Inspection on 03/04/07 for Swan House

This inspection was carried out on 3rd April 2007.

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

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

Other inspections for this house

Swan House 19/05/09

Swan House 20/05/08

Swan House 06/11/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Swan House 47 - 49 New Road Chatteris Cambridgeshire PE16 6EX Lead Inspector Elaine Boismier Key Unannounced Inspection 3rd April 2007 9:55 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.V331269.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.V331269.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) ***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.V331269.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 28th November 2006 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 £340 to £600 and additional costs include hairdressing, newspapers and toiletries. A copy of the inspection report is available at the home or, alternatively from the CSCI website. A vacancy has arisen for a registered manager. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This summary includes references to enforcement activity carried out by us; a random unannounced inspection carried out on 3rd January 2007 and Protection of Vulnerable Adult (POVA) meetings held since the key inspection of 28th November 2006. 1st December 2006 Following the key inspection of 28th November 2006 a statutory requirement notice was served on 1st December 2006. This notice was due to the home’s failings to protect residents from the risk of harm to the health with regards to medication. 3rd January 2007 A random unannounced inspection was carried out on 3rd January 2007 to assess if the home had complied with the statutory requirement notice served on the 1st December 2006. It was assessed that the home had taken action to comply with the regulations set out in this notice. During this inspection information provided by staff and other evidence suggested that the standards of care of the residents was not acceptable with regards to their health and welfare and choice of how they wished to live. This was due to insufficient number of staff working at the home. Four requirements were made as a result of this inspection. 11th January 2007 A POVA meeting was held on 11th January 2007 with regards to the home’s management of a resident with a complex medical condition. It was found that the home had not failed to provide adequate care of this person. This inspection was the first key inspection of Swan House for 2007/08. The inspection was unannounced and was carried out by two Inspectors between 9:55 and 14:30 and took just over 4.5 hours. Forty surveys were sent to the home for residents to complete, of which 15 were returned and forty relatives’/visitors’ comment cards were also sent to the home, of which 13 were returned. The home manager provided information before the inspection. A relative asked to speak to the Inspector before the inspection and this discussion took place via telephone. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 6 On the day of the inspection there were 21 residents living at Swan House of which 7 of these people were spoken to. A tour of the premises was made, examination of documentation was carried out, staff were observed in carrying out their duties and staff and the home manager were spoken to. Although there has been some improvement in the standards of care and the standards of management, this improvement has not been sufficient to improve the overall assessment of Swan House. Swan House remains a poor service due to the risks posed to residents’ health and welfare. Residents of Swan House live in a friendly and welcoming home that has the potential to become an adequate service should action be taken to meet the requirements and consider the recommendations in this report and any improvements that are made are sustained. What the service does well: What has improved since the last inspection? A requirement was made for a copy of a revised Statement of Purpose to be submitted to the Commission for Social Care Inspection. This has now been received. A requirement was made that records of medication administered to residents were accurate. This requirement has been met. A requirement has been made to ensure records of the stock balances of controlled drugs are accurate. A requirement has been made to ensure procedures are in place to ensure health, welfare, care and treatment of residents. This requirement has been met. A requirement was made for the dignity of residents to be respected at all times. This requirement has been met. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 7 A requirement has been made to ensure that the health and welfare of residents is protected at all times with particular regard at meal times. This requirement has been met. A recommendation has been made for information about how to make a complaint be made available to all residents and their families/friends. This recommendation has been considered. A recommendation was made for staff to meet the needs of residents in a timely manner. As there is insufficient evidence to suggest that residents do not receive care in a timely manner this recommendation has been considered. A recommendation was made to demonstrate that residents had been consulted about their views of the home. This recommendation has been considered. A recommendation has been made for the names of staff who have attended fire drills to be detailed in the associated records. This recommendation has been considered. A recommendation was made to consider updating the policies and develop operational procedures for the safe use of medicines. Policies have been updated and this recommendation has been considered. A recommendation was made to monitor the medicines refrigerator temperature using the maximum/minimum thermometer in place. This recommendation remains. This recommendation has been considered. What they could do better: A requirement was made for care records to contain sufficient detail to guide staff in how to care for residents’ needs. This requirement has not been met and has been carried forward with a new timescale. A requirement has been made for the health and welfare of residents to be protected and promoted at all times with regards to hair washing. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 8 A requirement has been made for the protection of the health and welfare of residents at risk of pressure sore development. A requirement has been made to ensure records of the administration of medicines clearly indicate the date on which medicines are given. A requirement has been made for staff to be competent to carry out their work. This requirement has not been met and has been carried forward with a new timescale for action. A recommendation has been made for the full names of staff to be included on the duty rosters. A recommendation was made for the home to have 50 of care staff with NVQ level 2 or equivalent. This recommendation remains. A requirement has been made for full and satisfactory information to be obtained about staff before they work at the home. A recommendation was made for the home to be managed by a registered manager with the registered manager’s award. This recommendation remains. 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.V331269.R01.S.doc Version 5.2 Page 9 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.V331269.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. Prospective residents have access to a good standard of information about the home to assist them in their decision where to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement had been made for a revised Statement of Purpose to be made and a copy of this to be submitted to the Commission. A copy of the revised Statement of Purpose was received on 21st December 2006. The contents of this document were satisfactory and as a result this required has been met. 100 of respondents of the residents’ surveys said that they had received enough information about the home before making the decision to move in. Two residents’ care records that were examined contained assessments about Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 11 the peoples’ needs and these assessments were carried out by health and social care workers before the people moved into the home to live. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 Quality in this outcome area is poor. Residents are at risk to their health and welfare due to poor standards of record keeping and poor standards of care practices. The standard of medication practices has improved from a poor standard to that of an adequate standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement was made following the key inspection of November 2006 for the care plan to provide clear guidance for care staff in how to meet the assessed health and social care needs of the service user. This requirement had previously not been met by 5th June 2006 and was carried forward with new timescale for action of 4th January 2007. During this inspection 2 residents’ care records were examined and findings indicated that guidance for staff, in how to meet the needs of residents, was Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 13 unclear. For example there were no guidelines for ranges of residents’ blood sugars for the management of their diabetes and no guidelines for residents’ weight gain or weight loss for the management of their nutrition. Care plans were not revised according to the changed needs of the residents. For example the care plan for a resident assessed to be at risk of nutrition and dehydration was assessed to need to drink between 1.5 to 2 litres of fluid each day. Records and discussion with the home manager indicated that this was not an accurate assessment although the care plan had not been revised to reflect the change of need of the resident. For another resident it was described that their normal blood sugar was to be at a range that the resident had never been able to achieve regardless of previous and current intensive medical and healthcare support. This requirement has not been met and has been carried forward with a new timescale for action. A requirement was made for residents’ health and welfare to be provided for at all times. This requirement was made following the random inspection carried out on 3rd January 2007 as a member of staff was working whilst being treated by their GP for a chest infection. This requirement has been met as staff working at the home, at the time of the inspection, were well. Residents spoken to, and comments included in one of the residents’ returned surveys, remarked that there was no hairdresser “since early January and I have not had my hair washed since then”. The residents said that staff did not always wash the residents’ hair and when this care was carried out it was on an infrequent basis. One resident said that it was 6 weeks since staff had washed her hair. A requirement has been made about this. The Manager stated that she has taken action to recruit a hairdresser. Examination of care records of a resident assessed to be at risk of pressure sores were examined and compared to the care plan documentation. The care plan documentation stated that the resident was to have their position changed every 3-4 hours. Care records indicated however that there were times when the resident did not have their position changed as according to the care plan. For example care records for 15th March 2007 stated that at 7:30 the person was assisted on their right side. At 10:00 the record stated “nails done”. At 16:30 the record indicated that the person was assisted in a sitting position. Care records for 16th March 2007 records that, at 4:00 the resident was positioned on their right side and 8 hours later they were assisted, by care staff, to a sitting up position. Care records for 17th March 2007 indicated that the person was placed on their right side at 13:00. The record indicated that the resident’s position was changed 6 hours later at 19:00. A care plan, dated 20th March 2007, indicated that this resident had Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 14 acquired a grade 2 pressure sore (see also standard 27 of this inspection report). A requirement has been made about this. 57 of respondents of the residents’ surveys stated that they always received medical support when it was needed; 43 of respondents of the residents’ surveys stated that they usually received medical support when it was needed. Two care plans that were examined and discussion with the home manager suggested that residents have access to a range of health care professionals that include GPs, district nurses, dieticians, a falls prevention co-ordinator and a diabetes specialist nurse. At the time of the random inspection of 3rd January 2007 information provided by staff indicated that on the morning of 3 January 2007 some residents had been assisted out of bed, by the night staff, from 6:00 onwards before the day staff commenced their duties. It would have been still dark at this time and residents would be out of bed at an early hour and for a longer than “normal” period of time. We were informed that the night staff provided this care because of an insufficient number of care staff on duty for the morning of 3 January 2007. A requirement was made about this. This requirement has been met as during this inspection no resident stated that they were assisted out of bed other than their usual time of getting up. Following the key inspection of November 2006 a statutory requirement notice was served on 1 December 2006 due to breaches of Regulations 12(1), 13(2) and 17(1)(a). Requirement were made that by 31 December 2006: • to ensure proper provision for the health, welfare, care and treatment of service users, • to ensure suitable arrangements were in place for the recording, handling and safe administration of medicines and • to ensure a record is made of all medicines kept in the care home for service users and the date on which medicines are administered to service users. During the random inspection of 3rd January 2007 it was assessed that the home had taken appropriate action to comply with the regulations of the statutory requirement notice. During this inspection, the improvements in medication procedures and records noted on the random inspection on 3rd January 2007 have been largely maintained. Medication records were consistent with what is prescribed and the records of medication administered were of a good standard. There is however, a need to clearly indicate the date on which medication is administered since it was noted that some hand-written medication records charts were not clearly dated. A requirement has been made about this. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 15 Medication storage facilities are satisfactory and the temperatures are controlled and monitored appropriately. There is an audit trail to ensure medication received, administered and disposed of is accounted for. There was a discrepancy found in the recorded stock balance of a controlled drug in that an entry made was made in the register that it had disposed of but it was still found in stock. Two recommendations were made following the key inspection of November 2007. The first recommendation was for the development of operational procedures for medicines handling pertinent to the practices within the home. The second recommendation was for the recording of the temperature of the medicines refrigerator using the maximum/minimum thermometer in place and for the home to ensure a procedure is in place for its use. Operational procedures have been revised and staff are now following these. The temperature of the refrigerator is no monitored using the maximum/minimum thermometer in place. Following the key inspection of November 2006 a requirement was made for the dignity of residents to be respected at all times. This requirement had been carried forward from the key inspection of April 2006 and a new timescale for action was made of 29th November 2006. During this inspection of 3rd April 2007 residents were observed to be treated with dignity by care staff. Residents spoken to said that staff were “good” and “kind”. This requirement has been met. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 Quality in this outcome area is good. Residents live a good quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 33.3 of respondents of the residents’ surveys said that the home always provided suitable activities that the resident could take part in; 60 of respondents of the residents’ surveys said that the home usually provided suitable activities that the resident could take part in; 6.7 of respondents of the residents’ surveys said that the home sometimes provided suitable activities that the resident could take part in. According to the manager residents have recently taken part in entertainment based on a pub theme. At the time of the inspection a resident was going to the local shops with assistance of a member of staff. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 17 100 of respondents of relatives’/visitors’ comment cards said that staff welcomed residents’ guests into the home at any time and that they could visit their relative/friend in private. Due to evidence provided by staff during the random inspection of 3rd January 2007 a requirement was made as staff stated that residents were provided with an explanation, and choice of being assisted out of bed by night staff (that was due to insufficient number of staff for the following morning shift), although it was reported that this was not the usual choice of the residents. A requirement was made as a result of this evidence. This requirement has been met as residents indicated that they were assisted out of bed by care staff when the residents wished to get up. Following the key inspection of November 2006 a requirement was made as some residents’ food was left out of their reach and the food was becoming cold. During this inspection there was no evidence that this practice had continued. As a result of this evidence, this requirement has been met. 28.5 of respondents of the residents’ survey indicated that they always liked the food; 64.2 of respondents of the residents’ survey indicated that they usually liked the food; 8.4 of respondents of the residents’ survey indicated that they sometimes liked the food. On the day of the inspection residents spoken to made positive comments about the food provided and that a choice was offered. The availability of choice of menu was also seen during the visit to the kitchen where menu records were seen. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 18 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. Residents are listened to and are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A recommendation was made following the key inspection of November 2006 for information about how to make a complaint should be provided to each service user and their representative. A copy of this information was seen in one of the resident’s rooms that was visited. Residents spoken to said that they knew who to go to if they were unhappy about something or wished to make a complaint. 58.3 of respondents of the residents’ survey stated that they always knew who to speak to if they were unhappy; 33.3 of respondents of the residents’ survey stated that they usually knew who to speak to if they were unhappy; 8.4 of respondents of the residents’ survey stated that they sometimes knew who to speak to if they were unhappy. 92 of respondents of the residents’ survey stated that they always knew how to make a complaint; 7.7 of Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 19 respondents of the residents’ survey stated that they usually knew how to make a complaint. In January 2007 the home was subject to an investigation carried out under the local reporting procedures for the protection of vulnerable adults (POVA). The home demonstrated co-operation with other agencies during this investigation. Allegations of physical neglect of a resident were not proven. The home has demonstrated to the Commission for Social Care Inspection a clear understanding of what procedures to follow after any concerns, complaints and allegations of abuse have been made. Examination of the complaints record was seen. The home has received 2 written complaints in the last twelve months and the responses to these complaints were seen and these were satisfactory. Staff and information provided by the manager before the inspection indicated that staff have attended training in POVA. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 20 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 good. Residents live in a comfortable, well-maintained and clean home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was made and findings indicated that the home is well maintained with comfortable furniture and a good standard of decoration. Information provided by the manager before the inspection notes that staff have attended training in infection control. 78.5 of respondents of the residents’ survey stated that the home was always clean and fresh; 21.5 of respondents of the residents’ survey stated Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 21 that the home was usually clean and fresh. A respondent of the relatives’/visitors’ comment cards said that, “Cleanliness of the home is excellent”. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 22 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 poor. Residents receive care from staff that although are adequately trained and adequately recruited are not always competent in carrying out their work thus putting residents’ health, welfare and safety at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the random inspection of 3rd January 2007 information provided by staff, and confirmed by documentation (of which copies have been taken) that staff had reported the shortage of staff to Four Seasons Health Care Limited. One of these records notes that the a request for agency staff on 21 December 2006 had been refused by the Company. Staff reported that the reason given for this refusal was based on financial cost. There were two other records noting that there was an insufficient number of staff on duty. As a result of this evidence a requirement was made. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 23 During this inspection, of 3rd April 2007, it was noted by discussion with the manager, observation of staff and examination of the duty rosters that the home is allowed to use agency staff to cover staff absences. A relative, via telephone conversation with the Inspector, confirmed that staffing numbers had increased following the random unannounced inspection of 3rd January 2007. A recommendation was made following the key inspection of November 2006 for staff to meet the needs of residents in a timely manner. 21.5 of respondents of the residents’ survey said that staff were always available when the resident needed them; 78.5 of respondents of the residents’ survey said that staff were usually available. 46 of respondents of the relatives’/visitors’ comment cards said that in their opinion there was always a sufficient number of staff on duty; 54 of respondents of the relatives’/visitors’ comment cards said that in their opinion there was not a sufficient number of staff on duty. At the time of the inspection residents were provided care by staff in an unhurried manner including during the busy lunch time period. This recommendation has been considered. The duty roster that was examined did not always include the full name of agency staff and a recommendation has been made as a result of this finding. A requirement was made following the key inspection of November 2006 for staff to be competent in their work. This was related to the running of the home by nurses when the home manager was not on duty. During this inspection the manager expressed concerns that when not at the care home staff consult her via telephone, even when she is on leave. Examination of care notes of a resident assessed to be at risk of pressure sores were examined. The care notes for 17th March to 21st March 2007 recorded that the resident’s skin was intact. A care plan of 20th March 2007 for this resident indicated that the resident had acquired a grade 2 pressure sore (see also standard 8 of this inspection report). The requirement for staff to be competent in the work that they do has not been met and has been carried forward with a new timescale for action. A recommendation was made following the key inspection of November 2006 for the home to have 50 of care staff, or above 50 , to have NVQ level 2 qualification in care. Information provided by the manger before the inspection notes that 44 of care staff currently working at the home have this qualification or equivalent. This recommendation remains. According to the manager she has submitted names of care staff for Four Seasons Health Care Limited to consider placing on training for this desired qualification in care. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 24 Two staff files were examined to assess the standard of recruitment practices. The majority of information was available with the exception of the following: 1) There was no photograph on one of the files. 2) There were no copies of their qualifications and no copies of their training on one of the files. 3) On one of the two files there was an unexplained gap in employment history between November 1984 and May 1986. A requirement has been made about these findings. Information provided by the manager before the inspection notes that staff have attended training in pressure care prevention and management, diabetes and medication handling and administration. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is adequate. 31,32,33,34 & 38 Residents live in a home that is adequately managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager is an RGN and was appointed to her current position in April 2006. A recommendation was made following both key inspections for 2006 for the home to be managed by a registered manager with the registered managers award, or equivalent. No complete application to register the manager has yet been received by the Commission and as such this recommendation remains. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 26 Both staff and residents reported respectively that the home is a friendly place to work and to live in and that the manager of the home is approachable and will act on what people say to her. 100 of respondents of the residents’ survey stated that they always felt staff listened to them and acted on what the resident said to the staff. A recommendation was made following the key inspection of November 2006 for the home to demonstrate that residents had been consulted about their views of the home. Four Seasons Health Care Limited in October 2006 carried out a survey. The survey sought the views of residents and the results of this survey were seen at the time of the inspection. This recommendation has been considered. Copies of the regulation 26 visits made by a representative of Four Seasons Health Care Limited were seen and these were reports of monthly visits. These visits included seeking views of residents and their guests and audits of care records and the standard of cleanliness of the home. Three residents’ monies, kept for safe keeping by the home, and associated records were examined and balances of their monies reconciled with the associated records. A recommendation was made to improve recording methods of staff who attend fire drill training. This improvement was to include the names of staff who had attended such training. The record of the fire drills that had been carried out was seen and this included the names of people attending this training exercise. This recommendation has been considered. Information provided by the manager before the inspection notes that staff have attended training in fire awareness, moving and handling, basic food hygiene and health and safety matters. Records for checks on temperatures of hot water, fire alarms, PAT checks, emergency lighting and accidents occurring in the home were seen and these were satisfactory. Records of temperatures of fridges and freezers were examined during the visit to the kitchen and these records were also satisfactory. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 27 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 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 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 3 x x x x x x 3 STAFFING Standard No Score 27 1 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 x 3 x x 3 Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15(1) Requirement The Registered Person must ensure the care plan provides clear guidance for care staff in how to meet the assessed health and social care needs of the service user. This requirement has not been met by timescales of 05/06/06 and 04/01/07. This requirement has been carried forward with new timescale for action. 2. OP8 12(1)(a) The Registered Person must ensure that service users’ health and welfare is provided for at all times with particular regard to prevention of pressure sore development. The Registered Person must ensure that personal care is provided with particular regard to hair washing. The Registered Person must DS0000024309.V331269.R01.S.doc Timescale for action 04/05/07 04/05/07 3. OP8 12(1)(a) 04/05/07 4. OP9 17(1)(a) 04/05/07 Version 5.2 Page 29 Swan House ensure that medication records clearly indicate the date on which medicines are administered. 5. OP9 13(2) The Registered Person must ensure that the records of medicines controlled under the Misuse of Drugs Act 1971 are accurate. The Registered Person must ensure that staff are competent to carry out their work that they do with particular regard to management of the home and care of service users’ health and welfare needs. The Registered Person must ensure that full and satisfactory information about staff is obtained and kept in the care home. 04/05/07 6. OP27 18(1) 04/05/07 7. OP29 19 04/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP27 OP28 Good Practice Recommendations The Registered Person should consider ways to improve the current method of recording the names of staff on the duty roster. The Registered Person should consider ways for the home to have 50 of care staff, or above 50 , to have NVQ level 2 qualification in care. 3. OP31 The home should be managed by a registered manager with the registered managers award, or equivalent. Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 30 Swan House DS0000024309.V331269.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office 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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