Inspection on 23/01/08 for The Nightingales

This inspection was carried out on 23rd January 2008.

CSCI found this care home to be providing an Good service.

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

Other inspections for this house

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

CARE HOMES FOR OLDER PEOPLE The Nightingales Furzehill Road Torquay Devon TQ1 3JG Lead Inspector Stella Lindsay Key Inspection (unannounced) 23rd January 2008 09:45 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 The Nightingales DS0000070594.V353192.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. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Nightingales Address Furzehill Road Torquay Devon TQ1 3JG 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) 01803 294674 thenightingales@btconnect.com Margaret Rose Care Ltd Ms Helen Marie Saw Care Home 23 Category(ies) of Dementia (23) registration, with number of places The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Dementia (Code DE) - maximum number 23 The maximum number of service users who can be accommodated is 23. This is the first inspection under the new ownership. Date of last inspection Brief Description of the Service: The Nightingales provides residential care for up to 23 older people. Under the new registration, the service is offered to people who have dementia. The house is a substantial nineteenth century building, close to Torquay town centre. There is a large communal lounge that looks out over the garden, a small lounge leading on to an enclosed courtyard, and a separate dining room. There are 21 bedrooms on two floors, some of which have en-suite facilities. Fees are currently £300 - £500, depending on the person’s care needs. The CSCI inspection report is available in the entrance hall. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was unannounced and took place over two days in January 2008. It involved a tour of the premises, and examination of care records and staff files, the medication system, and some of the home’s policies and procedures. Care practice was observed, and we met three residents in their rooms as well as spending time with residents in the lounge and at meal times. This approach aims to gather information about what living at the home is like, and make sure that residents’ experience of the home forms the basis of this report. We also met with visitors to the home and six staff on duty, as well as the Registered Manager, Mrs Helen Saw, the Registered Provider, Mr Graham Greenaway, and a Manager from another home in the Margaret Rose group who is providing management support. The Registered Manager had provided useful information about the running of the home prior to this inspection. Staff and professionals who visit the home returned surveys and comment cards to the Commission for Social Care Inspection, and their views are included in the text. What the service does well: The home is light and airy, and is a comfortable and attractive place to live. Staff are friendly and approachable, and residents appreciated the way that Senior staff talk with them, with understanding. Visitors have stated that they are always made to feel welcome and can visit at any time. The Manager is qualified and experienced, and there is a core group of committed and caring staff. ‘We are there to support the residents and their family at all times’, said a staff member. They have worked well with health professionals to maintain good care for residents. Medication was well managed, promoting good health. A major building project was underway, to install a shaft lift and improve access around the home, and to build a new kitchen, as well as improve bathing facilities. It was being organised carefully to minimise disruption for the residents. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Some of the improvements already introduced need further work to meet their own objectives. The new holistic care plans and reviews were not in place for all residents. Some staff were seen to be needing further training in communication skills with people with dementia. Although staffing had increased, there were times when a group of residents had no carer available for a considerable period of time during the morning. While developing the building, the Registered Provider should take professional advice about the design of accessible bathrooms, in order to make the best use of available space. Access to the garden should be improved, and communal space indoors should be increased, to give residents a choice in dining areas so that they do not have to eat in a large group. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 7 Criminal Records Bureau clearances and checks against the Protection of Vulnerable Adults list must be made as part of every staff recruitment, to avoid any potential harm to residents. It would be good practice to keep a record of minor concerns that are raised, and any action taken, so that people know that they have been listened to. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good information is provided for people who are considering moving into The Nightingales, and the Manager ensures that a full needs assessment is undertaken before accommodation is offered. EVIDENCE: A new Statement of Purpose had been produced. It was clearly written and attractively presented. It gave good information about the staff, the service provided, and procedures in the home. It was generally accurate, but there were overstated claims regarding access to the garden, which the Manager undertook to amend. It included the efforts made to respond to individuals’ requirements by understanding their life history, and the arrangements made to help residents know where they are and what they may be doing, as well as how their health care needs can be met. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 10 The files of recently admitted residents were examined. The Manager had an assessment process that was seen to have been fulfilled, with visits to prospective clients and gathering of information from health and social service professionals. She had taken another Manager with her when there had been complex needs to consider. In one case the resident had previously spent a short stay at the home. Advice was gathered from an Occupational Therapist and Physiotherapist, and a Community Care Worker and Social worker from the hospital were involved in the admission. The Community Mental Health team were involved in the admission of another resident, who had dementia. This is to help the Manager make good decisions about whether The Nightingales can suitably offer care, and to help prepare for the person’s arrival, by ensuring that any equipment is provided in time, and that staff can be given information about what they need and what they like. It was seen that the Manager had written to the prospective resident or their representative to confirm when the decision had been taken as to whether or not the home could suitably provide care. Intermediate care (Standard 6) is not offered at The Nightingales. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although not all plans were fully completed and reviewed, good systems had been introduced to ensure personalised care was given consistently. Staff worked well with health care professionals, and medication was well managed, promoting good health. EVIDENCE: Care plans had been drawn up for each resident. A full assessment of their care needs was recorded. The Manager was introducing ‘person centred’ planning, where the care given is described in terms of what the person wants, rather than tasks for the staff. She had sat with a resident to compile a list of what they liked, and she had started to write personal profiles for each, as an introduction. This is important, as the home had recently been registered to care for people with dementia, and it is necessary to help staff understand their point of view. Agreements to care plans were seen to have been recorded, signed by residents’ next of kin. ‘Room plans’ were in each resident’s bedroom. These gave details of what was expected from domestic and care staff each day in the room, and staff had The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 12 signed to record what they had done. This promotes accountability for each staff member, and consistency for the residents. ‘My Life, my History’ booklets had also been started with residents, but not those who chose not to. Some family and friends had been helping with these. This is to help staff understand each resident, and to know what has been important to them. The Manager had introduced a system to ensure that care plans are checked weekly, with the three Senior carers each taking responsibility for some, and completing a ‘Care plan review form’. Although some were still blank at the time of this inspection, the system is good and will ensure that all are kept up to date, and information is shared with all staff. Weekly meetings had been taking place with the Manager and Senior staff to discuss one or two residents’ care and any issues arising. These had been found to be useful and enlightening, sharing good practice between the team and discussing what worked best for each client. Risk assessments were also in the process of being up-graded. Such assessments were seen to have been carried out for Moving and Handling, danger of falling, and vulnerability to choking. These included advice for staff on how to reduce the risk. One of the Senior staff had trained the carers in proper recording so that where fluid and food charts were necessary, they were being kept in an effective way for the better care of the resident. Professional advice had been gathered from District Nurses, the Community Mental Health team for Older people, Occupational Therapists and Physiotherapists. One professional had recorded that a couple with widely differing needs, ‘have both been helped by their stay at The Nightingales.’ The home has sit-on scales that are brought out once a month to weigh those for whom weight gain or loss may be important. Equipment was in place for those who were vulnerable to pressure areas, including suitable mattresses, and care plans for maintaining intact skin were seen. A hospital bed was provided promptly when required. The medication policy and procedure were seen to be correct, and recording was accurate and done with care. A Senior carer was seen giving medication individually, talking gently to each resident, and making sure they were happy to take their tablets. No long-term residents had been assessed as being competent to manage their own medication, but a person who was at The Nightingales for a respite stay was enabled to keep their own medication with the support of their next of kin. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This service has a strong commitment to promote social activities and good communication with residents, and though some staff needed to improve their skills, the team were working well towards this. Meals are well presented, with good variety and choice, and include fresh food and healthy options. EVIDENCE: Residents said that they get up when they want to, and are asked whether they prefer to take a shower, bath or strip wash. They are encouraged to choose what they want to wear. At the time of this inspection, eleven people chose to spend a large part of the day in the lounge. Some sat quietly during the mornings, while others were enjoying each other’s company. One of the Senior staff spoke of residents who enjoyed laying tables for meals, and others who had enjoyed reminiscing. Staff also told us that some residents like to watch football together in the evenings. During the afternoons, it was arranged that either a staff member or an outside entertainer would provide activities. On the second afternoon of this The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 14 inspection a musical entertainer was seen to have engaged residents in dancing, singing and playing instruments. It was very successful, and some of the people who normally stay in their rooms had come to join in. At other times, residents were not all happy. Some staff were skilled and experienced in communicating with the residents, while others had more to learn to enable them to provide social stimulation for people with diverse needs, and to make people feel that they were noticed and included. There were photos on display of dancing at Christmas, and an outing to the orchid centre. Recent outings had also included Paignton Zoo, and touring the Christmas lights. Visitors are welcome at any time that suits the resident. The small lounge is available for quiet times. One visiting relative said that all staff, but particularly the Manager, had been helpful. Yoghurts and fruit were offered as well as biscuits with morning coffee. The menus were on display in the dining room, and the main dish of the day was written on a white-board beside the hatch to the kitchen. Residents knew what lunch would be and said they are asked each day. ‘They are very good in the kitchen’, said one person, ‘it makes such a difference – something to look forward to each day.’ A small posy of fresh flowers on each table added to the attractive appearance of the dining room. Music was played softly during lunch, and the lighting and décor were pleasant. Residents may take their meals in their rooms, but were encouraged to come to the dining room. During this inspection the meals served were savoury mince with jacket potatoes or rice, and on the second day roast pork was served with three vegetables including cauliflower cheese. Fresh meat and vegetables were used, and the meals were tasty and nutritious. It was suggested that the residents would manage the meat better if it were sliced more thinly, and the Manager and Cook agreed that an electric carving knife would be helpful. A Senior Carer was seen to describe gently to a resident what their pudding was (a fruit flan), and to offer an alternative when the person still could not recognise it. A less experienced staff member was seen to stand while feeding a resident, and would benefit from guidance in doing things ‘with’ residents rather than ‘for’ them. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies, procedures and staff training are in place to protect residents. Staff were alert to the need to understand and deal with disturbed behaviour. EVIDENCE: The home’s Complaints procedure was on display in each resident’s bedroom. There was a book for recording complaints, but nothing was recorded, as no formal complaints had been made. Minor concerns had not been recorded, which would demonstrate that people are listened to, and that action has been taken in response, if appropriate. All staff who returned surveys to the CSCI said that they knew what to do if a resident or their relative raised a concern, and a visiting professional said that the service always responded appropriately to any concern or issue that was raised. One visiting relative said that they had found that they could talk to the manager in an emergency, and found her to be ‘very good – she made me feel better’. All staff had received training in the Protection of Vulnerable Adults, and the Manager had undertaken Advanced POVA training with the Torbay Care Trust. A safeguarding referral had been made appropriately to enable a resident to have their financial affairs dealt with safely. All residents had a lockable drawer in their bedroom, where they could keep their valuables safely. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 16 A resident who stays in their room said that they feel safe, and would speak to any of the staff if they were worried about anything. One resident in the lounge said that they did not always feel safe, as someone had gone into their room (another resident). Another had pushed a resident into their chair, and that person had hit out at them. Staff had been present, but unable to prevent this. They had reported it to the Senior and Manager. The staff were learning about what might trigger disturbed behaviour. Senior staff had attended training on dealing with challenging behaviour. Management need to monitor levels of staffing as well as training and awareness, in order to maintain safety in the home. Staff told us that it is normally calm in the home, and in surveys staff said that the residents ‘are happy and content’ and that ‘the service has the care of the users and all of their needs first and foremost when they are in our care’. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although at the time of this inspection there was not good access around the premises, and improvements to the kitchen were needed, work was in progress to provide a good environment. EVIDENCE: Major building works were in progress at the time of this inspection. Although access around the house was not good, work was planned to provide good access. A shaft lift was due to be installed. Floor levels on the upper storey were being altered, and the lift was designed to give access to both the upper levels, giving free access to all parts of the building. Building work was carefully planned with safety of residents maintained. Rubble from the lift shaft would go out of a window; drilling by the lounge took place before residents came down in the morning; decoration of the room where the occupant would not leave was being done in such a way as to inconvenience them as little as possible. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 18 Work had started on a completely new kitchen, in order to provide good conditions for food preparation and storage, as it had not been possible to install an extractor fan or a dishwasher in the current site. An accessible shower (wet room) had been provided, and en suite toilets had been built in more bedrooms. The Home owner said that showers would not be installed in en suite bathrooms, as they did not anticipate admitting residents who were able to shower without assistance. He said that he was planning to install an accessible bathroom on the ground floor. It would be good practice to obtain professional advice from a Occupational Therapist in the planning stage of bathrooms and toilets, to ensure best design in the space available. The communal space was sufficient for the level of occupancy at the time of this inspection (16) but would not meet the National Minimum Standard of 4.1 square metres per person if full occupancy were achieved. The home owner said that he would build a conservatory if he were allowed planning consent. This could benefit residents by enhancing their outlook over the garden, as well as providing the extra space needed. At present, although there is a double glass door from the lounge leading to the garden, it is blocked with a sofa looking inwards. This door leads onto several steep steps to the lawn, and is not considered safe for residents. At present their only route to the garden is via a rough surface, and all would need assistance. There was no garden furniture. This should be provided in time for Spring. As well as the large lounge and adjoining dining room, there is a small lounge (the ‘pink lounge’) suitable for quiet activities and private visits. It leads to an enclosed courtyard, via two steps. A grab rail is fitted, and a portable ramp is available. This door may be kept unlocked to give residents free access. There is a keypad on the front door. There are suitable locks on residents’ bedroom doors, for privacy, not needing a key. A new call bell system was due to be installed four weeks after this inspection, much better suited to the service. Using the current system staff have to go to the kitchen to cancel the bell. With the new one they will carry pagers, and will know where to go immediately. Calls and response times will be recorded, which will provide a record of care needed and improve accountability of staff. The bells will be quieter at night, to avoid disturbance to sleepers. Televisions had been supplied in all bedrooms, and fixed on wall frames, for safety and convenience. The laundry is in a separate building, and was seen to be clear and in good order. A cleaner had been appointed. The house was clean and well presented in spite of the building work in progress. Slight odour was found in one room, but this room was due to be fitted with a new carpet. Liquid soap and paper towels were available in dispensers in all bedrooms. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels were sufficient to meet the needs of residents, and staff had received training in care of people with dementia, although further training is needed to ensure that all staff provide quality care. EVIDENCE: Written rotas are kept, which show that a Senior carer and two other carers are on duty between 8am and 8pm. The Manager is additional to this, Monday to Friday. At night there are two carers, one awake and one on sleeping in duty. A cleaner is also employed, and a new cook started work during this inspection. This represents a considerable improvement in staffing from when the new owners took over. The number of residents had increased, and the home had started to specialise in the care of people with dementia, so management must continue to monitor staffing levels with respect to meeting the changing needs of current and in-coming residents. We considered the level of staffing to be sufficient. Incidents that occurred might have been better handled through further training and experience of this client group, rather then by increased numbers of staff. However, we saw that during the mornings there was not always a staff member present in the large lounge, and at times during the afternoons the carer based in the lounge had to be called away to help colleagues elsewhere. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 20 In surveys staff said that, ‘every staff member is working well as a team to provide positive and quality care to every resident.’ During the inspection staff told us that they work together well. Three of the current twelve care staff had achieved a National Vocational Qualification in care, level 2 or higher. Further progress is needed to achieve a qualified workforce. The Manager had provided all staff with induction training. The in-house training was seen to be thorough with regards to physical health care of residents, but did not include an element of training in communication skills or understanding of the person with dementia, which should come before all other processes. Staff were also working on or had completed a Skills for Care induction training. All staff who returned surveys said they were given training that helps them meet the individual needs of residents and keeps them up to date with new ways of working. All staff had attended a training session on Dementia Care Awareness. Senior staff had followed a more in-depth course, and were enthusiastic about their learning, and about developing good practice in their work. This should be continued so that all staff build their competence particularly in communication skills, understanding dementia, dealing with challenging behaviour, and promoting social activities of normal daily life with residents. Moving and handling training had been provided for all staff, and certificates were seen. Some staff were seen to need refresher training, as some poor practice was seen, but Senior staff were on hand to show the correct procedure. The Manager arranged a training day for later in the week of this inspection. Training in control of infection had been provided in the week before this inspection, and the Health Protection Unit had been invited to the home. Food hygiene training and Health and Safety training had also been provided, to assure safe working practices in the home. The files of two recently recruited staff were examined. It was seen that verbal and written references had been obtained, and proof of identity had been checked. The Criminal Records Bureau (CRB) check had been applied for on behalf of one of the staff, but the POVA check had not been done. This means that they had not checked whether the applicant’s name was on the list of people who are prohibited from working with vulnerable adults, because they have been found to be abusive in some way. We were told that this part of the recruitment process is dealt with centrally by the company, and that the Manager had been advised by the company that CRB checks were not needed for recruits who were arriving from overseas for the first time. However, guidance from the CSCI is that these checks must be made, for the protection of residents from potential harm. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Nightingales is well run in the interests of the residents. Record keeping is good, and safe working practices are maintained. EVIDENCE: Mrs Helen Saw is the Registered Manager of The Nightingales. She has appropriate qualifications including Registered Managers’ Award, NVQ care level 4 and A1 assessor’s award. She has completed an ASET dementia training course over 32 weeks, with one of her Senior carers. She has worked with a variety of client groups, and has previously managed a home for older people. We recommended that she further advance her specialist training in dementia care, in order to lead her team in implementing good practice in the home. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 22 She had not received a Job Description, which is needed to be clear about her role and responsibilities. The Responsible Individual for the company is Mr Graham Greenaway. He has carried on care homes since 1994, and has been seen to require good levels of performance from his staff teams. The well qualified and experienced Manager of another home in the Margaret Rose group is giving management support, particularly in the areas of health care and staff training. An administrator who is employed by Margaret Rose Care Ltd, and based at another home in the group, gives administrative support to The Nightingales, and is on the premises one day per month. Weekly and monthly audits of systems within the home had been carried out, to ensure that standards were maintained. Questionnaires had been sent to relatives, and the first two had been received. The supporting manager said they would provide questionnaires for visiting professionals. He also said that he had been asked by the Registered Provider to make monthly visits to The Nightingales and to speak with residents and staff and report on the standard of care, the condition of the premises, and records of events and of any complaints, and to supply a report to the company and to the CSCI, in accordance with Regulation 26. A food questionnaire had been circulated, resulting in menu suggestions. A residents’ meeting had been held, when menus, outings and entertainments were discussed. A Relatives meeting had been held in early December, for them to meet the new home owner. He told them of his planned improvements, and the Manager reassured them that staff were staying. Some cash was held in the safe for several residents. Records were kept of each transaction with a running balance and two signatures. Receipts were labelled so they could be crossed checked. Two accounts were checked and found to be accurate. Residents could get to their money at any time, and they also have secure storage in their own rooms. The Manager had met with each staff member individually for supervision and appraisal, with records kept confidentially. Staff who returned surveys all said that they get good support to carry out their work and meet the different needs of the residents, and confirmed that they meet regularly with their Manager. Fire risk assessment were completed by the previous management. The Registered Provider had obtained the current risk assessment format from the local Fire Safety Officer, with the intention of up-dating this work. The fire precaution system had been professionally serviced on 11/04/07. In-house The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 23 fire safety training had been delivered regularly through the previous year, and professional fire safety training was delivered on 08/01/08. Sufficient staff are trained in First Aid to assure a First Aider is on duty at all times. The certificate for the five year electrical circuit check was not available. The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 24 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 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 2 X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? This is the first inspection under new management. 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 OP29 Regulation 19 Requirement CRB and POVA checks must be made as part of every staff recruitment. Timescale for action 29/02/08 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 OP16 Good Practice Recommendations Minor concerns should be recorded, so that people know that they have been listened to, and that action has been taken, if appropriate. Communal space should be increased to give residents choice of dining and social areas. Garden furniture should be provided, and access to the garden improved before the good weather arrives, so that residents may enjoy the open air. The Registered Provider should consult an Occupational Therapist while planning accessible toilets and bathrooms, in order to ensure best design and make them as useful as possible to residents with mobility problems. DS0000070594.V353192.R01.S.doc Version 5.2 Page 26 2. 3. OP20 OP20 4. OP21 The Nightingales 5. OP27 Management should monitor staffing levels, and respond promptly to changing needs. While a group of residents is in the lounge through the mornings, a carer should be available. Management should continue with provision of dementia care training, and ensure that it is included in initial induction training, so that new staff start by learning to communicate well with residents. The Registered Manager should have a Job Description, to clarify her role and responsibilities. The Regulation 26 reports should be supplied to the CSCI, to assure us of on-going good practice and progress with the improvements. The Registered Provider should forward a copy of the electrical circuit 5 year certificate to the CSCI, to assure us that safe conditions are maintained in the house. 6. OP30 7. 8. OP31 OP33 9. OP38 The Nightingales DS0000070594.V353192.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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