Inspection on 28/02/06 for Swallows Residential Home

This inspection was carried out on 28th February 2006.

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

Swallows Residential Home 30/06/09

Swallows Residential Home 19/01/09

Swallows Residential Home 05/09/08

Swallows Residential Home 15/05/08

Swallows Residential Home 12/06/07

Swallows Residential Home 30/10/06

Swallows Residential Home 15/05/06

Swallows Residential Home 29/11/05

Swallows Residential Home 05/09/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Swallows Residential Home Helions Bumpstead Road Haverhill Suffolk CB9 7AA Lead Inspector Jane Offord Unannounced Inspection 28th February 2006 09:45 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 DS0000063929.V285115.R01.S.doc Version 5.1 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. DS0000063929.V285115.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Swallows Residential Home Address Helions Bumpstead Road Haverhill Suffolk CB9 7AA 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) 01440 714745 01440 761315 Burrows Care Homes Miss Annmarie Burrows, Mr Harold Burrows, Mrs Donna Burrows Mrs Megeita Barrett Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places DS0000063929.V285115.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2005 Brief Description of the Service: The Swallows residential home offers care and accommodation for up to sixteen older people, in single storey accommodation situated on the outskirts of the town of Haverhill in a rural position. The home was first registered in 1995 and the building adapted to provide appropriate accommodation for seven residents. In February 2000 an extension was completed, providing good quality and pleasant additional communal and bedroom accommodation and increasing the registration of the home to fifteen. In November 2000 a previous office was converted into an additional resident bedroom and the total again increased to sixteen residents. All resident bedrooms are for single occupancy with one room having an ensuite toilet facility. The home came under new ownership and management in June 2005 and the new owners have already made changes to improve and upgrade the environment. DS0000063929.V285115.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the third visit of the year and was to follow up specific concerns arising in the management of the home and to check on progress made since the inspection in November 2005. The inspection took place on a weekday between 9.45 and 15.00. An action plan had been compiled by Anna Rogers, regulation manager and Jane Offord, regulatory inspector to address current concerns and this formed the foundation for the inspection. During the day the registered manager was available to assist the inspection process. One of the registered owners was also present as they now work a number of hours weekly as a carer. The inspector spoke with a number of residents and relatives, carers and the manager, the chef and a visiting community nurse. Three residents’ and three staff files and some policies were inspected, the lunchtime medication administration was observed and all areas of the home were visited. The day of inspection was very cold with flurries of snow but the home was warm and the residents were appropriately dressed. Interactions between staff and residents were caring and assistance was offered sensitively. There was a steady stream of visitors during the morning who were welcomed and offered a hot drink on arrival. What the service does well: What has improved since the last inspection? The new owners are gradually making improvements to the décor and have recently redecorated the lounge and put up new curtains. They have also stripped and sealed the wooden floor in the dining room, which now looks attractive and is easy to keep clean. The back garden has been landscaped and will be planted as soon as the weather is better. There are paved paths throughout the garden and a paved area for a barbeque, which will allow wheelchair access. Two staff meetings have been held and minutes are circulated. The manager said that a residents’ meeting is planned and there has already been a DS0000063929.V285115.R01.S.doc Version 5.1 Page 6 consultation with residents about the menus and their views will be used to introduce changes to the menus. In response to a requirement from the last inspection the service has begun to introduce more activities for the residents. This needs to be built on and a proper activities programme developed but a start has been made and the residents appreciated that. What they could do better: 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. DS0000063929.V285115.R01.S.doc Version 5.1 Page 7 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 DS0000063929.V285115.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1. People who use this service cannot be assured that the Service User Guide will contain the information required to help them reach a decision about the service offered by the home. EVIDENCE: The present Service User Guide is a three-fold leaflet containing information on principles and values followed by the home, some frequently asked questions, the complaints process, a brief description of the home and some of the services offered. It does not contain all the information as listed in standard 1 of the NMS. DS0000063929.V285115.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11. People who use this service can expect to be treated with respect, have their health needs met and have an individual plan of care. However they cannot be assured that the present medication practice will protect them or that sufficient assessment will be done to identify all their needs. EVIDENCE: Three residents’ personal files and care plans were inspected and all contained evidence that health needs were recognised and met. Each file had a list of contacts for professionals supporting the resident for example GP, dentist, optician, chiropodist and hairdresser. There was a record of visits to or by doctors, community nurses and other health professionals. The care plans had interventions for managing personal care to suit the resident, night needs, communication, diet and continence. There were assessments for tissue viability, nutrition and moving and handling. The only risk assessment completed was for using the keys to the resident’s bedroom. One resident had been admitted following falls but there was no risk assessment or care plan intervention to address that. There was evidence that residents’ weight is regularly monitored. DS0000063929.V285115.R01.S.doc Version 5.1 Page 10 A visiting community nurse was spoken with and they said they had no concerns about the level of care the residents’ received. The home was good at ringing them if they had an issue of care with any resident. The personal files contained evidence that residents’ final wishes had been ascertained and recorded together with the next of kin to make the arrangements and whether the resident had made a will. The residents preferred form of address was recorded and in interactions it was noted that some residents were addressed by their first name and others, more formally as Mr. or Mrs. None of the files seen contained a recent photograph of the resident. The daily records seen were informative and written in appropriate language although one record had had no entry for the previous three days. As the resident had only been in the home for about a week it was concerning that better observation was not happening to ensure the resident settled. Staff were observed knocking on bedroom doors before entering and offering residents choices. Residents could choose to remain in their room or join other residents and visitors in the lounge. They were offered the choice of where to eat their lunch and what they wished to do after the meal. Residents who needed support during the meal were offered assistance sensitively and discreetly by the carers. The administration of the lunchtime medication was observed. The home uses a monitored dose system supplied by the local pharmacy. Medication is stored in a locked medicine cupboard in the dining room. The MAR sheets were seen and it was noted that there were some gaps in the signature boxes with neither a signature nor a code to indicate why a medication had not been administered. As required medication (PRN) that gave a choice of dose i.e. one tablet or two did not record the number of tablets given. At one point the manager who was administering the medication left the room to give tablets to a resident in their own room. The cupboard was not locked and the keys were left in the lock. It was noted that prescribed creams and eye drops had ‘r/carer’ written on the prescription sheet. The manager said the carers administered them during personal care and there was a system for signing kept in the resident’s room. One sheet for signing was seen but the record was for one cream and the resident had three different types in the room including Hydrocortisone 1 cream. The signature record was incomplete with no entries for some dates. When asked about eye drops the carer said they did not administer them, as they were medication. When questioned the manager said some carers did administer eye drops but did not sign the MAR sheets. DS0000063929.V285115.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People who use this service can expect to be offered a lifestyle to suit them, be encouraged to maintain contact with family and friends and receive a well balanced diet. EVIDENCE: All the personal files seen had notes of residents’ hobbies and interests as well as a life story. There were records of the next of kin, the relationship and contact details. In some files there were contact details for a number of relatives. During the day several visitors came to the home and were all offered a hot drink on arrival. Vases were found for flowers that one visitor brought for the lounge. One resident spoken with said they enjoyed their own company and spent quite a lot of time in their room. They had a newspaper delivered each day and watched television. They joined other residents for meals. They had enjoyed the arrangements at Christmas and had been to see a pantomime. Their records noted, ‘went to see Sleeping Beauty. Had a really good time’. Raising money at a Christmas raffle had paid for the visit to the pantomime. The owner said they planned another raffle at Easter to pay for further outings. DS0000063929.V285115.R01.S.doc Version 5.1 Page 12 The lounge in the home is in two areas divided by the dining room. At one end there is a music centre and television the other end appeared to be devoted to quieter occupations such as conversation and knitting. One resident said that two people visit sometimes and organise card games and bingo. The owner said that staff would also play cards or read with residents when they can. One resident said they used to go to church before coming to The Swallows but they were not well enough now. They enjoyed church services and ‘Songs of Praise’ on the television. The lunch served on the day of inspection was beef casserole with mashed potatoes, cabbage and sweet corn, followed by pancakes with lemon juice and sugar. One resident who has diabetes had sweetener instead of sugar with their pancake. Another resident chose to have a jacket potato with salad and a yoghurt for dessert. In discussion with the chef it was clear that individual likes and dislikes are catered for. They explained that the menu for the following day was to be braised liver and one resident really disliked liver. They had talked to the resident and ascertained that they would like sausages as an alternative. The spouse of one resident had concerns that they had gained weight since admission to the home and it was having a detrimental effect on their mobility. The chef was willingly proposing to try and offer healthy alternatives to the resident in an effort to address the problem. DS0000063929.V285115.R01.S.doc Version 5.1 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. People who use this service cannot be assured that the present level of training in Protection of Vulnerable Adults (POVA) will give the staff sufficient knowledge to protect them. EVIDENCE: A repeat requirement from the last inspection was for the home’s POVA policy to reflect the POVA guidelines of the Suffolk Interagency Procedures. A policy has been written and the Suffolk guidelines are available to staff. There was also a requirement that staff were made aware of the procedures. There was no evidence in staff files that training had been given. Although the manager said some training has taken place staff spoken with said they had not received any. DS0000063929.V285115.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 26. People who use this service can expect to have specialised equipment available to help maintain their independence but they cannot be assured that storage in the laundry is safe. EVIDENCE: There was evidence in some of the residents’ rooms seen of pressure relieving mattresses and cushions in use. Residents in their rooms all had call bells well placed for easy access. The accommodation is single storey and access to the outside is level for facilitating wheelchair use. The bathrooms have Parker baths to enable residents with poor mobility to bathe. The laundry was tidy and kept locked when there were no staff there. The washing machine has a sluice programme and staff were able to explain the policy for managing soiled linen. Gloves and aprons were available for preventing contamination. The boiler cupboard, which was very small and warm, had clothes hung up to air and a pillow lying on the boiler. The practice of using the cupboard in this way poses a fire risk. DS0000063929.V285115.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30. People who use this service cannot be assured that they will be protected by the present staff recruitment practice and induction or that there are dedicated cleaners employed. EVIDENCE: Three staff files were seen, two relating to new staff members and one to a carer who has been in post for three years. The previous manager compiled the file of the established staff member. A recent Criminal Record Bureau (CRB) had been done, as the previous manager had not requested one. The files of the two more recently appointed staff did not contain evidence of identity checks or a recent photograph. One file contained two references but one was only confirmation that the person had been employed by the referee not of their character or abilities. One file had no evidence of a CRB or POVA 1st check and the carer had been in post for three months. When asked the manager was able to provide evidence of a POVA 1st check but said they needed to follow up the CRB as it had been requested but they had not yet received it. One Curriculum Vitae (CV) had a work gap of three years and there was no evidence that this had been explored. The manager said they had asked about it during the interview but there were no interview notes on file to confirm this. There was no evidence of a formal induction process in any file. Staff spoken with had done some shadow shifts but no formal induction programme had been followed. One staff member has been in post for three months and not had moving and handling training yet. DS0000063929.V285115.R01.S.doc Version 5.1 Page 16 The staff rotas were seen and showed sufficient care staff to meet residents’ needs but there were vacant posts for the two domestic staff. The home looked clean and tidy on the day of inspection and a carer spoken with said the care staff do extra shifts that are domestic ones. The manager said they had advertised the vacant posts and is hoping there will be applicants soon. DS0000063929.V285115.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 38. People who use this service can expect the management process to be transparent and positive however they cannot be assured that all health and safety practices will protect them. EVIDENCE: As noted in the last inspection report there had been concerns raised about the relationship between the manager, the Responsible Individual and the staff team. The deputy manager has left since the last inspection and the manager has appointed a new deputy manager due to take up post in four weeks time. In discussion with the owner it seems that previous friction within the staff team has resolved itself. Staff spoken with were content in their job. There is still no recorded on-call system but both the owner and manager said there were at least four senior staff who could respond at any time and the phone contact numbers were available to all staff in the office. DS0000063929.V285115.R01.S.doc Version 5.1 Page 18 The manager and owner said the manager is more frequently at the home than the rota shows. Their presence at the home must be recorded on the staff rota. A member of staff said the manager would often telephone the home in an evening to check there are no problems if they have not been there that day. As noted earlier in this report the health and safety folder is from Suffolk Social Care and relates to a large organisation but not to a small care home. The folder with Control of Substances Hazardous to Health (COSHH) information looked comprehensive. General risk assessments and equipment checks were not inspected this time. The practice of airing clothes and storing bedding in the boiler cupboard in the laundry poses a fire risk. DS0000063929.V285115.R01.S.doc Version 5.1 Page 19 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 2 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X X X 3 X X X 2 STAFFING Standard No Score 27 2 28 X 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X X X 1 DS0000063929.V285115.R01.S.doc Version 5.1 Page 20 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 OP1 Regulation 5 (1) Requirement The Service Users Guide must be updated to include all the information required in standard 1 of the NMS. More thorough assessment of residents’ needs must be undertaken to inform the care plan of necessary interventions. The residents’ files must contain a recent photograph of the resident as required in Schedule 3. MAR sheets must be correctly completed to show medication has been administered or the code to indicate why it was not administered. PRN medication that gives a choice of dose i.e. one tablet or two must have the number of tablets given recorded each time. A procedure to ensure topical creams and eye drops are administered and signed for correctly must be devised. The medicine cupboard must be secured when the person administering medication is not DS0000063929.V285115.R01.S.doc Timescale for action 30/04/06 2. OP7 14 (2) 31/03/06 3. OP7 17 (1) (a) 31/03/06 4. OP9 13 (2) 28/02/06 5. OP9 13 (2) 28/02/06 6. OP9 13 (2) 28/02/06 7. OP9 13 (2) 28/02/06 Version 5.1 Page 21 8. OP18 13 (6) 9. OP26 13 (4) (c) 10. OP27 18 (1) (a) 11. OP29 19 (1) 12. OP30 18 (1) (c) (i) 13 (6) 13. OP38 in the room. All staff must receive POVA training and be made aware of the guidelines set out in the Suffolk Interagency Procedures for the Protection of Vulnerable Adults. This is a repeat requirement. The practice of storing bedding and airing clothes in the boiler cupboard in the laundry must cease immediately. Provision must be made to ensure standards of cleanliness do not fall while the domestic posts are vacant and that carers are not combining care duties and domestic work in the same shift. Recruitment checks must be undertaken as required in Schedule 4 and evidence must be available at future inspections. This is a repeat requirement. A recognised induction programme must be implemented for new staff. This is a repeat requirement. A health and safety folder relating to the service must be compiled as appropriate reference for staff to use. 31/03/06 02/02/06 28/02/06 28/02/06 31/03/06 30/04/06 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. Refer to Standard OP27 OP29 Good Practice Recommendations The rotas should reflect the staff working in the home at any time. Interview notes should be kept on staff files. DS0000063929.V285115.R01.S.doc Version 5.1 Page 22 3. OP9 A recent photograph of the resident should be attached to the prescription sheets for identification and resident safety. DS0000063929.V285115.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 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 DS0000063929.V285115.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!