Care Home: Nightingale House (Strafford Road)

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What the care home does well Provides a homely and supportive environment in which residents feel relaxed and well cared for. Provides good quality care from staff that know residents needs well. Seeks the input of healthcare professionals in residents` care when necessary. Provides a varied menu that residents enjoy and involves residents in choosing the menu. What has improved since the last inspection? The home now provides an excellent range of in house activities and opportunities for residents to go out. The service is more responsive to individual needs. The support available to staff has improved. Team meetings are more regular and all staff have one-to-one supervision. The training opportunities available to staff have increased. A new nurse call system has been installed. The system records all response times which means that the manager can audit the response to call bells. What the care home could do better: Ensure that information about residents` medication is accurate so that all medication is administered safely. Fit a window restrictor in the first floor bathroom. Repair the window in the second floor bathroom. Key inspection report Care homes for older people Name: Address: Nightingale House (Strafford Road) 10 Strafford Road Twickenham Middlesex TW1 3AE     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Simon Smith     Date: 0 1 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Nightingale House (Strafford Road) 10 Strafford Road Twickenham Middlesex TW1 3AE 02088921854 02088915541 v.nayar@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Sushma Nayar,Mr Vipin Nayar care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Condition of registration of categories of care The Commission has a list of the service users who have dementia or mental health needs. A condition of registration of the categories of care, is that the number of places for dementia and mental health needs are for the existing service users only and the home is not to admit any new service users with these conditions unless another variation is submitted for consideration. Date of last inspection Brief description of the care home Nightingale House has been registered as a care home since 1976 and was purchased by the present owners in 1998. The home provides accommodation for a maximum of 21 older people in single and shared rooms. The property is situated in a quiet residential area and is within walking distance of Twickenham town centre, which provides a range of shops, pubs, restaurants and Care Homes for Older People Page 4 of 24 Over 65 9 1 21 0 0 0 Brief description of the care home community resources. The River Thames and open spaces are within easy reach and there is good access to access to public transport. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three stars. This means the people who use this service experience excellent quality outcomes. We used information from a range of sources when making this judgement about the home. This included visiting the home unannounced on 1 July 2009 and speaking to people who live there, the owner and the Operations Manager. We checked some written records including residents files and health and safety checks. We also took into account any information the home had sent us since the last inspection. This included notifications of any accidents, incidents, complaints or safeguarding alerts. The manager filled in a Quality Assurance Assessment (AQAA) which gave us information about the home in the last year. We made surveys available to residents, their relatives and staff. Surveys were Care Homes for Older People Page 6 of 24 returned by five residents, 15 relatives and nine staff. The feedback provided by surveys was very positive in every case. Residents said they enjoy living at the home and that staff provide good care. Residents also said they appreciate the opportunities they have to go out and that they enjoy the events and activities that take place at the home. Relatives said that the home provides a warm and friendly environment and highlighted the quality of care and the food as particularly good. Staff said that they have access to regular training and have good support from the Operations Manager. The work put in by the Operations Manager to improve the service since the last inspection should be highlighted. Since his arrival residents have more opportunities to take part in activities and to go out to places of interest. In addition the Operations Manager has improved the support available to staff and the way in which the staff group communicate and share important information about residents care. Some of the comments made by residents relatives and staff are included below: Residents said: The home is very well kept clean and tidy and has excellent carers. The manager is a very kind and thoughtful man and takes us out to local historical places. The food is delicious and varied. All aspects of the home are very good. We are taken out on a Monday for refreshments - very nice. Relatives said: Nightingale House provides genuine, kind, dedicated care. All the staff and management work so hard to make our loved ones happy and comfortable. Nightingale House creates a loving family environment for all the residents there. The staff treat the residents like members of their own family and provide love and support to them. Very good in all aspects of care. It has a very caring attitude and adapts well to individual requirements. Very good care, excellent food. Nightingale House provides a caring supportive friendly environment. The manager is a very caring and kind gentleman always trying to do his best. The food and staff are both wonderful. Nightingale House is very homely and caring. It provides many activities and has a sense of family. Staff are amazing. The additional involvement of volunteers is such an important benefit for the residents in helping to widen their interests. Nightingale House provides compassionate care for my mother and a genuine caring attitude towards residents and their wellbeing. Staff said: They provide training we can attend that helps us perform our duties effectively. We have regular supervision that helps us improve the quality of care we give. The home manager gives us support and excellent training. The home provides training on new equipment and techniques. The home caters for all residents individually. Activities have improved a lot under the new manager. The carers are provided with training and supervision that can improve the care delivered to clients. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 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. Residents rights are set out in a written agreement. The home only admits people whose needs it can meet. Evidence: Residents have a written agreement which outlines their rights and the terms and conditions of their accommodation at the home. The home carries out comprehensive assessments to establish prospective residents needs before they move in. Where people are placed by a local authority a care manager from the placing authority also carries out an assessment. There was evidence that the home does not admit residents whose needs it cannot meet, for example those with advanced dementia. The inspection also provided evidence that people are supported to move on if their needs change to such an extent that the home can no longer meet these needs. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive good care and see healthcare professionals when they need to. Care practices at the home promote and maintain residents privacy and dignity. The home must ensure that information about residents medication is accurate so that all medication is administered safely. Evidence: Each resident has a written care and support plan. The plans we checked contained good information about residents needs and their preferences in terms of how their care is delivered. We found that care plans are reviewed monthly to identify any changes in need. Care plans also contained risk assessments to identify risks to residents from falls pressure sores or moving and handling. There was evidence that the home consults healthcare professionals about residents care when necessary. For example one residents care plan demonstrated that a district nurse visits regularly to change dressings whilst another care plan recorded Care Homes for Older People Page 11 of 24 Evidence: visits from the district nurse to treat and monitor a pressure ulcer. Correspondence on residents care plans provided evidence that residents see healthcare professionals such as podiatrists, neurologists and dermatologists when they need to. Staff deliver care in a manner that maintains residents privacy and dignity. Residents are able to see healthcare professionals and other visitors in private. The home has secure lockable storage for medication and uses a monitored dosage system for administration, which is supplied by Boots. Boots also supplies training for staff in medication administration. The manager said that he assesses staff competency in administering medication every two months and carries out regular spot checks on medication records. We checked medication administration records for six residents. There were some inconsistencies in the written information about three residents medication. The medication profiles stated that the residents had no known allergies to medication but the administration records recorded that the residents were allergic to some medication. It was also noted that there were no times specified for the administration of some medication. These issues should be addressed by the home to ensure that medication is administered safely. Care Homes for Older People Page 12 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides an excellent range of activities which residents really enjoy. Friends and relatives are made to feel welcome when they visit. Residents enjoy the food provided by the home and are consulted about the menu. Evidence: The range of activities that the home provides has increased greatly since the last inspection. Residents now have opportunities to go out regularly and visit local shops and pubs as well as places of interest. As well as trips out, events in the home have been organised such as tea parties and visits by singers and entertainers. Volunteers augment the programme of activities and local school pupils regularly spend time reading newspapers and books with residents. Many of the comments made by residents in surveys and during the inspection told us how much they value the opportunities they now have to go out and to enjoy activities at the home. Relatives said that staff are welcoming when they visit and find time to speak to them about their family members well being. Care Homes for Older People Page 13 of 24 Evidence: The cook has worked at the home for three years and has got to know residents likes and dislikes. The part time cook who covers the full time cooks days off has also worked at the home for some time. Residents are asked what they would like to see on the menu and can have alternatives to the published menu if they wish. The inspector ate a meal with residents and observed that lunch was a relaxed occasion during which staff were attentive and provided good support to residents when they needed it. The food served was enjoyed by the residents, some of whom chose to eat in the homes small lounge. Care Homes for Older People Page 14 of 24 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. There is a clear complaints procedure and residents know how to complain if they are unhappy about something. The home works with local authorities in investigating safeguarding alerts where necessary. Staff are trained to recognise and report abuse. Evidence: There is a written Complaints procedure which is readily available in the home and all complaints are recorded. Residents surveys said that they knew how to complain if they were unhappy about something. There have been no complaints since the last inspection. There had been one referral to the local authority safeguarding team since the last inspection. The manager of the home attended meetings with the local authority and assisted their investigation. The summary of the investigation identified improvements that the home could make in care practice. These improvements have now been implemented by the home. There was evidence that staff attend training in the protection of vulnerable adults (POVA). Care Homes for Older People Page 15 of 24 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 location of the home means that residents have easy access to local community facilities. The house is clean, homely and well decorated. Residents can personalise their rooms as they wish. Evidence: The home occupies a corner plot on a quiet residential street close to Twickenham town centre. There are gardens to the side and rear and two off street parking spaces. The home is well decorated, warm and comfortable. The home has a large lounge and separate dining room. Residents accommodation is arranged over three floors. Most bedrooms have en suite bathroom facilities. There are also communal bathrooms on each floor of the home. Residents are able to personalise their rooms and the bedrooms seen during the inspection reflected individual tastes and preferences. Residents surveys said that the home is kept clean and tidy. The window in the first floor bathroom must have a restrictor fitted. The window in the second floor bathroom window needed repair. Some radiators in the home are not Care Homes for Older People Page 16 of 24 Evidence: covered. This issue has been discussed with the owner, who was able to demonstrate that the decision not to cover the radiators has been taken following appropriate risk assessments. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by people they know and who understand their needs well. The home carries out appropriate checks on staff when they start work. Staff have access to good training opportunities and regular one-to-one supervision. Evidence: The Operations Manager said that the home was fully staffed at the time of inspection and that the turnover of staff at the home was low. This means that residents are cared for by people they know and who understand their needs well. The Operations Manager has improved the support available to staff and the sharing of information amongst the team. A meeting for all staff is held once a month and senior staff (the Operations Manager, deputy manager and two senior support workers) meet weekly. The Operations Manager said that all staff have achieved a minimum of NVQ level 2 and that more than half have achieved NVQ level 3. The home has an agreement with a training provider to deliver all aspects of core training and the home is able to access local authority training without charge. Care Homes for Older People Page 18 of 24 Evidence: We checked three staff files during the inspection. All contained two references and two had Criminal Records Bureau disclosures. One did not but the home had carried out a POVA First check and made sure that the member of staff did not work unsupervised until the disclosure was obtained. All staff now have a contract and job description. Staff said that they have access to good training opportunities and that the Operations Manager gives them regular supervision and good support. The Operations Manager introduced an appraisal system in 2008 although not all staff have yet had an appraisal. There was evidence that new staff have a comprehensive induction with the Operations Manager which is based on the induction standards set by the Skills for Care organisation. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Operations Manager has introduced measures that have resulted in real benefits for residents. There is a commitment to seeking residents opinions about the home and the service they receive. Checks are carried out regularly to maintain residents health and safety. Evidence: The Operations Manager has been in post since September 2007. He has appropriate qualifications for his role including a post graduate certificate in managing care. The Operations Manager works alongside the homes owner who is the registered manager of the service. The Operations Manager has worked hard since his arrival to improve the service the home provides and this has resulted in real benefits for residents. These benefits are Care Homes for Older People Page 20 of 24 Evidence: reflected in the positive comments made by residents and their relatives in surveys and during the inspection. In addition the Operations Manager has improved the support available to staff and the way in which the staff group communicate and share important information about residents care. The Operations Manager is committed to seeking residents opinions about the home and the service they receive. Residents meetings are held monthly and the Operations Manager gave several examples of events that had been introduced following residents suggestions. Some residents choose to deposit small amounts of money with the home for safekeeping. There was evidence that the home keeps appropriate records of income and expenditure and receipts of all transactions. Access to residents monies is restricted to the Operations Manager. The home has an appropriate fire alarm system. There was evidence that the fire alarm, emergency lighting system and fire fighting equipment were serviced by an engineer in March 2009. The last fire drill was held in June 2009. There was evidence that lifting equipment is checked regularly. Electrical appliances were checked for safety in September 2008. The Landlords Gas Safety record was issued in September 2008. The five year electrical installation report was issued in January 2008. The home had appropriate employers liability insurance at the time of inspection. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 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 9 13 Ensure that information about residents medication is accurate. Repair the window in the second floor bathroom. 30/09/2009 2 19 23 30/09/2009 3 19 23 Fit a window restrictor in the 30/09/2009 first floor bathroom. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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