Care Home: Nightingale Care Home

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What the care home does well Individuals needs are accurately assessed before admission is agreed. This ensures the home is suitable for them. Health and personal care needs were identified in the personal files seen and this enabled staff to ensure peoples needs were met. People said they were happy with the standard of support and services provided at the home and felt that the staff team and management were friendly, approachable and skilled in their work. What has improved since the last inspection? A new format for individuals personal files has been implemented for all new admissions to the service. The manager confirmed that this format would be used for everyone living at the home eventually. This new format was easy to follow and as the manager stated was clear, concise and more in depth. This enables staff to access information easily regarding each person, which in turn will support them in providing a consistent approach to the care and support they give. No requirements or recommendations were left at the last inspection visit to the home. What the care home could do better: The service was good at identifying individual`s health and personal care needs and at assessing and actioning any risks identified. However to ensure a holistic approach to care was given further information was required to ensure individual`s recreational interests, hobbies and social skills and needs were met. Although the comments made indicated that people were happy with the activities provided at the home, there was limited information in the care plans seen to demonstrate individual`s interests and hobbies. Efforts should be made to gather information on each persons life history to enable a more person centred approach to be given. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Nightingale Care Home Fourth Avenue Edwinstowe Nottinghamshire NG21 9PH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Angela Kennedy     Date: 2 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Nightingale Care Home Fourth Avenue Edwinstowe Nottinghamshire NG21 9PH 01623824480 01623824480 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Midland Healthcare Ltd Name of registered manager (if applicable) Susan Chilvers Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: People accommodated in service user category PD shall be aged 50 years or above People accommodated in service user category PD shall be aged 50 years or above Service users shall be within categories OP(40), PD(3) or DE (20) over 60 years Date of last inspection Brief description of the care home Nightingale is a care home providing personal care and accommodation for 40 older people and includes 20 beds which can be used for someone with dementia over the age of 60 years and 3 beds which can be used for someone with a physical disability over the age of 50 years. The home provides short and long term care and will accept emergency admissions. Care Homes for Older People Page 4 of 29 care home 40 Over 65 0 40 0 20 0 3 Brief description of the care home The home is owned by Midland Healthcare, which is run as a family business. Nightingale care home is located in a residential area of Edwinstowe close to shops, pubs, the post office and other amenities. The home was opened in 1996 and consists of a purpose built building. 38 of the homes bedrooms are single, and 31 of the bedrooms have en-suite facilities. Bedrooms are located on 2 floors and there is a passenger lift. The home has 3 gardens that are well maintained and easily accessible. There is ample car parking available. The home does not have a website but further information can be obtained from the manager. The manager confirmed that the charges made by the home on 27/01/09 currently range from £355 to £395 per week. Care Homes for Older People Page 5 of 29 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: two star good 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 last key inspection undertaken at this service was on the 6th February 2007.This key inspection was unannounced. Key inspections take into account a wide range of information and commence before the site visit by examining previous reports and information such as any reported incidents. The site visit is used to see how the service is performing in practice and to meet with the people using the service. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people using the service and their views on the service provided. This process considers the providers and registered managers capacity to meet Care Homes for Older People Page 6 of 29 regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. An Annual Quality Assurance Assessment (AQAA) had been completed by the service. This is a self-assessment for providers which is a legal requirement. This assessment gives the provider and registered manager an opportunity to let us know about their service and how well they think they are performing. The information provided in the AQAA is reflected within this report. At this inspection visit two people were case tracked. Case tracking is a method used to track the care of individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. This includes looking at care plans and other documents relating to that persons care, talking to staff regarding the care they provide and if possible talking to the individual. One person case tracked were able to express their views of the service and the support it provided. Other people living at the home that were not case tracked were also spoken with. Their views of the service and the care and support provided are included within this report. Two members of staff were spoken with at some length and their views and opinions of the care provided, the support and training given to them is included within this report. The comments provided within two surveys received from the people living at the home, two relatives surveys and four staff surveys are also reflected throughout this report. 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 set out 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 29 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 29 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. Peoples needs were assessed before admission was agreed, to ensure the home was right for them. Evidence: The surveys returned by the people living at the home and relatives confirmed that they had enough information about the home before they made a decision to move in. Two people spoken with said that they had come to the home for a respite/ short stay on a few occasions and had then decided to move in permanently. The comments received from the people spoken with indicated that they were very satisfied with the care and services provided. One person said, I cant fault it, I think it is very good here, Im very glad I chose this home and its excellent, the care is first class. Care Homes for Older People Page 10 of 29 Evidence: Both of the people that were case tracked had assessments held in their files that demonstrated that an assessment of their needs had been undertaken before they moved into the home. This ensured that the home was suitable for them. The assessments seen had been undertaken by the manager of the home and by the local authority for people whose care was funded. The records seen demonstrated that from these assessments care plans had been developed that instructed the staff on the support each person needed and on what they were able to do for themselves. Risk assessments had also been developed from the needs assessments in place. These assessments identified risks and instructed the staff on the steps to take to minimise these risk to ensure individuals were kept safe Records were also seen to demonstrate that annual reviews of care took place that included the individual when possible and their representative, such as a family member.This ensured that any changes in the initial care package agreed could be identified and actions taken to address these changes. Care Homes for Older People Page 11 of 29 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. Detailed information within care plans and risk assessments ensured the staff team were able to meet individuals needs in a safe way. The medication practises in place ensured that people were able to take their medication as prescribed. Evidence: As stated in the pre admission assessment information, the home had developed a new format for care plans and assessments. This new format was seen in the file of one person case tracked. The information within this file was easy to follow and as stated by the manager was clear, concise and more in depth. This enabled staff to access information easily regarding each person, which in turn supported them in providing a consistent approach to care. Both people case tracked had care plans in place that had been developed from their initial needs assessments. The care plans identified the support required in each area of personal and health care, along with any aids or adaptations needed and the number of staff that were required to enable that support to be given in a safe way. Care Homes for Older People Page 12 of 29 Evidence: Risk assessments were also in place that related to areas of care where a risk had been identified.The risk assessments in place instructed the staff on the actions to be taken to ensure each risk identified was minimised, again ensuring people were supported in a safe way. All of the care plans and risk assessment seen had been reviewed regularly and in one persons file it was evident that this had been done in consultation with this persons family representative. The other person case tracked did not have evidence to demonstrate that they or a family representative had been involved or were in agreement with their care plans. However records were in place that showed that annual reviews of care were undertaken with the involvement of individuals and their family. In one persons file no life history had been gathered. In the other persons file seen a summary of their life history was in place. This gave the staff some information to help them identify with this person. However the information gathered was limited and could have been further explored to provide staff with more detailed information that would have helped them to get to know the person better. This in turn would enable more person centred plans of care to be developed. As stated in the pre admission assessment information, detailed records were in place that demonstrated that health care needs were met.The information seen included each persons medical history and information on their health care. For example weight records were in place as part of the nutritional screening that was undertaken. The format of the weight recording charts enabled staff to identify any gradual weight loss or gain and any actions that were required in relation to this. Records were in place to support that the manager and staff worked with other professionals in ensuring peoples health care needs were met. This included health visits and appointments with doctors, district nurses and chiropodists. Relatives confirmed that they were informed if any health care issues were identified. One person said, yes I get a phone call from staff . Comments from relatives regarding the care provided was positive and included, they take great care to do things right, which should be rewarded sometimes and my mother has help with dressing and washing. I find her always smelling clean and tidy and ...is taken care of with kindness and skill. People living at the home also indicated that they were supported by staff in a way they preferred and to a high standard. One person said the care is very good, I am Care Homes for Older People Page 13 of 29 Evidence: very satisfied with everything. The medication practises were assessed and demonstrated that people were supported to take their medication in a safe way. Both of the people case tracked had medication care plans and risk assessments in place that provided information on their prescribed medication and the times and dosage of this medication. The risk assessments confirmed if the individual or the staff team was to store and administer this medication. This was dependent on the individuals ability to do so safely and their preferred choice. The medication administration records for the two people case tracked were looked and and no gaps in their recording was noted. Records were checked against medications held and indicated that medication had been administered as prescribed. Handwritten medication sheets had not been countersigned.Records were held of medication received and returned to the pharmacist. Medication was stored safely and in line with legal requirements. It was noted that the home did not have a controlled drugs (C.D) register which is required by law for certain controlled drugs. This was discussed with the manager. At the time of this inspection there were no controlled drugs that by law were required to be recorded in a C.D register. Other controlled drugs, not required by law to be recorded in a C.D register were recorded on loose sheets using the same format as a C.D register. This medication was counted and corresponded with the records kept. This indicated that this medication had been administered as prescribed. Throughout the visit staff were observed supporting people at the home in a respectful and dignified way.Comments from relatives and people living at the home also confirmed this. They look after my mum so well, shes always clean and they always make her feel thats shes wanted and a special person Care Homes for Older People Page 14 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples social and recreational needs were met and they were supported to maintain contact with family and friends. The meals provided were enjoyed by the people using the service. Evidence: Information provided by the manager prior to this visit stated that the people using the service were involved in the activities programme through consultation.This information should be transferred into individuals care plans.The manager also said that families and friends of people living at the home were actively encouraged to join in with activities, which has led to many successful and enjoyable events. The manager confirmed that they did not employ an activities coordinator and therefore incorporated the activity coordinators hours into the care staffing hours, which enabled activities to be planned and undertaken by the care staff team. As stated in the information provided by the manager prior to this visit a record was kept of the activities undertaken and this was also transferred into the daily logs held for each person. The records showed that activities were undertaken on a regular Care Homes for Older People Page 15 of 29 Evidence: basis. Comments from people living at the home and their visitors also indicated that activities were provided regularly and enjoyed. A hairdresser was at the home for one and a half days week and a salon was available in the home for this purpose. There was a library area available, however the manager confirmed that this was rarely used by the people presently using the service. As well as the large lounge there was a smaller lounge next to visitors kitchen and a lounge on the first floor with dining room attached. All lounges had TVs. However most lounges seen, apart from the large lounge were empty.Most people that were not in their own rooms, out with visitors or walking around were seated in the large lounge. On discussion with the manager and some of the people using the service it appeared that this was mainly due to the large wide screen TV that was on the wall. This meant that chairs were positioned in rows to enable everyone to see this television. The manager stated that she continuously attempted to encourage people to use other communal areas, which they would do in the short term but always returned to the large communal lounge.Discussions with people living at the home confirmed that they were able to move around the home as they wished. One lady spoken with, that was sitting in the large lounge area said I prefer sitting in here, you can see people coming and going, I sat upstairs last night in the lounge but prefer it down here. Visitors spoken with confirmed that they were always welcomed by staff and offered refreshments. A kitchen was available off one lounge area for visitors to make drinks if they wanted to. Observations throughout the day demonstrated that people were seen coming and going out with family and friends and the rapport between visitors and staff was warm and friendly. The catering team consisted of a catering superviser, a cook and two kitchen assistants. The rota showed that either the superviser or cook were on duty to prepare and cook meals. The manager confirmed that menu plans updated regularly and used by the cook. The menus seen showed one main meal and a diabetic alternative to that meal. The manager stated that if someone wanted an alternative it would be prepared for them. People spoken with said that the meals were very good. They confirmed that there was enough variety and that the quality of the food was very good. Although there was a dining room upstairs the manager confirmed that people liked to eat downstairs, as most were seated in the large communal lounge with the exception of one person who preferred to take her meals in their room. Care Homes for Older People Page 16 of 29 Care Homes for Older People Page 17 of 29 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. Complaints are addressed promptly by the service to ensure any issues are resolved quickly.The practises in place and the training provided ensured people were protected from abuse. Evidence: A complaints policy was on display within the entrance of the home.The information provided by the manager prior to this visit stated that policies and procedures for highlighting concerns, issues and complaints are provided in the home and the service user guide provides all the relevant information regarding this. The surveys returned indicated that people are confident that concerns are addressed promptly. Discussions with visitors also confirmed this although those spoken with did say they had not had any cause to make a complaint and said they found the manager and staff team very approachable. The home confirmed that they had received three complaints since last inspection. The records of these complaints were looked at and showed that these had been addressed within the required timescale and actions had been taken to address the concerns raised. Since the last inspection visit there has been one Safeguarding investigation undertaken regarding a person that had lived at the home. This investigation was Care Homes for Older People Page 18 of 29 Evidence: undertaken by the local authority and it was concluded that the home had followed the correct procedures, but could have been more proactive in identifying the changing needs of this individual. From discussions with the manager and from records seen at this visit, it was evident that following this investigation more rigorous practises are now in place to identify any changes in health and personal care needs. As stated in the information provided by the manager prior to this visit the training records seen demonstrated that safeguarding training was provided to the staff team . The staff spoken with demonstrated a good understanding of the procedures to follow in the event of any safeguarding concerns.The information provided by the manager stated that a safeguarding and whistle blowing policy was in place.These policies were not looked at during this visit. People living at the home that were spoken with confirmed that they felt safe at the home and were looked after by staff. Care Homes for Older People Page 19 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment was well maintained and was kept safe for the people living there, staff working there and visitors. Evidence: A partial tour of the home was undertaken. From observation the home appeared clean and well maintained.Comments from people living at the home and their visitors also supported this.It was noted that there were few environmental cues around the home. Further cues would enhance the support for people with dementia, by promoting their orientation to time and place.This was discussed with the manager and staff team. The laundry area was tidy and appeared well organised. The rotas demonstrated that it was staffed seven days week. Comments from relatives indicated that they were happy with the laundry service provided. One relative said, my mum always looks nice, her clothes are always clean and ironed. There was sufficient bathrooms within the home that had suitable moving and handling equipment to ensure personal care was provided in a safe way.Service certificates Care Homes for Older People Page 20 of 29 Evidence: were seen to demonstrate that this equipment was regularly serviced, ensuring it was safe to use. As stated earlier in this report there were several communal lounges available to the people at the home although these were not utilised that well. Bedrooms that were seen appeared clean and personalised to each persons taste.As stated in the information provided by the manager prior to this visit, people spoken with confirmed that they were able to bring personal items for their own rooms. It was noted that individuals names and or photographs were not provided on their bedroom doors. This was also identified by the manager in the information she provided before this visit. Discussions took place regarding how this could support people to identify their own private rooms, especially people with dementia. The manager confirmed that a maintenance person was employed at the home for four hours each day throughout the week and was on call at weekends for emergencies. The maintenance person was also responsible for weekly fire alarm test to ensure the equipment was working, should it be required in the event of a fire. The records were seen to demonstrate that these tests were undertaken each week to ensure people were protected from fire. Records seen demonstrated that infection control training was undertaken by the staff. Staff were observed throughout this visit and were seen using the appropriate personal protective equipment to ensure good standards of hygiene were maintained.Positive comments were received from people living at the home and their visitors regarding the standards of hygiene and maintenance at the home. The information provided by the manager prior to this visit confirmed that continuous improvements are made to the home regarding decorating and internal and external maintenance. Care Homes for Older People Page 21 of 29 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. Sufficient numbers of safely recruited and trained staff are available to ensure people needs are met. Evidence: Information provided by the manager prior to this visit stated that home had sufficient and highly qualified staff to meet individuals needs and this was reflected in the comments received from staff, people living at the home and visitors. The rotas seen showed that staffing levels were maintained to ensure peoples needs were met . The recruitment records for two members of staff were seen and demonstrated that thorough recruitment checks as required by law had taken place to ensure the staff employed were safe to work with the people using the service. Training records and certificates were in place to demonstrate that training was ongoing to ensure staff had the training and competence to do their job. The records confirmed training was undertaken as stated in the information provided by the manager. This training included fire safety, moving and handling, food hygiene, health and safety, infection control,dementia care and safeguarding adults. Induction records were also seen within the staff files looked at and demonstrated that a thorough Care Homes for Older People Page 22 of 29 Evidence: induction took place at the start of employment, to ensure new staff were supported and guided to undertake their job competently. Records of staff with National Vocational Qualifications (NVQs) were in place. Records showed that just over 50 of staff had achieved an NVQ. Of these three had achieved an NVQ at level 3 and the manager confirmed that a further two staff had been booked on to NVQ 3 training and a further two staff onto NVQ 2 training. Staff spoken with very positive about the training, support and guidance provided by management and senior staff. Staff spoken with said they enjoyed their work and demonstrated an enthusiastic and positive attitude to their work. They talked about the support they gave to the people living at the home, to enable them to maintain their skills and independence whenever possible. People living at the home and their visitors made very positive comments regarding the staff team and confirmed that staff were caring and friendly and skilled in their work. Care Homes for Older People Page 23 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A robust management structure was in place and peoples views were listened to and acted upon. The safe working practises in place protected the people living at the home, their visitors and the staff team. Evidence: As stated in the information provided by the manager,there is an experienced care staff team that are able to demonstrate an awareness of their roles and responsibilities. They are supported by the manager and deputy manager who ensure there is solid leadership in place at the home. This was confirmed in the positive comments regarding the manager from staff, people living at the home and visitors. Comments made confirmed that the manager was available, approachable and easy to talk to. One relative said, I pop into Nightingale at any hour of the day. It is always the same, made as a happy as possible by the wonderful staff,led by Sue Chilvers, she is wonderful. Care Homes for Older People Page 24 of 29 Evidence: Since the last inspection visit the manager has confirmed that she has achieved the Registered Managers Award.This is a management qualification for managers working within the care sector. In the information provided by the manager she stated that quality audits were undertaken monthly by herself and the staff team, with corrective actions identified and implemented. She also confirmed that monthly visits were undertaken by the quality assurance manager and records of these visits were seen. The manager stated in the information provided prior to this visit that the home encourages and facilitates an open door policy. This enables people using the service, staff, relatives and visiting professionals to take an active role, make suggestions and comments that influence and enhance the quality of service provided. Further evidence of this was seen in the questionnaires that were sent out to people living at the home, their relatives and visiting professionals in October 2008.The outcome of the audit produced from these questionnaires was seen. It demonstrated that very positive comments had been received which showed that people were happy with the care and support provided by the staff team. The manager confirmed that people were supported to manage their own finances when possible. One person case tracked had monies that were kept by the home in safe keeping for them, as they were unable to manage their finances. The monies held for them was checked against their financial transaction records and corresponded, which demonstrated that that their money was appropriately safeguarded by the home. Supervision records were in place and demonstrated that regular staff supervision was undertaken.Appraisal records were also seen, which showed that staff development was maintained and promoted. A sample of service certificates were checked and corresponded with the information provided prior to this visit. All records and certificates seen were up to date, which demonstrated that safe working practises were in place . Care Homes for Older People Page 25 of 29 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 26 of 29 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 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 1 7 Life historys should be gathered for each person staying at the home to provide staff with a more detailed picture of each person. This will enable person centred care to be provided. Written evidence should be in place to demonstrate that individuals or their representatives are involved in the formulation of their care plans. The home should have a Controlled Drugs Register to ensure that any schedule 2 Controlled drugs prescribed are recorded as required by law. Handwritten medication administration records should be countersigned. This will demonstrate that a second member of staff has checked the handwritten instructions to ensure no errors have been made. Activities should be made available in smaller communal areas to encourage people to access other communal facilities within the home. Additional signs, cues and other items, such as photographs on bedroom doors, a simple calendar/ board where the day and date are recorded should be provided to enhance the well being of people with Dementia and Page 27 of 29 2 7 3 9 4 9 5 12 6 22 Care Homes for Older People increase their orientation to time and place. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!