Inspection on 26/05/09 for Seaswift House

This inspection was carried out on 26th May 2009.

CQC found this care home to be providing an Good 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Seaswift House 05/12/07

Seaswift House 16/11/06

Seaswift House 24/01/06

Seaswift House 02/08/05

Seaswift House 04/03/05

Seaswift House 13/08/04

Seaswift House 31/03/04

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Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Seaswift House Sea Hill Seaton Devon EX12 2QT     The quality rating for this care home is:   two star good 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: Deirdre McEvoy     Date: 2 6 1 1 2 0 0 8 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 35 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 35 Information about the care home Name of care home: Address: Seaswift House Sea Hill Seaton Devon EX12 2QT 0129724493 0129721149 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Kathryn Sara Jackson Name of registered manager (if applicable) Ms Carole Rundle-Drew Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Seaswift is a care home that has been adapted from a row of 3 houses. The home provides accommodation and personal care for up to 14 residents who have needs associated with old age. Accommodation is provided over three floors and is linked by stair lifts. All bedrooms are single occupancy and 12 of the 14 have en suite facilities. There is a communal lounge and conservatory and two dining rooms, all situated on the ground floor. The home is close to the centre of Seaton and the seafront. The front aspect overlooks a bowling green and gardens. The rear of the home has a small patio style garden. Seaswift does not have dedicated parking. Care Homes for Older People Page 4 of 35 care home 14 Over 65 14 0 Brief description of the care home The fees charged at this home range from four hundred and twenty five pounds to four hundred and eighty pounds per week. This fee does not cover items such as newspapers etc but does cover toiletries and the majority of transport. Further information about this home, including reports, is available from the home. Care Homes for Older People Page 5 of 35 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: two star good 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: As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home, and an assessment of what they do well and what they plan to improve upon. Before our visit to Seaswift House we sent a number of confidential surveys to people living there, to staff and outside professionals to hear their views. We received completed surveys from 8 people living at the home, one GP and from 2 staff. The comments and responses we received have helped us to form the judgements we have reached in this report. We (The Commission) spent just over 9 and a half hours at the service. There were 9 Care Homes for Older People Page 6 of 35 people living at the home at the time of our visit. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to 4 people. Most people living at the home were seen or spoken with during the course of our visit and we spoke with 5 people in depth to hear about their experience of living at the home. We also spoke 5 members of staff, including the manager and owner. We looked around the home and checked records, such as, care files, medication records, staff recruitment and training records, quality assurance records, and some safety records. A random inspection was completed on 28 March 2008. The reason for this inspection was to follow up issues raised in relation to the safe handling of medicines at the key inspection of 5 December 2007. A copy of this report can be obtained from the Commission. What the care home does well: What has improved since the last inspection? The home has or is working towards meeting the requirements and the recommendations made at the last inspection. Aspects of care planning have improved helping to ensure that people receive the care they need. Areas relating to the management of medicines have also improved, for example, record keeping has improved and medicines that require refrigeration are Care Homes for Older People Page 8 of 35 now stored securely and records show they are kept at the appropriate temperature (see what they could do better). New care plans consider the mental capacity of people living at the home to help identify where they may need assistance with decision making. The planned training for staff in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards will ensure staff have the knowledge and skills to support people who may lack capacity. The home no longer uses door guards as a form of restraint and we found that people could move freely around the home. People living here are protected from infection by satisfactory infection control procedures and practices. Recruitment practice has improved helping to ensuring that people are protected from unsuitable workers. At the last inspection we identified several areas of concern in relation to fire safety. These have now been addressed and a visit by the local fire safety officer found satisfactory fire safety standards at the home. What they could do better: One requirement and five recommendations for good practice have been made as a result of this inspection. Aspects of the management of medication must be addressed to ensure that safe practice is maintained. The home must ensure that secure storage, in line with current regulation, is available should controlled drugs need to be kept at the home. Some care plans do not have enough detail to guide staff about individuals needs and how to meet them. Care plans should be expanded to ensure they are person centred and clearly show how identified individual needs, such as skin care, will be met by staff at the home. The home has been asked to provide staff with clear guidelines for monitoring peoples blood sugar, to ensure agreed and appropriate action is taken when needed. The home should have a written agreement with health professionals when undertaking delegated nursing tasks, such as giving Insulin. Staff training records should be available to show that they have received the necessary training to give Insulin. When creams are prescribed the home needs to make sure that a record is kept of their application. We have asked the home to ensure that social activities continue to be developed so that everyone at the home has the opportunity to enjoy leisure time, including outings. The home should ensure accurate records are kept, the home should ensure that the staff rota correctly reflects which staff are on duty at any time, including staff cover at night and the hours worked by the owner. The home have been asked to evaluate the results of the latest quality assurance Care Homes for Older People Page 9 of 35 questionnaires and ensure that improvements are made where required, for example better opportunities for people to enjoy activities. 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 10 of 35 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 35 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. Good information about the services offered here is available to people to help them decide if the home will suit their needs. People benefit from a good admissions process, which ensures that the home is able to meet individual needs. Evidence: The home has a colour brochure, which contains most of the information people need to help them decide if Seaswift House can meet their needs and preferences. All people responding to our survey told us they were given enough information about the home. One person told us, I had been in twice before and another said, My daughter came to visit first. This is a wonderful place. People are so friendly, really superb. We heard that people who are interested in moving into the home are given written information to support the verbal information given to them during the assessment Care Homes for Older People Page 12 of 35 Evidence: visit. People said that they had been offered the opportunity to visit the home before moving in on a permanent basis, and relatives are also given an opportunity to visit the home prior to their relative moving in. The home encourages people considering a move to come and stay for a trail period of one month to make sure Seaswift is the right place for them. People returning our surveys told us they had been given a contract, which helps to protect their rights and sets out their responsibilities. We looked at the way the home assesses peoples needs to ensure that individual needs can be met. Either the manager or deputy manager meet with people who are considering a move to the home to get to know them, to provide information about the home, to answer questions, and to carry out an assessment. We saw that information had been gathered from health and social care professionals for the most recently admitted person. The home had also completed a assessment of this persons daily living needs. Together this information gave staff sufficient details about the persons needs and preferences to develop a care plan. We spoke with this person about their admission to the home, they said, I arrived and never looked back. I settled beautifully here. I have my own stuff around me, which makes it so homely. I am very happy here. The home does not provide intermediate care. Care Homes for Older People Page 13 of 35 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. Improved care plans provide the staff team with most of the information needed to enable them to support people in a way they prefer. Peoples personal care needs are well met, and people feel they are treated with respect. The arrangements in place for the management of medication need attention to ensure medication is handled safely. Evidence: People living at the home told us they always receive the care they need. One person wrote, Excellent care, another wrote, I am very happy here and have no problems. Comments from people spoken with during our visit included, Life is very nice here, comfortable and friendly, which means a lot; The staff are very good. They look after you and see you have everything you need; They look after me very well and I really dont want for anything. We looked at four care plans to help us judge how care is planned and delivered. Since the last inspection, the manager and care staff have worked to improve the quality of information in care plans. Care Homes for Older People Page 14 of 35 Evidence: A new computer package has been purchased to help senior staff record and plan individual care needs. These care plans generate instructions for staff to follow when delivering care depending on the individuals needs. Consideration has been given to peoples mental capacity, preferences, health and personal care needs and a risk assessment is an integral part of the care plans generated. Although care plans gave good information about what people could manage themselves and the areas they needed support with, the care plans were not particularly person centred. For example, two people with a similar problem, for example dizziness, had the same instructions in their care plan generated by the computer. Two care plans indicated that peoples skin condition was to be continually monitored but gave no instructions about the action staff should take as a result of monitoring or possible changes. There was no clear information in care plans about specific pressure relieving equipment to be used to improve the condition of one persons skin. The daily notes for these people showed that their skin was sore and that staff were using cream daily to treat this. There was no record in the care plans or daily notes about which cream to use, nor when or where to use it. On visiting one person we saw that they had an appropriate pressure relieving cushion in place. This person told us, My skin is much better now. They (staff) look after me very well. Another care plan indicated that the person had a catheter but there were no guidelines in place for staff to follow regarding the care to be delivered, however, staff spoken with were able to tell us how they supported this person with their catheter care. Care plans lacked information about how peoples social, emotional and spiritual needs are to be met and just tended to say Nothing to impact on his or her taking part (Refer to standard 12). Staff told us they always have up to date information about peoples needs. They described the systems in place for ensuring that relevant information is shared with staff, such as, a hand over for each shift and a communication book which contained information about any changes to peoples needs. Staff spoken with demonstrated a good knowledge of the peoples needs and personalities. One staff member told us, Staff liaise quite well with each other to let us know of any changes. The manager and deputy manager recognised where care plans needed to be more person centred and additional information can easily be added to the existing care plans. Some people told us they had been consulted about the care they required, one person told us, I gave them lots of information about what I need. I am extremely Care Homes for Older People Page 15 of 35 Evidence: happy with care I get. Other people couldnt remember. People living at the home told us they always receive the medical support they need. A visiting health professional told us the home always seeks advice when necessary and acts on advice given with regards to peoples care and support. The health professional seemed confident that peoples needs were met and told us there was an Excellent caring environment at Seaswift. Records showed that outside professionals visit people regularly, for example GP, community nurses, chiropodist, and other specialists, such as the Community Psychiatric Nurse (CPN). One persons care plan provided staff with good information about how depression can affect this person, and daily records show that staff consult with the CPN and are considerate towards this persons emotions and mood. People are also supported to attend out patient clinics. Daily notes show that staff take action to address peoples health needs promptly. Peoples weight is monitored regularly to alert staff to any problems; records showed the steps taken to address one persons weight loss, which had now stabilised. The home is not developing specific care plans for people with diabetes, which would be good practice. Although some staff demonstrated a good understanding of diabetes, there were no clear guidelines about the support people need, or an agreed range of acceptable results for blood sugars, which would ensure all staff know what to do should levels fall outside of the range. We were told by the manager that the District Nurses (DNs)had trained senior staff to monitor peoples blood sugar levels. This has not been agreed in writing to ensure that delegated nursing tasks are carried out safely. The manager said she would ensure an agreement and care plan was drawn up with the DNs. The CSCI Regional Lead Pharmacist completed a random inspection in March 2008, to follow up issues raised in relation to the safe handling of medicines at the key inspection of 5th December 2007. It was pleasing to see that a number of the requirements made in relation to medication have been addressed. Record keeping has improved; this includes staff signing for all medicines given or recording the reason for not giving medicines. In addition, where variable doses are prescribed a record is kept of the actual dose given. Medicines that require refrigeration are now stored securely and records show they are kept at the appropriate temperature, although the medication fridge would benefit from being defrosted. The home still needs to work to address some outstanding issues. The manager told us that the DNs had trained senior staff to administer one persons insulin, however the Care Homes for Older People Page 16 of 35 Evidence: manager did not have written evidence of the training or a written agreement and protocols from the DNs confirming this arrangement. It was agreed that this would be addressed immediately by the manager. The home is to be commended for supporting and encouraging people to manage their own medication where possible. People sign a consent form taking responsibility for their medication and secure storage is available in their bedrooms to keep medicines safe. Care plans identify who can manage medication independently and there is a comprehensive record of peoples current medication and possible side effects. However, care plans would benefit from more detail about the associated risks and exact support people need to manage their own medication. When staff apply prescribed creams to sore skin there are no accurate records of when this is done, or the area the cream is to be applied to. No one living here currently needs a medicine that should be stored as a Controlled Drug. However, were someone to be prescribed such a medicine, the home do not have the appropriate facilities for storing them. We saw that staff responsible for administering medication have received certificated training. Peoples personal care is well attended to, which promotes their dignity and improves their feeling of self worth. People were well dressed and groomed, and attention to their personal care was good. Two female residents told us how much they enjoyed having their hair and nails done. People told us about the ways staff promote their privacy and dignity. We were told that staff were very respectful, and always listened and acted on what people said, and always knocked on peoples doors before entering. One person told us, Staff are super, always smiling and jolly. We saw staff that were friendly and caring in their approach and they showed a good understanding of peoples needs and characters. One staff member skilfully engaged with one person, who was a little confused. The staff member listened carefully and responded in a positive way to this persons requests, therefore reducing their confusion and anxiety. Care Homes for Older People Page 17 of 35 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. Routines are flexible but peoples preferences and expectations with regards to social and recreational interests are not met sufficiently to ensure that they enjoy a full and satisfying lifestyle. People benefit from contact with their family and friends, which is encouraged and supported by the home. Evidence: Details of peoples preferred daily routine is recorded in their care plans to ensure staff are aware of favoured times for getting up and going to bed etc. We spoke with several people about the routines at the home, and people told us that the routines were flexible and suited their needs. Comments included, I am never told what to do, I can do what I like, have visitors when I want. It is fairly easy here, and You can do what ever you like here. We asked people about the social activities provided at home. People returning surveys told us there were always or usually activities they could take part in at the home. Two people told us they choose not to take part in activities. People spoken with told us they would like more opportunities to take part in activities Care Homes for Older People Page 18 of 35 Evidence: and trips outside the home. One person told us, We have bingo once a week but not much else, another person said, Theres not a lot to do here, no activities for me to do and a third person told us, Im not keen on bingo so cant do a lot. All three said they would like to see an improvement in activities including more opportunities to get out and about. Staff spoken with also said they would like to see an improvement in the activities on offer. Care plans contain little relevant information about peoples interests and hobbies. Where reference was made it was a general comment like, Nothing to impact on his or her taking part. More relevant information would help when trying to develop interesting and meaningful occupation and stimulation for people. The AQAA shows that the home is aware that activities need to be improved. Trips to the theatre and pantomime were being organised. We saw that staff had time to spend with people individually. Staff were seen to read the local paper to one person and chat about local events. Some people enjoyed a manicure, whilst other people enjoyed a chat with staff. One person told us they particular liked the regular communion service at the home provided by a local church. People also talked about the friendships they had developed at the home, one person told us, I have made friends with everyone. A hairdresser visits the home weekly and provides a much appreciated service for people. Visitors are welcome at the home and people told us they could see their visitors when it suited them. People can choose where to spend time with their visitors, either in the privacy of their bedroom or one of the communal spaces. We saw that people were given simple choices throughout the day, for example what they wanted to eat and drink, where they sat, what clothes they wore. People said that they were able to choose when they got up or went to bed. People responding with surveys said that staff always listen to them and act on what they say. In surveys people told us they always or usually like the food, one person said they sometimes enjoy the food. Comments included, Excellent home cooking, One can always get an alternative if you dont like the menu and Sometimes could vary the food. We spoke with several people during our visit and most said the food was very good, comments included, We have excellent home cooked food!, The food is always good and We have lovely food, I particularly like the puddings. One person said, We have traditional meals here. Another person said the food was not too bad but said they would like a better choice sometimes. One person told us they required a special diet, which they said was provided along with a choice. People told us they could have an alternative to the main meal if they wanted and there is always a Care Homes for Older People Page 19 of 35 Evidence: vegetarian option. Lunchtime was observed to be a sociable occasion for most, with people enjoying an opportunity to chat. Several people enjoyed a glass of sherry with their lunch. The dining rooms were pleasantly laid for mealtimes, with good attention to detail, for example flowers, place mats and condiments were on the tables. The mealtime was unhurried and staff were available to assist people where needed. The main meal is served at lunchtime, which seemed to suit most people. Care Homes for Older People Page 20 of 35 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. The home has a satisfactory complaints system, with evidence that people feel their concerns or complaints would be listened to and acted on. People are protected from abuse by well informed staff. Evidence: The manager told us the home had not received a complaint in 17 years. The Commission has received no complaints or concerns about the service. Everyone returning our survey said they knew how to make a complaint and who to speak with should they be unhappy about anything. People spoken with told us, I dont have any complaints but would speak with the manager and There is nothing to complain about. When asked what the home does well, one person told us, The comfort and security here. All people spoken with told us they felt safe at the home and that they were well cared for by staff. One person said, We are all very well looked after, another said, Staff are very very kind. Staff spoken with had attended training in order to ensure people are safeguarded from abuse. Staff spoken with had a good understanding of what to do should they suspect poor practice or abuse of any kind. One new member of staff was booked to Care Homes for Older People Page 21 of 35 Evidence: attend safeguarding training and had seen the policies and procedures during their induction. This person was also aware of the reporting process. At the last inspection a requirement was made to ensure that people living at Seaswift were not restrained by the use of door guards. The manager told us that this practice had stopped immediately after the last inspection and we saw no evidence to suggest that this practice continues. A visit by the local fire safety officer (following our last inspection) also confirmed that door guards had been removed. Care Homes for Older People Page 22 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has been decorated and maintained to a pleasant standard. All areas were clean, safe, comfortable and homely. Evidence: The home has a programme for redecoration and improvement to ensure that people enjoy a good standard of accommodation. A full time maintenance person is employed and one person told us about the little jobs this person helps her with, such as hanging pictures or shelves in her bedroom. Since the last inspection several bedrooms have been re-decorated, and new carpet has been laid in the dining room, hallway, landing and stairways. Two bedrooms have been fitted with en suite facilities, which the manager said did not require any planning or building control permission. The manager was advised to inform the local Fire Safety Department to ensure their floor plans of the home are up to date. We visited several bedrooms and found every room had been attractively decorated and furnished, and appeared clean, tidy and homely. People are encouraged to bring items of furniture, pictures and personal belongings with them to make their rooms feel like home. One person told us this was very important to them. Care Homes for Older People Page 23 of 35 Evidence: The home has the necessary equipment to assist people and meet their needs. A stair lift to access the first floor is in place, the home has a hoist, and assisted toilets and baths are installed which are capable of meeting peoples individual needs. At the last inspection we identified several areas of concern in relation to fire safety. These have now been addressed and a visit by the local fire safety officer found satisfactory fire safety standards at the home. The home is generally safe for people; radiators are covered to reduce the risk of burning to people. Windows on the upper floors are restricted to prevent accidents from falls, and records show that water temperatures are regulated to prevent harm from scalding. The home was clean and free from offensive odours throughout. People responding with surveys said the home was always clean and fresh. Staff training and good practice maintain infection control. Staff have the necessary protective equipment, such as gloves and aprons. There is liquid soap and disposable towels in toilets and bathrooms to promote good standards. The laundry is situated in an out building in the back garden and has the necessary equipment to deal with the homes laundry needs. People were particularly happy with laundry service and told us, They do a good job with the laundry, returned to me all washed and ironed and They take care of my laundry. My things are washed, ironed, folded and out away. Care Homes for Older People Page 24 of 35 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. Staffing levels are sufficient to ensure that peoples needs are met in a timely way, and experienced and friendly staff support people well. Recruitment practices have improved helping to protect people from unsuitable workers. Evidence: People told us, (via surveys) that staff were always available when needed. During our visit one person said, You never have to wait long for attention, to demonstrate she rang her call bell and a member of staff arrived almost immediately. All spoken with during our visit confirmed that staff were always available when needed. Several people spoke highly of the staff. Comments included, The staff are very nice, and The staff are very good, they look after you. Two staff responding with surveys told us there were always enough staff on duty, one member of staff wrote that there were sometimes enough staff on duty. On the day of our visit the manager and deputy manager were on duty along with a senior care assistant, a cook and maintenance person. The rota shows that there are usually two care staff on duty. The owner who lives on the premises spends a lot of time in the home supporting staff daily. However, the rota does not reflect the number of hours worked by the owner. She also provides cover at night, but this is not recorded on the duty rota either. Care Homes for Older People Page 25 of 35 Evidence: There were 9 people living at the home at the time of this inspection. At night there are two people who live on the premises (the owners) and provide sleeping cover. The owner told us she was hardly ever disturbed at night. People told us that they felt confident that if they ring for assistance during the night someone would attend to them. The owner said that once all vacancies were filled a permanent night staff member would be recruited for waking nights. There is a small staff team of five carers working at the home. The AQAA shows that the home does not use agency staff. We looked at the recruitment records of the most recently employed person. A completed application form was on file, and a copy of the interview notes and an assessment of interview were also available. We found that required checks, such as POVA first checks and references had been obtained before the staff were confirmed in post. Staff told us via surveys that their induction training covered everything they needed to know when first in post. Records show that the new staff member was undertaking induction training, which meets nationally recognised standards. This member of staff told us, the manager went through everything with me. The AQAA shows that three of the five care staff holds a nationally recognised qualification in care (NVQ 2 or above). This helps to ensure that general care standards within the home are maintained. Staff told us that they receive training relevant to their role, including mandatory training such as manual handling, infection control and safeguarding. Since the last inspection staff have attended training related to Dementia Care, and other specialist training provided includes diabetes and Parkinsons Disease awareness. The AQAA shows that staff are to attend training related to the Mental Capacity Act. Staff felt they received the support needed to do their and that they had the right experience and knowledge to meet peoples needs. Staff spoken with said they were not expected to care for people outside of their area of knowledge. Care Homes for Older People Page 26 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is well managed, and run in the best interest of the people living there. Satisfactory systems are in place to promote the safety and health of people living and working at the home. Evidence: The manager is both qualified and experienced. She has several years of experience managing a care home. The manager works hard to ensure people living and working at Seaswift are happy and safe. People living at the home and staff expressed their confidence in the manager, one person told us, You can talk to Carole. She is so sensible. Staff told us they felt well supported by the manager, who has a friendly and open approach. An able deputy manager, who is currently working towards NVQ 4 in care, supports the manager. The owner is also available daily to provide support. Care Homes for Older People Page 27 of 35 Evidence: A quality audit has been undertaken since the last inspection to gather peoples views relating to the running of, and the quality of life experienced at the home, including standards of care, quality and variety of food, activities, and environment. The results of the last survey completed in October 2008 show a high level of satisfaction, with most people ticking excellent for outcomes. The only area highlighted for improvement in the surveys was activities. The manager is to prepare a report and action plan reflecting the overall outcome of the surveys. The home had ensured that the majority of requirements made by the commission or, other regulatory bodies are carried out. Peoples monies and belongings are kept safe. Staff are not involved in managing peoples finances. Health and safety at the home is generally well managed. The home employs a Health and Safety consultant to undertake twice yearly checks to assess and highlight any health or safety concerns. During our tour of the building no immediate hazards were identified. Staff receive mandatory training such as manual handling, infection control, fire safety and where appropriate food hygiene. The fire log book has been completed to show that all fire safety equipment has been checked and maintained in accordance with the guidance laid down by the fire service. Staff have received regular fire drills and fire training. The fire log book has been completed to show that all fire safety equipment has been checked and maintained in accordance with the guidance laid down by the fire service. Staff have received regular fire drills and fire training. Care Homes for Older People Page 28 of 35 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 7 15 (2) (c) If decisions are being made 28/03/2008 on behalf of any person living here, these must be done using the Mental Capacity Act (2005) and decisions must be made and recorded in accordance with the related Code of Practice. Not inspected as part of this inspection original date for compliance 28/02/08 2 7 15 (1) (2) (b) All the people who live here 28/03/2008 must have a plan of care that details how their health and welfare needs are to be met. Actions taken to meet needs and the outcomes of these actions should be recorded and reviewed so that only appropriate care is delivered. Not inspected as part of this inspection original date for compliance 28/02/08 3 8 13 (1) (b) People who have 28/03/2008 psychological problems should have these monitored and recorded so that appropriate preventative actions can be taken and appropriate care given in a consistent way. Not inspected as part of this Page 29 of 35 Care Homes for Older People inspection original date for compliance 28/02/08 4 9 13 (2) The people who live here must have their medicines managed safely. Staff administering medicines by specialised techniques must receive training from an appropriate professional. Any medicines that require refrigeration must be stored securely and at an appropriate temperature. Records kept in relation to the management of medicines must be kept up to date. This includes staff signing for all medicines given or recording the reason for not giving medicines. In addition, where people are managing their own medicines, records relating to these must be accurate and up to date. 28/04/2008 5 18 17 (1) Where restraint is used staff 28/03/2008 (a)Schedule 3 must keep a record of this and records must include the reasons for this. Not inspected as part of this inspection original date for compliance 31/01/08 6 18 13 (7) People living at Seaswift should not be restrained unless this is the only practical means of securing their welfare and there are exceptional circumstances. 28/03/2008 Care Homes for Older People Page 30 of 35 Not inspected as part of this inspection original date for compliance 31/01/08 7 19 23 (4) People living here must be safe from the effects of fire. This includes: Ensuring that all fire doors close properly. That the placement of furniture does not prevent fire doors from closing. That checks carried out identify where there doors do not close and that actions are taken to deal with this. That the manager checks with the local fire service, before using locking door guards, that the use of these do not pose unacceptable risks to the people living here. Not inspected as part of this inspection original date for compliance 31/01/08 28/03/2008 8 26 13 (3) People living here must be protected from infection by ensuring that good infection control procedures and practices are in place. Not inspected as part of this inspection original date for compliance 31/01/08 28/03/2008 9 27 18 (1) (a) People living here must have 28/03/2008 their needs met 24 hours a day. There must be sufficient staff on duty at night to meet people?s needs without resorting to the use of restraint. Not inspected as Care Homes for Older People Page 31 of 35 part of this inspection original date for compliance 31/01/08 10 29 19 (1) (b) Schedule 2 People living here must be kept safe from being cared for by inappropriate people. All staff should undergo robust recruitment checks which should be received before they begin working with people unsupervised. Not inspected as part of this inspection original date for compliance 31/01/08 28/03/2008 11 31 10 (1) People should live in a home 31/03/2008 that is managed with sufficient care, competence and skill to ensure that their needs are met, that they have rights and that they are kept safe. Care Homes for Older People Page 32 of 35 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 9 13 You must review the 29/06/2009 arrangements for storing controlled drugs, to ensure that, if such medicines are received into the home any time in the future secure storage facilities comply with current legislation. To ensure that controlled drugs are securely stored 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 7 It is recommended that you continue to develop care plans that set out in detail the action, which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of people are met. It is recommended that an agreed range of acceptable levels for blood sugars be recorded in care plans to ensure that staff are aware of the appropriate action to take should levels fall outside agreed levels. Records of staff training for administering medicines by specialised techniques should be kept at the home. Where Page 33 of 35 2 8 3 9 Care Homes for Older People staff undertake a delegated nursing task, such as administering Insulin, a written agreement and protocol should be in place between the home and the District Nursing Team. When creams are prescribed a record should be kept of their application. 4 12 It is recommended that the home continue to develop stimulating and meaningful activities for all people living at the home, which meet with their preferences and capabilities. This should include opportunities to enjoy activities outside of the home. You should ensure that the duty rota accurately reflects the staff on duty at all times, including night time cover and the hours worked by the owner. 5 27 Care Homes for Older People Page 34 of 35 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. 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. 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