Care Home: Nightingale House

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What the care home does well There is detailed information including the most recent Care Quality Commission inspection reports made available to help people decide if the home will be suitable for them. Before a person is offered a place in the home or moves in the manager carries out an assessment of the individuals health, personal and social care needs. They review the medical needs of each person to make sure that the home will be able to accommodate these and they ensure that appropriate equipment such as air beds are available before the person moves in. Each person has a care plan, which describes their health, personal care and social needs. Care plans include information, where available as to how people would like to be cared for and any preferences for male or female staff when attending to personal care. Staff act promptly and ensure that residents see their doctor should they become unwell. There are planned activities for residents to help keep them occupied and stimulated. Residents receive meals, which they generally enjoy and there are alternatives available. The home is generally well manged and people are consulted with and asked for their views as to how things could be improved. What has improved since the last inspection? The way in which information is recorded about the assessed needs of residents and the way in which staff are to support and care for them has improved. Care plans are clear and easy to follow and residents are well cared for. A new activities co - ordinator has been employed in the home. This person arranges a plan of activities to help keep residents occupied and stimulated and to provide opportunities for socialising and relaxation. There have been improvements made to the home`s environment. New carpets have been provided in communal areas such as lounges, and resident`s bedrooms. Old bedroom furniture and hand basins have been replaced and bedrooms have been redecorated so that they are clean and bright. What the care home could do better: When there are identified risks to the health, safety or welfare of residents such as risks of falls or injury, how these risks are to be minimised is not always clear. Where risks are increased, the way in which staff are to support the person to help minimise risks and prevent injury is not always clear. Staff do not always ensure that residents receive the medicines that they need according to how it has been prescribed. Some residents are not always made aware of the choices they have such as choice of meals from the menu. All of the checks to ensure that only suitable staff are employed in the home, such as references from previous employers and checking employment history are not consistently carried out. Staffing levels are not always appropriate to the needs of residents especially when monitoring and helping to minimise risks of falls. The home is generally well managed however the manager and proprietor must address the concerns and issues raised in the inspection, which affect the welfare of people living in the home. Key inspection report Care homes for older people Name: Address: Nightingale House 69-71 Crowstone Road Westcliff On Sea Essex SS0 8BG     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: Carolyn Delaney     Date: 1 0 0 5 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 Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 Older People Page 3 of 32 Information about the care home Name of care home: Address: Nightingale House 69-71 Crowstone Road Westcliff On Sea Essex SS0 8BG 01702338552 01702331788 xassist@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Abi Oduyelu Name of registered manager (if applicable) Mrs Anita Mary Veronica Martin Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: One named person known to the CSCI who is under 65 years of age. Personal care may be provided for up to 30 people over the age of 65. Personal care may be provided for up to 30 service users with dementia over the age of 65. The number of service users for whom personal care is to be provided should not exceed 30 (total number not to exceed 30). Date of last inspection Brief description of the care home Nightingale House is registered to care for both older people over the age of 65 and those over 65 who may have dementia. At the current time the home is primarily caring for people with dementia. The home is situated near Southend seafront. It is Care Homes for Older People Page 4 of 32 Over 65 30 30 0 0 0 1 0 5 2 0 0 9 Brief description of the care home close to the shops and local bus routes. The home has a small car park to the front and a garden at the rear. The fees are £438.88 to £500.00. Additional charges would be made for hairdressing, chiropody and taxis etc. The home has information available for prospective residents. A copy of the latest inspection report is readily available in the reception area. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a routine unannounced inspection, which included a visit made to the home which lasted 8 hours. The last inspection was carried out on 30th April 2009. As part of the inspection process we reviewed information we had received about the service over the last twelve months including notifications sent to us by the manager of any event in the home, which affects residents such as injuries, deaths and any outbreak of infectious diseases. We also looked at the information the manager provided us with in the homes Annual Quality Assurance Assessment. This document is a self-assessment, which the registered provider or owner is required by law to complete and tell us what they feel they do well, how they evidence this and the improvements made within the previous twelve months. We also looked at the improvement plan that we asked the manager to send us following the last inspection. This plan described how the manager was to address the issues as identified at the last inspection. Care Homes for Older People Page 6 of 32 We sent surveys each to the home to distribute to residents and staff and to complete and tell us what they think about the home. At the time of writing this report we had received surveys from eight residents living in the home and seven members of staff who work there. During the inspection we spoke with five residents, four relatives, two visiting health care professional and three members of staff. The views and comments expressed by these people were reflected in the report. When we visited the home we looked at information that was available to people to help them decide if the home would be suitable for them. We looked at how the needs of people were assessed before they moved into the home. We looked at residents care plans and information available to staff to help them support residents. We looked at how staff were recruited to work in the home and how they were trained to support residents. We looked at how the home was managed and how residents were involved in this. We also observed how staff interacted with residents when supporting them with activities such as meals and providing recreation and stimulation. A brief tour of the premises was carried out and communal areas including lounge and bathrooms were viewed. Information obtained was triangulated and reviewed against the Commissions Key Lines for Regulatory Activity. This helps us to use the information to make judgements about outcomes for people who use social care services in a consistent and fair way. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: When there are identified risks to the health, safety or welfare of residents such as risks of falls or injury, how these risks are to be minimised is not always clear. Where risks are increased, the way in which staff are to support the person to help minimise risks and prevent injury is not always clear. Staff do not always ensure that residents receive the medicines that they need according to how it has been prescribed. Some residents are not always made aware of the choices they have such as choice of meals from the menu. All of the checks to ensure that only suitable staff are employed in the home, such as Care Homes for Older People Page 8 of 32 references from previous employers and checking employment history are not consistently carried out. Staffing levels are not always appropriate to the needs of residents especially when monitoring and helping to minimise risks of falls. The home is generally well managed however the manager and proprietor must address the concerns and issues raised in the inspection, which affect the welfare of people living in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that the home will meet their needs because they are given information about the services provided and their individual needs are assessed and planned for. Evidence: The manager told us in the Annual Quality Assurance Assessment that they ensured that relevant, accurate and up-to-date information about the home was made available to people who were looking for a care home. They told us that the information was reviewed periodically as needed and that copies of the most recent Care Quality Commissions inspection reports were also available so as to help people decide if the home was right for them. The manager told us that the needs of people were assessed before they were offered a place in the home. They said that people were only admitted when a decision had been made that the home could adequately meet each persons assessed needs. Care Homes for Older People Page 11 of 32 Evidence: Before we visited the home we received surveys from eight people living in the home. Of the eight, seven told us that that they had received enough information about the home to help them decide if it was the right place for them. They also told us that they they had been given written information about the homes terms and conditions (contract). When we visited we saw that there was detailed information about the home available to residents, families and health and social care professionals in the statement of purpose and service users guide. This information had been recently reviewed. There were also copies of the last inspection report available. We spoke with the relatives of three people living in the home and they confirmed that they had been given information and the opportunity to visit the home before their loved ones moved in. One person told us We were given information about the home but we did not visit as this was arranged by social services. We spoke with three residents who had recently moved into the home, however they were unable to tell us about their experiences of moving into the home as they did not remember. We looked at how the needs of people were assessed before they were offered a place in the home. We looked at the assessments carried out for two residents. We saw that the manager had visited both people either in their home or hospital to complete the assessment. There was information recorded for both people around their health, personal and social care needs. The assessment covered activities of daily living including personal care, mobility, eating and drinking, sleeping, socialising and communicating. There was information recorded about both individuals health care needs and how these impacted on their ability to carry out daily activities. We saw that the manager reviewed information gathered and based upon this made the decision that the home would be able to accommodate residents and meet their assessed needs. The manager told us that where a person required specialist equipment such as pressure relieving mattresses to help prevent pressure sores, that this was always sourced before the person moved into the home. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are well cared for, however they are not always supported according to their needs or receive medicines as prescribed for them. Evidence: The manager told us in the Annual Quality Assurance Assessment that they ensured that residents health, personal and social care needs were set out in an individual plan of care and that relatives were kept informed of any changes in the health and well being of residents. They told us that care plans included information about each individuals needs and how staff were to support them. Before we visited the home we reviewed information (notifications) we had received from the manager about any incidents which affect the safety, health or welfare of people living in the home such as outbreaks of infectious diseases, injuries and deaths. We saw that the manager informed us of any incident in a timely manner. Seven of the eight residents who completed surveys told us that they always received the care and medical support that they needed. One person said that they usually did. Care Homes for Older People Page 13 of 32 Evidence: One resident told us Staff look after me well I am happy here. Another person said Staff look after residents and keep them clean and tidy. Other residents and relatives told us that The care was very good. One visiting doctor we spoke with during our visit told us The manager is very good and there are no issues with my patients. When we visited the home we looked at how the needs of residents and the support they required was recorded. We looked at the care plans for four people. We saw that improvements had been made in how information was recorded and that some care plans reflected the individual needs of people, including each persons capabilities so as to help them to remain as independent as possible. However where there were changes to the need or health of some individuals care plans had not been reviewed and amended to reflect these changes. For example where on resident had sustained a number of injuries through falls, their care plan had not been updated so as to show how staff were to support the individual to minimise risks of injuries. Two residents who completed surveys and two relatives we spoke with during the inspection commented that they felt there were shortages of staff. One relative commented Sometimes there are no staff around on the first floor to keep an eye on residents and this is a worry as one resident falls a lot . I have been here for 45 minutes and not seen any staff. Each of the seven members of staff who completed surveys told us that they were always given up to date information about the needs of they people they support and cared for. They told us that the ways they shared information with other carers and the manager about the people they cared for always worked well. Staff commented there is good interaction between staff and residents and that staff give residents a high standard of care. The manager told us in the Annual Quality Assurance Assessment that where appropriate residents were supported to administer their medicines and that they were protected by the homes policies and procedures for dealing with medicines. When we last visited the home we identified concerns around the way in which staff dealt with medicines. We saw that staff did not complete records accurately so as to evidence that they had administered medicines to residents as prescribed. We told the manager and proprietor to tell us in an action plan how they were to address these concerns and ensure that residents received the medicines in accordance with their planned treatment. The manager told us in the action plan that staff would receive further training and that checks would be carried out so as to ensure that they followed the homes policies and procedures. Care Homes for Older People Page 14 of 32 Evidence: When we visited the home we looked at the arrangements in place so as to ensure that residents received their medicines appropriately. We saw that staff who were responsible for administering medicines were being given training around the safe handling, recording and disposal of medicines. We saw that each resident had care plan, which indicated whether they could safely keep control of their medicines and staffs responsibilities around this. We looked at the medication administration records for all the residents in the home. We saw that the records for four residents had not been completed accurately on a number of occasions during the two weeks prior to our visit. Staff had not signed to indicate that they had administered medicines. We carried out checks of medicines remaining against the numbers of medicines received into the home and found that in most cases residents had received medicines as prescribed. However records and our checks indicated that one resident had been given the incorrect dose of one of their medicines. It was not possible to determine when during this period these errors occurred. We also saw that a resident had not received a medicine as they had run out and staff had not taken the appropriate action so as to ensure that they had been ordered and received before the weekend. We discussed our concerns with the manager and their failure to ensure that the concerns raised at the last inspection had been addressed appropriately. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are kept occupied and provided with opportunities for relaxation and socialising. Evidence: The manager told us in the Annual Quality Assurance Assessment that they provided a daily and weekly plan of social activities within the home bearing in mind that some elderly residents would want an active, well organised, structured social life while others would want a level of privacy and independence from others. They told us that a member of staff had been employed as an Activities Co-ordinators and were responsible for producing and managing a weekly activities programme. When we last visited the home there was little in the way of arrangements for providing opportunities for occupation and social activities for residents. We told the manager to tell us in an action plan how they were to address this and they told us that they would employ a person to coordinate and plan suitable activities for residents according to their wishes and capabilities. Four of the eight residents who completed surveys told us that there were always activities in the home that they could participate in. Two said that there usually were Care Homes for Older People Page 16 of 32 Evidence: and two said that they didnt know. One relative commented More activities could be provided, I have not seen any during my visits, which is usually twice a week. One member of staff commented that thought that staff could try more to get involved in residents daily activities. They told us that the manager had arranged training around activities for older people and hoped that this would improve things. When we visited the home we looked at the arrangements for keeping residents occupied and enabling them to do the things they wished to during the day. We saw that an activities coordinator had been employed to coordinate and plan activities three days each week. The manager showed us that they had enrolled this person on a course around providing activities for people who have dementia. We saw that a plan for providing activities had been developed and this had been based upon the wishes of residents. The plan included outings, entertainment, board games, quizzes, bingo and ball games. We spoke with three residents and they told us that they could do the things they wished to do. One resident told us I enjoy sitting in the garden and watching football. Another resident told us that they go out each morning with the manager to get a newspaper and that they looked forward to this. During the inspection we saw some of the activities provided for residents. The activities coordinator planned board games and quizzes for groups of residents who expressed a wish to participate. There was also a game of bingo where residents had the opportunity to win prizes. Residents we spoke with told us that they enjoyed the activities. Each of the four relatives we spoke with during the inspection told us that they were always welcomed into the home when they visited. The manager told us in the Annual Quality Assurance Assessment that they ensured that the choice of food was varied and that the food served was balanced, nutritious, appetising and plentiful. They also told us that they ensured that those residents who cannot feed themselves were helped. Six of the eight residents who completed surveys told us that they always enjoyed the meals in the home and two said that they usually did. When we visited the home we looked at the arrangements for providing meals for residents. We saw that there was a planned menu with a choice of meals and a dedicated person was employed to cook. However when we spoke with residents, five of them told us that there was no choice of meals. One person said There are two choices, eat it or leave it. Another person said We used to have a choice but we dont now, and one person said We eat whatever is put in front of us. Care Homes for Older People Page 17 of 32 Evidence: On the day of the inspection we saw that residents were served liver and bacon with potatoes and vegetables. The meal was well presented and looked appetising. There was no evidence that residents had been offered a choice. We discussed this with the manager who told us that staff asked residents which option they wanted from the menu each day and that alternatives were always available. They said that staff would record this but there were no records for this on the day of the inspection. Later one resident told us that following a chat with the manager they now knew that there was a choice of meals available. Three residents told us that they generally enjoyed the meals provided. Two residents told us that the meat was often tough. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are safeguarded from harm and know that their concerns or complaints will be taken seriously. Evidence: The manager told us in the Annual Quality Assurance Assessment that they had in place a complaints policy and procedure, both of which were on display in the home for all. They told us that they also had an Adult Protection Policy in place and that their training records showed that staff were up-to-date with Adult Protection Training. The manager told us that they had received two complaints within the previous twelve months and that these had been investigated in accordance with the homes policy and procedure. Each of the eight residents who completed surveys told us that they knew who to speak informally if they were unhappy and how to make a complaint. When we visited the home we spoke with five residents and four relatives. Each person we spoke with said that they did not have any complaints about the home. Relatives told us that the manager was very approachable and that they felt confident to discuss any concerns with her. We looked at the homes complaints policy and procedure, and while it was detailed and comprehensive many of the people living in the home would not understand its content. We discussed this with the manager and asked if there were any other Care Homes for Older People Page 19 of 32 Evidence: forums or arrangements in place whereby residents could complain. They told us that where a person would not have the capacity to understand the policy that this would be given to their relatives. However this would not enable residents to raise concerns or complain. The manager told us that residents meetings were not held and that there had been a suggestion box in the home, which had recently been removed during decoration of the home. They told us that the box had never been used. However many residents may not have been aware of it and those we spoke with told us that the did not know that there was one in the home. We looked at how complaints received had been dealt with and saw records to indicate that they had been investigated and responded to appropriately. We looked at the arrangements for safeguarding people who live in the home from harm or abuse. We saw that staff had access to the homes policy and procedure and the local safeguarding teams procedure and information and had received training around how to recognise signs of abuse and how to act and report any incidents appropriately. Each of the xxx staff who completed surveys told us that they knew how to act if anyone raised concerns about the home. We looked at how staff were recruited to work in the home and appropriate checks including Criminal Records Bureau disclosures and Independent Safeguarding Authority checks (formally PoVA First) were carried out for all staff before they commenced work at the home. These checks help to ensure that only suitable people are employed in the home to protect interests and welfare of residents. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, safe and comfortable and improvements have been made to the environment so as to improve facilities for residents. Evidence: The manager told us in the Annual Quality Assurance Assessment that they ensured that the physical environment and surroundings in which residents are cared for are well maintained, clean, comfortable, pleasant and safe. They told us that the ambience and physical environment in which elderly people are looked after has been considerably improved over the last 12 months. They told us that they had installed CCTV and alarms external doors so as to promote the safety of people living in the home and alert staff to residents who may wander and attempt to leave the home unsupervised (where this would pose a risk to their safety or wellbeing). The manager told us that they have also made substantial improvement to the physical environment of the home including replacing and upgrading the existing carpets with new carpets and flooring throughout the corridors, lounges and the communal areas and residents bedrooms on both the ground and first floors. Each of the eight residents who completed surveys told us that the home was always fresh and clean as did the majority of people we spoke with on the day of the inspection. Care Homes for Older People Page 21 of 32 Evidence: When we visited the home we carried out a brief tour of the premises and looked at communal areas and six residents bedrooms. We saw that there had been improvements made to the physical environmnent since the last inspection. Old carpets had been replaced with new ones and old broken bedroom furniture such as wardrobes and wash hand basins had been replaced. Communal areas and residents bedrooms had been redecorated to look cleaner and brighter. Communal areas including lounge and conservatory were clean, warm and bright. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are not always recruited robustly and do not always act in accordance with the homes training, policies and procedures to meet the needs of residents appropriately. Evidence: The manager told us in the Annual Quality Assurance Assessment that they ensured that they have a good skill mix and that they had an up-to-date recruitment policy & procedures in place. They told us that they encouraged and provided training facilities and support for staff in all aspects of their care work. They told us that they ensured that staff were deployed in sufficient numbers to undertake the duties in the home and in particular, to support the more dependent residents at meal times. They told us that the manager as well as the proprietor also provide additional pair of hands to support the staff and residents especially at meal times. Four of the eight residents who completed surveys told us that staff were always available when they needed the. Four said that there usually were. One person told us The manager works very well with the staff she has but is very understaffed. Four of the seven members of staff who completed surveys told us that they felt that there were usually enough staff to meet the individual needs of all the people in the home and three told us that they felt there always were. Two relatives we spoke with commented that they did not feel that there were always enough staff available to support residents and one person commented that The manager seems to work very Care Homes for Older People Page 23 of 32 Evidence: hard but there is a marked change when she is not here and things do not always get done, I have found my father in soiled and wet clothing when I visit. When we visited the home we looked at how staff were deployed to work in the home and to support residents. We looked at copies of the staff duty rotas and the manager told us that they staffing levels for the home were four staff during the day and three ant night. They told us that in addition they and the homes owner were available to support when needed. However there were no assessments of residents level of dependencies so as to determine that staffing levels were appropriate. A number of residents were at risk of falling and some residents required assistance of two members of staff when mobilising or carrying out personal care tasks so current staffing levels may not always be appropriate to the needs of residents. Each of the seven members of staff who completed surveys told us that all of the checks including references and Criminal Records Bureau disclosures were carried out before they started work. Five members of staff told us that their induction covered everything they needed to know to do the job when they started. Two said it mostly did. When we visited we looked at how staff were recruited to work in the home. We looked at the recruitment files for two people who had recently started work in the home. We saw that the manager had interviewed both people to help determine that they were suited to work with older people. We saw that references ad been obtained for both individuals, however these were not from previous employers and the manager had not checked both persons employment history for gaps and overlaps so as to explore further and ensure that information was correct. Criminal Records Bureau disclosures and Independent Safeguarding Authority checks had been undertaken for both people before they started work in the home. These checks help to ensure that only people who are suitable to work with vulnerable individuals are employed in the home. Each of the seven members of staff who completed surveys told us that they were being given training, which was relevant to their roles, helped them understand and meet the individual needs of people, kept them up to date with new ways of working and gave them enough knowledge about health care and medication. Staff told us that they were supported by the manager and met with them regularly to discuss how they were working. When we visited the home we looked at how staff were trained and supported to meet the needs of people. We saw that there were some certificates in staff files to evidence Care Homes for Older People Page 24 of 32 Evidence: that they had undertaken training around safe moving and handling of people, safeguarding vulnerable people from harm, infection control and supporting people who have dementia. Records were not well maintained and some certificates were for training that staff had undertaken in 2005 and 2006. There was no evidence that some of these staff had received training updates so as to ensure that they were kept up to date with new ways of working. We discussed this with the manager and she said she would compile a matrix, which evidenced current staff training and send this to us. The manager told us that further training was planned around supporting people who have had a stroke and person centred care for people who have dementia. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the interests of the people who live there however some aspects are not consistently well managed. Evidence: We were told in the Annual Quality Assurance Assessment that the home has a care home manager who is qualified and experienced to run the Home. They told us that the manager is supported by the proprietor and a team of loyal and dedicated staff in the day-to-day running of the Home. They said that they now have three new team leaders who are able to take charge of the home and that it was well run and well managed. Residents, staff, relatives and visiting health professionals we spoke with during the inspection spoke very highly of the manager. One person told us she is very approachable, knowledgeable and professional, another person told us Nightingale House is run to a very high standard and the residents receive excellent care One relative said My father is very happy here which in turn makes my family very happy. Care Homes for Older People Page 26 of 32 Evidence: Anita is a brilliant manager who takes a personal interest in her residents which goes a long way in making them feel at home. One person commented that things were not always done when the manager was not there. When we visited the home we looked at how the views of residents, their families and other relevant people were obtained and acted upon. We saw that residents, relatives and health and social care professionals were asked to complete surveys to tell the manager about their experiences and to highlight any areas for improvement. We saw that the responses in the six surveys we were provided with were very positive. We discussed the issues of concern we had identified around medication and assessing and minimising risks to some people living in the home. Both manager and proprietor told us that they would deal with these issues promptly so as to ensure that people living in the home were cared for and received the treatment and medication they needed. Care Homes for Older People Page 27 of 32 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 9 13(2) Procedures for checking all 30/06/2008 medicines received, administered and disposed of must be reviewed so as to ensure that residents receive medicines which have been prescribed for them and to minimise the risk or errors and mishanding Staff must handle and maintain accurate records in respect of medicines in the home, in accordance with homes policies and current regulatory requirements. This is to ensure that medicines are handled appropriately and the risks of misuse or error are minimised. 30/06/2009 2 9 13 Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be reviewed 30/07/2010 and amended where there are changes to the needs, health or wellbeing of residents. This must be done so as to ensure that care plans reflect the needs of individuals and staff have up to date and accurate information to be able to support residents for their needs. 2 8 13 Risks to the health, safety and wellbeing of residents must be kept under review and amended where necessary. This must be done so as to ensure that the appropriate action is taken according to the level of risks posed and that residents are protected from unnecessary harm. 30/07/2010 Care Homes for Older People Page 29 of 32 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 9 13 Staff must ensure that medicines are handled, administered safely and appropriate records are maintained. This must be done so as to ensure that residents receive the medicines as prescribed for them as part of their care and treatment. 25/06/2010 4 29 19 All of the appropriate checks 30/06/2010 including references from previous employers must be obtained for all staff before they are employed at the home as part of a robust recruitment procedure. This must be done so as to help ensure that only suitable people are employed in the home and the safety and welfare of residents are protected. 5 30 18 Staff must be trained and skilled to meet the assessed needs of the people living in the home. This is to ensure that residents are supported and cared for properly and they receive the treatment and medication they need. 30/07/2010 Care Homes for Older People Page 30 of 32 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 3 15 16 27 Staff should ensure that residents are offered a choice of meals from the planned menu each day. More could be done so as to enable residents to express concerns or to make complaints should they be unhappy. Staffing levels, skills and experience should be reviewed in accordance with the changing needs of people living in the home to ensure that people are supported and cared for appropriately. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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