Inspection on 20/05/08 for Swan House

This inspection was carried out on 20th May 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Swan House 19/05/09

Swan House 06/11/07

Swan House 03/04/07

Swan House 24/04/06

Swan House 12/08/05

Swan House 12/04/05

Swan House 25/10/04

Swan House 01/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Swan House 47 - 49 New Road Chatteris Cambridgeshire PE16 6EX Lead Inspector Elaine Boismier Unannounced Inspection 20th May 2008 10:00 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 Swan House DS0000024309.V364344.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. Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Swan House Address 47 - 49 New Road Chatteris Cambridgeshire PE16 6EX 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) 01354 696644 01354 696645 Four Seasons Homes (No 4) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Manager post vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability over 65 years of age of places (40), Terminally ill over 65 years of age (25) Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No more than 25 nursing places only No more than 25 places for terminally ill residents over 65 years of age (TI(E)) only 6th November 2007 Date of last inspection Brief Description of the Service: Swan House, close to the centre of the town of Chatteris, is a care home registered to provide care, including nursing care, for people over 65 years of age. There are 40 single bedrooms and 39 of these have ensuite facilities. Six bathrooms are also available in the home. The home is arranged on two floors that offer bedroom accommodation, dining room areas and a choice of sitting rooms. The upper floor can be reached via stairs or a lift. There is a small garden at the back of the home. Current fees range from £343 to £750 and additional costs include hairdressing, chiropody, newspapers and toiletries. Further information about fees should be available from the home. A copy of the inspection report is available at the home or, alternatively from our CSCI website at www.csci.org.uk. Swan House DS0000024309.V364344.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 2 star. This means the people who use this service experience good quality outcomes. We, The Commission for Social Care Inspection, carried out this key unannounced inspection, by three Inspectors, between 10:00 and 14:30, taking 4.5 hours to complete. We spoke with the Manager, staff, residents and visitors. We watched staff working, looked at documentation and had a look around the building. Before the inspection we received surveys from residents (4), staff (4) and relatives/advocates/carers (6). We also received a completed annual quality assurance assessment (AQAA) from the Manager. We also looked at the history of the home since our last inspection, in November 2007, and up to this inspection of May 2008. All of the above have been referred to in this inspection report. For the purpose of this report people who live at Swan House have been referred to as “people”, “person” or “resident/s”. What the service does well: People said in both surveys and when we spoke with them that they had nothing to complain about and had positive comments about staff saying that they were “kind and attentive” and ““….are wonderful, they help promptly and willingly.” People have access to a good standard of information to assist them in their decision where to live. People are satisfied and are safe from the risk of abuse. People live in a well maintained and generally clean home. People are safe and well cared for by a team of kind, well-recruited and generally well-trained staff. Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Swan House DS0000024309.V364344.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 Swan House DS0000024309.V364344.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 Quality in this outcome area is good. People have access to a good standard of information to assist them in their decision where to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA informed us that any person admitted to the home has a full assessment of their needs, before they move in. The home, as well as any placing authority, carries out all of these preadmission assessments. Discussion with one of the people and examination of another person’s care records indicated that the people had had a full assessment of their needs before they moved into the home. A copy of the last inspection report was available in the entrance hall of the home. Staff and visitors told us that they had seen this report. Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. People receive an improved standard of health and personal care although medication practices could be better for people to be safer. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA said that all care plans are reviewed each month and the Manager or Deputy Manager audits these. The AQAA also said that “Care plans have improved and more person centred… All care plans are written and collated with input from resident and/or family if they so wish.” Examination of a number of care records and cross referencing these with our observations and discussions with people indicated that the care records are actively reviewed each month; there was evidence that care plans are developed with the changed needs of the people and that there was clear guidance for staff in how to meet the individual needs of the people. Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 10 Following on from our last inspection we expected the home to consult people, or their representatives, about the care plans. Although it was not clear from the records that this had acted on we found evidence, following discussion with people and relatives that they knew what care was being delivered and the reason why. We expect this improvement to continue to be developed. One of the resident’s surveys said “The district Nurse has been in to change the dressing. She has now referred me to a GP and Physio.” Another of these surveys said” Nursing staff are very efficient.” Examination of people’s care records, and observation of the standard of people’s personal care indicated that there has been an improvement in this area. People were well presented with clean clothes and hair and had been helped by staff to wear their personal jewellery. Care records indicated that people have had access to a range of health care professionals including podiatrist (feet) services, local hospitals, physiotherapists, dieticians, GPs and tissue viability nurses and nurses specialised in diabetes (mellitus). Care records indicated also that action had been taken to record people’s weight, make sense of these recordings and action taken in the event of significant unintentional weight loss. Although we expected the home to record desirable target weights for people we found that this action had not been taken. Nevertheless we are satisfied that people’s weights are being monitored closely as evidenced in this report. Other targets were clearer such as those for blood pressure and blood cell counts. The AQAA informed us that there was no person currently living at the home, who had acquired a pressure sore and we found this was the case following our examination of some of the people’s care records. A specialist pharmacist inspector examined practices and procedures for the safe storage, handling, administration and recording of medicines. Medication was stored securely for the protection of residents. Medication cupboards and trolleys were clean and orderly with the keys being held by the care staff. Daily temperature records were kept of where medicines were stored and these were acceptable. Clear records were kept of all medicines coming into and leaving the home. Records were kept when medication was given to residents and these were generally of a good standard. The stock balance of medication left over from the previous month should be recorded so that staff can fully account for all medication in use. Some medication is not being given as prescribed, for example one person is prescribed a cream to be used “two or three times a day” and for not more then 7 days but the record of when it is used shows it was only used once a day and it had been used for more than seven days. Some of the hand-written medication records did not clearly indicate the month and year of use. Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 11 We observed staff interacting with people in an appropriate and respectful manner. We also observed medication being given to some residents at lunchtime and this was done with due regard to people’s personal choice. However, some medication was left unattended on top of the medicines trolley that could then have been used by a person other than it was prescribed for. It is expected that the home will manage this without the need to make a requirement at this stage. Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 12 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 & 15 Quality in this outcome area is good. People have improved opportunities to live a good quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the residents surveys said that home provided activities that the person could take part in. The AQAA told us “ We have greatly improved the activities within the home-with a weekly planner for activities and trips out.” There is an activities committee and the AQAA told us that 3 of the residents are on this committee. Examination of the record of activities indicated that these range from visits by a “pat” dog”, games of bingo and a celebration of St George’s Day. Visitors told us that they had taken part in the recent Bar-B-Q, held at the home. We saw some of the people taking part in ball games supervised by an outside organiser, “Sporting Chance”. We expected the home to offer choice of how people wished to live with particular regard as to when they got up and when they went to bed. Discussion with the people indicated that they now do have the choice of when they get up and when they go to bed. All of the surveys from Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 13 relatives/carers/advocates had told us that residents are supported to live the life that they choose. We saw people receiving visitors in their own rooms or in the communal areas of the home. All of the residents’ surveys said that they liked their meals. One of residents wrote “I enjoy my meals” and the majority of people we spoke with said that the food was good. We saw people being offered a choice of food for their lunch that included gammon and egg, a chicken dish and a choice of desert including fresh fruit and yoghurt. Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 14 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 & 18 Quality in this outcome area is good. People are satisfied and are safe from the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the residents’ surveys and all of the surveys from relatives/carers/advocates said that the person knew who to speak to if they were unhappy about something and knew how to make a complaint. One person wrote that they had no cause to make a complaint. All of the 4 surveys from staff said that they knew what to do if a concern about the home was made to them from either a resident or visitor. Discussion with people, staff and visitors indicated that on the whole people knew what to do if they were unhappy about something and how to make a complaint. One of the residents said, “I have nothing to complain about.” The AQAA told us that by December 2007 all of the staff have attended training in safeguarding (previously referred to as protection of vulnerable adults or POVA) and that there have been no complaints or safeguarding referrals. We have had no complaint about the home and we have had no allegations of abuse about any resident, since our inspection in November 2007, and examination of the record of complaints confirmed this to be the case. Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 15 Staff told us that they had attended training in safeguarding and were able to describe what they would do if they witnessed verbal abuse against a resident by a member of staff. Examination of staff training records indicated that staff have attended training in safeguarding vulnerable people against abuse. Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 16 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 & 26 Quality in this outcome area is adequate. People live in a well maintained and generally clean home that could be improved upon further. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of the minutes of the most recent residents’ meeting indicated that people are consulted about the décor of the home. The AQAA identified areas that the home could improve upon and this included redecoration of corridor walls and an “upgrading” of the bathrooms. According to the AQAA arrangements had been made for new dining room furniture and curtains to be provided and we saw that these items had now been provided. Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 17 Following on from the last inspection we expected the home to take action to ensure that the carpets in the home were less “grubby” looking. We noted that some of these carpets, although clean, remained “grubby” in their appearance. The AQAA told us that there has been an increase in the number of domestic staff to deep clean the carpets in the home. According to the Manager, and the AQAA, action has been taken to employ an additional member of staff to shampoo the carpets. We have made no requirement on this occasion as the home has taken action to try and improve this part of the home’s environment although the outcome of the action taken will be assessed at future inspections of the home. All of the 4 residents’ surveys said that the home was always clean and fresh, and we found this to be the case as there were no offensive odours. Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 18 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 & 30 Quality in this outcome area is good. People are safe and well cared for by a team of caring, well-recruited and generally well-trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the 4 staff surveys said that there was always enough staff on duty to meet the needs of the residents. According to the Manager there has been an increase in the number of permanent staff, including a deputy manager, who was on duty when we were at the home. We observed staff working and they were carrying out their duties in an unhurried manner. We timed the response to call bells and this was less than 3 minutes duration. According to the AQAA “Our staffing has improved greatly. We have very little agency usage within the home, if any” although the home had used between January and March 2008 118 hours of temporary or agency nursing staff and 597 hours for temporary or agency care staff. The Manager explained that agency staff were used when the home was taking new admissions and staff vacancies were waiting to be filled. Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 19 From the staff surveys, and discussion with the staff, it appears staff are happy working at the home. One of the staff surveys said “Swan House is an exceptional place to work and I would be very happy for any of my relatives to be receiving care at this home.” Another of these surveys said, “In my opinion the service is of a very high standard and everything is done well.” A survey from a relative said, “Most of the carers are brilliant, they are friendly and if I have a concern I can go and talk to them. They treat my uncle very well and he has settled in very well and he seem (sic) happy.” One of the resident’s surveys said” Staff deliver a great service” and another of these surveys told us “The staff are wonderful, they help promptly and willingly.” One person said that staff were “Very kind, very attentive.” Visitors to the home told us that staff were very good and caring and that the home felt like “a family”. The AQAA told us that the home has only 25 of staff with an NVQ level 2 or above in care although 16 of care staff are working towards this desirable qualification. The AQAA also told us that the recruitment procedures are “followed to the letter…” and examination of three staff files indicated that this was the case; all of these files had all the required information about the person before they started working at the home. All of the 4 surveys from staff said that the person felt that they had the knowledge and skills and support to be able to meet the needs of the residents. One of these surveys told us “Four seasons (sic) and my manager have been very helpful and have offered me the opportunity todo (sic) as much training as I want to do…” Examination of staff training records and discussion with the staff indicated that staff attend induction training and ongoing training. Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 20 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): 31,32,33,35 & 38 Quality in this outcome area is good. People benefit from an improved and well managed home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager has been in post since November 2007. She is a registered general nurse, has the registered manager’s award and an NVQ level 4 in management. She has held various senior roles whilst working in care homes for the last 15 years and has recently attended a two day course in safeguarding awareness and procedures. She demonstrated a good knowledge about individual residents and individual staff and demonstrated her commitment in improving the quality of life and care of the people who live at the home, as evidenced in this inspection report. Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 21 She informed us that an application to register her as the Manager has been submitted to us. We received positive comments about the management of the home and both visitors and staff told us that the atmosphere is friendly and the Manager is approachable. The AQAA told us that Four Seasons Healthcare Limited has sent out surveys and the responses from this indicated that there has been an increase in the overall satisfaction of the home from 73 to 82 . Results of the survey were seen and confirmed the information provided by the AQAA. Copies of reports made by a representative of Four Seasons Healthcare Limited were seen for April and May 2008 and both of these reports provided evidence that views of residents, visitors and staff are sought. Audits are also carried out to include those for medication, health and safety matters and the home environment and records of these were seen. The AQAA was completed in an adequate manner although improvements could be made to tell us what action is being taken to improve the identified areas. For example the AQAA said that an area to improve was regarding quality assurance systems in relation to standard 33. The AQAA provided no detail as to how this was to be achieved. We acknowledge this is the first AQAA from Swan House and we expect that the next AQAAs that we receive contain more detail. Records for people’s personal monies were seen and discussion with staff indicated that people’s monies are safeguarded. The AQAA said that 66 of catering staff have attended training in safe food handling and 24 members of staff have attended training in infection control. Staff training records and discussion with staff indicated that staff attend training in safe moving and handling, fire safety, including fire drills and infection control. Records for safety checks on hoists, passenger lifts, fire alarm and emergency lighting and temperatures of hot water (in one of the bathrooms) were satisfactory. The home has identified that annual tests for portable appliance equipment are now due. At our last inspection, in November 2007, we noted that three fire doors in the laundry area were held open in a manner not approved by the fire safety officer. We noted, during this inspection, that action had been taken to make sure people were safe from the risk of the spread of fire as we saw no fire door was held open in an unsafe and unapproved manner. Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 22 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 3 8 4 9 2 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 2 x x x x x x 3 STAFFING Standard No Score 27 4 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x x 3 Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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) 17(1)(a) Requirement Residents must be protected by being given medication as prescribed by their doctor and records made of when medication is given to residents must be accurate to show that they have received their medication correctly. Timescale for action 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Swan House DS0000024309.V364344.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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