Care Home: Nightingales Care Home

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What the care home does well Nightingales provides a good standard of care in a homely environment. Residents are thoroughly assessed before being assured their needs can be met at the home. Care planning is well organised and the standard of record keeping is very high. Health care professionals speak well of this home and one questionnaire returned to the home noted: `I cannot see any improvements required - I have always found the care to be excellent.` The social needs of residents are catered for and there is a friendly and relaxed atmosphere within the home. Mealtimes at the home are a sociable affair, and the cook received plenty of praise from residents who enjoy their meals. On the day of the inspection residents had two choices of main course and five choices of pudding, including two different home made puddings. The environment is well maintained with a continuous programme of refurbishment and maintenance. The home was clean and fresh smelling throughout, with no unpleasant odours.The residents benefit by having an experienced manager with a stable staff team. All those spoken with were complimentary about the staff and the service provided at Nightingales. What has improved since the last inspection? CARE HOMES FOR OLDER PEOPLE Nightingales Care Home Islet Road Maidenhead Berks SL6 8LD Lead Inspector Helen Dickens Unannounced Inspection 7th February 2008 10:10 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 Care Home DS0000067097.V357586.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 Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingales Care Home Address Islet Road Maidenhead Berks SL6 8LD 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) 01628 621494 Thames Carehome Limited Mrs Richelle Anne Dix Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th August 2006 Brief Description of the Service: Nightingales is a converted detached house set in attractive grounds, in a quiet residential area close to the river Thames in Maidenhead. The home provides care for older people who require personal support, and is not registered to admit residents with dementia-related conditions. The home is registered for up to seventeen residents – though two double rooms have now been converted into single rooms and there is only one double room remaining, currently occupied by one resident. Bedrooms are located on the ground and first floors, with bathrooms and toilets available on each floor and a lift is provided, serving both floors. Some rooms have en-suite facilities. The home has a single lounge with an attached spacious conservatory. There is a small dining room, which provides seating for up to eight residents, and a dining table at one end of the lounge for the remaining residents. Some people prefer to eat in their armchair in the lounge or the conservatory, or in their bedroom. The home was taken over by new providers in 2006, and the manager and staff are happy with the new arrangements, with the staff team remaining constant throughout. Fees at the time of inspection ranged from £425-£700 per person per week depending on whether it is a shared or single room, and whether en-suite facilities are available. Additional charges are made for hairdressing, private chiropody and newspapers. Nightingales Care Home DS0000067097.V357586.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 people who use this service experience good quality outcomes. This key inspection was unannounced and took place over 7 hours. The inspection was carried out by Mrs. Helen Dickens, Regulation Inspector. Mrs. Richelle Dix, Registered Manager, and the deputy manager, represented the establishment. A partial tour of the premises took place and a number of files and documents, including resident’s assessments and care plans, staff recruitment files, quality assurance information, and the annual quality assurance assessment (AQAA) were examined as part of the inspection process. A number of questionnaires returned to the service from residents, relatives and healthcare professionals were also used in writing this report. Some residents and relatives also returned questionnaires to CSCI and these were also considered. Most residents were spoken with individually during the day and the inspector spent some time sitting with the residents over lunch. The inspector would like to thank the residents and staff for their time, assistance and hospitality. What the service does well: Nightingales provides a good standard of care in a homely environment. Residents are thoroughly assessed before being assured their needs can be met at the home. Care planning is well organised and the standard of record keeping is very high. Health care professionals speak well of this home and one questionnaire returned to the home noted: ‘I cannot see any improvements required - I have always found the care to be excellent. The social needs of residents are catered for and there is a friendly and relaxed atmosphere within the home. Mealtimes at the home are a sociable affair, and the cook received plenty of praise from residents who enjoy their meals. On the day of the inspection residents had two choices of main course and five choices of pudding, including two different home made puddings. The environment is well maintained with a continuous programme of refurbishment and maintenance. The home was clean and fresh smelling throughout, with no unpleasant odours. Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 6 The residents benefit by having an experienced manager with a stable staff team. All those spoken with were complimentary about the staff and the service provided at Nightingales. What has improved since the last inspection? What they could do better: The home must ensure that their in-house policy on the protection of vulnerable adults fits closely with the local authority policy – especially in relation to reporting and investigating any suspected incidents. Recruitment files must contain all the information required by the Regulations, including a full employment history for all staff, and references from the last care employer of any staff taken on. Arrangements for monitoring health and safety within the home must be reviewed to ensure any shortfalls are identified and dealt with as quickly as possible. Please contact the provider for advice of actions taken in response to this Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 7 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 Care Home DS0000067097.V357586.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 Care Home DS0000067097.V357586.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): 3 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit by a thorough assessment of their needs prior to them moving in to Nightingales. EVIDENCE: Three resident’s files were sampled on the day of the inspection. Initial assessments by the home were found to be comprehensive and well completed. Areas covered included personal care, mobility and food and nutrition. The Annual Quality Assurance Assessment (AQAA) returned to CSCI prior to the inspection stated that the manager visits all prospective residents prior to admission and they and their relatives are encouraged to visit Nightingales prior to moving in. All records were signed and dated by the person who had carried out the assessments. Resident’s spoken to and questionnaires returned to CSCI showed people were happy with the admission arrangements and those residents who were unable to visit in advance said Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 10 arrangements had been made by their families who had been to look around the home themselves. Nightingales Care Home DS0000067097.V357586.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 the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit by having their personal and healthcare needs properly documented in their care plans, and by the high standard of record keeping in relation to their files. Medication administration is well organised, ensuring the safety and well-being of residents. Residents also benefit by being treated with dignity and respect by staff. EVIDENCE: Three resident’s care plans were sampled and found to be properly completed and regularly reviewed. Improvements had been made to care plans as the manager had introduced a new care plan format which had more detail and clearly separated sections on each area where support was needed. All activities of daily living were covered with special reference to cultural and religious needs. Dependency profiles had been carried out for each resident on admission and then regularly reviewed, with appropriate action taken if residents began to deteriorate. Keyworkers had made thorough notes on resident’s files which gave a comprehensive picture, over a period of time, Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 12 about resident’s care needs and any changes made. Daily notes were also kept, including a separate sheet regarding what personal care had been given, and any activities the residents had participated in that day. Staff interviewed were very knowledgeable on the needs of residents, for example one care worker who described the specific communication needs of one resident due to a hearing impairment. Staff should be congratulated on their standard of record keeping which was very good on all resident’s files seen by the inspector. Discussion was held with the manager and a recommendation will be made that more detail is added to care plans in regard to how residents would like their support to be delivered. Healthcare needs of residents were properly recorded and a number of policies in place to ensure resident’s health needs were monitored. For example each resident is weighed on admission and a nutritional risk assessment is carried out. These are regularly reviewed and staff were knowledgeable on how to support residents in relation to their meals and nutrition. The cook was interviewed and knew resident’s likes and dislikes and their special diets without referring to her written records. The inspector asked the manager to review one resident in relation to weight changes – whilst this was being monitored by staff, and the resident had been seen by the community nurse for other reasons, the resident’s GP had not seen them for some time. The manager agreed to follow this up. Some very favourable comments were received from healthcare professionals when the home had carried out their annual survey of stakeholders. Questionnaires returned to the home stated they were happy with the care given to residents, there was always a member of staff to confer with, and that the home and staff always acted on their recommendations. Comments included Keep up the good work.Thanks to Ricci and her team. and All is well, the foot hygiene is excellent. Staff are very helpful. One community nurse, on the question regarding any improvements they thought the home could make, replied; ‘I cannot see any improvements required - I have always found the care to be excellent. The administration of medication is well organised at this home. All staff who administer medication are trained by the local pharmacy, and the PCT arranges for the local pharmacist to inspect and advise the home in relation to medication. A medication administration session was observed and staff were observed to be sensitive to resident’s needs and to keep the medication trolley secure when it was unattended. Residents were asked if they would like their as required medications, and were clearly given choices about whether they had their medication and how they took it. Three medication administration records were checked and contained no unexplained gaps. This is an improvement from the last inspection where minor recording errors had been noted. The local pharmacy responded to the homes annual questionnire and Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 13 and said they thought there was a Very good working relationship between the home and the pharmacy. All personal care is carried out in private at this home and staff were seen to be respectful towards residents. Residents were addressed by their preferred name and staff were knowledgeable about the special communication needs of residents. Examples of residents being shown respect included staff knocking on doors before entering residents rooms, and giving residents choices about where they wanted to sit, where they wished to have their meals, and about which activities they wished to participate in. Staff were also noted to be offended on behalf of residents who they felt were not being treated well by others, for examle one resident who was being denied rehabilitation services. The manager and staff were following this up to ensure the resident had equal access to these services. Nightingales Care Home DS0000067097.V357586.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 the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit by having a varied programme of activities and by maintaining links with family and friends. There are good contacts with the local area and this enables residents to feel included in the community in which they live. Residents derive a great deal of pleasure from their food and enjoy mealtimes at this home. EVIDENCE: There is a planned programme of regular activities at Nightingales, and this is supplemented by ad hoc entertainments and outings. Residents choose whether to join in or not and the planned programme has recently been changed to remove bingo as the manager said it was no longer popular with residents. The home has 6 hours of reminiscence therapy each week for residents who wish to participate. It was noted that most residents purchase a daily newspaper of their choice and during the morning those sitting in the conservatory and lounge area were seen to be reading. There is a regular hairdresser and a chiropodist visiting the home and a monthly baking day when a staff member involves residents in making something seasonal or topical for that month. Individual records are kept about who participates. Questionnaires returned to Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 15 CSCI from residents showed they were aware of the activities programme and could choose when to participate, for example one resident said they just go on the outings. The inspector noted that the Christmas programme of events had included a pantomime at a local school, late night Christmas shopping, a garden centre visit, as well as a Christmas party. Notes from staff indicated that residents had been asked as early as September last year, what Christmas activities they wished to have, and all their suggestions had been noted and taken into account in the planning for December. Relatives and friends are encouraged to maintain links with residents. Visiting times are flexible though the service user guide asks those who wish to visit after 8pm to telephone in advance. It also states that relatives are welcome to have a meal at the home for an additional charge. Relatives were seen to come and go throughout the day and staff were knowledgeable on their involvement with residents. The manager was able to give examples of closer involvement with some families. There are good links with the local community, with the home using local health services and the pharmacy; there are also good contacts with local churches and schools. One local school sends older children to spend time talking with residents and getting involved in activities. The home sometimes has social work students from Reading University who work on special projects with residents. For example a reminiscence project collecting photographs of a particular residents life history and displaying these to good effect with written headings on when and where the photographs were taken. Residents are encouraged to bring personal possessions into the home and those rooms belonging to permanent residents were very personalised - some had brought their own furniture as well as paintings, photographs, TVs and radios, and favourite cushions etc. There were many examples of residents being supported to exercise choice and control over their daily lives. For example in relation to choosing their meals, what to wear, where to sit, and whether to participate in activities. Most residents spoken with were fully able to make their opinions known. A few residents who had difficulty communitcating were assisted by staff who understood their needs very well. Residents at this home have a very pleasant mealtime experience. Some go to the small dining room which seats up to eight people, and others use a smaller dining table which is at one end of the lounge. Others choose to either stay in their armchair and have a small table brought to them, or remain in their rooms. It was a sociable time for residents who chatted to each other and to the staff who were very attentive throughout. There were two choices of main course and five choices of pudding on the day of the inspection. The cook made two different home-made puddings; blackberry and apple crumble, and an apple sponge for the diabetic residents. Prior to the puddings being brought in on a trolley, residents told the inspector that the cook made wonderful spongecake.’ The residents praised the food at the home which is mostly homemade. On the day of the inspection the cottage pie was very tasty and Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 16 enjoyed by all those spoken with - it was accompanied by three other vegetables. The cook was spoken to at length and was knowledgeable on residents likes and dislikes, and special diets. Those residents who needed a softer diet could have certain items liquidised; the cook said items were always liquidised separately to maintain the colour and presentation of the food. Many favourable comments were received about the food including comments such as Very tasty, Vey nice and one resident who is unable to speak gave the thumbs up sign when asked by the inspector about the food. Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 17 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 the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their concerns and complaints will be listened to and taken seriously at this home, and they are protected from abuse. EVIDENCE: The home has a complaints procedure and this is contained in the service user guide which the manager said is in each residents room. A record is kept of any complaints recieved at the home and none have been since the last inspection in August 2006. No complaints have been received to CSCI about this home since the previous inspection. Residents also have regular meetings, the annual questionnaires, regular reviews, and discussions with their key workers where they could raise any concerns. Residents were noted to get on well with staff and most would be able to speak up if there was something they were unhappy about. The home has an in-house policy on the protection of vulnerable adults (safeguarding) and the manager has downloaded the most recent Windsor and Maidenhead local authority procedures on this subject from the internet. There have been no safeguarding referrals made in regard to this home since the last inspection. Staff have had training in this subject. However, the in-house policy needs to be reviewed to ensure it fits with the local authority procedures, especially in relation to when to report an incident and who investigates suspected incidents of abuse. The manager said she would adopt Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 18 the Windsor and Maidenhead council policy for the home, and add some extra information which is directly relevant to her staff. She was asked to ensure the new policy was circulated to staff and they understood their responsibilities Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 19 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 the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s benefit by living in a homely and well cared for environment that is clean, pleasant and hygienic throughout. EVIDENCE: A partial tour of the premises took place with the inspector visiting all the communal areas and, with their permission, four resident’s bedrooms. The home is generally well furnished with a rolling programme of maintenance and renewal. Nightingales offers a very homely environment and residents are encouraged to be involved in any changes – for example the home has recently had new chairs delivered. The manager said residents had had the opportunity to try out a selection of chairs and choose colours etc before an order was placed. Positive comments were received from residents about their surroundings and six residents who were specifically asked about their rooms said they were happy with the current arrangements. Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 20 During the tour of the premises some issues relating to health and safety were discussed with the deputy manager, and later with the manager – these matters are covered under Standard 38 at the end of this report. Some minor decorative issues were highlighted to the deputy for attention including two toilet pedestals which had peeling paint and were discoloured, and the storage of equipment under the stairs in the lounge needs to be reviewed, for example it could be hidden with screening, to ensure this corner does not detract from the otherwise very homely appearance of the lounge area. The home has good systems in place for the control of infection. Staff are trained on this issue, and there are very good hand-washing arrangements throughout the home with soap dispensers in all communal areas, as well as in individual resident’s bedrooms. Nightingales is clean and fresh smelling throughout and there were no concerns raised by residents or relatives in relation to the cleanliness of the home. The laundry area was inspected and found to be clean and tidy. Since the last inspection the home has purchased a new washing machine and tumble drier. Unfortunately the laundry room is accessed through the kitchen though the home has arrangements in place to ensure any hazards are minimised. The rolling programme of renewal includes refurbishment of the kitchen and the laundry area being re-sited during the coming year. Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 21 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 the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents at Nightingales benefit from a stable staff team who are trained to meet their needs, and from being encouraged to be involved in the recruitment process for new staff. EVIDENCE: The staff rota was sampled and there were sufficient staff on duty to meet the needs of residents. Extra staff are on duty during busy periods. Residents were observed to have a good relationship with staff and those people needing assistance were given this in a timely fashion. The home employs catering and cleaning staff and care workers were assisting at lunchtime to distribute meals and assist any residents who needed support to eat. The AQAA returned to CSCI prior to the inspection noted that 9 of the 15 permanent care staff already have an NVQ Level 2 qualification or above, and currently one further member of staff is working towards this qualification. This exceeds the National Minimum Standards which recommends at least 50 of staff have this qualification. Two staff recruitment files were sampled and found to contain a good record of pre-employment checks, including enhanced Criminal Records Bureau certificates. There was evidence that potential staff had been checked against Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 22 the protection of vulnerable adults register (POVA List), to ensure they had not been deemed unsuitable to work with vulnerable people. The home should be commended for including residents in the recruitment of new staff. Residents are invited to take part in staff interviews and then to comment on each candidates suitability. The comments of four residents had been noted on one filed examined, and there was evidence that the manager had taken their comments into account. However, there were a few shortfalls on the two staff recruitment files sampled. One had a four year gap in their employment history which should have been identified and followed up. This staff member was on the premises and provided a written note of their employment during this time. This person did not have a reference from their last care employer. Though a reasonable explanation was given for this oversight, the reference does now need to be taken up. The manager agreed to do this the following day. The second file examined showed the staff member had not worked for an employer before coming to Nightingales, so, in addition to a reference from their college, there was also a character reference from a friend of the family. It is not good practice to get references from friends unless they are also of considerable standing in the community, for example a GP or faith leader. An alternative referee was suggested and this will be followed up and added to the file. Both staff files sampled had a good record of any training they had undertaken and on progress with their induction; this home uses the Common Induction Standards, recommended by Skills for Care. There is a training matrix which enables the manager to see at a glance which staff have done which training courses, and when refreshers are due. The manager had already identified where extra training was needed as each staff member has an individual training and development plan; these plans are reviewed on a 6-monthly basis. Staff are not asked to carry out tasks without training, for example two new staff were not yet giving out medication as their training had not yet been undertaken; the manager said both were booked on a medication training course. Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 23 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 the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Nightingales is a well managed home which is run in the best interests of residents. Their financial welfare is safeguarded. Systems for promoting their health and safety are generally good but need to be reviewed to minimise any potential risks to residents. EVIDENCE: The manager is appropriately experienced and qualified to run the home. She has attained Level 4 NVQ and the Registered Manager’s Award. She also has a Leadership Programme certificate and is an accredited trainer for POVA, infection control and moving and handling training, as well as having completed a general train-the–trainer course. She also attends other training from time to time to maintain current knowledge. There are clear lines of Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 24 accountability, both within the staff team in the home, and externally with the new owners who carry our monthly monitoring visits at Nightingales. The manager commented that the new owners were very receptive to staff requests for anything which improved the quality of life of residents or the standards within the home. The home has a number of steps in place to ensure the quality of the service they provide. The new owners make regular monthly visits to the home and annual questionnaires are sent out to residents and other stakeholders. Comments from those who visit residents in a professional capacity such as community nurses and the GP made very favourable comments about this home and these are noted earlier in the report under healthcare. Residents meetings are held and there are reviews of residents care plans on a regular basis. Residents are encouraged to be involved in planning menus, choosing activities, and even interviewing potential staff. Systems are in place for monitoring health and safety within the home and this is discussed further under Standard 38 below. Staff at this home do not get involved in resident’s finances. For residents who cannot manage their own financial affairs, a relative or power of attorney deals with their money. Residents were observed to have a daily paper of their choice delivered to the home and the manager said bills for their newspapers, hairdressing etc, were passed to the family for payment. The home has a number of arrangements in place to promote the heath and safety of residents. Most radiators are covered and thermostatic controls have been fitted to hand basins to prevent residents being scalded. Health and safety audits are carried out on a regular basis and a maintenance worker is employed and was observed to be very responsive to any shortfalls which may have had an impact of residents safety. For example on the day of the inspection a number of the door guards were not working properly - these allow doors to close automatically when the fire alarm goes off and therefore protect residents in case of fire. One guard had a low battery, and two others were sticking due to the painting of the doors and door frames upstairs. The maintenance worker dealt with these shortfalls immediately. However, a number of other shortfalls were identified during the inspection and these had not been picked up by staff. A Requirement will be made to review the systems in place to ensure any lapses or shortfalls in health and safety are identified and dealt with in a timely fashion. The issues discussed with the manager included: • • A blanket was found draped over the boiler in the boiler cupboard - the door had a notice which said keep locked shut but the key was in the door. Some cleaning materials were not kept securely - some cleaning and air freshening liquids were left unattended. DS0000067097.V357586.R01.S.doc Version 5.2 Page 25 Nightingales Care Home • • • A fire door was wedged open in a bathroom and one resident’s bedroom door had been wedged open by them with a pillow - the maintenance worker fitted a door guard to this room before the completion of the inspection. One residents en-suite had a number of bottles and lotions including hibiscrub hand cleanser with a screw top - this was used by the community nurses. A risk assessment must be in place in such circumstances and this was carried out immediatley by the deputy manager. There is a risk assessment in place for the laundry, but this did not include the fact that the door is not locked when it is not in use. The manager said she would include this in the existing risk assessment. Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 26 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 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 Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? 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 OP16 Regulation 13(6) Requirement The in-house policy for the protection of vulnerable adults (safeguarding) must be reviewed in line with the latest local authority procedures for the area. This new policy should then be circulated to all staff to ensure everyone is clear about reporting and investigating any suspected abuse. Recruitment files for staff must contain all the information set down in Schedule 2 of the Care Homes Regulations 2001 (as amended), including following up any gaps in employment history, and ensuring references from each candidate’s last care employer are taken up. The system for maintaining the health and safety of residents, staff and visitors must be reviewed to ensure that any shortfalls are identified and dealt with in a timely fashion. Timescale for action 07/03/08 2. OP29 19 Schedule 2 07/03/08 3. OP38 13(4)(a) (b)(c) 07/03/08 Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 28 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 OP7 Good Practice Recommendations Resident’s care plans should contain some more detail about how each resident would like their support to be delivered. Nightingales Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone, Kent 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 Care Home DS0000067097.V357586.R01.S.doc Version 5.2 Page 30 - 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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