Care Home: Nightingales

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What the care home does well The admission procedure allows for a comprehensive assessment process of any prospective resident, and for the result of this to be communicated to the assessed person and if necessary their representative. The registered manager and supporting team are committed in providing a good standard of care within a homelike and friendly atmosphere, where communication between staff, residents and visitors is positive open and friendly. It was evident that activities and contact with the local community is an important factor to the way the home is run. Close contact is maintained with family and friends, visiting is not restricted and people are encouraged and supported in maintaining family links by attending family activities and outings whenever possible. The quality and standard of the food in the home is good and residents complimented the food. The environment is pleasant and clean and there is an attractive garden area. What has improved since the last inspection? The care documentation has improved since the last key inspection and now provides clear guidance to care staff on how to meet individual needs. Although risk assessments for those residents who self-administer medicines have not been fully documented there is evidence that staff have consulted with appointed GP`S for their view and agreement. Staff training continues to be progressed and the home has now achieved 50% of their care staff having a National Vocational Qualification in care at level 2 or above. The registered manager has reviewed the fire precautions in the home and has fitted `hold open` devices that are linked into the fire alarm system in key areas. What the care home could do better: There is a need to develop appropriate risk assessments that are linked to individual care plans for specific care needs, both long and short term with clear guidance for staff to follow.The systems for handling medicines need to be improved to ensure medicines are stored appropriately safely and at the correct temperature. The home needs to ensure that practice in the home minimises the risk of cross infection. Suitable policies and procedures on infection control need to be adopted. Further advice on this matter is available from the Department of Health in the document `Infection control guidance for Care Homes`. The home must have suitable policies and procedures that are up to date and make proper provision for the health and welfare of residents and take into account relevant legislation and guidelines. CARE HOMES FOR OLDER PEOPLE Nightingales 38 Western Road Newick East Sussex BN8 4LF Lead Inspector Melanie Freeman Unannounced Inspection 4th August 2008 10:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingales Address 38 Western Road Newick East Sussex BN8 4LF 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) 01825 721120 anne@nightingalescarehome.co.uk Mrs Anne Lewis Mrs Anne Lewis Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. From time to time the service may accommodate service users under the age of 65 years 8th November 2005 Date of last inspection Brief Description of the Service: Nightingales is an older extended property situated in the village of Newick. The village centre with its facilities and shops is a short level walk away and local bus services run past the home. Accommodation is over two floors, a stair lift is fitted to assist access to the first floor. Bedroom accommodation consists of twenty single and one double room. The home has large gardens to the side and rear and ample off road parking at the front of the building. The home is registered to accommodate twenty-two older people and the registered provider is Mrs Anne Lewis, who is also the registered manager. The fees charged start from £500 per week. These are dependant on the room to be occupied and the level of care and individual may need and includes all hotel costs, the provision of personal care, basic toiletries, all activities including outings to a local luncheon club and day care provision. All personal items like books newspapers magazines are charged for along with additional services like chiropody and hairdressing. Intermediate care is not provided at Nightingales. The most recent inspection report is contained in the homes’ statement of purpose and is also available upon request. Nightingales DS0000021172.V369262.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 2 star. This means the people who use this service experience good quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Nightingales Care Home will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and follow up contact with a visiting health care professional. The allocated inspector spent approximately six hours in the home and was able to discuss matters with the registered owner/manager and one of the deputy managers. During this assessment visits the inspector was able to spend time with residents, staff and visitors and to observe practice in the home. A tour of the premises was undertaken and a range of documentation was reviewed including the homes statement of purpose and service users guide, pre-admission assessment procedures, the systems in place for handling complaints and protecting residents from harm, staff recruitment files and quality assurance systems. The home’s health and safety procedures and checks were also discussed with the manager. The care documentation pertaining to two residents were reviewed in depth and the inspector ate a midday meal with the residents in the dining room. Comments shared by residents and their representatives during the inspection process included ‘Nightingales has a lovely family atmosphere and the residents are treated like honoured guests’ ‘they have improved the quality of life for a very old lady and made her more sociable and content – an enormous improvement to living alone’ ‘The size of the home is just right for a home. There is not a clinical feel at all. All the staff are very friendly and supportive’. The required Annual Quality Assurance Assessment (AQAA) was completed by the registered manager when requested. It was well completed and its contents were used to plan the inspection and to inform the report. At the time of compiling the report, in support of the visit, the Commission received survey forms about the service from eight residents and eight staff members. Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There is a need to develop appropriate risk assessments that are linked to individual care plans for specific care needs, both long and short term with clear guidance for staff to follow. Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 7 The systems for handling medicines need to be improved to ensure medicines are stored appropriately safely and at the correct temperature. The home needs to ensure that practice in the home minimises the risk of cross infection. Suitable policies and procedures on infection control need to be adopted. Further advice on this matter is available from the Department of Health in the document ‘Infection control guidance for Care Homes’. The home must have suitable policies and procedures that are up to date and make proper provision for the health and welfare of residents and take into account relevant legislation and guidelines. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Nightingales DS0000021172.V369262.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 DS0000021172.V369262.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides prospective residents and relatives, with a good level of information about the home, its facilities, services and the costs involved. The admission procedures ensure that all prospective residents are fully assessed by a competent person before admission, and are assured that their needs can be met by the home. Intermediate care is not provided at Nightingales. EVIDENCE: Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 10 The home has a suitable combined service users guide/statement of purpose. This document is available in the entrance area of the home, and includes a copy of the most recent inspection report and latest Annual Service Review (ASR) completed by the commission. A review of this document indicated that it needed to be updated slightly to reflect more fully all the information that it is required to contain. For example it should record the number and size of rooms in the home, and the homes fire precautions. The registered manager confirmed that she would review and update this document as necessary. The surveys received indicated that good information was provided to prospective residents although some feedback said that contracts were not supplied. This was discussed with the manager who confirmed everyone had an appropriate contract and there was evidence in the home to confirm this. She agreed to clarify this with residents and their representatives. Prospective residents are provided with a copy of the service users guide/ statement of purpose and every effort is made to share information about the home. For example the home plans to have the statement of purpose/service users guide put on videotape to aide those residents with sight problems. An assessment of the admission process followed included the review of the documentation relating to the last two admissions to the home. These confirmed that everyone is assessed prior to admission by one of the management team. This ensures that Nightingales can meet the prospective residents needs and this is then confirmed in writing, stating on what basis the decision is reached. It was however noted that the assessments completed were not always dated or signed. This was highlighted to the registered manager to address and to ensure accurate record keeping. As a matter for further improvement it was suggested that the assessment documentation record where the assessment took place and who else was present, or had an input into the assessment process. Discussion with a visiting relative reflected a positive experience for her and her relative in respect of the admission procedure, which she described as ‘organised’ and ‘supportive’ for both of them. Nightingales does not provide intermediate care. Nightingales DS0000021172.V369262.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst residents needs are being met and individual plans of care are devised these need to take into account individual risk assessments that cover all areas of risk. Resident’s health care needs are met with the advice and support of community health care professionals. On the whole the homes practice ensure resident’s medicines are administered safely. Care is delivered in such a way that promotes and protects the residents’ privacy, dignity and individuality. EVIDENCE: Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 12 Two individual plans of care were reviewed in depth as part of the inspection process each of these demonstrated a person centred approach to care that recorded individual choices. They recorded what residents like to do throughout the day and what care intervention is needed. Care plans are reviewed on a regular basis and amended as and when required. Daily reports are also maintained in individual books held for this purpose, these record any activity participated in and any visists from professionals or realtives. During the review of documentation it was noted that a nutritional screening is not routinely completed although weights are recorded and staff clearly know the residents well. It was also noted that pressure area assessments are not recorded despite this being set out within the homes procedures as a routine practice. The registered manager confirmed that she was in discussion with her senior staff about evidencing the basis of care more clearly and she agreed to review practice around individual risk assessments for residents on admission. Contact with residents and relatives during the inspection confirmed that they are consulted and kept up to date with regard to any changing care needs. The manager also said that a copy of the plan of care that the resident or their representatives have signed to show their agreement is kept separately in the office. All residents spoken to were very satisfied with care provided at the home. Relatives spoken to and the completed surveys supported this view. Comments received included ‘This home is providing excellent care and is very supportive to the residents and I am more than happy with the care, support and the lovely staff there’ ‘There is a very good link with the local health centre’. A selection of resident’s medicine records were reviewed and these were found to be accurate. A number of shortfalls were however identified with regard to the storage arrangements for medicines and these included • Small facility without any natural ventilation and not having its temeparature monitored. • There was no locked facility to store medicine when it needs to be kept in a fridge. • Although Temazepan was being stored in the Controlled drug cupboard it had not been recorded in the register. • There was no audit process for the controlled drugs kept in the home. It was also noted that prescribed creams administered were not recorded on the medicine charts. In addition although the GP’s are consulted when residents want to self-administer an individual risk assessment is not documented. The homes medicines procedures need to be updated to ensure safe handling of all medicines in the home. Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 13 It was clear from direct observation that residents are treated in a respectful manner with their views and choices being taken into account at all times. Staff knew all the residents well and addressed them by their preferred name. Resident’s rooms are seen as their own personal accommodation and those viewed were attractive and personalised. Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are able to make a range of choices about their lives and are helped in maintaining links with friends, relatives and the community. Resident’s benefit from staff providing stimulation, which includes leisure and recreational activities in and outside of the home. Residents receive a wholesome and appealing diet and are provided with choice. EVIDENCE: There are a variety of activities in the home that residents can join in if they so wish, these have been discussed with the residents and make up the ‘activity agenda’ that is changed to meet the residents needs on a monthly basis. They currently include: poetry and reading, musical sing alongs, scrabble afternoons, musical bingo, reminiscence, seniorcise, massage and reflexology, Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 15 Jigsaw puzzles, quiz days, pub lunches, fish and chip suppers, pianist, guitarist and film sessions in the home. Visits to local gardens and afternoon tea with other people who live in the village are also organised. Residents spoken to said how they enjoyed the scrabble and the outings that have been arranged.Contact with the local community is supported and residents said that they could go to the local church service if they wanted and attend local village events. Residents have access to a computer in the library area and have a garden patio area that can be enjoyed when the weather permits. Access to more garden and walkways is currently being developed. During the assessment visit Nightingales had a relaxed atmosphere with music playing in one of the communal areas, some residents were sitting in the conservatory reading papers and others preferred to spend time alone in the library area. Visiting is very much encouraged and all are warmly welcomed and offered a beverage, residents said that visitors could also stay for meals if they want. Two visitors were spoken to and they were complimentary about the visiting arrangements and said how comfortable they felt when coming to the home. One visitor had some suggestions on possible improvements and had not had the opportunity to share these; this view was raised with the manager who acknowledged the need to use this resource. Nightingales has a mobile home in its grounds and this is available to relatives who wish to stay close to any resident when they are unwell. Residents are given many opportunities to express their views formally through questionnaires and to staff who they said they found ‘approachable’. When residents were asked what could be improved in the home they could not say what would benefit from any changes. The meal that was eaten with residents was both attractive and good to eat, a choice was available and residents said that the evening meal was also ‘very good’ and provided three courses. Comments from residents included ‘The food provided is excellent there is also a lot of choice in the menus’ ‘the food is home cooked and usually delicious’. The dining room provides an attractive environment with condiments and fresh flowers on the table. Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are confident that any complaint would be listened to and responded to appropriately. Staff training and information in the home ensures that any Safeguarding Vulnerable Adult issue would be responded to appropriately when identified. EVIDENCE: A clear complaints procedure is available in the home and feedback from residents recorded that they know what to do if they wanted to make a complaint, and would be comfortable to do so if needed. A record of complaints held in the home confirmed that the management team take all complaints seriously and record them fully along with any action taken to resolve them. Complaints received since the last key inspection related mainly to communication issues and dissatisfaction around food and choices. All complaints are recorded on a complaint form, which are then kept securely to ensure confidentiality. The home has an appropriate Safe Guarding Vulnerable Adults procedure and both deputy managers have completed ‘train the trainer’ training on Adult Protection. There was also evidence in the home that other staff have received Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 17 training in this area recently. The home did not have the most recent local policies and procedures on Safeguarding Vulnerable Adults and the deputy manager said that she would source a copy as a priority. Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, homely, safe, well maintained and clean environment for residents to reside in. EVIDENCE: Nightingales is a converted premise that has retained a home like environment and has been upgraded and extended to meet the National Minimum Standards. A tour of the home confirmed that it is well equipped and the new conservatory situated off the sitting room is both very attractive and well used. There is a patio area with seating through the conservatory doors and the manager advised that further walkways and seating areas are to be provided. Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 19 Resident’s accommodation is found on the ground and first floor and a stair chair lift provides access for residents with some mobility limitations to the first floor, although a flight of steps still needs to be negotiated to access one area of the home. Rooms seen were personalised and of a good size. One residents said how much she liked her room and having her ‘bits and pieces’ around her. During the tour of the home it was noted that two radiators were not guarded. Once these were identified to the manager she made arrangements for them to be guarded and confirmed in writing the next day that this had been completed. The home was found to be clean and well decorated throughout. All laundry is completed on site however it was unclear what procedures were followed in the home to ensure any risk of cross infection were minimised in respect of the laundry and the cleaning of commode pots. It was also noted that tablets of soap were available for communal use and one pot of cream had not been named for individual use only. These infection control issues were discussed with the manager along with the most recent Department of Health ‘Infection control guidance for care homes’. Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing numbers and skill mix provides a competent and well-motivated staff team that meets residents health and personal care needs. Residents are protected by the recruitment practice followed. EVIDENCE: At the time of this assessment visit there were 21 residents living in Nightingales Care Home. Feedback from staff surveys raised concerns around the number of staff and meeting the needs of an increasingly dependent resident group. The home has been extended and has increased its registration from 17 to 22 this year. Although the number of staff have been increased and now provides three carers for most of the waking day supported by a deputy manager, with two carers at night. It was noted that the care staff complete a number of domestic chores that include breakfast and evening meal preparation all washing up and laundry duties. The registered manager acknowledged that these extra duties need to be reviewed and has employed some extra support in the kitchen over Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 21 the summer holidays. She has found it difficult however to recruit on a permanent basis but agreed to review the whole staffing arrangements taking into account staff views to ensure suitable flexible arrangements. Residents spoken to said that they believed that there was enough staff and that they were available when needed, however they did say that if they needed any assistance they would wait and fit in with what the staff were able to do and when they were able to do it. All feedback received about the staff working in the home was very positive and comments received included ‘The staff couldn’t be more helpful’ ‘It has a lovely atmosphere here and the staff are full of kindness. My mum says she is ‘treated like a Queen’ ‘This home is providing excellent care and is very supportive to the residents and I am more than happy with the care, support and the lovely staff there’ ‘All the staff are very friendly and supportive’. Information recorded in the AQAA and discussion with the registered manager confirmed that over 50 of the care staff have completed a National Vocational Qualification in care at level 2 or above and that there is a real commitment to staff training. There was evidence in the home that full induction training is completed by all new staff and that there is an ongoing rolling programme for training in the home. It was recommended that the home should use a training matrix so that this can be recorded clearly. The recruitment files pertaining to three staff were reviewed as part of the inspection process and were found to be mostly full and included an application form evidence of two references and the required Criminal Records Bureau (CRB) and POVA checks on all staff. It was however noted that one staff member was working with a POVA first check. The deputy manager assured that she was working under supervision and that the staffing requirements had necessitated her working before receipt of her CRB. No photographs were on file and the deputy manager said that these had been taken and would be put on file shortly. Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a qualified and competent manager who is approachable and provides clear leadership. Systems for monitoring the quality of care take account of resident’s views and resident’s financial interests are safeguarded. The health, safety and welfare of residents and staff are generally promoted and protected although practice in the home needs to be supported by appropriate policies and procedures. Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 23 EVIDENCE: The registered manager who is also the proprietor of the home has worked in this care setting for 21 years and holds a management qualification in managing care, a nursing qualification and is an NVQ assessor. She has owned the home for nine years and over this time has developed the service rebuilding and extending parts to improve the environment. She is supported by two deputy managers who have both worked in the home for over seven years and are NVQ assessors. One has a nursing qualification and the other has an NVQ level 4 in care and is completing her Registered Managers Award. This structure provides a strong management team and all feedback confirmed that the managers were approachable and pleasant at all times. The home uses questionnaires to gain residents views on the services in the home; these are reported on and used to improve the home wherever possible. It was recommended that these are shared with interested parties through the service users guide. The AQAA was well completed and is being used to audit and review the quality in the home. The home does not take any responsibility for any of the resident’s finances and in most cases resident’s families deal with them if this is not possible, an allocated person is sought. The AQAA confirmed that relevant safety checks have been completed and that staff receive training on health and safety matters. It was however noted that the homes policies and procedures are not up to date an example of this is the infection control procedures. In addition it was noted that there was no safe bathing procedure. The manager agreed to ensure that the policies and procedures are reviewed and up dated accordingly and to implement a safe bathing policy and procedure. The registered manager confirmed that the fire risk assessment was up to date and that environmental risk assessments are completed in the home, and that the maintenance man checks the hot water to ensure it is provided at a safe temperature. Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 24 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 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 X 3 X 3 X X 2 Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 25 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 14(1) Requirement That the registered person ensures that appropriate risk assessments are in place to cover all areas of risk and are responded to. These should cover those residents who self medicate, risks associated with nutrition and skin damage. The registered person makes suitable arrangements to ensure all medicines are stored correctly and safely. Timescale for action 01/10/08 2 OP9 13(2) 01/10/08 3 OP26 13(3) 4 OP38 12(1) The registered person must 01/10/08 ensure suitable arrangements are in place to prevent the risk of cross infection. This should include suitable procedures for dealing with soiled laundry, cleaning commode pots and the risk associated with tablets of soap and unlabelled pots of cream. The registered person needs to 01/10/08 ensure that all the homes policies and procedures are up to date and make proper provision DS0000021172.V369262.R01.S.doc Version 5.2 Page 26 Nightingales for the health and welfare of residents. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Nightingales DS0000021172.V369262.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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