Care Home: Nightingale House

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What the care home does well The pre-admission needs assessment process is thorough and well documented and could form a good basis on which to build a plan of care. The residents are being given the help they need to maintain their personal hygiene. We were told that seventeen of the twenty-five residents had holidays abroad in the preceding twelve months. People told us that they enjoy their meals. They are offered a choice of at least two set dishes at mealtimes and alternative meals will be provided on request. By providing regular meals, ensuring people take any medicines they may have and providing warmth and shelter the home is able to improve the physical health of the residents. What has improved since the last inspection? Some rooms have been redecorated since the last inspection and this gives them a cleaner and fresher appearance. There is a new landscaped decking area for barbecues, relaxation and other functions. What the care home could do better: The information that is made available to people considering moving into Nightingale House does not give them or their representatives a clear description of the service that is provided. This means that people may not understand that the long term care provided is highly structured rather than person centred and designed to keep the residents safe from harm. Care planning is service led rather person centred. This means that people live in a home that is based on existing routines, that they must fit into the routines and that the service provided is not based on meeting peoples individual wishes and needs. Although the service is meeting peoples personal hygiene and physical health needs, it is not meeting their social, recreational, occupational emotional or psychological needs and people have little to do other than watch television. The staffing levels are low. This means that the service cannot provide the support that people may need to enable them to maintain or develop their social and independent living skills. Overall Nightingale House provides an institutional service and the people who use the service are required to fit into the established routines. Key inspection report Care homes for adults (18-65 years) Name: Address: Nightingale House Landscore Close Teignmouth Devon TQ14 9LD     The quality rating for this care home is:   one star adequate 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: Judy Hill     Date: 1 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 39 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: Nightingale House Landscore Close Teignmouth Devon TQ14 9LD 01626773904 01626770331 info@korcare.co.uk www.korcare.co.uk Korcare Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Wendy Apps Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 27. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Mental disorder (Code MD) Past or present alcohol dependency (Code A) Date of last inspection Brief description of the care home Nightingale House is registered to provide accommodation and care for a maximum of twenty-seven people in the registration categories of Mental Disorder and Past or Present Alcohol Dependency. The registered service provider is KorCare Limited and the registered manager is Mrs Wendy Apps. Care Homes for Adults (18-65 years) Page 4 of 39 Over 65 0 0 27 27 Brief description of the care home Nightingale House is in Teignmouth, Devon. The home is within walking distance of the town centre, which has a good range of shops and facilities, a train station and local bus services. KorCare Limited make information about the service available on a website www.korcare.co.uk and in a Statement of Purpose and a Service User Guide. Copies of previous inspection reports can be located on our website www.cqc.org.uk. The Statement of Purpose tells us that the weekly fees for new admissions are £775.00. The fees include all personal care, food and dietary requirements, basic utilities, in-house activities and laundry. Extra charges are made for professional hairdressing, chiropody, dental fees not covered by the NHS, external entertainment, holidays, clothing, toiletries and other personal expenditure. Care Homes for Adults (18-65 years) Page 5 of 39 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection included an unannounced visit to the home that was carried out by two inspectors on 11th January 2010. The information contained in this report was gained from an Annual Quality Assurance Assessment that was completed and returned to us by the Responsible Individual. Information we hold on our service files, including previous inspection reports, improvement plans, the homes Statement of Purpose and Service Users Guide. During the site visit we spoke with the registered manager, some of the staff on duty and some of the people who live at Nightingale House. We also had a look around the home and looked at some records. The records we saw included residents needs assessments and care plans, staff recruitment and training records, staff rotas and medication administration records. Care Homes for Adults (18-65 years) Page 6 of 39 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. Care Homes for Adults (18-65 years) Page 7 of 39 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 Adults (18-65 years) Page 8 of 39 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 39 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information provided to prospective residents does not give them an accurate description of the service provided. This means that they do not have the information they need to make an informed judgement about whether Nightingale House will be right for them. Evidence: The Statement of Purpose tells us that the aim of the service is to provide structured, therapeutic and holistic care to meet the needs of people who are suffering from Korsakoffs Syndrome and Alcohol Related Brain Disorders and lists the key values which the service tries to reflect as autonomy, attainment, citizenship, individuality, diversity, well being and inclusion. Throughout the inspection we looked for evidence that the service provided matched our understanding of the above description and our findings were that it did not. Evidence to support our findings will be referred to throughout this report. The criteria for admission to the home is clearly defined in the Statement of Purpose. People must have a diagnosed medical condition, such as Korsakoffs Syndrome or an Care Homes for Adults (18-65 years) Page 10 of 39 Evidence: Alcohol Related Brain Disorder and must not have a current dependence on alcohol. Nightingale House is not registered to provide nursing care and cannot offer detoxification therapies or treatments, nor does the service claim to do so. Referrals for new admissions can be made privately but the normal route is through Social Services or Care Trusts. The home will consider admitting people who have been medically diagnosed with Korsakoffs Sydrome and enquiries from Social Services or Care Trusts will be will only be considered following the receipt of an individual needs assessment and care plan from the sponsoring authority. KorCare will carry out a further assessment to to decide whether or not to offer the prospective resident a place at the home on a three month trial basis. The Statement of Purpose tells us that prospective residents and their representatives are able to visit the home prior to their admission. Although contracts are exchanged between the contracting authority and the home, the residents are not given copies of their contracts. This means that they do not have access to information about the service that has been agreed for them between their sponsoring authority and the home. The residents are given a copy of a Service User Guide, but these documents do not provide them with sufficient information about what they should expect from the home and the service provided. Care Homes for Adults (18-65 years) Page 11 of 39 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provided is task based and not person centred. This means that the people who live at Nightingale House are not in control of their own lives and have few opportunities to make their own choices and decisions. Evidence: In the report of our last key inspection, which was dated 17th March 2009, we noted that a new system for recording plans of care had been purchased and that a start had been made to transfer the information from the old system to the new recording system. Very little progress has been made on this and the staff were still using the original records. We looked at some of the care planning records and found very little evidence that the people who use the service had been involved in planning and reviewing how they would like their care to be provided. This lack of consultation means that the individual wishes of the people using the service, which should underpin how the service is delivered, is not being considered and the resulting care plans are institutional rather Care Homes for Adults (18-65 years) Page 12 of 39 Evidence: than person centred. During the inspection we met and spoke with several of the people who use the service and these conversations, together with our conversations with the registered manager and our inspection of records told us that the home does not encourage people to make decisions for themselves, and that people are not given the information and support they need to help them work towards greater independence. For example, one person told us that he had to make a fuss if he wanted access to his own money or to buy anything for himself. He did not know how much money he had. He did not receive any support to help him manage his own finances and there was no evidence to show how the home had reached the conclusion that he could not hold his own money or manage his own finances. The provider told us that the resident had agreed to this arrangement. The Statement of Purpose tells us that on admission people must hand over their money and bank cards for safekeeping. The Company Secretary acts as Client Finance Manager and will act as appointee for residents if necessary. Following the trial period, a bank account will be set up in trust for the client with the Company Secretary as signatory. This procedure is an example of institutional practice as it is applies to everyone and is not therefore based on the individually assessed needs and wishes of individual residents. Four people we spoke with told us that the home was like a prison. They said that they had little or no access to a social worker or independent advocate, and therefore they felt powerless to find alternative accommodation or to have any say in their futures. They said that they had little or no involvement in drawing up their care plans and seemed unaware of the content of these documents. The provider told us that peoples perception is often distorted because they have Korsakoffs syndrome. We saw no evidence of any participation in daily routines in the home or in the decision making process. People were, however, consulted through residents meetings held every three months and these had been minited. We found evidence in the homes records and in conversations with the residents and registered manager that indicated that people are not allowed to take any risks. For example, they are not able to hold their own mobile phones, their medicines or their own money and are not given keys to their bedrooms. Going out without an escort is actively discouraged. The provider told us that this was for reasons of safety. The individual plans of care do not include personal goals and individual risk assessments had not been carried out to justify the restrictions that are placed on the residents. Care Homes for Adults (18-65 years) Page 13 of 39 Evidence: In conversation with the registered manager it was clear that her intention was to protect people from physical harm and although this is being achieved, the quality of life of the people who use the service is suffering because they are overprotected. Care Homes for Adults (18-65 years) Page 14 of 39 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are not able to make choices about their life style and are not supported to develop their life skills. Evidence: The Statement of Purpose tells us that the key values that the service tries to reflect are autonomy, attainment, citizenship, individuality, diversity, well-being and inclusion but in practice we found little evidence of these values. We spoke with some of the people who use the service about their lifestyles and found that they had very little control over their lives. The registered manager told us that people could not go out alone because they may get lost, although we saw no evidence in the form of individual risk assessments to support this. Some of the people we spoke with agreed that they might not be able to Care Homes for Adults (18-65 years) Page 15 of 39 Evidence: find their way home if they went out. Others said that they would be able to find their way home once they had familiarised themselves with the local area. Assessments had not been undertaken to determine this. One resident told us that he could not go out because he was in prison, although he did not know what crime he had committed. Three other people told us that the home felt like a prison. It was of concern that people held this view. The provider and manager responded by saying that often client moods and frustration will lead to the release of this type of outburst or comment. People are not allowed to keep their mobile phones when they enter the home, we were told that this was because they may get stolen or used to make calls to friends and families at unsuitable times or to call the emergency services but saw no evidence that individual risk assessments had been carried out to support this. People do not have direct access to a landline to make and receive calls but can ask to use the telephone in the staff office or a cordless phone in the privacy of their bedrooms. Visitors to the home are asked to give notice to the staff if they are planning a visit and personal contact with families and friends is kept to a minimum in the first three months of a new placement. The Statement of Purpose states that short notice is quite acceptable. The reason given for this was that people need time to settle in, but we could not see how a lack of contact with the people closest to them could make the settling in process any less difficult for the residents. One resident told us that she would like to help with the general housecleaning duties, such as vacuuming, but could not do so because she had been told that the staff were insured against accidents, such as tripping over the flex, and the residents were not. Another person said that he had previously enjoyed helping in the garden but this had been stopped. He said that he had been told that it was not safe and that the homes insurance would not cover him. It was suggested by the service providers that the residents views could be confabulation as most people who live at the home are prone to develop a perception that is not based on fact. It was agreed that staff needed to help and encourage people to do housework and gardening. The residents do not have access to tea and coffee making facilities and we were told that this was because they might scald themselves. People do not have keys to their bedrooms and the registered manager told us that this is because it is the policy of the home not to give people keys to their rooms. The registered provider has since told us that keys are issued to all residents on request. The registered manager told us that people are not allowed to handle their own Care Homes for Adults (18-65 years) Page 16 of 39 Evidence: personal spending money, because they may spend it inappropriately. Although people told us that they could go to bed when they chose to do so. Several residents said that they had to be in their bedrooms by 10.30pm and that they were woken at 7am. We saw no written policy to explain or support this and the registered service provider has told us the information which we received from the people who use the service is inaccurate. The service claims to provide therapeutic care and when we asked the registered manager to tell us what was provided she told us about the activities that take place within the home, such as music, quizzes, sing a longs, animal visits and outdoor activities including group outings to Bowling, Bingo and meals. The service providers have since told us that the term therapy is being used to describe activities that relieve tension. The residents told us that they spent most of their time watching television because there is nothing else for them to do most of the time. The home employs a chef who prepares the main meals each day. There is a two weekly menu that is varied and provides a choice of two set meals. We found that the people living in the home had not been actively encouraged to participate in menu planning. The menus were drawn up by the registered manager, taking into account her knowledge of peoples likes and dislikes. People living in the home were not allowed to go into the kitchen to prepare their own meals, or to be involved at any stage of the meal preparation or clearing up afterwards. People were not involved in shopping or meal planning. The dining room appeared functional and was clean, but had a canteen style appearance. There were no attractive features in the room to make mealtimes feel like a special occasion. Meals are served in two sittings. Care Homes for Adults (18-65 years) Page 17 of 39 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are helped to maintain their physical health and personal hygiene, but their specialist care needs are not being met. Evidence: Nightingale House provides accommodation and care for people with alcohol related conditions such as Wernicke Korsakoffs disease and alcohol related brain disorders. The home does not provide nursing care, detoxification treatments and therapies or any other rehabilitative therapies or counselling. Although short term care can be provided, most of the people who live at Nightingale House are unlikely to be able to return to independent living and require long term care. The people who were seen during the site visit were clean and well dressed, which tells us that the staff are helping them to maintain a good standard of personal hygiene. Records were seen that told us that the physical health of the residents is monitored and that people have access to their GPs, dentists, opticians and district nurses as and when necessary. People who need to attend hospital appointments will be Care Homes for Adults (18-65 years) Page 18 of 39 Evidence: provided with transport and a staff escort to enable them to keep their appointments. The Statement of Purpose and Service Users Guide acknowledge that people who have Korsakoffs syndrome and other alcohol related conditions need a specialist service to ensure that their holistic needs are met. The service is clearly meeting peoples physical needs by ensuring that they eat regularly, that they do not have access to alcohol and that they have warmth and shelter. However, we saw no evidence of specialist training or evidence that the management and staff had the knowledge and expertise to enable them to meet peoples emotional, psychological, intellectual, occupational or spiritual needs. People who come into the home must hand any prescribed medicines they have to the staff. There was no evidence of any individual risk assessments to show that the home had considered why people could not hold their own medicines or to have some involvement in the management of their medications. We saw no evidence of any plans to support people towards self medication. Medicines are stored in a locked cupboard in the staff office and suitable facilities are provided for the safe storage of controlled medicines. Staff training records told us that the staff who handle medicines for the residents have received training to enable them to do so safely. We looked at some of the medication administration record sheets and found them to be clearly recorded and up to date. We did note that the records of prescribed medicines in peoples individual plan of care had not been updated as part of the review process. Care Homes for Adults (18-65 years) Page 19 of 39 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples right to make complaints and to raise concerns about their care are not respected. Evidence: The home has a complaints procedure and this is displayed in the entrance hall. Each of the residents has been given a Service Users Guide and this contains a summary of the complaints procedure. The summary tells people that they can make a complaint directly to the Care Quality Commission but does not provide them with the current address and phone number to do so. No information is provided in the Service Users Guide to enable people to contact the Department of Social Services or Care Trust responsible for their placement at the home, who may also receive complaints. The ability of people to make a complaint externally may also be limited by their personal abilities and so may require assistance from the staff. We also noted that some people have only annual input from their Social Workers. During the site visit we met and spoke with several people who live at Nightingale House. As on previous visits, some people told us that they were satisfied with the way the service was provided but others were not. The dissatisfaction was largely focussed on boredom caused by the lack of things that they could do within their home environment. We asked the registered manager to show us the record of complaints that had been Care Homes for Adults (18-65 years) Page 20 of 39 Evidence: made in the past twelve months and she said that no complaints had been received. The AQAA told us that one complaint had been received which had been dealt with and upheld. Policies and procedures are in place to protect the residents from abuse and the staff have received training in the Protection of Vulnerable Adults. The AQAA acknowledges the need to access training on the Mental Capacity Act 2005. Care Homes for Adults (18-65 years) Page 21 of 39 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home is reasonably well maintained, the way that the premises are used does not provide the people who live there with an environment that enables them to lead active lives. Evidence: The registration for Nightingale House includes Porch House which is a separate self contained house providing single en-suite bedrooms, a lounge and a kitchen for three people. The people who live at Porch House were in Porch House at the time of the site visit but this is not always the case as the staff rota suggests that Porch House is not generally staffed during the day. The providers and manager told us that staff are available to enable people to use Porch House during the day. The communal rooms at Nightingale House consist of a large lounge, a dining room and a smoking room. There is no games room, although some of the people who use the service have told us and the management, on several occasions, that they would like somewhere to play snooker or pool and darts. The residents bedrooms are on the ground and first floor. All of the bedrooms are single rooms. Some of the bedrooms we saw during the site visit had been personalised by their occupants. The bedrooms we saw were adequately furnished and Care Homes for Adults (18-65 years) Page 22 of 39 Evidence: decorated. Each of the bedrooms has been fitted with a lock to enable people to lock their bedroom doors from the inside but the Statement of Purpose tells us that it is a policy of the home not to give people keys to their bedrooms so that they can lock their bedroom doors from the outside when they leave their rooms. We asked the registered manager why people could not be issued with keys and no explanation for this policy was given. The laundry facilities are located through the staff lounge. The kitchen is adequate for the preparation of meals but the residents are not encouraged to go into the kitchen and assist with meal preparation and, at the time of the inspection, did not have any facilities outside the kitchen to enable them to make themselves hot drinks and snacks. There are two offices on the ground floor, one is used by the registered manager and the other by the staff. The second floor of the home provides office space for the responsible individual and the care support liaison officer. The front door has an electronic key pad on it to prevent people leaving the home as and when they choose to do so. People must ask the staff to open the door for them if they want to go out. There is limited off road parking to the front of the house. Nightingale House has a well landscaped garden to the back of the house. This is enclosed with high fencing and a gate provides access to Porch House. There is a greenhouse and a large workshop in the garden, both of which could be used to provide occupational facilities for the residents. However, the greenhouse is presently used for storage. One of the support workers is also responsible for maintenance work and he had been busy redecorating the lounge, the dining room and some of the bedrooms since the last inspection. We asked if any of the residents had been invited to assist with this work as it could help them to be involved in maintaining their home but were told that they had not. Care Homes for Adults (18-65 years) Page 23 of 39 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Insufficient care staffing levels and a lack of specialist training prevent the service from meeting their stated aims and objectives and the individual wishes and needs of the people who use the service. Evidence: The registered manager told us that since the last key inspection two new members of staff had been appointed. We looked at their recruitment records and saw that application forms had been completed and CRB checks had been carried out. We saw two references on one of the files, but only one on the other. The registered manager confirmed that she had not requested a second reference. We asked for and were given a copy of the staff rota for week ending 17th January 2010. This told us that although there was some fluctuation in the number of staff on duty at any given time, most of the day and evening shifts were covered by a senior care worker and one or two care workers. Given that the AQAA tells us that there are currently twenty-five people living at Nightingale House and Porch House we do not consider that current daytime and evening care staffing levels to be high enough to provide the type of service that the Statement of Purpose tells us that the home aims to provide. We discussed this with the Registered Manager who told us that she felt that the staffing levels were generous. The rota also told us that a housekeeper was Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: employed on Monday for 3 hours, on Tuesday for 2 hours and on Thursday and Friday for 4 hours. This means that the care staff were required to carry out some housekeeping duties in addition to their care work on at least three days a week. The rota told us, and the registered manager confirmed, that there are two members of staff on waking night duty at Nightingale House and one person on sleeping in duty at Porch House throughout the night. However, the rota also told us that two of the people who covered the waking night shift at Nightingale House also covered day shifts either before or after their waking night duty. For example, one senior care worker appears to have covered a day shift and a waking night shift on four out of seven days. Another appears to have worked without a break for twenty-four hours. The Statement of Purpose tells us that Nightingale House specialises in providing care for people suffering from Korsakoffs Syndrome and Alcohol Related Brain Disease. We saw evidence that staff training has been provided in health and safety related topics, including First Aid, Manual Handling, Fire Safety, Food Hygiene, Health and Safety and Infection Control. We did not see any evidence that service specific training had been provided for the manager or staff to enable them to provide a specialist service. Although it is acknowledged that specialised training opportunities may be difficult to access locally, the AQAA tells us that there are plans to improve staff training within the next twelve months by finding a suitable training course on Person Centred Planning, providing further training on Adult Protection and providing training on Equality and Diversity. The Statement of Purpose tells us that all members of staff have a National Vocational Qualification in Care at Level 2 but the AQAA tells us that only seven out of a total of nineteen care staff have achieved a National Vocational Qualification in Care at Level 2 or above. Care Homes for Adults (18-65 years) Page 25 of 39 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The stated aims and key values of the service are being undermined by institutional practices and poor management. This means that the people who use the service are not receiving a service that understands and can meet their individual needs. Evidence: The registered manager is Wendy Apps. The AQAA tells us that Mrs Apps has over ten years experience in providing care for people with Korsakoffs Syndrome and that she has gained her Registered Managers Award and a National Vocational Qualification in Care at Level 4. Mrs Apps is responsible for the day to day running of the home and she manages the senior care staff, care staff and ancillary staff. Although Mrs Apps has undertaken periodic training while managing the home, she was unable to demonstrate that she understood key values that the service providers tell us in their Statement of Purpose that the home is aiming to promote. These values are Autonomy, Attainment, Citizenship, Individuality, Diversity, Well-being and Inclusion and we saw no evidence that these values are being applied in practice. Care Homes for Adults (18-65 years) Page 26 of 39 Evidence: KorCare Limited is the registered service provider and it is their responsibility to oversee the management of the home and to ensure that their registered manager has the support and training she needs. The home has used surveys to gain feedback about the service from the people who use the service and their relatives and friends. We have been given copies of some of the completed surveys, but no information about how this information is being used to develop the service. We have also been given a copy of a the minutes of a senior management meeting and notes from a clients meeting. These documents show us that the service providers are aware of the need to carry out quality monitoring and to produce annual development plans but they do not provide any evidence about how the home is using feedback from the people who use the service and their representatives to review and develop the service provided. Since the inspection the providers have developed a spreadsheet that plots action planned. This is the beginning of a quality monitoring process. The AQAA tells us that all of the policies, procedures and codes of practice that are required and recommended to be kept at the home are kept at the home and have been reviewed within the last year. The AQAA also tells us that the premises electrical circuits, portable electrical equipment, hoists, fire detection and alarm equipment, emergency lighting, heating system and gas appliances have all been serviced within the past year. Care Homes for Adults (18-65 years) Page 27 of 39 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 1 5 Further amendments must 04/09/2009 be made to the Service Users Guide to ensure that all of the required information is included. To meet this standard it will also be necessary to include the recommended information. This is to ensure that current and prospective residents have access to full and accurate information about the service provided. 2 1 4 Further amendments must 04/09/2009 be made to the Statement of Purpose to ensure that all of the required information is included. To meet this standard it will also be necessary to include the recommended information. This is to ensure that current and prospective residents have access to full and accurate information about the service provided. Care Homes for Adults (18-65 years) Page 28 of 39 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 3 6 12 Care plans and reviews must 04/09/2009 demonstrate that the individual needs, wishes and aspirations of the people using the service are taken into account and provide clear guidance to the staff on how to meet each of the residents individual needs. Previous timescale for compliance 04/02/09 not met. 4 7 12 The people who use the service must be offered choice and be able to make decisions about their lives. Their privacy and dignity must at all times be respected. Individual personal risk assessments must deal with access to and from the building, mealtime choices and all regimes that are restrictive. Previous timescale for compliance 08/01/09 not met. 04/09/2009 5 9 12 & 13 The registered persons must 04/09/2009 demonstrate through individual personal risk assessments that any restraints or restrictions placed upon the residents are justified on the grounds Page 29 of 39 Care Homes for Adults (18-65 years) 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 of safety and well being of the individual. Previous timescale for compliance 08/01/09 not met. 6 13 18 Adequate staffing levels must 04/09/2009 be maintained to enable the residents to become a part of the community and engage in community activities. Evidence of this should be provided on the staff rota. Previous timescale for compliance 04/02/09 not met. The registered persons must 04/07/2009 ensure that the residents have access to a telephone that they can use to make and receive calls at any time. Unreasonable restrictions should not be placed on the ability of residents to receive visitors. Previous timescale for compliance 08/01/09 not met. 7 15 16 & 4 8 16 13 The registered persons must 04/07/2009 ensure that the home operates in a way that enables the people who use the service to exercise their rights and retain control over their lives. Care Homes for Adults (18-65 years) Page 30 of 39 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 Previous timescale for compliance 08/01/09 not met. 9 17 16 Safe facilities must be provided to enable the residents to make themselves snacks and hot drinks, if and when they choose to do so. Previous timescale for compliance 04/02/09 not met. 04/07/2009 10 33 18 The registered persons must 04/07/2009 ensure that enough care staff are employed to meet social, occupational and recreational needs of the people who use the service as well as their personal care needs. Previous timescale for compliance 04/02/09 not met. 11 39 24 The registered providers 04/08/2009 must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the home. This quality monitoring system must include consultation with the people who use the service and their representatives. Care Homes for Adults (18-65 years) Page 31 of 39 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 Previous timescale for compliance 08/01/09 not met. Care Homes for Adults (18-65 years) Page 32 of 39 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 The registered persons must 28/06/2010 make available to the people who use the service a copy of the contract that has been agreed for them by the sponsoring authority and the home. This is to ensure that the people using the service know what to expect from the home and the service provided. 2 1 4 The registered persons must 28/06/2010 ensure that the Statement of Purpose provides accurate information about the service privided. This is to enable people considering moving into the home and their representatives to make an informed decision about whether or not the service will meet their individual wishes and needs. Care Homes for Adults (18-65 years) Page 33 of 39 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 3 6 12 The registered persons must 28/06/2010 demonstrate that the individual needs, wishes and aspirations of the people using the service are taken into account and provide clear guidance to the staff on how to meet each of the residents individual needs. This is to help the staff to provide care that is person centred rather than service led. 4 7 12 The people who use the service must be offered choice and be able to make decisions about their lives. Their privacy and dignity must be respected at all times. This is to help the service become person centred rather than service led. 28/06/2010 5 9 13 The registered persons must 28/06/2010 demonstrate through individual personal risk assessments that any restraints or restrictions placed upon the residents are justified on the grounds of safety and the well being of the individual. Care Homes for Adults (18-65 years) Page 34 of 39 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 This is to help the service to become person centred rather than service led. 6 16 13 The registered persons must 28/06/2010 ensure that the home operates in a way that enables the people who use the service to exercise their rights and retain control of their lives. This is to enable the service to become person centred rather than service led. 7 17 16 The registered persons must 28/06/2010 provide safe facilities for the residents to make themselves hot drinks and snacks, if and when they choose to do so. This is to enable the service to become person centred rather than service led. 8 22 22 The registered persons must 26/06/2010 update the address and telephone number of the Care Quality Commission in the complaints procedure. People must also be given contact details for the council or health care body with full or partial funding responsibilities. This is to provide people Care Homes for Adults (18-65 years) Page 35 of 39 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 with the information they need to make complaints to someone outside the home if they choose to do so. 9 33 12 The registered persons must 26/06/2010 ensure that enough care staff are employed to provide a service that meets their stated aims and objectives. This is to enable the wishes and needs of the residents to be met. The registered persons must 26/06/2010 obtain two written references before appointing a new member of staff to work at the home. This is to ensure that safe practices are used to recruit new staff members. The registered persons must 26/06/2010 ensure that the staff have the training and skills they need to understand the aims of the service and to meet the specialist needs of the people who use the service. This is to break down institutional barriers and provide a service that meets peoples needs. The registered persons must 26/06/2010 ensure that the registered 10 34 19 11 35 18 12 37 9 Care Homes for Adults (18-65 years) Page 36 of 39 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 manager has the training and support she needs to gain the skills that she needs to manage Nightingale House in a way that promotes the stated aims and key values described in the Statement of Purpose. This is to reduce institutional practice and develop a services that is demonstratively based on the individual wishes and needs of people who live at Nightingale House and Porch House. 13 39 24 The registered persons must 26/06/2010 establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the home. Reviews must involve consultation with the people who use the service and their representatives. This should enable the people who use the service to influence improvements in the quality of care that is provided for them. Care Homes for Adults (18-65 years) Page 37 of 39 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 8 11 People should be encouraged to participate in all aspects of life in their home. People should be helped and encouraged by the staff to maintain and develop their independent living skills by participating in general household activities. People should be assessed to determine their ability and support needs to able them to go out either alone or with staff support as and when they choose to do so. Enable people to use the garden, greenhouse and workshop as occupational facilities. The people who live at Porch House should not have to spend time at Nightingale House unless they choose to do so. 3 12 4 5 24 28 Care Homes for Adults (18-65 years) Page 38 of 39 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). 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