Care Home: Nightingale House

What the care home does well The home has a very relaxed and homely atmosphere. The residents and relatives all spoke about Nightingale House being a nice place to live. It was evident that the home is run in the best interests of the residents. Every effort is made to ensure that their views and those of their relatives and friends are taken into account on any decisions in relation to the running of the home. Staff were seen to treat residents with kindness and respect and were knowledgeable of residents` needs. Residents appeared well dressed and groomed; all of the residents were dressed individually, some of the women were in dresses/skirts and some in trousers. The men also had different attire some were wearing shirts and trousers and others in tee shirts and casual trousers. Residents and relatives were very complimentary of Nightingale House. Relatives` comments were, "I have seen a big improvement in the home. I am very pleased with the care Mum receives", "Mum has only been here a short while and taking everything into consideration she has settled well", "My husband is very well looked after and this means that I can sleep at night" and "His health has really improved since being here, I am very happy". Residents` comments included, "They are lovely here, they look after me", "We go out to the park, I really enjoy that", "The food is really good, I always eat it all up". A social care professional stated, "I have recently carried out a review and I was very satisfied with the care". The home`s policies and procedures on safeguarding, whistleblowing and recruitment are comprehensive. Staff recruitment and supervision was found to be sound and staff have received training in health & safety, safeguarding adults, risk assessment, first aid and fire training. The manager is aware of her responsibilities and has referred to the local authority Safeguarding Coordinator when required. Residents, relatives and staff were clear on who they would approach if they had any concerns regarding the welfare of the residents. What has improved since the last inspection? Nightingale House has made significent improvements since the last key inspection (July 2007) and the Pharmacy inspection (February 2008). From these two inspections 9 Requirements and 7 Recommendations were identified. Eight of the Requirements and 5 of the Recommendations have been met. The manager is ensuring that she undertakes a pre-admission assessment on all prospective residents prior to a placement being offered. Residents` risk assessments are being regularly evaluated and updated; this will ensure that residents` current needs are being reflected and acted upon. There is an Annual Quality Assurance programme currently being undertaken. Residents, relatives and stakeholders` views are being sought on the quality of the service being provided. These views are being sought through satisfaction questionnaires. Comments, from resident and relatives` meetings and the complaints and compliments records, will also be taken into consideration. This information will then be used as a basis for a development plan that reflects the aims and outcomes for the residents. Nightingale House has worked extremely hard in ensuring that the environment is conducive to people living with dementia. Doorframes have been painted in a different colour; all of the bedroom doors have photographs of the resident in their younger days (wedding photographs and family portraits). Toilets and bathrooms have pictorial signs and toilet seats are in a different colour; this assists residents in finding the appropriate room and utensil. All along the corridors are pictures and photographs of London in years gone by and in the main hallway there is a large frame with photographs of all of the residents; these become talking points between residents and residents and staff. All of the remaining bedrooms have been redecorated, new carpet fitted and new furniture. Staff levels have increased and there are now appropriate levels of staffing at all times; this will ensure the needs of the residents are adequately met. From this inspection it is noted that the handling, administration and recording of medication at Nightingale House has significantly improved. The medication policies and procedures now meet the National Minimum Standards. Medication Administration Records (MAR) charts are being completed appropriately and medication records reconciled with the medication available. All medication folders display a recent photograph of the resident. The Controlled Drugs register now states whether the medication is in capsule, tablet or liquid form. The storage temperatures of medication should not exceed 25c and all recordings from the 1st April 2008 did not exceed 24c. The home now has available the correct disinfection granules for dealing with blood spillages and these are kept with protective gloves and aprons. What the care home could do better: There is one repeated Requirement and two Recommendations. The manager has ensured that all of the care plans are evaluated on a monthly basis and she has commenced 6 monthly reviews, however she needs to ensure that all of the care plans are reviewed as soon as possible. The Recommendations are for a staff training profile to be introduced and this will identify what training individual staff have undertaken and what further training is required and that it would be good practice if there was a Quality Assurance group within the home, which could consist of residents, relatives and staff. This group could look at various aspects of the home. CARE HOMES FOR OLDER PEOPLE Nightingale House 57 Main Road Gidea Park Romford Essex RM2 5EH Lead Inspector Julie Legg Unannounced Inspection 10:00 6th May 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingale House Address 57 Main Road Gidea Park Romford Essex RM2 5EH 01708 763124 01708 745087 info@nightingalehouse1.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Nightingale Residential Care Home Ltd Manager post vacant Care Home 37 Category(ies) of Dementia - over 65 years of age (37) registration, with number of places Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th December 2007 Brief Description of the Service: Nightingale House is a registered care home for 37 people aged 65 and over. The home is situated in a residential area of Romford. It is on several bus routes and approximately ten minutes walk from a main line station. The home is a large two storey detached house with extensions, the house is set back from the main road and surrounded by well - maintained gardens. There are a total of 22 bedrooms, providing shared and single accommodation and two of the single rooms have an en-suite. All of the other bedrooms have a vanity unit and there are ample communal toilets on both floors. There are five bathrooms, three of which have medic baths, which are a special walk- in and sit down type of bath. There is also a shower room and a further domestic bath. Personal care is provided on a 24- hour basis, with health care needs being provided by health professionals such as GPs and community nurses. The Statement of Purpose and the Service User Guide are issued to every prospective resident and both of these documents are displayed in the entrance hall of the home. A copy of the most recent inspection report is also available. A resident or relative/representative could ask for his or her own copy, which the manager would make available. The fees for the home are £480-£600 a week. The area manager made this information available on 6th May 2008. Additional charges are applicable for hairdressing, chiropody and other sundries. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection undertaken by the lead inspector Julie Legg. The inspection took place on one day between 10.00 and 18.30. The area manager was present for the duration of the inspection and was available for feedback at the end of the inspection. Discussions took place with the manager; the cook and four care staff. Further information about Nightingale was also gathered from service users, staff and relatives. Telephone calls were made to health and social care professionals to ascertain their views on the service being provided at Nightingale House. A tour of the home was undertaken and all of the rooms were seen to be clean and free from any offensive odours. Service users’ files were also examined and case tracked: including risk assessments and care plans, together with the examination of staff files and other home records. These records included medical charts, financial transactions, and staff rotas and staff records. Also as part of the inspection we specifically looked at the National Minimum Standards for protection and safeguarding to assess whether people who use the service are protected from abuse. We also looked at the recruitment procedure to assess whether people who use this service are supported and protected by the home’ s recruitment policy and practices. Additional information relevant to this inspection has been gained from the Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment tool, which all providers are required to complete once a year. It focuses on how well outcomes are being met for people using the service. It also provides us with some statistical information about the service. There was a general discussion on the broad spectrum of equality & diversity issues and the manager was able to demonstrate a good understanding of the varied needs around religion, sexuality, culture, disability and gender. We asked people who use the service how they wished to be referred to in this report and those people who were able to respond expressed a wish to be referred to as residents. This is reflected accordingly throughout this report. What the service does well: Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 6 The home has a very relaxed and homely atmosphere. The residents and relatives all spoke about Nightingale House being a nice place to live. It was evident that the home is run in the best interests of the residents. Every effort is made to ensure that their views and those of their relatives and friends are taken into account on any decisions in relation to the running of the home. Staff were seen to treat residents with kindness and respect and were knowledgeable of residents’ needs. Residents appeared well dressed and groomed; all of the residents were dressed individually, some of the women were in dresses/skirts and some in trousers. The men also had different attire some were wearing shirts and trousers and others in tee shirts and casual trousers. Residents and relatives were very complimentary of Nightingale House. Relatives’ comments were, “I have seen a big improvement in the home. I am very pleased with the care Mum receives”, “Mum has only been here a short while and taking everything into consideration she has settled well”, “My husband is very well looked after and this means that I can sleep at night” and “His health has really improved since being here, I am very happy”. Residents’ comments included, “They are lovely here, they look after me”, “We go out to the park, I really enjoy that”, “The food is really good, I always eat it all up”. A social care professional stated, “I have recently carried out a review and I was very satisfied with the care”. The home’s policies and procedures on safeguarding, whistleblowing and recruitment are comprehensive. Staff recruitment and supervision was found to be sound and staff have received training in health & safety, safeguarding adults, risk assessment, first aid and fire training. The manager is aware of her responsibilities and has referred to the local authority Safeguarding Coordinator when required. Residents, relatives and staff were clear on who they would approach if they had any concerns regarding the welfare of the residents. What has improved since the last inspection? Nightingale House has made significent improvements since the last key inspection (July 2007) and the Pharmacy inspection (February 2008). From these two inspections 9 Requirements and 7 Recommendations were identified. Eight of the Requirements and 5 of the Recommendations have been met. The manager is ensuring that she undertakes a pre-admission assessment on all prospective residents prior to a placement being offered. Residents’ risk assessments are being regularly evaluated and updated; this will ensure that residents’ current needs are being reflected and acted upon. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 7 There is an Annual Quality Assurance programme currently being undertaken. Residents, relatives and stakeholders’ views are being sought on the quality of the service being provided. These views are being sought through satisfaction questionnaires. Comments, from resident and relatives’ meetings and the complaints and compliments records, will also be taken into consideration. This information will then be used as a basis for a development plan that reflects the aims and outcomes for the residents. Nightingale House has worked extremely hard in ensuring that the environment is conducive to people living with dementia. Doorframes have been painted in a different colour; all of the bedroom doors have photographs of the resident in their younger days (wedding photographs and family portraits). Toilets and bathrooms have pictorial signs and toilet seats are in a different colour; this assists residents in finding the appropriate room and utensil. All along the corridors are pictures and photographs of London in years gone by and in the main hallway there is a large frame with photographs of all of the residents; these become talking points between residents and residents and staff. All of the remaining bedrooms have been redecorated, new carpet fitted and new furniture. Staff levels have increased and there are now appropriate levels of staffing at all times; this will ensure the needs of the residents are adequately met. From this inspection it is noted that the handling, administration and recording of medication at Nightingale House has significantly improved. The medication policies and procedures now meet the National Minimum Standards. Medication Administration Records (MAR) charts are being completed appropriately and medication records reconciled with the medication available. All medication folders display a recent photograph of the resident. The Controlled Drugs register now states whether the medication is in capsule, tablet or liquid form. The storage temperatures of medication should not exceed 25c and all recordings from the 1st April 2008 did not exceed 24c. The home now has available the correct disinfection granules for dealing with blood spillages and these are kept with protective gloves and aprons. What they could do better: There is one repeated Requirement and two Recommendations. The manager has ensured that all of the care plans are evaluated on a monthly basis and she has commenced 6 monthly reviews, however she needs to ensure that all of the care plans are reviewed as soon as possible. The Recommendations are for a staff training profile to be introduced and this will identify what training individual staff have undertaken and what further training is required and that it would be good practice if there was a Quality Assurance group within the home, which could consist of residents, relatives and staff. This group could look at various aspects of the home. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 and 5 (standard 6 is not applicable to this service) People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Prospective residents and their relatives have detailed information on the home, which assists them to make an informed choice about moving into the home. A pre-admission assessment is undertaken of all prospective residents, this will ensure that their identified needs can be appropriately met by the home. Prospective residents and their relatives are able to visit the home prior to their admission. EVIDENCE: The Statement of Purpose sets out the objectives and philosophy of the service and states what the home can provide. This has recently been reviewed and updated. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 11 The Service user guide is informative and written in plain English; it is also available in pictorial format. A copy of this document has been given to all of the residents and relatives. Copies of this document were seen in some residents’ bedrooms and five relatives confirmed that they had also received a copy. The files of three residents were looked at. The manager had undertaken an assessment, which includes sections on: personal care, mobility, transfers, communication, and medical history covering physical and mental health, personal safety. An assessment from the local authority had also been undertaken and information had been gathered from families and GP. During the first week of admission a further detailed assessment takes place that leads to a comprehensive care plan. See standard 7. Residents and relatives are able to visit the home prior to a resident moving in. the inspector spoke to five relatives, all of whom stated their parents or partners were unable to visit the home prior to their admission this was due to their frailty. However all of the relatives had visited Nightingale House prior to their relative’s admission. One relative stated “I visited other homes but I chose Nightingale House because the manager spent time talking to me and showing me around the home”. Another relative stated, “Because Mum was coming straight from hospital, we were able to put all of her own bedroom furniture in her room before she was discharged. We are sure this helped her settle in more quickly ”. The home does not provide Intermediate Care. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, 10 and 11 People who use 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 health, social and personal care needs of each resident are set out in individual care plans. These plans are comprehensive and person centred, which ensures that the residents receive the appropriate care to meet their needs. There are clear medication policies and procedures for staff to follow and the home’s medication systems and practices are now robust which ensures that residents are not put at risk. Residents are treated with respect and the arrangements for their personal care ensures that their right to privacy is upheld. Residents and relatives can be assured at the time of the resident’s death that they are treated with sensitivity and respect. ‘Preferred place of care’ plans are being completed and this will ensure that residents’ wishes regarding their final days are carried out. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 13 EVIDENCE: Each resident has their own care plan; the inspector examined four of these plans. Each resident’s care plan identifies his or her personal care, moving & handling, meals & nutrition, safety & protection, social contact, autonomy and choice (keys, management of finances and medication), communication, health, cultural, religious, sexuality needs as well as likes and dislikes. The care plans are detailed and person centred, such as ‘D likes two weetabix and warm milk for her breakfast’, ‘E likes white toast and marmalade for breakfast’ and ’F likes a cup of hot chocolate and biscuits before going to bed’. Each resident also has an individual night care plan, which details how many pillows they like, whether they like the light left on; one care plan stated ‘ C likes two pillows and listening to the radio whilst going off to sleep’. Daily records are an accurate reflection of the care the resident received and relate to the residents’ care plans. There was evidence that the manager has commenced monthly evaluations of residents’ care plans. However not all of the care plans (with the involvement of the residents and relatives and other appropriate people) have had six monthly reviews. This is Requirement 1 Residents’ health needs are identified as part of their care plan and how these needs should be met. The recordings of fluid and food intake are taking place and pressure wound charts would be completed if required. Residents who have diabetes have comprehensive health care plans and that blood sugar monitoring was being undertaken in accordance with their care plan and the instruction of the GP or community nurse. All residents are weighed regularly and if any weight loss is noted over two consecutive months, then the resident is referred to their GP. A health care professional stated, “I visit the home regularly and I am satisfied with the care the residents are receiving. The staff are following our instructions”. Residents’ files also have written evidence that they are seen by other health professionals including opticians, dentists, chiropodists, community nurses, GP and hospital out patient appointments. Some of the residents are taken for health appointment and other residents receive their health care within the home. During the inspection an ambulance was called to attend to one of the residents. The accident and incident book was reviewed. Accidents were recorded in full and residents received follow up checks to ensure there were no further health-associated risks. The Commission for Social Care Inspection has been Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 14 informed of these incidents and accidents in line with Regulation 37 Notifications. A ‘Personal Risk Screening Tool’ is completed on every resident. This document covers areas such as mobility, moving & handling, falls, going out, tissue viability, nutrition, hydration, personal hygiene, infection control, pain management, social isolation, challenging behaviour, mental capacity, managing finances. This comprehensive document will then determine whether further detailed risk assessments are required. Residents where possible and relatives have been consulted in formulating these risk assessments. Medication policies and procedures have been reviewed and updated and now meet the National Minimum Standards. The manager advised the inspector that the home has recently changed pharmacist, as they were able to provide a more comprehensive service and have also provided medication training for the senior care staff. The manager has also met with local GP surgeries to try and improve communication between the home and surgeries. All of the medication folders and blister packs display a recent photograph of the resident. Four residents’ medication was checked against the Medication Administration records (MAR) charts. The charts had been completed appropriately and the amount of medication remaining was correct. Liquid medication was checked and all bottles had the date recorded of when first opened written on the label, this will ensure that usage does not go beyond the in-use shelf life. To ensure that medication is administered safely only senior staff can administer medication and whilst they are administering medication they wear a red tabard; this is to ensure that residents or staff do not disturb the member of staff and thus decrease the likelihood of the wrong medication being administered. The medication storage room was inspected; this was very tidy with all medicines stored in a locked medicines cupboard. The storage temperatures of medication should not exceed 25c and all recordings from the 1st April 2008 did not exceed 24c. The medicines fridge storage temperatures records were correct and up to date. The Controlled Drugs register was examined and all entries now state the form of the medication i.e. capsule, tablet or liquid. The home now has available the correct disinfectant granules (containing sodium dichporoisocyanurate) for dealing with a blood spillage and these have been placed with disposable gloves and apron in the medicine cupboard. From this inspection it is noted that the handling, administration and recording of medication has significantly improved, this ensures that residents are not put at risk. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 15 The home is currently involved with the ‘End of Life’ care initiative and is completing with the assistance of the residents and relatives ‘end of life’ care plans. The McMillan nurse and the local funeral directors have already spoken to the staff and they are to receive further training in this area. Last year the home had a resident who expressed her wishes to remain in the home. The care staff, community and McMillan nurses, GP and relatives all worked together to ensure the resident’s wishes were met. One bereaved relative wrote ‘ thank you for all you did for D. Your patience is quite outstanding. Once again thank you for the care and attention you showed D’. A number of residents and relatives were spoken to and all said that the staff were very respectful when attending to personal care. Residents stated “the girls help me to look after myself””, “they are lovely, they sit and talk to me ”, “the girls are kind and don’t rush me”. A relative stated, “I have no complaints whatsoever. My Mum is very happy and that is good enough for me”, another stated, “they are all very kind and have the patience of a saint”. A relative had written ‘ thank you and all the staff for the care given. We are very happy for the way they are settling mainly due to your patience and care’. Staff were talked to and observed to treat residents in a respectful and sensitive manner. They understood the need to promote dignity through practices such as, the way they addressed residents and knocking on bedroom and bathroom doors before entering. Residents’ privacy and dignity are covered during the staff’s induction programme. They were seen to be gentle when assisting residents to transfer from their armchair and offered explanation throughout the activity. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use 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 residents are able to participate in a varied programme of activities, which suit individual needs, preferences and capacities. Visiting times are flexible and people are made to feel welcome, this ensures that residents are able to maintain contact with relatives and friends. Residents are helped to exercise choice and control over their lives, which enables them to retain as much autonomy as possible. The meals in the home are well presented and nutritionally balanced and they offer both choice and variety to the residents. EVIDENCE: Several residents were asked their views and care plans and other records were examined. There is a general programme of activities available for all of Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 17 the residents and regular visits by professional entertainers also take place. The manager has also produced a newsletter, which also gives details of all forthcoming events. The care plans contain information about preferred activities including both spiritual and cultural activities. Most of this information has been gathered through staff, residents and relatives completing ‘Life Stories’ on each resident. These ‘life stories’ contain written information and photographs from childhood, through employment, marriage, becoming parents, grandparents and bereavements. Residents’ birthdays are celebrated with a birthday cake and a special tea and one couple have recently celebrated their wedding anniversary, which was attended by their family. Photographs showed that everyone enjoying them selves. Nightingale House employs a workforce from diverse cultures and backgrounds, some of which are different from the residents living in the home. In the lounge is a board that gives details of the day’s activities and also says ‘good morning’ in Ukraine, Polish, Malawi, Zambia, Zimbabwe and Hindu (these are the languages that are spoken by the care staff). English is not the first language of one of the residents and one of the care staff is able to converse with her in her first language and their relative is also advising the manager on food that is culturally appropriate. There is a small room that leads off from the dining room and the manager has developed this room into a ‘Reminiscence Room’; this room has been furnished with a grandfather clock, an old style telephone and typewriter and other reminiscence materials such as photographs, games and other objects, which are being used for individual and group work. One of the proprietors organises all of the social activities and she visits the home at least three days a week. Monthly activities that have taken place include; Shrove Tuesday (some of the residents enjoyed tossing the pancakes), Londoner’s day (residents enjoyed pie, mash & liquor dinner, a quiz on London and a traditional sing-a-long with an entertainer), St Patrick’s Day (Irish Stew and an Irish dance show), clothes party (residents were able to choose and buy their own clothes) Easter Sunday and St George’s day. Future events include: A Reminiscence week, a Royal Family special celebrating the Queen’s birthday and Trooping of the Colour, Wimbledon Final (with a cream tea), Picnic in the Park, visits to Southend-on-Sea and to the local theatre. The manager has also arranged for the mobile library to visit every three weeks. A local vicar visits once a month and ‘friends of the catholic church’ also visit some of the residents. A cheese and wine evening has been arranged for the residents and relatives to meet the new manager, who commences on 12th May 2008. Weekly activities include all of the residents (who wish to participate) going out at least once a week, either to the shops or the local park, one resident stated Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 18 “I really enjoy going to the park and watch the children play and I enjoy feeding the ducks”. Another residents stated, “We are doing lots of things now, I really enjoy baking cakes”. On a Thursday morning a keep fit instructor visits the home and carries out exercises to music and cookery sessions are held on a Friday morning and residents have made sausage rolls, cakes, and Cornish pasties. A movie afternoon also takes place where resident can sit and enjoy a movie of their choice. The hairdresser visits three times a week and staff manicure residents’ nails. Daily activities that are taking place include card games, ball games, musical exercises, arts & crafts and board games. Residents also make full use of the garden, when the weather permits. On the day of the inspection several of the residents were sitting under umbrellas eating ice creams. Staff are also encouraged to spend time sitting and talking to residents on a one to one basis. Some of the residents are living with dementia and activities are organised in a way that takes their needs into consideration. On the desk in the reception area the manager has placed some information on local bus routes, activities and hotels in the area. The signing-in book showed that there is a steady stream of visitors to the home every day, on the day of the inspection seven residents received visitors and two of the residents went out with their relatives. Visiting times are flexible and visitors confirmed that they could visit at any time. All of the relatives that were spoken to said that they were made to feel welcome and they were always offered a cup of tea or coffee. Relatives stated, “I am in here at least three times a week and I am amazed as there always seems to be something going on, even if it’s the care staff sitting talking to the residents”, “I always feel comfortable when I visit and I do not feel restricted in any way” and “I enjoy coming to see B I am always feel welcome”. Relatives confirmed that they could see their family member either in the lounge, in their own bedroom or in the garden. Resident’s care plans indicate their preferred name, their choice as to where they take their meals and their wishes regarding illness or death. Residents are encouraged to bring into the home their own personal possessions and this was evident when residents’ bedrooms were visited. Residents and relatives meetings are taking place and a befriending service through Age Concern is being implemented. Meals are mostly served in the dining room, though residents can take their meals in their bedroom or garden if they so wish. The cook is very aware of residents’ likes and dislikes and has recently devised new tea menus, in consultation with the residents. All of the menus are in pictorial form and this ensures that residents who may have dementia are able to make some informed choices. The cook confirmed that if a resident did not want either of the choices, she would prepare them something different. Breakfast there is a choice of cereals and toast and on Sundays residents can choose to have a cooked breakfast. The cook stated that she uses mostly fresh vegetables and the majority of the cakes are home made. Some of the residents are diabetic Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 19 and the cook advised that she tries to provide them with the same or similar dessert, so that they do not feel different from the other residents. The dry food cupboards, refrigerators and freezers were adequately stocked. Fresh fruit platters are regularly available, as are fresh fruit juices and on some days residents are offered cornets or ice-lollies. Both residents and relatives were complimentary of the food; one relative stated, “I have been here at mealtimes and the food looks lovely, it is nicely presented”, a resident stated, “I really enjoy my food, I have more than enough to eat”. A few of the residents require assistance or encouragement with eating their meals and staff were seen to carry out this task appropriately, talking to residents and not rushing them. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents and relatives can be confident that their complaints will be listened to and acted upon. There are policies and procedures on safeguarding adults and staff have undertaken training, which ensures there is an appropriate response to any allegations or concerns regarding abuse. EVIDENCE: The complaints book was examined during the inspection and one complaint has been recorded since the last inspection. There was written evidence that that the complaint had been resolved to the satisfaction of the complainant. The complaints procedure is on the notice board and three residents were asked, “If you were unhappy about anything in the home or you felt frightened or unsafe, who would you talk to”? One resident said, “I would talk to my daughter”, another resident said “ I would tell the manager or my son” and the third resident said, “I would talk to the manager or A (member of staff)”. Five relatives that were spoken to said that they would talk to the manager or Ashley/Nav (two of the proprietors) and felt confident that their concern would Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 21 be listened to and acted upon. One relative stated, “I had a minor concern and I spoke to Sandy (manager) who dealt with it straight away”. All of the residents have relatives/friends who visit and there are resident and relatives meetings, where ‘safeguarding’ is discussed. The manager is also in discussion with Age Concern regarding a befriending service as some of the residents may find it easier to talk to someone other than a relative or a member of staff. The manager stated she operates an open door policy and welcomes any suggestions, concerns and complaints as she feels this can only improve the quality of the service that is being provided at Nightingale House. A comments book is available in the reception and the manager has also produced a newsletter, which gives information on how to make a complaint and details of the quarterly relatives’ meetings. Families or representatives administer all of the residents’ finances. The home hold small amounts of money for hairdressing, newspapers and chiropody and toiletries. Six residents money were checked and all were accurate with receipts tallying with the amount of money spent. There was written evidence that the manager regularly audits the financial records. There is a written procedure and policy for dealing with safeguarding adults and whistle blowing. The home also has a copy of the Department of Health’s document ‘No Secrets’ and the local authority (London Borough of Havering) documentation on safeguarding adults. At this inspection we particularly looked at safeguarding issues and were satisfied that staff were very knowledgeable about these policies and procedures. They have also undertaken appropriate training and this topic is regularly discussed during staff meetings. When talking to staff it was evident that they were aware of the various types of abuse such as emotional, physical, financial and sexual. Staff were also aware of the actions needed to be taken if they had any concerns regarding the welfare and safety of the residents. Comments from staff were “We are here to look after the residents and I would report anybody who I felt was being unkind to a resident”, “If I as much heard somebody raising their voice to a resident I would tell the manager or a senior”. Staff were also able to demonstrate an understanding of diverse needs of people due to age, disability, culture, religion and sexuality; the resident whose first language is not English and that a member of staff is able to converse with her in her first language. Nightingale House is registered from people with dementia; staff have undergone training to enable them to understand the different dementias and how it affects people in different ways. The service does promote independence and choice as much as possible and respects the rights of people using the service. Risk assessments are completed where necessary with the involvement of the resident and other appropriate people. Residents are able to access the garden independently but can only access the outside if the keypad number is known; this ensures that Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 22 the people living with dementia have some freedom of choice but without their safety being compromised. The manager was clear in what incidents needed to be referred to the Local Authority as part of the local ‘safeguarding adults’ procedure and in the past has referred to the local authority’s Safeguarding Co-ordinator. Since the previous inspection there have not been any safeguarding incidents at the home and The Commission for Social Care Inspection has not received any complaints. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25 and 26 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents live in a safe, clean and hygienic environment, with access to indoor and outdoor facilities. Residents’ bedrooms suit their needs and are decorated and furnished in a way that suits them. There are sufficient toilets and bathrooms situated on both floors. EVIDENCE: A tour of the home was undertaken including residents’ bedrooms. The home is situated on a busy residential road; which means facilities within the community are easily accessible. The home is decorated and furnished in a homely fashion and all areas of the home were maintained, clean and free from any offensive odour. The home has in infection policy and would seek Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 24 advice from external specialists if and when required. The laundry and the kitchen were inspected and both of these rooms were maintained to a good standard. The kitchen is lacking in cupboard space and worktops to prepare and serve meals, however when the new extension commences (within the next couple of months) the kitchen will be part of the new extension and will be refitted. There was a good supply of food within the cupboards, refrigerators and freezers and this was stored appropriately. There was evidence that refrigerator and freezer tempretures are regularly recorded. The living area of the home consists of a large lounge and separate dining room, both of these rooms have been refurbished; the lounge has new armchairs and a fish tank and further refurbishment and redecoration will take place when the lounge is extended as part of the new extension. The dining room has been redecorated with new curtains and blinds as well as dining room furniture, which has been arranged so that residents sit at tables for two or four people rather than all sitting at two large tables. All of the tables had clean tablecloths, napkins and small vases of fresh flowers; this coupled with the seating arrangements gave the dining room a more homely feel to it. One of the residents stated, “I love sitting watching the fish, they are so relaxing”. One of the relatives stated, “It’s a real pleasure to see Mum sitting in the dining room eating her meals”. As the ability of people living with dementia to communicate with words decreases, the use of non-verbal cues and the environment are important in enabling them to cope with daily life and orientation. For example, through the use of visual clues such as colour and signage, changes in colour in different areas to assist with orientation, toilet seats that are in a different colour to the rest of the room and using pictorial signs as well as written signs to assist with identifying different rooms. Appropriate pictures such as photographs of the local area and of London, that would have been familiar to residents in their younger days, can be used as points of discussion with people with dementia. Nightingale House has worked extremely hard in ensuring that the environment is conducive to people living with dementia. Doorframes have been painted in a different colour; all of the bedroom doors have photographs of the resident in their younger days (wedding photographs and family portraits). Toilets and bathrooms have pictorial signs and toilet seats are in a different colour; this assists residents in finding the appropriate room and utensil. All along the corridors are pictures and photographs of London in years gone by and in the main hallway there is a large frame with photographs of all of the residents; these become talking points between residents and residents and staff. All of the bedrooms that are staying have been redecorated and refurbished with new carpets and curtains; all were cleaned to a high standard with fresh bed linen on the beds. All of the bedrooms are personalised with resident’s own furniture such as, dressing tables, chests of drawers, a writing bureau, as well as televisions, radios, photographs, pictures, ornaments and one resident has Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 25 a budgerigar in their bedroom. Two of the bedrooms are shared rooms, which are shared by two married couples. One relative stated “Whilst Mum was in hospital we were able to furnish her bedroom with her own bedroom furniture and put all the family photographs on the walls, I’m sure this has helped her to settle”. There are sufficient toilets and bathrooms on both floors, three of the bathrooms have medic baths, which are a special walk-in and sit down type of bath. The remaining bath is an ordinary bath that residents have difficulty in using; the proprietor is currently obtaining estimates to change the bath to a walk-in shower. The gardens are well maintained and new garden furniture has been purchased. Many of the residents enjoy sitting out in the garden, as was seen on the day of the inspection. One resident stated, “It’s lovely to be outdoors and to be able to watch and listen to the birds ”. The home is cleaned on a daily basis and throughout the inspection all areas of the home were found to be very clean and tidy. Additional cleaning time is made available once a week to ensure that the standard of cleanliness is maintained. There are adequate control systems in place to ensure that the home is free from any offensive odours. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home’s staffing levels are satisfactory and there are sufficient staff on duty and the staff have the appropriate skills to meet the individual needs of the residents. The home has a clear recruitment policy and procedure and appropriate checks are undertaken, which ensures the protection of the residents. EVIDENCE: Staff rotas were examined and the rota correlated with the number of staff on duty, during the day there are four care staff, at least one of the staff is a senior and two waking night staff, as well as a part- time activities coordinator. On the day of the inspection there were sufficient staff on duty to meet the needs of the residents. Staff were being deployed effectively to ensure that residents choosing to remain in their bedrooms were being cared for appropriately. The home has recently undertaken a recruitment drive and has offered posts to a manager, a leading senior carer and a senior carer. These three members of staff are due to commence work next week (12th May 2008). Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 27 Four staff files were examined and all showed that all the relevant recruitment procedures had been adhered to. All files had a completed application form; two written references, satisfactory Criminal Records Bureau checks and copies of birth certificate and passport were also on file as well as proof of address. Normally two people are involved with interviewing prospective staff and in keeping with equality & diversity; all candidates are asked the same questions and there are written responses to the questions. Three members of staff were spoken to and all confirmed that these checks had taken place prior to them commencing work. One member of staff stated, “I was surprised at how thorough they were but they can’t be too careful as we are working with frail people”. Nightingale House employs a workforce from diverse cultures and backgrounds, some of which are different to the people living in the home. However, staff have undertaken training in equality & diversity. This ensures that the spiritual, cultural, sexual and any other diverse needs of the residents are understood by staff and appropriately met. All newly appointed staff undertake an induction programme, which is in line with the Skills for Care Council. Topics covered during the induction period are, moving & handling, first aid, understanding the principles of care, recognising and responding to abuse, communicating effectively and maintaining safety at work. More than 50 of the staff have attained their NVQ 2/3. Other training that has been undertaken in the past twelve months includes: record keeping & report writing, managing behaviour that challenges, safeguarding adults, risk assessment & fire awareness, what to do when a death occurs, moving & handling and community care and the law. Most of the staff have attended a one-day course on dementia awareness and a psychiatric consultant has undertaken further training in the diagnosis of dementia and working with behaviour that challenges. Information was not readily available regarding training that staff have undertaken. It is a recommendation that a staff training profile is introduced that will identify what training individual staff have undertaken and what further training is required. This is Recommendation 1. Staff that were spoken to stated “I am very happy working here “, another staff member stated, “This is the best home I have worked in”. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 People who use 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. During the absence of a registered manager, the area manager is currently managing the home. She has experience of working in a care home and has taken on board the areas in which the home needed to improve. Residents, relatives, staff and stakeholders are currently being consulted to ensure that the home is run in the best interests of the residents. Residents’ financial interests are safeguarded by the policies and procedures of the home. Residents and staff’ health, safety and welfare are promoted and protected. There is a system in place to ensure that staff receive regular supervision and yearly appraisals. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 29 EVIDENCE: The home has been without a registered manager for the past year. The area manager who is a very experienced manager has been managing the home for the past six months. Comments from residents, relatives and staff were complimentary, saying that she is helpful, supportive and always has time to listen. In discussion with the area manager, we were advised that the home has had a successful recruitment drive and have offered the post to an experienced manager; she has accepted and is due to take up her post on 12th May 2008. One of the senior posts has been converted into a leading senior’s post; again this has been advertised and successfully recruited to. Because the home has been without a registered manager for a considerable period of time, it is a requirement that the newly appointed manager applies for registration to the Commission for Social Care Inspection within three months. This is Requirement 3. The current manager is the area manager for the company and there will be a four week handover/induction period for the new manager; this will ensure a smooth transition and will enable the area manager to return to her substantive post, which is to line manage the manager of Nightingale House. Discussions with the area manager showed she was able to describe a clear vision for the home, particularly in relation to continuous improvement of the service. The Annual Quality Assurance Assessment (AQAA) also clearly identified areas for improvement. The area manager has also carried out ‘spot checks’ outside of ‘normal hours’. From discussion with the residents, relatives, staff and documentation that ‘safeguarding’ is given a high priority this includes; detailed risk assessments, clear financial procedures, appropriate training for staff and an open door policy with residents and relatives. Under the requirements of Regulation 26 of the Care Home Regulations the registered provider should be carrying out quality monitoring visits and reports of these visits should be available to the Commission. There was evidence that these visits are taking place and information within these reports is comprehensive. There is an Annual Quality Assurance programme currently being undertaken. Residents, relatives and stakeholders’ views are being sought on the quality of the service being provided. These views are being sought through satisfaction Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 30 questionnaires. Comments, from resident and relatives’ meetings and the complaints and compliments records, will also be taken into consideration. This information will then be used as a basis for a development plan that reflects the aims and outcomes for the residents. It would be good practice if there were a Quality Assurance group within the home, which could consist of residents, relatives and staff. This group could look at various aspects of the home. This is Recommendation 2. The home has an appropriate policy and procedures regarding the safeguarding of residents’ finances. Currently neither the manager nor any member of the organisation acts as appointed agent for any of the residents. Residents’ accounts that were checked, showed sound financial procedures are being followed. From discussion with the manager and staff it was evident that staff supervision is taking place, as well as regular staff meetings and yearly appraisals. This was also evidenced from examining staff files. The Annual Quality Assurance Assessment (AQAA) identified that all of the policies and procedures have been reviewed and updated within the past twelve months. A wide range of records were looked at and these were found to be detailed up to date and accurate. The home has carried out all health and safety checks. Fire drill and alarm testing are regularly undertaken as are water, freezer and refrigerator temperatures. Fire alarms and extinguishers, portable appliances, the lift and the electrical installation have all been tested this year and the gas service is due next month. The manager is notifying The Commission of all serious incidents, hospital admission and death of a resident via Regulation 37 notifications. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(2)(b) Requirement All residents’ care plans must be reviewed at least every six months this will ensure that residents’ current needs are being met. Previous timescale of 31/10/07 not fully met The registered person must ensure that the newly appointed manager applies for registration to the Commission for Social Care Inspection within three months. Timescale for action 31/08/08 2 OP31 8 31/08/08 Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP30 OP33 Good Practice Recommendations It is a recommendation that a staff training profile is introduced that will identify what training individual staff have undertaken and what further training is required. It would be good practice if there were a Quality Assurance group within the home, which could consist of residents, relatives and staff. This group could look at various aspects of the home. Nightingale House DS0000066621.V362999.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Contact Team 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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