Inspection on 10/03/10 for Swarthmore

This is the latest available inspection report for this service, carried out on 10th March 2010.

CQC found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Swarthmore 17/05/07

Swarthmore 13/02/06

Swarthmore 27/09/05

Swarthmore 02/03/05

Swarthmore 08/09/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: Swarthmore Marsham Lane Gerrards Cross Bucks SL9 8HB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Maureen Richards     Date: 1 0 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Swarthmore Marsham Lane Gerrards Cross Bucks SL9 8HB 01753885663 01753891645 carehome@swarthmore.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Swarthmore Housing Society Limited Name of registered manager (if applicable) Ms Lilli Joan Porter Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 40 The registered person may provide the following category of service only; Care home only (PC) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Swarthmore is situated in Gerrards Cross, Buckinghamshire. The service was opened in 1947 and was founded by members of the Religious Society of Friends (Quakers). It was originally opened for the accommodation of members of the Society of Friends, however it happily accepts non-Quakers. 0 5 0 5 2 0 0 9 0 Over 65 40 Care Homes for Older People Page 4 of 37 Brief description of the care home Swarthmore is registered for 40 older people. Service users are accommodated in single rooms or in one of four flats for more independent people. There is a range of communal rooms including a quiet room/library. There are two passenger lifts which permit access to all levels of the building. There are grab rails in toilets, bathrooms and bedrooms. There is also hoisting equipment to facilitate safe moving and handling practice and a call bell system is in place. Swarthmore is situated close to all local amenities such as shops, pubs, a library and cinema. Service users are able to access such amenities on foot, by car or use of the local bus service. The service has a local doctors practice with the support of a district nurse team if needed. Service users are actively encouraged to use the services of a doctor of their choice. Other healthcare services are also available by way of a referral through the doctor; such services include physiotherapists, occupational therapists and podiatry. Please contact the provider for the current range of fees. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted on the 10 th March 2010. It commenced at 09.40 and finished at 20.00 hrs. The inspection covered all of the key National Minimum Standards for older people. Prior to the inspection, a detailed self assessment questionnaire known as an Annual Quality Assurance Assessment document was sent to the registered manager for completion and was returned within the required timescale. This was informative and clearly demonstrated what has been achieved over the previous twelve months and the plans for improvement over the next 12 months. Comment cards were sent to ten residents, ten staff, eleven residents and seven health and social care professionals. Nine resident, nine staff, five relative and three health and social care professionals completed surveys were received in respect of this inspection. The verbal feedback received during the inspection was positive with residents, relatives and staff telling us they were happy with the quality of care Care Homes for Older People Page 6 of 37 provided. This was further evidenced in the written feedback received. The feedback that has been received has helped to form judgements about the service and have been reported on under the relevant sections of the report. The inspection consisted of discussions with the registered manager, two staff on duty, a relative and informal discussions with five residents, examination of some of the homes required records, observation of practice and a tour of the premises. Information received by the Commission since the last inspection was also taken into account. Feedback on the inspection findings was given to the registered manager during the course of the inspection. The registered manager, staff and people who use the service are thanked for their co operation and hospitality during this unannounced visit. Requirements made at the previous inspection were complied with and this inspection has resulted in two requirements to further improve outcomes for residents. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? The statement of purpose and complaints procedure has been updated to include the Care Homes for Older People Page 8 of 37 Commissions correct contact details. A new person centred care plan system is being introduced which will better promote and meet residents needs. A key working system has been introduced to benefit residents. Improvements have been made to medication practices which includes a revised policy and procedure, a change of supplier, competency assessments and training for staff and the introduction of a medication audit to monitor practices which safeguards residents. A locked cupboard has been purchased to store residents belongings and money. A copy of the Local Authority safeguarding of vulnerable adults policy has been obtained and made accessible to ensure staff follow correct procedures to safeguard residents. Improvements have been made to recruitment practices with all of the required checks in place prior to staff commencing work at the home to safeguard residents. The application form have been improved to ensure gaps in employment are followed up on to safeguard residents. Training is being made available to non care staff and distance learning training has been accessed to ensure that all staff are suitably trained in their role to meet residents needs in a safe and consistent way. Staff appraisals and staff supervisions have been put in place, which support staff in their roles in working with residents. Residents views have been sought which has resulted in the introduction of a comment book for meals and changes to the programme of activities on offer which provides better outcomes for residents. A risk assessment of the premises have been conducted and the fire risk assessment has been reviewed with action taken to address identified risks to promote residents health and safety. A contingency plan has been put in place to ensure that an appropriate place of safety is accessible in the event of the home becoming inhabitable to promote residents safety. An infection control policy has been reviewed and updated with the appropriate equipment being provided to deal with clinical waste to safeguard staff and residents. The servicing of equipment is up to date to promote peoples safety. What they could do better: The registered manager was very aware that improvements were required to the care plan documentation and had started the process of putting a more person centred plan Care Homes for Older People Page 9 of 37 in place with the aim being for all residents to be on the new care plan system. As part of this development care plans need to be more specific and detailed in meeting residents needs and show evidence of residents involvement in their development and review. A nutritional needs assessment must be completed for each resident with a risk assessment in place to manage identified tissue viability risks to safeguard residents. Individual risk assessments must be put in place to address risks associated with residents health, medical and mental health needs to safeguard residents. A written protocol must be put in place regarding the administration of individuals as required medication. This must be signed off and agreed with the prescribing General Practitioner to safeguard service users. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents to the home are provided with the key information on the home and are assessed to ensure the home can meet their assessed needs. Evidence: The Annual Quality Assurance Assessment document tells us that they have compiled a resident information file for each resident and actively sought out the opinion of residents before putting it in place. A copy of this document was viewed and was found to be in line with standard 1. A recommendation was made at the previous inspection that the statement of purpose be updated the Commissions correct contact details. This has been addressed. The Annual Quality Assurance Assessment document tells that that the home has had eight admissions in the previous twelve months. The home has an up to date pre admission policy and procedure in place which outlines the areas of assessment. The registered manager confirmed that a referral form is completed at the first point of Care Homes for Older People Page 12 of 37 Evidence: contact with a prospective resident followed by an assessment by her or the head of care with the aim being for senior carers to be trained in this role. An assessment of need form is completed at this point. The assessment of needs form outlines needs in relation to physical health and well being, emotional well being, intellectual assessment, self care ability and life style choices and preferences. The registered manager confirmed that prospective residents and their families are encouraged to visit the home prior to admission and they make a decision as to whether they want to come to the home. The assessment documentation for two residents was viewed and found to be informative, comprehensive and in place prior to admission. The home does not provide intermediate care but have a flat on site which enables residents to live independently with support. When their needs change they then move into the care home. The registered manager confirmed she is looking at ways at trying to make better use of those flats to ensure full occupancy. Written feedback from residents confirm that they were all given enough information on the home and were provided with a contract. Care Homes for Older People Page 13 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents personal and health care needs are met which promotes residents health and well being. Care plans are in place but they are not specific as to how identified needs are to be meet with care plans lacking risk assessments which potentially could put residents at risk. Medication is well managed and audited to safeguard residents. Privacy and dignity is promoted which promotes residents rights. Evidence: The home uses the standex system of care planning documentation with this in the process of being updated and replaced by a more person centred care planning format. The new care plan format includes a photograph of the resident, it is much more accessible and covers a wider range of needs, including promoting needs arising Care Homes for Older People Page 14 of 37 Evidence: from equality and diversity. Seven resident care plans were viewed, which included care plans from the standex care plan format and the new format. A plan of care is put in place for problems/needs identified in the need assessment document however the action to address need is not detailed and specific to ensure a safe and consistent approach by staff. Care plans did not make reference to medical needs for example diabetes and the support required in managing this. Care plans did not evidence resident involvement in their development and review and did not outline frequency of review. The registered manager confirmed that care plans are reviewed at three and six monthly reviews and as needs change. This needs to be evidenced on care plans. The registered manager was very aware that the care plan documentation needs to be further developed with the aim being to transfer all the care plans onto the new care plan system. As part of this development care plans need to be more specific and detailed in meeting residents needs. Daily records are maintained to indicate personal care needs are met. The standex care plans viewed included a pressure sore and nutritional screening assessment however where the risk was considered high there was no risk assessment in place to address the risk. It was noted on file and during a visit to one resident that pressure relieving aids and equipment is provided and district nurses are involved with residents who were considered to be at risk. Risk assessments must be in place to evidence this. The new care plan format did not include a nutritional screening assessment tool even though the pre admission assessment documentation indicated that some of those individuals required such an assessment. Residents care plans included moving and handling risk assessments however some did not clearly outline the support or equipment required to assist with moving and handling. Care plans did not include risk assessments to address risks associated with falls and other individual risks associated with residents medical and mental health needs for example diabetes, short term memory loss, wandering off. The Annual Quality Assurance Assessment document tells us that an area for improvement was to review the nutritional screening tool. This must be addressed as a priority and ensure that risk assessments are in place for all identified risks to safeguard residents. The registered manager was proactive in immediately starting to address this. The registered manager had attempted to access nutritional training for staff to support them in their roles and this was being actively pursued at the time of the inspection. Care plans made reference to continence but was not specific and detailed as to how this was to be managed. This should be addressed as part of the development of care plans. A key working system has been introduced with a key working policy put in place to support practice. Residents confirmed that they had a key worker and that this role was being developed. Care Homes for Older People Page 15 of 37 Evidence: Residents are registered with a local General Practitioner who visits the home weekly with new admissions to the home being given the choice to register with a General Practitioner of their choice. Residents have access to chiropody, opticians, dentists and specialist nursing services. Individual records are maintained in care plans of appointments with all health professionals and the outcome of those visits to support and evidence this. The home has a medication policy in place, which was reviewed in November 2009 in line with the changes made to the management of medication at that time. This is a comprehensive and detailed policy which outlines the procedure in relation to the ordering, receipt, administration of medication, which includes controlled drugs and homely remedies, storage and disposal of medication. The head of care is responsible for the ordering and receipt of medications with senior carers being trained in this role. The head of support and senior carers are responsible for the administration of medication. Residents who are able to, are supported to self medicate with a risk assessment in place to evidence this. Those residents are supplied with a cash box to keep their medications secure. A consent form is signed by residents who require staff to administer their medication. Staff responsible for medication administration complete medication training and are assessed and deemed competent prior to administering medication. Evidence of this assessment is maintained on staff files. Some staff are undertaking distance learning medication training with Aylesbury College and the supplying pharmacy has facilitated training for staff on their processes and medication administration. A sample of medication administration records were viewed. Some medication records showed gaps in administration or the correct code not being used to indicate why a medication was not dispensed. However this had being picked up by the registered manager as part of her monthly auditing which she had introduced and was being addressed with staff members concerned. Two residents medication administration records indicated that they are prescribed as required medication however there was no protocol in place to indicate when this medication was to be administered. The medication administration records evidences that one person was having the as required medication administered every third day but the daily record did not evidence why this was necessary. The administration of as required medication must be administered in line with a written protocol and this must be addressed, agreed and signed off by the prescribing General Practitioner to ensure this medication is administered consistently to safeguard residents. The home has some residents on controlled medication which was found to be stored appropriately with accurate records maintained to evidence that these are being administered appropriately. The home has a record of disposal of medication and is audited by the supplying pharmacy to further promote good practice. A recommendation was made at the previous key inspection that items of value such as Care Homes for Older People Page 16 of 37 Evidence: service users money are not to be stored in medication cabinets. This has been addressed and a separate lockable cupboard has been purchased to store items of value and residents money in. The residents information file outlines the ethos, philosophy and aims and objectives of the home to promote residents rights, privacy, dignity, independence, security, civil rights, choice, fulfillment, diversity and lifestyle. Staff common induction standards evidence that staff are made aware of these basic principles and how they promote them. Residents can have telephones in their bedrooms or some have their own mobiles. Residents wear their own clothes, and are called by their preferred term of address with care plans making reference to this. The registered manager confirmed that all medical examinations, consultations and treatments take place in private. Staff were observed during the inspection to knock on residents bedrooms and address residents in a polite, friendly and dignified manner. They confirmed that this is reinforced to them during their induction. Residents spoken with during the inspection confirmed that staff always promote their privacy and dignity and treat them well. Written feedback received from residents confirm that eight out of nine residents indicated they always receive the care and support they need, one resident indicated that they usually receive the care and support they need. All nine residents indicated they receive the medical care they need. One resident commented under what the home does well makes me feel that I really belong here. Written feedback received from staff confirm that what the home does well is good at caring for people, provide care for residents to a very high standard, the home strives to meet the physical,emotional and spiritual needs of the residents. They listen to residents and is inclusive in its approach to making changes. They treat residents as individuals and provide excellent level of care, very caring and friendly home where residents needs are paramount. Written feedback received from relatives indicate that they are always happy with all aspects of care provided and include comments such as my father is delighted with the care and support which he receives, Swarthmore is an exceptionally caring home. its staff are exceptional, the staff are efficient, caring and friendly, they take a real interest in my relative and make visitors very welcome, they encourage Independence. Written feedback from three health professionals involved with the home indicate that they are always and usually happy with the care provided. They included comments such as excellent overall care for all residents, respectful of residents wishes and Care Homes for Older People Page 17 of 37 Evidence: dignity, staff and residents seem very happy, home is generally well run and has the care of residents at heart always. One health professional commented under what the home could do better was better communication of medical history to visiting medical staff and that the change in the supply of medication has been a deterioration in service. This was fed back to the registered manager who confirmed she had already discussed those issues with the individual concerned. Care Homes for Older People Page 18 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to a varied programme of activities, their choice and autonomy is promoted, visitors are welcomed and they are provided with a nutritious and varied diet which promotes their well being. Evidence: The home offers a weekly programme of activities for residents, which include discussion groups, art classes, library, music club, exercise classes, Quaker meeting, literature classes, film clubs and drives out. A variety of religious meetings are also available and the Annual Quality Assurance Assessment document tells us that the homes aims to further develop the programme of activities to meet specific requests from residents. The programme of activities is displayed on the notice board and is included in the residents information file. Some residents and relatives are involved in facilitating specific activities which they confirmed during discussion with them. Residents confirmed that they felt the programme of activities on offer was sufficient to meet their needs whilst being intellectual and stimulating. The home has recently introduced a non profit making shop for residents which is run by a relative with input from residents on what they require. Residents fed back that this had been very successful. Care Homes for Older People Page 19 of 37 Evidence: In written feedback from residents six residents indicated that the home always arrange activities that they can take part in and three residents indicated that the home usually arranges activities that they can take part in. Residents commented under what the home does well is provide a variety of stimulating activities, provide a comfortable social environment, residents are encouraged to be as active as possible, as well as being encouraged to join in activities if they are able to. Written feedback from staff included a comment under what the home could do better was a bit more interactivity, some discussions and few more group sessions. This feedback should be explored further with the staff team to seek clarity on what the area for improvement is. There are no restrictions on visitors with visitors able to visit at times convenient to them and the resident. Relatives can see the resident in private in their bedrooms or wherever the resident chooses to entertain them. Verbal feedback from relatives raised no issues in relation to visiting their relatives. Residents spoken with confirmed that their relatives are made to feel welcome. Residents are encouraged to take responsibility for their finances and are able to bring their personal possessions into the home if they choose to. The registered manager confirmed that there are advocates involved for residents who require this. Residents are encouraged to exercise choice and control over their lifes and this is evident in residents involvement in aspects of running the home. The home has a weekly menu on display with residents encouraged to make their meal choice. Residents are provided with three meals a day, the lunch and evening meal consist of two courses with afternoon tea and cake also made available. Fresh fruit and yogurt is available daily. An alternative meal choice and or vegetarian diet is available if the main menu choice is not to their liking and records are maintained when a resident has chosen an alternative. Residents have a choice of cereals, toasts and juices for breakfast but do not have the choice of a cooked breakfast or egg. This should be explored further with residents. Residents are provided with assistance with their meals if required and the chef confirmed that soft diets and specialist diets are catered for. The inspector sampled lunch, socialised with residents and observed practices in the dining room. The meals were unhurried, calm and relaxed with staff being attentive and polite. The food sampled was of good quality, nicely presented and tasty. Residents spoken with confirmed that the meals provided were very good. Staff are provided with a meal and they sit all together at a table in the dining room. The benefits of this practice, is under review by the registered manager. The home has recently introduced a comment book on the meals provided to encourage feedback on Care Homes for Older People Page 20 of 37 Evidence: meals and further improve the meals provided. The comment book was viewed and as a good practice recommendation the chef /cook should evidence when negative comments made have been addressed. The inspector went into the kitchen immediately after lunch and found it to be calm and well organised with the catering staff working well together to clean up. Records relating to food hygiene and cleaning schedules are in place. The cooks food and hygiene training certificate was on display and found to be out of date. The chef confirmed that he had this training but his certificate was not available. The registered manager confirmed that she is in the process of getting the catering staff on a variety of mandatory training to support them in their roles. The cook is scheduled to go on the next food and hygiene training. Written feedback from residents indicated that five residents always like the meals at the home, three residents indicated they usually like the meals at the home and one resident indicated that they sometimes like the meals at the home. One resident commented under what the home does well that the meals are well planned and the catering staff take note of residents comments. One resident commented under what the home could do better was to improve the meals. Written feedback from staff commented that the catering was to a very high standard. Care Homes for Older People Page 21 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies, procedures and training is in place to enable residents to raise concerns and be safeguarded from potential abuse. Evidence: The resident information file includes the complaints policy and procedure which outlines who to complain to and the time frame for response to complaints. As recommended at the previous key inspection it includes up to date contact details for the Commission. The Annual Quality Assurance assessment document tells us that the home has had four complaints. A record is maintained of the complaints made and action taken, which evidences that complaints are handled appropriately. The home does not keep an actual log of complaints and as a good practice recommendation this should be addressed and put in place. The Commission have received no complaints in respect of this service in the period under review. Residents and relatives spoken with confirmed that they know what to do if they are unhappy with any aspect of care. They confirmed that the registered manager is very receptive and responsive to issues raised by them. Written feedback received from residents confirm that they know how to make a complaint. Written feedback received from staff confirm that they know what to do if someone has concerns about the home. Written feedback received from relatives confirm that they know how to make a complaint. Care Homes for Older People Page 22 of 37 Evidence: The home has an up to date whistle blowing policy in place and guidance for care staff on what to do if they witness abuse. These policies are included in staffs individual induction and training files. The registered manager was unable to locate the homes safeguarding of vulnerable adults policy during the inspection. The Annual Quality Assurance Assessment document tells us that it was reviewed in August 2009 and she agreed for this to be made available as a priority. A recommendation was made at the previous key inspection that a copy of the Local Authority inter agency safeguarding procedure should be obtained. This had been addressed. The Annual Quality Assurance Assessment document tells us that the home has had no safeguarding of vulnerable adults referrals or investigations in the previous twelve months. Staff training records indicate that the majority of staff have up to date safeguarding of vulnerable adults training with this training scheduled to take place by the beginning of April 2010 for new staff and staff who require updates. The staff spoken with during the inspection confirmed that they know what to do if they witness bad practice or potential abuse. The home has an up to date finance, violence and aggression and restraint policy in place. Care Homes for Older People Page 23 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well maintained to a high standard and is comfortable and homely which promotes a positive environment for residents Evidence: Swarthmore is located a few minutes walk from the centre of Gerrards Cross. The building is a large detached property which has been tastefully extended on over the years. The building is located along a short residential road in a quiet area and has extensive, beautifully kept grounds at the rear of the building. There is adequate parking at the front of the property for staff and visitors. The home is registered for up to forty people which includes a separate provision for four independent people in a property known as Burman Lodge at the bottom of the garden. Burman Lodge was not visited as part of this inspection. The home is spread over two floors with a passenger lift between floors. All bedrooms are single occupancy with the standard bedrooms having a vanity unit and the remaining bedrooms with en-suite facilities. The home has no shared bedrooms. The bedroom viewed was clean, a good size, nicely decorated and personalised. The home has a spacious dining room, comfortable quiet room /library, sitting room, kitchen, laundry and two sluice rooms. There are yearly premises inspection meetings and three monthly premises sub committee meetings with records maintained to evidence this. The minutes indicate that the Committee is proactive in dealing with maintenance issues and in ensuring that a programme of maintenance and decoration is in place and met. The Annual Quality Assurance Care Homes for Older People Page 24 of 37 Evidence: Assessment document tells that over the next 12 months they plan to replace easy chairs in the main lounge, replace the dining room carpet, replace floor coverings in the facility areas with non slip covering, redecorate Burman Lodge and creosol the summer houses and garden furniture. The Annual Quality Assurance assessment document tells us that the infection control policy and all the infection control procedures have been reviewed and updated. A daily security check of the building has been introduced and the use of appropriate laundry bags for soiled linen has been purchased and are in use. The home has separate housekeeping staff who are responsible for cleaning communal areas, residents bedrooms and laundry. The registered manager is currently reviewing rotas for housekeeping staff to ensure that there is sufficient housekeeping staff on duty at all times during the day including weekends. At the time of the inspection the home was found to clean, hygienic and odour free with the level of cleanliness maintained to a high standard. The laundry is sited away from food areas and hand washing and disinfecting facilities are sited throughout the home. The registered manager confirmed that mandatory training was being introduced for the housekeeping staff. Written feedback received from residents indicate that they think the home is always clean and tidy. One resident commented under what the home could do better was perhaps spend more on the fabric of the older part of the building, for example the windows are not double glazed and let in drafts. Written feedback received from staff confirm that the cleaning and catering at the home is to a high standard . Staff commented that it is pleasant, clean, stimulating, tidy, always warm, lovely and homely environment to live in. One staff member commented under what the home could do better was to try to provide a more central reception area and visitor toilet facility. Care Homes for Older People Page 25 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are suitably recruited, inducted and trained with staffing levels sufficient to meet residents needs in a safe and consistent way. Evidence: The registered manager confirmed that there are five staff on the morning shift, four staff on the afternoon shift and two staff at night. The registered manager has reviewed the rota to ensure that there is always a senior person for example the head of support or senior carer in charge of the shift and ensures that there is a good skill mix of staff on duty to meet residents needs. The registered manager and senior staff provide on call support to night staff and at weekends. The registered manager is not included in the numbers but she takes an active role in hands on care and escorting residents for appointments when required. The registered manager confirmed that staffing levels are reviewed as residents needs change and the Annual Quality Assurance Assessment document tells us that they use the care staffing tool of the residential forum to review staffing levels. In addition to the care staff the home has an administrator, chef, cook and housekeeping staff. The home currently does not use agency care staff but is putting systems in place to ensure that agency staff can be accessed if required. The staff team appeared to work well together, with staff confirming that they are being trained and supported to take on other roles and responsibilities which they feel will develop them and benefit residents. Team meeting have commenced with records maintained to evidence this. Care Homes for Older People Page 26 of 37 Evidence: The Annual Quality Assurance Assessment document tells us that twelve out of the twenty three care staff have achieved an National Vocational Qualification with other staff being enrolled on this training. Four staff recruitment files were viewed. The files viewed were generally well organised with a tick list at the front of the file to confirm what information had been obtained and when. The files viewed contained an application form, offer of appointment, job description, contract of employment, medical questionnaire, evidence of identify and copies of criminal records bureau checks and POVA first checks. Three of the four files viewed included three references and one of the files viewed had two references on file with evidence of the third reference being followed up. None of the files viewed contained an up to date photograph of the staff member and two of the files viewed included their interview assessment questions. In one file viewed the start date on the contract and at the front of the recruitment file was before the POVA first check had been obtained however the rota for that period viewed confirmed that the staff member did not commence employment until after the POVA first check was obtained. An immediate requirement was made at the previous inspection that all of the required Schedule 2 recruitment checks are to be obtained and satisfactory before staff start working at the service. Staff are not to be permitted to carry out care duties until a full enhanced Criminal Records Bureau check has been obtained. Staff may undertake restricted duties under close supervision following a satisfactory preliminary POVA first check. This is assessed as being complied with. An immediate requirement was made at the previous inspection that full working history since leaving full time education is to be requested of applicants and gaps to their employment explained to ensure that there is a complete and accurate account of peoples backgrounds. The application form has been revamped to include a full working history with a prompt on the application form to check any gaps in employment. The files viewed evidences that gaps in employment are being explored. This requirement is assessed as being complied with. One of the senior care staff is responsible for inducting staff and in ensuring that they are booked on the required mandatory training. She is skilled in developing templates and electronic records to evidence this and has been invaluable to the registered manager in assisting her to put electronic systems in place. All staff have an individual induction and training folder and this folder includes copies of key polices which staff are expected to read and understand. A record is not maintained to evidence that they have done this. New staff shadow experienced staff in getting to know residents and their care needs. Formal records other than the rota are not maintained to evidence this. A new staff member spoken with confirmed this that they worked in a supervised Care Homes for Older People Page 27 of 37 Evidence: capacity in getting to know residents. Staff are expected to complete and work through common induction standards. The senior staff member responsible for training and inducting new staff spends a lot of time in formally inducting staff but in house induction records to supplement common induction standards are not maintained to evidence this. The registered manager agreed to work on developing this with her. The home has a training matrix in place which confirms that care staff have the required mandatory training with updates in this training highlighted and booked as required. A low percentage of staff have specialist training in care of the dying, diabetes, dementia awareness, continence promotion, equality and diversity and mental capacity act training. The registered manager has identified individuals skill gaps and is proactive in trying to source a wide range of training for staff to address this. Distance learning training in infection control, medication administration, risk assessments and dementia has been accessed with staff from all departments being expected to complete this training. The registered manager is due to attend deprivation of liberty training. Verbal feedback from residents and relatives confirm that they feel staffing levels are appropriate. They feel staff are kind, caring, responsive and have a good understanding of their needs. Staff confirmed that they are suitably inducted, trained and supported to do the job expected of them. Written feedback received from residents indicate that eight residents feel the staff are always available when you need them, one resident indicated that the staff were usually available when you need them. All nine residents fed back that staff always listen and act on what they say. Residents commented under what the home does well is that the staff work as a team, the staff are cheerful, helpful and treat residents carefully and as individuals, the relationship between staff and residents is very supportive and not intrusive, ideas and plans are well thought out and sensitively put into practice where appropriate. Written feedback received from staff confirm that they are always and usually fully inducted, suitably trained, kept informed, get enough support and that there are sufficient staff to meet residents needs. One staff member commented that the manager is excellent. She makes sure residents are looked after in a proper way and treats staff with good equality and fairly. She has insured that staff are properly trained with policies and procedures in place. One staff member commented under what the home could do better was better staff Care Homes for Older People Page 28 of 37 Evidence: relationships. Sometimes feels that what is said is not what is actually done. Consistency on some issues would be nice. No examples were given to support comments made. This feedback should be explored further with the staff team. Care Homes for Older People Page 29 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed with monitoring and quality assurance systems in place and these are being further developed to monitor practices, promote health and safety and improve outcomes for residents. Evidence: The home has a registered manager who has been in post since July 2009. She has obtained her registered managers award and has a varied range of training to support her in her role. She continues to keep herself up to date by attending training. She is experienced in managing and setting up social care settings and has made many improvements in the home in the short time she has been in post. Residents and relatives commented that she was personable, accessible, approachable and responsive to their requests and needs. One resident commented that they felt the staff morale had improved greatly since the new manager had been appointed. In written feedback received one resident commented that the new manager had made a great difference, the atmosphere had changed for the better and is much better. Care Homes for Older People Page 30 of 37 Evidence: Another resident commented that the manager and staff team work very hard to maintain first class standards. Feedback from staff confirm that they feel the home is well managed and the manager is approachable, supportive, encouraging, empowering, knowledgeable, proactive, respectful and able to give constructive feedback. One staff member commented that she makes them feel valued and they feel inspired, motivated and committed to their job by her. They feel she demonstrates good practice and acts as an excellent role model to staff. The lines of accountability and responsibility within the home is being developed with the registered manager keen to develop senior members of the team. The registered manager confirms she feels supported and meets with the management committee monthly. Team meetings and committee meetings take place regularly with minutes available to evidence this. The registered manager has been proactive in addressing the requirements from the previous inspection. She had already recognised the deficits in the homes care planning paperwork and had started to address those shortfalls. She agreed to immediately act on putting the required risk assessments in place for residents as reported on under standard 7 and in supporting the senior staff member to put an in house induction package in place for new staff. The registered manager presented as being very committed, enthusiastic, motivated, knowledgeable, experienced, forward thinking and has been proactive in making improvements within the home. The Annual Quality Assurance Assessment document received in respect of this inspection was well completed, informative and gave an accurate reflection of the progress made over the year and identified areas for improvement over the next 12 months. The dataset section of the Annual Quality Assurance Assessment document was accurately and fully completed. The registered manager is keen to develop quality monitoring systems within the home. She has set up a monthly audit of medication administration and seeks feedback from residents in the form of a questionnaire. The feedback from the questionnaire is used to improve outcomes for residents and this has included the introduction of a comments book on the meals provided and looking into other activities that residents would like to be involved in. The registered manager confirmed that members of the Committee carry out monthly Regulation 26 visits and completes a report. Those reports were not requested or viewed at this inspection. Alongside this members of the Committee meet with residents and staff quarterly and feedback to the registered manager. A finance committee meeting take place quarterly and the Committee carry out a premises inspection which is scheduled to take place in June 2010. The registered manager is responsible for ensuring that policies and procedures are Care Homes for Older People Page 31 of 37 Evidence: reviewed and up to date. The Annual Quality Assurance Assessment document confirms that all policies and procedures were reviewed in 2009. Residents are encouraged to be responsible for their own money with a locked facility provided in the office for residents to keep their money and valuables safe. A record is kept of money in and out with receipts obtained for purchases. Residents care plans outline appointee or power of attorney where this is the case. The home has an up to date finance policy in place which includes the policy for staff on accepting gifts and on giving financial advice to residents. The Annual Quality Assurance Assessment document tells us appropriate supervision formats have been compiled along with comprehensive job role descriptions and these have now commenced. The aim is for senior staff to be trained in this role and for the supervision to take place every two months as care best practice legislation directs. The registered manager confirmed she had just completed staffs annual appraisals and from this had identified some gaps in skills and knowledge. Training will be provided to address this. Staff confirmed that they feel supervised and supported in their roles. Care staff have up to date mandatory training with updates booked where required. The aim is to include the housekeeping and catering staff on this training. A sample of health and safety records were viewed and found to be in good order. The registered manager confirmed that she intends to improve and re organise the health and safety records. Accident and incident reports are completed and filed in residents files with a body map completed on admission and following an accident/incident. Trends in accidents/incidents are picked up through the monthly reporting. During the inspection it was noted in one residents daily record that bruising had been noted the day prior to the inspection. The body chart was not completed and there was no indication as to the action taken. This was addressed by the registered manager during the inspection. The home has kept the Commission informed under Regulation 37 of events that affect the well being of residents. The Annual Quality Assurance Assessment document confirms that equipment is serviced and up to date. A sample of the servicing records were viewed and found to be in order. A requirement was made at the previous inspection that a gas safety certificate or evidence of servicing for gas appliances is to be obtained and made available on the premises. This has been complied with and the most recent gas safety check took place on the 8th October 2009. A requirement was made that a risk assessment of the premises is to be conducted and action taken to reduce risks were there are issues. This is to include the safety of uncovered radiators. A premises risk assessment has been completed dated January 2010. The exposed radiator identified at the previous key inspection Care Homes for Older People Page 32 of 37 Evidence: has been covered and the registered manager is currently risk assessing an uncovered radiator in the lounge which has come about due to the reorganising of the room. This requirement is assessed as being complied with. The registered manager has put generic risk assessments, a fire risk assessment, COSHH risk assessments and data sheets in place. A business contingency plan has been completed and an asbestos survey has been carried out with remedial action taken to address survey results. Care Homes for Older People Page 33 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 34 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 The registered manager must ensure that as part of the development of care plans that a nutritional needs assessment is completed for each resident with a risk assessment in place to manage identified tissue viability risks and other risks associated with residents health, medical and mental health needs. To safeguard service users. 10/05/2010 2 9 13 The registered manager 30/04/2010 must ensure that a written protocol is put in place regarding the administration of individuals as required medication. This must be signed off and agreed with the prescribing General Practitioner. To safeguard service users Care Homes for Older People Page 35 of 37 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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