Inspection on 03/05/05 for Nightingales Residential Home

This inspection was carried out on 3rd May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 19/09/07

Nightingales Residential Home 16/08/06

Nightingales Residential Home 31/10/05

Nightingales Residential Home 09/12/04

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

CARE HOMES FOR OLDER PEOPLE Nightingales Residential Home 24 Foxholes Road Southbourne Bournemouth Dorset BH6 3AT Lead Inspector Marjorie Richards Unannounced 3 May 2005 09:30 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 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 D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Rhodes Care Home Limited Mr Geoffrey Rhodes CRH PC - Care Home Only 11 Category(ies) of DE(E) Dementia - over 65 (11) registration, with number MD(E) Mental Disorder -over 65 (11) of places Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 9 December 2004 Brief Description of the Service: Nightingales is a care home for 11 older people who have 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 and Christchurch and beyond. Nightingales is a large detached house which 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 which is accessible to residents and garden furniture is available. The accommodation is comfortable and homely. 24-hour personal care is provided. Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out on 3rd May 2005, between the hours of 9.30am and 5.30pm. Nightingales underwent a change of ownership last year and Rhodes Care Home Ltd took control on 30 September 2004. Mr Geoffrey Rhodes is now managing the home on a day-to-day basis. At the previous inspection in December 2004, a number of requirements and recommendations were made. The purpose of this inspection was to check on progress towards meeting these. Conversation also took place with eight residents and three staff, as well as Mr and the assistant manager, to gain their views about the home and the changes currently taking place. (Because of their dementia/mental disorder, not all of the residents were able to sustain a conversation or make their views known.) Unfortunately, there were no visitors to the home on the day of inspection. A number of records were also examined and a tour of the premises took place. What the service does well: Residents enjoy a varied life within the home and a number of activities are made available to them. Many of these are not planned but take place at any time, such as the sing-along during the morning of the inspection. Visitors are encouraged to visit as often as possible and made to feel welcome at any time. Residents receive good wholesome food, most of which is homemade using fresh ingredients as much as possible. Residents may choose where to take their meals. Mealtimes are seen as social occasions and are relaxed and unhurried. Residents commented very favourably about the food provided: I had a lovely dinner and We always have lovely soups every day. A programme of refurbishment and redecoration has commenced to ensure that residents live in safe, comfortable and attractive surroundings. Work completed so far is of a good standard. The home is clean, with no unpleasant odours. Sufficient staff are on duty throughout the day to ensure the care needs of residents can be met. Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 6 Mr Rhodes and his staff have developed good relationships with the residents. This results in a supportive, caring and relaxed environment where residents feel comfortable and secure. Staff are well motivated, enthusiastic in their work and keen to learn. Mr Rhodes has given us a lot of training and I feel I have an important job to do. I am looking forward to learning a lot more. The training makes my job more interesting. The home has a friendly and relaxed atmosphere. One resident said, I am very happy here. The people are all very nice and I like it here. What has improved since the last inspection? What they could do better: Mr Rhodes and the assistant manager carry out pre-admission assessments prior to anyone moving into Nightingales, to ensure the home is able to provide whatever care is needed. At present, these assessments are not sufficiently detailed which means there can be no reassurance that care needs can be fully met. Prospective residents (or their relatives/representatives) are not assured in writing that the home can meet their needs. Although Mr Rhodes has made considerable improvements to the homes documentation and is producing new forms for use by staff, more needs to be done in actually implementing these new systems and ensuring they are used Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 7 properly. For instance, the new format care plans are in place but most have not yet been fully completed. This means residents may be placed at risk because staff do not have the necessary up to date information to ensure that individual care needs can be met. Nightingales has a policy for the protection of vulnerable adults, but this needs to be amended so that it is in line with the Department of Health No Secrets guidance, to ensure that staff follow the correct procedure in the event of any allegation about abuse being made. Not all staff have received training in Adult Protection matters, (but this is now arranged for June 2005.) All new staff receive some induction and foundation training but the homes training programme does not meet National Training Organisation guidance. Training details are not fully recorded. This means is not possible to check exactly what training has been undertaken or that staff have received the recommended minimum three paid days training per year. Therefore, residents cannot be assured that staff have all the necessary skills and experience to deliver the services and care which the home offers to provide. Measures are in place to promote the health and safety of residents. However, risks posed by unguarded radiators may compromise resident safety. (Mr Rhodes is currently having radiator covers made to measure and these will be fitted as soon as possible.) It was not possible to confirm from records that staff fire training is taking place at the appropriate intervals. (An Immediate Requirement Notice was issued to ensure that urgent action was taken to rectify this and ensure that all staff know what to do in the event of fire.) Although not assessed on this occasion, a number of requirements and recommendations made at the previous inspection are carried forward. No scores or outcomes have been allocated in respect of these. (Requirements, Standards 24, 33, 37. Recommendations Standards 14, 22, 23.) Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Standard 6 is not applicable to this home Only limited progress has been made in improving the admission procedure and ensuring a proper assessment is carried out prior to anyone moving into the care home. Without this, there is no reassurance that care needs can be fully met. EVIDENCE: Mr Rhodes and the assistant manager say that they visit all prospective residents, whether in their own homes or in hospital etc, to make their own assessments so that they can be sure the home can meet all of the individuals care needs. Following this process, the home does not assure prospective residents in writing that their needs can be met. Mr Rhodes says that a new form is still being developed to record the home’s own assessments. The form currently in use does not cover all of the points listed in Standard 3. The pre-admission assessment for one resident was viewed but had not been fully completed. There were gaps in the available information, which meant Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 10 that parts of the subsequent care plan were also not fully informed. (The resident concerned was unable to comment about any involvement in the assessment process.) These issues were identified during the last inspection in December 2004 and a requirement made for pre-admission assessments undertaken by the home to be fully documented and contain all of the information detailed in Standard 3.3. This has clearly not yet been fully achieved. Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Little progress has been made in improving arrangements to ensure that the care needs of residents are fully identified and met. These shortfalls have the potential to place residents at risk because staff may not have the necessary information to ensure care needs are met. Some progress has been made in the arrangements for storing and handling medicines in the home, to ensure the safety of residents. More needs to be done to ensure that staff always uphold the dignity of residents. EVIDENCE: Mr Rhodes has introduced new style care plans for all residents but, of the four seen, only one was found to be completed. This lack of up-to-date information for staff leaves residents potentially very vulnerable. Where risks have been identified, these are not always carried through to the action plan to ensure that staff know exactly what to do in order to prevent or minimise the risk. The daily report for one resident states, Turned regularly. Fluids given but there are no records to evidence when turning takes place Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 12 and the timing/amount of fluids given. Mr Rhodes said he was intending to implement such charts. Some information is documented, but this is not always being followed by staff. For example, the care plan states likes listening to music, but not classical. This resident was found in the bedroom with the radio tuned in to a classical music station. Staff questioned seemed unaware that the resident did not like classical music. Daily entries are made into care records, but these tend to be repetitive rather than informative, e.g. She has been fine. There is no evidence that care plans are being reviewed by staff at least once a month and updated to reflect changing needs. Photographs of residents are now in place on each file and Mr Rhodes says he is trying to involve relatives and/or representatives with care planning, although he has only achieved this for one resident at the present time. The requirements made at the last inspection regarding the need to ensure that all aspects of health, personal and social care needs be recorded, including the monitoring of psychological health, nutritional screening and all necessary risk assessments, have not been fully actioned. The Commission for Social Care Inspection Pharmacist Inspector made a follow up visit to the home and found progress had been made in the arrangements for storing and handling medicines in the home. The requirement regarding the crushing of medicines had not been met and is again repeated at the end of this report. Further work is needed in respect of the medication policy, implementing a system for regularly monitoring Medicine Administration Records (MAR charts) with the Monitored Dosage System (MDS) cassettes and creating an audit trail to confirm that medicines are given as prescribed and accurately recorded. Mr Rhodes said that named staff administer medicines and that he was trying to organise training on the safe handling of medicines. The home does not have Patient Information Leaflets (PILs) for medicines. There is currently no system for recording and prompting GP reviews of service user’s medication. Although staff are polite and treat residents with respect, more needs to be done to ensure the preservation of dignity with regard to looking after residents clothing. In one of the shared rooms, items of clothing were found hanging in both wardrobes, which belonged to the other occupant of the room. This also applied to underwear in the chests of drawers. Not all clothing was named. Some clothing was found to be named for other than the two occupants of this room. Wardrobes were poorly presented, with many items creased and two dresses hung up completely inside out. Some clothing was falling off hangers and some items lay crumpled on the floor of the wardrobe. Some clothing appeared stained and one nightdress was soiled. Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 13 The recommendation from the last inspection, that the policy about preserving privacy and dignity be reviewed and expanded, has not been actioned. It is strongly recommended that this now take place. Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 14 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 standard(s) 12, 13 and 15 Residents experience a varied life within the home with a range of informal recreational and social activities made available. Visitors are encouraged at any time and good, wholesome meals are provided at times and locations convenient to residents. EVIDENCE: Staff undertake activities with residents both individually and as a group. Some activities are planned in advance but many happen spontaneously. The daily living arrangements are flexible and can be varied to suit residents’ time and preference. The assistant manager says that she sometimes organises cake baking sessions with residents. Gentle armchair exercise to music and weekly manicures are now arranged. The home has just purchased a collection of CDs with songs from World War 2 and these have proved very popular. Different entertainers are booked to come to the home on a monthly basis. The activities in progress during the inspection included a sing-along and armchair ball games. Residents commented: I like singing all the old songs. I enjoy going for walks and wish we could go more often. I love singing the songs my mother used to sing. Mr Rhodes says he intends to gather information about therapeutic activities, such as reminiscence therapy, as recommended in the last inspection report. Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 15 There were no visitors in the home on the day of inspection. Mr Rhodes says relatives and friends are encouraged to visit as often as possible. This was confirmed in discussion with residents and staff and by viewing the Visitors Book. The written policy for maintaining the involvement of friends and relatives still needs further development so that it fully reflects current good practice. Meals are served wherever is most appropriate for residents, either in the lounge, dining room or bedroom, but the majority of residents prefer to sit together in the dining room. Three course lunches are provided and on the day of inspection this was home-made vegetable soup, followed by roast pork with mashed potatoes, Brussels sprouts, leeks, carrots and swede. Residents then enjoyed chocolate sponge and custard. Fruit squash is served with the meal, followed by tea or coffee afterwards. Staff offered discreet assistance with prompting or helped with feeding where necessary and the meal was enjoyed in a relaxed, unhurried manner. Menus are based around the known likes and dislikes of residents and although no choice of menu is available, alternatives were seen to be provided to suit individual preference and taste. Residents commented very favourably about the food provided: I had a lovely dinner. We always have lovely soups every day. I cannot remember exactly what it was for lunch, but I do know that I enjoyed it. Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 16 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 standard(s) 18 There has been progress in developing an Adult Protection procedure, which will ensure a proper response to any suspicion or allegation of abuse. However, this is still not in line with Department of Health guidance. Training for all staff in Adult Protection issues is being arranged. Once completed, this will help ensure that residents will be properly protected. EVIDENCE: The existing Adult Protection policy and procedure has been improved and updated, but still does not link in with the Department of Health No Secrets guidance. Mr Rhodes is aware of this and is currently working to make the necessary changes. Mr Rhodes says he has discussed the importance of protecting vulnerable adults from abuse with all staff and this was later confirmed in discussions with staff. Mr Rhodes has also arranged for every member of staff to receive training in Adult Protection issues with an external trainer in June 2005, to further demonstrate the homes commitment to understanding abuse and protecting residents. Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 and 26 A programme of refurbishment and redecoration is currently in progress to ensure that residents live in safe, comfortable and well-maintained surroundings. The home is clean, with no unpleasant odours. EVIDENCE: Since purchasing the home, Mr Rhodes has redecorated and re-carpeted the communal areas and rooms at Nightingales, with the exception of the dining room. He also intends to redecorate, re-carpet and refurbish all of the bedrooms. A start has been made on one bedroom and the rest will be achieved gradually, in order to cause the minimum of disruption to residents. Mr Rhodes has also carried out a number of maintenance tasks around the home in order to ensure resident safety. (The requirement made after the last inspection regarding the provision of suitable furniture and equipment in bedrooms is still applicable and is repeated at the end of this report.) The communal rooms at Nightingales consist of a lounge and separate dining room. Both are homely and comfortable. The lounge has been newly Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 18 carpeted and furnished. Residents commented favourably on other additions in the lounge, such as the new television and a fish tank Additional communal space is available in the porch and also the entrance hall, where residents 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. Some of the paved areas in the garden have become rather uneven and may cause residents to trip and fall. Because of the potential hazards in the garden at present, Mr Rhodes says he always insists that staff accompany residents whenever they go outside. Residents are never left alone in the garden. He intends to make improvements to ensure resident safety and also to replace the rather worn patio furniture. One resident confirmed, One of the ladies (indicating a care assistant) comes with me when I go for a walk in the garden. Mr Rhodes is making significant improvements to the laundry and installing a commercial washing machine and tumble dryer. The infection control policy has not yet been updated, as required following the last inspection, but staff training in infection control has now been arranged and will take place in June 2005. The home is clean and there are no unpleasant odours. Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 The home employs enough staff to meet the needs of residents and to ensure their safety and comfort. Progress has been made in ensuring that staff are equipped with the 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 domestic duties such as cleaning and laundry. One Care Assistant also has responsibility for cooking meals but has no care duties during this time. Three care assistants are on duty from 8 a.m. until 2 p.m. and two care assistants from 2 p.m. until 8 p.m. In addition, the assistant manager is on duty from 8 a.m. until 4 p.m. and involved in hands-on care. Mr Rhodes is available most days and although mainly involved in management tasks he also occasionally 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. A part-time member of staff is also employed to carry out maintenance tasks. Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 20 Residents spoke positively about staff. One said, They are always here when you need them, and another said, That lady (pointing to a Care Assistant) is very kind. They are all very kind. The present induction and foundation training system does not meet National Training Organisation targets but Mr Rhodes is working to implement a new staff training and development programme which will ensure that all staff receive appropriate training so they can fulfil the aims of the home and meet the needs of residents. Mr Rhodes is also trying to encourage staff to undertake NVQ level 2 training so that the 50 target by 2005 can be achieved. At present, three staff are enrolled for NVQ training. Further training for all staff is being planned for June 2005. This will include moving and handling, infection control, Adult Protection and abuse, first aid and basic food hygiene. A requirement made after the last inspection concerned staff receiving training appropriate to the work they were to perform, for example dealing with dementia, mental disorders and challenging behaviour. This has not yet been achieved, but Mr Rhodes says he intends to include such topics in the training planned for June. Discussions with staff show that they are well motivated, keen to learn and value the training that is being offered. Individual staff training and development files are being implemented for all staff. It is intended that these will then provide evidence to show that all staff receive a minimum of three paid days training per year and copies of all training certificates will be kept. Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 36 and 38 Mr Rhodes ensures that the management approach of the home provides a positive, open and relaxed atmosphere, which supports residents and offers a clear sense of direction and leadership to staff. A formal staff supervision system is now in place, but this is not being implemented at the recommended intervals. The home endeavours to provide a safe environment for residents. However, unguarded radiators pose risks and records of staff fire training do not show this is being held at the required intervals to ensure resident safety. EVIDENCE: Discussions with staff show that they are well aware of their duties and responsibilities and feel them to be important. They say that the management approach within the home creates a calm, friendly and inclusive atmosphere where they feel valued. Staff commented: Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 22 “I like to come to work. This is a very happy place to be.” “Mr Rhodes has given us a lot of training and I feel I have an important job to do. I am looking forward to learning a lot more. The training makes my job more interesting.” Mr Rhodes is introducing the idea of person centred care and making sure that care is tailored to suit the needs of individual residents. A member of staff confirmed, “Mr Rhodes makes sure that we do not do things by the clock, but when the resident wants to do it. A resident commented, I am very happy here. The people are all very nice and I like it here. Requirements made after the last inspection regarding the introduction of quality assurance and monitoring systems and record keeping have not yet been dealt with, but Mr Rhodes says he has plans to implement these shortly. At the last inspection, a requirement was made with regards to the introduction of formal supervision sessions for all care staff. This has now been implemented. 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. However, records show that supervision is not taking place on a regular basis and a few staff have not yet received any formal supervision. On touring the premises, 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 all windows. However, most radiators do not have guards in place leaving residents at risk from hot surfaces. Mr Rhodes provided evidence that he is currently having radiator covers made to measure, as the radiators at Nightingales are not of a standard size. These will be fitted as soon as possible. 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 and fire fighting equipment is taking place. Routine checks are carried out at appropriate intervals and this is confirmed by staff. Staff also say that fire training and fire drills are taking place but it is not possible to evidence from records that these are held at the required intervals and that all staff have received appropriate training. This was highlighted at the last inspection and a requirement made. An Immediate Requirement Notice was issued requiring urgent steps to be taken to ensure compliance. Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 x 15 3 COMPLAINTS AND PROTECTION 3 2 x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x 3 x x x 2 x 2 Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 24 YES Are there any outstanding requirements from the last inspection? 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 3 Regulation 14(1) Requirement Timescale for action 30/9/05 2. 3 14(1) 3. 7 14 and 15 4. 8 13, Schedule 3 (m) The registered person must ensure that new residents are admitted only on the basis of a full assessment. Pre-admission assessments undertaken by the home must be fully documented and contain the information detailed in this Standard. (Previous timescale of 1/4/05 not met.) The registered person must 30/9/05 confirm in writing to the resident that, having regard to the assessment, the care home is suitable for meeting his/her needs in respect of health and welfare. All aspects of each resident s 30/9/05 health, personal and social care needs must be recorded and regularly reviewed. Care plans are to be agreed and signed by the resident or their representative wherever possible. (Previous timescale of 1/4/05 not met.) Risk assessments, monitoring of 30/9/05 psychological health, nutritional screening etc, must be carried out as necessary for all residents and be fully recorded. (Previous Version 1.30 Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Page 25 timescale of 1/4/05 not met.) 5. 9 13(2) and 15 If medicines need to be crushed there must be a clear care plan for this including the rational for this method of administration and the agreement of care professionals, relatives and/or service user involved. Care plans must be reviewed monthly or at other times of significant change. The directions to crush should also be included on the prescription so that this is printed on the label and on the MAR chart. (Previous timescale of 1/4/05 not met.) The medication policy must be revised to allow selfadministration within a risk management framework. The home must have a clear audit trail for medicines not in the MDS e.g. recording the date when a new pack is started or entering a carry forward balance on the MAR chart. The registered person must introduce a system for regularly monitoring MAR charts with the MDS cassettes and the audit trail to confirm that medicines are given as prescribed and accurately recorded. The registered person must ensure that the care home is conducted in a manner which respects the dignity of residents. More care must be taken with the laundry process to ensure residents receive their own clothes to wear and clean clothing is stored appropriately. The registered person must develop an Adult Protection policy and procedure that is in line with the Department of 31.7.05 6. 9 12(2) & 13(4) 13(2) 30.6.05 7. 9 30.6.05 8. 9 13(2) 31.7.05 9. 10 12(4)(a) 30/9/05 10. 18 12 (1) and 13 (6) 31/7/05 Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 26 11. 24 23 (2) and 13 (4) 12. 26 18(1) 13. 30 18(1) 14. 33 24 15. 36 18(2) Health No Secrets guidance and ensure staff receive suitable training so that it may be fully implemented if necessary.(Previous timescale of 1/4/05 not met.) Suitable accommodation for each resident must be provided which is furnished and equipped as detailed in Standard 24. (Where this is not provided, e.g. table to sit at and bedside table; lockable storage space; the reason for this should be recorded. Where it is due to risk, risk assessments must available to support this.) (Previous timescale of 1/6/05 still current.) The registered person must ensure that the infection control policy is updated to reflect current practice within the home and that staff receive training in infection control issues. (Previous timescale of 1/4/05 not met.) The registered person must ensure that all staff receive training appropriate to the work they are to perform. This should include suitable induction and foundation training. (Previous timescale of 1/6/05 still current.) The registered person must introduce effective quality assurance and quality monitoring systems. These should be in place to measure success in meeting the aims, objectives and Statement of Purpose of the home. (Previous timescale of 1/6/05 still current.) The registered person must ensure that staff are appropriately supervised. (Previous timescale of 1/6/05 still curent.) 30/9/05 31/7/05 30/9/05 30/9/05 31/7/05 Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 27 16. 37 17(1) and Schedules 3/4 17. 38 23(4) The registered person must 31 thing ensure that records required by and/7/05 Regulation for the protection of residents and for the effective and efficient running of the business, be maintained up to date and accurate.(Previous timescale of 1/4/05 not met.) Staff fire training must take Immediate place at the appropriate intervals and be recorded in detail. (Two half hour sessions in the first month for new staff, thereafter every six months for day staff and every three months for night staff.) (Previous timescale of 1/4/05 not met.) 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 9 Good Practice Recommendations All staff, who administer medicines, should have accredited training on medicines, how they are used and how to recognise and deal with problems in use. Repeated The home should have patient information leaflets on all medicines used available for the service user or their advocate and for staff reference. The home should have a system for recording when the GP reviews medication for each service user as recommended in the NSF for older people (annually or 6 monthly for four or more medicines). It is recommended that the present policy about preserving privacy and dignity be reviewed and expanded. Repeated. It is recommended that consideration be given to the further development of therapeutic activities which are suitable for this service user group, such as reminiscence therapy. Repeated. It is recommended that the policy on maintaining relatives and friends involvement with residents be further developed to reflect current good practice. Repeated D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 28 2. 3. 9 9 4. 5. 10 12 6. 13 Nightingales Residential Home 7. 14 8. 9. 10. 11. 14 20 22 23 12. 13. 23 28 It is recommended that the Registered Person investigate local advocacy services and makes information available in the home for residents, their relatives, friends or representatives. Repeated It is recommended that the home develop a policy in respect of access to personal records that is in accordance with the Data Protection Act 1998. Repeated It is recommended that planned improvements to the rear garden are carried out to ensure residents safety. It is recommended that the alarm call system be extended to all parts of the home accessible to residents, including the communal rooms. Repeated It is recommended that residents make a positive choice to share with each other and further, when a shared place becomes vacant, the remaining resident has the opportunity to choose not to share, by moving into a different room if necessary. Such choices should be documented. Repeated. It is recommended that residents preferences be recorded, in respect of giving personal care in shared rooms, so that dignity is not compromised. Repeated. 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. Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 29 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole Dorset 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 Nightingales Residential Home D55 S61189 Nightingales Residential Home V229227 030505 Stage 4.doc Version 1.30 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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