Inspection on 12/03/07 for Swallownest Care Home

This inspection was carried out on 12th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Swallownest Care Home 07/09/06

Swallownest Care Home 15/03/06

Swallownest Care Home 21/09/05

Swallownest Care Home 08/03/05

Swallownest Care Home 06/07/04

Swallownest Care Home 06/01/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Swallownest Nursing Home Chesterfield Road Swallownest Sheffield South Yorkshire S26 4TL Lead Inspector Eileen Engelmann Key Unannounced Inspection 09:00 12th March 2007 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Swallownest Nursing Home Address Chesterfield Road Swallownest Sheffield South Yorkshire S26 4TL 0114 2540608 0114 254 8846 none None Southern Cross Care Homes No 2 Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) ** Post Vacant *** Care Home 65 Category(ies) of Old age, not falling within any other category registration, with number (65) of places Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th September 2006 Brief Description of the Service: Swallownest is a care home providing nursing care and residential care for 65 older people. It is located in the village of Swallownest, which is on the Sheffield/Rotherham border and near the M1 motorway. The home is within easy reach of local shops and other community services. The home is purpose built and was developed in three phases. The design of the unit is in three wings, each with its own lounge and dining area. All bedrooms are single occupancy and seventeen of the bedrooms have en-suite facilities. The garden area is fitted with seating and raised flowerbeds; they also have a rear patio with access to the garden from the sun lounge and dining areas. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents, along with the latest inspection report for the home are on display in the reception area of Swallownest Care Home. Copies of these can be obtained from the manager of the home. Information given by the manager within the Pre-Inspection Questionnaire indicates the home charges a range of fees from £303.00 to £477.00 per week depending on the type of care needed by each individual, and there are additional charges for hairdressing, private chiropody, private optical care and toiletries. Details of the costs of these are available from the manager. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last inspection in September 2006 when there was no manager in post, a new person (Mary Day) has been appointed. Ms Day has yet to be registered with the Commission but within this report she is referred to as the manager. This unannounced inspection was carried out with the operations manager (Helen Encery), the manager (Mary Day), staff, relatives and residents of Swallownest Care Home. The inspection took place over 1 day and included a tour of the premises, examination of staff and resident files and records relating to the service. Four staff on duty, five of the residents and three visitors were spoken to; their comments have been included in this report. Information was gathered from a number of different sources before the inspector visited the home. Questionnaires were sent out to a selection of staff, relatives and residents and their written response to these was adequate. The inspector received 1 back from relatives (5 ) although some individuals have helped residents complete their forms, 7 from staff (35 ) and 31 from residents (50 ). The owner of the home completed a pre-inspection questionnaire and returned this to the Commission within the given timescale. There are a number of requirements from the previous report (January 2006), which remain unmet. The registered person and the manager of the home must prioritise these for action, as failure to meet the regulations could result in enforcement action being taken in the future. What the service does well: The home is welcoming and has a comfortable environment. Residents said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. Residents have good access to professional medical staff and are able to access external services such as dentists and opticians. Residents are able to keep in contact with relatives, visitors and friends and are satisfied with the social, cultural and recreational activities within the home. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home could give more information about the home so that people can make a better choice about if they wanted to live there. New people coming into the home must have had a professional person look at what care they need and the manager of the home must make sure she tells new people that the home can meet their needs, before they are admitted. The staff do not always write down what care each person living in the home needs to make their life and health better. They should be talking to the residents more to find out what they like and how they want to be looked after. This helps the residents to have choice in how they are cared for and helps them stay as independent as possible. Staff must make sure that the medication they give out to the residents is given at the right time and the time is recorded correctly, to make sure people stay healthy and safe. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 7 Staffing numbers in the home must get better to make sure there are plenty of staff on duty to offer people living in the home the care and support they need, and in a way that is dignified and respectful. Extra staff must be around when the home is busy to make sure people living there are not kept waiting for a long time before someone comes to help them. The manager must take action to gather the viewpoints of those living within the home on a regular basis and use this information to ensure the home is meeting their needs and expectations, as well as achieving the home’s aims and objectives. There must be a positive drive to ensure that all residents are able to have a voice within the service and that their opinions are listened to and given value. The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to her during this visit. Your comments and input have been a valuable source of information, which has helped create this report. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 6. Quality in this outcome area is adequate. The admission process is inconsistent and does not guarantee that all residents undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission. This means that residents are not assured that their needs can be met by the service and this could affect their health and wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the last inspection report (September 06) a requirement was made for the service user guide to reflect the aims, objectives and facilities at the home and be regularly updated. At this visit it was seen that this has been done and the requirement is now met. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 10 The statement of purpose and service user guide are on display in the entrance of the home and can also be found in each resident’s bedroom. These documents are available in a clear print format and can also be produced in a tape format. Since the last visit the manager has updated the documents and is in the process of putting the residents’ views of the service into the guide. Information from the surveys suggests that around 50 of the respondents received sufficient information about the home to help them make the decision to move there. Two individuals said that ‘time was an issue due to the hospital discharge, so we didn’t have the opportunity to get much information before hand,’ and ‘it was out of my hands as I was in another home and not happy there’. In the last report (September 06) a requirement was made that every resident must have an up to date contract. During this visit it was seen that this has been partly met and therefore the requirement will remain in this report. Three of the five residents case tracked during this visit were seen to have signed and dated contracts, but two others did not. The manager said that she is working towards ensuring everyone has a contract in place and this should be done within the next three months. Private paying individuals have been notified of fee increases and given at least one months notice of this taking effect. In the last report (September 06) a requirement was made that no resident must move into the home without having had a needs assessment and being assured by the management of the home that their identified needs would be met. At this visit it was seen that this requirement is partly met and the manager is working towards improving admission practices within the home. The requirement will remain in this report. Two of the five residents case tracked during this visit were seen to have a full needs assessment completed by the Social Services who are funding their placement. One person is fairly new in and their care plan from the Social Services was faxed to the home the day they were admitted. This is not ideal, as it does not give the manager time to read and assess if the home can meet the persons needs. Discussion with the manager indicated that she tries to go out to meet the prospective residents before they are admitted and completes her own needs assessment. Confirmation of the offer of a place is often done verbally over the phone and the manager should consider moving towards a written format for this practice. In the last report (September 06) a requirement was made that staff do not admit residents who are out of category. This has now been met. Discussion with the manager indicates that individuals with dementia who have been accepted at the home have now undergone reassessment from their funding social service teams and all are deemed to be in the right placement Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 11 within the Older Person (OP) category. However, the inspector spoke to the niece of one individual who is not satisfied with the care her aunt is receiving around continence, weight loss, diet, medication, communication and hygiene. A number of the issues relate to the lack of staff numbers and this is discussed in more detail later on in this report (see standard 27). Four residents also voiced concerns over the lack of staff and how this impacted on their care. Everyone was full of praise for the staff themselves, saying they worked extremely hard to maintain standards, but they could not physically do everything with the time they had. Information from the Pre-Inspection Questionnaire completed by the manager and discussion with the residents, indicates that five (9 ) of the residents are male and fifty (91 ) are female. Residents are able to make a limited choice of staff gender when deciding whom they would like to deliver their care, as the home has one male member of care staff (2 ). The manager said this was due to a lack of suitable male applications when jobs are advertised. Everyone is of a white/British nationality, but the home would assess any person with specific cultural or diverse needs on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. The home does not accept intermediate care placements so standard six is not applicable to the service provided. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is adequate. The staff morale is low with high levels of sickness having a detrimental impact on the standard and consistency of care offered within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information from the surveys and discussion with the residents indicates that there is some dissatisfaction with the care being given. Residents commented that ‘ Sometimes when the staff are busy I am left waiting for assistance,’ ‘Every week I have to wait ages for my shower, which is very frustrating’, and ‘ if the carers have the time they are very good, but if they are busy then I have to wait’, ‘ I do quite a lot of waiting when I need someone’. One person said that ‘ I feel that no-one listens to me’. One relative told the inspector that ‘on a number of occasions they have had to dress their relative when they have visited, they have also found them sat on a Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 13 commode with a buzzer that does not work. Commodes are left full for a long time and that over the past year the care has deteriorated’. Four residents spoken to said that they only receive on bath or shower a week, as the staff do not have the time to do more. Throughout these discussions the relatives and residents stressed that the staff are kind, caring and friendly individuals, but they are ‘run off their feet’ and ‘ do not have enough staff on duty to get all the jobs done’. In the last report (September 06) a requirement was made that the care plans must reflect how the health and welfare needs of the residents are to be met. This information must be accurate and kept under review. At this visit it was seen that this was partly met. Each of the five residents case tracked during this visit has a care plan in place and all but one of these has been reviewed and updated on a monthly basis. The plans set out the physical and personal needs of the residents and have risk assessments in place for nutrition, pressure sores, moving and handling, falls and others relating to daily activities of living. There were some areas of the plans that need improving and these include •Staff are not completing the hygiene sheets on a regular basis, and therefore the information within them is not consistent. These must be either written daily or the information recorded in the daily notes. •Social needs are not always being identified and documented in the care plans. This must be done for everyone to ensure they are able to participate in activities and events that interest them and help them mix with others in the home. •Some of the care plans do not document the religious beliefs and needs of the residents, or include their wishes regarding death and dying. The manager must ensure this information is recorded for all residents. •Staff are not always recording in the daily diary, and this means there is a lack of evidence of the care given. This is not acceptable practice and the manager must ensure that staff keep a continuous record of care. •Where staff are completing risk assessments, it was seen that they are not always completing a plan of care where risk is identified. One resident who has bed rails in place has a risk assessment completed, but there is no input or agreement from the family or the resident documented on the record. The manager must ensure that staff complete risk assessments and develop a plan of care accordingly. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 14 In the last report (September 06) a requirement was made that appropriately trained staff must carry out risk assessments and revise the care plans accordingly. This has been partly met and the requirement will remain in this report. It is recommended that the manager arrange for staff to access training around effective record keeping to ensure they have the skills and knowledge to write the care plans. Three residents said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Responses to the surveys indicated that the residents and relatives are satisfied with the level of medical support given to the people living at the home. Comments from four residents indicated that there are some issues around bathing, with staff being too busy to give individuals more than one a week. Checks of the care plans showed that staff are not always documenting the hygiene care being given so it is impossible to say that this is not the case. This was discussed with the manager and she assured the inspector that she would look into the matter and ensure improvements are made. One relative commented that their family member living in the home has lost a lot of weight. Checks of the care plans found that staff are not weighing individuals even though the manager said there are scales suitable for all residents. One resident has been referred to the GP for a dietician appointment, but this was some weeks ago and there is little evidence in the care plan that staff have followed this up. The manager dealt with this issue as soon as it was brought to her attention by the inspector. Nutritional, fluid balance and pressure care charts in the residents bedrooms are not being completed properly by the staff, and important information is missing. This was also brought to the attention of the manager. Nutritional assessments are completed on admission, but these must include residents’ weights and be reviewed on a regular basis, with professional help sought if the home has concerns about a resident’s nutritional wellbeing. Equipment being used by residents with breathing difficulties (nebulisers) is dirty and staff do not appear to be washing out the mask and chambers after use. This was discussed with the manager who said she would speak to the staff and ensure the equipment was cleaned regularly. A discussion took place between the inspector, operations manager and manager about recent Department of Health guidance around a possible Flu Pandemic in 2009. The need for an emergency plan for the home in the event Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 15 of a Flu crisis was spoken about and the inspector advised that the manager access the guidance for care homes from the Department of Health website. The medication policy for the home says that individuals can self-medicate if they want to and after a risk assessment has been completed and agreed. Five of the residents spoken to prefer to have staff administer their medication although one individual likes to take their own nebulisers. This self-medication is accurately recorded and monitored by the staff. Comments from relatives and residents indicate that the times that staff give out medication do not always correspond to the times on the medication records, they said that ‘drugs recorded as given at 08.00 are sometimes given at 10.00’ and one individual was seen to be keeping his medication for lunchtime. When asked why he said his consultant had changed the time for it to be given but staff have taken no action and continue to give it at the old times. Discussion with the staff indicated that when they were short staffed then the person giving out medication is under a lot of pressure and is sometimes called away to give help elsewhere, this slows up the medication round. This was discussed with the manager who said she would follow these concerns up immediately. Checks of the medication records at this visit showed that staff are recording consistently on the charts and there is a controlled drugs register in place with accurate and up to date records kept. In the last report (September 06) a requirement was made for staff to respect the residents and visitors and treat them with dignity. This has been partially met and remains in this report. Discussion with the relatives and residents indicate that they have a high regard for the staff and feel that individuals are friendly, welcoming and supportive. However, a lack of staff numbers is eroding the good care that they are trying to give and resulting in standards falling. In the last report (September 06) a requirement was made that staff receive formal training around death and dying practices. This has now been met. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. Residents’ views are sought from time to time, but they do not perceive them as having much effect in changing how the home is run. This is restricting their choice and decision making around their daily lives, social activities and mealtimes, and could affect their health and wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Resident and relative comments in the surveys and discussions with individuals indicates that on the whole the people living in the home are satisfied with the social activities and leisure events taking place, however one person felt that ‘the residents are ignored a lot, especially those whose mental facilities are working but their body is not’. Three residents said they enjoy their own company and like to spend time in their bedrooms, and the staff respect this. However, there are spacious sitting areas throughout the home where individuals can mix with others and take part in activities. Interests discussed with the residents included watching Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 17 television, listening to the radio, reading large print books provided by the mobile library service, bingo sessions in the home and trips out in the company minibus. Discussion with the residents indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. Two relatives spoken to were full of praise for the staff saying they worked extremely hard and were good at making sure relatives are kept up to date with information about their loved ones health and welfare. Two other visitors expressed some concerns that those residents who are less able than others are being left to fend for themselves and do not always get the support they need. These concerns were shared with the manager and operations manager. Three residents spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. The manager said she is aware of the advocacy groups in the community that residents can access, and the contact information is on display within the home. All the residents said that the home encouraged them to bring in small items of furniture and personal possessions to decorate their bedrooms. Comments received by the inspector throughout this visit have raised some concerns that the rights of all residents may not always be respected or represented within the home. Meetings for residents and staff are not held regularly, satisfaction questionnaires are only sent out once a year and staff do not have much time to stand and listen to the residents during their working day. Some individuals commented that care in the home is becoming more institutionalised because there is a lack of time to give person orientated care. Residents and relatives have little input into the care plans and staff do not seek to include them in the monthly reviews. It is extremely important that the manager takes action to gather the viewpoints of those living within the home on a regular basis and use this information to ensure the home is meeting their needs and expectations, as well as achieving the home’s aims and objectives. There must be a positive drive to ensure that all residents are able to have a voice within the service and that their opinions are listened to and given value. Comments from the surveys received from staff, residents and relatives indicate that overall there is a good level of satisfaction with the meals provided by the home. One individual said ‘the food is lovely, choices are good and there is plenty of it’; another commented ‘there are always nice things to Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 18 eat on the menu’. Some individuals said that things could be better in that ‘the vegetables are always overcooked’, and ‘we get a lot of repetition such as chicken; corned beef and jam sandwiches’. In the last report (September 06) a requirement was made for residents to be given options of menu to choose from, staff to be available to help residents at mealtimes, kitchen staff to be aware of special diets, comfortable seating to be provided in the dining rooms and residents to have the option of eating in the dining room or elsewhere. This has been partially met. The inspector was told by people within the home that relatives sometimes have to feed their loved one at mealtimes due to a lack of staff on duty and that some individuals try to help out by serving drinks and sandwiches at teatime. Kitchen staff regularly help out with serving meals, especially when the units are short staffed due to people ringing in sick. The manager must take action to provide the residents with comfortable and pleasant mealtimes, which make eating and drinking a pleasurable experience and not one fraught with stress and lack of time for all those involved in the process. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. The home has a satisfactory complaints system with some evidence that residents feel that their views are listened to and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the last report (September 06) a requirement was made that staff must be aware that all complaints are to be recorded and the home is expected to keep a summary of the complaints made during the proceeding twelve months and the action that was taken in response. This has now been met. Checks of the complaints record indicate that the manager has dealt with 15 minor complaints since the last inspection, these often related to food and missing clothing. All are now resolved. The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. Three residents said that they were confident of using the procedure should they have need and that they understood who to speak to if not happy. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 20 In the last report (September 06) a requirement was made for all staff to receive training on protection of vulnerable adults and formal procedures as to who needs to be involved. This has now been met. The staff on duty displayed a good understanding of the vulnerable adults procedure and three residents spoken to said they ‘felt safe at the home’. Staff training files show that Protection of Vulnerable Adults from Abuse training has taken place and is an ongoing process, and information from the staff surveys indicates they are confident about the whistle blowing procedure and discussing any concerns with the management team. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint, and management of resident’s money and financial affairs. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 and 26. Quality in this outcome area is good. The standard of environment within the home is good, providing residents with an attractive and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is divided into three units. The Ellis and the Stuart units are the residential units where service users requiring personal care are placed. These are separate units either side of the nursing unit which is known as the Kendal unit. Ellis unit has an upstairs unit and a downstairs unit. Observation of the premises showed that the downstairs unit has a large, open and spacious lounge area, supplied with television and video appliances for the residents’ Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 22 entertainment. Residents are seated in comfortable armchairs and footstools are provided for those who need or wish to elevate their legs. The manager said that the laminate flooring in the dining room and the lounge carpet were fitted in October 2006. It was noted that the downstairs toilet requires a new clinical waste bin and the downstairs bathroom was lacking a thermometer for testing water temperatures. The manager said these would be dealt with immediately. The upstairs unit requires the sluice room locking when staff are not using this facility and staff are not locking the medicine trolley to the wall in the treatment room. The manager said these issues would be dealt with straight away. A glass windowpane on the stairwell between the two units is blown and needs to be replaced. Stuart unit also has an upper and lower floor. Observation of this unit showed that there are a number of waste bins without lids in the toilets and bathrooms, toilet roll holders are missing and during the visit a sluice engineer was busy repairing the sluice machine on the lower floor. In the last report (September 06) a requirement was made that the lounge on Kendal was impersonal and needed reorganisation. This requirement is now met. The manager has worked hard to improve the atmosphere and living space, moving furniture around to create smaller groups of seating where residents can sit and chat to each other comfortably. A fish tank with aquatic occupants is now placed in the lounge and one resident said how much she enjoyed watching the fish during the day. Inspection of the home showed that it has been designed and built to meet the needs of disabled individuals. Doorways to bedrooms, communal space and toilet/bathing facilities are wide enough for wheelchairs, and corridors are spacious and have enough room for people in wheelchairs or with walking frames to pass by comfortably. The home is built on two floors with flat walkways inside and out, providing safe and secure footing for people with limited mobility. Access to the upper floor is by use of a passenger lift. Discussion with the staff indicates that there is a wide range of equipment provided to help with the moving and handling of the residents and to encourage their independence within the home. This includes mobile hoists, stand aids and handrails. Four residents spoken to were very pleased with their individual rooms and said that they had ‘brought in a number of personal possessions to make them feel more at home’. The rooms are decorated to a high standard and supplied with sufficient furnishings to meet the needs of the residents. All bedrooms are supplied with door locks and lockable storage space to ensure resident’s valuables are kept safe. Staff have a master key, which can be used to gain access in an emergency. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 23 All three units are clean, tidy and odour free, but comments from the residents and relatives indicated that a deep clean programme had taken place the weekend before this visit and that the environment has improved tremendously because of this. The manager must ensure that this high standard of hygiene and cleanliness continues. The laundry unit found on the lower floor of Ellis unit does not have a hand washbasin in the room, and staff have to go across the corridor to wash their hands after handling the laundry. The room is very small and there is no separate areas for clean and dirty linen although there is a clothes rail and baskets on the wall for staff to put residents clothes into once washed and dried. The manager must ensure that hand washing facilities are prominently sited in areas where infected material and/or clinical waste are being handled. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. Staff morale is low, resulting in high levels of sickness and poor attendance that does not offer consistency of care to the people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the last report (September 06) a requirement was made that the staff on duty must reflect the size and layout of the building and the dependencies of the residents. This is an outstanding requirement from previous reports (given timescales of 31/05/05, 21/11/05, 15/03/06 were not met). Information gathered before and during this inspection indicates that staffing levels at the home are below those needed to meet the aims and objectives of the home and the needs of the residents. The staff rotas show that the management team has calculated sufficient levels of staff, but persistent high levels of staff sickness are causing problems on a regular basis. Feedback from the staff, residents and relatives all mentioned concerns about staffing shortages that are impacting on the care being given in the home. Staff say they feel rushed and stressed all the time and commented that not all the staff work as a team, which creates problems and an unfair distribution in Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 25 the workload. Comments from the staff indicated that ongoing problems of staff absenteeism are creating unfair pressure on the rest of the staff, and there is a lack of quality time spent with the residents. Some individuals said that ‘ we are getting fed-up of the working conditions and the lazy attitude from other staff’. Discussion with the manager indicated that she is aware of the staffing problem and is starting to take disciplinary action against those who are ringing in sick without giving sufficient time for senior staff to get cover. Residents said the staff are lovely, but felt that those residents who are more independent faired better than those who needed more assistance as the staff did not have sufficient time to deal with everyone’s needs. Three staff spoken to said that ‘there is a need for more staff on duty so care can be person centred and not task orientated, and sufficient time can be spent with each individual to talk to them and discuss any issues’. The registered person must develop a staffing strategy that will provide enough staff cover at all times to meet the needs of the residents and the service. This needs to take effect urgently as failure to meet this requirement could result in enforcement action being taken against the home by the Commission. In the last report (September 06) a requirement was made that the staff training and development programme met the needs of the staff employed and the residents. This has now been achieved and the manager continues to look at how it can be improved. There is an induction course for new members of staff, and 58 of the care staff have achieved an NVQ 2 or 3. The home provides a mandatory stafftraining programme, which all staff have attended, and it also includes some specialised training that reflects the different care needs of the client group. Concerns raised in this report over the quality of documentation in care plans, nutrition, fluid balance and pressure care charts mean that there is a need for the manager to monitor and assess how successful the training programme is in giving staff the right knowledge and skills to do their jobs. There is no evidence that staff have received training around equality, diversity and disability rights and this should be included in the rolling programme of staff training and development. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 26 The manager said that she has tried to recruit more male carers in the past as she is aware that the majority of staff are female, but this has proved difficult as there have been few suitable applicants. She is aware that this may affect resident’s wishes regarding gender choice for giving of personal care, and this is discussed before an individual is offered a placement at the home. Comments from the manager indicate that all of the current residents are from a white British background, but the home is able to offer a range of services when they are approached from someone of another culture or ethnic group. The home has a comprehensive recruitment policy and procedure and when four staff files were checked it was evident that the manager follows the procedure, and ensures the interview process, police/CRB checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. One staff member whose file was looked at is from another country and has undergone all checks necessary for foreign workers including work permits, passport and immunisation records. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. Quality in this outcome area is adequate. The management team has a good understanding of the areas in which the home needs to improve. The registered person must plan and set out how these improvements are going to be resourced and managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the last report (September 06) a requirement was made for the organisation to employ an appropriately qualified, experienced individual to manager the home. This requirement has now been met. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 28 Mary Day is a registered general nurse who has experience of management and care of the elderly. She has been in post since 2006 and has applied to the Commission for Social Care Inspection for registration as manager of Swallownest. This application is being processed. Mary started her Registered Manager’s Award training in February 2007 and hopes to have this completed by the end of the year. In the last report (September 06) a requirement was made that there must be effective and efficient quality assurance and quality monitoring systems in place. This has been partially met and will remain in this report. Staff, residents and relatives have commented that regular meetings do not take place, satisfaction questionnaires are only distributed once a year and individuals have little input into their own care plans. This means that people working and living in the home are not encouraged to voice their opinions and viewpoints of the home and service, and the management team is not taking advantage of the opportunities to gather feedback from those who use the service. There is no annual development report produced as part of this process to highlight where the service is going or indicate how the management team is addressing any shortfalls in the service. The annual development report must be produced to ensure the service meets the resident’s needs and is run in their best interests. Outcomes from this inspection show that the manager needs to promote a more open forum for staff, residents and relatives to input ideas about the running of the service and give them the opportunity to talk about concerns or issues within the home. It is imperative that the manager provides the leadership and direction necessary for the staff to raise the standards within the service and it is up to the manager to ensure staff and residents understand the aims/objectives and purpose of the home. Checks of the financial records showed that residents are able to have Personal Allowance accounts in the home. These records are computerised and detail the transactions undertaken and the money held for each resident, the administrator updates these each week. Information from the manager indicates that the majority of the residents have a family member or representative who looks after their monies and these individuals make sure the Personal Allowances are sent/brought into the home. Resident’s who have asked the home to look after their personal allowances are able to access their money on request. All monies are kept safe and secure within the home and only the administrator or manager has access to the funds. In the last report (September 06) a requirement was made that all staff must receive formal supervision at least six times a year and there must be documentary evidence to support this. This requirement is now met. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 29 Staff supervision files showed that individuals are starting to attend formal supervision sessions with their line managers. The manager said that she has yet to do the staff appraisals, but these are being planned and will take place in the immediate future. In the last report (September 06) a requirement was made that records required by regulation for the protection of residents must be up to date and accurate. This requirement is partially met. Needs assessments, care plans, nutrition, fluid balance and pressure care charts, have all been identified in this report as needing some improvements to their documentation. The manager must ensure this is completed as soon as possible. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, cot sides and daily activities of living. Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X 3 X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 2 3 Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 (b)(c) Requirement The registered person must ensure that each resident is given a written contract/statement of terms and conditions at the point of moving into the home, so individuals are aware of the fee levels, what services are provided for the fee and the rules of living within the home. (Given timescale of 28/10/06 was not met). The registered person must ensure that residents do not move into the home without having had a needs assessment completed, and the management at the home has assured them that the identified needs would be met. This is so residents can be confident that they have chosen the right facility and one, which will promote their health and welfare. (Given timescale of 08/09/06 was not met) The registered person must be able to show that the home has sufficient staff on duty to meet the assessed needs of the residents, so individuals can DS0000003089.V318542.R01.S.doc Timescale for action 01/07/07 2. OP3 14(1) 01/07/07 3. OP4 12(1) 01/05/07 Swallownest Nursing Home Version 5.2 Page 32 4. OP7 15 (1) 5. OP7 15 (2)(b) 6. OP7 15 (2)(c) 7. OP8 12(1) receive the care and support they need to have a good quality of life. Each resident must have a care plan that identifies what risks, needs and/or abilities they have for achieving their health, personal and social goals, so all staff give that person the right care at the right time in the right way. (Given timescale of 08/09/06 was not met) The care staff must review the care plan at least monthly; so it meets the resident’s current needs and objectives for health and personal care. Care plans must be written with the involvement of the resident; be recorded in a way they can understand and be agreed and signed by the resident or their representative. The registered person must ensure that residents are given the opportunity to bathe or shower as they wish, to promote their hygiene standards and personal confidence. 01/07/07 01/07/07 01/07/07 01/07/07 8. OP8 14(1)(a) (2) The registered person must ensure that where the resident is identified as being ‘at risk’ then appropriate intervention is recorded in the plan of care, to protect their health and wellbeing. The registered person must 01/07/07 ensure that staff maintain a nutrition record for each resident, including weight gain or loss and take appropriate action where needed. This ensures residents remain healthy and nutritional problems are identified and action taken to resolve them. DS0000003089.V318542.R01.S.doc Version 5.2 Page 33 Swallownest Nursing Home 9. OP9 13(2) 10. OP10 12(4)(a) 11. OP14 12(2)(3) 12. OP15 12(1)(a) (b) 13. OP19 23(2)(d), (5) The registered person must ensure that staff are giving out medication at the right times and that this is accurately recorded. This is to protect the residents’ health and welfare and reduce the risk of overdose. The registered person must ensure there are sufficient numbers of staff on duty to carry out personal care, bathing, washing and continence care for residents, in a manner that respects their rights to privacy and dignity. (Given timescale of 08/09/06 was not met) The registered person must ensure that there is a positive drive within the home to make the most of residents abilities to make personal choices and express views, to ensure that all residents are able to have a voice within the service and that their opinions are listened to and given value. The registered person must ensure that there are enough staff on duty at mealtimes, to ensure that meals are not hurried and residents are given sufficient time to eat. Staff must be available to offer assistance in eating where necessary. (Given timescales of 08/09/06 were not met) The registered person must ensure there is a programme of routine maintenance and renewal of the fabric and decoration of the premises produced and implemented with records kept, to demonstrate that the home is maintaining a safe and comfortable environment for the residents. DS0000003089.V318542.R01.S.doc 01/05/07 01/05/07 01/07/07 01/05/07 01/07/07 Swallownest Nursing Home Version 5.2 Page 34 14. OP26 16(1)(j) (k) 15. OP26 13(3) 16. OP27 18(1)(a) The registered person must ensure the home maintains a satisfactory standard of hygiene, and waste bins are suitable for the disposal of general and clinical waste. The registered person must ensure that hand washing facilities are provided in the laundry room on Ellis unit, to enable laundry staff to wash their hands before leaving the laundry and prevent the spread of infection within the home. The registered person must ensure there are sufficient staff on duty to meet the needs of the residents and the aims and objectives of the home. (Given timescales of 31/05/05, 21/11/05, 15/03/06 and 08/09/06 were not met) Additional staff must be on duty at peak times of activity during the day, to ensure residents receive the care and support they need, when they require it without having to wait excessively long times. The registered person must develop a programme of quality assurance and provide an annual development plan, based on seeking the views of the residents. This will enable individuals using the service to voice their opinions about the home and enable the registered person to see how well the home is meeting their aims and objectives and the needs of the residents. (Given timescales of 15/05/06 and 29/09/06 were not met) The registered person must ensure that records required by regulation for the protection of DS0000003089.V318542.R01.S.doc 01/07/07 01/07/07 01/05/07 17. OP33 24 (1)(a)(b), (2)(3) 01/07/07 18. OP37 17(1-3) 01/07/07 Swallownest Nursing Home Version 5.2 Page 35 residents must be up to date and accurate. This ensures the health, safety and welfare of the residents is promoted and protected. (Given timescales of 29/09/06 were not met) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP7 OP8 OP19 OP30 OP30 Good Practice Recommendations The manager should arrange for staff to access training around effective record keeping to ensure they have the skills and knowledge to write the care plans. The manager should ensure that staff are keeping nebuliser equipment clean and hygienic. The manager should ensure the repairs and maintenance issues raised in this report are carried out in a timely manner. The manager should ensure that staff receive equality, diversity and disability rights training, and include it in the rolling programme of staff training and development. The manager should monitor and assess how successful the staff training programme is at giving staff the necessary skills and knowledge to do their jobs to a high standard. The manager should complete her Registered Managers Award by December 2007. The manager should promote a more open forum for staff, residents and relatives to input ideas about the running of the service and give them the opportunity to talk about concerns or issues within the home. 6. 7. OP31 OP33 Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Swallownest Nursing Home DS0000003089.V318542.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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