residents are assured of sound management of their financial interests. Not all staff are being supervised at the recommended intervals, to ensure good practice. The home works to ensure the health, safety and welfare of residents. However, records showing staff fire training need improvement, to evidence
DS0000061189.V307668.R01.S.doc Version 5.2 Page 27 this is taking place at the appropriate intervals so that vulnerable residents are not placed at risk in the event of fire. EVIDENCE: Nightingales Residential Home provides a supportive, caring and relaxed environment where residents feel comfortable and secure. Mr Rhodes says he is a very “hands-on” manager and feels it is important to remain open and accessible to residents, visitors and staff. This was demonstrated throughout the inspection. Mr Rhodes clearly has a good relationship with residents and staff. Discussions with staff show that they are well aware of their duties and responsibilities and feel the work they do is valued. Staff commented: “Everyone working here feels part of a team. We are well supported by Mr Rhodes.” “Mr Rhodes is very approachable and easy to talk to.” Mr Rhodes is currently undertaking the National Vocational Qualification (NVQ) level 4 in management, which he was hoping to complete early in 2006. Mr Rhodes admits that, due to unforeseen circumstances, this has not been achieved but he plans to concentrate on this in the coming months. At the last inspection, a total of six requirements and five good practice recommendations were made. Five of these requirements and three recommendations have now been met. The home has now commenced a quality monitoring system, based on seeking the views of residents, relatives, staff and other visitors to the home. A “Comment and Suggestions Box” is available in the hall. Questionnaires are also available in the entrance hall, but Mr Rhodes says so far, only a limited response has been received. It is now necessary to consider taking a more pro-active role in dealing with quality assurance, in order to measure success in meeting the aims, objectives and Statement of Purpose of the home. In order to protect residents, the home prefers wherever possible to have no involvement in personal finances. Therefore, all residents who are unable or have no wish to handle their own affairs have a relative or other representative to deal with their finances. At present, the home pays for services such as chiropody and hairdressing and keeps a record of what is owed. This amount is then invoiced to relatives or representatives for payment. Information about advocacy services is available to residents and their relatives within the home, should they need independent advice or support. DS0000061189.V307668.R01.S.doc Version 5.2 Page 28 The home does hold small sums of money for one resident. An account is kept showing all transactions and receipts are retained. These are then passed to the resident’s solicitor. All monies and related records are held securely. Care staff should receive formal supervision at least six times a year, as a means of ensuring good practice, emphasising the philosophy of care within the home and looking at individual career development needs etc. At the last inspection, records showed that a formal supervision system had been implemented. However, the two staff files examined on this occasion evidenced that staff supervision is not always taking place at the recommended intervals. From touring the premises, looking at records and discussions with staff and residents, it is evident that measures are in place to promote the health and safety of residents, e.g. all substances that could be potentially hazardous to health are handled and stored safely and restrictors are fitted to windows. All radiators are guarded, to minimise the risks to residents from hot surfaces. Staff demonstrated an awareness of health and safety issues. Examination of the fire records shows that regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is taking place. Routine checks of emergency lighting, fire fighting equipment and the fire warning system are carried out at appropriate intervals and staff confirm this. Examination of the fire records shows that appropriate procedures are in place to ensure the safety of service users and staff. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is taking place. Routine checks are carried out at appropriate intervals and staff confirm this. Fire drills are taking place but it is difficult to evidence from records that all staff have received appropriate fire training at the required intervals. The staff on duty confirmed that they had received fire training. Mr Rhodes is developing a system that will clearly record fire training and drills for all staff. The importance of effective training and fire drills cannot be overstressed in ensuring that all staff know what to do in the event of fire, particularly where residents are vulnerable because of their dementia or mental disorder. The fire records show appropriate checks and servicing being carried out on the fire warning system, emergency lighting and fire fighting equipment and staff take part in fire training and drills so that they are fully aware of what to do in the event of fire. However, it was difficult to evidence from records if all staff had received fire training at the appropriate intervals. Electrical and gas safety certificates are in place. DS0000061189.V307668.R01.S.doc Version 5.2 Page 29 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 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 3 17 X 18 3 3 3 X X X 2 X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 DS0000061189.V307668.R01.S.doc Version 5.2 Page 30 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 2 Standard OP10 OP24 Regulation 12(4) 12(4) Requirement The registered person must ensure that staff, at all times, respect the dignity of residents. The registered person must ensure that bedrooms are furnished and equipped to ensure the preservation of privacy and dignity. The registered person must operate a thorough recruitment procedure to ensure the protection of residents. All staff must be properly checked before being employed. (Previous timescale of 28/02/06 not met). The registered person must make sure that staff receive training appropriate to the work they are to perform. This should include dealing with dementia, mental disorders and challenging behaviour. (Previous timescales of 1/6/05, 30/9/05 and 28/02/06 not met). Timescale for action 30/11/06 31/12/06 3 OP29 19(1) Schedule 2 30/11/06 4 OP30 18(1)(c) 31/12/06 DS0000061189.V307668.R01.S.doc Version 5.2 Page 31 5 OP33 24 The registered person must be more pro-active in carrying out effective quality assurance and ensuring quality monitoring systems are in place, to measure success in meeting the aims, objectives and Statement of Purpose of the home. The registered person must ensure that staff are appropriately supervised at the recommended intervals. 31/12/06 6 OP36 18(2) 30/11/06 7 OP38 23(4)(d) All staff must receive fire training 30/11/06 at the appropriate intervals and a detailed record be maintained. 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 OP24 Good Practice Recommendations It is recommended that risk assessments be carried out where residents do not have secondary lighting in their bedrooms for reasons of safety. It is recommended that a minimum ratio of 50 per cent trained members of care staff at NVQ level 2, or equivalent, is achieved by 2005. Repeated. 2 OP28 DS0000061189.V307668.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000061189.V307668.R01.S.doc Version 5.2 Page 33 - 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!
