Inspection on 04/06/09 for Sweyne Court

This is the latest available inspection report for this service, carried out on 4th June 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sweyne Court 11/07/06

Sweyne Court 01/03/06

Sweyne Court 11/10/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sweyne Court Hockley Road Rayleigh Essex SS6 8EB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diane Roberts     Date: 0 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Sweyne Court Hockley Road Rayleigh Essex SS6 8EB 01268774530 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): christine.skeets@excelcareholdings.com Sweyne Healthcare Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 43 Number of places (if applicable): Under 65 Over 65 43 43 dementia old age, not falling within any other category Additional conditions: 0 0 The service users` bedrooms with an area of less than 10 sq.m. will be used only following a written assessment. The assessment should include consideration of whether the facilities in the room are suitable for, and acceptable to the service user, taking into account their mobility needs. The service user plan should reflect the assessment of findings. Date of last inspection Brief description of the care home Sweyne Court is a two storey building set in a cul de sac. It is close to Rayleigh High Street and is convenient for bus and train transport. The home is registered for 43 older people with dementia. The accommodation consists of single and double bedrooms, some of which may not be suitable for wheelchair use or those needing moving and handling equipment. The downstairs of the home has recently been refurbished and now has some bedrooms with ensuite facilities. There is a large Care Homes for Older People Page 4 of 30 Brief description of the care home lounge/diner down stairs and also a small quiet lounge. Upstairs have a number of rooms, which can be used for lounges or dining facilities. There is a secure garden at the centre of the home, which is easily accessible for the downstairs residents and has seating available during the summer months. There is also a second secure garden, which can also be used. The home has adequate parking for visitors and staff, and there are facilities on both floors for visitors to see residents in private. Sweyne Court also has a Day Centre as part of its premises, but this is run entirely separately. Fees to the home are #416.29 a week. Care Homes for Older People Page 5 of 30 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: one star adequate 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: We visited the home for a whole day and met with the manager and the operations manager. Prior to this we reviewed all the information that we already had on the home and this included the managers Annual Quality Assurance Assessment. The manager was asked to complete this. This tells us how well they think they are doing, what they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. On the day of the inspection we spoke/interacted with four residents and 4 staff at the home and prior to that we sent out surveys to relatives asking for feedback on the home. Due to the needs of the majority of residents in the home it was not possible to obtain and detailed feedback from them, but all appeared quite happy and interacted well with us. Whilst at the home we also reviewed a range of records and undertook a tour of the Care Homes for Older People Page 6 of 30 home. Since the last key inspection we undertook a random inspection on the 17th September 2008, following a series of complaints and an adult safeguarding referral. This report is referred to in the text. The random report is available on request from CQC. What the care home does well: What has improved since the last inspection? What they could do better: 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 set out 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 8 of 30 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 9 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be assessed, but the process is not as thorough as it could be meaning that residents cannot always be fully assured that the home could meet their needs. Evidence: The manager has a service users guide in place and this was seen to be available in the reception area of the home but not in service users rooms. Consideration should be given to making this guide more freely available. The guide is user friendly and has pictorial element to help those with dementia. At the current time the information on social activities does not reflect what is actually being offered in the home, for example, SONAS (sensory activities) sessions six times a week are not taking place. Two pre-admission assessments were reviewed. The manager said that she completes the assessments along with her deputy and one other senior carer. The assessment Care Homes for Older People Page 10 of 30 Evidence: also has a dependency rating tool as part of the documentation. This is a scoring tool and gives a dependency rating. It was seen to give limited information other than the score. Whilst the assessments had been completed, information was limited at times and contained no person centred information giving a picture of the actual person themselves. It was also noted that information on residents abilities, behaviors and needs with regard to dementia were limited. One assessment was not signed by the assessor and the overall assessment does not indicate whether the home would be suitable for the prospective resident. There was evidence that family members had been involved in the assessment process and where appropriate, information from the referring authority was also available. The manager in her AQAA said that all prospective service users receive a comprehensive needs assessment. We would not fully concur with this statement. Relatives who commented in surveys said that usually had enough information about the home in order to make decisions. Care Homes for Older People Page 11 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Outcomes for residents with regard to their personal care are variable at the current time and the care provided is not always person centred. Evidence: The manager has a care planning system in place. Three care plans were reviewed along with further care related documentation for cross referencing. Overall the required care plans were seen to be in place and they were generally up to date. Respite residents, who are meant to have weekly reviews, were not reviewed in line with the managers guidance. Those are plans in place were seen to be sufficiently detailed in order to guide staff as to the basic care needs of residents but they either contained limited or no person centred information to give staff a picture of the resident as an individual and their preferences etc. There was some evidence that staff are promoting residents independence with personal care. There were some care plans that were out of date that did not reflect the current care of the resident, although the date showed that it had been reviewed. For example, one care plan said that a resident was being cared for in bed and from observation, this was not the case. Care Homes for Older People Page 12 of 30 Evidence: The manager has a thinking ahead care planning system in place so that residents can express what they would want for themselves in the future. This is a good tool but unfortunately staff have yet to use this to its full potential as many are not completed. On discussion with staff they generally knew the residents well and knew residents preferences. However, it is felt that this knowledge is not put into practice in the actual provision of care. For example, staff who could tell us that a specific resident was very particular about their appearance and clothes etc. but on observation they were seen to have not been supported to maintain this as their dementia progressed and were noted to be unkempt and their hair not well cared for. This detail from staff was also not reflected in the care plan. The manager in her AQAA said that a detailed care plan is put in place, which includes risk assessments to enable staff to support residents. We would would not fully concur with this at the current time. Residents were seen to have a range of risk assessments in place. Some of these were not dated or signed so it was unclear as to how up to date they were, for example, falls risk assessments. Not all residents had a nutritional risk assessment in place or had been weighed on admission. This needs addressing to ensure residents are appropriately monitored and supported. In some cases staff had identified that residents were at risk, for example, with pressure sores or even had them, but had then not put a care plan in place to outline the management of the risk or wound. It was also noted that risk assessments for those with pressure sores were not regularly updated, having been reviewed in January or February 2009 and then May 2009. The manager in her AQAA said that four residents had developed pressure sores in the home in the last twelve months. Assessments for the use of bed rails were completed well, along with manual handling assessments. Records showed that residents were being weighed but the records for some residents were more inconsistent than others. Some residents had fluid balance recording sheets in their rooms but these were seen to be inconsistently completed by staff therefore not giving an accurate picture of their intake. It was also noted that a resident had a jug of squash in their room but no glass/beaker to drink from. Minutes of staff meetings also showed that the manager had raised this matter previously with the staff team. The manager had completed an audit of the care planning system in the home in May 2009 and said that care planning training was currently in progress. The audit identified shortfalls in care planning that we would concur with. For example, the care plans are not all up to date, do not always reflect current needs and that they need to be more person centred. Overall relatives who commented in our surveys said that the team at the home usually meet the residents needs and staff usually have the skills needed to meet those needs. Relatives commented that they felt that residents with incontinence Care Homes for Older People Page 13 of 30 Evidence: should be checked more to ensure that they dont get sore. The morning medication round was observed to start at 09.30 upstairs and went on late into the morning, not giving sufficient time between medication rounds. A review of the timing of the medication rounds is needed and/or the timing of once day medications to relieve the burden of the early morning round, to ensure that residents get their medication appropriately. Medication administration in the home was reviewed and generally found to be in good order with the required recording and checks in place. The manager reported that she was about to commenced monthly auditing of the medication system. Prescribed creams were seen in a residents room with the prescription label torn off meaning that it was not possible to check whether the item belonged to or if it was suitable for that resident. The use of creams was not always reflected in the residents care plan. Training records showed that none of the current senior team have completed up to date training in the safe administration of medication. At the random inspection the laundry was found to be poorly organised, with many items of resident clothing unidentified and relatives complaining of lost items. We visited the laundry again and despite assurances that this issue would be addressed we found that there were still a lot of unnamed items and residents did not therefore have access to some of their belongings. The manager is currently re-looking at the key worker system in the home and this may help with the laundry items. This system does need review as on discussion, staff understand the key worker role, for example caring for residents clothes and personal items, but, the actual practice is not put into place. On viewing residents clothes and personal items, wardrobes and clothes were poorly looked after and this does not respect residents dignity. The manager said that she plans to recruit more laundry staff to give cover at weekends as this is currently variable. Staff working in the laundry confirmed that weekend cover is an issue and depending on who is on duty whether any laundry is done at the weekends. Relatives continue to raise shortfalls with the manager about the laundry and care of their relatives clothing at consecutive relatives meetings. On interaction with residents, it was noted that attention to residents grooming was lacking. Residents were noted to have dirty nails, be unshaved and had not been helped or supported to wash their eyes properly. Care Homes for Older People Page 14 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Outcomes for residents are variable in relation to social care, routines and mealtimes. Evidence: From discussion with staff and observation, the routines of the day are generally person centred. Staff spoken to said that with the new manager residents had more choice about routines such as when they get up. This was also reflected in the minutes of the staff meeting where the manager was promoting this approach. Some, more able, residents were seen to be walking around the home spending their time where they wished. Others were seen sitting in the dining room at 09.15 and had had their breakfast there. They were still seen sitting in the same place at 10.50, with no social stimulation. Social care assessments are completed and these give some information on residents past occupations and family history etc, giving staff a picture of the person as an individual. Not all of these had been completed and the managers, May 2009, care plan audit also identified this shortfall. Whilst residents had social care plans in place, these did not always contain an actual assessment of need. For example, under social needs staff had written will go if encouraged. Some care plans did show that staff Care Homes for Older People Page 15 of 30 Evidence: had thought about the residents social needs and had identified what would be positive for them. However, there was no evidence that the care plan had actually been acted upon. Records showing residents social interactions were inconsistently completed, for example, one resident, who stays in their room, had not had any social interaction since March 2009 and we visited in June 2009. Another resident just had one event of snakes and ladders one month and nail cutting in another month. The activities programme displayed around the home was seen to be out of date. The programme included painting, bingo, ball games, arts and crafts, looking at scrap books, memory boxes, bowls, exercise to music, cooking and quizzes. There is a one to one day once a week but again, residents individual records do not reflect this. Agency staff who were meant to be engaging residents with activities were observed to be leaning against a wall throwing a ball up in the air to them-self. Other residents were seen to be given coloring to do but staff did not spend sufficient time explaining what it was for and on discussion with these residents they were not interested in the activity and were unsure what it was for. Staff were heard to say just colour this in. Discussion with the activities officer, who had only been in a post a few months showed that she was keen to do well for the residents but possibly lacked some training and direction as to how to provide a programme that met both individual and group needs. She currently works 30 hrs a week and the manager said that she planned to provide the officer with an experience link in another one of the companies homes so she could gain some knowledge and experience. The activities officer has started new records and these were good, showing the activity offered and the level of interaction from the residents but the activities offered are not based upon a social needs assessment. She was able to evidence that she had been taking some residents out to church and the local market, which is good. The manager in her Aqaa said that they need to encourage staff to interact/stimulate dementia clients and not rely on the activities co-ordinator. She also said that they planned to develop a more structured activities programme meeting the needs of all of the residents. Discussion with the chef showed that she was aware of residents specialist dietary needs and knew the residents, including new residents, needs and preferences, so that she could cater for them well. Records showed that there are two choices for the main meal in the home and sufficient is cooked so that residents, especially those with dementia can choose at the point of serving. We were told that the menus in Excel homes are all very similar and therefore not primarily resident led. A Fathers Day, special menu was displayed in reception but not seen around the home for residents to easily see. Every Thursday the chef makes scones with jam and cream for afternoon tea and these were seen to be popular with residents. Relatives who commented on our surveys felt that the meals at the home Care Homes for Older People Page 16 of 30 Evidence: were generally good. Tablecloths are used for residents who eat in the dining room downstairs but not upstairs where residents also may have dementia. Consideration should be given as to how to manage this so that all residents are treated equally. Some residents were seen to be waiting for lunch for 40 minutes before their meal was served. Not all residents had access to condiments during the lunchtime period and it was also noted that upstairs residents were being fed their main meal from small shallow bowls, approx 5-6 inches in diameter. On discussion with the manager it is unclear as to why these are being used. These bowls were seen to give residents small portions and it is a concern as to whether this is sufficient. The residents on this unit may not be able to communicate as to whether they would want more food. During the day, drinks were not seen to be freely available other than at times when the drinks rounds were being undertaken. This needs to be addressed to ensure that residents have an adequate fluid intake. One resident spoken with said that she had enjoyed her lunch. Care Homes for Older People Page 17 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their concerns would be listened to but cannot be assured that they would be fully protected, as far as possible, from abuse in the home. Evidence: The complaints procedure was seen to be displayed in the reception area of the home and forms were available that people could complete. Information on advocacy services were also displayed. The manager has a logging system for complaints and these were seen to be completed properly. Four complaints were noted since our last visit and these related to staffing, menus and access to food, bathing, laundry, residents dignity, medication, lack of choice and lack of management and staff supervision. Overall the complaints were seen to have been dealt with in an objective way and written responses were available. Relatives who commented said that they knew about the complaints procedure and that they were either always or usually satisfied with the outcome of anything that they had raised. Staff need to be more security conscious when letting people into the home, as the regulation inspector was allowed into the home without any request for identification and had to wander around the home looking for the person in charge. Staff spoken to confirmed that they had attended adult protection training, knew where the current guidance could be located in the home and demonstrated an understanding of the issues around adult abuse. The training records submitted to us Care Homes for Older People Page 18 of 30 Evidence: by the manager showed that out of 38 staff only 10 had completed adult protection training. Only 6 staff out of the whole team had training in dealing with challenging behavior. This needs to be addressed to ensure that residents are protected as far as possible. It is of particular concern that the manager and the majority of the senior care team in the home have not up to date training on these subjects. The manager in her AQAA said that staff are trained in the protection of vulnerable adults and that adult protection is covered in the staff induction. As well as the shortfall in the numbers of staff trained, from records it is apparent that the staff induction to the home is also lacking, as staff had not completed thier induction despite working in the home over three months. Care Homes for Older People Page 19 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean home that is maintained to an adequate standard. Evidence: A unaccompanied tour of the home was undertaken. For a home, primarily for people with dementia, the signage generally remains poor and this was raised at the last inspection. Some new signs have been put up for toilets and bathrooms but residents rooms remain poorly identified. This does not assist residents to maintain their independence and promote their self worth. Stimulation for residents around the home is limited and there are only a few pictures down the corridors etc. where residents wander. The manager reports that they have had the items some months, to put up, but this has not happened. The home therefore still has an institutional feel in some parts. Since the random inspection, some bedrooms in the home have been decorated/painted and now are at an acceptable standard. The corridors and main hallway have also been painted. When painting, consideration was not given to the care of people with dementia, for example, colour coding the corridors. Overall a lot of the bedroom furniture is in a poor state of repair with broken knobs, drawers etc. and an ongoing replacement programme is needed. Carpets in some bedrooms are old and in a poor state requiring replacement. Care Homes for Older People Page 20 of 30 Evidence: The gardens, whilst generally tidier, remain uninviting to spend time in. The previous manager said in her improvement plan that this would be completed by Spring 2009. On discussion, the new manager said that they are getting quotes in after receiving a local authority grant and are awaiting agreement from the provider. It is planned to put patio doors in from the small lounge downstairs, giving residents better access to the courtyard garden. The front of the home is now more tidy and inviting and planted nicely but residents cannot use this section of the grounds. Overall the home was seen to be clean and tidy. Relatives who commented said in the what the home does well section of our surveys that the cleanliness of the home was good. The home has access to a maintenance man two days a week. The maintenance man has a significant amount of records and checks to make and it should be reviewed as to whether two day a week is sufficient time for this home. The records were also very mixed and in some cases repeated, but generally showed that regular checks had been made on, for example, hot water temperatures. However some records showed that items requiring more work, had been consistently recorded and no action had been taken for months to address the matter. For example, leaking gutters and the poor condition of the windows. On discussion the manager said that she hoped for a full time maintenance man to be working at the home. Fire safety records were reviewed. Internal checks and tests had been completed for the fire alarm and emergency lighting and records maintained. Staff had attended a fire drill in May 2009. A fire safety risk assessment was in place but this had no date. This needs addressing and checking that it is still up to date. It was noted that a fire safety company maintaining the system in March 2009, advised that the detectors should be changed as they were over ten years old. This was discussed with the manager and there is no action been taken on this matter to date. Care Homes for Older People Page 21 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team are not well trained and residents cannot be confident that they are suitably skilled to ensure their needs would be met. Evidence: On arrival at the home we were informed by the person in charge of the home that they were short of senior care staff that day. The managers AQAA reflects that senior staff shifts in the home are being covered by agency staff at times. On discussion with the manager she acknowledges that the senior team at the home are quite new and some input is needed to their development in order to help improve care standards at the home. The manager reports that there has been some turnover of staff since she has been in post but this has now settled. She said that staff usually cover any shifts needed but they are still short of senior cover. Staff said that they generally liked working at the home and that the staff team were good and worked hard. Some said that there were staff shortages at times when they could not cover, but this had improved. A group of the staff were overheard to be very negative about the home and gave a poor impression of the current situation in the home. Staff spoken to said that the routines of the homes were now more person centred than they had been, but the Care Homes for Older People Page 22 of 30 Evidence: mornings were very busy and they had little time to talk to the residents. This could have an impact on providing person centred care and promoting residents independence. The current staffing levels are 1 senior and 3 carers on each floor on an early and late shift and 1 senior and 3 care staff at night - deploying 2 upstairs and 2 downstairs. The manager reported that she is planning to review the staffing in relation to the skill mix, primarily at night. The morning shift commences at 08.00 hrs and consideration should be given as to whether this meets the residents current needs when providing person centred care. The rotas showed that on the whole the staffing levels are maintained apart from odd shift that they are unable to cover at short notice. Staff spoken to confirmed that they were undertaking NVQ qualifications. Training records submitted by the manager show that out of the care staff, only 2 had completed an NVQ qualification. Agency staff were working in the home on the day of the inspection and no profile had been received for one of them. The manager reported that they were usually in place and that this was an oversight as the agency they used were generally good at sending them through. 2 staff files were reviewed and these were seen to be in good order with the required checks and documentation in place. Both these staff had started some months before, in early 2009 and neither had any evidence of having had an induction. The manager confirmed that they had not had an induction. The manner showed us other in house inductions for other staff and whilst these had been started, they had not been completed. This needs to be addressed. The training matrix showed that there are significant gaps in the staff training programme, with only manual handling having a good compliance level. Some staff have had training in care planning, nutrition and infection control. The number of staff who have completed training in the care of people with dementia is low and insufficient for a home with a registration to care for such residents. Staff training is a key area for work in this home to ensure that the residents are cared for by a competent team. The majority of the staff have not been trained in fire safety, health and safety, food hygiene and first aid. The manager in her AQAA under what we could do better said more staff training. Care Homes for Older People Page 23 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team are working to address the shortfalls in the home and ensure that it is run in the residents best interests. Evidence: The manager has been working at the home since November 2008 in an acting role and has recently been appointed into the substantive post. She has been registered with the Commission previously and has held 3 managerial posts. On discussion she said that there had been a lot of work to undertake in the home but she felt that she was getting there. The manager has NVQ 3 and 4 qualifications. Training records show that the manager has up to date training in manual handling and some dementia training but does not have any other up to date training, for example, for example fire safety. The manager is meeting with the care staff every few months and the minutes show that she is raising care shortfalls with them and generally promoting a person centred Care Homes for Older People Page 24 of 30 Evidence: approach to care. The provider has a system in place whereby residents and relatives are surveyed for their comments and feedback on the services provided. At this visit there were no up to date surveys available. In addition to this the management team at the home undertake care plan audits and the manager plans to start auditing the medication systems. Relatives comments to us were variable and included the staff are very kind and easy to talk to, Sweyne Court looks a lot better now, some of the staffs abilities with English is an issue and can make it difficult sometimes, they need to have one or two male carers, they take really good care of my relative and understand xs mood wings and deal with them appropriately, residents need to go out occasionally, more activities would be a good idea, the general care and well being offered by staff to residents continues to be at a high standard, more motivational therapy needed for residents, the TV and music offered should be more age appropriate, there has been a general improvement with the new management - we hope its maintained and laundry ruined and clothes missing. Minutes of relatives meetings show that the manager is meeting with families regularly. The minutes show that these are open forums for discussion and relatives are comfortable in raising any issues. For residents safety, proper locks should be considered for the sluices and chemical cupboards contained therein as we found it was easy to access both these areas. Staff were observed moving residents in wheelchairs not using the footplates for residents safety despite them being on the wheelchair. Accident records were reviewed and found to be completed quite well, although staff should be more consistent with recording the times of the accidents, for auditing purposes. Where appropriate the manager refers residents to the local falls prevention team. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 12 16(2)(n) The registered person having 31/10/2007 regard to the size of the care home and the number and needs of service users, consult service users about the programme of activities arranged by or on behalf of the care home and provide facilities for recreation including, having regard to the needs of the service users, activities in relation to recreation, fitness and training. This is in connection to developing your activities programme further and ensuring it is also suitable for those residents with dementia care needs. Care Homes for Older People Page 26 of 30 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 2 14 Prospective residents should have a comprehensive assessment prior to coming into the home. So that residents can be assured that their needs will be met. 15/08/2009 2 7 15 Residents must have all the care plans in place that they need, based upon assessment and the care plans should be up to date. To help ensure that residents needs are met and that outcomes are good. 30/08/2009 3 8 12 Ensure that residents have the risk assessments in place that they require linked to up to date care plans. So that their health needs are met in a proactive way. 30/08/2009 Care Homes for Older People Page 27 of 30 4 10 12 The laundry must be organised and managed so that residents clothes are properly looked after. So that residents dignity is maintained and so that they do not loose their belongings. 30/08/2009 5 12 16 Residents must have an 30/08/2009 assessment of their social care needs and the care plan must include their preferences. So that residents social care needs are met in an individual and group way. 6 15 16 Review the use of small dishes on the upstairs unit and the availability of drinks around the home. To ensure that residents have enough to eat and drink. 15/08/2009 7 18 13 Staff must be trained in adult protection matters. So that residents are protected, as far as possible, by the staff team in the home. 15/09/2009 8 19 23 Keep all parts of the home in 30/09/2009 reasonable repair - with specific reference to furniture in bedrooms. So that residents have a nice home to live in. Care Homes for Older People Page 28 of 30 9 38 13 Staff should ensure that the health and safety of residents is taken into account on an ongoing basis. So that residents are safe as far as possible. 15/08/2009 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 1 2 3 4 1 7 8 9 Consideration should be given to making the service user guide more widely available in the home. Continue to developed person centred care planning in the home. Put a system in place to help ensure that all residents are weighed regularly. Review the timing of the morning medication round to ensure that residents receive their medication at appropriate times. Provide the activities officer with some training and experience to support her in the role that she has. Continue to develop person led approach to the routines of the day. More staff should be trained on how to manage residents with challenging behavior. Provide more visual stimulation for residents to see when they walk around the home. Update the fire safety risk assessment. Improve signage around the home to promote residents independence. The manager should ensure her training is kept up to date in order to lead her team. 5 6 7 8 9 10 11 12 12 18 19 19 19 31 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or 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. 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