Care Home: Nightingale

What the care home does well People had their needs assessed before moving into the home. Each person had a written plan of care that detailed their needs and what action staff needed to take. The records showed that people`s health care needs were met. In the main the medication system was safe and was monitored by the management. People told us they were treated with respect. Relatives spoken to confirmed this and our observations on the day were positive. There is an activities programme in place and staff told us people were encouraged to take part. Staff welcomed and encouraged contact with family and friends and relatives told us they were made welcomed when they visited. Many of the people using the service needed assistance to make choices. Staff told us they were able to assist with choices by having detailed information about the person, talking to relatives and taking clues from peoples reactions. People told us they were happy with the food provide, this was supported by relatives and staff. The home has a complaints procedure, which is displayed. Staff were able to tell us the steps they took on a daily basis to protect people from abuse and confirmed they had received training on the protection of vulnerable adults. The environment was safe and well maintained and there were procedures, equipment and the skill of the staff to promote good hygiene standards. Staff told us there were enough staff on duty to meet peoples needs and that staff worked well as a team. In the main the recruitment procedures were safe and staff received the training they needed to help them to do their jobs. People using the service, staff and relatives told us the home was well run and that the management was approachable. People are able to comment on the way the service is run and there comments are used to develop the service. There are safe working practices and the health safety and welfare of people using the service and the staff is promoted and protected. In the questionnaires people using the service, relative`s, staff and professional visitors made the following comments. Queries about medication is checked out and sorted out quickly Staff have received and or receiving training on safe administration of medication. The pharmacies are kept up to date with people`s medication requirements. A new monitored does system has been introduced and works better. The staff looks after people respecting their personal dignity. Excellent manager who has the respect of the staff. Information about people is detailed in the care plan and staff have access to all information. There is usually enough staff on duty. The staff gives support to people when they ask or need it. I am always given training. Staff and manager very helpful we are kept up to date. There is fantastic communication between staff and manager. Staff work well as team. The home provides a safe place for people when at their most vulnerable while supporting family. The locality and care provided is second to none. Excellent care and support provided always I consider all aspects of the care home to be excellent I am happy here. I am very satisfied. What has improved since the last inspection? Care plans had been improved however there is still further improvements to be made which was acknowledged by the manager. There are safe procedures for booking in and recording medication received into the home. People using the service are in the main provided with appropriate social stimulation to enhance their quality of life. All staff have been provided with training on safeguarding adults. The home is adequately furnished and there are procedures in place to promote good standards of hygiene. Specialist training in dementia care has been provided for staff and is ongoing. What the care home could do better: People made the following comments in the surveys received before the visit. There should be more trips out. I think there should be more interactive things to do instead of watching television and listening to the radio. On our visit to the home we found the following could be done better. Care plans, risk assessments and daily recordings need to be further developed. The home`s procedures on the administering and signing for medication need to be followed at all time to reduce the risk of mistakes being made. The manager needs to make sure that appropriate authorities are notified of relevant accidents and incidents. CARE HOMES FOR OLDER PEOPLE Nightingale Nether Lane Ecclesfield Sheffield South Yorkshire S35 9ZX Lead Inspector Shirley Samuels Key Unannounced Inspection 19th January 2009 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 Nightingale DS0000002990.V373722.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. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingale Address Nether Lane Ecclesfield Sheffield South Yorkshire S35 9ZX 0114 257 1281 0114 257 1279 nightingalesheff@aol.com None Paxfield Associates (Sheffield) Limited 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) Manager post vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (40) Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Under 65`s can only be accommodated with the consent of the Registering Authority. 26th March 2008 Date of last inspection Brief Description of the Service: Nightingale care home is a purpose built, two-storey building situated in Ecclesfield. It can accommodate up to 40 older people aged 65 years and over, who require personal care because they suffer from dementia or mental disorder. It is located near a shopping area and is close to a supermarket, a chemist shop and a bank. It is accessible by public transport. The manager informed us that the range of fees was between £369.00 and £500.00 per week, including third party top up fees. Items not covered by the fee, included hairdressing, personal toiletries, newspapers and private chiropody. Further information about Nightingale and its services can be obtained from the home. Nightingale DS0000002990.V373722.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 two star. This means people who use the service experience good quality outcomes. “We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken.” This was a key inspection carried out on this service by Shirley Samuels on the 19th of January 2009 from 9:45-18:45. The manager assisted throughout the inspection and was given feedback at the end of the visit. In the report we make reference to “us” and “we”, when we do this we are referring to the inspector and the Commission for Social Care Inspection. We received six service user, four staff and four professional visitor questionnaires. On the day of the visit we sought the views of five people using the service, three staff, seven relatives and the manager. This visit was a key inspection and we checked all the key standards. During this visit we looked at the environment, and made observations of the staff’s manner and attitude towards people. We checked samples of documents that related to peoples support, care and safety. These included three assessments and care plans, three medication records, and three staff recruitment files. The inspector looked at other information before visiting the home. This included the Annual quality assurance assessment (AQAA). This is a form completed by the manager of the service which tells us how they think the service is doing, what has improved and what further action they plan to take to develop the service. The inspector would like to thank everyone for their co-operation and welcome. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 6 What the service does well: People had their needs assessed before moving into the home. Each person had a written plan of care that detailed their needs and what action staff needed to take. The records showed that people’s health care needs were met. In the main the medication system was safe and was monitored by the management. People told us they were treated with respect. Relatives spoken to confirmed this and our observations on the day were positive. There is an activities programme in place and staff told us people were encouraged to take part. Staff welcomed and encouraged contact with family and friends and relatives told us they were made welcomed when they visited. Many of the people using the service needed assistance to make choices. Staff told us they were able to assist with choices by having detailed information about the person, talking to relatives and taking clues from peoples reactions. People told us they were happy with the food provide, this was supported by relatives and staff. The home has a complaints procedure, which is displayed. Staff were able to tell us the steps they took on a daily basis to protect people from abuse and confirmed they had received training on the protection of vulnerable adults. The environment was safe and well maintained and there were procedures, equipment and the skill of the staff to promote good hygiene standards. Staff told us there were enough staff on duty to meet peoples needs and that staff worked well as a team. In the main the recruitment procedures were safe and staff received the training they needed to help them to do their jobs. People using the service, staff and relatives told us the home was well run and that the management was approachable. People are able to comment on the way the service is run and there comments are used to develop the service. There are safe working practices and the health safety and welfare of people using the service and the staff is promoted and protected. In the questionnaires people using the service, relative’s, staff and professional visitors made the following comments. Queries about medication is checked out and sorted out quickly Staff have received and or receiving training on safe administration of medication. The pharmacies are kept up to date with people’s medication requirements. A new monitored does system has been introduced and works better. The staff looks after people respecting their personal dignity. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 7 Excellent manager who has the respect of the staff. Information about people is detailed in the care plan and staff have access to all information. There is usually enough staff on duty. The staff gives support to people when they ask or need it. I am always given training. Staff and manager very helpful we are kept up to date. There is fantastic communication between staff and manager. Staff work well as team. The home provides a safe place for people when at their most vulnerable while supporting family. The locality and care provided is second to none. Excellent care and support provided always I consider all aspects of the care home to be excellent I am happy here. I am very satisfied. What has improved since the last inspection? What they could do better: People made the following comments in the surveys received before the visit. There should be more trips out. I think there should be more interactive things to do instead of watching television and listening to the radio. On our visit to the home we found the following could be done better. Care plans, risk assessments and daily recordings need to be further developed. The home’s procedures on the administering and signing for medication need to be followed at all time to reduce the risk of mistakes being made. The manager needs to make sure that appropriate authorities are notified of relevant accidents and incidents. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 8 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. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 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 Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 6 People using the service experience good outcomes in this area This judgement has been made using available evidence including a visit to this service. People have the information they need and are assessed before moving into the home. EVIDENCE: Relatives told us that they received written information about the home, the services provided and the standard of care they could expect. The statement of purpose and the service user guide has been updated to include changes to the service and the management of the home. This showed that people were provide with the information they needed. On each of the files checked there was assessments completed which detailed people’s needs. The assessments were carried out by a social worker or a representative from the home for people who were self funding. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 11 Staff told us that in the main they received enough information to make a judgement about whether or not they were able to meet a person’s needs. They added that where there were gaps in information social workers and family provided information reasonably quickly. This showed that people did not move into the home without having their needs assessed. The home does not provide intermediate care. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and10 People using the service experience Good outcomes in this area This judgement has been made using available evidence including a visit to this service. In the main people’s care needs are identified and met, health care needs are met and people are treated with privacy and dignity. The medication system is safe however there are shortfalls in procedures. EVIDENCE: Since the last inspection the information detailed in the care plan has been developed substantially. Relatives told us they were asked to contribute to care plans jointly with the person using the service or on their behalf if the person using the service did not have the capacity to contribute. Care plans were developed from the assessment and were developed over time as staff got to know people better. From reading daily recordings, records of accidents, incidents and talking to staff about people. This identified some gaps in the care plans. For example Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 13 people who displayed challenging behaviour. This was recorded in the daily notes, staff were able to tell us about behaviours, who was at risk, what they did to reduce the risk. This information however was not transferred into a care plan or risk assessment. The records stated care plan reviewed. There was no evidence however that the previous months daily recordings were used to inform the review. This meant that Care plans were not always amended to reflect change when it was clear from daily recordings and other documents that there had been some change. The records show that people have appropriate access to health professionals such as district nurse, GP, chiropodist aromatherapies and Community psychiatric nurse. Visits are recorded along with the outcome and the actions that staff need to take. The home has links with one GP surgery and the Same GP calls each week and carries out a “ward round” style visit where people’s health care needs and medication is reviewed and monitored. The GP, staff and relatives told us that this worked well and ensured continuity. A team of district nurses linked to the same GP surgery also supported the home. This made sure that people’s health care needs were met. Staff responsible for the administration of medication received training and refresher training to maintain competence. The manager told us that she carried out monitoring of the medication system. The medication system has been reviewed since the last inspection and has improved. The pharmacy carries our monitoring visits and the records show that the system is satisfactory. Observations were made of the medication round. People’s meal was interrupted to take medication. A pot with tablets was seen in the drugs trolley when asked about this the staff member said this medication was prescribed to be administered in the morning, the person preferred to take the tablets in the afternoon and that this was ok with the GP. This was not recorded and meant that medication was not administered according to the instructions. The staff told us at the time of the medication round, medication was removed from the original container by one staff member (who signed the record sheet) then given to another staff member to give to the person. This means that the person actually giving the medication to the person is not signing the medication sheet. This is poor practice raises unnecessary risk. The manager told us, controlled drugs were not prescribed for anyone. People using the service and the relatives spoken to on the day of the visit told us that they observed good practice with regard to the way people were Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 14 treated. They said that privacy and dignity was promoted and that staff worked hard to encourage independence. Staff were able to tell us how on a daily basis they promoted privacy and dignity. Some of the examples included treating people as individuals, respecting choices, carrying out personal care in a way that reduced embracement, maintaining confidentiality and treating people in a way you would want your loved one to be treated. This shows that people’s rights are upheld. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience good outcomes in this area This judgement has been made using available evidence including a visit to this service. Activities are provided contact with family is encouraged and a balanced diet is provided. EVIDENCE: The home employs an activities co-ordinator. The post had been vacant but the manager told us it had now been recruited to. There is an activities programme, which is displayed. Records or kept of the date ,times, people who took part and the activity provided. The activities provided included, reading daily papers, exercises, quizzes, music and singing, reminiscence, pamper sessions, bingo, art and craft. People told us they enjoyed the activities. People were observed taking part on the day of the visit. This shows that people do have the opportunity to take part in meaningful activities if they wish. Records of meetings shows people would like the opportunity to go out more. The staff told us they were trying to make this happen for individuals who wanted to go out and are looking at ways of accessing a mini bus. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 16 People using the service, staff and relatives told us that people were encouraged to maintain contact with family and friends. Relatives told us they were always made welcomed and offered a drink when they visited. Peoples choice was promoted on a daily basis by offering options at mealtimes, raising and retiring times, having knowledge about people’s preferences, communication between staff relatives and people using the service. Relatives told us that staff were good at keeping them up to date and staff told us they were able to use the knowledge, experiences and information they had to make choices on behalf of those who are sometimes unable to choose for themselves. The menu for the day was displayed. People were given a choice. Hot and cold dinks were offered with meals and in between meals. Jugs of water were seen in each of the bedrooms. The manager told us these were changed every morning. We observed lunch being served. Meals were well presented and looked appetising. People who were reluctant to eat were encouraged to eat. One gentleman told a member of staff, he did not want anything to eat and wanted to stay sitting in the chair in the lounge. The member of staff did not force the issue but pulled a small table up to where the person was sitting and placed his meal on the table. The gentleman ate all his meal including a pudding. This was a very good example of staff finding solutions and responding to people on an individual basis. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 17 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 and 18 People using the service experience good outcomes in this area This judgement has been made using available evidence including a visit to this service. There is a procedure for making complaints people are protected from harm and abuse. There is a shortfall in the notification of incidents to external organisations. EVIDENCE: The home does have a written complaints procedure. Relatives told us they did know how to make a complaint. Some relatives’ told us if they had any concerns or comments speaking to the manager or the staff usually resolved any issues. There were no complaints recorded in the complaints file. The manager told us no complaints had been made. From reading the minutes of staff meetings these show that there is a problem with laundry going missing. Relatives told us they had raised this with the staff they also added that clothing usually eventually turned up but could be missing for some time. Laundry procedures have been reviewed to try and reduce the incidents of this. Staff have received training on safeguarding adults. Staff were able to tell us the action they take on a daily basis to protect people from harm or abuse. There have been no safeguarding referrals made in the last 12 months however there was a record of an incident where one person using the service Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 18 assaulted another, which resulted in minor injuries. Action had been taken by the staff to reduce the risk of this happening again and relatives were satisfied that appropriate action had been taken. This incident had not however been referred to the Sheffield City Council safeguarding adults team or reported to us. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 19 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 and 26 People using the service experience good outcomes in this area This judgement has been made using available evidence including a visit to this service. The home is well maintained and clean. EVIDENCE: The environment is well maintained, decorated, homely and pleasant. People told us they were happy with their bedrooms some bedrooms were more personalised than others. The grounds of the home were accessible to people and the garden areas attractive with flower beds and seating areas. There were no offensive odours and staff said they had the equipment and materials to maintain a clean and hygienic environment. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 20 We noted that the light pull cords in some of the toilets were dirty and needed replacing. There was a metal toilet frame, which was corroded and could be a source of infection. Gloves and aprons were provided and procedures in place for the washing and disposal of soiled linen and continence supplies. This ensures that the home is clean pleasant and hygienic. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 21 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 People using the service experience good outcomes in this area This judgement has been made using available evidence including a visit to this service. Staff are employed in sufficient number and training is provided. There are minor shortfalls in the recruitment and induction process. EVIDENCE: The rota shows that there is enough staff employed at the home and that safe staffing levels are maintained. Staff told us that most of the time there are enough staff on duty. They said the staff work well together and are committed to attending work and doing a good job. Relatives told us, “The staff give support to people when they need it or ask for it” Another relative told us, “the staff provide a safe place for people when at their most vulnerable while supporting the family”. On the day of the visit staff were observed being kind, helpful, sensitive and patent with people. They also demonstrated skill in terms of defusing potential volatile situations and conflicts between people. Supervision of people in dining rooms and corridors was carried out discreetly this made sure that people were safe and not placed at unnecessary risk. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 22 Relatives told us they visited at different times of the day and found the good standard of care to be consistent. The manager told us that nine staff had completed their National Vocational Qualification (NVQ) level 2 in care. This made sure that staff had the skills to meet people’s needs. The manager told us that new staff do go though a two day induction the documents showed that this covered a health and safety and the homes policies and procedures. The induction is not the one recommended or described by TOPPS England/skills for care. This means that staff are not sufficiently indicted into the job. Three staff files were checked. The majority of the information required by the regulations was in place. They included training, qualifications previous experience, contract, Criminal records check and references (although for one person it was not from the last employer). There were examples in two files of gaps in employment history, which had not been checked at interview. Copies of passports were on file the black and white images of people were unclear the manager agreed she would replace them. The records showed, in the last 12 months staff training included dementia training, depression in older people, adult safeguarding, first aid, fire training, care planning and reporting, medication, infection control, health and safety, food hygiene, moving and handling equality and diversity. This shows that staff are trained and supported to do their job. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People using the service experience good outcomes in this area This judgement has been made using available evidence including a visit to this service. The home is well managed and the health safety and welfare of people is promoted. EVIDENCE: A new manager has been appointed since the last inspection she is a registered mental nurse and has some experience as the deputy manager of the home. Staff and relatives told us that the manager was approachable and was committed to a high standard of care. People using the service staff and relatives are able to comment on the way the home is run. There was evidence to show that people were listened to for example staff trying to enable people to go out more by accessing a mini bus Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 24 and taking people out individually to the local shops. We received surveys from four health care professionals who made positive comments about the service and the manager and the staff. The records show that the manager carries out quality assurance assessments on a weekly, monthly, quarterly and annual basis. These include. Checking fire, general maintenance, care flies, staff training etc. The manager told us that surveys had been sent out to relatives and other people interested in the running and standards at the home. Surveys were sent out in December 2008 this information had not yet been summarised. This shows the home is run in the best interest of the people using the service. There is a system in place for the safe management of people’s finances. Records were checked and detailed income and expenditure along with corresponding receipts. This showed that people’s financial interest is safeguarded. Staff have received health and safety training. They were able to tell us how on a daily basis they promoted the safety of people and of themselves. They told us they made sure they used the equipment provided, used protective clothing and used safe moving and handling procedures. The records showed the fire system and equipment were checked regularly to make sure they were safe. Staff understood their responsibility for reporting hazards and for reducing the risk of accidents and injury to people. Fixed electrical systems must be checked every three years the records showed that this was last checked in 2000. The manager contacted the contractor when this was brought to her attention and booked for the system to be checked. Records of accidents were detailed in people’s files and on an accident or incident form and the manager carried out monitoring of accidents and falls. The records showed, from January 2008 to November 2008 falls had been reduced from 40 a month to 4. This shows that people are supervised and there are procedures in place to promote the health safety and welfare of people using the service and staff. Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 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 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Individual care plans must be improved to ensure they are appropriately developed, implemented and the care provided must be properly recorded, evaluated and reviewed. Risks that people face must be appropriately assessed and managed. This will ensure that all identified care needs are addressed. Improvement has been made since the last inspection however further improvements are needed to fully comply therefore this requirement is carried forward. To reduce the risk of mistakes being made and being placed at risk. Medication must be administered from the original container. The staff member administering the medication must be the person who signs the record sheet. To protect people from harm all incidents of a safeguarding DS0000002990.V373722.R01.S.doc Timescale for action 20/02/09 2 OP9 13 20/02/09 3 OP18 13 20/02/09 Page 27 Nightingale Version 5.2 4 OP29 18 5 OP38 13 nature must be reported to the local authority safeguarding team and to the commission for social care inspection. To protect people from harm references wherever possible must be obtained from the last employer. Gaps in employment history must be checked. To ensure people’s safety the fixed electrical system must be checked every three years. 20/02/09 20/02/09 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 3 Refer to Standard OP9 OP19 OP30 Good Practice Recommendations Unless medication needs to be administered on an empty stomach staff should wait until people have finished their meal. The light pull cords in the toilets and the corroded metal toilet frame should be replaced. All new staff should receive the induction recommended and described by Topps England/Skills for care Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. Extracts may not be used or reproduced without the express permission of CSCI Nightingale DS0000002990.V373722.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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