Inspection on 09/05/06 for Swan House

This inspection was carried out on 9th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 36 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Swan House 30/06/08

Swan House 28/08/07

Swan House 19/01/07

Swan House 21/02/06

Swan House 11/07/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Swan House 6 Newholmes Monyhull Hall Road Kings Norton Birmingham B30 3QF Lead Inspector Alison Ridge Unannounced Inspection 9th May 2006 09:50 Swan House DS0000062628.V293909.R01.S.doc Version 5.1 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 DS0000062628.V293909.R01.S.doc Version 5.1 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 Adults 18-65. 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 DS0000062628.V293909.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Swan House Address 6 Newholmes Monyhull Hall Road Kings Norton Birmingham B30 3QF 0121 444 2710 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) South Birmingham Primary Care Trust Family Housing Association Limited Care Home 6 Category(ies) of Learning disability (6), Physical disability (6), registration, with number Sensory impairment (6) of places Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That South Birmingham Primary Care Trust inform the CSCI of their intentions for the future management of the home by 31 May 2005. The home can accommodate six people with a learning disability under 65 years. The home can accommodate three named people over the age of 65 years 21st February 2006 Date of last inspection Brief Description of the Service: Swan House was purpose built as a care home, on the site of what was previously Monyhull Hospital. South Birmingham Primary Care (NHS) Trust manages the staff and the home, and Family Care Housing Association owns the premises. At present the home accommodates six men. The men all have a Learning Disability; some have impaired mobility, and some display behaviour’s that challenge. The accommodation comprises of six single bedrooms, a communal lounge, dining room, a w.c, supported bathroom, shower room, kitchen and laundry room. The home has a garden at the rear of the home, with garden furniture and shade. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken over one day. During the visit the inspector was pleased to meet all six of the men accommodated in the home, the staff on duty, a visitor, the acting manager, and two student nurses. This is a home that the CSCI has been, and remains concerned about. A large number of requirements made at previous inspections were unmet, and further visits to establish compliance in these areas will be undertaken. What the service does well: What has improved since the last inspection? The dining room, lounge and hallway had been redecorated. This work was urgently required, and the result is pleasing. The men, staff and visitors indicated that this was a big improvement. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 6 A new lounge suite had been purchased for the home, and this looked much nicer, and was comfortable to sit on. Feedback from the men accommodated was positive about this. Medication management had improved. The previously made requirements had been met, with the exception of one regards creams. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed at this inspection. EVIDENCE: The home has a stable service user group, and there are no residential vacancies. These standards were not assessed. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. Service users needs and risks are not well planned for. This could result in service users needs being unmet. It was evident service users are consulted regards activities they would like to undertake. Consultation and involvement in care planning was not evident. Service users records are stored securely and information about them is passed sensitively. EVIDENCE: One complete plan of care was assessed, along with two further plans that were tracked regards specific issues. At the last inspection in February 2006 staff had explored the commencement of new plans, which would better address service users needs, and which would be more person centred. To date these have not been commenced. The inspector could not establish that the current plans of care accurately reflect or underpin the known needs of service users. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 10 Evidence was sought regards how staff ensure service users wishes are incorporated into the plan of care. It was pleasing to see that involvement in the planning of activities had increased, but no changes regards service users involvement in care planning had occurred. Assessments of risk were in need of review and updating, to reflect the current needs and risks service users take. The risks posed to service users by other people accommodated had not been assessed. Risk assessments had not been re-visited after critical incidents. Records regards service users were all securely stored. Interactions between service users and staff were all observed to be respectful, and mindful of the person’s privacy. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Service users do have opportunity to undertake in house and community based activities. Service users are supported to stay in touch with friends and family. Service users are offered a nutritious and varied diet. EVIDENCE: The lifestyle of two service users were tracked, using the homes daily records, observation, and discussion as evidence. The inspector did not observe any opportunities provided during the inspection, or recorded in the daily planner for personal development, or learning. The opportunities for service users to access the community are now planned each week with service users. This is an area the inspector considers to have improved. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 12 One of the service users tracked had been supported to access the community four times in three weeks. One of these opportunities was a healthcare appointment. Three planned activities were cancelled due to lack of transport, or petty cash. Weekly planning must ensure these factors are taken into account. When at home the majority of records for this service user reported watching TV, and listening to music. Opportunities to access the community for the second person tracked were greater, (Nine activities in fourteen days). The service must be further developed to ensure there are adequate numbers of staff on duty to provide interesting and stimulating activities for service users, both in the home and community. The inspector was pleased to meet one relative during the inspection. They reported favourably regards the welcome they received at the home. Three comment cards were received from relatives. One identified the need to improve the dining furniture, and to ensure relatives are kept informed when service users are admitted to hospital. The menus provided, and records of food eaten showed a very varied diet is offered. The staff continue to prepare much of the food from fresh, and include plenty of vegetables and fruit. The inspector identified one service user who was overweight. There wasn’t a plan to help him reduce weight, and records of weight monitoring showed no reduction had been achieved. This area must be reviewed. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. Service users personal care needs are well met, and medication is administered as prescribed. Healthcare needs are not all well planned for or met. EVIDENCE: All six of the service users were supported to undertake personal care. All the men appeared very individual in style, and had been supported to undertake their personal care to a high standard. The healthcare needs of service users were tracked. It was evident that opportunities to see the dentist, optician, and GP were provided. The plan of care for one service user with epilepsy remained out of date re the persons current care needs. It remains of concern, that the service user is prescribed rescue medication which staff are not qualified to administer. One service user was noted to have disturbed sleep. The night plan of care did make reference to this, but did not make explicit the action to be taken to support the service user when awake in the night. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 14 Night records were being maintained. These had not been used to evaluate the effectiveness of the night care plan. The inspector tracked the action taken by staff in response to critical incidents such as falls, chest infections, and challenging behaviour. Plans of care and risk assessments had not been reviewed in light of these. The service users weight was tracked. One service user was noted to be overweight. A plan of care re weight reduction was not available, and it was of concern this person was slowly increasing in weight. Another service user at nutritional risk, who is underweight, was tracked. He had not been weighed with the required frequency, as stated by the dietician. Medication management had improved. The records of medication available, tallied with the FP10 prescription. Records of receipt and administration were all complete. Medicines not blister packed were being audited by staff, and were correct when checked during the inspection. PRN Protocols were available, and these were up to date. Management of creams was the only area outstanding. Staff must ensure creams are dated when opened, and used or discarded within 28 days. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. Service users and others can raise a complaint using the procedure available. If followed this would ensure a robust investigation into the concerns raised. Service users are at risk from each other, and the strategies described as being employed to keep people safe were not in practice at the time of the visit, and the risks were not documented. This could put service users at further risk of harm. EVIDENCE: The acting manager reported that no complaints had been received. The acting manager has referred to Social Care and Health re incidents where one service user had harmed another of the men accommodated. While this referral was positive, and it was good that advice had been sought from psychology no care documents or strategies were available in the home to reflect these risks, or evidence application of the advice sought. The inspector observed periods of time when service users known to be at risk from each other were left unsupervised, and when two service users were seated adjacent at the dining table, a known high-risk time. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The environment has improved since the last inspection, and is now mainly clean, comfortable and homely. EVIDENCE: The dining room, hall, and lounge of the home had been decorated, and appeared much brighter and cleaner. A new lounge suite had also been provided, which was comfortable, and which service users seemed pleased with. The home urgently required new dining furniture. At the time of inspection garden chairs were being utilised, and several of the chairs available were very wobbly. The acting manager believes delivery of a new suite is due by the end of the week. It was required this be followed up. It is recommended that the function of the office and smoke room be reviewed. At present office furniture and equipment is located in both rooms. One of the rooms should be returned to use by service users. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 17 The bathrooms, and service users bedrooms will need attention to the décor in the near future, and it is required this be scheduled. The kitchen is scheduled to be replaced. At the time of inspection no date for this work was available. Swan house was clean and homely. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The rota did not evidence that there always enough staff on duty, or that staff provided had received the required training. EVIDENCE: The staff training records did not evidence that staff had been provided with all mandatory training, or in the areas, specific to the men accommodated. The last recorded fire training was August 2005. This is now overdue. Service users have specific needs including epilepsy, ageing, celiac disease, dysphasia and healthy eating, for which no evidence of training was available. The rota provided shows that most shifts operate with a minimum of three staff. The acting manager supplements this on two or three days each week, and by student nurses. The inspector remains concerned that three staff is adequate when staff work a long day. Examples of weekend shifts where the team of three includes two staff working a long day (who take 90 minute break each) were evident. This would leave the home with two staff for three hours. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 19 The CSCI was notified of occasions where due to staff sickness the numbers of staff on duty had dropped to two (Four times in two weeks). The provider must review cover in these circumstances. The staff on duty at the time of inspection worked in a friendly and respectful way with service users. It was evident that staff had positive regard for the service users they were working with, and that they had acquired a lot of in depth knowledge about their likes and dislikes and life history. The recruitment records of three staff were assessed. All the required records were available in the files. The inspector raised concern regards one applicant who had not provided references from their last employer, and referees were listed as a friend, and one, which was confirmation of employment over a period of time-and, did not mention performance. These were not robust, and it has been required the procedure in this instance be reviewed. Staff had received supervision from the acting manager. Records regards these were detailed. The inspector spoke with staff on duty who reported feeling supported by the manager, and their colleagues. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The ongoing management and operation of the home was of concern. Work was identified as being required ensuring the outcomes for service users are safe, well planned; and consistently met. EVIDENCE: The acting manager has returned to work in the home, following a period of development. He was present for part of the inspection. He appeared motivated to undertake the required work, and reported the development of an action plan to address these. The organisation needs to make app.lication to register the manager with the CSCI. It was of concern that in addition to the significant development required at the home, the acting manager was mentoring and assessing two student nurses. It is recommended that the placement of students in homes, which are Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 21 performing poorly, be reviewed, to enable manager’s greater time to concentrate on development of the service. The care records were not easy to use. Information about care needs was located approximately half way down a large lever arch file, and it is recommended this be reviewed, to ensure staff have ready access to the important information. General household records were also in a muddle. A lot of information could now be destroyed or archived, and some files being duplicated did not assist locating information. Records about service users money tallied with money available. The inspector remained concerned that records were being made on loose pages. Staff were completing the financial record on two sheets (personal money summary and service user expenditure sheet). These did not easily cross reference with each other. Regulation 26 visits had been undertaken. These had not been undertaken monthly, and it was of concern that Family housing had no recent recorded visits. At the time of inspection the fire alarm test was one week out of date. It was reported that a fire drill had been undertaken in February 2006. This drill had not been written in the fire log, which recorded the last drill to be November 4 2004. Records to evidence that the assisted bath and hoist had been serviced were not available. This was identified in February 2006, and it is of serious concern that service users have gone on using an appliance that has not been tested for safety. The fire risk assessment (21/12/05) identified work as being required to improve the fire safety of the home. Confirmation that this has been addressed was a requirement of the last report and remains outstanding. The water supply had been tested for legionella. The report of this identified work was needed. Evidence that this had been addressed was not available. Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 2 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 1 1 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 1 1 1 X 1 2 X Swan House DS0000062628.V293909.R01.S.doc Version 5.1 Page 23 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 YA6 Regulation 15 12(1)(a) Requirement Unmet from the previous two inspections. Care documents must clearly state peoples needs and how these are to be met. Unmet from the previous two inspections. Service users known wishes and preferences must be recorded in the plan. Unmet from the previous two inspections. Service users must be kept informed of the content of plan, and it kept under review with them. Unmet from the previous two inspections. Risks faced by service users must be underpinned with a risk assessment. Unmet from the previous inspection. Clinical risks must be assessed and plans implemented to manage them. Unmet from the last inspection. Critical incidents and near DS0000062628.V293909.R01.S.doc Timescale for action 01/08/06 2 YA6 12(2) 01/08/06 3 YA6 12(2) 15(1-2) 01/08/06 4. YA9 12(4)(a-c) 01/08/06 5. YA9 12(4)(a-c) 01/08/06 6. YA9YA19 13(4)(b-c) 01/08/06 Swan House Version 5.1 Page 24 7. YA12 16(2)(m-n) 8. YA17 16(2)(i) 9. YA19 12(1)(a) 13(6) 10. YA19 18(1)(a) 11. YA19 12(1)(a) 13(1)(b) 15 12(1)(a) 13(1)(b) 15 12. YA19 13. YA19 12(1)(a) 13(6) 14. YA19 12(1)(a) misses must prompt a review of risk and care documents and care practice. Unmet from the last inspection. The range and frequency of activities available to service users in the home and community must be increased. Diets as required by service users to aid in the gaining or loosing of weight, must be provided. Not assessed at this inspection. Guidelines must be developed regards one service users eating and drinking needs. Strategies to ensure service users can eat undisturbed must be developed. Unmet from the last inspection. Staff must receive awareness training regards service users needs. Unmet from the previous two inspections. Clear guidance on how clinical and care needs are to be met must be provided. Unmet from the previous two inspections. An Epilepsy care plan must be developed, and the use of rescue medicines reviewed with the GP Unmet from the previous two inspections. Reactive plans and behaviour protocols must be developed if required. Staff must be provided with clear guidance on how to meet service users nighttime DS0000062628.V293909.R01.S.doc 01/08/06 09/06/06 01/08/06 01/09/06 01/08/06 01/08/06 01/08/06 01/08/06 Swan House Version 5.1 Page 25 needs. 15. YA19 13(4)(c) 12(1)(a) Unmet from the previous inspection. Records of physical health must be monitored and the required support obtained when required. Plans of care that detail weight increase or decrease must be provided. Unmet from the previous inspection. The use of rectally administered medicines must be reviewed with the GP. Systems to ensure their safe administration must be developed if they continue to be prescribed. Creams must be dated when opened, and used or discarded within 28 days Unmet from the previous two inspections. All possible strategies and actions must be implemented to protect service users from harm. Unmet from the previous inspection. Security arrangements and the perimeter fencing must be reviewed and increased as required. Unmet from the previous two inspections-new chairs reported to be on order. The dining room chairs must be clean, fit to use, and adequate seating provided for all service users. Unmet from the previous two inspections-new kitchen reported to be on order. The kitchen must be maintained in a satisfactory DS0000062628.V293909.R01.S.doc 01/08/06 16. 17. YA19 YA20 12(1)(a) 13(2) 01/08/06 01/08/06 18. 19. YA20 YA23 13(2) 13(6) 09/06/06 09/06/06 20. YA24 23(2)(a) 01/09/06 21. YA24 23(2)(b) 09/06/06 22. YA24 23(2)(b) 01/07/06 Swan House Version 5.1 Page 26 23. YA27 23(2)(d) 24. 25. YA33 YA34 18(1)(a) 19 Sch2&4 26. YA32 18(1)(a) 27. YA37 9 28. 29. YA37 YA41 9 26 30. YA41 17 31. YA42 23(4)(c) (iv) 23(4)(a) 32. YA42 state of repair. Work surfaces accessible to the service users accomodated must be provided. CSCI must be notified of the timescales in which the bathrooms and wc will be redecorated. Adequate staff must be on duty across the day. Unmet from the previous two inspections. Recruitment records must evidence robust procedures are in use, and that staff are fit for work. Outstanding from previous inspection. An audit of training delivered and required must be undertaken, and training as identified delivered. The registered provider must ensure the management arrangements at the home are adequate for the service. The acting manager must make application to the CSCI for registration. Unmet from the previous inspection. Regulation 26 visits must be undertaken monthly and a record of such maintained. Records keeping must be reviewed and records held, rationalised, and sorted into an accessible order. Unmet from the previous two inspections. Fire alarm tests must be undertaken weekly. Unmet from the previous inspection. Confirmation that work as identified in the fire risk assessment has been undertaken must be DS0000062628.V293909.R01.S.doc 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 09/06/06 09/06/06 Swan House Version 5.1 Page 27 provided. 33. YA42 23(2)(c ) Unmet from the previous inspection. Evidence that the assisted bath equipment and hoist have been serviced as required must be provided. Confirmation that work as identified in the water risk assessment has been undertaken must be provided. Fire drills must be undertaken at least six monthly, and a record of such maintained in the home. 09/06/06 34. YA42 13(4)(b-c) 09/06/06 35. YA42 23(4)(d-e) 09/06/06 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 3 4 5. 6. Refer to Standard YA6 YA12 YA24 YA24 YA28 YA37 Good Practice Recommendations It is recommended that the order in which care records are presented be reviewed to ensure current active material is easily accessible. It is recommended that household activities be included in the service users plan. It is recommended that ways to ensure service users rooms are private to them be explored and developed. It is recommended that cupboards be fitted on the walls in the kitchen cupboards It is recommended that one of the small communal rooms be returned to service users use. It is recommended that the placement of student nurses in poorly performing care homes be reviewed. 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