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Inspection on 05/09/08 for Swallows Residential Home

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

This inspection was carried out on 5th September 2008.

CSCI found this care home to be providing an Poor 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 offers comfortable and homely accommodation to a small number of residents. The staff get to know the residents well and try to meet their needs in an individual manner. The home is well appointed clean and tidy and residents bedrooms have been individually personalised. The home provides a range of activities and a varied nutritious diet. People living in the home said that they enjoyed the various activities and confirmed that the food was very good and had further improved over recent weeks.

What has improved since the last inspection?

A review of the service users` care plans has been commenced with more detail of care needs and how these are to be met being recorded. All the required recruitment checks were seen to have been carried out for staff employed since the last inspection this to ensure the protection and safety of the people who use the service. A review of the medication systems has been commenced some staff have received additional training and further training for other staff has been arranged. The home has revised its Safeguarding Policy and Procedures for staff guidance based on the guidelines set out in the Suffolk Interagency procedures.

What the care home could do better:

Work has commenced on meeting some of the requirements made at the last inspection but as yet these have not all been fully met. Further work is required in relation to care planning to bring all care plans up to a uniform and adequate level. In respect of safeguarding more training for staff is recommended. Regular supervision arrangements for all staff need to be established. Serious shortfalls remain in respect of medication administration storage and the auditing of records and these shortfalls leave the service users at risk. The new manager said that she intends to apply to the Commission for registration. She demonstrated an empathy with her service users and had a kind and caring approach to their care and well being. She remains positive that she has the ability to drive forward the improvements needed in the service to ensure the full safety and protection of the service users and to fully meet the requirements of the National Minimum Standards.

CARE HOMES FOR OLDER PEOPLE Swallows Residential Home Helions Bumpstead Road Haverhill Suffolk CB9 7AA Lead Inspector Mrs Jan Sheppard Unannounced Inspection 5th September 2008 09:00 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 Swallows Residential Home DS0000063929.V372955.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. Swallows Residential Home DS0000063929.V372955.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 Manager post vacant Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th May 2008 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 increased to sixteen residents. All resident bedrooms are for single occupancy with one room having an en-suite toilet facility. The home came under new ownership and management in June 2005. The owners three family members who trade as Burrows Care Homes are the registered persons. The manager’s post became vacant in March 2008 when one of the registered persons took over as manager. The fees range between £331.00 and £375.00 per week. The cost of newspapers, chiropody, hairdressing and some transport is not included in the fees. Swallows Residential Home DS0000063929.V372955.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 0 star. This means the people who use the service experience poor quality outcomes. This key inspection was conducted during a weekday when a pharmacy and a regulation inspector spent a total of twelve hours in the home. The manager, Ms. Donna Burrows, was present through out and along with others members of the management team offered their full help and assistance. During this inspection the regulation inspector made a tour of the building, had in depth discussions with the manager spoke with other staff on duty and met and spoke with a number of residents. Spot checks were made on a number of the home’s records. The pharmacy inspector, accompanied for part of the time by the regulation inspector, carried out checks on the medication storage areas, records and stocks of medicines and spoke with the staff who administered the medication. The detail in this report reflects the findings on that day and also takes account of information sent periodically to the Commission by the homes management. Information contained in the AQAA (Annual Quality Assurance Assessment) and in a number of pre-inspection surveys sent to service users were also taken into account. A pharmacy inspector accompanied the Regulation Inspector for this inspection due to a history of serious shortfalls in respect of medication administration storage and the auditing of records. During this inspection as soon as further error was identified in order for the inspection to properly continue a Code B Notice was issued to the manager under the Criminal Evidence Act 1984. What the service does well: What has improved since the last inspection? Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 6 A review of the service users’ care plans has been commenced with more detail of care needs and how these are to be met being recorded. All the required recruitment checks were seen to have been carried out for staff employed since the last inspection this to ensure the protection and safety of the people who use the service. A review of the medication systems has been commenced some staff have received additional training and further training for other staff has been arranged. The home has revised its Safeguarding Policy and Procedures for staff guidance based on the guidelines set out in the Suffolk Interagency procedures. 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. The summary of this inspection report can be made available in other formats on request. Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 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 Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to receive an assessment of their care needs prior to their admission to the home. Standard 6 does not apply as the home does not accept referrals for intermediate care. EVIDENCE: Information given in the AQAA stated that “Before a client is admitted to the home a needs assessment is carried out”. Since the last inspection there have been three new residents admitted to the home. Their files were seen to contain a pre-admission assessment completed by the service. The manager explained that she or another of the managers will visit the prospective resident in their home or other setting to make this assessment and then if it is felt that the home can meet their needs that they Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 9 will invite them, accompanied by relatives if they wish, to visit the home view the accommodation and meet with the other residents. It is recognised that being a small home compatibility amongst the residents is important. A social care needs assessment is obtained from social services where they have been involved and appropriate medical and nursing reports also where these services have been previously had dealings with the applicant. People living in the home said that their admission had been planned and they had a chance to visit the home before moving in. The Statement of Purpose and the Service Users Guide were on display in the entrance to the home. Information on the four pre-inspection surveys from service users said that they had received enough information about the home before they moved in so as to be able to decide if this was the right place for them. Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 10 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 and 10. People who use this service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to have a care plan in place but cannot be assured that all their care and health risks will be fully identified. Medication practices do not offer sufficient levels of protection to people living in the home. EVIDENCE: The manager said that since the last inspection on the 15th May 2008 she had commenced a review of the care plans. However although the home only had thirteen residents on the day of this visit all the plans had not yet been reviewed but the manager she was able to show the inspector the improvements made on a revised plan as compared to an old one. The revised plans have been set out more clearly into separate sections where the information is much easier to access and where needs can be more clearly identified. The people who use this service all have a named key worker and Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 11 during this inspection one was heard to be offering to bring in some personal shopping items for her key resident. Staff were observed to be knocking on bedroom doors before entering and to be offering service users choices and to be addressing them in a respectful manner with due regard to their dignity. The residents’ assessed care needs were seen to be recorded along with health care information and risk assessments for nutrition and moving and handling. A detailed risk assessment for one resident along with a clearly documented plan as to how care was to be delivered to prevent the re-occurrence of unacceptable behaviour towards another more vulnerable resident was seen to give good detail and to outline the risks and identify the role of safeguarding. The manager said that the situation had much improved and that the home was working with the resident and her remaining relatives who had requested for her to move to another home situated nearer to them. During the inspection it was observed that this resident was relating to other residents in a friendly manner asking them to help her with an activity. The health care needs assessment of one recently admitted resident were seen to have identified their need for a hearing test which was carried out on 13th August. The records of doctors’ visits to all service users were recorded but it could not always be evidenced that the doctors’ instructions had been fully implemented. Staff maintain daily records and monthly summaries were being undertaken to identify any changes in care needs. An improvement in the detail of these records was noticeable since the last inspection and the manager said that she had asked staff to expand their recording to ensure that the records better reflected the care being given. Since the last inspection on the 7th July 2008, one of the senior staff had attended a half day training on Care Planning at West Suffolk College and she was now assisting other staff to make these recording improvements and was discussing this with the staff during the staff meetings. One care plan examined did not however have the person’s care needs relating to their epilepsy documented although staff spoken with were aware of this condition. In this case it could not be evidenced that the person’s health care needs were being fully met. In another set of records there was evidence of the home working with the GP to monitor medication and the nutritional intake of a recently admitted resident. These records showed the very imaginative ways in which the new cook and the manager had tried to encourage the resident to take a nutritionally balanced diet and that nutritional drinks and individual additional meals were being given to supplement. The cook was keeping records of meals Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 12 offered their nutritional content and details of what was actually consumed. Records of the weight of the service user were being kept. The home continues to use a monitored dosage system to manage its medication. This is supplied by Boots in Bury St Edmunds and the Pharmacist from that branch was found to be visiting the home on the day of this inspection. This inspection was conducted by the Commissions Pharmacy inspector Mark Andrews. The reason for this inspection was to assess the homes medicine management practices following issues raised during the key inspection of 15/05/08 and the previous pharmacy inspection of 28/07/08. The manager was on duty at the time of this inspection. The findings of the inspection were discussed with the manager and deputy via verbal feedback. During the inspection we issued a Code B Notice to the Manager under the Police and Criminal Evidence Act 1984 which she accepted. We took copies of medication related records and provided the manager with a written list of documents taken. When we arrived at the Inspection we noted that the keys to medication storage were being kept safely and medicines were secure. Since the previous inspection the home has secured the cabinet to the wall in the office area but the cabinet had been fixed by four screws and not by bolts through the controlled drug compartment in line with the Misuse of Drugs (Safe Custody) Regulations. We noted that for a person living at the home self-administering their medicines the risk assessment has been reviewed twice since the last inspection. The review considers the security of medicines. We were accompanied by the manager to the person’s room and found that medicines were being stored in a lockable drawer which they were able to manage. The home continues to highlight medication chart entries for medicines not supplied in monitored dosage system (MDS) containers to assist in ensuring that staff always select these medicines for administration. However, we noted there to be some medicines where their medication chart medicine entries did not specify the dose to be given to the person or the frequency in which it must be administered. For these medicines, there were inadequate instructions for staff to follow when selecting medicines for administration. At the time of the previous pharmacy inspection of 28/07/08 we found that for one person living at the home a painkiller was being administered at a strength differing from that entered on the medication chart. The manager had agreed to take urgent steps to resolve this and arrange for the prescription to be reviewed. When we examined the person’s care notes during this inspection we Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 13 noted an entry on 10/08/08 in the GP visit notes indicating the doctor had authorised a dose reduction from 1-2 tablets to only one tablet. However this information had not been written on the medication chart and the dose remained unchanged. We found the same person now has laxatives senna and lactulose liquid on the medication chart but they were not on the immediately previous chart. The medicine labels for these two medicines related to their supply in May 2008. There were no records in the persons notes indicating that these medicines were to be either stopped or re-started. When we looked at current and immediately previous medication charts we found there to be overall fewer gaps in the records for the administration of medicines. However, we found that for external medicines administered by carers in people’s rooms the records were inadequate as they indicated the medicines were seldom applied by carers as prescribed. For one medicine, a topical antibiotic cream, the medication chart indicated the medicine must be applied three times daily. The chart was left blank but the hand written chart used in the persons room stated the cream was to be applied twice daily. Further we noted that on most days, records indicated it was actually only being applied once daily. We found that when medicines were not administered to people as scheduled, records sometimes did not indicate the reason why the medicine was not given. When code ‘F’ was used equating to ‘other ‘ reason there were no further records stating the exact reason why. There were also incomplete records where medicines prescribed with variable doses were given to residents (e.g. paracetamol tablets 1-2 four times daily) but where the exact doses administered were not recorded. This practice does not allow these medicines to be accounted for. Overall we noted an improvement in records for the receipt of medicines into the home on behalf of people. However when a person living in the home was admitted to hospital their medicines were also sent but again there were no records of these medicines leaving the home to enable them to be accounted for. At the time of the previous inspection, we identified that the home did not have a record- keeping system in place to ensure all medicines could be accounted for. The manager had agreed that there ‘should be carried forward figures’ in place at the start of new medication charts to enable this. The day of this inspection was the fifth of the new 28-day medication chart cycle (starting 01/09/08). A senior carer on duty confirmed that carried forward quantities of medicines implied to be at the start of the 28-day medication chart period had only been recorded on the day before the Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 14 inspection. This was by retrospective calculations using quantities of medicines available on the fourth day of the cycle. This led to confusion when we conducted a sample of medicine audits during the inspection. Where we could conduct audits of medicines that were not supplied in the MDS containers we found there to be discrepancies. We checked the discrepancies with the deputy manager and the senior care member of staff on duty. These were quantities of medicines in both surplus and deficit suggesting that they had not been given to people as prescribed. For example, a person prescribed sodium valporate tablets for the prevention of epileptic seizures there was a discrepancy suggesting the medicine had not been given at the correct dose. We noted the dose of medicine had changed in recent months so the number of tablets to be given had changed. When we asked, both the manager and deputy were unclear what type of seizures the person suffers from but confirmed that the person had been admitted to hospital following a ‘larger seizure’, One of the inspectors found there to be an inadequate care plan in place relating to the person’s condition. For the same person, we found a discrepancy surplus of 3 tablets of a diuretic (water tablet) started on 28/8/08 suggesting that on three occasions in the previous eight days the medicine had not been given. For the person self-administering medicines the home is not recording quantities of medicines supplied to the person to enable them to be accounted for. When we discussed training for staff authorised to handle and administer medicines the manager said that so far, medication training had still not been arranged with West Suffolk College. However, she confirmed that since the previous inspection the supplying pharmacy had provided training for the manager, deputy and a senior carer. Five further members of staff have still not received recent training and some since 2005. The manager said that she had been assessing staff competence relating to handling and administration of medicines by observation but had not recorded assessments of staff competence or yet started any formal supervision events for staff. Five requirements have been made as a result of this pharmacy inspection where the home has failed to meet the previous timescales. The Commission is now considering enforcement action to effect improvement. Action must be taken to meet requirements as they are made under the Care Standards Act 2000. Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 15 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. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to be provided with a range of activities to meet their various choices. People who use this service can be confident that they will be offered choices from a varied diet of nutritious home cooked food. EVIDENCE: The home provides daily activities for service users who wish to participate. The plan of activities for the next month was seen displayed in the lounge. This evidenced a mixture of group and individual activities along with visits from outside entertainers and musicians and outings into the local area. Service users spoken with said that they had plenty to do and whilst there was no compulsion if they asked for something different staff always tried to arrange this. A fortnightly craft session was clearly popular as were the bingo and sing a long sessions. One resident who was trying to complete a large jig saw puzzle was seen to be getting help from staff and fellow residents alike. Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 16 The home is situated in a very rural position but service users explained that they could always order a taxi if no staff member could take them to the nearest town, Haverhill. The daily records evidenced that friends and family make regular visits to the home and service users confirmed that they are always made welcome. The residents’ files contained good details of family contacts and their relationship to the resident. The kitchen was visited as part of this inspection and discussion was had with the cook about the revision of the menus which she has started following consultation with the residents. The kitchen was found to be clean tidy and well organised with temperatures of fridges and freezers regularly recorded. The recently recruited cook holds NVQ qualifications at level 2 and has had experience of professional catering in a commercial setting. The menus evidenced that good choices are available and the fresh vegetables are used daily and home baked cakes and puddings also being regularly available. The cook said that being such a small setting she was able to meet individual choices and for one resident with particular eating difficulties the records evidenced the considerable care and attention that had been given to trying to find dishes that he liked and that would meet his nutritional needs. The serving of lunch was observed. The tables were nicely laid with a range of condiments and fresh drinks. The meal looked appetising; the main meat course was served from the kitchen to each resident on individual plates but vegetables were in tureens on the tables so that residents could help themselves. Staff were seen to be assisting where needed but generally lunch was a relaxed and happy occasion residents who took a long time over their meal were allowed to do so without being hurried. All the residents commented very positively on the food generally and one said how much this had improved since the arrival of the new cook. Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 17 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. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service can be confident that the policies and procedures in place will ensure that their concerns and complaints are listened to and investigated. However they cannot be assured that the manager and staff have sufficient knowledge and understanding to fully safeguard service users. EVIDENCE: The Complaints policy was on display in the entrance to the home. Preinspection surveys from residents and those spoken with during the inspection said that they would know what to do if they had a complaint; all said that they would go immediately to the manager. The Commission has not received any complaints about this home since the last inspection and neither have the home received any. Since the last inspection the home has reviewed its policy and procedures on Adult Protection and Whistle Blowing and these revisions were bought to the staffs attention during a staff meeting on the 3rd July 2008. Senior staff and the Manager were able to evidence some understanding of safeguarding systems and whistle blowing procedures and mentioned the training about this that they had undertaken during their NVQ studies. However they could not Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 18 fully evidence that their knowledge of the key steps necessary in a safeguarding situation enabled them to have these steps fully at their finger tips. To ensure that all grades of staff fully understand and are comfortable with the process of reporting any suspicions that they may have the Manager agreed that a refresher Safeguarding training for all grades of staff would be advantageous. Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 19 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 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service will find that it is homely comfortable and clean and the physical design and layout is with one exception, (radiators without low surface temperature covers), generally safe. EVIDENCE: A tour of the home was undertaken as part of the inspection. The building was found to be clean tidy and well arranged and with one minor exception (in an unoccupied room) it did not have any unpleasant odours. The task to re-clean or replace the carpet in this room had already been planned .The home was found to be well appointed and well maintained with fresh attractive decorations; service users’ bedrooms were well personalised in a homely manner which reflected their individual tastes and styles. All the residents Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 20 spoken with said that they were very happy with their rooms and confirmed that they had all the furniture and equipment that they needed. One said that if I want anything changed Mr. X (the caretaker) is always very helpful. The resident names were seen to be on the doors of their rooms and keys were available. Each room also had a lockable storage space. One service user who retained her medication in her room had a suitable locked drawer in which to keep this although it was explained that since the last inspection and with her agreement the key to this was now kept in the office and given to her at medication times. Where required call bells had extended leads so that these could be accessed by the residents from all points of their room. The laundry was visited and was found to be clean tidy and well maintained and to provide sufficient storage area for each service users clean clothes to be kept separately. Service users were all complimentary about the standard of their laundry and on the day of this inspection they were seen to be well dressed with freshly ironed clothing. The system for handling soiled linen was clearly stated on the laundry wall and staff consulted could evidence a good awareness of the importance of maintaining good infection control measures. The washing machine has a sluice cycle and red bags are used. Adequate supplies of gloves, aprons and liquid soap were seen in the laundry and at other key locations around the home. Some staff were observed to be carrying individual hand wash. Many of the radiators around the home were found to be without low surface temperature heat covers which must be provided to ensure that the service users live in a safe environment. Swallows Residential Home DS0000063929.V372955.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 and 30. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to be cared for by adequate numbers of staff who have had some training and who have been robustly recruited . EVIDENCE: On the day of this inspection the levels of staffing were seen to be adequate to meet the needs of the residents and to ensure the smooth running of the home. In fact it was seen that the numbers of staff on duty exceeded the numbers on the rota for that day. The Manager explained that this was because all the management team and a number of extra carers who administer medication had come on duty that day so that they could join in with the meeting with the Boots Pharmacist. The home is fortunate in retaining quite a stable core group of care staff. In the AQAA completed prior to the previous inspection it was stated that 75 of the current staff have achieved NVQ at level 2 and that several more were undertaking this training. Staff confirmed both in speaking with the inspector and in their written survey replies that they have good training opportunities. The records evidenced that since the last inspection one carer has undertaken a course on care planning, several care staff have attended a Boots medication training and the new cook has been booked on to a Food Safety Course. Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 22 The Manager said that since the last inspection three experienced carers had commenced taking maternity leave but that fortunately she had been able to recruit experienced replacement staff one of who held a NVQ qualification at level3. The recruitment records for the newly appointed members of staff were examined as part of this inspection. They were found to contain the required information, an application form, two references, copies of certificates, personal identification records, evidence of address. Criminal Record Bureau and POVA first checks along with recorded evidence of the interviews were all seen to be being maintained. The manager said that she now ensured that a reference was obtained from the applicants previous employer and she discussed with the inspector the best way in which to securely retain the CRB identification numbers for these and for the existing staff. The CRB checks made on three other staff who have commenced duties since the beginning of 2008 were evidenced to the inspector along with all the other required documentation. The manager also explained that all new staff complete induction training and work initially shadowing another staff member so as to be able to get to know the residents and the ways in which the home operates. Swallows Residential Home DS0000063929.V372955.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 and 38. People who use this service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home’s manager has not been sufficiently proactive in meeting the requirements made at the last inspection. Although some elements of good management practice were evident the homes shortfalls continue to put people at risk. The new management team have indicated that they wish to improve the service to meet all the standards but as yet have not had sufficient time to fully do this. Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 24 EVIDENCE: At the time of this inspection the home was being managed by one of the proprietors who had taken over that role in March 2008 when the previous manager and senior carer left. She explained that she had many years of previous experience of working as a carer with older people but did not have experience of managing a home. She holds an NVQ qualification level 2 in Care and is currently studying for the level4 Registered Managers Award. She stated that she is planning to make her application for registration to the Commission for Social Care Inspection and had downloaded the application from the internet. She is assisted in the day- to -day management of the home by a deputy manager and an assistant manager. They are both experienced carer deputies and hold NVQ qualifications. All the management team presented as kind and helpful and to share a common ethos of being understanding and considerate to the service users whose needs there were endeavouring to meet. Spot checks were made on a number of the home’s records including hot water temperature monitoring and the procedures for and frequency of fire alarm checks. The minutes of residents meetings and minutes of staff meetings evidenced that these were held regularly. The home has a policy and procedure to safeguard service users’ finances and both staff and a service user spoken with had an awareness of this. Staff spoken with all told the inspector that they were well supported by the homes managers with whom they could talk freely. However no formal system for regular staff supervision and annual appraisal could be evidenced. This requirement is outstanding from a previous inspection in 2006. Concern was expressed to the manager that whilst a number of improvements had been made since the last key inspection on 15th May 2008 and the pharmacy inspection on 28th July 2008 not all the requirements made at those inspections had been fully met and this meant that in some aspects of their care the service users remained at risk. The manager replied that she remained positive that she has the ability to drive forward the improvements needed in the service to ensure the full safety and protection of the service users and to fully meet the requirements of the National Minimum Standards. Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 25 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 1 X 2 Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13(2) Requirement The cabinet used for the storage of controlled drugs must be properly secured to the wall by a minimum of two bolts in line with the Misuse of Drugs (Safe Custody) Regulations. This to ensure full safety for the service users. REQUIREMENT NOT MET. ENFORCEMENT ACTION IS NOW BEING CONSIDERED. 2. OP9 13(2) Full and accurate records for the administration (and non administration) of medicines must be completed at all times when medicines are scheduled for administration. Safe medicine administration procedures must be followed at all times. This to ensure full safety for the service users. REQUIREMENT NOT MET. ENFORCEMENT ACTION IS NOW BEING CONSIDERED. 02/11/08 Timescale for action 02/11/08 Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 27 3. OP9 13(2) Full and accurate records for the receipt and disposal of medicines including those sent with people to hospital must be completed at all times. This to ensure full safety for the service users. REQUIREMENT NOT MET ENFORCEMENT ACTION IS NOW BEING CONSIDERED. 02/11/08 4. OP9 13(2) Medicines must be given in line with the most recent prescribed instructions. This must be demonstrated by the homes record keeping practices at all times. This to ensure full safety for the service users. REQUIREMENT NOT MET ENFORCEMENT ACTION IS NOW BEING CONSIDERED. 02/11/08 5. OP9 13(2) Full and accurate records of authorised changes to medicines or their doses must be completed at all times ensuring people are administered doses of medicines as intended by the most recent prescribed instructions. This to ensure full safety for the service users. REQUIREMENT NOT MET ENFORCEMENT ACTION IS NOW BEING CONSIDERED. 02/11/08 6. OP7 15 All care plans must be consistent and fully record all the social care and health care needs of the people who use the service. DS0000063929.V372955.R01.S.doc 30/09/08 Swallows Residential Home Version 5.2 Page 28 7. OP36 18 (2) All staff must receive regular supervision. 30/09/08 8. OP19 13 (4)(a) THIS IS A REPEAT REQUIREMENT. To ensure the full safety of the 30/09/08 people who use the service all radiators must risk assessed and where a high risk is identified they must be protected by low surface temperature covers. 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 OP9 Good Practice Recommendations The competence of care staff authorised to handle and administer medicines should be assessed on a regular basis. The home should conduct frequent audits of medicines ensuring they can be accounted for and where discrepancies are identified prompt action taken to resolve them. To ensure that all staff including management are fully aware of safeguarding and whistle blowing procedures refresher training should be arranged. 2. OP9 3. OP18 Swallows Residential Home DS0000063929.V372955.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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