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Inspection on 30/06/09 for Swallows Residential Home

Also see our care home review for Swallows Residential Home for more information

This inspection was carried out on 30th June 2009.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is small and only offers accommodation to 16 people, so it is in a position to be able to develop a homely and comfortable environment. The staff aim to get to know the people living in the home and try to meet their needs in an individual manner. The home is well appointed clean and tidy. People’s bedrooms have been individually personalised.Swallows Residential HomeDS0000063929.V376453.R01.S.docVersion 5.2The home provides a range of activities and a varied, nutritious diet. People told us that they liked living in the home and that the staff are kind to them and treat them with respect. The sitting room has a corner that is dedicated to reminiscence; there are pictures and photographs on the walls and objects from bygone days are placed on the table along with articles of interest and the local paper. A large magnifying glass is left on the table for people to use if they want to see the pictures better. From time to time everything in the area is changed to renew interest.

What has improved since the last inspection?

Mrs Burrows has put a lot of work into improving the quality outcomes for the people living in the home since she took over management. She has completed her registered manager’s award and has begun her NVQ 4 in health and social care and has taken training appropriate to her role including the mental capacity act and deprivation of liberty. Most of the requirements made at the last inspection have been complied with; a new fly screen has been fitted to the kitchen window and the frame has been painted. The water temperature was regulated centrally, but when it became apparent that the water in the kitchen wasn’t hot enough to maintain hygiene standards the thermostat was turned up. This meant that the water to the bedrooms was too hot, so individual controls have been fitted to the hot water taps to regulate the temperature so that the water does not go above 43 degrees centigrade. The home has continued to maintain standards in the management and storage of medication since our pharmacy inspector carried out a random inspection and made several requirements in December 2008. Medication training has been taken by senior staff who carry out assessments on other care staff to make sure they have a good understanding of the homes medication policy. This means the staff have a better understanding of good practice and of the dangers of leaving medication unsupervised, which was an issue raised in the last report.

What the care home could do better:

A requirement that the radiators are covered to protect people living in the home from being burnt if they come in to prolonged contact with them has been made in two previous reports. This requirement has not been completely met, during this visit we noted that some radiators have been covered and we saw that Mrs Burrows had bought several other covers with her that morning which she intended to have fitted that week. She has put in place risk assessments in regard of the radiators left undone and has put safeguards in place to minimise the risks until the rest are fitted, she has undertaken to get the task done before the heating is turned on again in the autumn. At thisSwallows Residential HomeDS0000063929.V376453.R01.S.doc Version 5.2 time, with the heating off, people are not at risk and Mrs Burrows feels that she is not fully responsible for the delay. However, the requirement has been standing since September 2008 and needs to be met by September this year. In the previous inspection Mrs Burrows was required to carry out the fire safety work she was recommended to do by an independent company who had carried out a fire risk assessment of the home 11th September 2008. On the day of the inspection we noted that the front door, which acts as a fire exit, was locked with the use of a Yale lock and was also kept bolted. There is another fire exit which leads out of the home to the rear of the building. The escape route sign that is outside the door directs people over ground that is grassed and very uneven. The registered providers must in consultation with the Fire Service take appropriate actions to safeguard residents.

Key inspection report CARE HOMES FOR OLDER PEOPLE Swallows Residential Home Helions Bumpstead Road Haverhill Suffolk CB9 7AA Lead Inspector Ann Wiseman Key Unannounced Inspection 30th June 2009 08:00 DS0000063929.V376453.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 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 Donna Burrows Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2009 Brief Description of the Service: The Swallows Residential Home offers care and accommodation for up to sixteen older people situated on the outskirts of the town of Haverhill in a rural position. The home is a converted bungalow so all the accommodation is on the ground floor, this makes all areas of the home accessible to everyone living in it. All bedrooms are single occupancy with one room having an en-suite toilet facility. The home came under new ownership and management in June 2005. The owners, who are family members, trade as Burrows Care Homes and they are the registered persons, Mrs Burrows has managed the home since February 2008. The fees range between £362.00 and £500.00 per week. The cost of newspapers, chiropody, hairdressing and some transport is not included in the fees. Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection; we arrived at 8am in the morning and stayed for a little over nine hours, this was the second inspection we have carried out this year, we last visited the home on the 19th January 2009. The manager, Mrs Burrows, who is also one of the registered providers, was at the home when we arrived and facilitated the inspection, which she did in an open and helpful manner. Whatever files and documents we asked to see, apart from some of the staff records, were produced quickly without delay. During the day we had a look around the home and talked to some of the staff and the people living there. We looked at information belonging to three people living in the home and three of the of the staff files. We also assessed some of the homes policies and procedures and sampled a random selection of the health and safety files and records. Mrs Burrows had sent us the Annual Quality Assurance Assessment (AQAA) she had completed prior to the inspection. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. The information given to us in the AQAA was detailed enough to enable us to judge whether they were aware of what things are needed to be done to continue improving quality outcomes for people living in the home. It also told us about plans the owners have for the future of the house. The home was clean and tidy and the atmosphere was friendly and congenial, interaction between the staff and the people living in the home was observed to be friendly and open. When talking about the people, staff did so in a supportive and respectful manner. What the service does well: The home is small and only offers accommodation to 16 people, so it is in a position to be able to develop a homely and comfortable environment. The staff aim to get to know the people living in the home and try to meet their needs in an individual manner. The home is well appointed clean and tidy. People’s bedrooms have been individually personalised. Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 6 The home provides a range of activities and a varied, nutritious diet. People told us that they liked living in the home and that the staff are kind to them and treat them with respect. The sitting room has a corner that is dedicated to reminiscence; there are pictures and photographs on the walls and objects from bygone days are placed on the table along with articles of interest and the local paper. A large magnifying glass is left on the table for people to use if they want to see the pictures better. From time to time everything in the area is changed to renew interest. What has improved since the last inspection? What they could do better: A requirement that the radiators are covered to protect people living in the home from being burnt if they come in to prolonged contact with them has been made in two previous reports. This requirement has not been completely met, during this visit we noted that some radiators have been covered and we saw that Mrs Burrows had bought several other covers with her that morning which she intended to have fitted that week. She has put in place risk assessments in regard of the radiators left undone and has put safeguards in place to minimise the risks until the rest are fitted, she has undertaken to get the task done before the heating is turned on again in the autumn. At this Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 7 time, with the heating off, people are not at risk and Mrs Burrows feels that she is not fully responsible for the delay. However, the requirement has been standing since September 2008 and needs to be met by September this year. In the previous inspection Mrs Burrows was required to carry out the fire safety work she was recommended to do by an independent company who had carried out a fire risk assessment of the home 11th September 2008. On the day of the inspection we noted that the front door, which acts as a fire exit, was locked with the use of a Yale lock and was also kept bolted. There is another fire exit which leads out of the home to the rear of the building. The escape route sign that is outside the door directs people over ground that is grassed and very uneven. The registered providers must in consultation with the Fire Service take appropriate actions to safeguard residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Swallows Residential Home DS0000063929.V376453.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 Swallows Residential Home DS0000063929.V376453.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): During this inspection we examined standards 1, 3, 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is given to people to help them make an informed choice about the home and is in the process of being reviewed. Need assessments are carried out before people move into the home and they are able to visit the home to assure themselves that it meets their expectations. This home does not offer intermediate care. EVIDENCE: In the Annual Quality Assurance Assessment (AQAA),which was completed in May 2009 Mrs Burrows told us that, “We have identified some amendments that need to be made to the statement of purpose so that it covers all the required elements and we need to set out our fees in the users guide.” Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 10 We looked at the statement of purpose and user guide while we were at the home and noted that the proposed amendments had not been made yet. There is an attractive pamphlet available, which has photographs of the home, information about the surrounding area, or an introduction to some of the staff and the amenities on offer at the home We were told that assessments are carried before people move in. The manager or the deputy manager visit them at home or in hospital and Mrs Burrows will invite families to help in the collection of information. Those people thinking of moving into the home are encouraged to visit with their relatives and assess whether the home can meet their needs and expectations. We looked at three peoples individual care files during the inspection and saw that all the files contained assessments that had been completed before they moved in. They were detailed enough to enable the manager to make an informed decision about whether the home has the right mix of skills and knowledge to be able to care for them properly. The file also contained sheets that record how the visits to the home went and what the person visiting felt about the home, they also note what family members thought and what their feelings were are about their relative moving into residential care. This is good practice as it encourages people to think about what their expectations are of the home, this will help them make a decision about staying. The sheet also notes when the contract, user guide and the complaints procedure are given out and they are signed by the new resident or their representative. This home does not offer intermediate care. Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were assessed on this occasion. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place, which are person centred, so people are supported in the way they want to be. Their healthcare needs are met and medication is managed safely. EVIDENCE: During the inspection we examined three individuals’ personal files and saw that the care plans were written in a way that detailed the action which needs to be taken by care staff to ensure that people’s needs are met. They were written in a person centred way, which means that it is individually planed around the person, their needs, wishes and expectations rather in a way that fits in with the homes routine. The care plans, which start with ‘this care plan belongs to………’ Which gives ownership to the person they are about and were reviewed regularly. We were Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 12 able to see that changing needs had been recognised and that amendments had been made to the plans. They included detailed night time care plans, which identified what time people preferred to go to bed, get up, if they wanted (or needed) to be checked at night, if they wanted a wake up call and if they would like a morning drink in bed. They also contained initial nutritional screening sheets, weight charts and skin viability assessments which were all revived monthly and were up to date. We saw evidence that people see a Doctor, dentist, optician or dietician when they need to and that specialist treatments are made available. There are copies of hospital appointments on file and records are kept of the outcome of any medical consultations so that staff are clear about any ongoing treatment required. When we arrived the front door was locked and bolted and was bolted again once we were in, when we asked why the door was bolted we were told that it was to stop vulnerable people from leaving the building. When we examined peoples care plans we did not see risk assessments that raised the question of whether people would be at risk if they left the building unaccompanied. Care must be taken that people living in the home don’t have their movements restricted without proper assessments being carried out to check that they lack capacity to make this decision for themselves. The home has continued to maintain standards in the management and storage of medication since our pharmacy inspector carried out a random inspection and made several requirements in December 2008. They use a monitored dosage system to manage the medication and senior staff have undertaken the Safe Handling of Medications training course at West Suffolk College and assess the other care staff before they are able to administer medication. The medication was stored as it should be and when we examined the cabinet we found that opening dates were recorded on tubes of cream and bottles of liquid medication so that staff knew when they needed to be disposed of, as they only have a limited shelf life once they are opened. We randomly checked three different medications belonging to the same person, two that were delivered in boxes and one that was in a blister pack, we found that the number of tablets left corresponded to the number recorded on the medication administration record (MAR) sheet, the other records were seen to be accurately recorded with any variation properly noted by the code letter with a written explanation on the reverse of the sheet. We observed medication being administered during lunch and saw that it was done in accordance to best practice as set out by the Royal Pharmaceutical Society, the tablets were dispensed individually and take to the person, when they were offered with a drink. Staff observed the tablets being taken before they initialled the MAR chart. At no time was the cabinet left open or unattended. Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 13 During our observations we saw that people were treated in a respectful way and that people’s dignity was protected. We talked to most of the people who live in the home and, without exception, we were told that they were happy living there, that they felt they were respected and that they got on well with the carers. One person said, “….the girls are lovely, so cheerful and helpful.” Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All of these key standards were judged during this visit. People using the 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 offers activities, the routine is flexible and people are able to maintain contact with family and friends. Meals are served in comfortable surroundings and are well prepared and varied. EVIDENCE: The home provides daily activities, which people can choose to participate in or not. The plan of activities for the coming month was displayed in the lounge. People we spoke to were all aware the various activities and said that they could join in if they wished. Several people said that they enjoyed taking part in the activities that they were offered, especially the external entertainers who regularly visit. While we were at the home a singer spent the afternoon entertaining people in the lounge, they joined in the singing and appeared to be enjoying themselves. Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 15 The sitting room has a corner that is dedicated to reminiscence; there are pictures and photographs on the walls and objects from bygone days are placed on the table. Articles of interest and the local paper are also put out for people to see. A large magnifying glass is left on the table for people to use if they want to see the pictures better. From time to time everything in the area is changed to renew interest. There is a notice in the lounge telling people to speak to staff if they want to arrange a trip either into town for shopping, to go sightseeing locally, or to attend a special function. Arrangements will be made for a staff member to come in especially for the outing, who will be paid for working the extra shift. We were told that group outings are occasionally arranged and photographs around the home supported this. The activities people take part in are recorded in their care notes but are not recorded centrally. If they were recorded on a separate log that listed what the event was, who took part and if it was popular it would be a useful tool to evidence that the home is proactive in providing activities that are tailored to meet people’s individual needs and aspirations. Christian ministers of various denominations will come into the home to visit people individually and Mrs Burrows affirmed that she would seek to provide access to other faiths if it was requested. During our visit we met a relative visiting someone in the home who told us that they were always made welcome when they arrived and were often offered a cup of tea. People told us that they enjoyed having visitors and that their families were always invited if the home held a party or other social event, such as BBQ’s that are held in the summer. When we asked Mrs Burrows how her staff gave people opportunities to exercise choice and control over their lives she said, “I remind staff to give people all the information they need to make a decision, I feel it is very important to promote independence.” She went on to say that she would make sure this is happening on the floor by observing practice and will discuss the topic during supervision and at staff meetings. The interaction we saw between people and staff was friendly, supportive and empowering. Lunch was served while we were at the home; it was toad in the hole, freshly made by the cook. It looked appetising and was in ample portions. The tables were attractively set with clean table cloths and linen napkins, condiments were available. The atmosphere was relaxed and people were not rushed, those who needed help were offered it and people were gently encouraged to eat or were offered an alternative if they didn’t fancy what was available. We spoke to the cook who showed a good knowledge of people’s individual dietary needs and preferences; she told us she was always happy to prepare a different meal for those who requested it. While the meal was being eaten we saw her go from table to table chatting to people and checking they were happy with what the meal. Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Key standards 16 and 18 were examined during this inspection. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and concerns are recorded in line with the home’s policy and procedures and staff training protects people from abuse. EVIDENCE: The complaints policy was on display in the home and is accessible for people to look at. There is a recording system for complaints, which is set out in a way that enables people to see that the complaints policy is followed. All complaints and concerns are recorded no matter how minor, which shows that the home takes them seriously and listens to what people have to say. Along with complaints the home keeps a file of compliments and there have been many collected over the years, most were cards from families thanking staff for caring for their relative well. When we asked people living in the home if they knew who they would approach if they wanted to make a complaint they said they did, one person said, “I would speak to the manager, but I haven’t needed to.” Another person Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 17 who was sat in the same lounge agreed and added, “They are always good to me, I would only have to mention something and it would be put right.” The visitor we spoke to also confirmed that they knew who to speak to if they wanted to voice concerns, they also said that in the past if they had any worries they were only small niggles and the care staff dealt with them as soon as it was mentioned. Mrs Burrows and her staff have undergone safeguarding of vulnerable adult (SOVA) training and there are policies in place around recognising and reporting abuse. The staff we spoke to were able to tell us about the complaints procedure and also displayed a good knowledge of the safeguarding training they had undertaken. In the past the home has made referrals to the local authorities safeguarding team when they have identified a possible abusive situation and they have cooperated with any investigations. Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All of these standards were judged on this occasion. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home offers a well maintained environment with comfortable communal facilities. Bedrooms suit people’s needs and are individual. The whole building is clean and hygienic. There are some fire safety issues that need to be addressed to allow people to be kept safe and to exit the building safely in the event of a fire. EVIDENCE: During a tour of the building it was easy to see that it was well maintained, the bedrooms viewed were clean, pleasantly decorated and furnished to a good standard. The rooms contained items of personal furniture, televisions, ornaments, photographs and pictures. Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 19 There was ample space in the communal areas so that people can chose to sit where they prefer. The lounge faces the front of the house and there are french windows the whole length of the room so that it can be properly ventilated in hot weather and gives people an interesting outlook. The bathrooms and toilets are sufficient in number and were clean; all of them have specialist equipment and adaptations to meet people’s needs and to prolong their independence. There were riser seats and hand rails to make it easier for people to manoeuvre and to support themselves. There were also aids throughout the home and in people’s rooms to help them to help themselves. There were phones with large numbers, an extra large TV remote control and an easy to read clock on the wall. There are also grab rails and hoists available that have been properly serviced. A patio with tables and chairs provides a pleasant outdoors area for people and their visitors to sit and enjoy the garden, which was tidy and well cared for. Personal protective equipment was available for staff use to enable them to maintain infection control. During the previous inspection some fire safety issues were highlighted, they have been dealt with but during this inspection we saw that there are further things to be done to ensure that people are safe and that they can easily exit the building in the event of a fire. On our arrival we noticed that a bolt was used to keep the door closed despite the presence of a Yale lock, it was drawn back by the staff member opening the door to us when we arrived and pulled across once we were in. When we asked why the door was bolted we were told that it was to stop vulnerable people from leaving the building. There is also a bolt at the bottom of the door and a security chain fitted. Fire safety guidelines say that fire exits should be easily opened with only one action; this is so that people trying to get out in a hurry, possibly in poor visibility or darkness can open the door quickly. Bolts may be out of reach or cause confusion and a delay in opening the door. A teddy bear was being used to keep one bedroom door open, it was explained that the occupant liked to stay in their room during the day but also liked to leave the door open so they could still feel included. This practice puts people at risk in the event of a fire, only a mechanical door stop can be used that would allow the door to swing closed if the fire alarm sounded. Similar devises are already used in other parts of the home. Signs displayed throughout the house tell people to leave the building by the nearest exit if the fire alarm is sounded but fails to tell people where the assembly point is and to ask people to muster there so the fire register can be called. The signs need to be amended to avoid visitors deciding to leave and not letting people know, this could lead to staff or fire fighters putting themselves in danger by going back into the building to look for those thought to be missing. Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 20 A directional sign just outside a fire door at the rear of the building points people to go to the left so that they can go around the building to the assembly point at the front. The ground in that direction is sloped and uneven and may be difficult to access by those with mobility problems. We discussed the above fire safety issues with Mrs Burrows during the inspection. Since then she has taken advice from independent fire safety advisers and has undertaken to act on their advice and has started to take action. The homes fire procedures do not include details of how they would deal with a night time emergency. We discussed the difficulties that could be involved with a night time evacuation with Mrs Burrows and she has agreed to think about making changes to the procedure to include these considerations. Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All of these key standards were examined during this inspection. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a sufficient number of skilled staff on duty to meet the assessed needs of the people they care for. Staff are trained and competent to do their jobs. EVIDENCE: Staff personnel files are kept at the home and we examined three of the staff files, we saw that there were some gaps, two of the tree files didn’t contain photographs of the staff member and one did not have proof of identity. It is important to retain proof of identity as part of a good recruitment practice which in turn will help to safeguard those using the service. We had an opportunity to talk to staff during the day and those we spoke to confirmed that they had a criminal records bureau (CRB) check and references taken before they started work. Once the new staff have been cleared we are told in the Annual Quality Assurance Assessment (AQAA) that, “All new staff shadow an experienced member of the care team and undergo comprehensive induction training.” We saw copies of the induction work in the staff files. Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 22 The care staff we spoke with displayed a good knowledge of the people in the home and understood their needs. Information given to us in the AQAA tells us that the home has met the minimum of 50 of its staff having attained the NVQ 2 in care or its equivalent and that their aim is to have all their staff qualified to at least an NVQ level 2 in the near future. Staff consulted said that they continued to be given training opportunities and the homes training records evidenced that staff have assess to specialist training such as care planning, the mental capacity act, handling medication and dementia as well as the mandatory training. The rota clearly sets out what staff is on duty, both care and management. It has previously been required that the manager must put her hours on the rota, which she has now done. Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36, 37, 38 were judged during this inspection. People using the service experience Adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that their views will be listened to and their concerns acted upon. However they can’t be confident that their health and safety will be fully safeguarded. EVIDENCE: Since the resignation of the previous registered manger, Mrs Donna Burrows has taken over as the homes manager. Mrs Burrows is one of the three registered providers. She has completed her registered manager’s award and is in the process of doing her NVQ level 4 in health and social care. Mrs Burrows has 20 years experience in working with older people and is a Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 24 member of the chartered management institute, which is an organization that is “Committed to raising the performance of business by championing management.” She also continues to update her knowledge, skills and competence. Some of the training she have undertaken in the last year includes depression in later life, health and safety, improving the links between employers, statuary bodies and the education sector, fire marshal operations training, improving nutritional care (part 1), mental capacity act for older persons residential care, supervision skills, dementia and care planning. In an earlier section of this report, we have highlighted health and safety breaches that have compromised the safety of the people living in this home. Whilst Mrs Burrows has been willing to address the issues raised, neither she nor the other registered providers has been sufficiently proactive to identify and address shortfalls in advance of a requirements being made. In our previous inspection in January 2009 we found that she had failed to carry out work suggested in a fire risk assessment done in September 2008 by an independent fire safety consultant. During this inspection we highlighted other infringements of the fire safety regulations which we believe Mrs Burrows should have been aware of, taking into account the fire training she has undertaken. It has been required in the last two key inspections that radiators are covered to protect people from being hurt if they come in prolonged contact with them. It is taking the providers a long time to comply with this requirement, Mrs Burrows explained that they have been let down by builders, which has caused the delay. Some of the radiators have been covered and we saw that more covers had been purchased that were going to be put in place that week. They have done risk assessments in regard of the ones left uncovered and have put safeguards in place to minimise the risks until the rest are done. Mrs Burrows has undertaken to get task finished before the heating is turned on again in the autumn. At this time, with the heating off, people are not in danger of being hurt so we have again extended the timescale for completion. Mrs Burrows told us in the AQAA that she had highlighted areas in the statement of purpose that needed improvement; we noticed that at the time of the inspection the changes had not been implemented. As previously requested to, the manager has produced a job description for herself, which enables her to take responsibility for fulfilling her duties. Her job summery says that she will, “Promote person centered quality care in a warm and friendly atmosphere.” People we spoke to agreed that this is a good description of the home they live in. One person said that, “I can’t be in my own home any more, but this will do. I am happy here.” The manager told us that, she has recently sent out quality assurance questionnaires to staff, people living in the home and their relatives so that she can find out what they think of the service and to give them an opportunity to make positive suggestions to improve it. Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 25 Questionnaires were also sent to GP’s, district nurses, a mental health nurse, social workers and other people that come into the home on a regular basis. Replies haven’t been returned yet, but the manager has undertaken to analyse the information and write a letter to the participants thanking them for their input and setting out the results of the survey and what action will be taken. People and their families are also given an opportunity to voice concerns and give their opinions of the home at the resident and relative meetings. The last meeting notes were displayed in the lounge and the topics discussed included meals, in house entertainment and the manager reminded people about the homes complaints policy. The home doesn’t manage people’s finances and will only keep small amounts of money to cover day to day spending. The money tin is kept in a locked cabinet and only senior staff have access to it. Records are kept of any transactions and receipts are kept. We examined the records and were able to match receipts to transactions on the record sheet and then we randomly checked one of the purses and found that the amount of money corresponded to the amount on the record. When we were examining the staff files we saw that there was evidence that people receive supervision and that staff meetings are held and notes are kept. Holding regular meetings with staff allows the supervisor to monitor peoples work, assess their training needs and offer direction. It also gives staff an opportunity to voice concerns and share ideas. The manager supervises the senior staff and they share other supervisions. The notes we saw were dated and signed by the supervisee. Health and safety checks are carried out by senior staff and we examined a random sample, they were found to be up to date. Fire equipment was serviced in January this year along with the emergency lighting equipment and the fire alarms. Hoists were serviced in October last year and portable electrical equipment was tested in May 2009. Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 26 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 3 2 Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 27 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 4 Requirement The statement of purpose must be updated and revised so that it contains all the information as set out in regulation 4. The work to cover all the radiators in the home to keep people safe from scalding must be completed by the beginning of September. Timescale for action 14/09/09 2 OP25 13 01/09/09 3 OP29 19 4 OP38 23 This is a repeated requirement that should have been met on 28/02/09 It is required that the manager 31/10/09 reviews staff files to make sure that they hold all the information as listed in schedules 2 and 4 so that she can evidence that she has fulfilled her duty as set out in requirements 18 and 19 It is required that the providers 01/09/09 address the concerns raised in this report around fire exits, escape routes and door stops in consultation with the Fire Service to ensure that potential risks have been identified and eliminated to ensure the protection of people living in the home. DS0000063929.V376453.R01.S.doc Version 5.2 Page 28 Swallows Residential Home 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 Refer to Standard OP12 Good Practice Recommendations It is recommended that the home records activities in a separate log that lists what activities take place, who took part and if it was popular. It would be a useful tool to evidence that the home is proactive in providing activities that are tailored to meet people’s individual needs and aspirations It is recommended that the homes fire policy and procedures are reviewed to incorporate the specific difficulties that may arise in the event of a fire occurring in the night. 2 OP19 Swallows Residential Home DS0000063929.V376453.R01.S.doc Version 5.2 Page 29 Care Quality Commission Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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