Inspection on 30/10/08 for Swan House

This inspection was carried out on 30th October 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 06/11/07

Swan House 13/04/06

Swan House 06/01/06

Swan House 10/01/05

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Swan House High Street Winslow Bucks MK18 3DR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mike Murphy     Date: 3 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Swan House Winslow High Street Bucks MK18 3DR 01296711400 01296711450 SwanHse@heritagecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Denise Curtis Type of registration: Number of places registered: Heritage Care care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Swan House is a care home registered to provide care and accommodation for up to thirty-two service users, sixteen of whom have a diagnosis of dementia. The home is administrated by Heritage Care and is situated in the market town of Winslow in Buckinghamshire. Separately constructed on the same development, as Swan House is Swan Court, a facility for service users who do not require conventional residential care and support but who require a little support to remain independent in their own homes. Swan Court is separately managed to Swan House and the only common denominators between the two buildings being that they share the same provider, garden and that one of the night staff based at Swan House supports Swan Court for some of the night. Swan House is constructed over two storeys and service users live Care Homes for Older People Page 4 of 31 Over 65 0 32 0 32 0 32 Brief description of the care home on one of two groups, depending on their specific needs. Both groups are fitted with communal lounges and kitchen/diners. Service users benefit from single room accommodation and these are fitted with en-suite facilities that consist of a walk in shower, toilet and hand washbasin. The home is within a short walk of the high street and there is relatively easy access to the towns of Bletchley, Aylesbury and Buckingham. The manager of Swan House has been in post since June 2004. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was carried out by one inspector in October 2008. The inspection process included consideration of information provided by the registered manager in advance of the inspection visit, a visit to the home, examination of records (including care plans), discussion with people living in the home and with staff and managers, a walk around the home and garden, observation of practice, and consideration of the results of a CSCI stakeholder survey carried out as part of this inspection. Fees at the time of this inspection ranged from 443.17 to 544.11 pounds per week. Care Homes for Older People Page 6 of 31 Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Establish a programme of redecoration to ensure that standards of the material environment are maintained. Acquire current editions of key texts on medicines for staff reference. Care Homes for Older People Page 8 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering using this service can be assured that a good assessment of needs will be carried out prior to admission to ensure that the home will be able to meet those needs. Evidence: All admissions to the home are arranged through Buckinghamshire Social Services. The referral information includes a copy of the community service order and a care plan based on the prospective residents needs which has been drawn up by a social worker. Recipt of this information at the home triggers an assessment by the home. The assessment is conducted by two members of staff - the manager or deputy manager and a care team leader. The assessment is carried out in the persons current place of residence and is structured by Heritage Care documentation. On conclusion of the assessment a Care Homes for Older People Page 11 of 31 Evidence: decision is made on whether the home can meet the persons needs. If it is can then a place is offered. The prospective resident or a member of their family may visit the home prior to admission and view its facilities and meet staff. If the offer of a place is accepted then the person is initially offered a trial admission of four weeks. At the end of the four week period a review meeting is held. This involves the person and their family, the care manager and staff from the home. If all parties are satisfied then a permanent place is offered to the person. The home has had six admissions since the last inspection. Examination of care documents showed that a good pre-admission assessment of needs had been carried out and that the staff involved had liaised appropriately with the referring social services department. Files included relevant information from social services. The home does not offer intermediate care therefore standard 6 does not apply. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have their assessed care needs met to a good standard, are treated with courtesy by staff, can be assured that the home will liaise with external health and social care agencies on their behalf as required, and that their right to privacy is upheld. The homes arrangements for dealing with medicines ensures that they are appropriately stored and are administered in line with the prescribers instructions and the persons needs. Evidence: A care plan is in place for each person living in the home. Each person has a key worker who is responsible for co-ordinating their care arrangements. The role of the keyworker is outlined in policy and procedure documents. The care plans and other care documents of four people were examined during the course of the inspection visit. Care plans were maintained to a good standard. Care Care Homes for Older People Page 13 of 31 Evidence: plans are comprehensive and detailed. They include a photograph of the person, a dependency score, a day care plan in which the essential aspects of the persons are are outlined, risk assessments, communications with other agencies - mainly health professionals in the care plans examined, missing person information, charts for recording the outcome of assessments, and monthly reviews. Daily care plans included information on: mobility, food preferences, daily routine, oral hygiene, the level of support required in personal care, allergies, weight, particular aspects of care (such as the management of an infectious condition), and medication. Some aspects were emphasised in red ink. Risk assessments included: manual handling, use of a wheelchair, going out of the building, cross infection, falls, and malnutrition (in one case a MUST (malnutrition universal screening tool) assessment was well completed). Care plans included evidence of communications with chiropodists, optician, dieticians, dentist, NHS hospital services, GPs, and district nurses. Care plans support the planning, organisation and provision of good care. However, the present system of care planning in Heritage Care, while comprehensive, is complex and has a more problem centred than person centred orientation. There was evidence that staff had tried to achieve a balance between these two aspects of care for example life plans, preferences for daily care, and records of the persons wish to continue involvement in a social activity which they had enjoyed before admission (such as going to the pub).This is particularly important in services for people with dementia. The organisation was addressing this - in part through its training programme for staff working with people with dementia but also through its plans to introduce new care records in 2009. It is expected that these will support a more person centred approach to care planning and recording. One indication of change in this respect might be the inclusion of more references to psychosocial aspects of care in daily notes. The daily notes examined during this inspection were relatively brief and focussed mainly on physical aspects of care. However, having said that, observation of interaction between staff and residents raised no significant concerns about the care of people with dementia living in this home. Staff and residents seemed comfortable together. On the odd occasion where there was potential for conflict staff handled the situation quietly and effectively. One particularly effective intervention was noted around lunchtime where one resident showed acute distress and appeared in pain. A staff member went over to the person and over a period of five minutes or so, through a Care Homes for Older People Page 14 of 31 Evidence: process of positive attention and reassurance, eased the persons anxiety and distress to a point where the person was calm, ceased to display any sense of pain, and was able to communicate more freely with the member of staff. A model example of good care. Medicines are prescribed by the persons GP. All residents are registered with one GP practice in Winslow. Residents may be seen in the home or may go to the surgery if they prefer and are able to. Medicines are dispensed either by Boots Chemists using its MDS (Monitored Dosage System) or Lloyds pharmacy. The administration of medicines is governed by Heritage Care policy. Staff competence in the administration of medicines is achieved through in-house training, supervised practice, and assessment of competence of competence by senior and experienced staff. An update is carried out annually and records are maintained on individual portfolios (not examined on this inspection). Each medince file included a photograph of the resident, a risk assessment, notes on as required (PRN) medicines prescribed by the GP, a protocol for some medicines if required, and the medicines administration record (MAR chart). Medicines requiring cool storage are stored in a lockable metal box in the fridge. The home did not have any person receiving medicines by covert means (i.e. disguised in food and given without the persons consent) at the time of this inspection. Examination of some MAR charts indicated that practice is satisfactory. Arrangements for storage of medicines in the home and for returns of medicines to pharmacy were considered satisfactory. Texts on medicines for staff reference were out of date and the home should acquire up to date references. It is suggested that these include CSCI guidance on the administration of medicines in care homes, the current guidance on medicines in social care published in 2007 by the Royal Pharmaceutical Society of Great Britain, and a good up to date general textbook on medicines (a suggestion was made during the course of the inspection). No concerns were noted with regard to the maintenance of peoples privacy and dignity. Residents were treated with courtesy. Personal care was given in the residents own bedroom. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported in keeping in contact with family and friends and have access to a varied range of activities. Meals are varied and nutritious Evidence: The interests of people living in the home are recorded in the Life History section of their care plan. This may indicate interests which they would still wish to pursue while living in the home. Residents are supported in maintaining contact with family and friends. The home is in convenient location for residents to enjoy the shops and other amenities of Winslow town centre. Managers were introducing personal photo albums for each person on the Windrush (dementia care) area. Two examples were seen during the inspection. Since individual responses to such images can vary this was being developed carefully with the person and their family to avoid causing distress to the person. The activities organiser works 25 hours a week plus additional hours on occasions. The Care Homes for Older People Page 16 of 31 Evidence: activities organiser divides her time equally between the two residential units which allows 12.5 hours for each unit per week. Around the time of this inspection towards the end of October 2008 the organiser and other staff were making preparations for a Halloween party the day after the inspection visit. The organiser was also planning events around Christmas including a pantomime and schoolchildren visiting the to sing carols. The home has shared use of a vehicle with another home in Aylesbury. Outings over the summer have included shopping trips to Milton Keynes Centre, trips along the river in Buckingham, pub lunches, Woburn Garden Centre and other garden centres. The programme of activities around the time of this inspection included: Hand Massage and Nail Care, Singing and Dancing to Music, Gift Group, Reminiscing with Music, Shop and Photo Reminiscing, Painting and Drawing, Baking, Making Christmas Cards, Dominoes, Card Games, Collage, and Films. Holy Communion is available monthly. As well as organised activities the manager is keen to increase the amount of individual activities: in particular to develop more individual activities for people with dementia. It is felt that these are taking place already but are not always recognised as activity, or, the therapeutic potential of such everyday encounters is not always recognised. The training programme Yesterday, Today and Tomorrow (see elsewhere in this report) is said to address this and both the activities organiser and care staff attend this programme and it is expected that this will be developed further in the new year. Meals are prepared in the kitchen and are supplemented by snacks which may be prepared by care staff in the kitchenettes. Breakfast includes: fruit juice, fruit, yoghurt, cereals, a cooked option if wished, bread or toast with preserves, and hot drinks. Lunch is the main meal of the day and is served around 12:45 pm. Menus operate on a rotating seasonal and weekly basis. Lunch is a two course meal consisting of a main course with vegetables followed by dessert. A roast meat based dish is always served on Sundays and a fish based dish on Fridays. Tea (Supper) is served around 5:30 pm and consists of a savoury snack (such as Smoked Haddock, Cornish Pasties and Macaroni Cheese), sandwiches, or soup and rolls. An alternate dinner choice menu is always available and includes Shephers Pie, Sausages, Salads or Jacket potatoes. The menu states If you have any special request, please ask a member of staff and we will do our best for you. Lunch was taken with residents during the inspection visit and was a pleasant event. The food was well cooked, quantities were adequate and it was well served. Water and fruit cordial were available to drink. Residents generally expressed satisfaction with the Care Homes for Older People Page 17 of 31 Evidence: food in the home although one person did say that the vegetarian choice can be limited. This observation was discussed with the deputy manager and staff during the course of the afternoon. Staff provided support to residents as required. Residents on Windrush needed more support than those on Dove and this led to a significant increase in demand on staff time over the lunch period. A chef in another home has a lead responsibility for nutritional standards across all the Heritage Care homes in Buckinghamshire and is in touch with this home. Nutritional assessments were noted in care plans. Referrals to dieticians are made where necessary. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns raised by residents, or by others on their behalf, are properly investigated and appropriate action is taken by managers. There are good and comprehensive arrangemenst in place to safeguard people living in the home from abuse. Evidence: There is a notice regarding suggestions, complaints and compliments in the lobby. A pack in each persons room includes information on the home, the service users charter, information on Action for Elder Abuse, an NCSC (the organisation prior to CSCI) leaflet on Right to Care, and a copy of the homes comment and complaints policy and procedure. Contact details on Action for Elder Abuse are on display around the home and the deputy manager said that people can be put in contact with an advocate from Age Concern if they wish. Two complaints were recorded since the last inspection. Both were promptly dealt with and upheld. It was noted that two record books were in use for recording complaints one a straightforward hard bound notebook and the other a form devised by Heritage Care. This may lead to weaknesses in recording, and innacuracy in reporting Care Homes for Older People Page 19 of 31 Evidence: complaints. It was agreed that only one book will be used hereon. CSCI has not received any complaints about this service since the last inspection. The organisation has a policy on Safeguarding Vulnerable Adults. Neither the current Buckinghamshire policy or Heritage Cares own policy on the subject were readily accessible at the time of the inspection visit. However, the deputy manager did download a copy of the current Buckinghamshire policy (March 2007) and of two relevant Heritage Care documents (both dated September 2008) before the inspection visit was completed. Managers undertook to ensure that relevant information will be made more accessible to staff. It is clear that the home takes this subject seriously since, as stated above, information on Action on Elder Abuse was on display at various points around the home and a leaflet on reporting abuse in Buckinghamshire was available in the lobby. All staff have received training on safeguarding adults (listed under its previous title as POVA or Adult Protection POVA on training records). Staff spoken to during the course of the visit were aware of the subject and of reporting arrangements within the organisation. The homes training programme on dementia includes training on responding to challenging behaviour. There are good procedures in place for dealing with residents money (summarised elsewhere in this report). Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, pleasant and comfortable environment for people living there. Evidence: The home is located close to the centre of Winslow within walking distance of the amenities of the town. Buses serve the town but are said to be infrequent. The nearest rail stations are Aylesbury (approx 10 miles) and Milton Keynes (approx 12 miles). The home is situated in a quiet close just off the High Street. There is parking to the front of the home and in nearby streets. Entry is controlled by staff. The home has 32 bedrooms on two floors. All rooms are en-suite (WC, handbasin and shower). The ground floor (Windrush) has 16 places for people with dementia, staff administrative offices, hairdressing room, a store room for medicines, and the kitchen. The first floor (Dove) has 16 places for ongoing care and the laundry.Stairs and a passenger lift provide access between the two floors. Entry to each of the residential areas is by a coded key pad. Each area has 16 bedrooms, 1 assisted bathroom, 1 dining room , kitchenette, living room, WCs and a staff area. All areas visited on the inspection visit were tidy, clean and free of Care Homes for Older People Page 21 of 31 Evidence: untoward odours. Bedrooms were of a comfortable size and had been personalised by the resident. There is a small sitting area on the ground floor. This leads on to the garden to the rear of the building. The garden is located between the home and an adjacent supported living complex which is also managed by Heritage Care. It is a medium sized area comprised of a patio with seating, a lawn, mature shrubs, and further seating. The laundry includes two washing machines, two tumble dryers, a sink and storage space. It was tidy and clean when inspected. The kitchen was inspected in the afternoon and was found to be in good order, tidy and very clean. While the home was clean and tidy it was beginning to show its age and some areas in particular would benefit from redecoration. The deputy manager said that new furniture had been purchased for both dining rooms and that there are plans for further furniture to be replaced and for some corridor areas to be redecorated over the next year. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home generally provides sufficient numbers of staff with the knowledge and skills required to provide care and support to the people living there. Procedures for the recruitment of new staff ensure that staff unsuited to work with vulnerable people are not appointed to posts in the home. Evidence: The present staff establishment for the home provides for three care staff in the morning and afternoon on Windrush, and two care staff in the morning and afternoon on Dove. There is one care team leader and three care staff covering both areas at night. These figures exclude the manager and deputy manager. In addition to care staff the home employs housekeepers, laundry assistants, cooks and a kitchen assistant, a part-time activities organiser, and two part-time administrative staff. One professional respondent to the CSCI survey expressed a need for Improved staffing levels.... The home is supported in the recruitment of new staff by a Human Resources (HR) department which is based in another Heritage Care Home in Buckinghamshire. The HR department collate and distribute job packs to enquirers, it processes applications, collates information relating to candidates for interview by managers, and prepares Care Homes for Older People Page 23 of 31 Evidence: papers for staff appointed to posts in the home. At the time of this inspection the home had ten staff awaiting clearance to take up post. That would leave around three full-time equivalent posts to fill (to be made up of five or six part-time posts). Four staff have been appointed since the last inspection. Staff files have been reorganised and were found to be in very good order. Four files were examined and all were found to contain all of the information required under Schedule 2 (recent photograph, two references, completed application forms, trackable employment history, Enhanced CRB certificates obtained before taking up employment, note on fitness for the post plus other information). All care staff have an individual portfolio containing a record of their induction, training record, supervision notes, the outcome of any assessments (such as the Boots and inhouse medication assessments), and copies of certificates. Staff training is organised by the organisations training department based at its head office in Loughton, Essex. At the time of this inspection 60 of care staff had acquired NVQ at level 2 or above. A major training initiative is an eight session course on the care of people with dementia - Yesterday, Today and Tomorrow. All care staff were required to attend this training and managers said that it was already having a positive impact on the care of people living in Windrush. A schedule of other training events attended by staff was provided for this inspection. This included Manual Handling, Fire Safety, Food Hygiene, First Aid, Emergency Aid, Medication, SOVA, Adult Protection POVA, Induction, Personal Care and Infection Control, Risk Assessment/COSHH/HACCUP, Challenging Behaviour, Health and Safety, and Mouth Care. In the AQAA (Annual Quality Assurance Assessment) submitted before the inspection visit the registered manager stated that she would like to see training on relevant conditions such as Parkinsons Disease and Diabetes and developments in end of life care. Staff respondents to the CSCI survey generally expressed satisfaction with their work, indicated that managers are supportive, that there is an appropriate focus on the needs of people living there, and that action to improve the quality of the service is ongoing. One staff respondent expressed a need for more staff to be trained in the administration of medicines in order to relieve pressure on the role of the DRP (Designated Responsible Person) at times. Another expressed concern at a decline in the role of keyworkers in recent years but also indicated that corrective action was now being to taken to improve matters. Respondents confirmed that managers hold regular staff meetings and that supervision is well established. Care Homes for Older People Page 24 of 31 Evidence: One staff respondent wrote Although we meet CSCI staffing levels it would be lovely to have more staff to spend individual/special time with each resident rather than feeling rushed. This lack of time is worse on the house keepers day off as you have her work to do as well. CSCI do not set staffing levels - these are a matter for the managers of the organisation and those with whom it has contracts (in this case local authority commissioners of services) in the context of standard 27. The point is accepted however and is supported by a professional respondent who also felt that Improved staffing levels.... would be desirable. Staffing levels need to be regularly reviewed by managers in line with the changing needs of people living in the home. Staff acknowledged the opportunities for training and the benefits for users of the service of being cared for by better trained and qualified staff. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This is a well managed service which is responsive to the views of residents and others and which provides its residents with a safe, supportive and stimulating place to live. Evidence: The registered (the manager) manager has managed the home for over eight years. The manager has extensive experience in care services for older people and has acquired the NVQ4 in Care and the Registered Managers Award (RMA). The deputy manager is also experienced in care services for older people and has acquired the NVQ4 in Care and RMA. The registered manager is accountable to the area manager. The staffing of the home includes a number of care team leaders, a senior care worker, care workers, and a number of support staff. Regulation 26 visits are carried out by senior managers, notes are made and held on Care Homes for Older People Page 26 of 31 Evidence: file for reference and inspection. The home is required to conduct a care pathway audit during the course of this year (April 08 to March 09) This had not yet been carried out by the time of this inspection but was expected to be completed by the end of March 2009. There were no plans for a wider stakeholder audit. A staff questionnaire had been circulated in October 2008 but the results were not yet available for this inspection. Comments on the home by health and social care professionals in the CSCI survey carried out in connection with this inspection were positive. Comments included: I have always found staff to be well informed, helpful and responsive to queries. Also they are always very attentive to the individual needs of the residents. Very well facilitated reviews. The manager and her staff run a happy, safe and client orientated home. Family members are encouraged to take part in the planning of their loved ones care. I have never been disappointed with the care of any clients I have placed at Swan House. Swan House always tries to meet individual needs. It is very person centred in its approach to care and strives to continually improve its service. ..the atmosphere is pleasant and residents appear content and well looked afetr. Staff who have been there for a while are very helpful to residents... Residents appear happy on my visits. One respondent felt that the staff dress code was not always appropriate to that kind of care setting. Copies of policies and procedures were said to be available on each of the residential units and via the organisations intranet. These are drawn up at Heritage Care head office in Loughton, Essex. Arrangements for dealing with residents monies are subject to the policies and procedures of Heritage Care and are mainly dealt with by administrative staff. An individual account is opened for each person. A safe is available for secure storage. All transactions are recorded and records are checked on Regulation 26 visits by area managers. The system was outlined on this inspection visit by the deputy manager. Records were examined and appeared to be in good order. Individual supervision of care staff is carried out in line with the policy of the organisation and a list is on display in the managers office. The manager and deputy manager supervise care team leaders and administrative staff and care team leaders supervise care staff. Meetings are held every two months but may take place more often if necessary. Notes of sessions are taken and retained in individual staff files. All staff receive an appraisal once a year. Care Homes for Older People Page 27 of 31 Evidence: Arrangements for maintaining safe working practices appear satisfactory. All care staff receive training at induction, basic and update levels in manual handling, fire safety, food hygiene and first aid (one day for care workers, four days for managers and care team leaders). The training summary did not include dates of training on infection control but the deputy manager said that such training was provided by a Heritage Care trainer. A fire risk assessment was completed in May 2008. Fire drills took place in May and October 2008. Staff attended a CD-ROM based fire training update in June 2008 and another session was planned for December 2008. Fire exits are checked daily. Fire equipment is checked weekly. Contracts are in place for the maintenance of fire safety equipment including alarms and emergency lighting). A fire safety inspection was carried out by the fire authority in January 2008. The single recommendation was to repair a push bar bracket on a fire door which had been damaged. The deputy manager said that the repair was promptly carried out. Gas appliances were checked in September 2007 and were due to be checked again aroud the time of this inspection. Fixed electrical wiring was checked in April 2008 and testing of portable electrical appliances (PAT testing) was carried out in August 2008. There are polices and procedures for dealing with COSHH materials and no concerns were raised during the course of this inspection. The kitchen was inspected by an environmental health officer in April and it is noted that in their report the officer noted a Very good standard of housekeeping in the kitchen. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 The Registered Persons should ensure that staff have access to appropriate and up to date reference texts on medicines and medicines administration in social care services. The registered persons should ensure that both the organisations own policies and guidance and those of relevant statutory authorities on safeguarding adults are readily accessible to staff. The registered persons should ensure that a programme of redecoration and refurbishment is maintained in order to maintain a pleasant environment for residents. 2 18 3 19 Care Homes for Older People Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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