Care Home: Nightingales

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What the care home does well The people living in the home told us they were very happy with the service they received. Comments included: ‘Your treated very well.’ ‘The staff are very attentive to the residents’ basic needs and cope well in a calm and efficient manner.’ Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 ‘All staff are very caring.’ ‘Caring.’ People were provided with information about the home and were able to visit before moving in to see if they liked the home. There was a range of activities available so people did not become bored and were able to lead fulfilling lives. People were happy that they were listened to and that their views were acted on. The meals at the home were varied and nutritious and people were very satisfied with the standard of catering. Comments included: ‘Meals and drinks are of quite good quality.’ ‘Food very good.’ ‘Food is excellent.’ ‘Meals very nice.’ ‘We have very good meals.’ The relationships between the staff and the people living in the home were good ensuring people were comfortable in their presence. The health and safety of the people living in the home were well managed ensuring their well being. The home was well managed and run in the best interests of the people living there. What has improved since the last inspection? The management of the medicines in the home had improved ensuring they were stored safely and people received their medication as prescribed. There had been improvements to the environment which enhanced the facilities available to people and ensured they were safe. Systems had been put in place to ensure people were safe at night. Policies and procedures had been updated so that people’s rights, health and safety were fully protected in light of new laws, best practice and codes of practice. Staff recruitment procedures had improved ensuring new staff were safe to work with the people living in the home. Staff had undertaken further training in safe working practices to ensure they were able to work safely with the people living in the home. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 What the care home could do better: Care plans should reflect the current needs of the people living in the home to ensure they receive person centred care on an ongoing basis. Risk management plans must be in place to ensure people are safeguarded. Record keeping should be improved to enable the home to demonstrate that people lead fulfilling lives. Food records should be improved so that it can be determined people are eating a varied and nutritious diet. Staff should acknowledge any expenditure made on behalf of the people living in the home to ensure they are fully safeguarded. Key inspection report CARE HOMES FOR OLDER PEOPLE Nightingales 34 Florence Road Wylde Green Sutton Coldfield West Midlands B73 5NG Lead Inspector Brenda O’Neill Key Unannounced Inspection 7th September 2009 09:15 DS0000017015.V377483.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 2 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 Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingales Address 34 Florence Road Wylde Green Sutton Coldfield West Midlands B73 5NG 0121 350 0243 0121 350 1135 tuskhome@talktalkbusiness.net.address www.tuskhome.co.uk Tuskhome Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Gayle Goodhead Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP) 13 The maximum number of service users who can be accommodated is: 13 17th September 2008 Date of last inspection Brief Description of the Service: Nightingales is a family run home that provides personal care for thirteen older people. Located in a residential area, the home is near local shops and public transport to Birmingham to Sutton Coldfield. There are ten bedrooms in the Victorian house; three are double rooms. The top floor is used as an office and for staff. On the ground floor there are bedrooms, a large lounge, a laundry room, kitchen and a conservatory/dining area. There is a stair lift for accommodation on the first floor and some steps and there are stairs to the second floor. This means that people with limited mobility could not be accommodated on the second floor. Some of the rooms have ensuite facilities, and there are communal toilets and assisted bathing facilities on two floors. Up to 5 people from the community come to the home for day care, and food is prepared in the home for a local meal delivery service. Fees range from £386.00 to £437.00 per week. Extra charges apply to: hairdressing, chiropody, outside entertainment, newspapers, periodicals and some special diets. The fee information applied at the time of our visit and up to date information should be sought from the management. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate outcomes. This inspection was carried out over one and a half days by two inspectors. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Three of the people living in the home were case tracked. This involves establishing individuals’ experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. During the course of the inspection we spoke with five of the people living in the home, three visitors, the manager, and three staff to get their views on the home. We sent seven Have your Say surveys to people who live in the home and six to staff members. All were returned from the people living in the home and five from staff. These views have been included in the report. What the service does well: The people living in the home told us they were very happy with the service they received. Comments included: ‘Your treated very well.’ ‘The staff are very attentive to the residents’ basic needs and cope well in a calm and efficient manner.’ Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 6 ‘All staff are very caring.’ ‘Caring.’ People were provided with information about the home and were able to visit before moving in to see if they liked the home. There was a range of activities available so people did not become bored and were able to lead fulfilling lives. People were happy that they were listened to and that their views were acted on. The meals at the home were varied and nutritious and people were very satisfied with the standard of catering. Comments included: ‘Meals and drinks are of quite good quality.’ ‘Food very good.’ ‘Food is excellent.’ ‘Meals very nice.’ ‘We have very good meals.’ The relationships between the staff and the people living in the home were good ensuring people were comfortable in their presence. The health and safety of the people living in the home were well managed ensuring their well being. The home was well managed and run in the best interests of the people living there. What has improved since the last inspection? The management of the medicines in the home had improved ensuring they were stored safely and people received their medication as prescribed. There had been improvements to the environment which enhanced the facilities available to people and ensured they were safe. Systems had been put in place to ensure people were safe at night. Policies and procedures had been updated so that people’s rights, health and safety were fully protected in light of new laws, best practice and codes of practice. Staff recruitment procedures had improved ensuring new staff were safe to work with the people living in the home. Staff had undertaken further training in safe working practices to ensure they were able to work safely with the people living in the home. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 7 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. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was information available for people to help them decide if the was home the right place for them. People could not be confident that their needs would be fully assessed before moving into the home and this could mean staff do not know peoples’ needs. EVIDENCE: There was a service user guide for the home which included the home’s statement of purpose, a brochure and a price list for the services offered. The information gave people an overview of what services the home could and could not provide. We were told everyone had been given a copy of the information. The people living in the home or their representatives had signed to say they had received a copy of the service user guide. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 10 The statement of purpose, brochure and most recent inspection report were on display in the home if people wanted to see them. Seven of the eight surveys returned to us before the inspection indicated that people had received enough information to help them decide if the home was the right place for them. All the people spoken with during the inspection were very satisfied with the service they were receiving at the home. We looked at the admission process for two of the people who had moved into the home since the last inspection. Assessments had been undertaken by the staff at the home. We were told these had been done when the people were on a day visit to the home. This was not indicated on the forms and one was not dated. This should be included so that it can be shown people have their needs assessed before being admitted to the home. Staff spoken with did confirm that either the manager went out and did assessments or they were done when people came to have a look at the home. The assessment document included most areas of the individuals’ lives but these were not always completed and there was little indication of what the specific needs of the individuals were. The assessment did not include any summary or say how the decision had been made that the home could meet the individuals’ needs. This could mean the staff would not be aware of peoples’ needs on admission or how to meet them. People were offered the opportunity to visit the home before moving in to see if it was suitable for them. The people living in the home that were spoken with were asked if they came to look at the home before they moved in some could not remember others confirmed they did visit. The files sampled during the inspection confirmed that people were issued with contracts when they moved into the home that detailed the terms and conditions of living in the home. This meant either the people living in the home or their representatives had been made aware of what to expect from the home. The home does not offer intermediate care. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the 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 lack of detail in the homes recording systems means that there could be a risk that people will not consistently get the care they need in a way they prefer. Medication management was good and ensured people received their medication as prescribed. EVIDENCE: We tracked the care for three of the people living in the home. This involved sampling their care plans, risk assessments and daily records, observing care practices, speaking to them and the staff that work with them. Two of the people had moved to the home quite recently another had lived there for some time. The files sampled included an assessment of daily skills for each of the individuals. These assessments covered numerous areas of peoples’ lives including, personal care, eating and drinking, mobility, personal safety and Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 12 leisure. The assessments identified the needs of the people living in the home. There should then have been corresponding care plans in place for any identified needs. For example, ‘one carer to prompt with washing, dressing and bathing’ was written on one assessment and then ‘please refer to care plan 1’. The care plan stated that the person needed assistance of carer to wash and dress but there was no detail of what assistance was needed or what the preferences of the individual were. Some parts of the assessments included some good detail about people, for example, ‘likes a glass of wine with tea’ but there was nothing in the care plans telling staff this or if the individual was to be given this. The two people who had moved to the home recently had very brief care plans with little detail of how staff were to meet their needs. There was more detail in the care plans of the person who had lived in the home for some time however this individual’s health had deteriorated recently and we were told and observed this had affected her ability to eat and drink. The care plan in relation to this had not been updated. The lack of detail in the care plans was discussed with the manager of the home and by the second day of the inspection she had begun to address the shortfalls and one of the care plans included details of such things as how to assist the individual with their oral care, what their preferences were in relation to personal care and how to manage their agitation. The manager of the home and the staff we spoke with were able to tell us very clearly what the needs of the people living in the home were and how people liked their care delivered. People were well dressed and groomed. Staff told us that one person liked to have a wet shave and that he was able to assist with his personal care by washing his hands and face. They were able to tell us what choices people were able to make and what their health care needs were. However the staff spoken with had worked at the home for a considerable amount of time newer staff would not have this knowledge and would need information in care plans to refer to so that they could care for people the way they wanted to be cared for. There were a variety of risk assessments on peoples’ files. The detail in these varied quite considerably. For example, one person’s risk assessments told staff very clearly why she needed arm and leg protectors and that she was moved using the standaid and wheelchair. These assessments were observed to be followed at all times. However another person’s pressure ulcer risk assessment put him at high risk but there was no management plan in place for this which could leave them at risk of developing pressure ulcers. Also this person’s management plan in case of a fall stated to use the standaid. This equipment can not be used if someone is on the floor. Staff need to have the details of the correct equipment to be used so that the person was not put at risk. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 13 People were having their weights monitored but these were being recorded in several different places on the files which could lead to confusion. One person had been weighed and the records showed there had been a big weight loss over a one month period. One record did not indicate that the weight loss had been followed up. Further on in this person’s file on the nutritional screening form the weight loss had been acknowledged and it was written ‘high risk weigh weekly’ however weekly weights had only been done twice and should have been done six times over the period that was dated. This was discussed with the manager and she was able to tell us that there was medical a condition that had caused the weight loss and that the person was now stable. However there were no records to show the weight had stabilised meaning this person could still be at risk. People spoken with were generally very satisfied with their care. Surveys returned to us indicate people were satisfied that they get the medical care they need. Comments received included: ‘Your treated very well.’ ‘The staff are very attentive to the residents’ basic needs and cope well in a calm and efficient manner.’ ‘All staff are very caring.’ ‘Caring.’ The records kept of visits by medical professionals were very detailed and showed that people had access to a wide range of professionals including, doctors, district nurses, chiropodists, continence advisors, dentists, community psychiatric nurses and occupational therapists. This ensured the well being of the people living in the home was monitored. One visitor told us that since going into the home their friend was ‘much better, looks better and has put on some weight’. They felt this was due to the attention the individual was receiving at the home in relation to both their physical and medical needs. The management of medication had improved since the last inspection. Further policies and procedures had been put in place in relation to such things as homely remedies. Storage of the medication was seen to be safe with the keys to the medication trolley being locked away and the cupboard where excess medication was kept was also locked. Medicines were being maintained according to the manufacturer’s instructions in relation to temperatures. Records were being kept to show safe temperatures of the medication fridge, the room where medication was stored and the lounge where the drug trolley was kept. The medication administration records sampled showed that people received their medicines as prescribed. Staff were seen to administer medicines Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 14 appropriately and sign the medication sheets as they were doing so. This ensured medicines were administered safely. The people living in the home were treated with respect and their rights to privacy upheld. Staff were very polite and interacted well with the people living in the home. Individuals could spend time in their bedrooms without being disturbed if they wished. Medical consultations were seen to take place in the privacy of peoples’ bedrooms. Assistance with personal care was offered discreetly. All comments received about the service offered at the home were very positive. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the 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 people living in the home had the opportunity to experience a lifestyle that met their needs and expectations. The people living in the home received a wholesome and varied diet that met any special dietary requirements. EVIDENCE: There were no rigid rules or routines in the home. One person commented ‘Can really please yourself what you do.’ Other people told us they chose when to go to bed and get up, what they ate and what they did with their time while in the home. Being able to make choices enhanced peoples individuality and promoted their independence. Peoples preferred activities and hobbies were detailed in their care plans to some extent. For example, for one person the care plan detailed they liked reading, knitting and going out to church. The person confirmed she did these things and was also observed knitting and reading. For another person the care plan detailed they liked going in the garden and cricket but the fact that they went to a day centre was not detailed in the care plan. This person was Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 16 not able to tell us what he did during the day but staff told us the individual liked a specific type of music and enjoyed quizzes. Records showed the person did listen to music and took part in quizzes. It is important that care plans are a true reflection of what activities people enjoy so that staff can facilitate them on an ongoing basis to have an enjoyable lifestyle. The home had a social event calendar that detailed one event a month including such things as, a barbecue, pub lunch, entertainers coming into the home and a day out in the City Centre. Records showed that these events generally took place. There was also a daily calendar of activities on the notice board which included, exercise to music, current affairs, coffee with staff, quizzes and games. The individual activity records had only letters or numbers entered to show what activity had taken place. The records did not show if people had enjoyed the activity, if they had declined or if they had just watched. Not all the people in the home could tell you what they had been doing or if they led a fulfilling life therefore records would need to show this to evidence peoples’ needs were being met. People spoken with confirmed there were activities available for them to take part in if they wished. Staff were seen to facilitate an activity during the inspection and people appeared to enjoy this. Staff ensured as many people as possible were involved. The people living in the home were able to keep in touch with people who were important to them. Visitors were seen to come and go throughout the inspection and they were made welcome by staff. We spoke with three visitors and they were very positive about the service offered at the home, they could visit at anytime and were always made welcome. One person was seen talking to a relative on the telephone. The people living in the home were generally satisfied with the meals being served to them. Comments received included: ‘Meals and drinks are of quite good quality.’ ‘Food very good.’ ‘Food is excellent.’ ‘Meals very nice.’ ‘We have very good meals.’ The menus at the home were varied and nutritious and offered people choices. The menus for teas and breakfasts were in picture format making it very easy for everyone to choose what they would like. The records of food eaten that were being kept by staff were not comprehensive enough to determine if people were receiving a balanced diet on an ongoing basis as staff were writing such things as ‘ate most of dinner and pudding’ but not what had been eaten. It was pleasing to note that where there were concerns about the amount of food people were eating much more detailed records were being kept. This Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 17 ensured it could be identified when people were at risk of not eating enough to sustain them. We had lunch with the people living in the home. The food was well cooked and nicely presented. Staff clearly knew where people were having soft diets, small portions and so on. People were asked what they would like before their meal was served. This ensured specific diets were catered for and people had the food they liked. Staff and the manager told us if people requested anything to eat that was not on the menu they would get it. Staff gave an example of where one person had asked for kippers and the manager had made sure these had been purchased. We were told about one person who had complained about the food and to try and help resolve the issues the individual had been asked to tell the chef what they would like. Lists of the preferred foods had been given to the chef and food records did show they were being catered for ensuring the individual got the food she liked. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the 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 could be confident any issues they raised would be listened to and acted on. Arrangements were in place to ensure people were safeguarded from abuse. EVIDENCE: People received a copy of the complaints procedure when they were admitted to the home. All the surveys returned to us indicated people knew who to speak to if they were unhappy about anything and all but one stated they knew how to make a complaint. The people spoken with told us they would ‘go to Gayle’ (the manager) if they wanted to raise any issues. The complaints log in the home showed that people were listened to and their views acted on. Three complaints had been entered since the last inspection. One was a written complaint from a relative in relation to poor practice. This had been fully investigated and responded to within the timescales given in the complaints procedure. The other two were more informal and had been raised by the people living in the home about staff attitude. These had been followed up appropriately by the manager. We had not received any complaints about the home. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 19 The interactions between the staff and the people living in the home were very good and people were comfortable in the presence of the staff and the manager which would give them the confidence to raise any issues. There were adult protection policies and procedures on site that were accessible to staff should they need them. Staff spoken with confirmed they had received training in adult protection issues. They were able to tell us what they must do should they suspect or witness any abuse in the home. They were able to tell us how they had reported some concerns they had about a person that attends the home for day care and how this had been managed by Social Services. They were very clear that they must report any issues immediately. This ensured people were safeguarded. The manager had demonstrated earlier in the year that she knew how to refer staff to the POVA (protection of vulnerable adults) register when necessary to try and ensure only suitable people worked with vulnerable people. The manager stated she had updated all the necessary policies and procedures, as requested at the time of the last inspection, so that people’s rights, health and safety were fully protected in light of new laws, best practice and codes of practice. The manager and senior staff at the home had undertaken training in relation to the Deprivation of Liberties Safeguards and the Mental Capacity Act. Records showed that the manager had made an application for a standard deprivation of liberties safeguard for one of the people living in the home as she felt this person lacked capacity. Although this was not granted as the person showed insight to their situation it was good practice as the manager had some concerns about the person’s capacity to make decisions. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, and 26. People using the 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 provides the people living there with a safe, comfortable, homely and clean environment in which to live. EVIDENCE: During the course of the inspection the communal areas and some bedrooms were seen. The home was very well maintained, safe and comfortable. Some issues had been raised at the last inspection that put people at risk, for example, not having access to the call system and the possibility of entrapment from some equipment. These had been addressed. The AQAA detailed that there had been several improvements in the home including new bathing facility, a lot of decoration and new chairs. These were Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 21 all seen at the time of the inspection and had improved the facilities available for the people living in the home. People spoken with were satisfied with the surroundings and said their bedrooms were comfortable. The communal space in the home consisted of one lounge and a conservatory which was used as the dining room. The dining area was quite small but not all the people living in the home chose to eat in there. Some preferred to have their meals in the lounge. The communal areas were well furnished and decorated. There was a safe, accessible and well maintained garden area for people to use in the warmer weather with seating available. There were plans to have the garden landscaped further to make it a better facility for the people living in the home There were adequate numbers of toilets throughout the home. The people living in the home had a choice of either having a bath or a shower. The new bathing facility allowed for full assistance from staff if needed. The shower was floor level and easily accessed however the room was quite small and would be difficult to access with wheelchairs. There was a range of aids and adaptations to help people maintain their independence including, ramps, handrails, raised toilet seats and grab rails. One part of the home had steps that had to be negotiated to access the bedrooms. This area would not be accessible to people with mobility difficulties. There was a stair lift giving easier access to the other bedrooms on the first floor. People living in the home also had access to a range of pressure relieving equipment such as very large pressure cushions, pressure mattresses, heel protectors and so on. This was to try and ensure people were comfortable and develop pressure sores. Bedrooms that were seen were pleasant and nicely furnished and decorated. People had been encouraged to bring personal possessions in to the home to make their rooms more individualised. Most of the bedrooms had en suite toilets which enhanced peoples’ privacy. Those that did not had toilets very close to the rooms. The home was clean and odour free throughout. There were appropriate systems in place to ensure good infection control throughout the home. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the 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 people living in the home were cared for by a well trained staff team that were able to meet their needs. Staff recruitment procedures were robust ensuring people were safeguarded. EVIDENCE: There had been some staff turnover at the home but some of the staff have worked there for a considerable amount of time. This is very good for the continuity of care of the people living in the home. It was evident that relationships between the staff and the people living in the home were very good. Without exception all the comments received about the staff team were very positive. These Included: ‘Staff are fine.’ ‘Staff are really good.’ ‘They will help if needed.’ ‘All staff are very caring.’ ‘All of the staff are friendly, patient and calm with the residents’. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 23 Rotas indicated that there were always adequate numbers of staff available to meet the needs of the people living in the home. The manager told us that she had recently changed the shifts staff were working to ensure there were adequate numbers available at the busiest times of the day. People living in the home confirmed there were always staff around when they needed them. Staff spoken with said staffing levels were appropriate and generally allowed them enough time with the people living there. Staff surveys indicated there are usually enough staff to meet the individual needs of the people living in the home. One did comment ‘more staff so there are extra people to escort residents to the shops if they want to go.’ An issue was raised at the last inspection in relation to staffing levels at night that was leaving people at risk. This was discussed with senior staff and has been resolved. There is still only one waking night care assistant but it has been reinforced with them if they need help to contact the person on call to them who will come to the home. The deputy manager was able to cite an occasion when this had happened. This should ensure people are safe at night. Staff spoken with were very knowledgeable about the needs of the people living in the home and how they liked to be cared for. They confirmed they received a range of training including manual handling, first aid, food hygiene, medicines management and fire evacuation. Some certificates were seen on file confirming the training. It was not possible to assess the extent of the training across the whole staff team as there was no training matrix covering all the staff. However it did appear staff received a good range of training to ensure they could care for the people in the home competently and safely. The AQAA that had been returned to us detailed that the staff employed at the home had an NVQ level 2 or above. This ensured people could be confident that staff had the skills and knowledge to meet their needs. Staff recruitment procedures had improved since the last inspection. The recruitment records for two staff were sampled. One of these staff members was from a staffing agency and was working on a trial basis at the home. Records showed that all the appropriate checks had been undertaken and that the people were safe to work with the people living in the home. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 35. People using the 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 manager ensured the home was run in a competent manner and in the best interests of the people living there. EVIDENCE: The manager of the home is also one of the owners and has been the registered manager for a considerable amount of time. She demonstrated throughout the inspection that she has a very good knowledge of the needs of the people living in the home and how they liked to be cared for. We received many very positive comments from staff, people living in the home and relatives about the management of the home. These included: Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 25 ‘You are treated very well.’ ‘The home appears to be very well run.’ ‘Management have tried to meet the diverse needs of all staff and clients.’ ‘The management have done exceptionally well in maintaining and running the home.’ ‘Management are understanding and gives support with up to date training.’ The people living in the home were clearly very comfortable with the manager and could approach her with ease. The issues raised at the inspection in relation to care planning and the lack of robust risk management plans were discussed with the manager. She showed a commitment to addressing the issues to ensure the people living in the home are fully safeguarded at all times and receive their care in ways they prefer. There is a quality monitoring system which includes the periodic audit of the systems in the home by an external agency. Areas covered during the audits include control of documents and records, management responsibility, customer focus and provision of resources. The outcome of the audit was that the home has an effective quality management system in place. The people living in the home and their relatives were given satisfaction surveys to complete periodically. The outcome of these are analysed and it was seen that some issues had been raised about staffing levels at certain times. In response to this the manager had changed the staff shifts. This shows people are listened to and their views acted on. The survey responses we saw were very positive. The home also had a news letter and the outcome of the satisfaction surveys was detailed in this so that people were aware of what had been done with the information. Records also showed that there were regular meetings with the people living in the home where such things as activities, menus, the garden and cleaning were discussed. The minutes indicated that people were satisfied with the activities and most were happy with the menus. One person commented about food and was told they could have something different to the menu if they wanted. As previously detailed this was being done. Staff meetings were also held to ensure staff were up to date with information. The home was managing some money on behalf of some of the people living there. The records for this were sampled. The records were all being kept together in one book. To ensure confidentiality and compliance with the data protection regulations people should have individual records. The manager had started this on the second day of the inspection. All income and expenditure was being detailed and receipts were available for expenditure. Receipts would be easier to cross reference and track if they were numbered. Staff were not signing for transactions this should be done so that it can be shown who is handling peoples’ money should there be any queries. This will also ensure people are fully safeguarded by the system. One person was having their Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 26 money from petty cash. This was then reimbursed by a solicitor. The individual concerned was signing for the receipt of the money. The health and safety of the people living in the home and the staff were well managed. The home was well maintained and safe and staff had received training in how to work safely with people. The AQAA indicated that all the equipment in the home was regularly serviced. The servicing records were sampled and found to agree with the information received. The in house checks on the fire system were all up to date. It was noted that the last fire drill was in February and the next one was not scheduled until December these should be undertaken every six months to ensure staff know how to keep people safe. A health and safety audit had been undertaken at the home by outside contractors no immediate recommendations were made. Those that were made were being addressed by the manager and signed off when completed on an action plan. This will ensure the home is entirely safe for the people living there. Accident and incident reporting and recording were appropriate this showed us that both being managed in the best interests of the people living in the home. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 2 X X 3 Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13(4) Requirement There must be robust risk management plans in place for all identified risks. This will ensure people are safeguarded and not exposed to any unnecessary risks. Timescale for action 30/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations Pre admission assessment documentation should include all the necessary information so it can be determined that the assessment has been undertaken before people have been admitted to the home and that the staff are able to meet the individuals needs. Care plans should include all the current individual needs of the people living in the home to ensure they receive person centred care on an ongoing basis. Weights should be monitored as indicated in people’s care plans/risk assessments. This will ensure any significant weight loss or gain is noted promptly as this can mean DS0000017015.V377483.R01.S.doc Version 5.2 Page 29 2. 3. OP7 OP8 Nightingales 4. 5. 6. 7. OP12 OP12 OP15 OP30 8. OP35 there is an underlying medical problem. Peoples’ preferred activities should be detailed in care plans so that staff can facilitate them on an ongoing basis to have an enjoyable lifestyle. Activity records should indicate if people are enjoying the activities offered so that it can be determined if they are leading fulfilling lives. Food records should be a true reflection of what people are eating so that it can be determined that peoples nutritional needs are being met. It is recommended that there is a staff training matrix for the whole staff team. This will enable easy tracking of training to ensure staff have all the required training to care for the people living in the home. Staff should sign for any financial transactions made on behalf of the people living in the home to ensure people are fully safeguarded. Nightingales DS0000017015.V377483.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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