Care Home: Nightingale Nursing Home

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What the care home does well The home provides a good level of support to those liveing there. People told us that they were well cared for by competent staff. They were encouraged to maintain contact with family and friend, enabling those people living at the home to continue to enjoy relationships that were meaningful to them. What has improved since the last inspection? Since the last inspection the home has reviewed it policies on how complaints would be dealt with and safeguarding vulnerable adults. This meant that people at Nightingale Nursing Home could be sure that any concerns they had would be listened to and acted upon and that staff were trained in protecting people. What the care home could do better: The home needs to continue to improve the care documentation for each resident so that staff have all the information they need to be able to deliver care appropriately. Although the home has recently purchased a new quality assurance monitoring tool it needs to implement it fully so that people using this service could be sure that it was run in their best interest. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Nightingale Nursing Home 2 Roslin Road Talbot Woods Bournemouth Dorset BH3 7JA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Amanda Porter     Date: 2 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 23 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Nightingale Nursing Home 2 Roslin Road Talbot Woods Bournemouth Dorset BH3 7JA 01202520120 01202520120 admin@nightingalecare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Nightingale (Bournemouth) Ltd care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 28 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Nightingale Nursing Home is a care home registered with the Commission for Social Care Inspection to provide nursing and personal care for up to twenty-eight older people. The home is situated in a tree lined residential area five minutes drive from Bournemouth town centre. There is a mature well-maintained garden that is accessible to service users and visitors. Car parking is available in the grounds of the home or in the surrounding roads. Accommodation is situated on two floors with eight bedrooms on the ground floor and thirteen on the first floor. A passenger lift provides access to the first floor for service users and visitors with mobility problems. The Registered Providers are Nightingale (Bournemouth) Ltd. Mrs Mitchell, a director of the company, Care Homes for Older People Page 4 of 23 Over 65 28 0 Brief description of the care home is the Registered Manager. At the time of the inspection the weekly fees are 700 pounds for a single room and 610 pounds for a shared room. Additional charges are made for hairdressing and chiropody. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_choos.as px Care Homes for Older People Page 5 of 23 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: two star good 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 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place on the 28th November 2008 and took approximately five hours. The purpose of the inspection was to assess all of the key standards and review requirements that were made at the last inspection. It was carried out by one inspector however the term We has been used throughout the report to reflect the findings of the Commission for Social Care Inspection. The Registered Manager, Mrs Rita Mitchell, was on hand throughout to aid the inspection process. We gathered information in a variety of ways, which included reports made to the Commission by the home; the annual quality assurance assessment completed by the home; a tour of the premises and discussion with those Care Homes for Older People Page 6 of 23 people living, working and visiting the home. We also reviewed a number of care records, recruitment and training records and maintenance documentation. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 23 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 23 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. New residents move into the home having had their needs assessed and been assured that these needs will be met fully. Evidence: We reviewed the pre-admission assessments for two new people living at the home. These assessments were thorough and looked at all aspects of care that might be needed. One person told us that they were visited by the registered manager whilst they were still in hospital and that a member of the family visited the home prior to any admission being arranged. They said that they were given sufficient information about the service so that they could make an informed choice about whether to stay. Care Homes for Older People Page 10 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Nightingale Nursing Home receive the care they need but this is not always supported through the care documentation available to staff. Evidence: We looked at the care documentation for two people living at the home and found that most of the information staff would need to be able to deliver care was contained within the files. However there were some shortfalls in documentation. The nutritional screening tool used in both files were not completed correctly and under estimated the care needs that may have been required. These residents were able to tell us that they were well nourished and found the food provided very good. Wound care charts did not include much detail about the size and type of wounds, which meant that not all staff would have a clear picture of what care was required. Some records instructed staff to apply cream to pressure areas. It was not clear why or even which cream should be used. The home has a good medicines policy and procedure in place. Examination of records indicated that medicines were properly administered so that residents were assured Care Homes for Older People Page 11 of 23 Evidence: that they would get the correct medication they needed in accordance with their GPs instructions. We looked at the medication administration records and found that these were being completed correctly with no gaps within the records. People told us they were well cared for by competent, kind and caring staff. During the inspection we saw staff carrying out their duties in a respectful and professional manner. Care Homes for Older People Page 12 of 23 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 who use this service are supported to maintain their life skills and are encouraged to make choices as far as possible. Social, spiritual and recreational activities meet the needs of the residents quite well. Evidence: The home continues to provide a range of social, religious and recreational support to people living there. People told us that they were happy with the lifestyle that living at the home afforded them. Some chose to spend time on their own but knew they could join in with any organised activities if they so wished. Activities included gentle exercise classes; outings to local places of interest; musical entertainment; visits from PAT dogs; hand and foot massage. Residents said that they could entertain their visitors in private and that they were always made very welcome. People told us that they were free to choose whether they wanted to handle their own financial affairs. Some preferred to have a family member to act on their behalf. All residents spoken with confirmed they enjoyed the food provided. Records showed that residents likes and dislikes with regard to food were known and residents were aware that alternatives to the main menu were always available. Care Homes for Older People Page 13 of 23 Care Homes for Older People Page 14 of 23 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 who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. Protection from abuse is promoted. Evidence: Since the last inspection the home has reviewed and updated their complaints and safeguarding policies and procedures. One complaint had been received and was investigated and acted upon in accordance with the homes policy. People told us that they knew who to speak with if they had any concerns and that staff were very approachable and understanding. Through discussion with staff it was evident that they have a good knowledge of safeguarding vulnerable adults and confirmed that they received regular training on this subject. Care Homes for Older People Page 15 of 23 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 standard of the environment at Nightingale Nursing Home is good providing residents with an attractive, homely and safe place to live. Evidence: We toured the premises and reviewed the maintenance documentation, which showed the home was well maintained inside and out. There was evidence that equipment was serviced regularly. Residents had easy access to all communal areas inside and out in the garden. Bedrooms were personalised with a variety of mementos, pictures and small items of furniture. People told us that they were comfortable. All areas of the home seen during the inspection were clean and free from any unpleasant odours. The laundry continued to be well managed. Adequate supplies of clean linen were seen to be available. Care Homes for Older People Page 16 of 23 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. Sufficient care staff are employed to meet the needs of residents. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. Staff are given the training and support so that they can give a good standard of care to the residents living at the home. Evidence: At the time of inspection staff rosters demonstrated that there are sufficient staff on duty at that time. During the inspection staff were on hand to meet the needs of the residents. People told us that staff were available when they needed them and they were not kept waiting. Since the last inspection there has been an increase in the number of hours allocated to cleaning and laundry. The home had an ongoing training programme, which included NVQ level 2 and 3 in care and over 50 per cent of the care staff hold the minimum of a level 2 award in care. We reviewed the recruitment files for three new members of staff. The files were well ordered and contained all the information required by law. POVA first and enhanced Criminal Record Bureau checks had been obtained for all new staff. Training files showed us that staff were receiving induction training and staff confirmed this. They also told us that they were encouraged to take up training opportunities provided. Recent training included infection control, the protection of vulnerable Care Homes for Older People Page 17 of 23 Evidence: adults, moving and handling, first aid, nutrition, challenging behaviour, legal and ethical issues in the care home. Care Homes for Older People Page 18 of 23 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 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 well organised and the daily management and running of the home centres around the care of residents. Good management practice, systems in place, and records kept, confirm the health and safety of all in the home. Evidence: Through discussion it was evident that residents and staff enjoy the way the home is run and find the Registered Manager is very approachable. Mrs Mitchell demonstrated throughout the inspection that she ran the home well and was supported in this by her husband, a fellow director in Nightingale (Bournemouth) LTD,who deals with administrative matters in the home. Mrs Mitchell followed robust procedures to ensure that she had a well-trained and competent staff to care for those people living at the home. People told us that Mr and Mrs Mitchell were very approachable. The home had recently purchased a new quality assurance monitoring tool and was in the process of implementing it in the home. This will be reviewed at the next Care Homes for Older People Page 19 of 23 Evidence: inspection. However people told us that they felt involved with what went on in the home and that their opinions mattered to the management team. The home does not hold any monies on behalf of people living there. We were told that residents could either deal with their own finances or have a representative to do so on their behalf. Records showed us that staff had received recent training in fire safety and manual handling updates. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded and appropriate action was taken as necessary. Care Homes for Older People Page 20 of 23 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 21 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans and other care records should be improved to ensure proivision of accurate information to staff to enable them to properly care for residents. The home should complete implement a robust quality assurance system, which should include a yearly internal audit. 2 33 Care Homes for Older People Page 22 of 23 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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