Care Home: Nightingale Court Residential Home

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What the care home does well The home provides information to help people decide if they wish to move into Nightingale Court. People can be confident that their care needs will be assessed before they do move in, so that the home can be sure that it is able to meet individual need. Care plans are in place and these are becoming more resident focused. People have access to health care services and medication is generally well managed. One relative wrote `I would like to give all of the staff a big thank you for the way they are continuing to care for my xx`. Another relative wrote ` Personal care is excellent lots of activities for residents generally atmosphere is very happy-newsletters give excellent information.` While another relative wrote `Treats everyone as an individual and lets them remain as independent as their condition allows.` People indicated during the inspection that they enjoy the food provided. People can be confident that the manager will listen to them if they have any concerns about the service provided. Staff showed an awareness of how to protect people from the risk of neglect or abuse. The home is clean and comfortable. Staff know how to protect people from the risk of cross infection. The manager works hard to ensure that the home is run in the best interest of people living there. Checks regarding health and safety are in place and well managed. What has improved since the last inspection? Following our last inspection the service took immediate action to improve a number of areas. These included ensuring that care plans are devised upon admission and the management of medication. People can now have greater confidence in these areas. Further refurbishment has taken place including the replacement of some window frames which were a potential risk. What the care home could do better: The home needs to ensure that the standard of care is maintained and that the positive moves toward providing a quality service for people with a dementia type illness are built upon. Key inspection report Care homes for older people Name: Address: Nightingale Court Residential Home 11 - 14 Comberton Road Kidderminster Worcestershire DY10 1AU     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: Andrew Spearing-Brown     Date: 1 7 1 2 2 0 0 9 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 32 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 32 Information about the care home Name of care home: Address: Nightingale Court Residential Home 11 - 14 Comberton Road Kidderminster Worcestershire DY10 1AU 01562824980 01562740025 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Majestic 3 Limited care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 43. The registered person may provide the following category of service only: Care Home Only (Code 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 (OP) 43 Physical disability - 65 years and over - PD(E) 43 Dementia - 65 years and over - DE(E) 43 Learning disability - 65 years and over LD(E) 4 Date of last inspection Brief description of the care home Nightingale Court is registered to provide care for 43 older people who are frail, who may have physical disabilities or who may have experienced mental health problems. Registration has also been granted for four older people who have a learning disability. Care Homes for Older People Page 4 of 32 Over 65 43 4 43 43 0 0 0 0 1 6 1 2 2 0 0 8 Brief description of the care home Accommodation for people using the service is situated on the ground, first and second floor and consists of single as well as some double bedrooms. All three floors can be accessed by means of a passenger lift although a small number of steps have to be negotiated to reach some rooms on the first floor. Nightingale Court is situated near to the centre of Kidderminster, close to the railway station and also on a bus route, with a frequent service to the town centre. Car parking is available to the rear of the home. For information regarding fee levels the reader should contact the service directly. Care Homes for Older People Page 5 of 32 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 last inspection at Nightingale Court was undertaken during December 2008. This inspection was what we call a key inspection; this is one when we look at what we believe to be the most outcomes for people who use the service. This key inspection involving one inspector and was carried out over two separate days. As part of this inspection, in addition to the visit to the home, we also took into account other information we had received. Prior to our visit we requested an Annual Quality Assurance Assessment (AQAA) from the registered persons. This is a document within which providers of care services are able to demonstrate to us where they believe they are providing a good service and where they believe they could improve in the future. The AQAA also provides us with certain data which we need to know. The AQAA was completed by the registered manager and returned to us. Care Homes for Older People Page 6 of 32 Prior to the inspection we posted out some surveys to residents, their representatives and staff. We have taken account of the surveys returned as part of this inspection report. During this inspection we had a look at communal areas within the care home. In addition we also looked at some peoples bedrooms. We read care plans, daily records and risk assessments regarding some people living in the home. We also viewed other documents such as medication and staffing records. We spoke to a number of people in the home including the manager, the operations manager, some staff on duty including seniors, carers and domestics and some residents. We observed care practices throughout our time in the home. Care Homes for Older People Page 7 of 32 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 32 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 32 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. Information is available to help people make a choice about whether they would like to live at Nightingale Court. The care needs of people who may use the service are assessed so that individuals and their relatives can be assured that staff will be able to meet these needs. Evidence: Before our inspection we asked people if they had received enough information about the home before they had moved in. On the surveys returned to us the majority of relatives stated that they had received this level of information. During our visit we saw a copy of the homes Welcome Pack within the bedroom of somebody who was recently admitted into the home. The Welcome pack contains a range of useful pieces of information for people who are considering moving into Nightingale Court. The pack includes a Service Users Guide, Care Homes for Older People Page 10 of 32 Evidence: details of planned social events, the homes latest newsletter and a sample menu. The Service Users Guide contains details about what people can expect when they move into the home. The guide is dated October 2008 which is the same as the date stated within our previous inspection report. Within our previous report we wrote that The document (Service Users Guide)is informative and easy to read. It contains information regarding most of the areas listed within the associated National Minimum Standard. It does not however contain any views of people using the service. This therefore remains the same. In addition some of the information needs to be reviewed. The example menu indicates that a starter is served prior to the main meal when it is not. Also information regarding complaints needs to include the address of the regulator rather than directing people to the latest inspection report. During the inspection we discussed with the registered manager and the operations manager other formats that the guide could be in. We were told that it could be possible to produce it both in large print and in Braille. At the time of our inspection the registered manager was anticipating the imminent launch of Majesticares web site. This will be an additional way of providing information about the home to people who may use the service or their representatives. In addition the registered manager plans to develop a photograph album of pictures taken around the home which can then be shown to people who may not be able to visit themselves. In the AQAA the registered manager wrote that the service encourages our prospective service users to view the home first before making a decision and also to stay and have lunch with us. The manager also told us on the AQAA that people are initially admitted on a trail period. We saw the assessment carried out by the registered manager of a recently admitted resident. The assessment gave brief details of the persons care needs covering a range of different needs such as personal care, oral health, mobility and diet. Following the assessment, carried out where the resident was at the time residing, a visit to Nightingale Court was arranged prior to the admission to enable staff to carry out a further assessment of care needs. The information provided was sufficient for the home to draw up an initial care plan for staff to be able to meet the identified care needs. We did not view any contracts or statements of terms and conditions regarding peoples residency at Nightingale Court, however the manager given us an assurance Care Homes for Older People Page 11 of 32 Evidence: that they are in place. The homes Statement of Purpose undertakes to Give each Service User a Contract or a Statement of Terms and Conditions specifying the details of the relationship. Within the homes Welcome pack was a useful publication issued by the Office of Fair Trading. The publication, although printed in 2004, gives some clear advice regarding what should be included within a contract. Care Homes for Older People Page 12 of 32 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. People have an individual care plan which is reviewed although at times some areas are not fully evaluated in order to give staff full and clear guidance. Risk assessments are in place to try and keep people safe. The management of medication good although improvement in returning unused drugs would ensure the system is fully robust. Evidence: Each person residing at the home has a written care plan as well as other records such as risk assessments and daily records. The files seen during this inspection were in good order making the information accessible. We saw a proposed care plan drawn up on the day a resident was admitted into the home following the initial assessment carried out by staff at the home. The information on the care plan was in line with the assessment and provided sufficient information for staff to carry out their duties. Peoples care needs are assessed and if a care need is identified a care plan is drawn Care Homes for Older People Page 13 of 32 Evidence: up. The care plans seen contained the necessary detail to enable staff to meet the identified need. Care plans at Nightingale Court are becoming more person centred. A person centred care plan is one written to take into account each persons individual needs and wishes and concentrates on what people can do rather than what they can not. Care plans are reviewed monthly and then fully evaluated every 3 months. At the time of the evaluation staff try to involve residents relatives or representatives to ensure the home is working alongside these people while meeting individuals needs. A relative wrote on our survey that her relation is cared for well and kept safe.Most relatives believe the service gives the support or care people need. Although we saw a significant improvement in care plans we did nevertheless raise some matters with the registered manager. One resident appeared to potentially need to have a personal care task carried out. We looked at the care plan to see what was recorded regarding this potentially embarrassing situation and found that no reference was made. Having an agreement as to how this is best managed could help everybody deal with it and save any embarrassment. One person told us that some female residents prefer not to have male carers attending to their personal care needs. However, others seemed to be unaware of these wishes and it was confirmed that this information would not be recorded on care plans. In order to ensure that personal preferences are maintained it is important that peoples wishes are sought and that these are recorded. We were informed that the home does not have a policy regarding gender. The need to establish these details are especially important within a home caring for people with a dementia type illness who may find it difficult to articulate their own feelings. Risk assessments were in place and we found that these are reviewed as needed. They contained detail such as the sling to be used in the event of somebody falling and staff needing to using the hoist. The manager has taken a particular interest in falls prevention and has appointed a Falls Champion as a method of trying to reduce the risk of people falling. While having a look around the home we saw that one resident was sleeping on a overlay mattress. These mattresses are designed to prevent pressure sores however as they are overlay they must be used with a conventional mattress. Not using this equipment correctly can place people at greater risk of developing sores. This matter was brought to the attention of the registered manager. Care Homes for Older People Page 14 of 32 Evidence: We saw another pressure relieving mattress which was inflated by an electric pump. The pump itself was showing a fault however the mattress seemed firm. Nobody had noticed this fault. The setting for the mattress was not recorded in the care plan and when we inquired staff were not aware of what the setting needed to be. The community nursing team was contacted for advice on why the pump was showing a fault and the pressure setting needed. The manager has established good working relationships with health care professionals. Records showed that the home requests support from health care professional such as community nurses and GPs whenever needed. On the questionnaire we asked whether the home makes sure people get the medical care needed. Everybody who responded answered always Following our previous inspection Majesticare took immediate action regarding some concerns we had in relation to the management of medication within the home. During this inspection we saw significant improvement in the management of medicines. We viewed many of the current MAR (Medication Administration Record) sheets. These were found to be in good order with medication signed as given or a code to record why an item was omitted. During our visit we saw a member of staff administering medication. We observed the member of staff concerned referring to each persons MAR sheet. On our second visit to the home breakfast medication was still being administered at 10.45 am. People receiving their morning medication at this time could be a concern especially if people are prescribed medication at lunch time as well. The member of staff involved administering the medication was aware of this and assured as that the necessary gap between doses of medication is be adhered to. We asked to see the homes medication policy. We were initially given one from Carmarthenshire County Council which was not suitable to the home due to some of the documentation it mentioned. Within the homes own medication policy we saw a statement saying All refused, not ingested, no longer in use etc medications must be recorded accordingly. We were shown a large bottle containing numerous tablets waiting to be returned to the pharmacy. We were told that the bottle was no more than a year old. Having a bottle of unidentifiable medication is potentially hazardous. Although recording was happening on the MAR sheet the home was not able to demonstrate a full medication audit trail due to the way medication is disposed of. As a result of us finding a shortfall in the medication procedure an immediate change Care Homes for Older People Page 15 of 32 Evidence: in practice was introduced. We were told that any medication which was refused following removing from the blister pack would be recorded and kept within separate envelopes ready to be returned to the pharmacy. During our inspection we saw no indication to suggest that staff do not respect the privacy and dignity of residents. Staff appeared to be kind and considerate at all times. The registered manager told us that more training is to be provided and she is also keen to appoint a Dignity Champion almost the staff team. Care Homes for Older People Page 16 of 32 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. People have access to a range of social activities and are encouraged to participate in daily living tasks in line with individual wishes and choice. People enjoy the food provided and are offered a choice of menu. Evidence: During our visit we were able to speak to some residents as well as observe what was happening within the home. Within the AQAA the registered manager wrote We have a monthly entertainment programme where families are encouraged to join in. The AQAA also made reference to people growing and harvesting their own vegetables and taking part in meaningful activities such as hoovering, dusting and working in the laundry. When we first arrived at the home we were told that some residents had gone out for the day. The outing to a local safari park included a Christmas lunch. People told us on their return from this outing that they had enjoyed themselves. One relative wrote on our survey They (the staff) do try to get the residents involved in different activities which they (the residents) appear to enjoy. Care Homes for Older People Page 17 of 32 Evidence: A wipe board in reception area shows the planned events for the day. On the day of the trip the board was not changed from the day beforehand as staff had overlooked this while getting ready to go out. The amount of stimulation seen for residents who remained within the home was minimal although one member of staff was seen doing some nail care. The home has an activities coordinator who works full time within the home and takes a lead in arranging all social activities within the home. We were told that care staff take part in activities such as moving to music and baking. When we returned the following day we saw some residents engaged in household tasks such as dusting and sweeping the floor. A member of staff was seen asking people if they would like to get the tables ready for lunch. We saw some board games and jigsaws able to be used by residents within one of the lounges. Staff reported that some residents appeared to be tired following the trip the day beforehand and this may have limited the usual amount of stimulation. The home had a relaxed atmosphere while at the same time busy with a number of residents walking freely around the ground floor corridor. Films are occasionally shown on a television in one of the seating areas, it was agreed that the availability of a larger flat screen television could enhance peoples enjoyment of an afternoon at the movies. Within the garden we saw the remains of a vegetable plot where some residents reportedly grow items for the kitchen as well as a greenhouse where we were told tomatoes were grown. We saw a copy of the most recent newsletter and we were sent an electronic version of an earlier one. The October - December 2009 edition contained photographs of some recent events. These were a trip to Llandudno for a stroll along the pier and fish and chips, champagne BBQ, a coffee morning in the garden and a 1920s evening. The newsletter also contained details of some forthcoming events such as a Halloween party and Christmas celebration. Other sections within the newsletter included news about residents and staff and an account from a resident about her time working for a major chocolate manufacturer. Residents are able to order a daily newspaper or a periodical of their choosing at their own expense. One resident took a great interest showing us a number of different news stories within her paper. Nightingale Court has some small domestic animals who live outside. We also saw a Care Homes for Older People Page 18 of 32 Evidence: cat and a caged bird within the home. One resident in particular spoke fondly of the cat. The days menu is written upon a white board in the main dining area. Lunch consisted of a choice between roast chicken or sausage with mashed potato, peas and carrots. Meals were plated up from a heated trolley in the dining room. We saw carers showing residents both chicken and sausage and asking them which they wanted. Staff assured us that they offer the same choice to people who have their meals in their bedrooms. We were told that residents who need the most assistance have their lunch before the majority of residents. People indicated that they enjoyed their meals. The tea time menu consisted of oxtail soup, assorted sandwiches, chicken salad, sultana sponge and cream and peaches and cream. Staff attended to residents in one dining room before then attending to people in the other. Once again we saw staff offering a choice between sandwiches or chicken salad. At each meal time we saw staff assisting residents with feeding as necessary. Staff were discreet and patient while encouraging people to eat. Snacks stations were located in the lounge areas as well as in reception. Having such snacks can encourage people, who may otherwise not eat sufficiently due to their dementia, to have small amounts of food throughout the day. These snacks included fresh fruit. Jugs of drink were also available around the home although we did not seen anybody helping themselves to a drink or any member of staff offering a drink other than from the hot drink trolley. Care Homes for Older People Page 19 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service and their representatives have access to the homes complaints procedure and are able to express any concerns they may have. People can be confident that their views will be listened to and acted upon. Staff receive training to help them know how to protect people from any risk of abuse or neglect. Evidence: A complaints procedure is included within the homes Service Users Guide. The procedure states that the home invites constructive suggestions about how things may be improved to meet our service users needs at any time. The procedure states the home aims to keep people informed about stages and timescales although the actual timescales are not mentioned within the procedures itself. The regulator is mentioned although our address is not given. Within the AQAA the manager wrote that the home would listen and act upon complaints within 28 days. The majority of relatives indicated upon our survey that they are aware of the complaints procedure within the home. A different procedure is displayed around the home including every bedroom. This procedure gives people details of how to contact the commission. The procedure also gave contact telephone numbers for Worcestershire Adult Services, the local Health Authority, the Alzheimers Society and Age Concern. Although the procedure was informative the size of the type used and in some cases the location where it was Care Homes for Older People Page 20 of 32 Evidence: displayed in the bedroom was not user friendly. We brought this observation to the attention of the manager who agreed with what we were saying. The manager told us that the home had not received any formal complaints since our last inspection. We were aware of some concerns raised by the family of one resident which were looked into by the individuals funding authority. The manager informed us that she has since met with family members and intends to carry on having regular meetings to ensure they are aware of the persons care plan and to discuss any other matters that may arise. A copy of the Worcestershire Adult Services Multi Agency procedures regarding safeguarding (the protection of vulnerable) people was held within the care office. We saw a copy of a booklet, also issued by Worcestershire in the managers office. The manager confirmed that a copy of the Department of Healths publication No Secrets is available within the home. A poster was on display within the staff room about adult protection. The manager has a good understanding of reporting procedures regarding potential safeguarding incidents within the home. One member of staff described the training that had taken place regarding protecting vulnerable people. We spoke to staff who told us about what they would do if they knew of any actual or potential incidents of abuse or neglect within the home. Some senior members of staff have received training upon Deprivation of Liberty and the Mental Capacity Act. We looked at the records for two recently appointed members staff. These showed that the required checks were carried out before the new employees commenced duties at the home. These checks include a CRB (Criminal Records Bureau) disclosure and written references. Care Homes for Older People Page 21 of 32 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. People live in a clean and homely environment. On going improvements are making the home increasingly safer and more comfortable. Staff are aware of procedures to be protect people from the risk of cross infection. Evidence: Nightingale Court was converted originally from four Victorian houses and has been extended and upgraded to provide the present three storey accommodation. Improvements to the environment have taken place however continual attention and regular maintenance is needed. Recently some bedroom windows have been replaced; work on others is scheduled in the coming months. During this inspection we viewed communal areas of the home as well as a number of bedrooms. Residents bedrooms are located on the ground, first and second floor. A call system is fitted within the home so that people can summand help if they need it. While looking around some bedrooms we saw that the leads were tided up. We were assured by a number of staff that these are untied when people are in their bedrooms. A passenger lift is provided to afford easy access to most areas of the home. The manager confirmed that the lift door has a full beam around it therefore preventing the risk of the doors closing shut on to people. Gates with a key code are fitted to all staircases to prevent people, who may be unable to successfully negotiate stairs, attempting to climb them. The manager does not believe these gates are acting as a Care Homes for Older People Page 22 of 32 Evidence: restraint or a deprivation of liberty. The manager stated that people could have the code if they wished to have it and that a risk assessment would be completed. There is some signage within the home to assist people with a dementia type illness find their way about. The manager recognises that the current signage could be improved to help further with peoples orientation. Other notices were displayed around the home reminding people about the importance of calcium within their diet. An area of the home which at one point was the dining room, is now a lounge / dining room. The sitting area also contains an section resembling a public bar. The lighting in this area and other communal parts of the home is domestic in appearance and sufficiently bright. One relative made a comment about the need to have a lighter, brighter interior. During our inspection we were told that some light fittings had been changed as they had failed. The lighting on the top floor corridor leading to the staff training room failed completely while we were visiting and needed to be attended to by the maintenance person. We were assured that due to the fittings in place in areas used by residents a failure to the above extreme where all corridor lighting had failed would not happen. The furniture within communal areas is generally satisfactory although the arm chairs in the bar area are showing signs of wear and tear in that the arms are in places stained or dirty. Some bedroom furniture and vanity units appear worn and tired. The wardrobes we checked were secured to the wall to prevent accidental toppling over. We have previously highlighted concerns about the condition of some window frames and the potential hazard they presented to people within the home as well as to people outside. We saw a risk assessment for these windows but it could not offer any methods to reduce risk other than making staff aware of the hazard and requesting replacement. During this visit we noted that some windows are now modern PVC rather than the worn wooden ones. It was confirmed by the registered manager and the operational manager that further windows are due to be replaced during January 2010. The standard of the decoration around the home is satisfactory. Paint work is damaged along communal corridors due to wheelchairs, the medication trolley and the food trolley knocking into it. Some wallpaper has either peeled off or worn away as a result of residents cleaning the handrails. We have previously noted that the heating in some bedrooms was not as good as others. The vast majority of rooms were warm however one bedroom was chilly as Care Homes for Older People Page 23 of 32 Evidence: was the en suite bathroom. A shower room was particularly cold, a thermometer on the window ledge showed a temperature of 8 degrees Centigrade. At one time the front lounge was also chilly, a resident said its cold. The manager undertook to carry out a risk assessment as well as speak to the manufacture of a bath and how the seat to the hoist was parked as it could be a potential hazard due to the space it takes up. A sluice room was locked although the key was hung up above the door. The home needs to be confident that this control measure is sufficient to safeguard people from potential harm. When we last visited the home the manager had high hopes that the planned porch at the front of the house would be built. Over the past 12 months some work has taken place including a large tarmac ramp leading to the front door. This inspection took place during December therefore the gardens at the rear of the home were not looking at their best. A patio area is provided around a garden pool. The pool is covered to prevent accidents. The patio was slippery due to decaying leaves although it was evident that attempts have been made to remove some during recent months. The garden has a greenhouse used, during the summer, by residents to grow tomatoes. We also saw a vegetable patch were residents had grown beans and sweet corn. A rabbit hutch was unoccupied as the occupants (rabbit and guinea pig) were living in an outhouse due to the cold weather. Infection control measures around the home seemed to be good. Staff consulted all told us that items such as disposable gloves and aprons are kept in each bedroom. Antibacterial gel is available at the front door. Liquid soap and paper towel dispensers are provided within communal toilets and bathrooms. Some staff were carrying their own supply of antibacterial hand wash on their person. Care Homes for Older People Page 24 of 32 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. Staff receive training to ensure that they have the skills and knowledge necessary to care for people. Robust recruitment procedures are in place to safeguard people. Evidence: During our inspection the registered manager confirmed that staffing levels within the home remain similar to those recorded within our previous report. The morning shift consists of 5 carers plus a senior, this figure is reduced to 4 carers and a senior during the afternoon into the evening. Three people are on duty throughout the night. Other staff are also employed within the home such as catering, domestic and maintenance staff. One relative felt that more staff are needed at weekends and during meal times. Another relative wrote Staff are always welcoming. They have a lovely way with all the residents,are always friendly and helpful and nothing seems too much trouble. Staff photographs are displayed in the entrance hall. We suggested that a photograph is also attached to the notice in each bedroom reminding people who their keyworker is. Training is provided for staff. A matrix is displayed within the staff training room. Although some gaps were evident a member of staff, who is now taking the lead for training, was aware of these gaps and assured us that training where necessary would take place. Care Homes for Older People Page 25 of 32 Evidence: During our inspection we were shown some internal correspondence regarding training for 2010. Topics mentioned for training input during the forthcoming 12 months include first aid, administration of medication, food hygiene, health and safety and equality and diversity. We were also informed that further dementia care is to be provided for staff. We looked at records to see how the home recruits new staff. We saw that the home has robust recruitment procedures, and that all the required checks are carried out before new members of staff start work. One recently appointed member of staff confirmed that following her appointment she had to wait until a Criminal Records Bureau (CRB) check was obtained. Carrying out this check as well as receiving references helps to protect people from the risk of neglect or abuse by making sure that only suitable people are employed. Care Homes for Older People Page 26 of 32 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 manager and her team work hard to ensure that the home is run in the best interest of resident. Procedures for monitoring health and safety in the home are robust and well documented. Evidence: The registered manager has experience of working in the care sector and holds both the Registered Manager Award (RMA) and a NVQ (National Vocational Qualification) level 4 in care. She has recently completed her Diploma in Person Centred Dementia Care and is working towards becoming an assessor for NVQ training. The manager continues to attend in house training alongside other staff members as well as attend training suitable for managers such as an advanced practitioners workshop in the Mental Capacity Act. Throughout our inspection it was evident that the manager has a desire to continue with the development of Nightingale Court. She demonstrated an interest in person centred care and took an interest in our feedback and recommendations. On the AQAA the manager stated that she has an open door policy. During our inspection a number of residents came into the office and spoke to the Care Homes for Older People Page 27 of 32 Evidence: manager about a range of different things. Residents seemed comfortable and relaxed while in the office chatting. The manager is supported by a deputy manager, house manager and care coordinator. The AQAA confirmed that the management team within the home has remained unchanged since our last inspection. We were told that the manager, as well as the deputy manager, has completed the Diploma in Dementia Care. The operational manager is now undertaking this training. Having senior staff trained in dementia care should provide the home with up to date information and strategies regarding good practice which should enhance the lives of people who have a dementia type illness. The manager completed the AQAA (Annual Auality Assurance Assessment) when we asked for it. Some information was missing within the data set however this appeared to be an issue with the computer template as it would not accept the details entered. Nightingale Court has a number of different internal systems for monitoring quality within the home. Within one file the manager had recorded that she found the home to be compliant in each of the National Minimum Standards. The document which was not dated, contained no review date and did not include any means of evidence or signpost the reader to other documentation to show how the outcome was reached. The operational manager attended the home during this inspection and took an interest in the process and our findings. The operations manager visits the home regularly to provide support for the registered manager and in order to carry out Regulation 26 visits. Reports following the Regulation 26 visits were detailed and available within the home. The areas covered within the reports matched the headings within the National Minimum Standards. The service carried out some user satisfaction surveys ealier during 2009. During our inspection we were told that the results of the survey were included within the summer edition of the homes newletter. The information on the newletter reported on the positive results but did not give any indication as to where improvements, if any, could be made. Letters and cards sent to the home complementing the service are displayed within a cabinet in the reception area of the home. The registered manager confirmed that the home does not hold any money or Care Homes for Older People Page 28 of 32 Evidence: valuables on behalf of people using the service. Any expenditure for hairdressing is invoiced to the family if the individual does not hold any of their own money. We asked staff about the formal supervision sessions they receive. The frequency some staff told us about would be in line with the National Minimum Standard. Other staff however indicated that their supervision sessions are less frequent. A member of staff appointed in August has, since her appointment, received an appraisal and one supervision session. We viewed a sample number of records regarding health and safety checks and found them to be well documented showing a desire to keep residents, staff and others safe. Regular checks to the fire system are happening and the alarm is tested in sequential order as recommended following our last inspection. Care Homes for Older People Page 29 of 32 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 30 of 32 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 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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