Inspection on 06/11/07 for Swan House

This inspection was carried out on 6th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 20/05/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Swan House 47 - 49 New Road Chatteris Cambridgeshire PE16 6EX Lead Inspector Elaine Boismier Unannounced Inspection 6th November 2007 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.V354307.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.V354307.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.V354307.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 3rd April 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 £343.40 to £620 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. A vacancy has arisen for a registered manager. Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This summary includes information about events that have happened since the last key inspection of Swan House on the 3rd April 2007 and up to this key unannounced inspection of the 6th November 2007. Statutory Requirement Notice-11th April 2007 Following the key unannounced inspection of the 3rd April 2007 we served a statutory requirement notice, dated 11th April 2007, as care plans were not adequate in telling staff how to care properly for people who lived at the home. Random Unannounced Inspection-14th May 2007 On the 14th May 2007 we carried out a random unannounced inspection to assess if the statutory requirement notice of the 11th April 2007 had been complied with. We found evidence that compliance had not been achieved. As a result of this finding we took copies of relevant documentation away with us. Meeting-21st June 2007 On the 21st June 2007 we met with representatives of Four Seasons Health Care Limited. The purpose of this meeting was to share our concerns about the safety of people living at Swan House. This meeting provided also the opportunity to show how the statutory requirement notice of the 11th April 2007 had not been complied with. We received no objection to our findings from Four Seasons Health Care Limited. Protection of Vulnerable Adults (POVA)/Safeguarding Adults-25th June 2007 On the 25th June 2007 we attended a meeting held under the POVA procedures (now referred to as safeguarding adults). This meeting was held following allegations of poor care practices. It was established that the home had failed to alert the Lead Practitioner of the local safeguarding team in the first instance. Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 6 At the meeting all parties that were present shared an overall high level of concern about the safety of people living at Swan House. Random Unannounced Inspection-13th July 2007 On the 13th July 2007 we carried out a random unannounced inspection. The purpose of this inspection was three-fold: 1) To assess the progress made with regards to the statutory requirement notice of the 11th April 2007. 2) To assess if people’s health and welfare was safe with regards to health and personal care. 3) To assess medication practices. Our findings led us to believe there remained non-compliance with the statutory requirement notice of the 11th April 2007. We took copies of care records away with us. We considered that a requirement had been met as we saw that people’s hair was clean. However we noted that people at risk of pressure sores had not received appropriate care. Two of the eight current (nursing) residents had acquired pressure sores since our inspection of the 3rd April 2007. As a result of our findings we considered that a requirement that had been made following the inspection in April 2007 had not been met. Medication practices were assessed. A new requirement was made, as people had not been given medication as prescribed. It was also found that two other requirements had not been met and copies of medication records were taken away with us. Statutory Requirement Notice-18th July 2007 Following the random unannounced inspection of the 13th July 2007, a statutory requirement notice, dated 18th July 2007, was served due to unsafe medication practices. Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 7 Random Unannounced Inspection-13th August 2007 On the 13th August 2007 we carried out a random unannounced inspection to assess if compliance had been achieved with regards to the statutory requirement notice dated the 13th July 2007. We found that this notice had not been complied with and we took copies of medication records away with us. No new admissions We were informed by representatives of Four Seasons Health Care Limited, during the meeting of 21st June 2007, that they felt that, until the standards of care had improved, they would not admit any new person to the home. We wrote to the Company on 14th August 2007 asking for formal confirmation about this action taken (not to admit any new person to live at Swan House). In our letter we also asked what would make the Company decide to start admitting any new person to the home. The reason for our last question was for us to be reassured that any new admission to the home would not pose any risk to the existing residents. We received a written response to our letter of the 14th August 2007 from Four Seasons Health Care Limited. The letter stated that until the standard of care provided was assessed to be at least adequate, there would be no new admissions to the home. Key Unannounced Inspection We, the Commission for Social Care Inspection, carried out this key unannounced inspection of 6th November 2007, by three Inspectors, between 10:00 and 14:30. Before the inspection we sent out 30 surveys to residents and 15 surveys to relatives and visitors. We received no surveys from residents but received 7 surveys from relatives. We received also a letter from a relative. At the time of the inspection there were 18 people living at Swan House. We spoke with people, visitors, staff, including the Home Manager and Regional Manager, looked at documentation, observed staff working and carried out a tour of the premises. Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 8 We have assessed that Swan House has improved from a poor quality service to that of an adequate quality service. We expect improvements, that have been made, to be sustained. We expect also that should further improvements be made these improvements are made as a result of the management of the home, by Four Seasons Health Care Limited, rather than any reliance on inspection and regulation activity carried out by us. For the purpose of this report people living at Swan House are referred to as “people”, “resident” or “service user”. The Home Manager and Regional Manager are referred to in this report as “the Management Team”. What the service does well: What has improved since the last inspection? There were 7 requirements made following previous inspections: A requirement was made, and subject to a statutory requirement notice, with regards to care plans. This requirement has been met. A requirement was made for people to receive proper care so that they would not develop pressure sores. This requirement has been met. Several requirements were made and were subject to a Statutory Requirement Notice concerning the storage, administration and recording of medicines. Apart from minor deficiencies seen on this inspection, the requirements have been met. A requirement was made for staff to be competent in their work. This requirement has been met. A requirement was made for full and satisfactory information to be obtained about staff before they started work at the home. This requirement has been met. Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 9 Two of the 3 recommendations have been considered since the last inspections: The home has more than 50 of care staff that have an NVQ level 2, or equivalent, in care. The duty roster provided the first initial and the complete surname, of care staff, including agency staff. Other improvements made include the following: An activities co-ordinator has been employed. Some areas have been provided with replacement floor covering. People told us that the home is a happier place to live and work in. What they could do better: The process of drawing up care plans, needs to be improved, to ensure that there is active consultation with residents, or if not possible, with their relatives. We expect the home to manage this issue, rather than we make a requirement on this occasion. We noted that there were some minor deficiencies in care plans such as target weights for people had not been recorded. We expect that this is managed by the home, rather than we make a requirement on this occasion. The care plan for one resident who has difficulties in swallowing made no mention of the method employed to ensure medication can be administered as prescribed and in a safe way. A requirement has been made about this. The process of offering people choice in when to get up out of bed, and any other choice of how they wish to live, must be improved upon. We expect the home to manage this issue, rather than we make a requirement on this occasion. Carpets in the corridors were grubby and stained. We expect the home to manage this issue, rather than we make a requirement on this occasion. A recommendation was made for the home to be managed by a registered manager, with the registered managers award. Although this recommendation will not appear in the recommendation table of this report, this recommendation remains. Three fire doors in the laundry area were held open by means not approved by the fire safety officer. Two doors were held open with the use of wooden wedges and one door was propped open by a container of fabric conditioner. As no other fire doors were held open in such an unsafe manner we have taken Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 10 the reasonable view for the home to manage this issue, rather than we make a requirement on this occasion. 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.V354307.R01.S.doc Version 5.2 Page 11 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.V354307.R01.S.doc Version 5.2 Page 12 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. 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: In June 2007, during a meeting, we were informed by representatives of Four Seasons Health Care Limited that the Company had made decision not to take in to the home any new residents and this was confirmed also in writing to us from the Company. The Management Team stated that when this decision would be reversed a full preadmission assessment of prospective residents would be done, to ensure that the home could meet the needs of the person. We reminded the Management Team of the current categories and conditions of registration for Swan House and that these should be considered during the preadmission assessments. Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 13 We will assess the home’s admission procedures at a later inspection, should new people have been admitted to the home. All the relatives’ surveys said there was information about the home to help the person make the decisions where the resident was to live. A letter from a relative confirmed this also to be the case. Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 14 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 adequate. People benefit from an improved standard of health care that could be improved upon further. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A statutory requirement notice, dated 11th April 2007, was served, as care plans did not provide sufficient guidance for staff in how to meet the assessed needs of people. We visited the home on 14th May 2007 to assess if there had been compliance with this notice. We believed that compliance had not been achieved and took copies of documentation away with us. On the 21st June 2007 we met with representatives of Four Seasons Health Care Limited. This meeting provided the opportunity to show how the statutory requirement notice of the 11th April 2007 had not been complied with. We received no objection to our findings from Four Seasons Health Care Limited. On the 13th July 2007 we carried out a random unannounced inspection. Our findings led us to believe there remained non-compliance with the statutory Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 15 requirement notice of the 11th April 2007. We took copies of care records away with us. During this inspection of 6th November 2007 we observed two people, who had complex nursing needs, and compared our observations with their care plans We considered that there had been improvement in the standard of record keeping and that the care plans accurately reflected the care that was provided. We noted that there were some minor deficiencies such as target weights for people were not recorded. We expect that this is managed by the home, rather than we make a requirement on this occasion. The care plan for one resident who has difficulties in swallowing made no mention of the method employed to ensure medication can be administered as prescribed and in a safe way. A requirement has been made about this. Following examination of care records and speaking with residents, consultation with people, or their representatives, might be patchy. We expect that this is managed by the home, rather than we make a requirement on this occasion. A requirement, following the key inspection of 3rd April 2007, was made, as the standard of care of people’s hair was poor. During the random inspection of 13th July 2007 we assessed this requirement had been met, as people’s hair was clean and tidy. During this random inspection of 13th July 2007, we noted that people at risk of pressure sores had not received appropriate care. Two of the eight current (nursing) residents had acquired pressure sores since our inspection of the 3rd April 2007. As a result of our findings we considered that a requirement that had been made following the inspection in April 2007 had not been met. During this inspection of 6th November 2007 we examined care records and spoke to staff. Evidence suggested that there was no person living at the home who had a pressure sore; there was evidence that any pressure sore that had been acquired had healed; staff were able to tell us what care should be provided to reduce the incidence of pressure sores and care records showed that staff were following the care plans to reduce the risk of pressure sore development. This requirement has been met. It was pleasing to see that the standard of care for a person, at risk of dehydration due to the amount of drink that they had been taking, had improved. Between 2:00 and 10:00 on the day of the inspection this person’s care records indicated that they had drunk 1000 mls of drink and this was in accordance with their care plan also. Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 16 Care records and discussion with staff including the Home Manager, indicated that there has been an improved consultation with specialist nurses for advice on diabetes and the treatment of pressure sores. All the relatives’ surveys informed us that the home met the needs of their relative who was living at the home. Practices and procedures for the safe storage, handling, administration and recording of medicines were examined by a specialist pharmacist inspector. Medication was stored securely for the protection of the service users. Medication cupboards and trolleys were clean and orderly with the keys being held by the care staff. It was disappointing to find that a medicine whose container clearly stated that it must not be refrigerated was stored in the fridge. The failure to store medicines at the proper temperature could result in residents receiving a treatment that is ineffective. This was, however, resolved during the inspection and staff must remain vigilant to ensure medicines are stored properly to make sure that they retain their quality and suitability for use. 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 of a good standard. Letters to the home from relatives were seen and these complimented staff. Visitors and people that we spoke with said that staff were good and we noted that staff spoke with people in a respectful manner. A relative’s survey said, “The staff always show respect and compassion towards my mother…” We saw that where people were receiving care, a notice was placed on the outside of the person’s door. This notice was to protect the privacy of the person against people entering their room during this private time. Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 17 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 are offered opportunities to live a good quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In October 2007 an activities co-ordinator was employed to work at Swan House. People and staff told us that Halloween and Bonfire Night was celebrated at the home to include decorations, fire works and seasonal food such as hot dogs and decorated cakes. Forthcoming entertainment and activities are announced in the home’s newsletter, The Trumpet, and copies of this newsletter were seen in people’s rooms. A resident informed us that they were anticipating a game of bingo in the afternoon. Another person told us that although activities were available they chose not to participate as they enjoyed being in their own room. We saw people receiving their guests and both care records and the visitors’ record book showed that people are able to receive their guests when then like. Five of the 7 relatives’ surveys said that the home always supports the resident in how to live the life that they choose. The remaining two surveys said that Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 18 this was not the case, although this was due to factors outside the control of the home. For example one of the surveys said, “Due to various reasons, health, incapacity etc., people cannot live the life they choose. However I believe the carers, nursing staff and all others attending my mother have her best interests foremost.” One person told us that they got up when staff came to them whereas another person told us that they got out of bed when it suited them. We expect the home to consider how people are offered choice of how to live, rather than we make it a requirement on this occasion. In one of the relatives’ surveys we were informed that the food was “good”. Another of these surveys informed us that the person considered that, “…the lunch menu could be improved. I find it repetitive and not always to my taste.” People that we spoke with told us that the food was good and that there was a choice of menu. Although we did not observe lunchtime, on this occasion, staff informed us that there were two hot options for lunch. We examined records of what people had eaten and there was a range and choice of food offered. Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 19 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 adequate. People are listened to and should be safer from the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We have received no complaints about the home since the key inspection of 3rd April 2007. The record of complaints was examined and the response to the complaint (about the standard of care and attitude of an agency worker) was satisfactory. The Management Team told us that there has been no other complaint received. Visitors to the home stated that they knew who to speak to if they had any concerns and that the response to their concerns they had been satisfied with. All the relatives’ surveys said that the person knew how to make a complaint and 5 of these surveys said that the home had always responded to the concerns raised; one of these surveys said that the home usually responded to the concerns raised. The remaining survey said that the person had not raised any concerns. On the 25th June 2007 we attended a meeting held under the POVA procedures (now referred to as safeguarding adults). This meeting was held following allegations of poor care practices. Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 20 It was established that the home had failed to alert the Lead Practitioner of the local safeguarding team in the first instance. Since this meeting we have not been informed of any further safeguarding alert and the Management Team confirmed that there has been no allegations of abuse made. As a result of this we are unable to assess if the understanding of what should be done, should any allegations of abuse be made, has become embedded in the management of the home. Staff and the Management Team stated that a number of staff have attended training in safeguarding procedures and further training has been arranged. Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 21 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 home that is well maintained that could be improved upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Approaching the home we saw that flowerbeds were tidy and free from weeds. During the tour of the premises we saw that some areas have been provided with replacement floor covering to meet the special continence needs of people. Tables in the downstairs dining room were pleasantly laid out with tablecloths and vases filled with ornamental flowers. We noted, although not reported on, that during the random inspections of May and July 2007, corridor carpets were unclean and grubby. During this inspection, of the 6th November 2007, we saw that although there had been some improvement in the standard of cleaning of these carpets, they remained Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 22 grubby looking. We expect the home to manage this issue rather than we make a requirement on this occasion. At the time of the inspection there were no offensive smells. Staff told us, and confirmed by the training records, that some staff have attended training in infection control. Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 23 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 receive proper care from staff who are well recruited, well trained and competent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement was made with regards to competencies of staff. This was in relation to managing the home when the Home Manager was not available and with regards to the standard of care provided. On entering the home the Home Manager was not on duty. We were satisfied, however, that the person in charge of the home was a permanent member of staff, had worked at Swan House for approximately 5 months and was aware of the procedure in contacting senior managers. During examination of a person’s care records we noted that in August 2007 staff had called the emergency services for a person. We considered that this was not the appropriate action to have been taken in the first instance. However we noted that since this event staff have taken appropriate action in treating a similar occurrence and thereby protecting the resident from further deterioration in their changing medical condition. Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 24 Examination of care records, including records of people’s weights, indicated that staff are making sense of the recordings and taken appropriate action in response to the findings. We saw, and recorded in this inspection report, that the outcomes of people living at Swan House, with regards to their health care, has improved, due to an improved level of competency of staff. The relatives’ surveys included such comments, “Staff are always friendly and helpful, staff are very caring.” One person thought that apart from the “odd agency staff” other staff had the right skills and qualifications to do the job. Four of the 7 relatives’ surveys said that staff always had the right skills and experience to look after people properly; the remaining 3 surveys said that staff usually had the skills and experience to look after people properly. This requirement has been met. Although Swan House has been subject to a number of increased inspections and scrutiny by the local authorities there is a number of staff who have remained loyal to the home and therefore people living there should feel reassured that they are cared for by people that they know. People were receiving care by staff in an unhurried manner and care was being carried out in a timely manner and according to care plans that we saw. A recommendation was made for the duty roster to be improved. Examination of the current duty roster included the initial and surname of care staff, including agency staff. This recommendation has been considered. A recommendation was made for the home to have 50 of care staff with NVQ level 2 or equivalent. Information provided by the Management Team indicated that six of the eleven care staff have this qualification i.e. 54.5 . This recommendation has been considered. A requirement was made for full and satisfactory information to be obtained about staff before they worked at the home. Examination of 2 most recently recruited staff was carried out and all information required was available. This requirement has been met. Examination of training records for staff induction, ongoing staff training and speaking to staff indicated that there has been an increase in training opportunities for staff that included care planning, treatment of pressure sores, infection control, customer care and leadership skills. Swan House DS0000024309.V354307.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): 31,32, 33,35,36 & 38 Quality in this outcome area is adequate. People benefit from a happier home, which could be safer. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A recommendation was made for the home to be managed by a registered a manager with the registered manager’s award. Since the inspection of 3rd April 2007 there has been a change of management arrangements of the home. Temporary arrangements were in place until the current Home Manager was appointed, as the permanent manager for Swan House, in October 2007. We were informed that the Home Manager has previous experience in working in and managing care homes and has the registered managers award. An application to register the Home Manager has yet to be received. This recommendation remains although will not appear in the recommendation table of this report. Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 26 A relative’s survey said that since there has been a change in management “(The Manager) takes time out of (their) busy day to see all the service users on a daily basis which no other manager at the home has done. The atmosphere is a happier one which is crucial for the well being of the service users and staff.” Another relative’s survey said that the home has “…a happy relaxed atmosphere for residents and visitors…” Staff and residents told us that they were happy respectively working at, and living in, Swan House. People that we spoke to were unable to say if they had been asked to complete a survey carried out by Four Seasons Health Care Limited. Minutes of the last 2 residents’ and relatives’ meetings were seen and these recorded information provided by the home to people and their guests and recorded comments also made by people and their guests. Copies of reports for September and October 2007 visits made by the Regional Manager to the home were examined. These were detailed reports of audits of the home environment, care records, staff training and speaking to staff and residents to ask for their views about Swan House. Minutes of a meeting for quality and clinical governance were seen and these recorded a number of quality assurance areas that were discussed. Two people’s balances of their personal allowances were examined and cross referenced with records of monies that had been paid into their individual accounts. These records were satisfactory. Records of staff supervision were seen and evidence suggests that this support and monitoring of staff has recently been implemented. A few staff have received their second supervision session. Two staff files that we examined indicated that the Home Manager had written to these members of staff requesting they arrange their supervision session with the Home Manager. Staff reported that they had attended training in first aid; fire safety, moving and handling training, fire drills and basic food hygiene and training records confirmed that this was the case. Records for fire alarm checks, emergency lighting checks, service checks on lifts and hoists, portable appliance tests and checks of temperatures of hot water were seen and these were satisfactory. During the tour of the laundry area three fire doors were held open by means not approved by the fire safety officer. Two doors were held open with the use of wooden wedges and the one door was propped open by a container of fabric conditioner. As no other fire doors were held open in such an unsafe manner we have taken the reasonable view for the home to manage this issue, rather than we make a requirement on this occasion. Swan House DS0000024309.V354307.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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 x 3 3 x 2 Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 13(2) 15 Requirement Where medication needs to be modified, e.g. crushed, before taking, residents must be protected by clear guidance in care plans to enable medication to be administered safely. Timescale for action 15/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Swan House DS0000024309.V354307.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Cambridgeshire and Peterborough Area 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.V354307.R01.S.doc Version 5.2 Page 30 - 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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