Care Home: Nettlestead

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What the care home does well Residents in this home are well cared for with their individual needs addressed and the service tailored to their individual specifications. Residents are provided with information on which to base their decision on whether the home is suitable for them. Generally all information was accessible and kept in an orderly fashion. Records for health and safety were well maintained and easy to extract information from. Staff are provided with training and support so the can efficiently carry out their work. The Directors were said to be very supportive of the staff and were always looking at ways to improve the quality of life for resident`s living there. What has improved since the last inspection? All of the procedures have been rewritten to be more outcome focused. Care Plans have been revised to be more outcome focused with greater resident input. Information sent to potential residents is now more comprehensive. The brochure and website have been updated to give far more detailed information to everyone. The choice and delivery of food has been made even better. The home has appointed an activities coordinator to ensure that there is stimulation for residents. What the care home could do better: The care plans must include clinical aspects of care to ensure resident`s needs can be fully met. Key inspection report Care homes for older people Name: Address: Nettlestead 19 Sundridge Avenue Bromley Kent BR1 2PU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rosemary Blenkinsopp     Date: 2 2 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Nettlestead 19 Sundridge Avenue Bromley Kent BR1 2PU 02084602279 02084643683 Nettlestead@Nightingales.Co.UK www.nightingales.co.uk Nightingale Retirement Care Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Kim Thomas Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 22 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Nettlestead is a large, detached three-storey Victorian house, converted for residential living, providing care and accommodation for twenty-two older people. The house is set within its own well-kept grounds, with a secluded rear garden. Off-road parking is located to the front of the property, with an in and out drive. The home is situated in a quiet residential area within walking distance of local shops and public transport links. The house has retained many of its original features, Care Homes for Older People Page 4 of 27 Over 65 22 0 Brief description of the care home particularly the wood panelling in the lounge. Residents accommodation is on all three floors, accessed by stairs or lift. There are 20 single rooms. Bedrooms are various sizes and shapes. Fees range between £632.00 up to £1,120.00 Central heating is provided to all areas of the home. Specialist bathing equipment and lifting aids are also available. There are telephones accessible to service users. All service users have a large button telephone in their own room connected to a central switchboard. The residents are cared for 24 hours a day by a team of care staff, ancillary staff and a management team. Fees include accommodation, food and staffing. It does not include hairdressing; private healthcare; newspapers, clothing; toiletries and other personal expenditure. The home has a Statement of Purpose and Service Users Guide providing information on the home and copies of inspection reports are available directly from the home. A copy of the inspection report is available on request from the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was conducted over a one day period by one inspector. The manager facilitated the site visit, assisted by the staff on duty. All of the minimum standards were assessed during this site visit. Periods of observation were undertaken in the communal areas on the ground floor. Prior to the inspection the manager had completed the AQAA and forwarded this to the CQC. The AQAA was very well completed and contained good information in each of the sections. No comment cards were received prior to the site visit. During the visit we met with several residents. One health professional also provided information on the service. Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated Care Homes for Older People Page 6 of 27 into this report. A selection of documents were inspected including care plans; staff personnel files as well as health and safety records. Feedback was provided to the manager at the end of the inspection. Other information which has been considered when producing this report and rating, is the information obtained through Regulation 37 reports, and complaints that CQC have been made aware of. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are subject to assessments conducted by the manager of the home. Assessment information helps to determine the homes ability to meet the residents needs and provides staff with information on which to provide care Evidence: At time of the site visit there were 20 residents on site there were two empty beds. Residents are subject to assessments conducted by the manager of the home, supporting information is obtained through members of the multidisciplinary team which gives a comprehensive picture of needs. Assessment information helps to determine the homes ability to meet the residents and the background information, that is obtained about residents, provides a good insight into the residents previous life. Care Homes for Older People Page 10 of 27 Evidence: Some residents were able to tell us about their experiences of moving in to this service. They said that they had received information and had opportunities to visit the home. The felt they were welcomed, supported and assisted during the transition period. There was a selection of information available including the Service Users Guide an the Statement of Purpose, both of which will need amending to reflect the correct Regulator, namely the CQC and the changes in staffing. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents care needs are met by staff in the home supported by members of the multi disciplinary team. Care plans are in place, and these provide good information for staff to deliver the care. Medications were safely managed which provides protection to residents. Evidence: It was evident that a lot of equipment was available for residents use. Staff were seen to assist residents when they were mobilizing using equipment and manual handling techniques. Additional equipment such as footstools and different styles and types of seating all adds to residents comfort. Care plans are in place for each resident. These are computer generated and person centered. The residents themselves dictate how they want their care delivered and were very personalized. These provide staff with good information on the physical health needs of the resident on how to address the individuals care. Supporting risk assessments are in place and kept under review. Care Homes for Older People Page 12 of 27 Evidence: Supporting risk assessments for skin integrity are retained by the District Nurse. Falls and manual handling risk assessments were in place although usually recorded under the observations section of the care plan. It is essential that there is fully comprehensive documentation in place to address and minimize these risks and where necessary care plans in place to address the issues and staff have easy access to this. Staff need to be able to access information easily to ensure care delivery . Weight records showed resident were weighed at regular intervals. Staff have been allocated as key workers and are responsible for updating information. Staff input information in to the computer generated records through a communal laptop. Staff have been trained in the use of the system and felt able to use it correctly. Relatives are assisted to look at records with staff assistance and these can be printed off when needed. Visits made by members of the multi disciplinary team are also recoded. We met with one visiting health professional and they confirming that in their opinion the home provided a good service and staff followed instructions regarding care . Only female staff are employed hence gender preference is difficult to address although the manager stated this had never been raised as a concern or requested. This needs to be kept under review. Daily records of care provided are made. We inspected the systems for storage recording and medication administration. All staff who administer medication are trained to do so. Staff have external training and attend a college course in safe administering of medications. The storage of the medication is cramped in a cupboard although the room temperature is checked daily to ensure medications are kept at their optimum temperature. The home uses the Boots monitored dose system. Those charts seen had the medication received recorded and were completed with the residents photograph and allergies stated. Some of the hand transcriptions on medication records needed two staff signatures to confirm the accuracy of the information. Care Homes for Older People Page 13 of 27 Evidence: Eye drops had been recorded as received and the date of opening was recorded on the bottle. The date is important as eye drop have a short life once opened and it needs to be very carefully monitored. Records for medications returned to the pharmacy were in place indicating the amount returned and signed by the staff member. The pharmacist also signs to confirm the records. We were told residents have their medications reviewed with the GP. At the time of the visit there were residents who were requiring Controlled Drugs, the records were fully completed and medications correct. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Choices are provided in residents day which promotes independence and enhances individuals well being. Activities, which are age appropriate, are provided regularly. Evidence: Activities are provided to residents that are both varied and age appropriate. Residents are encouraged to spend time where they want to even if this is in their own bedrooms, although there are several very pleasant communal areas. Several residents were seen in their own bedrooms watching TV or engaging in other activities. There was a lot of equipment including computer games, magazines, board games etc to entertain residents. Several were watching the TV in the ground floor communal room. The lunchtime meal was served in a beautifully presented dining room . Residents were offered choices in the meal and seconds provided, where requested. The AQAA told us the following : All residents have a large number telephone in their room for internal calls and which can also be connected to the BT exchange. For those Care Homes for Older People Page 15 of 27 Evidence: who do not want this service, calls can be made and received on a portable phone which is taken to them. Everyone receives their post unopened.We always ensure our residents have a choice in whatever they do. Whilst we encourage them to join in with our activities programme, we always respect their wishes if they do not want to, and it is they who set their daily routines. A flexible programme of daily activities is available and a schedule is placed on the activities board. This is formed from the residents own preferences and, wherever possible, reflects hobbies and activities they did before coming into the home. Residents are offered three nutritious home cooked meals daily which can be taken in the dining room or the residents own room if preferred, and at a time of their choice although most prefer to eat with their companions. There is a choice of menu for each meal and this is discussed with each resident individually when their order is taken. Residents are encouraged to eat and drink regularly, and drinks and snacks are always available in addition to mid-morning coffee, sherry and mid-afternoon tea being served. Special dietary needs are catered for, and individual likes and dislikes are recorded on the residents care plan. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their concerns and complaints will be dealt with and staff have sufficient knowledge to take appropriate action Evidence: The home has procedures in place to protect the residents living there. There are comprehensive policies and procedures relating to dealing with concerns and complaints These policies were on display and clear to see. The policy is included in the Statement of Purpose. Within the policy there is reference to the CQC investigating complaints. The CQC no longer has responsibility for investigating complaints and this statement should be revised. All complaints are recorded . The home has investigated two complaints since August 2009. The information retained was to a good standard and included the investigation and the response. The CQC has been advise of no Adult Protection issues relating to this service. The management of the service have an open door policy for any person to speak with them at any time. The AQAA told us the following : We have a clear complaints procedure which is summarized in both our Guide for Residents and Terms and Conditions. All complaints are dealt with in a timely manner and will not be considered closed until the complainant is completely satisfied. Care Homes for Older People Page 17 of 27 Evidence: All new staff are subject to CRB and POVA checks prior to employment. Staff have received training in abuse and it is covered during the induction period. Those staff spoken to were asked about the action they would take in suspected or actual abuse. They were well aware of how to recognize it and the need to report it although information regarding external bodies was known by some staff and others less so. Staff have access to information to remind them of whom to contact. In relation to whistle blowing staff told us they understood the term and how it should be actioned. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with a safe, comfortable home which is well maintained and personalised to individual preferences. Evidence: The home was toured by us and this included individual bedrooms and communal areas. All areas were to a good standard both in terms of cleanliness and decorative order. Individually colour coordinated bedlinen curtains and seat coverings made bedrooms feel homely and individual. Residents told us they were happy with their accommodation. Bedrooms are different shapes and sizes and the fee range reflects this. There is lift access to other floors. There are several areas to sit in all of which were comfortable . The conservatory was particularly pleasant. There is a large garden that is about to be completely redesigned with residents input. Bathrooms were to a good standard whilst having sufficient equipment to ensure residents needs are met. There is enough equipment including hoists and specialized Care Homes for Older People Page 19 of 27 Evidence: baths. The AQAA told us the following: Nettlestead is a residential home offering support to 22 elderly ladies and gentlemen in an extremely comfortable and homely atmosphere. Whilst accommodating the special needs of our client group, we strive to avoid an institutionalised setting. During 2008 our refurbishment programme not only included greatly improving the facilities offered, but also the upgrading of carpets, pictures and lighting. Great care has been taken to ensure that the improvements are sympathetic to both the Victorian building and the demographics of our residents. There is a dedicated maintenance person responsible for the upkeep of the house and gardens Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs sufficient staff that are provided with enough training and support to carry out their roles. Evidence: There is a Registered Manager in post supported by a team of care staff. Further support is provided by, cooks, domestic assistants and a maintenance person.Currently there is a vacancy for an activities worker 27 hours per week and a part time care staff. The home is staffed 24 hours a day, with two waking night-time staff. The majority of the staff team have been in post for several years. Staffing levels are reviewed frequently and increased as residents needs dictate. Staff told us that in their opinion enough staff were employed to meet the needs of residents. We looked at the checks completed for staff including the newest recruits. All three had the information as required under the Regulations. It was evident that no one is employed without a CRB, checks on references or identity checks. Pre employment health screening is also undertaken. Contracts and job descriptions were retained. Care Homes for Older People Page 21 of 27 Evidence: Notes are taken during the interview of the answers that the prospective employee gives. Staff are subject to a three and nine month appraisal and supervision takes place regularly there after. The home is a member of Bromley Consortium which provides regular and specific training to staff in care homes. Staff told us that they received training regularly and this included up dates on the mandatory topics and NVQ qualifications. All staff except three have NVQ qualifications, two of which are due to start the course. Staff felt that they were supported in their roles not only by the training provided but by the management team. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by an experienced individual. Health and safety measures ensure that the home is maintained to a safe standard. Quality assurance enables all those involved with the service to have input into developments of it . Evidence: Kim Thomas has been Head of Home and Chris Wiseman has been Assistant Head of Home for more than 10 years. The manager has completed the NVQ level 4 and the RMA . She is planning to do a risk assessment course and has completed the supervision course. There is ongoing support from the directors of Nightingale Retirement Care Ltd. In addition there are many members of the staff team who have been in post for many years giving consistency in care. A selection of health and safety maintenance certificates were seen by us and these included those for gas safety, electrical appliances and the lift. All were found to be Care Homes for Older People Page 23 of 27 Evidence: current indicating that the equipment was safe to be used and had been subject to regular servicing. A recent Environmental Health inspection had produced a good verbal report although there was no written report yet available. Water testing had been conducted February 2010. The fire risk assessment had been updated February 2010. The fire book indicated that weekly fire alarm testing was conducted. Fire instruction and training is provided by way of fire drills and the use of a training DVD. Signatures were in place for all those staff attending fire drills, separate drills are conducted for the night staff. All staff attend a one day first aid course. First aid boxes are available throughout the building . The AQAA told us the following : Good standards cascade down from the top, and everyone is committed to the highest standards of professionalism. From the owners down, Nightingales provides an open, positive and inclusive ethos through the friendly and supportive interaction of all members of staff and residents. We implement a continuous and thorough review of all our operating standards and procedures. Every procedure is audited at least annually, and more frequently in response to changes in policy or legislation. Quality is monitored through constant interaction with stakeholders, residents and other professionals, as well as via Quality Questionnaires that are issued twice annually. Requirements identified by external inspectors are prioritised and acted upon with the agreed timescales. There is a development plan for the home which builds on residents wishes and feedback, and which is reviewed bi-annually or more frequently as required. This includes Nightingales Insights, a system built on the principles of the European Forum for Quality Managements Excellent Model, and Balanced Scorecard principals. We actively seek residents and other interested parties views both through formal bi annual surveys, residents meetings and informal conversations. It was apparent staff had a good rapport with residents ad the manager has an open door policy. We saw evidence of the Regulation 26 visits and the reports for these were to a good standard. Quality Assurance measures include the views of all those who use the service . Those audits and survey results seen, showed a high percentage of satisfaction with the home. Residents money is safely stored and accounted for. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Hand transcriptions of medications must have two signatures in place to confirm the accuracy of the record made. To ensure that residents get the correct medication. 26/05/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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