Care Home: Nightingales Residential Home

What the care home does well There are clear, recorded admissions processes into the home. Prior to admission individual`s needs are assessed in order to ensure that Nightingales is able to support them in all areas of their care and support needs. There is a stable and consistent team of management and staff at this home. Staff have developed good relationships with those who live at the home and have a sound understanding of individuals needs and preferences. Care plans are well written and detailed, these provided clear information about peoples needs, and provide guidance to staff in order that they can support people in the way they want to be cared for. These care plans are kept under review and are updated when required to ensure that peoples assessed needs are recorded and met. Nightingales is comfortable and individuals appeared to be settled and `at home`. People told us "I like it here, the staff are lovely". "I have friends here and I am happy". What has improved since the last inspection? Only two recommendations were made during our last visit to the home on 19th September 2007, both had been met fully by the home. Information about these is detailed below.The arrangement at Nightingales for the hygienic cleaning of commodes has improved. The home has installed a separate sink for hand washing in the laundry and there is now a separate sluice facility for cleaning commodes. The home should have developed a procedure to inform the staff what happens in the event of a resident requiring an emergency admission to hospital under the Mental Health Act 1983. This document provides clear guidance for those involved. What the care home could do better: Risks for those who live at the home are recorded, however these assessments are not always clear. In order that all are fully aware of potential risks and how these should be managed it is required that risk assessments have clearer links to the care plans of those individuals who live at the home. The home has a detailed medication policy and this covers a number of important areas, however this document would be improved if it contained details of who staff must contact in the event of a medication error, this must include notifying the Commission. It was noted that there is a `key pad` system, which is in use to exit and enter the home. Those living at Nightingales have a diagnosis of dementia and most would not retain the code number needed in order to leave the home. To ensure that the home is fully aware of the rights of people living at the home and to demonstrate that individuals movements are not restricted in line with the proposed deprivation of liberties legislation (April 2009) it is recommended that the home review the `key pad` system which is in place for all people who are living at the home. In order that those living at the home are supported by staff who are fully trained in all core areas it is required that staff must receive training in first aid, this would further improve staff knowledge and skill. In order that those living and working at the home can be confident that fire procedures at the home are robust the home should include within the homes fire risk assessment and policy what the procedure is should a fire occur at night. CARE HOMES FOR OLDER PEOPLE Nightingales Residential Home 24 Foxholes Road Southbourne Bournemouth Dorset BH6 3AT Lead Inspector Odette Coveney Unannounced Inspection 19th September 2008 08:45 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 Residential Home DS0000061189.V368445.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 Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingales Residential Home Address 24 Foxholes Road Southbourne Bournemouth Dorset BH6 3AT 01202 429515 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) rhodescarehome@aol.com Rhodes Care Home Ltd Mrs Lesley Denise Wheal Care Home 11 Category(ies) of Dementia - over 65 years of age (11), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (11) Nightingales Residential Home DS0000061189.V368445.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 providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia aged 65 years or over on admission - Code DE(E) Mental disorder, excluding learning disability or dementia - aged 65 years of age or over on admission - Code MD(E) The maximum number of service users who can be accommodated is 11. 19th September 2007 2. Date of last inspection Brief Description of the Service: Nightingales is a care home for 11 older people with dementia or a mental disorder. It is situated in a quiet residential road, within walking distance of local shops and approximately half a mile from the cliff top and coastal walks. The main centre of Southbourne with all its amenities, such as post office, shops, churches, GP surgeries, library etc, is about one mile away. There is limited off-road car parking available at the front of the home, with further parking on the road outside. Buses are available nearby to and from Southbourne, Bournemouth, Christchurch and beyond. Nightingales is a large detached house that has been converted to a care home, offering accommodation on the ground and first floors. A stair lift is available to assist access between floors. There are nine bedrooms for residents in the home, two of which are shared by two people. Three of the bedrooms have ensuite facilities and there is sufficient bathroom and toilet provision on both floors. The home also has a lounge, separate dining room and porch area where some residents like to sit. There is an attractive rear garden that is accessible to residents and garden furniture is available. The accommodation is comfortable and homely. 24-hour personal care is provided. Laundering of personal clothing, bed linen etc is carried out on the premises. All meals are prepared and cooked within the home. Although a choice of menu is not offered for the lunchtime meal, a Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 5 variety of alternatives are available to suit individual taste and preference. The current fees are as follows: £500- £525 per week, fees is based upon an assessment of individual’s needs. Rhodes Care Home Ltd also owns one other care home in Dorset. Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience Good quality outcomes. The key inspection was undertaken in line with the Care Standards Act 2000 and following the Commission’s Inspecting for Better Lives guidance. The purpose of the visit was to review the progress to the requirements and recommendations from the last key visit undertaken in September 2007 This visit took place on Saturday 20th September 2008, all of the key standards were inspected the visit commenced at 08:45 and lasted seven hours. The methods used during this visit included record checks, reviewing the care and associated documents for two people who live at The Nightingales, a tour of the home and discussion with people who use the service, the registered Manager and staff. What the service does well: What has improved since the last inspection? Only two recommendations were made during our last visit to the home on 19th September 2007, both had been met fully by the home. Information about these is detailed below. Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 7 The arrangement at Nightingales for the hygienic cleaning of commodes has improved. The home has installed a separate sink for hand washing in the laundry and there is now a separate sluice facility for cleaning commodes. The home should have developed a procedure to inform the staff what happens in the event of a resident requiring an emergency admission to hospital under the Mental Health Act 1983. This document provides clear guidance for those involved. What they could do better: 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 Residential Home DS0000061189.V368445.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 Residential Home DS0000061189.V368445.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, 2, 3, 4, 5, 6. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. There is comprehensive information describing the service available to individuals living at Nightingales. Individual’s needs are assessed prior to admission and these are kept under review. Each person living at the home has a contract which outlines the terms and conditions of the placement. EVIDENCE: Nightingales is a care home registered with the Commission for Social Care Inspection (CSCI) to provide personal care and accommodation for up to 11 people who have a diagnosis of dementia or a mental disorder. Mr Rhodes owns Nightingales. The home is one of two homes operated by Mr Rhodes; the other home is ‘Highview’ also located in Southbourne, Bournemouth. Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 10 Within the homes statement of purpose and service users guide there is comprehensive and clear information for people living at the home and their relatives about the services and facilities provided at the home. These documents also contained information about the staff and management arrangements at the home, information about the rights of residents; rights to privacy, to be treated with dignity and supported to maintain their independence. Information also included how individuals are supported with their admission into the home, the services and facilities provided by the home and other agencies as well as information about how to make a complaint and how individuals needs would be assessed and met. We saw within the homes completed AQAA received prior to this visit that the home plan to develop a brochure for the home, as they believe this might help prospective residents when they are making a choice about which home to move into. The manager confirmed that this brochure was still being investigated and is likely to be written in conjunction with the other home owned by Mr Rhodes. We look forward to reviewing this at our next visit to the service. There is a clear process to ensure that the service is able to meet the assessed care needs of prospective people moving to the home. There is an admission procedure, which is included in the statement of purpose and full assessments of need were undertaken. The home also has a policy on trial periods; people have between 4-6 weeks in order to decide if the home is able to meet their needs and also for the home to determine if the placement is an appropriate one. We reviewed the care and associated records for the most recently admitted person into the home and saw that a comprehensive care management assessment had been completed prior to their admission to the home. The home had used this information, as well as their own assessment and consultation with the individual in order to develop a care plan for the individual based upon their wishes and choices as well as their assessed need. Each person living at the home has a contract which outlines the terms and conditions of the placement. The manager confirmed that these contracts are in place for all of the people living at the home. We saw that the contracts outlined the facilities and services, which are provided by the home and the responsibilities of the resident. We saw that information was also given about visitors, how people would be supported if they were in ill health, insurance details and notice periods. We saw that fees are fully inclusive with the only extras that people would have to pay being hairdressing and chiropody. During our visit staff were observed interacting with individuals, using appropriate language and tone of voice. Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 11 Intermediate care is not provided at this home. Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 12 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, 10. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Individual’s personal and health care needs are being met. Individuals are protected by the home’s medication administration and practice; improvements to the medication policy would make the procedure in the event of a medication error more robust. EVIDENCE: Care files reviewed during this site visit, all showed evidence of pre-admission assessments to enable staff to develop personalised care plans for people who live at the home and record how the needs were to be met. Information recorded with the care plans included individuals how individuals would be supported with their emotional wellbeing and how they would be assisted in a way they prefer. We also saw recorded individuals special needs and religious and cultural preferences. Care plans seen were detailed and explicit and the daily report contained entries of what, when and how care was provided. Information recorded on Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 13 care documentation corresponded with information told to us by the manager about the level and individualised levels of support that people living at the home received. It was clear that support provided was flexible and tailored to individuals identified and requested support needs. The statement of purpose also recorded that individual’s civil rights are protected stating that the home would ‘ensure that all residents have full and equal access to the National Health Service’. We saw at this visit that the health needs of individual’s are well met with evidence of good multi disciplinary working taking place on a regular basis. All of those living at the home are registered with a general practitioner; evidence was in care records to confirm that individuals are supported with their primary healthcare needs such as optician, dentist and chiropody and that specialist advice is obtained when needed such as support from the district nursing service. One of the people living at the home told us that the doctor visited them when needed; this person told us that the healthcare and personal care given to them was ‘wonderful’,’ I have no complaints’, ‘we are well looked after’. A monitored dosage system of medication administration is in place at the home and this appears to work well. All of the people who live at the home are supported with all aspects of their medication. There is no controlled medication in place at this home. Records of medication administration are in place, as are photographs of people who live at the home. All staff that give medication has received training in this area. We saw that the home has a detailed medication policy and this covers a number of important areas, however this document would be improved if it contained details of who staff must contact in the event of a medication error. This must included notifying the Commission. We saw that the manger had a copy of the latest guidance in respect of medicines in care homes, which had been produced by us and also a copy of the Royal Pharmaceutical Guidelines. Demonstrating a commitment from the manager in meeting the standards in this area. It was evident at this visit that the staff are sensitive to the emotional, physical and health needs of those living at the home and through observation and discussion demonstrated respect to the wishes of individuals living at the home. Furthermore staff were observed going about their duties in a friendly and calm manner and responding to the people living in the home in a friendly, familiar style. Nightingales Residential Home DS0000061189.V368445.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, 15. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Those living at the home are enabled to maintain contact with families, friends and local communities. Choices are provided to in respect of meals and mealtimes. The home provides those living at Nightingales with structured and meaningful activities and they are able to choose whether they wish to participate or not. EVIDENCE: During this visit we saw that staff were friendly, polite and caring in their approach. They were seen to be supportive. We saw them listening to people and answering questions, providing reassurance and information as requested. We saw within the homes statement of purpose that visitors are welcome to the home. There are some people who have regular visitors others do not. The manager told us that photographs of relatives are used as prompts to support people with short-term memory difficulties in order to reassure them and remind them of visitors they have received. Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 15 During our visit one of the people living at the home went out for a walk with one of the staff members, this person told us they ‘ I had a lovely time’, ‘its lovely and sunny outside’. This person told us they often go out and have many visitors. We saw that the home were visited in May this year by an environmental health officer from Bournemouth Council, there were no concerns raised and recommendations had been dealt with. The kitchen was seen to be clean and tidy at our visit. We arrived at the home in the morning when some of the people living at the home were still having breakfast and we also sat in the dining room whilst people were having their lunch. Lunch being served was homemade spaghetti pasta with garlic bread and fresh fruit salad. We saw that people were supported and encouraged with respect and kindness by staff to eat their meals. People were offered an alternative if they did not appear to like what they were having. We saw that special dietary needs and individual’s likes and dislikes were well recorded in individual’s records and these were known to the cook and the staff. We also noticed that the daily menu was on display in the dining room this provided information for people of the meals for the coming day. In the lounge was a display cabinet with interesting memorabilia items familiar to older people such as old kitchen utensils, familiar baking brands and items of interest such as a box browning camera, this promoted discussion within the lounge with people talking to us about things they used to do and things they enjoy doing now. People told us that they enjoy knitting and participating in the quizzes and games held in the home. The homes have a dedicated activities co coordinator who organises activities based on the wishes and abilities of people living at the home. We saw that clergy who visit the home supports people with their religious beliefs. People are encouraged, where they are able, to participate in gentle exercises when ‘extend’ visit, these are people who are trained to provide gentle therapeutic exercises for older people. One lady told us ‘I enjoy the keep fit’. The manager also confirmed to us that outside entertainers also visit the home on a regular basis. Nightingales Residential Home DS0000061189.V368445.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, 18. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Complaints are responded to at this home and there are clear systems and protocols in place to protect those who live at the home from abuse. The home makes sure that as far as possible those living at the home are protected from harm by having policies and procedures. EVIDENCE: The Statement of Purpose assured people living at the home of their security that the home would ‘protect residents from all forms of abuse and from possible abusers’. We viewed the homes record of complaints and saw that there had not been any made to the home for sometime. We saw that where an issue is raised it had been responded to promptly and dealt with effectively. We had not received any complaints prior to our visiting the home and no issues or concerns were raised with us during our visit. Records of recently employed staff members were viewed and contained personal information and record of identity. Other information seen included, record of previous employment, references, protection of vulnerable adults checks and satisfactory Criminal Record Bureau disclosures. Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 17 We saw that staff had attended training about how to protect vulnerable people and this is also covered within the National Vocational Qualification undertaken by staff at the home. We saw that two of the most recently recruited members of staff had yet to complete this training, the manager confirmed that this was in hand and she would be arranging this training. Nightingales Residential Home DS0000061189.V368445.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, 2-, 21, 22, 23, 24, 25, 26. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. People at Nightingales live in a clean, homely, safe environment that reflects their choices and enables them to be involved in daily activities in the home. EVIDENCE: Nightingales is situated in a quiet residential road, within walking distance of local shops and approximately half a mile from the cliff top and coastal walks. The main centre of Southbourne with all its amenities, such as post office, shops, churches, GP surgeries, library etc, is about one mile away. There is limited off-road car parking available at the front of the home, with further parking on the road outside. Buses are available nearby to and from Southbourne, Bournemouth, Christchurch and beyond. Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 19 Since our last visit to the home we saw that the people living at Nightingales have benefited from new UPVC bay windows at the front of the house, a front conservatory, new lounge chairs, new carpets in several bedrooms and new flooring in the dining room. Demonstrating a commitment from Mr Rhodes to provide a well-maintained comfortable home for people. The lounge was comfortable and homely and there was a separate dining room for people to have their meals. The home also has a pleasant garden area for residents use; people would be supported and escorted in this area due to the fishpond. We saw a number of individual’s rooms and saw that these had been personalised with photographs, pictures, plants and soft furnishings, all were well decorated to a good standard. We noted that the home has a key pad entry and exit system linked to the front door and discussion took place about individuals restriction to leave, balanced with risk and the providers ‘duty of care’. The manager was fully aware of her responsibilities in this area. In order to ensure that the home is fully aware of the rights of people living at the home and to demonstrate that individuals movements are not restricted in line with the proposed deprivation of liberties legislation it is recommended that the home review the key pad system which is place for people who are living at the home. Lighting within the home is domestic in style and of a good standard, emergency lighting is provided throughout the home, this is checked on a monthly basis. The home has sufficient toileting and bathing/showering areas for individuals’ use. These areas are close to people’s rooms. The temperature in the home at the time of our visit was warm and comfortable. The home is appropriately adapted to meet the needs of the current group of people who live in the home. Specialist equipment has been obtained for individual’s following identified need; examples of these include mobility, sensory aids, continence aids and equipment to assist with manual handling. We also saw a stair lift and a hoist is in place to support those with limited mobility. The manager confirmed that this equipment are well maintained and are serviced by an appropriate contractor on an annual basis. It was recommended during our last visit undertaken to the service in September 2007 that the home make plans for improvement to the laundry area concerning hand washing facilities and the installation of a sluicing area. At this visit we saw that a hand washbasin had been installed in the laundry area and a separate area had facilities for the hygienic cleaning of commodes. This recommendation had been met. Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 20 At this visit all areas seen were clean, tidy and odour free. Nightingales Residential Home DS0000061189.V368445.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, 30 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home ensures that all staff have been employed following robust recruitment and selection processes. Staff are trained to support older people, and core skills have been undertaken by staff, however, staff must also undertake training in first aid to ensure those living at the home are fully supported. EVIDENCE: There is a well-established staff team at Nightingales. During the visit the manager and staff were able to demonstrate a clear understanding and knowledge of the individuals who use the service, and of their role in the home. The manager was able to demonstrate that she and the staff team have developed good relationships with those who live at the home and have a sound understanding of their needs, wishes and aspirations. These are well recorded in individual’s records. We viewed rotas for the forthcoming three weeks and saw that staffing provision appeared to be consistent with levels and skills needed due to assessed care needs of the individual’s. The staff team have a varied range of knowledge and skills, they were observed by us to be good listeners, effective Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 22 communicators and were interested and motivated in meeting the needs of those living at the home. On duty on the day of the visit was the Registered Manger Lesley Whealer; two care staff, a cook, a general handyperson and domestic staff. Mrs Lesley Whealer confirmed that at night there is a member of staff, who is awake, to support people during the night. Information contained within individual staff files were all of a consistent standard. The files for two staff were reviewed; including the most recently recruited staff member. All of the required documentation was in place in respect of robust recruitment and selection practices. The recruitment files for two members of staff were seen. It was found that all of the checks and records required under Schedule 2 of the Regulations had been complied with, including two references being taken up, a Criminal Record Bureau check and clearance from the register of people deemed unsuitable to work with vulnerable adults had been checked before the staff started working at the home. The homes completed AQAA told us that there are nine permanent care staff employed at the home, three of whom have a National Vocational Qualification (NVQ) at level two or above and a further three staff who are currently working towards this award. We read the file of the most recently appointed staff member and saw that they had completed their induction in line with the guidance produced by ‘skills for care’ this member of staff told us about their recruitment process and that they felt well supported at the home. We saw a training matrix, which showed us that staff have received training in health & safety, manual handling, infection control and basic food hygiene. Staff have also undergone training in dementia and supporting people with behaviours, which can challenge. We noted that no staff have a current first aid certificate and previous training dates for renewal had expired. In order that those living at the home are supported by staff that are fully trained in all core areas it is required that staff must receive training in first aid, this would further improve staff knowledge and skill. The manager confirmed that this training would take place and that she would arrange this for staff. During this visit we saw that staff were respectful to those who live at the home and their privacy was respected. Staff spoke to people living in the home discreetly and politely, doors were knocked before entering and staff were heard asking permission and did not presume that it was okay to enter. Nightingales Residential Home DS0000061189.V368445.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, 36, 37, 38. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The Home benefits from good management; its practices have offered protection to the health and safety of those who live at the home. The home is run in the best interests of those who live at the home ensuring that individual’s interests and rights are promoted and protected by a committed staff team. EVIDENCE: Nightingales is privately owned and is the second care home of the proprietor. Mr Rhodes who also owns ‘Highview’ which is also located on Southbourne, Bournemouth. Mrs Lesley Whealer took over as Registered Manager of the home in September 2007. Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 24 Mrs Whealer is experienced, appropriately qualified and committed to improving the quality of life for the people who live at the home. People living in the home spoke positively of the care provided. Practice observed was of good relationships between those who live at the home, staff and management. Mrs Whealer fully engaged with us during this visit and was able to locate all necessary information and documents easily. This evidences that the home has good systems in place and is well run. Prior to the site visit the Commission received from the registered provider a completed annual quality assurance assessment. The annual quality assurance assessment (AQAA) is a process that is being used for all regulated services from April 2007. The AQAA is in two parts: Part one is a self-assessment, part two is a dataset. It is a legal requirement for all services to return an AQAA to the Commission. The document received from the registered was fully completed and sufficiently detailed. In response to the question within the AQAA ‘What the service does well’, the response from the home was; ‘We are a needs led service that is committed to the ongoing improvement in all areas’. The company employs an administrator, who, as stated within the homes completed AQAA ‘assures sound management of service users finances’. As this visit took place on a Saturday records of residents money held at the home for safekeeping were not available. The manger assured us that records were well maintained, receipts were kept and only the administrator and Mr/s Rhodes had access to individual’s money. Staff files also contained evidence of supervision and positive comments were noted in the feedback to staff. Frequency of supervision was generally good and staff had received the required sessions. Areas of discussion included guidelines and policies of the home, individual’s expectations and an evaluation of their performance and how this can be developed. It was recommended during our last visit to the service undertaken in September 2007 that the home develops a procedure for emergency admissions to hospital under the Mental Health Act 1983. We saw that this procedure had been developed it was sufficiently detailed to protect the rights of residents and to inform and guide staff practice. The completed AQAA for the home also confirmed that the pre admission assessment include a reference to this Act to ensure this was fully covered with individuals upon their admission to the home. Risks for those who live at the home are recorded, however these assessments are not always clear. In order that all are fully aware of potential risks and how these should be managed it is required that risk assessments have clearer links to the care plans of those individuals who live at the home. Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 25 We viewed the fire logbook for the home. The home was completing the appropriate checks on the fire equipment and the recording of fire drills and the testing of equipment were satisfactory. We saw the fire panel in working order. In order that those living and working at the home can be confident that fire procedures at the home are robust the home should include within the homes fire risk assessment and policy what the procedure is should a fire occur at night. Nightingales Residential Home DS0000061189.V368445.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 3 3 3 3 3 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 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 2 Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A 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 OP38 Regulation 4(C) Requirement Risks for those who live at the home must clearly show how these are managed in accordance with individuals plan of care. Staff must receive training in first aid in order that they are equipped with the knowledge and skills needed to perform their duties. Timescale for action 20/10/08 2. OP30 18 (1) c (i) 20/12/08 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. 2. 3. Refer to Standard OP38 OP9 OP19 Good Practice Recommendations The homes fire risk assessment & policy should include what the procedure is at night. The homes medication policy should include who should be contacted in the event of a medication error. Consideration should be given to the use of a ‘key pad’ entry and exit system, which is linked to the front door. Nightingales Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Residential Home DS0000061189.V368445.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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