Nightingale House Care Home Service Adults 154-158 Main Street Auchinleck Cumnock KA18 2AS Telephone: 01290 425790 Inspected by: Alison Iles Lorraine McIntyre Type of inspection: Unannounced Inspection completed on: 18 March 2013
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 10 4 Other information 19 5 Summary of grades 20 6 Inspection and grading history 20 Service provided by: Mohammad Shafique Service provider number: SP2003000144 Care service number: CS2003000771 Contact details for the inspector who inspected this service: Alison Iles Telephone 01294 323920 Email enquiries@careinspectorate.com Nightingale House, page 2 of 22
Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 4 Good Quality of Environment Quality of Staffing N/A N/A Quality of Management and Leadership 4 Good What the service does well This service has a static staff team. This ensures that the staff know resident's needs, likes and dislikes and ensures that there is continuity in the care provided. Management and staff build up positive relationships with residents and their families. Staff access a range of relevant training opportunities throughout the year. What the service could do better The service need to further develop how they involve residents, their relatives and relevant external agencies in taking the service forward. This is recognised by the service as an area for development. They should also look at producing a development plan that shows how they plan to take the service forward in the coming months and years. Consideration needs to be given to address the need to review and upgrade/refurbish areas of the home within this plan as well as take into account feedback from residents and relatives in relation to the environment. Nightingale House, page 3 of 22
What the service has done since the last inspection Inspection report continued The service has worked on addressing areas highlighted by us at previous inspection. There remains a commitment to work to continually improve the service to meet the care and support needs of those who live in the home. Conclusion As previously stated this service continues to take on board any feed back given by us in order to improve the overall service. Our findings from this inspection have demonstrated that the management team is responsive and that it has managed to continue to move the service forward. Feedback we received from residents continues to highlight that staff work well to meet their individual care and support needs. Who did this inspection Alison Iles Lorraine McIntyre Nightingale House, page 4 of 22
1 About the service we inspected Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body, the Care Inspectorate took over the work of the Care Commission, including the registration of care services. This means that from 1 April 2011 this service continued its registration under the new body. The history of grades that the service had previously been awarded, by the Care Commission, is available on the Care Inspectorate website. Nightingale House is a privately operated Care Home for Older People situated in the centre of the town of Auchinleck in East Ayrshire, within easy access to local shops, community facilities and public transport. The care home was extended in 2005 which increased the number of registered places from 19 to 35, which included 4 respite places. In August 2010 the Provider reviewed the aims and objectives of the service to state that they would no longer provide a care home service that included nursing care. Accommodation is provided over two floors, connected by a passenger lift. There are 23 single and 6 twin rooms, 19 of which have en suite facilities. The majority of the double rooms are being used for single occupancy. The home has a choice of sitting areas and has a safe enclosed garden to the rear of the building. At the time of the inspection 25 people were residing in the care home. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Environment - N/A Quality of Staffing - N/A Quality of Management and Leadership - Grade 4 - Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices. Nightingale House, page 5 of 22
2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection We compiled this report following an unannounced inspection. The inspection was carried out by Inspectors, Alison Iles and Lorraine McIntyre. The inspection took place on the 18 March 2013 between 9.20am and 3.45pm We provided feedback to the provider, manager and depute manager on the day of the inspection. We gathered evidence from various sources, including the following: * observing how staff work * personal plans of people who use the service * health and safety records * meeting minutes for those who use the service and staff * accident and incident records * discussions with various people, including: - manager - care staff - the people who use the service * examining equipment and the environment. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects Nightingale House, page 6 of 22
of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org Nightingale House, page 7 of 22
What the service has done to meet any recommendations we made at our last inspection One recommendation was made at the last inspection. This related to management reviewing and updating the homes Brochure. The homes brochure had been reviewed and updated since the last inspection. This recommendation is met. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. A self assessment was not requested as part of this inspection. Taking the views of people using the care service into account Residents spoke with at this inspection generally spoke positively about their experiences of Nightingale House. The spoke highly of the care and support they received from the staff team and commented on the quality of food. Those spoken with advised that they were asked their views on the service and had recently been involved in choosing some new furnishings for the home. Residents made the following comments: * Its smashing here * Staff are just great * Plenty to eat always get tea and snacks * Will get out when weather is better * Plenty to do inside Nightingale House, page 8 of 22
* Enjoy other peoples company * First experience in home and its been ok * Great place * Staff are wonderful * My room is beautiful * I am very happy here * Staff are just the best * No complaints just very happy. Taking carers' views into account No relatives were spoken with during this inspection. However a number had recently completed a suggestions survey form for the home and had made the following comments: * Care is first class * Dinning and sitting areas are in need of a face lift * Friendly welcoming atmosphere * Décor leaves a lot to be desired * More activities required * Nicer décor in dining area to make it much brighter and inviting * Back garden in need of a make over. Nightingale House, page 9 of 22
3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths Taking into account the evidence presented and discussions with those who used the service, relatives and staff, the service have retained the grade of good in relation to this Quality Statement. We remain confident that the service continues to demonstrate a commitment to involving others in improving what it offers. For example, the company's participation strategy sets out the ways in which the home involves those who use the service, their representatives and outside agencies, such as health and social work, in influencing the way it provides the service. Residents continue to have personal care plans in place that detailed their care and support needs. There continued to be evidence that those who used the service or their relatives had been involved in the development and review of the plans. Regular resident and relative meetings took place. From the minutes of these meetings and discussions with residents we could see that the service had frequently consulted residents and families about what was happening in the service. Relatives and residents had recently provided feedback on the service and had suggested areas for improvements. Management were in the process of developing an action plan on how these suggestions would be taken forward in the service. The management team had had an open-door policy that allowed relatives and residents to raise any issues/concerns at any time. A complaints procedure was in place. Information on advocacy continued to be Nightingale House, page 10 of 22
displayed in the home for any resident or relatives who might have a need for this service. Areas for improvement Inspection report continued The service were aware that they needed to continually review the ways in which it consulted with people about the service provided and that they would continually review and update their participation strategy to reflect this. As part of this the service should consider developing ways in which it can gauge the views of those service users with memory impairments as well as how it can engage other service users and carers who do not attend the service user/relative meetings. This will provide the service with a broader response of peoples views and wishes in terms of changes being made to the service (see recommendation 1 and 2). Although the service could show that regular meetings took place with residents regarding the service provided it was not possible to evidence that where actions were identified that residents were being kept informed if the actions had been completed or any reason for delays. The service should consider bringing the action plan forward to the next meeting to ensure that people are kept up-to-date with any changes previously agreed or provided with an explanation as to why something has not been achieved. This will ensure that residents are kept fully informed of progress being made. Although the service had a complaints procedure there were a number of versions of this available in the home. The manager should ensure that only the current and most up-to-date version is available to all who use, visit or work in the service. At the last inspection we highlighted improvements that could be made in relation to signage on residents doors as this would help those who tended to be more confused when walking round the building. At this time the manager had advised that they planned to develop Memory boxes to assist residents in this area. At the time of this inspection the manager was clear it was still part of their agenda in terms of improvements to the home but their was no timescale available for this work to take place. Management should consider incorporating this in to the services development plan that has been suggested under Quality Statement 4.4. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The service should consider and implement a strategy on how they plan to gauge the views of those service users with significant memory impairments. Nightingale House, page 11 of 22
National Care Standards: Care Homes for Older People Standard 11 Expressing Your Views. 2. The service need to develop ways in which it can engage other service users and carers who do not attend the service user/relative meetings. National Care Standards: Care Homes for Older People Standard 11 Expressing Your Views Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths The service had maintained the grade of good in relation to this Quality Statement. The service had been able to maintain improvements in ensuring that it met resident's health and well being needs. This remained evident in personal care plans, and was confirmed in our discussions with residents and through our observations. Within this service the residents all appeared to be well cared for. The atmosphere in the home was calm and peaceful. Staff were supporting people in a dignified, appropriate and unhurried manner. People were dressed in a way which looked comfortable and dignified. Personal plans were in place for all residents and from the sample seen at the inspection contained clear information regarding resident's health care needs. A range of health care assessments were completed on a regular basis. These covered areas such as nutrition and continence. There was evidence of regular communication with a range of health professionals. The support plans were reviewed monthly and we saw evidence that where change was necessary, it took place. Where people required assistance to meet their health needs this was provided by staff. Staff were observed to interact well with residents and attended to peoples personal needs. Residents also told us that the quality of the food was good. We observed very good practice by staff during lunch whereby residents were offered choice and were supported to enjoy their meals. Staff training was ongoing and relevant to meet the needs of the resident group. Nightingale House, page 12 of 22
Areas for improvement We were unsure how issues and actions identified at care reviews were carried forward and actioned by the service. The service should consider how it can ensure that where issues are raised that they can demonstrate that these have been addressed as quickly as possible and reflected in the individuals personal care plan. From the sample of personal plans looked at it was not always clear if the person acting on behalf of the residents had legal authority to do so. The service must ensure that this is clearly documented and ensure that they receive a copy of the authority to ensure that they act within the guidance of this. We examined records in relation to the administration of medication to residents. We found that these records were not always being completed in line with good practice guidance available. This included hand written entries that did not detail how or when the medication should be given. The service needed to ensure that they followed the relevant guidance in relation to the recording of medication (see recommendation 1) Where people were prescribed medication to assist with managing pain there was no evidence of a care plan or pain management tool in place to assist the service to monitor the effectiveness of this medication. The service had worked with the GP practice to have the appropriate documentation completed to allow residents to receive medical treatment where the individual was unable to give consent to treatment. As an area for improvement the service should work with the GP practice to ensure not only that the relevant certificate is in place but also that a treatment plan is attached specifying what treatment is covered. This is in line with the recommendation in the Code of Practice for practitioners authorised to carry out medical treatment or research under part 5 of the Adults with Incapacity (Scotland) Act 2000, issued by the Scottish Ministers. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The service provider should ensure medicines are managed according to recognised best practice. To do this they should ensure that: * all handwritten entries on MAR charts should be signed and dated by person making the change, and referenced to indicate where the handwritten information was obtained, or the authority for any change of dose. * where there are instructions such as "5 or 10ml", "one or two" the actual dose given should be recorded. National Care Standards Care Homes for Older People 5.12, 15.6, 15.7 and 15.9 Nightingale House, page 13 of 22
Quality Theme 2: Quality of Environment - NOT ASSESSED Nightingale House, page 14 of 22
Quality Theme 3: Quality of Staffing - NOT ASSESSED Nightingale House, page 15 of 22
Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths Taking in to account the evidence presented at this inspection the service achieved a grade of good in relation to this Quality Statement. See the comments made under Quality of Care and Support 1:1 in relation to participation. Questionnaires completed by residents and relatives continue to indicate that they were very happy with the manager of the service and felt that any issues taken to them were quickly addressed. The service had questionnaires for professional visitors such as district nurses and social workers to complete that sought on their views of the service. There were also questionnaires for guests and visitors. These were aimed at ensuring that the service could obtain views from a range of people about the service provided at Nightingale House. The home had a statement of aims and objectives which were included in the services brochure. This detailed what the home planned to provide for residents and set out how this would be achieved. Areas for improvement See the comments made under Quality of Care and Support 1:1 in relation to participation. Management need to review the methods used to ensure a broader response to all areas, particularly around staffing and management. This is an area that requires some work. Management were aware that this needed to be given some priority and we will follow up if this has been achieved at the next inspection. Although the service had questionnaires for external professionals to comment on the home there needs to be a more proactive approach taken to actively encourage people to complete these or comment in other ways on the service provided. The service should then be able to show that any views expressed are taken in to account and shared with residents as appropriate. Nightingale House, page 16 of 22
The service will be asked to submit a self assessment document to us prior to the next inspection. As an area for development they need to consider how they can involve the residents, relatives and staff views when they are completing this document. This will allow them to show that they have discussed the areas covered in the self assessment with all relevant parties and that their views are reflected in the evidence submitted (see recommendation 1). Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The service should be able to demonstrate how service users, carers and staff are involved in completing the self assessment. National Care Standards Care Homes for Older People Standard 11: Expressing Your Views Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide. Service strengths The service had achieved the grade of good in relation to this Quality Statement. The service was aware of their responsibilities to notify the Care Inspectorate, Scottish Social Services Council regarding any notifiable incidents. This included any unto ward incidents in the home as well as issues of staff practice. The management team could clearly evidence that any issues raised by residents or relatives were being clearly addressed. They continue to have a good presence in the service. Residents and relatives knew them and spoke highly of them. The service had build on the range of audits they carry out as part of there Quality Assurance processes. These included audits in relation to the accommodation as well as audits relating to health care of residents such as medication. There was evidence that where issues were raised in these audits that action was taken to address them. The service submitted its self assessment and annual return to us when requested. Areas for improvement An area for improvement relates to the further development of the quality assurance systems currently in place to ensure that they cover all aspects of service provided and can clearly reflect discussion with residents, their representatives, staff and stakeholders. This should allow the service to clearly show what it does well and what Nightingale House, page 17 of 22
it needs to improve on. The service should consider creating a development plan for the home that clearly identifies the homes priorities over the coming years. This should clearly show how they planned to address issues highlighted through the services own questionnaires, internal audits and inspections. This could be developed and shared with residents, their relatives and staff to show what the priorities would be for the home and demonstrate how and by when they planned to address these (see recommendation 1). Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should bring together a development plan that shows how they plan to move the service forward in the coming months and years. This should be done following consultation with residents, their relatives and staff and take account of feedback already received in relation to the environment. National Care Standards Care Homes for Older People Standard 5: Management and Staffing Nightingale House, page 18 of 22
4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Nightingale House, page 19 of 22
5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 3 4 - Good 4 - Good Quality of Environment - Not Assessed Quality of Staffing - Not Assessed Quality of Management and Leadership - 4 - Good Statement 1 Statement 4 4 - Good 4 - Good 6 Inspection and grading history Date Type Gradings 23 Apr 2012 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership Not Assessed 23 Nov 2011 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate 30 May 2011 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate 23 Nov 2010 Unannounced Care and support 2 - Weak Environment 2 - Weak Staffing 2 - Weak Management and Leadership 2 - Weak Nightingale House, page 20 of 22
9 Sep 2010 Announced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 2 - Weak 24 Jun 2010 Re-grade Care and support Not Assessed Environment Not Assessed Staffing Not Assessed Management and Leadership 2 - Weak 2 Nov 2009 Announced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate 1 May 2009 Unannounced Care and support 1 - Unsatisfactory Environment 2 - Weak Staffing 2 - Weak Management and Leadership 1 - Unsatisfactory 1 Dec 2008 Care and support 2 - Weak Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate 5 Sep 2008 Care and support 3 - Adequate Environment 3 - Adequate Staffing 2 - Weak Management and Leadership 2 - Weak All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Nightingale House, page 21 of 22
To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on 0845 600 9527. This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: www.careinspectorate.com or by telephoning 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com Nightingale House, page 22 of 22