CARE HOMES FOR OLDER PEOPLE
Nightingales Residential Home 24 Foxholes Road Southbourne Bournemouth Dorset BH6 3AT Lead Inspector
Marjorie Richards Announced Inspection 31st October 2005 09:30 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 Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 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) 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) Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd May 2005 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, 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, 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 DS0000061189.V258897.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over seven hours on the 31st Oct 2005 and was one of the two statutory inspections carried out each year. The main purpose of the inspection was to check that the residents living in the home were safe and properly cared for and to check on progress in meeting the two requirements from the previous inspection. A tour of the premises took place and a variety of records and related documentation was examined, including the care records for three residents and a deceased resident. Time was spent talking with six residents, as well as Mr Rhodes, the staff on duty and a visitor to the home. (Because of their dementia/mental disorder, not all of the residents were able to sustain a conversation or make their views known.) What the service does well:
Written information about Nightingales is available for prospective residents and their relatives or representatives, to let them know what they can expect from the home and help them decide if Nightingales is right for them. All residents are issued with a contract describing the terms and conditions of occupancy at the point of admission to the home. Pre-admission assessments are carried out to ensure that only people whose needs can be met are offered places within the home. Prospective residents and their relatives or representatives are encouraged to visit the home prior to admission. A trial period of up to two months is available. Staff were observed throughout the inspection to be treating residents with courtesy, patience and kindness. The privacy and dignity of residents is respected. Residents enjoy a varied life within the home and a number of activities are made available to them. Some are planned, but others take place spontaneously. Monthly live entertainment is arranged. Open visiting arrangements are in place and visitors are made to feel welcome at any time. Residents are helped to make their own decisions and choices wherever
Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 6 possible, in order to exercise some control over their own lives. Residents receive good wholesome food, most of which is homemade using fresh ingredients wherever 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 really enjoyed my dinner and I like the puddings best. A system is in place for dealing with any complaints. Residents said they had no concerns. I have no worries. I tell the man in charge. He puts things right. A visitor remarked, I have no concerns about this place, quite the opposite. The programme of refurbishment and redecoration is proceeding, to ensure that residents live in safe, comfortable and attractive surroundings. Work completed so far is of a good standard. Residents have access to comfortable communal areas within the home and there are sufficient bathrooms and toilets to meet their needs. Appropriate equipment is provided to help residents maintain their independence. 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. Staff are well supervised and Mr Rhodes provides clear leadership throughout the home. Mr Rhodes and his staff have developed good relationships with the residents. This results in a supportive and caring environment where residents feel comfortable and secure. Discussions with staff show they are well aware of their duties and responsibilities. They feel the management approach within the home creates a calm and relaxed atmosphere where residents and staff are really valued. A visitor commented, This is a very friendly and welcoming place. Staff say Mr Rhodes helps and encourages them and is very approachable. Staff commented, This is a good place to work. A policy is in place regarding the safeguarding of residents finances. The home is not handling any residents monies, but pays for services such as chiropody and hairdressing and invoices this amount to relatives or representatives for payment approximately every two months. Information about advocacy services is available to residents and their relatives within the home, should they need independent advice or support. What has improved since the last inspection?
Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 7 The Statement of Purpose and Service User Guide have been recently updated to ensure prospective service users have all the information they need before making any decisions about moving into the home. Pre-admission assessments are carried out to ensure that only those whose needs can be met by the home are offered places there. Considerable work has taken place to ensure that each resident now has a care plan. These are supported by daily care notes, which evidence the care that residents receive. Records now show that residents have access to GPs, district nurses, dentists, chiropodists etc. Improvements have been made to the laundry process to ensure residents receive their own clothes to wear and clean clothing is stored appropriately. The privacy and dignity of residents is better protected. Screening is now available in shared bedrooms. An Adult Protection policy and procedure has been recently updated, in line with the Department of Health No Secrets guidance, to ensure any possible allegations of abuse are properly managed. The programme of refurbishment and redecoration is continuing. All communal areas, bedrooms and corridors have now been recarpeted. Replacement furniture for bedrooms has been ordered and will be installed in phases over the next three months. All radiators have been guarded to prevent any risk to residents from hot surfaces. The kitchen has been fitted with new units, gas hob, fridge, microwave and kettle. Plans are in hand to make improvements to the downstairs bathroom and rear garden. The alarm call system has been extended to the lounge and dining room. An infection control policy and procedure is now in place, but training in infection control matters for all staff has yet to be completed. Additional cleaning staff have been employed, allowing care staff more time to spend with residents. Staff are well motivated, enthusiastic in their work and keen to learn. Since the last inspection, staff have undertaken external training in moving and handling, basic food hygiene, health and safety and fire safety. I have learned a lot since I started working here and it is very helpful with my job. A quality assurance and monitoring system is currently being implemented, with questionnaires about to be sent out to relatives and other visitors to the home. Formal supervision sessions are now taking place for all care staff, as a means of ensuring good practice, emphasising the philosophy of care within the home and looking at individual career development needs etc. Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 8 Of the 17 requirements made after the last inspection, 13 have been met in full and 2 partially met. Of the 13 recommendations, 11 have been implemented. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 10 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): 1, 2, 3 and 5 Standard 6 is not applicable to this home Information provided about Nightingales and a thorough admissions procedure allows prospective residents to make informed decisions about admission to the home and ensures that only those whose needs can be met by the home are offered places there. However, the outcome of pre-admission assessments is not confirmed in writing, so prospective residents cannot be fully assured that their care needs will be met. Residents are issued with a contract describing Terms and Conditions of occupancy at the point of admission to the home. Prospective residents and their relatives or representatives are invited to visit the home prior to admission to enable them to assess the facilities and services provided. A trial period is also available before making any decision about whether or not to stay. Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 11 EVIDENCE: The Statement of Purpose and Service User Guide have been recently updated and contain all of the information required about the home and its facilities. The Service User Guide gives a good indication of what a resident can expect from the home. All residents at Nightingales are issued with terms and conditions of residence. It is recommended that the relevant parties sign this document and a copy be retained in each residents records. Individual care records are kept for each resident and three of these were examined. All showed that, prior to moving to the home, care needs had been assessed by Mr Rhodes. However, the outcomes of such assessments were not confirmed in writing, so these residents were not fully assured prior to admission that their care needs could be met. Mr. Rhodes stated that he encouraged prospective residents and their relatives to visit the home prior to admission. He felt it helpful to have opportunities to look round the home, meet with other residents and staff, assess facilities and ask any questions. A trial period of up to two months is available and further information can be found in the Service User Guide. Staff confirmed that prospective residents and their relatives/friends visit the home prior to admission. Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 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, 10, and 11 A care planning system is in place, but this needs some improvement to ensure that staff have sufficient information to meet the health, personal care and social needs of residents. Care plans are not being reviewed frequently enough, to ensure they are always updated to reflect changing needs and current objectives. Residents are treated respectfully and care is offered in a way that protects their right to privacy and dignity. Residents are treated with sensitivity and respect at the time of their death. EVIDENCE: Mr Rhodes has worked hard to improve care plans since the last inspection in May 2005. Each resident now has a plan of care and three of these were examined. Detailed assessments are made on admission to the home, but this information is not always used to inform care plans. There is only very limited information about social care needs. Care plans are not being reviewed at least monthly, to ensure they reflect changing needs and objectives and are always fully up-to-date.
Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 13 Daily care notes support and evidence the care of residents. These are more detailed and give further information about the care provided, visits by community health professionals and relatives etc. However, such information is not always used to inform the care plan. For example, instructions given by a GP were recorded, but not carried forward to the care plan. Records show that residents have access to GPs, district nurses, dentists, opticians, chiropodists, etc and attend for hospital appointments as necessary. Residents and staff confirmed this during the inspection. The Commissions Pharmacist Inspector, Miss Christine Main, visited Nightingales in June 2005 to inspect the arrangements for the recording, handling, safekeeping, administration and disposal of medicines. Four requirements and three recommendations were made as a result of this visit. This standard was not fully assessed during this inspection, but Mr Rhodes stated that the four requirements and two of recommendations had been met in full. (One of these requirements was checked and evidenced to have been met.) The third recommendation, concerning accredited training for all staff that administer medicines, is almost met. (Five members of staff are currently undertaking such training.) This standard will be examined in detail at the next inspection. Residents say they have opportunities to be on their own if they wish, or to have privacy for any visitors or personal care needs. One resident commented, I can go to my room whenever I wish. I can go where I like. Staff were observed throughout the inspection to be treating residents with courtesy, patience, kindness and respect. Staff offered assistance wherever needed and toileting activities were carried out discreetly. Residents commented: The people here are very nice. I like the lady who looks after me. Where rooms are shared, new screening has been installed to help preserve residents privacy and dignity. It was evident from looking at the care plan of a recently deceased resident that the individual’s comfort was considered paramount. The care provided was well detailed and relatives had been kept informed of the situation. Health care professionals provided support to the home’s staff. The home has a death and dying policy in place to advise staff of the procedure to follow. Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 and 15 Residents experience a varied life within the home with a range of informal recreational and social activities made available. However, there is only limited information recorded about individual residents social, cultural, religious and recreational needs, so it is difficult to assess if their needs and expectations are fully met. 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. 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 others may 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 and softball are provided. The home has a collection of CDs,
Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 15 videos and DVDs, which are used for pleasure and reminiscence purposes, and these have proved popular with residents. Further reminiscence materials have been purchased and staff will be trained to use these. Monthly live entertainment is arranged and the home also has access to karaoke equipment. Residents commented: I like it best when we do singing. We do keep fit which is a bit of fun. At present, care plans contain only limited information about background, social history, previous hobbies and interests etc. so is difficult to be certain that activities are tailored to meet each residents individual needs. Mr Rhodes is considering the introduction of life histories for each resident. These will help to ensure that the activities on offer at Nightingales will be meeting the needs, preferences and expectations of individual residents and assist staff in providing person centred care. Mr Rhodes says relatives and friends are encouraged to visit as often as possible. This was confirmed in discussion with residents, visitors and staff and by viewing the Visitors Book. A written policy for maintaining the involvement of friends and relatives is now in place. Residents are encouraged to choose their own lifestyle within the home and make choices wherever possible. These include choosing 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. Residents commented, I go to bed when I like, - late sometimes. Do you like my dress? I like to wear this, it is my favourite. Meals are served wherever is most appropriate for residents, either in the lounge, dining room or their bedroom. Three course lunches are provided and on the day of inspection this was vegetable soup, followed by sausage casserole (with a variety of fresh vegetables) and mashed potatoes, followed by summer fruit gateau and cream. Fruit squash is served with the meal, followed by tea or coffee afterwards. Staff offer discreet assistance with prompting or with feeding where necessary. The meal was enjoyed in a relaxed, unhurried manner. One resident is a very slow eater, but declined the offer of staff assistance. She says she prefers to feed herself, however slowly and her wishes are respected. 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. Residents commented very favourably about the food provided: I liked the soup, it was very nice. I really enjoyed my dinner. I like the puddings best. Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 A system is in place for dealing with any complaints. Residents are confident complaints would be listened to and dealt with appropriately. Not all staff have received training in adult protection issues. The policy and procedure alone are not sufficient to ensure residents are fully protected from the possibility of abuse. EVIDENCE: The home has a complaints policy and procedure that is included in the information provided to residents or their representatives and is also displayed in the entrance hall. No complaints have been received by the home or the Commission since the last inspection. Mr Rhodes says he talks with residents every day and always encourages them to discuss any concerns, however small. This gives an opportunity to take any necessary action and hopefully avoids the need for some complaints. Residents spoken to say they have no concerns, “I like it here. I am very happy here.” “I have no worries. I tell the man in charge. He puts things right.” A visitor remarked, I have no concerns about this place, quite the opposite. The home has an Adult Protection policy, which has been recently updated. The policy seen makes reference to the Department of Health No Secrets guidance and is in line with this guidance, ensuring that any allegations of abuse will be managed effectively. However, not all staff have yet received Adult Protection training, to ensure a proper response to any suspicion or allegation of abuse. Mr Rhodes says he is currently planning such training.
Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 21, 22 and 26 The programme of refurbishment and redecoration is still in progress to ensure 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. There are sufficient communal bathrooms and toilets, which meet the needs of residents. Appropriate equipment is provided to assist residents in maintaining their independence. The home is clean and pleasant, with no unpleasant odours. EVIDENCE: Since purchasing the home, Mr Rhodes has redecorated and re-carpeted the lounge and dining rooms at Nightingales, as well as the entrance hall, stairway, landing and corridors. All bedrooms have been recarpeted since the last inspection and good quality replacement furniture ordered. This will be installed in a phased approach over the next three months, in order to ensure
Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 18 the minimum of disruption to residents. All radiators have been guarded to prevent any risk to residents from hot surfaces. Improvements have also been made in the kitchen. New cupboards have been fitted, along with new equipment such as a six-ring gas hob, fridge, microwave and kettle. The home is well maintained to ensure resident safety. 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. Further equipment checks are programmed, including testing of all portable electrical appliances and the stair lift. Both the lounge and dining room are homely and comfortable rooms. Additional communal space is available in the entrance hall and porch, 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, staff confirm that they always accompany residents whenever they go outside. Residents are never left alone in the garden. Plans are in hand to make improvements in this area and ensure resident safety. There are sufficient communal bathrooms and W.C.s to meet the needs of residents. Suitable locks, which can be opened from the outside by staff in case of emergency, are fitted to all bathroom and W.C. doors. Three bedrooms have ensuite WCs. At present, the ground floor bathroom is little used, as residents prefer the assisted bath on the first floor. Mr Rhodes has plans to change the ground floor bathroom into a more easily accessible shower room. A suitably qualified person has undertaken an assessment of the premises and facilities to ensure they meet the needs of residents and that appropriate equipment is provided to assist residents in maintaining their independence. Equipment (such as a stair lift, assisted bath, grab rails, raised toilet seats, toilet frames and commodes) is available to assist residents as necessary. The recommendations made in the Occupational Therapists report have all been completed. An alarm call system is installed in the home, permitting residents to summon staff assistance if necessary. This has recently been extended to include the communal rooms. Mr Rhodes has made significant improvements to the laundry facilities and installed a commercial washing machine and tumble dryer. Plans are in hand to paint the walls of the laundry to ensure they are readily cleanable. The infection control policy has been updated, as required following the last inspection, but training for all staff in infection control has not yet been completed. The home is clean and there are no unpleasant smells, making life
Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 19 within the home more pleasurable. Suitable procedures are in place for the disposal of clinical waste. Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The home employs sufficient staff to meet the needs of residents and to ensure their safety and comfort. Employment and recruiting procedures have been improved since the last inspection, but some work is still needed to ensure the protection of residents. Progress continues to be made in ensuring 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 have been responsible for carrying out all personal care tasks for residents, as well as domestic duties such as cleaning and laundry. Mr Rhodes has recently separated the caring/cleaning tasks and employed additional staff to carry out the cleaning duties within the home. One Care Assistant also has responsibility for cooking meals but has no care duties during this time. On the day 8 a.m. -- 2 9 a.m. -- 1 9 a.m. -- 1 2 p.m. -- 8 8 p.m. -- 8 of inspection, p.m. 2 p.m. 1 p.m. 1 p.m. 2 a.m. 1 staffing was as follows: Care Assistants Care Assistant (Cook) Domestic Assistant Care Assistants wakeful Care Assistant and 1 sleeping in, on call.
DS0000061189.V258897.R01.S.doc Version 5.0 Page 21 Nightingales Residential Home 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. Two part-time members of staff are also employed to carry out maintenance tasks and assist with administration. Residents spoke positively about staff. One said, They are nice people here, they are my friends. 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 working towards achieving this standard. Two staff now have NVQ level 2 certificates and two staff are currently studying for a NVQ level 3. One member of staff is due to commence training in February 2006. In addition, Mr Rhodes is employing three staff from abroad whom he believes have the equivalent of NVQ level 3 training, but this has yet to be evidenced. The home has now implemented a thorough recruitment procedure based on equal opportunities and ensuring the protection of residents. The two files examined for recently employed staff showed that the necessary documentation is in place. However, some documentation remains outstanding in respect of a few staff working in the home before Mr Rhodes took control. Mr Rhodes is confident this will be fully resolved shortly. Where staff are coming from abroad, the files demonstrate that appropriate information is gathered about the right to work in the UK and any possible restrictions on that work. It is suggested that staff files would benefit from a checklist detailing all information such as the date on which the application form is received, details such as CVs checked, when the candidate is interviewed, when references, Criminal Records Bureau disclosures etc have been requested and the dates on which such documentation is received, as well as the date employment starts. This would ensure that details of the recruitment process are fully recorded and the state of progress can be viewed at a glance. Mr Rhodes is working to implement the 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. Individual training and development files are being implemented for all staff. These will provide evidence that staff receive a minimum of three paid days training per year. Copies of all training certificates are being retained. Mr Rhodes has copies of the recently introduced Skills for Care Common Induction Standards and will be implementing these at Nightingales. Since the last inspection, all staff have undertaken external training in moving and handling, basic food hygiene, health and safety and fire safety. Infection
Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 22 control training is being planned. A requirement made after the last inspection concerning staff receiving training appropriate to the work they were to perform, for example dealing with dementia, mental disorders and challenging behaviour, has still not been achieved. Mr Rhodes says this is currently being arranged. Discussions with staff show that they are well motivated, keen to learn and value the training that is being offered. I have learned a lot since I started working here and it is very helpful with my job. Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 36 The registered person is qualified and experienced in care. Staff are well supervised and Mr Rhodes provides clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. The home is commencing reviews of its performance and, wherever possible, is seeking the views of residents, as well as staff, relatives and other visitors to the home, to ensure Nightingales is run in the best interests of residents. Residents are assured of sound management of their financial interests. EVIDENCE: Mr Rhodes is currently undertaking the National Vocational Qualification (NVQ) Level 4 in management, which he hopes to complete in the next few months. Mr Rhodes says enjoys being a hands on manager. He has recently employed a part-time administrator, in order to allow himself more time with
Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 24 residents. Mr Rhodes says he feels it is important to remain open and accessible and this was demonstrated throughout the inspection. Working relationships between the Registered Person, visitors, staff and residents were directly and indirectly observed throughout the course of the inspection. They were amicable, yet professional, contributing to the welcoming and relaxed atmosphere, which is beneficial to all in the home. A visitor commented, This is a very friendly and welcoming place. Staff speak highly of Mr Rhodes, He is a very good boss. He helps and encourages staff. He is very fair. He listens and is very understanding, you can talk to him. 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, relaxed and inclusive atmosphere where they feel valued. Staff commented: “This is a good place to work.” “I like to come to work, I enjoy my work very much.” Requirements made after the last inspection regarding the introduction of quality assurance and monitoring systems and record keeping are currently being implemented. Questionnaires are about to be sent out to relatives and other visitors to the home and the results will be looked at during the next inspection. An Annual Development Plan is now being prepared. This details plans and actions to date and will be used to reflect on aims and outcomes for residents. A policy is in place regarding the safeguarding of residents finances. In order to protect residents the home prefers, wherever possible, to have no involvement in personal finances. Therefore, all residents who are unable or do not wish to handle their own affairs, have a relative or other representative to deal with their finances etc. At present, the home is not handling any residents monies but 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 approximately every two months. Information about advocacy services is available to residents and their relatives within the home, should they need independent advice or support. At the last inspection, a requirement was made with regards to the introduction of formal supervision sessions for all care staff. 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. This system has now been fully implemented. Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 2 3 3 X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X X Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 26 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 OP3 Regulation 14(1) Requirement The registered person must 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. (Previous timescale of 30/9/05 not met.) All aspects of each resident s 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. Timescale for action 28/02/06 2 OP7 14 and 15 28/02/06 3 OP8 12(1) 4 OP18 13(6) (Previous timescales of 1/4/05 and 30/9/05 not met.) The registered person must 28/02/06 promote and maintain residents’ health. Information from assessments and advice given by professionals must be included in care plans and plans updated accordingly. The registered person must 28/02/06
DS0000061189.V258897.R01.S.doc Version 5.0 Page 27 Nightingales Residential Home ensure that staff receive suitable training to ensure residents are fully protected from the possibility of abuse. (Previous timescales of 1/4/05 and 31/7/05 not met.) The registered person must operate a thorough recruitment procedure to ensure the protection of residents. All staff must be properly checked before being employed. 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 and 30/9/05 not met.) 5 OP29 19(1) Schedule 2 28/02/06 6 OP30 18(1)(c) 28/02/06 Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP2 OP12 Good Practice Recommendations It is recommended that the terms and conditions of residence document (contract) is signed by the relevant parties and a copy retained in each residents records. It is recommended that much more be recorded about each residents background, social history, hobbies and interests etc, so that activities in the home can be tailored to meet individual needs. It is recommended that planned improvements to the rear garden be carried out to ensure residents safety. Repeated. It is recommended that staff receive training in infection control issues. 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. 3 4 5 OP20 OP26 OP28 Nightingales Residential Home DS0000061189.V258897.R01.S.doc Version 5.0 Page 29 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
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