We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

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1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Florence Nightingale Care Home 60 Village Street, Normanton, Derby, DE23 8SZ Tel: Date of Inspection: 17 June 2014 Date of Publication: July 2014 We inspected the following standards as part of a routine inspection. This is what we found: Care and welfare of people who use services Management of medicines Requirements relating to workers Staffing Supporting workers Assessing and monitoring the quality of service provision Met this standard Met this standard Action needed Met this standard Action needed Action needed Inspection Report Florence Nightingale Care Home July

2 Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activities Entercare Limited Mrs Keilash Vati Mcilwee This is a newly purpose built care home. It has facilities on all three floors including bedrooms, shower rooms and bathrooms. The home is able to cater for a maximum number of 20 people male and female. The provider has applied to the Care Quality Commission to change their regulated activities to a care home without nursing. This means that nursing care is not provided by the staff at the home. Care home service with nursing Accommodation for persons who require nursing or personal care Diagnostic and screening procedures Treatment of disease, disorder or injury Inspection Report Florence Nightingale Care Home July

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 What we have told the provider to do 6 More information about the provider 6 Our judgements for each standard inspected: Care and welfare of people who use services 7 Management of medicines 9 Requirements relating to workers 11 Staffing 12 Supporting workers 13 Assessing and monitoring the quality of service provision 14 Information primarily for the provider: Action we have told the provider to take 16 About CQC Inspections 19 How we define our judgements 20 Glossary of terms we use in this report 22 Contact us 24 Inspection Report Florence Nightingale Care Home July

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 17 June 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and reviewed information given to us by the provider. We talked with commissioners of services and talked with other authorities. What people told us and what we found There were six people using the service which was registered for up to 20 adults over 65 years. This was the service's first inspection since the provider's registration in Our inspection was unannounced and because of concerns raised we responded to the concerns by bringing the inspection forward. The service was in a state of transition as it had removed nursing care from its provision on 13 June The registered manager was no longer employed by the provider. This meant the provider was in day to day charge of the service. The provider was also responsible for the daily meals of people who used the service. Staff told us being responsible for the shifts was a new challenge for them and they needed time to adjust to this. People using the service told us that they "missed the nurses for advice", although the care staff were helpful to them. This meant there were levels of uncertainty for people using the service and staff about how the service was to be run. As part of our inspection we spoke with six people who used the service. We also spoke with two health care professionals, four members of staff and the provider who was managing the service daily with a senior care worker. We considered all the evidence we gathered under the outcomes we inspected. We used the information we always ask; Is the service safe? We looked at the suitability of the environment to ensure people lived in a home where the décor and environmental standards were appropriate. We found the home was clean, safe and well maintained but there was a smell from the downstairs drains that lingered in the corridor. The provider told us he would attend to it. All the necessary recruitment checks had been completed prior to staff commencing their Inspection Report Florence Nightingale Care Home July

5 employment at the home before the changes. Following the changes the recruitment practices in place were not as safe as new staff had not been through a thorough vetting process. This meant there was a potential risk to vulnerable adults of unsuitable staff working with them. Medicines used at the home were stored and administered safely. On talking with staff they told us that they would benefit from further training information around the management of medicines. One person spoke about their medication they said "They're very, very good with that". This meant people were appropriately supported and we found medications were administered and stored in a safe way. We found a small number of recording errors for when medicines were administered and for the return of some prescribed items. We bought these to the attention of the senior and provider for further investigation. During the day time to ensure people were safe there was at least one member of staff in the lounge area. One person told us "Everyone tries to help you" and another person said "Staff are around when you need them and this makes me feel safe". Another person told us there were "Enough staff on duty when they needed them and if they ever had to wait for assistance the staff were always pleasant and helpful". This meant people were supported by staff who could meet their needs. The Mental Capacity Act 2005 (MCA) is a law providing a system of assessment and decision making to protect people who do not have capacity to give consent themselves. We were told by the provider there was no one who needed a Deprivation of Liberty Safeguard. This is where a person is restricted of their freedom and considerations are made in the person's best interest. Is the service effective Staff were not always supported to provide care to the people using the service. This was because they had not had sufficient time to prepare for the transition for being in charge of the shifts now that nurses were no longer employed at the service. The provider was also busy covering shifts in the kitchen whilst supporting senior care workers with the management of medications, should one of their experienced managers not be available at the home. We found that less experienced care workers were not always being supervised by senior staff and we saw a staff member who applied a topical medicine for a person without wearing protective equipment for their hands. This meant the ability to monitor staff's performance was difficult to oversee on a regular basis and further development of the systems in place for staff support was needed. Is the service caring? We observed staff during the inspection. We saw staff had warm and friendly relationships with people using the service. We observed people's care and support during the visit and saw that they were well supported. People we spoke with told us they were satisfied with the care and support they received and we saw they were usually treated respectfully. Is the service responsive? Inspection Report Florence Nightingale Care Home July

6 During the inspection visit we spoke with a person who was receiving specific treatment. They told us staff gave them their medicines when they needed them and checked that they were not experiencing any problems by checking their treatment levels twice a day. People told us staff supported them when they needed their help. This included applying medicated creams when they were in discomfort. People told us they had no cause to complain as their needs were being met by helpful supportive staff. A complaints procedure was available for people to use although we found that it may need to be placed in a number of prominent positions throughout the home due to the home's design and being built on three floors. Is the service well led? Not all quality monitoring systems were available for us to see during the inspection. The provider explained that they helped to monitor the medications with the senior care worker in charge. This was done by checking medicines were handled correctly and kept safely. People told us they were given their medicines when they needed them. Information to confirm the employer's liability insurance was up to date was sent to us as requested following our visit. Other information to confirm that servicing at the home took place and was up to date was also sent to us by the provider. The quality of the service that people received was managed in their best interests although the documentation for this was not always organised for the purposes of monitoring. Below is a summary of what we found. To see the evidence supporting our summary please read the full report. You can see our judgements on the front page of this report. What we have told the provider to do We have asked the provider to send us a report by 27 August 2014, setting out the action they will take to meet the standards. We will check to make sure that this action is taken. We have referred our findings to Local Authority: Commissioning. We will check to make sure that action is taken to meet the essential standards. Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take. More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Florence Nightingale Care Home July

7 Our judgements for each standard inspected Care and welfare of people who use services Met this standard People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. People experienced care, treatment and support that met their needs and protected their rights. Reasons for our judgement We saw people undertaking activities of their choosing, such as reading newspapers and those people who wished to stay in their own room did so. We saw that the meal time was a pleasant experience for people and that those people requiring support were assisted properly. People told us they enjoyed their food. One person told us "The food is very good". Other comments from people using the service included: "Staff are brilliant", "It's very, very good here", "The place is nice but I'm bored", "I've no complaints", "It's all very pleasant", "Staff chat to me when they have time but they're busy". A visitor said the staff were pleasant and welcoming. We looked at three people's care records. We saw that the records were up to date and that risk assessments for key areas such as falls, nutrition and pressure ulcers were updated monthly. There were corresponding care plans in place where a risk had been identified that gave clear instructions to staff on how to provide the care. We saw that where people had specific medical needs there were clear instructions for staff on how to meet this need. We saw that visits by health professionals such as General Practitioner, optician and chiropodist were organised as required. The provider informed us that the district nurses were now aware of the changes at the home and were able to support people living there. An external health professional we spoke with confirmed that the service acted on their advice and that people's care and health needs were addressed. They told us "The staff appear kind and attentive", and they confirmed that the care needs of the person they were involved with had been met. In this way people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. During this inspection visit one person was seen by a health care professional who visited a person using the service. Staff did not direct them to a private room so that the person Inspection Report Florence Nightingale Care Home July

8 could have their consultation in privacy. This meant people's care and treatment was not always delivered in a way that ensured people's welfare. The provider confirmed that senior care staff were trained to deal with first aid situations and all staff had fire safety training. The provider confirmed that they were available to staff 24 hours each day and because of this there were arrangements in place to deal with foreseeable emergencies. Inspection Report Florence Nightingale Care Home July

9 Management of medicines Met this standard People should be given the medicines they need when they need them, and in a safe way Our judgement The provider was meeting this standard. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Reasons for our judgement We looked at the medication sheets for all six people, to see if there were any unexplained gaps. The provider may find it useful to note that there were one or two unexplained gaps pre 13 June We noted that two types of Medication Administration Records (MAR) were in use when new people came to the home. The medication trolley was locked when the staff member was away from it. This helped to ensure that medications could not be accessed inappropriately. When the medicine trolley was stored on the upper floor there was nowhere to fasten the trolley to the wall. The provider may wish to revisit this aspect of medication safety. We saw medicines were prescribed and given to people appropriately. We checked the controlled medication. It was checked and stored appropriately. It was no longer required by the person as it had not been given for over a month; however the provider may wish to note that the need for this had not been reviewed. We found that when people had been transferred to nursing establishments some of their prescription medicines such as catheters or dressings had not all been sent with them. This meant that the provider had not returned them in the correct way to the supplying pharmacist for the home. A lockable refrigerator specifically for storage of medicines was available. The temperature of the refrigerator was in built. In this way staff were able to check that medication requiring cold storage was being stored in accordance with the manufacturer's instructions. Currently there were no medicines in the medicines fridge. The provider had a medication policy and procedures for staff to follow. We saw that two staff who administered medications had completed training in July The provider assured us that all staff as appropriate had received medication training. The provider informed us that they have a level two qualification in the safe handling of medication and was able to support staff when required. Inspection Report Florence Nightingale Care Home July

10 A list of staff signatures for staff who gave medicines was in place. This enabled the provider to check if errors had taken place and the responsible staff member would be identified. We saw a list of people's names had been created and placed in the front of the medicines folder. This was to act as a reminder to all staff administering medicines. However this list had not been updated to include the care staff who now gave medicines. We saw that when people required cream to be applied to their body, it was not recorded where the cream should be applied. People using the service were asked by staff where they wanted their cream to be applied. This meant that there was a risk of cream being inappropriately applied. The member of staff with responsibility for medicines told us they carried out weekly checks on medicines to ensure they were ordered correctly, delivered and stored safely. We found some items had not been returned correctly. The provider may wish to ensure medication audits coincide with the medications being delivered and returned to the dispensing pharmacist and to keep the documentary evidence to support this. Inspection Report Florence Nightingale Care Home July

11 Requirements relating to workers Action needed People should be cared for by staff who are properly qualified and able to do their job Our judgement The provider was not meeting this standard. Effective recruitment and selection processes were in place however they were not always followed. This meant people were at risk of receiving care from staff that were not fully checked as being safe to work with vulnerable adults. We have judged that this has a minor impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement We looked at the records of three care workers at the home. We found two of the care workers had been appropriately recruited and safety measures and checks had been undertaken. During the inspection we met a new care worker whose induction had taken place the day before. This was their first day working with people who used the service and the provider had not ensured that the first part of the clearance from the Disclosure and Barring Service had been completed. This is a government agency that checks people's names against a register to ensure they have been cleared to work with vulnerable adults. Other checks were seen and were satisfactory. This meant people were at risk of receiving care from staff who were not fully checked as being safe to work with vulnerable adults. The provider told us they would send evidence of the new workers having a current DBS and they have sent this to us. Inspection Report Florence Nightingale Care Home July

12 Staffing Met this standard There should be enough members of staff to keep people safe and meet their health and welfare needs Our judgement The provider was meeting this standard. There were enough qualified, skilled and experienced staff to meet people's needs. Reasons for our judgement It was clear from discussions with people that they felt comfortable with the support provided to them and staff had built a good rapport with the people using the service. One person commented, "They are all friendly and helpful, it's a pleasure to see them". Most people told us they did not have to wait long for assistance and that staff, including the night staff, came promptly when they were called. One person said the longest period they had ever had to wait for assistance was ten minutes and it was usually much quicker. However, the provider should note that one person told us they needed assistance quickly when requiring the toilet and this did not always occur in a timely way resulting in the person being in discomfort. The provider may find it useful to consider the design of the building and the amount of time it may take for staff to reach this person. There were six people at the home during this inspection visit none required nursing care. There were 11 care staff, one secretary, one senior care worker as the acting manager and the provider. Since this inspection the provider has informed us further staff have been employed including one kitchen staff member and there are now five people living at the home. We looked at the staff rota for the weeks 26 May June This showed us there were two care staff designated for the morning shift and afternoon shift and one waking and one sleep-in member of staff at night. This was consistent with the number of staff available during this inspection visit. The rotas confirmed that from 14 June 2014 no nurses were providing care and the provider told us that everyone who had been reassessed as requiring nursing care had been moved out of the home. The provider may find it useful to note that for visitors to the home it would be helpful to have a system in place that identifies the person in charge of the shift and this could also be added to the rota. Inspection Report Florence Nightingale Care Home July

13 Supporting workers Action needed Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was not meeting this standard. At the time of our inspection visit people were not always cared for by staff who were sufficiently supported to deliver care and treatment safely and to an appropriate standard. We have judged that this has a minor impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement We looked at staff supervision records and saw that six care staff had received supervision in the last three months. It was clear from the records what areas had been discussed. Two of the three staff records we looked at showed training had taken place for staff. The new care worker was being trained by staff on duty and able to watch a DVD for their learning until the mandatory training was commenced with the training company appointed by the provider. Since our inspection visit the provider has written to inform us that further training has been arranged for all staff with an external training company. This will include all mandatory training and the safe administration of medication for all staff up to a level two and will be completed by the 11 July Further training for the level three in social care for the staff will be commenced and training the new manager to a level five in social care qualification will be commenced, and certificates will be available as part of their documentary evidence of training for staff. The provider has also informed us that an experienced manager from another service in the group is willing and able to help with managerial duties at the home and hopes to register with the Care Quality Commission. Inspection Report Florence Nightingale Care Home July

14 Assessing and monitoring the quality of service provision Action needed The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was not meeting this standard. The provider did not have an effective system to regularly assess and monitor the quality of service that people receive. We have judged that this has a minor impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement The provider had not obtained any feedback from people using the service. A satisfaction survey was developed during our inspection visit that the provider said they would put into practice as soon as possible. This meant that at the time of our inspection people's views were not captured so that improvements to their care and treatment could be analysed and acted on. We saw records that showed there had been staff meetings in November 2013, January 2014 and March The records showed that areas such as infection control practice and confidentiality were discussed. This showed that staff had the opportunity to participate in discussions about important issues about the service. The provider sent us information to confirm that they complied with all safety standards in relation to the building. This included Portable Appliance Testing and other equipment less than a year old that did not require a test. The five year electrical check for the building was not needed as the building was new and just over a year old. The gas safety check was completed on 28 March The fire alarm service was due August 2014 and the fire alarm was tested every week. The date of the first fire risk assessment was on 2 April 2013 and the last one was on 25 June The date of the fire officers last visit was October 2013 and the fire safety audit report asked for work required to satisfy fire safety risk assessments, this was carried out and the provider has told us this is now completed. Portable extinguishers were checked on 20 March 2014 and the invoice was shown to us. The hoist service check that was due every six months had not been serviced in May 2014 because they were not under contract. The provider told us that a new contract for this year will be revisited. However, the hoists were not being used at this moment in time as there was no person at the home that needed a hoist. The provider told us the lift was serviced every six months. The legionella risk assessment was considered but there were Inspection Report Florence Nightingale Care Home July

15 no stored water in tanks in the roof space. All water came from boilers which were stored at above 60 degrees Celsius and returns at 54 degrees Celsius therefore no testing was needed. The provider confirmed all risk assessments for the home were up to date. We saw the provider did not have a clear system in place to assess and monitor the quality of the service. Records were often not attainable or not found during our inspection visit to indicate that audits or checks were undertaken to ensure the service provided was to a good standard. However, kitchen records were available to show that daily cleaning schedules were undertaken and we saw records of refrigerator temperatures that showed theses were operating safely. The kitchen at the home was awarded a five star rating from Derby City environmental health in April An infection control audit was carried out on 16 February The provider told us they undertook visual checks of the building and undertook any necessary repairs but we saw no records to verify this. We did not see any audits that showed medication and care records were checked to ensure they were up to date and there was no analysis of any accidents or incidents that had occurred. The provider had also not been notifying us at the Care Quality Commission of important events occurring in the service, as legally required. People we spoke with told us they would discuss any concerns with staff or the provider and felt they would be listened to. However, several did not know how to make a formal complaint. The provider told us he would act on any issues brought to his attention straight away. He said he had not received any complaints and we saw there were no records of any informal issues raised. Since our inspection visit the provider has confirmed there were no known complaints in the last twelve months and there have been no safeguarding referrals. Inspection Report Florence Nightingale Care Home July

16 This section is primarily information for the provider Action we have told the provider to take Compliance actions The table below shows the essential standards of quality and safety that were not being met. The provider must send CQC a report that says what action they are going to take to meet these essential standards. Regulated activities Accommodation for persons who require nursing or personal care Diagnostic and screening procedures Treatment of disease, disorder or injury Regulated activities Accommodation for persons who require nursing or personal Regulation Regulation 21 HSCA 2008 (Regulated Activities) Regulations 2010 Requirements relating to workers How the regulation was not being met: The registered person must (a) operate effective recruitment procedures in order to ensure that no person is employed for the purposes of carrying on a regulated activity unless that person (i) is of good character, (ii) has the qualifications, skills and experience which are necessary for the work to be performed, and (iii) is physically and mentally fit for that work; (b) ensure that information specified in Schedule 3 is available in respect of a person employed for the purposes of carrying on a regulated activity, and such other information as is appropriate; (d) take appropriate steps in relation to a person who is no longer fit to work for the purposes of carrying on a regulated activity. Regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Regulation Regulation 23 HSCA 2008 (Regulated Activities) Regulations 2010 Supporting workers Inspection Report Florence Nightingale Care Home July

17 This section is primarily information for the provider care Diagnostic and screening procedures Treatment of disease, disorder or injury Regulated activities Accommodation for persons who require nursing or personal care Diagnostic and screening procedures Treatment of disease, disorder or injury How the regulation was not being met: (1) The registered person must have suitable arrangements in place in order to ensure that persons employed for the purposes of carrying on the regulated activity are appropriately service users safely and to an appropriate standard, including by (a) receiving appropriate training, professional development, supervision and appraisal; Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Regulation Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010 Assessing and monitoring the quality of service provision How the regulation was not being met: (1) The registered person must protect service users, and others who may be at risk, against the risks of inappropriate or unsafe care and treatment, by means of the effective operation of systems designed to enable the registered person to regularly assess and monitor the quality of the services provided in the carrying on of the regulated activity against the requirements set out in this Part of these Regulations; (2) For the purposes of paragraph (1), the registered person must have regard to (iii) the information contained in the records referred to in regulation 20, (e) regularly seek views (including the descriptions of their experiences of care and treatment) of service users, persons acting on their behalf to enable the registered person to come to an informed view in the standard of care and treatment provided to service users. Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations Inspection Report Florence Nightingale Care Home July

18 This section is primarily information for the provider The provider's report should be sent to us by 27 August CQC should be informed when compliance actions are complete. We will check to make sure that action has been taken to meet the standards and will report on our judgements. Inspection Report Florence Nightingale Care Home July

19 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Florence Nightingale Care Home July

20 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Florence Nightingale Care Home July

21 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Florence Nightingale Care Home July

22 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Florence Nightingale Care Home July

23 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Florence Nightingale Care Home July

24 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report Florence Nightingale Care Home July

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